是在一个公众号中看到的这个病例，然后找了原文来看看。主要目的是把影像学资料放上来，所以文章就用GPT总结了一下。
Brief Summary:
This paper presents a rare case of a life-threatening complication during a routine deciduous tooth extraction in a 14-year-old girl with the Pierre Robin sequence and deletion of the long arm of chromosome 4. During the extraction of tooth 85, massive bleeding (approximately 700 mL) occurred, leading to tachycardia and hypotension. Immediate measures were taken to control the bleeding and stabilize the patient. Subsequent imaging revealed extensive vascularized tissue in the mandible, maxilla, and other facial bones, indicative of a low-flux angiomatous formation. The paper highlights the importance of being prepared for unexpected complications even in seemingly simple procedures.
What did the doctors do to save the child?
- The doctors took immediate action to save the child:
- The patient was intubated to protect the airway.
- The surgeon temporarily controlled the bleeding by compressing the bleeding area with a finger and aspirating the blood in the oral cavity.
- An acute transfusion was given to avoid hypovolemic shock.
- The hemorrhage was controlled by initial bipolar cautery, followed by the application of bone wax and fibrin glue.
术前全景片从事后来看可以看到一些异常，但是这些地方事前可能会被忽视掉，尤其是85部位的骨质看着并没有明显异常，45牙囊周围的骨质看着“骨白线”也很清晰。
事后拍摄的CT就很明显了。
According to the paper, how to avoid this situation?
The paper emphasizes the importance of being prepared for unexpected complications, even in seemingly simple procedures. To avoid such a situation, it suggests the following:
-
Preoperative Assessment: A thorough preoperative assessment, including detailed imaging studies, should be conducted to identify any underlying vascular abnormalities or other risk factors that could lead to complications during the procedure.
-
Operating Room Protocol for "Fragile Children": The paper highlights the importance of following a protocol for treating "fragile children" (children with syndromes or other comorbidities) in the operating room, where emergency equipment and personnel are readily available to handle unexpected complications.
-
Immediate Response to Bleeding: In case of unexpected bleeding, the surgeon must remain calm, temporarily arrest the bleeding, and ultimately control it definitively. This may involve applying pressure, using hemostatic agents, or performing ligation of the offending vessel.
-
Multidisciplinary Approach: Collaborating with other specialists, such as interventional radiologists or hematologists, may be necessary to manage complex cases and prevent complications.
-
Patient Monitoring: Close monitoring of the patient during and after the procedure is crucial to promptly identify and address any complications that may arise.
By following these guidelines and being vigilant for signs of potential complications, healthcare providers can minimize the risk of severe hemorrhage during dental extractions and other procedures in children with underlying health conditions.