title: Initial management of massive oral bleeding after midfacial fracture.
abstract: BACKGROUND
  This article reviews initial outcomes of the treatment of massive oral bleeding after midfacial fracture.
  
  
  METHODS
  Massive bleeding was defined according to the criteria of Buchanan and Holtmann. The incidence of patients who met these criteria, hematocrit, the type of fracture, time from injury to initial management, source of bleeding, duration of management, and treatment strategy were recorded.
  
  
  RESULTS
  We identified massive bleeding in the maxillofacial region in 5 of 521 patients (0.96%). All patients demonstrated profuse bleeding from the nose, and no active source of bleeding was evident in the oral cavity. Bleeding was controlled by nasal packing and temporary reduction in all patients, none of whom required artery ligation or embolization.
  
  
  CONCLUSIONS
  Massive oral bleeding associated with midfacial fractures is frequently derived from the nasal cavity and associated structures. Although the nose may be the cause of the bleeding, the sinuses, skull base, and nasopharynx may also have active bleeding that has cleared through the nasal cavity and nasopharynx into the oral cavity. Control of this massive nasal bleeding during the early stage can therefore improve morbidity associated with severe exsanguination.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Medical School, Kawagoe, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shimoyama
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kaneko
authors.forename: Norio
authors.initials: N
authors.lastname: Horie
mesh_terms: D000293:Adolescent; D002648:Child; D005151:Facial Injuries / Q000150:complications*; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006400:Hematocrit; D006801:Humans; D008297:Male; D006472:Oral Hemorrhage / Q000209:etiology* / Q000628:therapy