Profusely bleeding oral pyogenic granuloma in a teenage girl.

Pyogenic granuloma (PG) is a kind of inflammatory hyperplastic soft tissue lesion of the oral cavity. The lesion, however, is not related to infection and arise as a reactive growth in response to various stimuli. It has a very high vascularity because of the presence of numerous prominent capillaries. The lesion has a bleeding tendency, even after a minor traumatic episode, such as during mastication. Bleeding may be at times very severe and difficult to control. We present the case of a profusely bleeding young PG in a young teenage child.

Topical Ankaferd hemostat application for the management of oral cavity bleedings in children with hemorrhagic diathesis.

Ankaferd blood stopper (ABS) is a hemostatic agent used topically for controlling bleedings of skin or mucosal surfaces in Turkey. It is currently topically used in bleedings of body injuries, traumas, and minor or major surgical interventions. Here we have evaluated 12 pediatric patients with hemorrhagic diathesis on whom Ankaferd was used for oral bleedings. Topical Ankaferd was administered for hemorrhages of oral cavity during 15 bleeding attacks. ABS administrations successfully stopped the bleedings, except for one patient with oral hemorrhage who did not respond to ABS application. Ankaferd is effective for oral bleedings of children with bleeding diathesis especially when other measures have failed.

Life-threatening arteriovenous malformation of the maxillomandibular region and treatment outcomes.

We report on cases of life-threatening maxillomandibular arteriovenous malformations (AVM) whereby patients had successful endovascular treatment with good outcomes. Out of a total 93 facial AVMs treated endovascularly between 1991 and 2009, five patients (5.4%) had maxillomandibular AVMs. All presented with uncontrolled dental bleeding. Endovascular procedure was the primary treatment of choice in all cases, either transfemoral approach with arterial feeder embolization or transosseous puncture, depending on the accessible route in each patient. NBCA (glue) was the only embolic agent used. Tooth extraction and dental care were performed after bleeding was controlled. All five patients (8-18 years) with a mean age of 12.4 years presented with massive dental bleeding following loosening of teeth, dental extraction and/or cheek trauma. The plain films and CT scans of four patients with AVMs of mandibles and one of maxilla, revealed expansile osteolytic lesions. The mean follow-up period was 6.6 years (ranging between one and 19 years). Three cases developed recurrent bleeding between two weeks to three months after first embolization, resulting from residual AVM and infection. Late complications occurred in two patients from chronic localized infection and osteonecrosis, which were successfully eradicated with antibiotic therapy and bony curettage. Complications occurring in two patients which included soft tissue infection, osteomyelitis and osteonecrosis were successfully treated with antibiotics, curettage and bone resection. No patient had a recurrence of bleeding after the disease had cured Initial glue embolization is recommended as the effective treatment of dental AVMs for emergent bleeding control, with the aim to complete eradicate the intraosseous venous pouches either by means of transarterial superselection or direct transosseous puncture. Patient care by a multidisciplinary team approach is important for sustained treatment results.

Long-term outcome of radiofrequency ablation for intraoral microcystic lymphatic malformation.

OBJECTIVE: To determine long-term outcome of radiofrequency (RF) ablation of microcystic lymphatic malformation (LM) of the oral cavity for control of recurrent infection and bleeding. DESIGN: Institutional review board-approved retrospective study, SETTING: Tertiary pediatric medical center, PATIENTS: Twenty-six patients with intraoral microcystic LM were treated with RF ablation from August 2002 through August 2010. INTERVENTION: Radiofrequency ablation of intraoral LM. MAIN OUTCOME MEASURES: Postoperative stay, diet, pain; control of bleeding and/or infection; recurrence; and indication for retreatment. RESULTS: The most common complaints necessitating initial RF ablation were recurrent infection (n=10 [37%]) and bleeding (n=9 [33%]). The most common problems requiring further ablation were bleeding (n=11 [41%]) and cosmetic deformity not affecting function (n=8 [31%]). Fourteen patients (55%) were discharged home on postoperative day (POD) 3; the remaining 11 (45%) were discharged home on POD 4. Thirteen patients (52%) resumed oral diet immediately on the day of the procedure. Ten patients (38%) began eating on POD 1, and virtually every patient was on full oral intake at discharge. Fourteen patients (55%) required only acetaminophen for pain control, 11 (41%) required acetaminophen with codeine, and 1 (4%) required oxycodone. The mean follow-up time was 47 months after treatment. At the most recent clinic evaluation, 13 patients (50%) were symptom free, 8 (31%) were stable and improved without need for future treatment, and 5 (19%) required further treatment. One-half of patients in the study group underwent more than 1 RF procedure for recurrence. The number of RF ablations in this series were 1 procedure (n = 13), 2 procedures (n = 7), 3 procedures (n = 2), 4 procedures (n = 2), and 6 or 7 procedures (n = 2). CONCLUSIONS: Radiofrequency ablation is an effective treatment for localized, superficial microcystic LM in the oral cavity. Pediatric patients tolerate the treatment with rapid postoperative recovery and minimal complications. The majority of patients required a short hospital stay for observation of the airway. Virtually every patient resumed oral diet by the time of discharge. Radiofrequency ablation is the treatment of choice at Children's Hospital Boston (CHB) for patients who present with symptomatic, superficial, and localized intraoral microcystic LM. For lesions involving deeper structures, multimodal treatments including surgical and sclerotherapy may be necessary.

