DOI QR코드

DOI QR Code

Epistaxis in dental and maxillofacial practice: a comprehensive review

  • Psillas, George (1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital) ;
  • Dimas, Grigorios Georgios (1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital) ;
  • Papaioannou, Despoina (School of Dentistry, Aristotle University of Thessaloniki, AHEPA Hospital) ;
  • Savopoulos, Christos (1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital) ;
  • Constantinidis, Jiannis (1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital)
  • Received : 2021.01.24
  • Accepted : 2021.04.20
  • Published : 2022.02.28

Abstract

The lifetime incidence of epistaxis in dental and maxillofacial practice has been reported to be as high as 60% and can be caused by dental implant placement, Le Fort I osteotomy, intranasal supernumerary tooth, odontogenic tumors, blood disorders and maxillofacial trauma. Most epistaxis cases are minor and easily managed with direct compression on the nares for 10 minutes. For more significant or recurrent epistaxis, other techniques might include electrocautery, anterior or posterior nasal packing, or Foley catheter balloon. For patients with refractory epistaxis, cauterization of the sphenopalatine artery under endonasal endoscopy or embolization of the internal maxillary artery should be performed. Epistaxis control is required in patients diagnosed with inherited or acquired bleeding disorders or with drug-induced coagulopathies during dental procedures. In these cases, hemostatic system adjustment and hemostasis achieved by local and adjunctive methods are required. Dentists and maxillofacial surgeons must be aware that the nasal cavity is a potential source of perioperative hemorrhage. Depending on the invasiveness of the dental intervention, preoperative involvement of the hematologist and cardiologist is usually necessary to reverse anticoagulation or to cease anticoagulant therapy.

