Prevention of hematoma on the floor of the mouth during dental implant surgery in the anterior mandible

Abstract

Objective To explore the cause and preventive measures of floor-of-mouth hematoma after dental implant placement. Methods The prevention of hematoma of the floor of the mouth in a case of lower anterior teeth implant placement was analyzed, and the literature was reviewed. Results Four mandibular vascular canals were found on the lingual side of the anterior mandible before dental surgery in the reported case. Two of them were quite thick (1.4 mm and 1.0 mm, respectively) and were located adjacent to the crest of the alveolar bone and superior to the mental spine. These two thick endosseous branches from the sublingual artery were dissected and ligated , and there was no obvious hematoma in the patients immediately after the operation and at the postoperative 3 d review. The results of the literature review show that the incidence of endosseous branches from the lingual vascular canal of the mandible is 90%-100%. The distribution of the vessels on the lingual side of the mandible is highly variable and adjacent to the lingual cortical plate. Accidental injury of the lingual cortical plate during implant surgery would probably lead to bleeding or hematoma on the floor of the mouth. Conclusion Mastering the anatomy of blood vessels on the floor of the mouth, elaboratively examining preoperative three-dimensional radiographic imaging, and cautiously exploring the lower jaw bone morphology after flap elevation are preventive measures to avoid damage to the arterial supply on the lingual side of the anterior lower jaw and to prevent complications of hematoma in the floor of the mouth.

Keywords

• oral implant surgery
• lingual vascular canal of mandible
• median lingual mandibular foramen
• accessory lingual mandibular foramina
• vascular anastomosis branch
• complications
• floor of mouth hematoma
• prevention