A case of extraction of mandibular wisdom teeth in patients with antiphospholipid syndrome who have severe mitral valve insufficiency

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  • MURAI Chika
    Oral Diagnosis and Oral Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University
  • SAKATA Ken-ichiro
    Oral Diagnosis and Oral Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University
  • YOSHIKAWA Kazuhito
    Oral Diagnosis and Oral Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University
  • SATO Jun
    Oral Diagnosis and Oral Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University
  • SATOH Akira
    Oral Diagnosis and Oral Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University
  • KITAGAWA Yoshimasa
    Oral Diagnosis and Oral Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University

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Other Title
  • 高度僧帽弁閉鎖不全症を伴う抗リン脂質抗体症候群患者の下顎埋伏智歯抜歯術の1例
  • コウドソウボウベン ヘイサ フゼンショウ オ トモナウ コウリン シシツ コウタイ ショウコウグン カンジャ ノ カガク マイフク チシ バッシジュツ ノ 1レイ

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Abstract

<p>Antiphospholipid syndrome (APS) is an autoimmune disease characterized by repeated episodes of arterial and/or venous thrombosis, and the main focus of treatment is prevention of the recurrence of thrombosis. Because surgical invasion is also a risk factor for thrombus recurrence, extreme caution is required when performing surgery. There have been no reports of oral surgery in patients with APS following severe cardiac disease.</p><p>　We describe a 32-year-old woman who had an infection on an impacted mandibular wisdom tooth. She was referred to undergo dental extraction. Her past medical history was remarkable for secondary APS with systemic lupus erythematosus and severe mitral regurgitation. We predicted highly invasive dental extraction. We decided to remove the impacted bilateral mandibular wisdom teeth with the patient under general anesthesia to avoid infectious endocariditis (IE) and new thrombosis due to the acute development of residual infection.</p><p>　We needed to apply severe perioperative management to prevent aggravation of cardiac failure, including restriction of infusion volume, control of blood pressure, and antibiotic prophylaxis for IE. D-dimer levels were measured perioperatively for thrombus monitoring. Continuous intravenous administration of heparin was performed for 72 hours as postoperative anticoagulant therapy, and the subsequent course was good.</p>

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