Tokuyama Kohei, Kiyosue Hiro, Shimada Ryuichi, Miyamoto Satomi, Abe Ayaka, Kawano Kenji, Asayama Yoshiki
Departments of1Radiology and.
2Department of Diagnostic Radiology, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan; and.
J Neurosurg Case Lessons. 2023 Jul 24;6(4). doi: 10.3171/CASE23118.
The present report describes 2 cases of arterial bleeding after removal of the upper third molar that were successfully treated with selective transarterial embolization.
The first patient underwent removal of the left upper third molar. A few hours later, facial swelling and massive bleeding appeared near the extraction socket involving the posterolateral wall of the maxillary sinus. Angiography showed a pseudoaneurysm involving the posterior superior dental artery, and the lesion was selectively embolized with an N-butyl cyanoacrylate (NBCA)-lipidiol mixture. The second patient underwent removal of the left upper third molar, and massive bleeding occurred from the extraction socket involving the greater palatine foramen. Angiography revealed the pseudoaneurysm of the greater palatine artery, and the lesion was selectively embolized with an NBCA-lipiodol mixture. Both patients were discharged uneventfully, and no recurrent bleeding was observed during the 82- and 5-month follow-up periods.
Massive arterial bleeding after a third molar extraction occurs from either the posterior superior dental artery or the greater palatine artery, which is associated with the location of the extraction socket. Selective transarterial glue embolization is a useful option for the treatment of arterial bleeding after the removal of the upper third molars.
本报告描述了2例拔除上颌第三磨牙后动脉出血的病例，经选择性经动脉栓塞成功治疗。
第一例患者拔除左上第三磨牙。数小时后，拔牙窝附近出现面部肿胀和大量出血，累及上颌窦后壁。血管造影显示后上牙动脉假性动脉瘤，用N-丁基氰基丙烯酸酯（NBCA）-碘油混合物对病变进行选择性栓塞。第二例患者拔除左上第三磨牙，拔牙窝累及腭大孔出现大量出血。血管造影显示腭大动脉假性动脉瘤，用NBCA-碘油混合物对病变进行选择性栓塞。两名患者均顺利出院，在82个月和5个月的随访期内均未观察到复发出血。
第三磨牙拔除后大量动脉出血源于后上牙动脉或腭大动脉，这与拔牙窝的位置有关。选择性经动脉胶水栓塞是治疗上颌第三磨牙拔除后动脉出血的有效选择。
