The help at a bleeding during mandibular and torus anesthesia’s.
Philosophy doctor of medical sciences F.I. Gasanov.
Chair of oral and maxillofacial surgery of the Azerbaijan Medical University .
For rendering of stomatologic service at modern level, irrespective of a service kind, in many cases local anesthesia is applied. During local anesthesia various complications may occur. These complications arise basically of technical mistakes and at incorrect observance of asepsis rules.
However some complications can arise even if the doctor ideally adhered to all the regulations. Irrespective of practice and knowledge sometimes it is impossible to expect them in advance. Considering that such complications can give the heavy consequences, each doctor must be aware and must be able to eliminate them. One of such complications is the bleeding, from damaged vein or artery during mandibular or torus anesthesia’s. (Fig. 1)
The increase and distribution of a bleeding, and haematoma between a maxillary bone and alate muscle of jaw is schematically possible to explain as follows.
(Fig. 2)
At mandibular or torus anesthesias the needle tip can damage a capillary; arisen bleeding is weak and not so dangerous for the patient. In some cases the vein or an bottom alveolar artery is damaged, the bleeding in this case can be considered to be the heavy one.
In process of increase of bleeding and blood accumulation under alate muscle of a jaw the pharynx is unilaterally obstructed, the patient starts to choke and cough, and cannot calm down. In the beginning the swell is not observed, but if the help does not rendered, the swell increases. Swell appears as a result of distribution of a bleeding from under the alate muscles of the bottom jaw through a mandibular notch, an articular head of the bottom jaw and a coronoid process of mandible under a masseter and around it. (Fig. 3)

Because of blood accumulation under a masseter a mouth opening is limited and impeded. Pulse becomes frequent, the asphyxia complicates a condition of the patient even more. The horror and fear of death already operate on mental state of the patient. Arterial pressure raises, cough, an asphyxia, and a hiccup disturb the patient. The patient cannot remain on one place, it starts to walk, worry, and shows by hand, that wishes to vomit.
It is necessary to notice, that such bleedings are very rare. In our 16-year practice such bleeding occurred twice. In first case help has been rendered instantly. The second case was more serious, but rendering assistance has all the same yielded positive result.
In order to avoid the specified complications, first of all it is necessary to observe anesthesia rules precisely. Only in rare instances it is impossible to avoid complications.
The majority of doctors in this case commit a mistake. On this occasion, we have addressed to the given theme.
The course of such bleedings can be divided on two stages
1. A condition of restriction of a haematoma and the bleeding termination in area of alate muscles of the bottom jaw.
2. A condition of continuation and distribution of a bleeding from area of alate muscles of the bottom jaw under a masseter and around it.
In the first case the patient is given intramuscularly or intravenously 2 mg of dysynone or dropwise of aminocapronum acid for strengthening of coagulability of blood. While putting compressing tampon in retromolar area, it is necessary to close the mouth so that retromolar triangle could be densely compressed. At the same time is recommended to put a cold on buccal region and parotid area.
In the second case - the bleeding proceeds under alate muscle of the bottom jaw and round it. Such cases arise usually in 2-3 hours after the patient leaves the doctor.
Therefore, the doctor should notice occurrence of the first case. In the second case the patient it is forced to consult the doctor as asthma, swells and asphyxia disturb him strongly. We have described this heaviest clinical condition of such patient above. In this case the patient should receive 2 mg. of dysynone for increase of coagulability of blood, 100 mg. dropwise of aminocapronum acid, platyphyllinum, dimedrol, for normalization of arterial pressure. Antibiotics are prescribed. For vomiting prevention a serucal or spinic should be intramuscularly entered.
Stomatologists should think of possibility of formation of a phlegmon in alate jaw muscle area on 3rd or 4th day after anesthesia. If the condition of the patient does not improve and asphyxia proceeds, it is recommended to put tracheostome and continue complex treatment in a stationary condition.

The literature
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2. T.G.Robustova. «Surgical stomatology». Moscow, Medicine, 2001, р.77,80.
3. JU.I.Bernadsky. «Basics of maxillofacial surgery and surgical stomatology»
Belmedkniqa, Vitebsk, 1998, p.14.
4. Larry. J. Peterson. «Contemporary oral and Maxillofacial surgery». Mosby,
1998