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A hematoma of the floor of the mouth formed after dental implant placement that was reported the following day. Compression was applied, and the swelling resolved after 48 hrs.
Source publication
Complications in dental implant surgery are possible. Bleeding complications have been described that may be serious, particularly in the floor of the mouth. We present two cases of sublingual hematomas during dental implant osteotomies that impeded but did not close the airway. The clinical courses of these patient’s complications are reviewed. On...
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Citations
... Trauma to the lingual vessels in the region due to perforation can cause severe bleeding and upper airway obstruction. 7,8 Cone-beam computed tomography (CBCT) is widely used in treatment planning before implant surgery to minimize complications and achieve more successful results. 9,10 By using software programs developed by different companies on CBCT images, the ideal positions and angles of dental implants can be determined in the virtual environment before surgery, and highly sensitive surgical guide plates can be produced in the light of these obtained data. ...
... 11 The incidence of implant placement outside the bony housing in the anterior edentulous mandibular region seems to be low because only a limited number of case reports were found in the literature. 7,12,13 Although there are a limited number of studies in the literature examining the relationship between crest types and lingual perforation in the mandibular posterior region, there is no study examining the relationship between crest types and lingual perforation in the edentulous mandibular anterior region. 1,14 The aim of this study is to evaluate the possible prevalence of lingual perforation of implants placed in the ideal position prosthetically on anterior edentulous mandibular regions on CBCT images using computer software and determine the relationship between the morphological structure of the crest and the risk of lingual cortical bone perforation. ...
... Perforations that may occur in the lingual vessels during osteotomy may cause severe bleeding and upper airway obstruction. 7,17 CBCT is accepted as the gold standard in determining the morphology of the bone and the localization of important anatomical structures when planning before implant surgery. 1,13 However, access to this imaging technique is not possible in many clinics, and a two-dimensional evaluation is performed on OPG. ...
Background: The aim of this study was to evaluate the prevalence of lingual cortical bone perforation caused by virtually placed implants on cone-beam computed tomography images in the edentulous mandibular canine region and determine the relationship between the morphological structure of the crest and the risk of perforation.
Methods: Eight hundred dental implants were virtually inserted on 100 qualified cone-beam computed tomography scans. Crests were divided into 4 groups according to the crest morphology as Type U, Type L, Type P, and Type C. The distance between the implant tip and lingual plate was measured using a digital caliper. Incidence of lingual plate perforation and proximity of the implant tip to the lingual plate were measured for 4 types of the alveolar crest.
Results: A total of 800 virtual implant applications were performed in 100 patients who met the inclusion criteria. The incidence of lingual plate perforation was found to be significantly higher in Type U crests than in the other types. It was also found to be statistically significantly higher in Type L crests than in Type P and Type C crests. When the relationship between implant length and perforation was evaluated, perforation in 14 mm implants was significantly higher than 8, 10, and 12 mm implants.
Conclusions: According to the results of this study, it was determined that high rates of perforation occurred in the U and L type crests and 14 mm implants during implant surgery in the mandibular anterior edentulous region.
... The perforation in lingual cortex and consequently a vascular damage may develop in this region during dental implant placement or other surgical interventions, especially in presence of concavity. The severe haemorrhage, upper respiratory tract obstruction and haematoma on the mouth floor may develop as a result of the vascular damage [7,15,16,31,32]. Up to 24% of haemorrhage complications have been reported after implant placement [11]. ...
Background:
In the presence of lingual concavity in the mandible, the cortical perforation and consequently the life-threatening intraoral hemorrhages obstructing the upper respiratory tract may be seen during the surgical intervention. In the present study, it was aimed to determine the prevalence of lingual concavity in the interforaminal region and to determine its relationship with gender and dentate status.
Material and methods:
The images of 106 patients undergone cone-beam computed tomography (CBCT) between 2016 and 2017 in Department of Dental and Maxillofacial Radiology Department of Faculty of Dentistry of Ondokuz Mayıs University were retrospectively examined. The images were obtained using a Galileos device (98 kVp, 15-30 mA). The bone height and width in interforaminal region and the frequency of lingual concavity were analyzed.
Results:
Of patients involved in the present study, 42.5% were male and 57.5% were female After the examinations performed, the bone was morphologically classified into four classes as Type I lingual concavity, Type II inclined to lingual, Type III enlarging towards labiolingual and Type IV buccal concavity. Type III (77.9%) was the most common type in the anterior region, followed by Type II (16.5%), Type I (4.7%) and Type IV (0.9%). The lingual concavity angle was 76.5 ± 3.69º and the concavity depth was 2.09 ± 0.34 mm.
Conclusions:
The lingual concavity can be detected by using the cross-sectional CBCT images and the complications related with lingual cortical perforation can be prevented.
