Hematoma of the Floor of the Mouth Requiring Emergency Tracheal Intubation after Secondary Dental Implant Surgery : A Case Report

<p>Dental implant surgery can cause fatal breathing problems due to accidental injury to surrounding tissues. In this paper, we report a case of a hematoma on the floor of the mouth that required emergency tracheal intubation due to hemorrhage of the floor of the mouth caused by dental implant surgery.</p><p>A 53-year-old female underwent vestibuloplasty procedures during second-stage implant surgery on the left mandibular molar at a dental clinic in March 2018. The wound was closed with a releasing incision on the periosteum of the lingual gingiva. After returning home on the same day, she became aware of rapid swelling in the lower part of the jaw and returned to the same clinic. During hemostatic treatment, she complained of respiratory distress. She was transported to our hospital's emergency room. At the time of initial examination, her level of consciousness was JCS (Japan Coma Scale) Ⅰ-1, and she was unable to open her mouth. The swelling was observed from the lower part of the left side of the jaw to the midline of the muscle. There was no active bleeding in the oral cavity. CT showed a 38×27 mm hypo-absorptive area with an air-containing image in the left parapharyngeal space, and the airway deviated to the right and was stenotic. The patient was admitted to the ICU on the same day, and emergency tracheal intubation was performed. SBT/ABPC 6 g, carbazochrome sodium sulfonate hydrate 50 mg, and tranexamic acid 1 g were administered daily. The patient was extubated on hospital day 6 and transferred to the general ward. She was discharged from the hospital on day 14 after good progress.</p>