Papadiochos Ioannis, Strantzias Paschalis, Bourazani Malamatenia, Derila Aikaterini, Petsinis Vasileios
Clinic of Oro-Maxillofacial Surgery, "Attikon" University General Hospital of Athens, Chaidari, Greece.
OMFS Department, "Genimatas" Athens General Hospital, Athens, Greece.
J Maxillofac Oral Surg. 2024 Apr;23(2):402-408. doi: 10.1007/s12663-023-01983-8. Epub 2023 Aug 29.
This case series aimed to describe a hemostatic technique that has been applied in patients admitted to emergency department (ED) of a tertiary hospital due to recurrent episodes of intraoral hemorrhage (IOH) after various dentoalveolar operations. The "tie-over" approach involved the intraoral use of Xeroform® gauze (as compressive bolster dressing) and the oral rinsing with a liquid mixture of hemostatic agents.
Between February 1, 2014, and July 31, 2017, we retrospectively reviewed the medical data and records of patients in ED who chiefly complained about IOH. The inclusion criteria were cases secondary to dentoalveolar surgeries that have been exclusively treated by tie-over bolster approach. Data such as frequency and severity of hemorrhage episodes, pain, and discomfort were assessed pre- and postoperatively.
The presented technique was applied in 23 patients, but 20 of them complied with follow-up evaluation. The mean age of those patients was 60.57 years (15-82 years) with a mean follow-up time of 5.05 days. Eighteen patients were taking antithrombotic medications, either per os (oral antiplatelets and anticoagulants-OAA group) or subcutaneously (heparin group). One patient from OAA group and 2 from heparin group experienced in total 4 bleeding events postoperatively. Three of those events were recorded as minimal (oozing) and did not last over 20 min. All the patients declared satisfaction about the non-bleeding oral status.
In addition to its compelling outcomes, we advocate that this approach conferred physiological benefits on patients who visited ED with symptoms of anxiety and malaise, secondary to multiple, lasting, or uncontrolled episodes of IOH related to extensive surgical trauma. The presence of the gauze intraorally was short-term and created minimal discomfort.
本病例系列旨在描述一种止血技术，该技术已应用于一家三级医院急诊科收治的患者，这些患者因各种牙槽手术术后反复出现口腔内出血（IOH）。“包扎”方法包括在口腔内使用黄碘纱布（作为压迫性支撑敷料），并用止血剂混合液进行口腔冲洗。
在2014年2月1日至2017年7月31日期间，我们回顾性分析了急诊科主要抱怨IOH的患者的医疗数据和记录。纳入标准为仅通过包扎支撑法治疗的牙槽外科手术继发病例。术前和术后评估出血发作的频率和严重程度、疼痛和不适等数据。
该技术应用于23例患者，但其中20例接受了随访评估。这些患者的平均年龄为60.57岁（15 - 82岁），平均随访时间为5.05天。18例患者正在服用抗血栓药物，口服（口服抗血小板药和抗凝剂 - OAA组）或皮下注射（肝素组）。OAA组1例患者和肝素组2例患者术后共发生4次出血事件。其中3次事件记录为轻微（渗血），持续时间不超过20分钟。所有患者对口腔无出血状态表示满意。
除了令人信服的结果外，我们主张这种方法对因广泛手术创伤导致的多次、持续或无法控制的IOH继发焦虑和不适症状而到急诊科就诊的患者具有生理益处。口腔内纱布的存在是短期的，产生的不适最小。
