Massive sublingual hematoma secondary to anticoagulant therapy complicated by a traumatic denture: a case report

Abstract

IntroductionSublingual hematoma secondary to excessive anticoagulation is a rare but potentially fatal condition, and few cases have been documented in the literature.Case presentationWe report the case of a 73-year-old Caucasian woman who attended our Accident and Emergency department with massive sublingual hematoma causing superior displacement of the tongue. The condition was found to be the result of an elevated international normalized ratio, further complicated by a traumatic mandibular denture.ConclusionsIn summary, we recommend the immediate reversal of anticoagulation therapy on admission of patients with severe sublingual hematoma. We further advise surgical decompression/drainage if required and to continue meticulous monitoring. In all cases of early recognition of sublingual hematoma, prompt medical treatment and continuous clinical monitoring is essential, and may prevent the need for a surgical airway procedure.

Life-Threatening Expansive Sublingual Hematoma

“…1,13,14,18,19 The edema caused by sublingual and/or submandibular hematoma caused by trauma to the lingual artery is known as the ''pseudo-Ludwig'' phenomenon, owing to the similar clinical appearance to Ludwig's angina. 14,24 This phenomenon (''pseudoLudwig'') was present in the case report and was initially controlled by maintaining the airway through the tracheotomy.…”

“…The infection of the hematoma was a potential complication that could have led to a worsening of the case. 27Y29 There were 2 reasons for the decision to drain the hematoma: the first was due to the continuous and gradual expansion of the hematoma, 24 and the second was the potential risk of hematoma infection due to wound contamination. 27Y29 The assessment of vascular lesions must be present in the initial care of patients with facial trauma and should be part of the routine of specialized trauma centers.…”

Pseudo-Ludwig's Phenomenon: A Rare Clinical Manifestation in Liver Cirrhosis

“…Floor of mouth hematomas have been described after trauma and dental implant procedures. 2 , 6 There are rare reports of hematomas in this region complicating excessive anticoagulation. 2 , 4 These hematomas are potentially life-threatening as they cause elevation of tongue and floor of mouth culminating in upper airway blockade.…”

“…The sublingual floor of mouth is an uncommon site of hematoma formation; spontaneous hematomas in this region resulting in noninfectious upper airway obstruction are known as pseudo-Ludwig's phenomenon. 2 – 6 To date, no case of spontaneous sublingual hematoma or pseudo-Ludwig's phenomenon has been described complicating cirrhosis of liver.…”

Sharp tooth induced sublingual hematoma in a patient with elevated international normalized ratio

“…Anticoagulants are used for mechanical valve replacement in rheumatic heart disease, deep venous thrombosis, pulmonary embolism, and cerebral venous thrombosis. [ 2 ] Estimated annual incidences of bleeding rates are 0.6% for fatal bleeding, 3% for major bleeding, and 9.6% for minor bleeding. [ 3 4 ]…”