Department of Oral and Maxillofacial Sciences, Sapienza, University of Rome, Rome, Italy.
Department of Biotechnologies and Medical Surgical Sciences, Sapienza, University of Rome, Rome, Italy.
J Oral Implantol. 2023 Aug 1;49(4):414-427. doi: 10.1563/aaid-joi-D-22-00130.
This article seeks to provide the most relevant aspects of the etiology, prevention, and management of bleeding in routine implant surgery. A comprehensive and systematic electronic search was conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews databases until June 2021. Further references of interest were retrieved from bibliographic lists of the selected articles and the "Related Articles" feature of PubMed. Eligibility criteria were papers about bleeding, hemorrhage, or hematoma associated with routine implant surgery on human subjects. Twenty reviews and 41 case reports fulfilled eligibility criteria and were included in the scoping review. Involved implants were mandibular in 37 and maxillary in 4 cases. The major number of bleeding complications was in the mandibular canine region. The most injured vessels were sublingual and submental arteries, due mainly to perforation of the lingual cortical plate. Time to bleeding occurred intraoperatively, at suturing, or postoperatively. The most reported clinical manifestations were swelling and elevation of the mouth floor and the tongue with partial or complete airway obstructions. First aid to manage airway obstruction was intubation and tracheostomy. For active bleeding control, gauze tamponade, manual or digital compression, hemostatic agents, and cauterization were applied. When conservative procedures failed, hemorrhage was controlled by intra- or extraoral surgical approaches to ligate injured vessels or by angiographic embolization. The present scoping review provides knowledge and evidence on the most relevant aspects of the etiology, prevention, and management of implant surgery bleeding complications.
本文旨在提供常规种植手术中出血的病因、预防和处理的相关要点。我们对 MEDLINE、EMBASE、Cochrane 对照试验中心注册库和 Cochrane 系统评价数据库进行了全面而系统的电子检索，检索时间截至 2021 年 6 月。还从选定文章的参考文献列表和 PubMed 的“相关文章”功能中获取了其他感兴趣的参考文献。纳入标准为涉及人类受试者的常规种植手术出血、 hemorrhage 或 hematoma 的相关研究。共有 20 篇综述和 41 篇病例报告符合纳入标准，被纳入范围综述。涉及的种植体在下颌骨 37 例，在上颌骨 4 例。大多数出血并发症发生在下颌尖牙区。受伤的主要血管是舌下动脉和颏下动脉，主要是由于舌侧皮质板穿孔。出血发生时间为术中、缝合时或术后。最常见的临床表现为口腔底部和舌头肿胀和抬高，伴有部分或完全气道阻塞。处理气道阻塞的急救方法为插管和气管切开术。对于活动性出血控制，采用纱布填塞、手动或数字压迫、止血剂和烧灼。当保守治疗失败时，通过口腔内外手术方法结扎受伤血管或血管造影栓塞来控制出血。本范围综述提供了关于种植手术出血并发症的病因、预防和处理的相关要点的知识和证据。
