Sfondrini Domenico, Marelli Stefano, Patriarca Rachele, Scribante Andrea, Preda Lorenzo, Savioli Gabriele, Novelli Giorgio, Bardazzi Alessandro
Department of Maxillofacial Surgery, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
Case Rep Dent. 2024 Dec 24;2024:8413875. doi: 10.1155/crid/8413875. eCollection 2024.
The authors present two cases of mouth floor hemorrhage consequences of implant placement within the atrophic anterior mandible. In one patient, the implant placement was associated with the guided bone regeneration (GBR) technique. This serious complication has been widely described in the literature, especially in the anterior mandible area. In cases of bone resorption, the edentulous ridge becomes closer to the artery, and the risk of vessel injury increases. In both patients, the hematoma rapidly spread in the loose tissues of the mouth floor, displacing the tongue posteriorly and cranially, with airway compromise. The patients were hospitalized with nasotracheal intubation to secure the airway. In both patients, the bleeding stopped spontaneously, and after a few days, the oral floor swallowing was reduced, allowing the endotracheal tube to be removed. In about 2 weeks, the hematoma completely resorbed without surgery. According to the literature, the main cause of floor of the mouth hemorrhage is the mandibular lingual cortical plate perforation during bone drilling with subsequent sublingual-submental artery injury. In fact, in the first patient presented, this surgical error was clearly noticeable on the CT scan. Differently, in the second case reported, no radiological signs of inner cortical perforation were observed, and together with a mouth floor hematoma, a blood collection was also evident on the lower lip, suggesting a different cause of bleeding. Most likely during the periosteal release incision, mandatory in GBR technique, the ascending mental artery was injured, and hematoma spread in the mouth floor through the similar incision done on the lingual flap. Firstly, the mouth floor hemorrhage caused by an injury of a vestibular soft tissue artery during GBR surgery was reported. Strategies and recommendations to avoid this life-threatening event are provided, based on the literature review and the authors' experience.
作者介绍了两例因在萎缩性下颌前部植入种植体而导致口底出血的病例。在其中一名患者中，种植体植入与引导骨再生（GBR）技术相关。这种严重并发症在文献中已有广泛描述，尤其是在下颌前部区域。在骨吸收的情况下，无牙嵴更靠近动脉，血管损伤的风险增加。在这两名患者中，血肿迅速在口底的疏松组织中扩散，使舌头向后上方移位，导致气道受压。患者住院并进行了鼻气管插管以确保气道安全。两名患者的出血均自行停止，几天后，口底吞咽功能恢复，气管内插管得以拔除。大约两周后，血肿完全吸收，无需手术。根据文献，口底出血的主要原因是在骨钻孔过程中下颌舌侧皮质骨板穿孔，随后损伤舌下-颏下动脉。事实上，在第一个病例中，CT扫描清晰显示了这一手术失误。不同的是，在第二个病例中，未观察到内皮质穿孔的放射学迹象，除了口底血肿外，下唇也有明显的血肿，提示出血原因不同。很可能在GBR技术中必需的骨膜松解切口过程中，颏升动脉受损，血肿通过舌瓣上的类似切口扩散至口底。首次报道了GBR手术期间前庭软组织动脉损伤导致口底出血的情况。基于文献综述和作者经验，提供了避免这一危及生命事件的策略和建议。