Ligature of external carotid artery as an optional technique in a patient with von Willebrand disease.

The von Willebrand disease (vWD) is a hereditary coagulopathy. There is no gender predilection. Clinically characterized by mucocutaneous bleeding, especially nose bleeding, menorrhagia and bleeding after trauma. This article reports a case of a 52-year-old Caucasian male patient with vWD, who presented with extensive bleeding in the tongue after a lacerating injury caused by accidental biting, and describes some clinical, pathological and treatment aspects of vWD. After repeated attempts to suture the wound and replace clotting factors, a decision was made to perform the ligature of the external carotid artery ipsilateral to the injury. There was favorable resolution of the case, with a good aspect of the scar 2 months after ligation. This case reinforces that it is extremely important to make a thorough review of medical history of all patients, searching for possible bleeding disorders or previous family history.

Microvascular bone grafting: a new long-term solution for intraosseous arteriovenous malformations of the mandible in children.

BACKGROUND: Intraosseous arteriovenous malformations (AVMs) in the maxillofacial area are rarely reported in the current literature. These malformations have been associated with severe hemorrhage resulting in significant morbidity and mortality. The recommended gold standard treatment of AVMs is an endovascular embolization, combined with surgery. Especially in children, disease management remains a challenge for the surgeon due to the process of bone growth. AIM: In this report, we describe our experience with a microvascular bone graft as another possible surgical technique for the treatment of intraosseous AVMs in children. PATIENT AND METHODS: A 15-year-old boy was admitted to our department with a life-threatening hemorrhage due to an AVM of the left mandible. The attempt of an ordinary tooth extraction had lead to the emergency. Several embolizations and surgical interventions were required. Finally, a bony reconstruction with a microvascular bone graft from the right iliac crest was performed in order to achieve a normal form and function of the mandible. Postoperative recovery of the patient was unremarkable, and no recurrence was reported. Dental rehabilitation and a good esthetic outcome were achieved by insertion of dental implants. RESULTS: The performed interventions resulted in a complete anatomic and clinical cure. CONCLUSION: We suggest microvascular bone grafts from the anterior iliac crest as a valuable alternative in the long-term treatment of intraosseous AVMs, especially for extensive defects and in children.

Novel application of percutaneous cryotherapy for the treatment of recurrent oral bleeding from a noninvoluting congenital hemangioma involving the right buccal space and maxillary tuberosity.

Cryotherapy is the application of varying extremes of cold temperatures to destroy abnormal tissue. The intent of this article is to describe a novel technique using percutaneous cryotherapy for treating a noninvoluting congenital craniofacial hemangioma (NICH). An 18-year-old woman with type 1 von Willebrand's disease, as well as a qualitative platelet aggregation disorder, presented with multiple recurrent episodes of oral bleeding from a NICH involving the right buccal space and maxillary tuberosity. The patient was initially treated with a combination of endovascular particulate embolization, percutaneous sclerotherapy, tissue cauterization, and laser therapy between the ages of 4 and 8 years of age. At 18 years of age, the patient presented with recurrent episodes of oral bleeding related to the NICH. Endovascular embolization was performed using particulate and a liquid embolic agent with limited success. Due to the refractory nature of this bleeding, the patient underwent successful lesion ablation using percutaneous cryotherapy. At 9-month follow-up, the patient is asymptomatic with no episodes of recurrent bleeding.

