Treatment of Odontogenic Abscess in a Patient with Hemophilia A: Case Report

Abstract

Haemophilia A is hereditary haemorrhagic disorders characterised by deficiency or dysfunction of coagulation protein factor VIII. This deficiency causes prolonged bleeding and delayed wound healing after injury, tooth extraction and surgical procedures. In this report; the patient was diagnosed with Hemophilia A and recurrent submandibular abscess despite of its medical treatments was presented. A 23-year-old male patient presented to our clinic with complaints of swelling and pain on the right side of his face and neck. In his anamnesis, it was learned that the patient first applied to the otolaryngology clinic, and after his treatment, were directed to our clinic, because of his recurrent complaints. In the clinical and radiographic examination, it was found that the abscess was caused by the right mandibular wisdom tooth and it was decided to be extracted. Firstly, the patient was consulted with a hematologist before the procedure was performed, and the patient was provided with antibiotic, analgesic and muscle relaxant medication for 3 days until the day of treatment. On the day of the procedure, factor VIII was transfused to the patient by the hematologist and than the wisdom teeth extracted and the wound was closed by suturing. Postoperatively, the wound was healed without any bleeding or healing problem. As a result; Hemophilia A disease is an important systemic disease that can be life-threatening. In these patients, surgical procedures should be performed by providing appropriate blood values in the most appropriate sterile conditions in the control of hematologist. 

Keywords

• Hemophilia,factor VIII,tooth extraction,odontogenic abscess,bleeding

Hemofili A Tanısı Almış Bir Hastada Meydana Gelmiş Odontojenik Apsenin Tedavisi: Olgu Sunumu

Abstract

Hemofili A koagülasyon proteini olan faktör VIII eksikliği veya fonksiyon bozukluğu ile karakterize kalıtsal hemorajik bir bozukluktur. Bu eksiklik yaralanma, diş çekimi ve cerrahi işlemler sonrası uzamış kanamalara ve gecikmiş yara iyileşmesine neden olur. Bu raporda; Hemofili A tanısı almış hastada, uygulanan medikal tedavilere rağmen tekrarlayan submandibular apse ve tedavisi sunulmaktadır. Olgumuz; 23 yaşındaki erkek hasta olup sağ tarafında yüzünde ve boynunda gelişen şişlik ve ağrı şikayetiyle kliniğimize başvurmuştur. Alınan anamnezinde hastanın ilk önce kulak burun boğaz kliniğine başvurduğu, buradaki tedavisini takiben şikayetlerinin tekrarlaması üzerine tarafımıza yönlendirildiği öğrenilmiştir. Yapılan klinik ve radyografik muayenesinde, apsenin sağ alt yirmi yaş dişinden kaynaklı olduğu tespit edilmiş ve dişin çekimi uygun görülmüştür. Hastaya işlem yapılmadan önce hematoloji uzmanıyla konsülte edilerek, hastaya işlem gününe kadar 3 gün süreyle antibiyotik, ağrı kesici ve kas gevşetici ilaç tedavisi uygulanarak ağız açıklığının artırılması sağlandı. İşlem günü hematolog tarafından hastaya faktör VIII yüklemesi yapılan hastada yirmi yaş dişi çekildi ve yara yeri süture edilerek kapatıldı. Postoperatif yapılan kontrollerde herhangi bir kanama veya iyileşmeyle ilgili problemi saptanmadan yara yeri iyileşti. Sonuç olarak; Hemofili A hastalığı hayati tehlike ihtiva edebilen önemli bir sistemik hastalıktır. Bu tanıyı almış hastalarda cerrahi işlemler hematoloğun kontrolünde en uygun steril şartlarda uygun kan değerleri sağlanarak yapılmalıdır.

