Ghanem Amr Amin, El Hadidi Yasser Nabil
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.
Craniomaxillofac Trauma Reconstr. 2017 Jun;10(2):166-170. doi: 10.1055/s-0037-1598102. Epub 2017 Mar 16.
Various forms of vascular lesion affect the head and neck region. The head and neck vascular lesions are classified into neoplasms and malformations. Neoplasm presents either as hemangioma or lymphangioma; neoplasm usually presents in young age compared with vascular malformation. A 9-year-old female patient presented to the outpatient clinic referred from the department of pedodontics after extraction of a right mandibular second deciduous molar. Extraction was done by dental GP in outpatient clinic. Massive bleeding followed the extraction. Bleeding was controlled by electrocoagulation of bleeding site and systemic and local application of antifibrinolytic agent. An intravenous line was placed to provide fluid replacement. Injection of intravenous cyklokapron was given to stabilize the blood clot. Selective embolization was performed 24 hours prior to surgical resection of lesion and the lesion was removed under general anesthesia followed by peripheral ostectomy of bone to remove any feeders. Different protocols are used to control life-threatening bleeding. Primary local measures such as Gelfoam packing, Tranexamic or Aminocaproic topical application, Surgicel application, Electrocautery, Bone wax, Ligation of External Carotid or Common Carotid Artery, or Selective Embolization of feeder vessel may be used to control the bleeding. Interventional radiographic blockage of feeder vessel currently shows high success rate in the management of life-threatening bleeding compared with previous techniques.
多种形式的血管病变会影响头颈部区域。头颈部血管病变分为肿瘤和畸形。肿瘤表现为血管瘤或淋巴管瘤；与血管畸形相比，肿瘤通常在年轻时出现。一名9岁女性患者在拔除右下第二乳磨牙后，由儿童牙科转诊至门诊。拔牙由全科牙医在门诊进行。拔牙后出现大量出血。通过对出血部位进行电凝以及全身和局部应用抗纤维蛋白溶解剂来控制出血。放置静脉输液管以补充液体。静脉注射氨甲环酸以稳定血凝块。在手术切除病变前24小时进行选择性栓塞，然后在全身麻醉下切除病变，随后进行骨周边切除术以清除任何供血血管。使用不同的方案来控制危及生命的出血。可采用如明胶海绵填塞、氨甲环酸或氨基己酸局部应用、外科止血纱布应用、电灼、骨蜡、结扎颈外动脉或颈总动脉，或对供血血管进行选择性栓塞等主要局部措施来控制出血。与以往技术相比，目前介入性放射学阻断供血血管在处理危及生命的出血方面显示出较高的成功率。
