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Hypercoagulopathy and dento-alveolar surgery: a case of exodontia in a patient with hughes' syndrome Vahe Petrosyan Richard WF Carr Tim Milton Peter J Revington Dental Update 2024 43:8, 707-709.
Authors
VahePetrosyan
BDS(Hons), MFDS RCSEd
Staff Grade in Oral and Maxillofacial Surgery, Northampton General Hospital, (vahe.petrosyan.vp@gmail.com)
Consultant Oral and Maxillofacial Surgeon, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK
Antiphospholipid syndrome is a thrombophilic disorder in which the presence of serum autoantibodies to phospholipid causes disruption of the protein C antithrombotic pathway. Deposition of these autoantibodies in small blood vessels can lead to intimal hyperplasia and acute thromboses. The associated hypercoagulopathy is problematic in dentistry since, if proper haemostasis is not achieved prior to discharge of exodontia patients, excessive haematoma formation may result. This case report and review of the literature discusses the condition in the context of hypercoagulation with reference to a patient undergoing a simple extraction, and suffering post-operative complications amounting to a large haematoma requiring evacuation.
CPD/Clinical Relevance: Post-operative bleeding is one of the most common complications of exodontia. This case report and review of the literature provides the reader with a concise summary of the clotting cascade in parallel with an unusual case of post-operative bleeding.
Article
Antiphospholipid syndrome is a thrombophilic disorder in which the presence of serum autoantibodies to phospholipid causes disruption of the protein C antithrombotic pathway. Systemically, deposition of these autoantibodies in small blood vessels can lead to intimal hyperplasia and acute thromboses affecting cerebral, renal, pulmonary, cutaneous and cardiac arteries. Locally, the associated hypercoagulopathy is problematic in dento-alveolar surgery. Indeed, following exodontia, if proper haemostasis is not achieved, excessive haematoma formation can result. We report a case of a patient with Hughes' syndrome undergoing routine exodontia and highlight the potential complications and management in such patients.
A 17-year-old Afro-Caribbean male was referred to the Oral and Maxillofacial Surgery (OMFS) department at Frenchay Hospital (Bristol, UK) by a general dental practitioner for the surgical removal of a partially erupted and mesio-angularly impacted mandibular right second molar tooth (LR7).
At presentation the patient reported a history of pain and sensitivity from the lower right quadrant. Following clinical and radiographic examination a diagnosis was made of pericoronitis exacerbated by trauma arising from the overerupted maxillary right second molar tooth (UR7). The medical history reported by the patient at that time was unremarkable and the patient opted for the removal of the LR7 and UR7 under local anaesthesia.
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