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References

Shastry SP, Kaul R, Baroudi K, Umar D Hemophilia A: dental considerations and management. J Int Soc Prevent Community Dent. 2014; 4:S147-S152
Ljung RCR How to manage invasive procedures in children with haemophilia. Br J Haematol. 2012; 157:519-528
Haemophilia A: Factor VIII Deficiency from Patient. 2014. https://patient.info/doctor/haemophilia-a-factor-viii-deficiency (Accessed March 2018)
Anderson JAM, Brewer A, Creagh D, Yeung CA Guidance on the dental management of patients with haemophilia and congenital bleeding disorders. Br Dent J. 2013; 215:497-504
Martinez-Rider R Dental management of a child with incidentally detected haemophilia: report of a clinical case. Case Rep Dent. 2017; https://doi.org/10.1155/2017/7429738

A forehead haematoma with an important diagnosis

From Volume 45, Issue 7, July 2018 | Pages 668-669

Authors

Carly Marples

DCT2 O&M Surgery, Chesterfield Royal Hospital

Articles by Carly Marples

Ibraz Siddique

Specialty Registrar in O&M Surgery, Chesterfield Royal Hospital

Articles by Ibraz Siddique

Lorna Mann

Specialty Doctor inO&M Surgery, Chesterfield Royal Hospital

Articles by Lorna Mann

Article

Patients with undiagnosed bleeding disorders can present with varying clinical features ranging from innocuous bruising to life-threatening haemorrhage. Haemophilia is an X-linked recessive bleeding disorder causing a disruption within the intrinsic clotting pathway. After trauma, patients with Haemophilia experience an increased bleeding time with excessive bleeding into mucosal tissue, muscles and joints,1 which carries a significant risk of morbidity and mortality.2 The authors highlight the diagnostic and management actions undertaken for a paediatric patient, in whom Haemophilia A was an incidental finding, who suffered a craniofacial injury.

An 18-month-old child presented with his parents to the Emergency Department following a mechanical fall with a persistent and expanding forehead swelling. Clinically, a 5 x 4 cm firm swelling over the left frontal region was noted (Figure 1). There was no family history of bleeding disorders.

Figure 1. (a) Anterior and (b) lateral views of the large forehead haematoma and adjacent bruising.

An urgent CT head was requested to rule out intracranial haemorrhage and fractures, which returned as normal (Figure 2). Haematological investigations revealed a factor VIII deficiency (< 0.01) indicating severe Haemophilia A. The haematoma was surgically drained under a general anaesthetic and the patient referred to a tertiary haematology centre for ongoing management.

Figure 2. Axial CT image showing a large forehead haematoma and no intra-cranial fractures.

The severity of Haemophilia is dependent upon the levels of remaining factor VIII and < 1% of the population suffer with severe Haemophilia. The usual presentation time for Haemophilia is during infancy after a traumatic event,3 as noted in this case. Emphasis should be placed upon obtaining a comprehensive history, examination and focused haematological investigations.4 Undiagnosed paediatric cases of Haemophilia A can present to the Oral and Maxillofacial Surgery department with abnormal bleeding following trauma. This stresses the importance of screening appropriate patients to diagnose this lifelong bleeding disorder5 and liaising with haematologists as necessary.

This case highlights the need for clinical vigilance in a child presenting with an inconsistent injury pattern following a perceived trivial injury. Optimum lifelong management of this patient was ensured.