[Life threatening oral hemorrhage after implantation into the distal right mandible]

In dental practice, surgical implant procedures are frequently conducted for pre-prosthetic surgery. Intra-operative complications are rare and can mostly be prevented effectively with adequate preparatory measures. However, not all risks can be anticipated a priori. Anatomical variation, such as variation in the path of blood vessels, is often unpredictable. This paper describes a life-threatening hemorrhage that occurred in a 60-year-old male during the insertion of an implant in the distal right mandible. It was impossible to stop the bleeding using local measures. Only extraoral ligation of the facial artery proved effective in suppressing the hemorrhage. The submentalis artery, a branch of the facial artery, had an atypical path directly below the caudal ridge of the mandible. The possibility of similar complications should make us re-evaluate preoperative preventive measures, and places greater demands on intra-operative complication prophylaxis. The international literature on this topic is discussed.