... They can occur in elderly patients and the theory behind is aneurismal changes in the facial and lingual arteries. It seems hypertensive patients probably are susceptible to rupture of these weak vessels and subsequent haematoma [1][2][3][4]. The lingual artery and its branches supply tongue well and any bleeding from these arteries can cause a severe haematoma [5]. ...
... Furthermore, as the floor of the mouth contained of several potential spaces which are covered by some loose tissue, any bleeding can cause an expanding haematoma and airway obstruction6. However, such haematoma following dental procedures or anticoagulation therapy are not rare [2][3][4] reported, a 45-year-old female who underwent placement of four implants in her anterior mandible. During the procedure, she demonstrated a severe pain, signs of airway obstruction, and dysarthria. ...
Lingual and sublingual haematoma without any associated trauma or any bleeding risk factors are rare entities and commonly described in patients on anticoagulation therapy. An 81-year-old female presented to our emergency department with a 2-hour-history of tongue swelling. Her medical history consisted of non-medicated hypertension without any coagulopathy. She was not taking any medication and had not underwent a dental work up. However, she underwent a semi urgent gastroscopy 2 weeks prior. The examination of the oral cavity revealed a mildly tender haematoma on dorsum and ventral surface of the tongue as well as the floor of her mouth. Her blood test parameters were within normal limits. She was admitted to otolaryngology ward under close observation for further investigations and probably potentially life-threatening airway obstruction. She remained stable without any progression of her swelling and was discharged home after 2 days without any intervention. On review 1 week later, there was a significant reduction in her haematoma size. In spite of few case reports of such haematoma in hypertensive patients, we conclude that in this case delayed lingual and sublingual haematoma following upper GI endoscopy should be considered as her blood pressure was not severely elevated.
Important anatomical structures such as mandibular incisive canal, tongue foramen, and mouth floor vessels may be damaged during implant surgery in the mandibular anterior region, which may lead to mouth floor hematoma, asphyxia, pain, paresthesia and other symptoms. In severe cases, this can be life-threatening. The insufficient alveolar bone space and the anatomical variation of blood vessels and nerves in the mandibular anterior region increase the risk of blood vessel and nerve injury during implant surgery. In case of vascular injury, airway control and hemostasis should be performed, and in case of nerve injury, implant removal and early medical treatment should be performed. To avoid vascular and nerve injury during implant surgery in the mandibular anterior region, it is necessary to be familiar with the anatomical structure, take cone-beam computed tomography, design properly before surgery, and use digital technology during surgery to achieve accurate implant placement. This article summarizes the anatomical structure of the mandibular anterior region, discusses the prevention strategies of vascular and nerve injuries in this region, and discusses the treatment methods after the occurrence of vascular and nerve injuries, to provide clinical reference.
The placement of dental implants is a safe and predictable procedure when performed by qualified staff. The incidence of complications derived from this type of surgery has increased due to the greater number of patients undergoing dental rehabilitation treatments in recent years. Floor of the mouth hematoma is a rare, but potentially fatal, complication that every oral surgeon should recognize for early diagnosis. As part of the clinical case presented here, two implants were removed and a hemorrhage in the floor of the mouth was found, which required an urgent intervention to control the bleeding. Two independent researchers conducted an electronic search of the available scientific evidence in relation to bleeding of the floor of the mouth in dental implant surgery. The research included references, which were written in English or Spanish, and published up to December 2022. Case reports, case series, systematic reviews, and meta-analysis were part of the inclusion criteria. Sixty-four bibliographic references were identified, and 39 full-text articles were selected. There were 30 cases of floor of the mouth hematoma in relation to implant surgery. In 13 patients the main location was interforaminal, in 5 in the canine area, in 6 in the incisor area, and in 6 in the molar premolar region. All cases were caused by perforation of the cortical bone or surgical manipulation (disruption of the periosteum, perforation of the sublingual mucosa by the stiff suture). The sublingual artery was most frequently involved. The clinical sign observed in all cases was elevation of the floor of the mouth. In 21 of the cases there was airway involvement, so the main treatment was intubation or tracheostomy. Floor of the mouth hematoma may be one complication associated with implant surgery. Given the seriousness of this clinical picture, early detection by the dentist and hospital referral are essential. Warning signs are sudden swelling of the floor of the mouth or submandibular area, accompanied by dysphagia and dyspnea.
Background
Perforation of the lingual cortex while placing dental implants in the interforaminal region of the mandible can cause severe hemorrhage. The purpose of this study was to evaluate the features of mandibular lingual foraminals (MLFs) and locational relationship between them and lingual mucosal vessels (LMVs) by CT/MRI fusion volumetric images.
