• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제27권6호
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• pp.560-564
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• 2001

The experienced surgeon can be surprised & challenged by the hazards of active bleeding during oral & maxillofacial surgical procedure, because of alterations in the surgical anatomy, bleeding disorders and surgical intervention of infected tissues. This is a report of two cases of active bleeding during surgical extraction of mandibular third molar, that had the pericoronitis, osteitis and adjacent neurovascular bundle in its apex. When the abrupt active bleeding was occurred during surgical extraction of mandibular third molar, pressure packing by hemostatie agent(bone wax) & wet gauze biting were applied into the extraction socket during 30 minutes. After 30 minutes, the wound was explored about the bleeding and active bleeding was then continued. In spite of repeated bleeding control method of the pressure dressing, the marked hemorrhage was generated continuously. Therefore, the author decised the bleeding as immediately uncontrollable hemorrhage and the pressure dressing was again applied for the more longer duration without wound closure. After 3 days, the pressure dressing was removed and iodoform gauze drainge was then established without the bleeding. The drain was changed as the interval of 3~5 days for prevention of infection & secondary hemorrhage and relatively good wound healing was then resulted in 6 weeks.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제35권6호
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• pp.431-436
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• 2009

There are five principal causes for excessive bleeding in the immediate postextraction phase ; (1) Vascular wall alteration (wound infection, scurvy, chemicals, allergy) (2) Disorders of platelet function (genetic defect, drug-aspirin, autoimmune disease) (3) Thrombocytopenic purpuras (radiation, leukemia), (4) Inherited disorders of coagulation (hemophilia, Christmas disease, vitamin deficiency, anticoagulation drug-heparin, coumarin). If the hemorrhage from postextraction wound is unusually aggressive, and then dehydration and airway problem are occurred, the socket must be packed with gelatine sponge(Gelfoam) that was moistened with thrombin and wound closure & pressure dressing are applied. The thrombin clots fibrinogen to produce rapid hemostasis. Gelatine sponges moistened with thrombin provide effective coagulation of hemorrhage from small veins and capillaries. But, in dental alveoli, gelatine sponges may absorb oral microorganisms and cause alveolar osteitis (infection). This is a case report of bleeding control by continuous rubber strip & iodoform gauze drainage (without gelfoam packing) of active bleeding infection sites of three teeth extraction wounds in a 46-years-old female patient with advanced liver cirrhosis.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권2호
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• pp.171-175
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• 2011

Implant placement on the anterior mandible is considered a common and safe surgical procedure. However, severe hemorrhage can occur if branches of the sublingual artery, which run through the lingual cortical plate of the mandible, are damaged. Excessive hemorrhage caused by injury to the sublingual artery can result in life-threatening problems such as airway obstruction. A 54-year old male patient without any generalized systemic conditions was referred due to active bleeding after implant placement in the anterior mandible. Gauze compression with surgicel and bosimin were performed and hemostasis was achieved. The patient was discharged after 3 days without any supplementary bleeding.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권4호
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• pp.303-308
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• 2010

Excessive oral and maxillofacial bleeding causes upper airway obstruction, bronchotracheal and gastric aspiration and hypovolemic shock. Therefore, the rapid and correct bleeding control is very important for saving lives in the emergency room. Despite the conventional bleeding control methods of wiring (jaw fracture, wound suture and direct pressure), continuous bleeding can occur due to the presence of various bleeding disorders. There are five main causes for excessive bleeding disorders in the clinical phase; (1) vascular wall alteration (infection, scurvy etc.), (2) disorders of platelet function (3) thrombocytopenic purpura (4) inherited disorders of coagulation, and (5) acquired disorders of coagulation (liver disease, anticoagulant drug etc.). In particular, infections can alter the structure and function of the vascular wall to a point at which the patient may have a clinical bleeding problem due to vessel engorgement and erosion. Wound infection is a frequent cause of postoperative active bleeding. To prevent postoperative bleeding, early infection control using a wound suture with proper drainage establishment is very important, particularly in the active bleeding sites in a contaminated emergency room. This is a case report of a rational bleeding control method by rapid wiring, wound suture with drainage of a rubber strip & iodoform gauze and wet gauze packing, in a 26-year-old male cerebral palsy patient with active oral and maxillofacial bleeding injuries caused by a traffic accident.

