• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.2
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• pp.189-195
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• 2010

Excessive oral and maxillofacial bleeding causes upper airway obstruction, bronchotracheal & gastric aspiration and hypovolemic shock. Therefore, the rapid & correct bleeding control is very important for life-saving in the medical emergency room. In spite of the bleeding control methods of the wound suture & direct pressure, the postoperative bleeding can be occurred, because of the presence of various bleeding disorders & postoperative delayed wound infections. The proper care of bleeding disorders & wound infections are very important for the control of the delayed postoperative rebleeding. In spite of these methods, active oral bleeding can be presented by the other causes of head injury. A rare but particularly dangerous sort of bleeding that may have an especial importance to the patient with severe basal skull fracture that damage large vessels and even the cavernous sinus. The occurrence of profuse nasal or oropharyngeal bleeding may arise from damage to the anterior and posterior ethmoidal vessels, but when mixed with brain tissue it is evidence of mortal damage. In this condition, rapid entire oropharyngeal packing is essential for the control of active oral bleeding. This is a case report of rapid rational bleeding control method by much amount of wet gauze packings, in a 44-years-old male patient with active oropharyngeal bleeding by basal skull fractures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.5
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• pp.383-389
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• 2002

This is a retrospective study on emergency patients with active oral bleeding. The study was based on a series of 135 patients treated as emergency patients at Wonju Christian Hospital, from Jan. 1, 1997, to Dec. 31, 2001. The postoperative bleeding was the most frequent cause of active oral bleeding in emergency room and bleeding from trauma and medically compromised (bleeding disorders) patients were next in order of frequency. In the injury of maxillofacial vessels, peak incidence was occurred in the inferior alveolar vessel (42.9%), followed by the submucosal vessel of lip & cheek, the superior alveolar vessel, and sublingual vessels. The most common disease of bleeding disorders was vascular wall alteration (infection, etc), followed by liver disease, thrombocytopenic purpura, anti-coagulation drugs in order. In the characteristics of dental diseases on bleeding disorders, periodontal disease and alveolar osteitis (osteomyelitis) were more common. The hemostasis was most obtained by use of wound suture, simple pressure dressing, drainage for infection control and primary interdental wiring of fracture. In the complication group, the infrequent incidence was showed in vomiting, hypovolemic shock, syncope, recurred bleeding & aspiration pneumonia. In the uncontrolled oral bleeding, the injured vessels were suspected as skull base & ethmoidal vessels. In this study, authors found that the close cooperation between the dentistry (Oral and maxillofacial surgery) and the medicine (emergency & internal medicine) was the most important for early proper control of active oral bleeding. And then post-operative wound closure, drainage for infection control and previous systemic evaluation of bleeding disorders were critical for the prevention of postoperative bleeding in the local dental clinic.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.6
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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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• v.36 no.4
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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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.3
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• pp.221-227
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• 2010

The most common local cause of active gingival bleeding is the vessel engorgement and erosion by severe inflammation. Abnormal gingival bleeding is also associated with the systemic disturbances. Hemorrhagic disorders in which abnormal gingival bleeding is encountered include the following: vascular abnormalities (vitamin C deficiency or allergy), platelet disorders, hypoprothrombinemia (vitamin K deficiency resulting from liver disease), and other coagulation defects (hemophilia, leukemia). There are many conventional methods for gingival bleeding control, such as, direct pressure, electrocoagulation, direct suture, drainage, application of hemostatic agents and crushing and packing. If the active continuous gingival bleeding is not stopped in spite of the application of all conventional bleeding control methods, the life of patient is threatened owing to upper airway obstruction, syncope, vomiting and hypovolemic shock. Therefore, the rapid and correct hemostatic method is very important in the emergency dental care. This is a case report of active gingival bleeding care via dental crown removal and emergency primary endodontic drainage as a last method in liver cirrhosis patient with advanced periodontitis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.6
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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.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.9 no.1
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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.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.2
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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.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.8 no.1
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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.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.6
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• pp.592-596
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• 2010

The common local causes of active gingival bleeding are the vessel engorgement and erosion by severe inflammation and injury to hypervascularity lesion. Abnormal gingival bleeding is also associated with systemic bleeding disorders (liver disease, leukemia etc.). There are many conventional methods for gingival bleeding control, such as, direct pressure, packing, electrocoagulation, tight suture and application of hemostatic agents. If the continuous gingival bleeding is not stopped in spite of the all local application methods, the medical consultation should be obtained for systemic condition care and the major feeding arterial embolization. This is a case report of severe gingival bleeding and periodontitis control in a patient with liver cirrhosis and oral metastatic lesion of hepatocellular carcinoma. The bleeding lesion was placed in left buccal mucosa and gingiva of the left mandibular molars. The control methods were dental crown removal, primary endodontic drainage, gingival sulcus drainage and maxillary arterial embolization with medical consultation.