Acute cervical haematoma after tooth extraction: an emergent and life-threatening complication

A male patient presented to the Otolaryngology Emergency Department with progressive onset of left facial, cervical and submandibular swelling and history of bleeding from the oral cavity, 5 hours following extraction of teeth 28 and 38. On physical examination, the patient had a violet-coloured, tense swelling of the left soft palate with uvular deviation, without active bleeding. Nasopharyngolaryngoscopy revealed a bulging of the pharyngeal walls up to the level of the epiglottis, with preserved laryngeal mobility. These findings were compatible with a large expanding post-extraction haematoma and prompted emergent orotracheal intubation in the operating room under visualisation with video laryngoscope for airway protection and surgical exploration for haemostasis. The progressive reabsorption of the haematoma allowed for the patient to be extubated after 5 days and after 1 month he experienced a near full recovery. This case alerts physicians, particularly otolaryngologists for the possibility of life-threatening vascular complications following molar extractions.