Methods
37 images within complete anterior mandibular region using both MSCT and three-dimensional volumetric interpolated breath-hold examination (3D-VIBE) MRI were taken from our imaging archives. After exclusion of 11 for lesions or artifacts, 26 CT/MRI fusion volumetric images were included to evaluate the frequency, diameter, and position of MLFs. The anterior mandibular region was divided into 4 equal segments under each teeth, and 40 regions were got from C5 to D5. Furthermore, the positional relationship between MLFs and LMVs was analyzed in this coordinate system.
Results
62 MLFs (73.81%) were located below the incisors, followed by premolars (21.43%) and canines (4.76%). Female bias, the mean diameter of the female was 0.08 mm while the male was 0.21 mm. The total number of LMVs was most distributed on lingual side of C1 and D1. According to Spearman’s correlation coefficient, the location of MLFs was related to LMVs. The MLFs in fourth segment of D1 were positively moderately correlated with LMVs in fourth segment of D4, while the MLFs in third segment of C1 showed a weak positive correlation with LMVs in third segment of D4.
Conclusions
The features and the correlation between MLFs and LMVs in CT/MRI fusion volumetric images may offer reference to dentists when only MLFs can been seen on routine preoperative CT examination of implants.
Trial registration
Retrospectively registered. (D2018-072)
Throughout adult life, there is a physiological decline in almost all body systems and with a greater proportion of population living to old age, dental practitioners will need to provide operative intervention in more medically complex patients. Dental implants are a common modality for the replacement of missing teeth; however, implant failure and associated disease present complex challenges to clinicians. Therefore, the aim of this narrative review is to discuss the cardiovascular, respiratory, haematological, endocrine, and musculoskeletal systems with respect to diseases affecting patients of an older age which can impact dental implant treatment. © 2023 The Authors. Oral Surgery published by British Association of Oral Surgeons and John Wiley & Sons Ltd.
Introduction:
This in vivo study aimed to clarify the position of the sublingual artery (SLA) relative to the mandibular bone and to infer the potential risk for injury during dental implant surgery.
Methods:
Contrast-enhanced computed tomography images of the mouth of 50 edentulous patients (100 sides) treated at Tokushima University Hospital were reviewed. Curved planar reconstructed images perpendicular to the alveolar ridge were processed and classified into molar, premolar, canine, and incisor regions. The SLA and its branches were identified, and the distance from the mandible to the SLA was measured.
Results:
The SLA was located close to the mandible (<2 mm) in the molar, premolar, canine, and incisor segments in 12.0% (95% confidence interval 5.6%-18.4%), 20.6% (12.6%-28.7%), 30.5% (21.3%-39.8%), and 41.8% (28.8%-54.9%) cases, respectively. The SLA was located within ±3 mm craniocaudally to the upper wall of the mandibular canal in the molar and premolar regions in 50% of cases and within ±5 mm craniocaudally to the mylohyoid ridge in the canine and incisor regions in the other cases, with no sex or age-related differences. The vertical distance from the alveolar ridge to the SLA was influenced by sex and age owing to alveolar resorption, indicating that the alveolar ridge is not a reliable reference for predicting SLA position.
Conclusions:
As the risk of SLA injury always exist during dental implant placement and there is no way to confirm the SLA pathways in a patient, clinicians must avoid injuring the sublingual soft tissue.
Purpose:
To provide the most relevant aspects of the etiology, prevention, and management of bleeding in routine implant surgery.
Materials and methods:
A comprehensive and systematic electronic search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews databases until Jun 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.
Results:
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, mainly due 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. The 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.
Conclusions:
The present scoping review provides knowledge and evidence on the most relevant aspects of the etiology, prevention, and management of implant surgery bleeding complications.
Background/Aim. A lingual foramen (LF) is a small opening on the lingual surface of the mandible, which is most frequently located in the middle of the anterior part of the mandible and which shows significant variations in its location, size and number. The aim of this study was to assess the location and anatomical characteristics of LF using cone beam computed tomography (CBCT). Methods. The research was designed as a retrospective study in which 99 CBCT scans were analysed. The analysis covered the number of LF, their location in relation to the teeth and the mandibular region itself, diameter, distance from the alveolar ridge crest, distance from the inferior border of the mandible, distance from the tooth apex and position in relation to the tooth apex. Results. The average frequency of LF per patient was 2.4 1.2. The largest number of LF were localised in the region of lower central incisors. Out of the total number of LF, 82.5% of LF belonged to median lingual foramen (MLF), while 17.5% belonged to lateral lingual foramen (LLF). In 63.2% cases, LF had a diameter of ?1mm, whereas in 98.3% cases it was localised below the tooth apex. There is a statistically significant difference in the distance of LF from the alveolar ridge crest and the LF diameter in relation to gender (p = 0.019; p = 0.008). Conclusion. LF can be reliably localised and visualised by means of CBCT. It is recommended that CBCT scanning of the mandible should be used while planning an oral surgical procedure and implant placement in order to prevent injuries of the neurovascular bundle which passes through LF.
