title: Asphyxial death related to postextraction hematoma in an elderly man.
abstract: We here report an autopsy case of a man in his seventies who died from asphyxia due to compression of the trachea caused by postextraction bleeding after extraction of his left mandibular third molar by a dentist in private practice. On the morning after the tooth extraction, he had complained of dyspnea and became unconscious at home. Although he was brought to the emergency room by ambulance, he died 7 days later without regaining consciousness. Autopsy examination revealed that the lingual side of the alveolar bone was fractured at the extraction socket. Moreover, subcutaneous bleeding that extended from the extraction socket to the thyrohyoid ligament in the cervical region and deviation of the epiglottis due to the bleeding were observed. Histological findings revealed liver cirrhosis; there were no significant findings in other organs. On the basis of these findings, we concluded that alveolar bone fracture occurred during the extraction and that the bleeding spread to the cervical region. Thus, the patient had died from asphyxia resulting from airway obstruction caused by cervical subcutaneous bleeding derived from postextraction bleeding. We emphasize that tooth extraction may cause fatal complications in patients with bleeding tendencies, particularly in the elderly.
authors.affiliation: Department of Legal Medicine, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan. watack14@naramed-u.ac.jp
authors.forename: Wataru
authors.initials: W
authors.lastname: Kawashima
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Hatake
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Morimura
authors.forename: Risa
authors.initials: R
authors.lastname: Kudo
authors.forename: Mari
authors.initials: M
authors.lastname: Nakanishi
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Tamaki
authors.forename: Shogo
authors.initials: S
authors.lastname: Kasuda
authors.forename: Katsuya
authors.initials: K
authors.lastname: Yuui
authors.forename: Akiko
authors.initials: A
authors.lastname: Ishitani
mesh_terms: D000368:Aged; D000539:Alveolar Process / Q000293:injuries / Q000473:pathology; D001237:Asphyxia / Q000209:etiology*; D049429:Forensic Pathology; D006801:Humans; D007572:Jaw Fractures / Q000209:etiology / Q000473:pathology; D008297:Male; D008964:Molar, Third; D006472:Oral Hemorrhage / Q000150:complications* / Q000209:etiology / Q000473:pathology; D014081:Tooth Extraction / Q000009:adverse effects*