Ligature of external carotid artery as an optional technique in a patient with von Willebrand disease

The von Willebrand disease (vWD) is a hereditary coagulopathy. There is no gender predilection. Clinically characterized by mucocutaneous bleeding, especially nose bleeding, menorrhagia and bleeding after trauma. This article reports a case of a 52-year-old Caucasian male patient with vWD, who presented with extensive bleeding in the tongue after a lacerating injury caused by accidental biting, and describes some clinical, pathological and treatment aspects of vWD. After repeated attempts to suture the wound and replace clotting factors, a decision was made to perform the ligature of the external carotid artery ipsilateral to the injury. There was favorable resolution of the case, with a good aspect of the scar 2 months after ligation. This case reinforces that it is extremely important to make a thorough review of medical history of all patients, searching for possible bleeding disorders or previous family history.

A doença de von Willebrand (DvW) é uma coagulopatia hereditária. Não há predileção por sexo. Clinicamente caracteriza-se por hemorragias mucocutâneas, sobretudo nasais, menorragias e hemorragias pós-trauma. Este artigo relata um caso clínico de DvW em paciente de 52 anos de idade, leucoderma, do sexo masculino, que apresentou extensa hemorragia em bordo lateral de língua após ferimento lacerante, além de descrever alguns aspectos clínicos, patológicos e terapêuticos da DvW. Após repetidas tentativas de sutura do ferimento e reposição dos fatores de coagulação, optou-se pela ligadura da artéria carótida externa ipsilateral ao ferimento, com resolução favorável do caso, notando-se bom aspecto cicatricial 2 meses após a ligadura. Este caso reforça que é de extrema importância a realização de anamnese criteriosa, buscando-se identificar possíveis distúrbios hemorrágicos prévios ou antecedentes familiares.

A novel use of esophageal tracheal airway: the control of torrential oral bleeding.

Combitube has been included in the American Society of Anesthesiologists (ASA) difficult airway algorithm for the emergency management of patients who can be neither intubated nor ventilated. The main advantages of the Combitube are minimal training required for its use and blind insertion with 90% success rate upon first attempt. The authors report a case of torrential oral bleeding in which the airway was secure and isolated by Combitube. The pharyngeal cuff of the Combitube was overinflated so as to create a tamponade effect to control otherwise uncontrollable and inaccessible oral bleeding.

[Salivary gland tumor of the hard palate]. / Speicheldrüsentumor des harten Gaumens.

BACKGROUND: Pleomorphic adenomas of the small salivary glands are very rare and usually arise from the hard palate. CASE REPORT: We present a female patient who was referred to our Department because of a bleeding enoral tumor, which persisted for 35 years. Histopathological examination after complete tumor excision showed a pleomorphic adenoma. CONCLUSION: Pleomorphic adenomas are an important differential diagnosis for tumors of the hard palatine. The therapy of choice is surgical excision.

Floor of mouth haemorrhage and life-threatening airway obstruction during immediate implant placement in the anterior mandible.

A majority of the procedures performed in the dental office setting are considered safe and minimally invasive. Despite this fact, as healthcare providers it is our responsibility to be able to anticipate, recognize and manage life-threatening emergencies that may occur. In the following report, the authors will describe a life-threatening complication that resulted from the placement of mandibular implants.

Hemorrhage in the floor of the mouth after second-stage surgery: case report.

Placement of dental implants in the interforaminal region of the mandible is generally considered a routine, simple, and safe procedure. However, severe bleeding and hematoma in the floor of the mouth have been reported as a rare but potentially fatal complication related to the placement of an implant in this region. The following report describes a case of life-threatening hemorrhage in the floor of the mouth after second-stage surgery to place the healing abutment. The implants were forced to match with the prosthesis in a severely atrophic upper jaw, resulting in a perforation of the lingual cortex and mucosa of the floor of the mouth. Clinicians who place implants should be knowledgeable in the treatment of such a serious complication.

Haemostatic management of intraoral bleeding in patients with congenital deficiency of alpha2-plasmin inhibitor or plasminogen activator inhibitor-1.

Haemostatic management of intraoral bleeding was investigated in patients with congenital alpha2-plasmin inhibitor (alpha2-PI) deficiency or congenital plasminogen activator inhibitor- 1 (PAI-1) deficiency. When extracting teeth from patients with congenital alpha2-PI deficiency, we advocate that 7.5-10 mg kg(-1) of tranexamic acid be administered orally every 6 h, starting 3 h before surgery and continuing for about 7 days. For the treatment of continuous bleeding, such as post-extraction bleeding, 20 mg kg(-1) of tranexamic acid should be administered intravenously, and after achieving local haemostasis 7.5 mg kg(-1) of tranexamic acid should be administered orally every 6 h for several days. In addition, when treating haematoma caused by labial or gingival laceration or buccal or mandibular contusion, haemostasis should be achieved by administering 7.5-10 mg kg(-1) of tranexamic acid every 6 h. Tranexamic acid can also be used for haemostatic management of intraoral bleeding in patients with congenital PAI-1 deficiency, but is less effective when compared with use in patients with congenital alpha2-PI deficiency. Continuous infusion of 1.5 mg kg(-1) h(-1) of tranexamic acid is necessary for impacted tooth extraction requiring gingival incision or removal of local bone.

