Journal of Oral Implantology October 2013 - (Page 603)

CASE REPORT Hemorrhage Secondary to Interforaminal Implant Surgery: Anatomical Considerations and Report of a Case Salah Sakka, DDS, MSc, PhD1* Christian Krenkel, MD, DMD, DDS, PhD2 Understanding the anatomy of the floor of mouth is very important as severe submandibular hemorrhages are life threatening. This case report illustrates the potential hemorrhage consequences of implant surgery within the interforaminal region. The highly vascularized interforaminal region is susceptible to hemorrhage, which can be induced simply by instruments causing vascular trauma. The risk of intraoperative bleeding can be minimized by painstaking preoperative clinical and radiological examination but cannot be averted as it is inherent in the underlying anatomy of the region. Key Words: oral implants, interforaminal region, hemorrhage INTRODUCTION M andibular atrophy as a result of long-term edentulousness in the mandible often results in functional and esthetic problems.1 Supporting the lower denture by means of dental implants was for many years the main way for clinicians to improve an edentulous patient’s unsatisfactory situation.2–4 Here, the interforaminal region is considered to be the place for such implantation. The anterior region of the lower jaw, like the entire facial region, is well supplied by collateral arterial systems, including the facial, lingual, and sublingual arteries that give the main supply to the highly vascular area of the anterior floor of the mouth.5 The facial artery is an anterior branch of the external carotid artery. It ascends the side of the neck, runs deep to supply the submandibular gland, and crosses the lower border of the mandible just in front of the angle of the mandible. At this point a submental branch of the artery runs along the inferior border of the mandible to the chin. After 1 Department of Oral Surgery, Al-farabi Dental College, Riyadh, Saudi Arabia. 2 Department of Oral and Maxillofacial Surgery, Paracelsus Medical School Salzburg, Salzburg, Austria. * Corresponding author, e-mail: DOI: 10.1563/AAID-JOI-D-10-00173 this submental branch, the facial artery crosses the mandible and travels across the face. The lingual artery supplies the tongue and the tissue of the floor of the oral cavity. It branches off the external carotid artery below the facial artery and then travels forward and deep, going beneath the hyoglossus muscle of the tongue and ending in 3 branches: (1) the dorsal lingual artery to the deep posterior part of the tongue, (2) the deep lingual artery to the deep anterior part of the tongue, and (3) the sublingual artery to the ventral surface of the tongue and floor of the mouth (Figure 1). The exact topographical relationship of the end branches of the sublingual artery (arteria interalveolaris medialis and lateralis and arteria spinalis) was described by Tsusaki in 1955.6 About halfway between the upper and lower edge of the lingual mandibular body this vessel divides into a descending and an ascending branch. The ascending branch splits into 2 twigs, a medial and a lateral one. The medial twig enters the bone between the medial and lateral incisors (medial interalveolar foramen); the lateral twig enters the bone between the lateral incisor and the canine (lateral interalveolar foramen). The descending branch also divides into 2 twigs, a superior and an inferior one. The twigs use the interspinal, supraspinal, and subspinal foramina to enter the bone near the mandibular spine.6 In the course of operations of the floor of the mouth, Journal of Oral Implantology 603

Table of Contents for the Digital Edition of Journal of Oral Implantology October 2013

Food and Drug Administration: Reclassification of Blade Form Dental Implants
Optimizing Platelet-Rich Plasma Gel Formation by Varying Time and Gravitational Forces During Centrifugation
Effect of Surface Roughness and Low-Level Laser Therapy on Removal Torque of Implants Placed in Rat Femurs
Impression Techniques for Multiple Implants: A Photoelastic Analysis. Part I: Comparison of Three Direct Methods
Impression Techniques for Multiple Implants: A Photoelastic Analysis. Part II: Comparison of Four Acrylic Resins
A Pig Model for the Histomorphometric Evaluation of Hard Tissue Around Dental Implants
In Situ Tooth Replica Custom Implant: A 3-Dimensional Finite Element Stress and Strain Analysis
Influence of Different Soft Liners on Stress Distribution in Peri-Implant Bone Tissue During Healing Period. A 3D Finite Element Analysis
Influence of Surface Nano-Roughness on Osseointegration of Zirconia Implants in Rabbit Femur Heads Using Selective Infiltration Etching Technique
Modified Titanium Surfaces Alter Osteogenic Differentiation: A Comparative Microarray- Based Analysis of Human Mesenchymal Cell Response to Commercial Titanium Surfaces
Hemorrhage Secondary to Interforaminal Implant Surgery: Anatomical Considerations and Report of a Case
Rehabilitation of a Patient With Mandibular Resection Using Osteointegrated Implants: A Case Report
Two-Stage Bone Expansion Technique Using Spear-Shaped Implants Associated With Overlapped Flap: A Case Report
Implant Esthetic Restoration in Ridge Deficiencies in Cases of Trauma: A Case Report
Rehabilitation of the Atrophic Maxilla With Tilted Implants: Review of the Literature

Journal of Oral Implantology October 2013