• 대한치과마취과학회지
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• 제11권2호
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• pp.177-182
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• 2011

There are five principal causes for excessive bleeding in the immediate postextraction phase ; (1) Vascular wall alteration (wound infection, scurvy, chemicals, allergy) (2) Disorders of platelet function (genetic defect, drug-aspirin, autoimmune disease) (3) Thrombocytopenic purpuras (radiation, leukemia), (4) Inherited disorders of coagulation (hemophilia, Christmas disease, vitamin deficiency, anticoagulation drug-heparin, coumarin, aspirin, plavix). If the hemorrhage from postextraction wound is unusually aggressive, and then dehydration and airway problem are occurred, the socket must be packed with gelatine sponge(Gelfoam) that was moistened with thrombin and wound closure & pressure dressing are applied. The thrombin clots fibrinogen to produce rapid hemostasis. Gelatine sponges moistened with thrombin provide effective coagulation of hemorrhage from small veins and capillaries. But, in dental alveoli, gelatine sponges may absorb oral microorganisms and cause alveolar osteitis (infection). This is a case report of bleeding and infection control by the circumferential suture and iodoform gauze drainage on infected active bleeding extraction socket under sedation and local anesthesia in a 71-years-old male patient with anticoagulation drug.

• Journal of Korean Dental Science
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• 제7권1호
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• pp.43-47
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• 2014

Few dental procedures are potentially life-threatening. Note, however, that a dental extraction can result in preventable death. Severe post-extraction bleeding can occur, which may give rise to an alarming situation if there is any delay in detecting and managing the problem. The most immediate danger for a healthy patient with severe post-extraction hemorrhage is airway compromise. Acute airway obstruction from post-extraction hematoma is relatively uncommon, but it may occur with fatal consequences if there is any reluctance to maintain the airway clearance. Therefore, dentists and oral and maxillofacial surgeons should have clear understanding of the problem and measures to control it. Active bleeding that is not controlled by local measures in a dental office should be referred to the nearest hospital emergency department as soon as possible for appropriate management.

• 대한장애인치과학회지
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• 제9권1호
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• pp.30-35
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• 2013

The four principles of treatment of odontogenic infection are as follows : (1) removal of the cause, (2) establishment of drainage, (3) institution of antibiotic therapy, and (4) provision of supportive care, including proper rest and nutrition. A separate incision is required to establish drainage, especially in the case of extensive fascial space infections. There are four principle causes for active bleeding in the immediate incision & drainage phase; (1) vascular wall alteration (infection, scurvy, chemicals), (2) disorder of platelet function, (3) thrombocytopenic purpuras, (4) disorders of coagulation (liver disease, anticoagulation drug). If the hemorrhage from incision & drainage site is aggressive, the site must be packed with proper wet gauze and wound closure & drainage dressing are applied. The specific causes of bleeding may be associated with hypoxia, changes in the pH of blood & chemical changes affecting vascular contractility and blood clotting. This is a case report of bleeding control by the circumferential suture & drainage on active bleeding incision & drainage site of temporal space abscess due to advanced odontogenic infection in a multiple medically compromised disabled patient.

• 대한장애인치과학회지
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• 제8권1호
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• pp.15-21
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• 2012

Extraction of all nonrestorable teeth prior to bone marrow transplantation is the major dental management of the patient being prepared for the transplantation. But, there are four principal causes for excessive bleeding in the immediate postextraction phase ; (1) Vascular wall alteration (wound infection, scurvy, chemicals, allergy) (2) Disorders of platelet function (3) Thrombocytopenic purpuras (4) Disorders of coagulation (liver disease, anticoagulation drug-heparin, coumarin, aspirin, plavix) If the hemorrhage from postextraction wound is unusually aggressive, the socket must be packed with local hemostatic agent and wound closure & pressure dressing are applied. But, in dental alveoli, local hemostatic agent (gelfoam, surgcel etc) may absorb oral microorganisms and cause alveolar osteitis (infection). This is a case report of bleeding and infection control by suture, pressure packing and iodoform gauze drainage on infected active bleeding extraction socket under sedation and local anesthesia in a 57-years-old multiple disabled patient with anticoagulation drug.

