J Korean Assoc Oral Maxillofac Surg.  2010 Aug;36(4):303-308. 10.5125/jkaoms.2010.36.4.303.

Emergency bleeding control in a mentally retarded patient with active oral and maxillofacial bleeding injuries: report of a case

• Mo DY
• Yoo JH
• Choi BH
• Sul SH
• Kim HR
• Lee CU

• KMID: 1457783
• DOI: http://doi.org/10.5125/jkaoms.2010.36.4.303

Abstract

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.

Keyword

Active oral hemorrhage; Shock; Mentally disabled patient; Wound drainage; Emergency hemorrhage control

MeSH Terms

Adult
Airway Obstruction
Blood Platelets
Cerebral Palsy
Drainage
Emergencies
Glycosaminoglycans
Hemorrhage
Humans
Hydrocarbons, Iodinated
Infection Control
Male
Mentally Disabled Persons
Purpura, Thrombocytopenic
Rubber
Scurvy
Shock
Sutures
Wound Infection
Glycosaminoglycans
Hydrocarbons, Iodinated
Rubber

Figure

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  Fig. 1. Initial 3D-CT view of mandibular and maxillary compound fracture. (3D-CT: 3 dimensional computed tomography)

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  Fig. 2. Primary wiring and rubber strip drainage view of a mandibular compound fracture.

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  Fig. 3. Primary gauze packing and rough wound closure view by use of iodoform gauze, long wet gauze and black silk in the maxillary compound alveolar fracture regions.

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  Fig. 4. Primary rough closure and rubber strips drainage view in the deep lacerated wounds of sublingual and mouth floor region.

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  Fig. 5. Primary rough wound closure and rubber strips drainage view in the deep lacerated chin wounds.

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  Fig. 6. Follow-up intraoral view of the mandibular arch bar application and the maxillary residual root rests with good healing of the adjacent soft tissue wounds.

Reference

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