Transradial embolization of a life-threatening tooth extraction socket hemorrhage and pseudoaneurysm

Embolization of oral hemorrhages due to tooth extraction, although rare, has been previously described.^1-4 In this video we present a unique case in which a life-threatening tooth extraction hemorrhage was incontrollable with local compression or surgical cauterization. The patient underwent emergent transradial coil embolization⁵ of the posterior lateral nasal branches of the sphenopalatine artery. However, the patient returned 11 days later with a lower volume bleed at the original site. Computed tomography angiography showed a pseudoaneurysm at the orthognathic surgery crater retrogradely recanalized through the greater palatine arcade. Surgical options were deemed too invasive, and the decision was made to attempt percutaneous direct puncture embolization. This was unsuccessful and repeat embolization with Onyx was performed through the contralateral greater palatine artery. The patient had complete resolution of symptoms.