Selective transarterial embolization for arterial hemorrhage after upper third molar extraction: illustrative cases

Area of Science:

• Oral and Maxillofacial Surgery
• Interventional Radiology
• Vascular Surgery

Background:

• Arterial bleeding is a rare but serious complication following third molar extraction.
• Identifying the specific bleeding source, such as the posterior superior dental or greater palatine artery, is crucial.

Purpose of the Study:

• To report two cases of massive arterial hemorrhage after upper third molar removal.
• To demonstrate the efficacy of selective transarterial embolization in managing this complication.

Main Methods:

• Selective angiography was performed to identify pseudoaneurysms in the posterior superior dental and greater palatine arteries.
• Embolization was achieved using an N-butyl cyanoacrylate (NBCA)-lipiodol mixture in both cases.
• Patients were monitored for recurrent bleeding post-procedure.

Main Results:

• Successful embolization of pseudoaneurysms in both patients.
• No recurrent bleeding was observed during follow-up periods of 82 and 5 months.
• Both patients were discharged without complications.

Conclusions:

• Massive arterial bleeding post-third molar extraction often originates from the posterior superior dental or greater palatine arteries.
• Selective transarterial glue embolization is a safe and effective treatment for arterial bleeding after upper third molar removal.