[Life threatening oral hemorrhage after implantation into the distal right mandible]. / Biochirurgische Wund-konditionierung mittels Madentherapie und Vakuum-verbänden nach Teilnekrose eines Haut-Muskel-Transplantats im bestrahlten Kopf-Hals-Bereich.

In dental practice, surgical implant procedures are frequently conducted for pre-prosthetic surgery. Intra-operative complications are rare and can mostly be prevented effectively with adequate preparatory measures. However, not all risks can be anticipated a priori. Anatomical variation, such as variation in the path of blood vessels, is often unpredictable. This paper describes a life-threatening hemorrhage that occurred in a 60-year-old male during the insertion of an implant in the distal right mandible. It was impossible to stop the bleeding using local measures. Only extraoral ligation of the facial artery proved effective in suppressing the hemorrhage. The submentalis artery, a branch of the facial artery, had an atypical path directly below the caudal ridge of the mandible. The possibility of similar complications should make us re-evaluate preoperative preventive measures, and places greater demands on intra-operative complication prophylaxis. The international literature on this topic is discussed.

Arteriovenous malformation of the mandible: embolization and direct injection therapy.

Arteriovenous malformation (AVM) of the mandible is a rare entity but one that can be potentially fatal as a result of massive hemorrhage. Traditional treatment involved extensive surgical resection of the mandible. With the advent of improved endovascular techniques, interventional radiology is now the best method to control active hemorrhage and ultimately cure these lesions. The authors describe three cases of successfully treated mandibular AVM by percutaneous and/or endovascular techniques.

Mandibular metastatic hepatocellular carcinoma: report of a case involving severe and uncontrollable hemorrhage.

Hepatocellular carcinoma (HCC) is a malignant tumor with a marked tendency to spread through the portal system. Metastases from HCC usually involve lungs, surrenal glands, the skeletal and gastroenteric systems, spleen, heart and kidneys. Secondary localizations to the mandible are rare. Generally, bone metastases from HCC appear as osteolytic lesions more likely localized to the ribs, spine, femor, omer, sternum, and then to the mandible. Mandibular metastatic HCC is hemorrhagic in nature because of its hypervascularity. Any diagnostic maneuver that could end in bleeding should be avoided. Non-invasive diagnostic procedures such as computer tomography (CT) scan should be preferred. Among the invasive diagnostic procedures, only fine needle biopsy should be attempted and palliative radiotherapy could be useful for the control of local symptoms. A case report of a hemorrhagic mandibular metastatic HCC that had to be treated surgically, in order to control the severe and profuse bleeding, is presented.

Surgical management of actinic cheilitis.

OBJECTIVE: An analysis is made of the etiologic factors underlying actinic cheilitis and of the results obtained following surgical treatment of the disease in a series of 54 patients (32 males and 22 females). STUDY DESIGN: The case history was evaluated, along with the triggering factors, histopathological pattern and recurrence of lesions. A cold scalpel vermilionectomy was performed in 41 patients, followed by primary closure of the defect using an oral mucosal flap. The remaining 13 patients were subjected to carbon dioxide laser vermilion ablation. RESULTS: The history of the patients revealed liver disease associated to alcohol consumption in 35.2% of cases and tobacco smoking in 77.8%. As regards solar exposure, 53.1% of the men referred open-air professional activities, while 100% of the women presented important solar exposure. The most frequent clinical manifestations were bleeding and the presence of leukoplakia patches; pain was reported in only 16% of cases. Over 40% of the patients were asymptomatic. Following treatment, and after a follow-up period of at least 6 months, 90.7% of the subjects showed complete healing. Of the 5 patients reoperated upon, four healed and one evolved towards squamous cell carcinoma. CONCLUSION: Vermilionectomy is the recommended treatment for actinic cheilitis, using either a cold scalpel or carbon dioxide laser. A histological study of the lesion is indicated in all cases to secure early detection of possible malignization. The control of the possible etiologic factors is also essential.