• Journal of Oral Medicine and Pain
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• 제9권1호
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• pp.11-22
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• 1984

The authors administered KCN, NaF,AS2O3 orally to rabbits and caused acute and chronic poisoning, then studied the teeth, jaw bones, and other oral tissues histopathologically. The results were as follows : 1. There was no significant difference between acute poisoned group by NaF and control group. But, vasodilatation in the connective tissues, esepcially marginal area of jaw bone, atrophy and destrution of glandualr cells was observed. 2. Chronic poisoned group by NaF showed degeneration and thicking of subcutanece fibrosis ective tissues, atrophy and degeneration of subcutaneous connective tissues, atrophy and degeneration of muscle fibers, vasodilation of subcutaneous in bone cavities(lacunae), and degeneration of odotlblasts in pulp tissue. 3. Acute poisoned group by KCN showed almost similar appearances as control group, and chronic poisoned group showed hyperplasia of baal layer in epitheilium, degeneration of subcutaneous connective tissues, vasodilation and huperemia, severe hemorrhage of marginal area of jaw bone. hyperplasia of salivary gland ducts, but normal arrangement of muscle fibers and narrow bone carity(lacunae) due to active osteoblastic action, osteodentin were observed. 4. Acute poisoned group by AS2O3 showed degeneration of basal cell, atrophy of blood vessels in palatal muscosa. Chronic poisoned group showed irregular cell arrangement and degeneration, reduction of capillaries in palatal mucosa. Osteoclasts in jaw bone were observed. 5. In Masson's Trichrome and Van Gieson Staining, chronic poisoned group by NaF showed thicking and loosening of subcutaneous connective tissues. Hyperplasia of intermuscular connective tissue was observed in chronic poisoning by KCN and NaF. In PAS staining, negative reation in outer layer of palatalmucosa, positive reaction in keratin layer and mild reaction of basal layer in palate and tongue mucosa was observed.

• Clinical and Experimental Pediatrics
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• 제50권12호
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• pp.1180-1187
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• 2007

Systemic lupus erythematosus (SLE) is an episodic, multi-system, autoimmune disease characterized by widespread inflammation of blood vessels and connective tissues and by the presence of antinuclear antibodies (ANAs), especially antibodies to native (double-stranded) DNA (dsDNA). Its clinical manifestations are extremely variable, and its natural history is unpredictable. Untreated, SLE is often progressive and has a significant fatality rate. The most widely used criteria for the classification of SLE are those of the American College of Rheumatology (ACR), which were revised in 1982 and modified in 1997. The presence of four criteria have been diagnosed as a SLE. Rashes are common at onset and during active disease. The oral mucosa is the site of ulceration with SLE. Arthralgia and arthritis affect most children and these symptoms are short in duration and can be migratory. Lupus nephritis may be more frequent and of greater severity in children than in adults. The initial manifestation of nephritis is microscopic hematuria, followed by proteinuria. The most common neuropsychiatric symptoms are depression, psychosis(hallucination and paranoia) and headache. CNS disease is a major cause of morbidity and mortality. Pericarditis is the most common cardiac manifestation. Libman-Sacks endocarditis is less common in children. The most frequently described pleuropulmonary manifestations are pleural effusions, pleuritis, pneunonitis and pulmonary hemorrhage. During the active phase ESR, CRP, gamma globulin, ferritin and anti-dsDNA are elevated. Antibodies to dsDNA occur in children with active nephritis. Antibodies to the extractable nuclear antigens (Sm, Ro/SS-A, La/SS-B) are strongly associated with SLE. Specific treatment should be individualized and based on the severity of the disease. Sepsis has replaced renal failure as the most common cause of death.