2018 Volume 64 Issue 10 Pages 600-604
We report a case of posterior superior alveolar artery damage caused by local anesthesia in which hemostasis was achieved by transcatheter arterial embolization. The patient was a 50-year-old woman who received local anesthesia for extraction of the maxillary left third molar at a dental clinic. Immediately after delivery of the local anesthetic, a swelling developed on the left side of her face, and the extraction procedure was cancelled. However, the swelling and pain increased; therefore, she was referred to our department. Swelling with dark-colored petechiae were observed from the left periorbital region to the submandibular region, associated with severe pain. Contrast-enhanced computed tomography (CT) and three-dimensional CT angiography suggested bleeding from the posterior superior alveolar artery. The swelling progressed despite pressure hemostasis at the site of arterial injury. Therefore, angiography was performed after consultation with a radiologist. Leakage of the contrast agent from the posterior superior alveolar artery was confirmed, and embolization of the artery using a gelatin sponge was performed. After the procedure, hemostasis was achieved, and bleeding did not recur. The swelling improved within a few days without any complications. Clinicians should consider the possibility of arterial injury caused by local anesthesia for dental procedures and take the necessary precautions.