Keywords

References

  1. Morgan DJ, Kellerman R. Epistaxis: evaluation and treatment. Prim Care 2014;41:63-73. https://doi.org/10.1016/j.pop.2013.10.007
  2. Solomons NB, Blumgart R. Severe late-onset epistaxis following Le Fort I osteotomy: angiographic localization and embolization. J Laryngol Otol 1988;102:260-3. https://doi.org/10.1017/s0022215100104670
  3. Krulewitz NA, Fix ML. Epistaxis. Emerg Med Clin North Am 2019;37:29-39. https://doi.org/10.1016/j.emc.2018.09.005
  4. Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin North Am 1986;30:207-29. https://doi.org/10.1016/S0011-8532(22)02107-3
  5. Ferguson M. Rhinosinusitis in oral medicine and dentistry. Aust Dent J 2014;59:289-95. https://doi.org/10.1111/adj.12193
  6. Stacchi C, Andolsek F, Berton F, Perinetti G, Navarra CO, Di Lenarda R. Intraoperative complications during sinus floor elevation with lateral approach: a systematic review. Int J Oral Maxillofac Implants 2017;32:e107-18. https://doi.org/10.11607/jomi.4884
  7. Alberti PW. Applied surgical anatomy of the maxillary sinus. Otolaryngol Clin North Am 1976;9:3-20. https://doi.org/10.1016/s0030-6665(20)32713-4
  8. Hong YH, Mun SK. A case of massive maxillary sinus bleeding after dental implant. Int J Oral Maxillofac Surg 2011;40:758-60. https://doi.org/10.1016/j.ijom.2010.11.027
  9. Nooh N. Effect of schneiderian membrane perforation on posterior maxillary implant survival. J Int Oral Health 2013;5:28-34.
  10. Kim HY, Yang JY, Chung BY, Kim JC, Yeo IS. Peri-implant bone length changes and survival rates of implants penetrating the sinus membrane at the posterior maxilla in patients with limited vertical bone height. J Periodontal Implant Sci 2013;43:58-63. https://doi.org/10.5051/jpis.2013.43.2.58
  11. Shihab OI. Intentional penetration of dental implants into the maxillary sinus: a retrospective study. Zanco J Med Sci 2017;21:1536-9. https://doi.org/10.15218/zjms.2017.001
  12. Bae OY, Kim YS, Shin SY, Kim WK, Lee YK, Kim SH. Clinical outcomes of reamer- vs osteotome-mediated sinus floor elevation with simultaneous implant placement: a 2-year retrospective study. Int J Oral Maxillofac Implants 2015;30:925-30. https://doi.org/10.11607/jomi.3779
  13. Lanigan DT, Hey JH, West RA. Major vascular complications of orthognathic surgery: hemorrhage associated with Le Fort I osteotomies. J Oral Maxillofac Surg 1990;48:561-73. https://doi.org/10.1016/s0278-2391(10)80468-9
  14. Mehra P, Cottrell DA, Caiazzo A, Lincoln R. Life-threatening, delayed epistaxis after surgically assisted rapid palatal expansion: a case report. J Oral Maxillofac Surg 1999;57:201-4. https://doi.org/10.1016/s0278-2391(99)90241-0
  15. Williams BJ, Currimbhoy S, Silva A, O'Ryan FS. Complications following surgically assisted rapid palatal expansion: a retrospective cohort study. J Oral Maxillofac Surg 2012;70:2394-402. https://doi.org/10.1016/j.joms.2011.09.050
  16. de Mol van Otterloo JJ, Tuinzing DB, Greebe RB, van der Kwast WA. Intra- and early postoperative complications of the Le Fort I osteotomy. A retrospective study on 410 cases. J Craniomaxillofac Surg 1991;19:217-22. https://doi.org/10.1016/s1010-5182(05)80551-7
  17. Eshghpour M, Mianbandi V, Samieirad S. Intra- and postoperative complications of Le Fort I maxillary osteotomy. J Craniofac Surg 2018;29:e797-803. https://doi.org/10.1097/SCS.0000000000004828
  18. Avelar RL, Goelzer JG, Becker OE, de Oliveira RB, Raupp EF, de Magalhaes PS. Embolization of pseudoaneurysm of the internal maxillary artery after orthognathic surgery. J Craniofac Surg 2010;21:1764-8. https://doi.org/10.1097/SCS.0b013e3181f40393
  19. Park B, Jang WH, Lee BK. An idiopathic delayed maxillary hemorrhage after orthognathic surgery with Le Fort I osteotomy: a case report. J Korean Assoc Oral Maxillofac Surg 2019;45:364-8. https://doi.org/10.5125/jkaoms.2019.45.6.364
  20. Garg S, Kaur S. Evaluation of post-operative complication rate of Le Fort I osteotomy: a retrospective and prospective study. J Maxillofac Oral Surg 2014;13:120-7. https://doi.org/10.1007/s12663-012-0457-4
  21. Niazi MH, El-Ghanem M, Al-Mufti F, Wajswol E, Dodson V, Abdulrazzaq A, et al. Endovascular management of epistaxis secondary to dissecting pseudoaneurysm of the descending palatine artery following orthognathic surgery. J Vasc Interv Neurol 2018;10:41-6.
  22. Bykowski MR, Hill A, Garland C, Tobler W, Losee JE, Goldstein JA. Ruptured pseudoaneurysm of the maxillary artery and its branches following Le Fort I osteotomy: evidence-based guidelines. J Craniofac Surg 2018;29:998-1001. https://doi.org/10.1097/SCS.0000000000004396
  23. Krishnan B, Parida PK, Gopalakrishnan S, Satyparakash MV. An unusual cause of epistaxis in a young patient: the supernumerary nasal tooth. Oral Maxillofac Surg 2013;17:315-7. https://doi.org/10.1007/s10006-013-0393-6
