Airway Management of a Patient with an Acute Floor of the Mouth Hematoma after Dental Implant Surgery in the Lower Jaw.
BACKGROUND
Over the last decades, dental implants have become increasingly popular in the prosthetic rehabilitation of patients. This has subsequently led to an increase of perioperative complications. Obstruction of the airway as a result of a floor of mouth hematoma after dental implant surgery is a rare but life-threatening complication.


METHODS
A 62-year-old man presented to the emergency department with a compromised airway caused by a hematoma in the floor of the mouth that occurred during dental implant surgery in the edentulous anterior mandible. Computed tomography angiography images revealed an elevation of the floor of mouth with subsequent occlusion of the airway. In addition, a perforation of the lingual mandibular cortical plate was observed that was caused by two malpositioned dental implants. Awake fiberoptic intubation was immediately performed, the two malpositioned dental implants were subsequently removed, and the patient was extubated after 3 days. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Perforation of the lingual mandibular cortical plate during dental implant surgery can lead to life-threatening bleeding in the floor of the mouth. This condition can be successfully treated by awake fiberoptic intubation and, if necessary, the malpositioned dental implants can be subsequently removed.
Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.
Maarten J J B
MJJB
Vehmeijer
Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands.
Naomi
N
Verstoep
Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.
Jan E H
JEH
Wolff
Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.
Engelbert A J M
EAJM
Schulten
Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands.
Bas
B
van den Berg
D000208:Acute Disease; D058109:Airway Management; D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy*; D015921:Dental Implants / Q000009:adverse effects*; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008334:Mandible / Q000601:surgery; D008875:Middle Aged; D009059:Mouth Diseases / Q000209:etiology*; D009060:Mouth Floor; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*
D015921:Dental Implants
acute floor of mouth hematoma; airway management; airway obstruction; dental implant complications