Selective transarterial embolization for arterial hemorrhage after upper third molar extraction: illustrative cases

Abstract

BACKGROUND The present report describes 2 cases of arterial bleeding after removal of the upper third molar that were successfully treated with selective transarterial embolization. OBSERVATIONS The first patient underwent removal of the left upper third molar. A few hours later, facial swelling and massive bleeding appeared near the extraction socket involving the posterolateral wall of the maxillary sinus. Angiography showed a pseudoaneurysm involving the posterior superior dental artery, and the lesion was selectively embolized with an N-butyl cyanoacrylate (NBCA)-lipidiol mixture. The second patient underwent removal of the left upper third molar, and massive bleeding occurred from the extraction socket involving the greater palatine foramen. Angiography revealed the pseudoaneurysm of the greater palatine artery, and the lesion was selectively embolized with an NBCA-lipiodol mixture. Both patients were discharged uneventfully, and no recurrent bleeding was observed during the 82- and 5-month follow-up periods. LESSONS Massive arterial bleeding after a third molar extraction occurs from either the posterior superior dental artery or the greater palatine artery, which is associated with the location of the extraction socket. Selective transarterial glue embolization is a useful option for the treatment of arterial bleeding after the removal of the upper third molars.

The Role of Cyanoacrylate after Mandibular Third Molar Surgery: A Single Center Study

“…With regards to the management of postoperative hemorrhagic complications, some authors used selective transarterial embolization in order to treat the emergence after third molar extraction or to enhance coagulation after venous mandibular neoformation surgery [ 26 , 27 , 28 , 29 ]. Gogulanathan et al [ 30 ] in their interesting randomized slit-mouth clinical trial reported superior results after third molar extraction in the group with fibrin sealant compared to traditional suture, with superior values of postoperative wound closure and mouth opening and reduced values in duration to achieve hemostasis and pain score.…”