  24. Iwai T, Aoki N, Yamashita Y, Omura S, Matsui Y, Maegawa J, et al. Endoscopic removal of bilateral supernumerary intranasal teeth. J Oral Maxillofac Surg 2012;70:1030-4. https://doi.org/10.1016/j.joms.2011.10.014
  25. Verma RK, Bakshi J, Panda NK. Ectopic intranasal tooth: an unusual cause of epistaxis in a child. Ear Nose Throat J 2012;91:242-4. https://doi.org/10.1177/014556131209100606
  26. Al Dhafeeri HO, Kavarodi A, Al Shaikh K, Bukhari A, Al Hussain O, El Baramawy A. Recurrent epistaxis caused by an intranasal supernumerary tooth in a young adult. Am J Case Rep 2014;15:291-3. https://doi.org/10.12659/AJCR.890710
  27. Kirmeier R, Truschnegg A, Payer M, Malyk J, Daghighi S, Jakse N. The supernumerary nasal tooth. Int J Oral Maxillofac Surg 2009;38:1219-22. https://doi.org/10.1016/j.ijom.2009.06.013
  28. Lee FP. Endoscopic extraction of an intranasal tooth: a review of 13 cases. Laryngoscope 2001;111:1027-31. https://doi.org/10.1097/00005537-200106000-00017
  29. Milam SB, Cooper RL. Extensive bleeding following extractions in a patient undergoing chronic hemodialysis. Oral Surg Oral Med Oral Pathol 1983;55:14-6. https://doi.org/10.1016/0030-4220(83)90298-0
  30. Gupta A, Epstein JB, Cabay RJ. Bleeding disorders of importance in dental care and related patient management. J Can Dent Assoc 2007;73:77-83.
  31. Rafique S, Fiske J, Palmer G, Daly B. Special care dentistry: part 1. Dental management of patients with inherited bleeding disorders. Dent Update 2013;40:613-6, 619-22, 625-6 passim. https://doi.org/10.12968/denu.2013.40.8.613
  32. Virupakshappa D, Rajashekhara BS, Manjunatha BS, Das N. Adenomatoid odontogenic tumour in a 20-year-old woman. BMJ Case Rep 2014;2014:bcr2013010436. https://doi.org/10.1136/bcr-2013-010436
  33. Wenig BL, Sciubba JJ, Cohen A, Goldstein A, Abramson AL. An unusual cause of unilateral nasal obstruction: ameloblastoma. Otolaryngol Head Neck Surg 1985;93:426-32. https://doi.org/10.1177/019459988509300327
  34. Kuhnel TS, Reichert TE. Trauma of the midface. GMS Curr Top Otorhinolaryngol Head Neck Surg 2015;14:Doc06. https://doi.org/10.3205/cto000121
  35. Dallan I, Tschabitscher M, Castelnuovo P, Bignami M, Muscatello L, Lenzi R, et al. Management of severely bleeding ethmoidal arteries. J Craniofac Surg 2009;20:450-4. https://doi.org/10.1097/SCS.0b013e31819b9803
  36. Yonezawa H, Yanamoto S, Hoshino T, Yamada S, Fujiwara T, Umeda M. Management of maxillary alveolar bone fracture and severely intruded maxillary central incisor: report of a case. Dent Traumatol 2013;29:416-9. https://doi.org/10.1111/j.1600-9657.2011.01111.x
  37. Pashen D, Stevens M. Management of epistaxis in general practice. Aust Fam Physician 2002;31:717-21.
  38. Kitamura T, Takenaka Y, Takeda K, Oya R, Ashida N, Shimizu K, et al. Sphenopalatine artery surgery for refractory idiopathic epistaxis: systematic review and meta-analysis. Laryngoscope 2019; 129:1731-6. https://doi.org/10.1002/lary.27767
  39. Shah QA. Bilateral tri-arterial embolization for the treatment of epistaxis. J Vasc Interv Neurol 2008;1:102-5.
  40. Tomljenovic B, Herrmann S, Filippi A, Kuhl S. Life-threatening hemorrhage associated with dental implant surgery: a review of the literature. Clin Oral Implants Res 2016;27:1079-84. https://doi.org/10.1111/clr.12685
  41. Lazaridis N, Tilaveridis I, Venetis G, Lazaridou M. Maxillary sinus osteoplasty with vascularized pedicled bone flap. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:828-32. https://doi.org/10.1016/j.tripleo.2008.05.030
  42. Aukstakalnis R, Simonaviciute R, Simuntis R. Treatment options for odontogenic maxillary sinusitis: a review. Stomatologija 2018;20:22-6.
  43. Levin M, Sommer DD. Endoscopic removal of ectopic sinonasal teeth: a systematic review. J Otolaryngol Head Neck Surg 2019;48:30. https://doi.org/10.1186/s40463-019-0353-8
  44. Peisker A, Raschke GF, Schultze-Mosgau S. Management of dental extraction in patients with haemophilia A and B: a report of 58 extractions. Med Oral Patol Oral Cir Bucal 2014;19:e55-60. https://doi.org/10.4317/medoral.19191
  45. Anderson JA, Brewer A, Creagh D, Hook S, Mainwaring J, McKernan A, et al. Guidance on the dental management of patients with haemophilia and congenital bleeding disorders. Br Dent J 2013;215:497-504. https://doi.org/10.1038/sj.bdj.2013.1097
  46. Dezsi CA, Dezsi BB, Dezsi AD. Management of dental patients receiving antiplatelet therapy or chronic oral anticoagulation: a review of the latest evidence. Eur J Gen Pract 2017;23:196-201. Erratum in: Eur J Gen Pract 2017;23:i-ii. https://doi.org/10.1080/13814788.2017.1350645
  47. Kwak EJ, Nam S, Park KM, Kim SY, Huh J, Park W. Bleeding related to dental treatment in patients taking novel oral anticoagulants (NOACs): a retrospective study. Clin Oral Investig 2019;23:477-84. https://doi.org/10.1007/s00784-018-2458-2
  48. Ho JPK, Bari N, Riffat F. Management of epistaxis in patients on novel oral anticoagulation therapy. J Laryngol Otol 2020;134:316-22. https://doi.org/10.1017/S0022215120000754