Keywords

• Hemofili,faktör VIII,diş çekimi,odontojenik apse,kanama

References

1. 1: Kulkarni R, Soucie JM. Pediatric hemophilia: A review. Semin Thromb Hemost 2011; 37: 737-744.
2. Referans 2: Seck M, Faye BF, Sall A, et al. Bleeding risk assessment in hemophilia A carriers from Dakar, Senegal. Blood Coagul Fibrinolysis 2017; 28: 642-645.
3. 3: Lanzkowsky P. Manual of pediatric hematology and oncology. 5th ed. London: Elsevier; 2011.p.396-409.
4. 4: Bennetts NA, Mergelmeyer JE, Reimer EJ, Melville JC. Initial Manifestation of Acquired Hemophilia A After a Routine Tooth Extraction. A Case Report and Literature Review. Journal of Oral and Maxillofacial Surgery 2018; 76(3): 490-494.
5. 5: Kazancioglu HO, Ak G. Faktör VIII’e Karşı İnhibitör Gelişen Hemofili Hastalarında Dental Tedavi Yaklaşımı. Cumhuriyet Dental Journal 2010; 13(2): 101-105.
6. 6: Srivastava A, Brewer AK, Mauser-Bunschoten EP, et al. Guidelines for the management of hemophilia. Haemophilia 2013; 19: e1-e47.
7. 7: Caglar K, Cetinkaya A, Aytac S. Use of recombinant factor VIIa for bleeding in children with Glanzmann thrombasthenia. Pediatr Hematol Oncol 2003; 20: 435-438.
8. 8: Alegbeleye BJ. Deep neck infection and descending mediastinitis as lethal complications of dentoalveolar infection: two rare case reports. Journal of medical case reports 2018; 12(1): 195.

9. 9: Iwasaki Y, Nagata K, Nakanishi M, et al. Spiral CT findings in septic pulmonary emboli. Eur J Radiol 2001; 37: 190–194.
10. 10: Zamiri B, Hashemi SB, Hashemi SH, Rafiee Z, Ehsani S. Prevalence of odontogenic deep head and neck spaces infection and its correlation with length of hospital stay. Shiraz Univ Dent J 2012; 13: 29–35.
11. 11: Zeitoun IM, Dhanarajani PJ. Cervical cellulitis and mediastinitis caused by odontogenic infections: report of two cases and review of literature. J Oral Maxillofac Surg 1995; 53: 203-208.
12. 12: Arias-Chamorro B, Contreras-Morillo M, Acosta-Moyano A, Ruiz-Delgado F, Bermudo-Añino L, Valiente-Álvarez A. Multiple odontogenic abscesses. Thoracic and Abdomino-perineal extension in an immuno competent patient. Med Oral Patol Oral Cir Bucal 2011; 16: 772–775.
13. 13: Peake I, Selighsohn U, Gitel S, Kitchen S, Zivelin A. The laboratory diagnosis of haemophilia: Recommendations by the Laboratory Activities Committee of World Federation of Hemophilia. Heamophilia 1995; 1: 159-164.
14. 14: Farrkh A, Garrison E, Closmann JJ. Dental surgical management of the patient with hemophilia. General dentistry 2016; 64(4): 14-17.
15. 15: Racocz M, Mazar A, Varo D, Spierer S. Dental extractions in patients with bleeding disorders. Oral Surg Oral Med Oral Pathol 1993; 75: 280-282.
16. 16: Borea G, Hontebugnoli L, Capuzzi P, Magelli G. Tranexamic acid as a mouthwash in anticoagulant treated patients undergoing oral surgery. An alternative method to discontinuing anticoagulant therapy. Oral Surg Oral Med Oral Pathol 1993; 75: 29-31.
17. 17: Todo K, Ohmae T, Osamura T, et al. Exsanguinating bleeding following tooth extraction in a 12-year-old girl: a rare case of acquired haemophilia A. Blood Coagul Fibrinolysis 2015; 26(8): 964-966.
18. 18: Açıkgoz MM, Guven GS, Zulfikar B, Gulsum AK. Oral Cerrahide Hemofili Hastalarına Güncel Yaklaşımlar-Current Surgical Procedures For Hemophilic Patients İn Oral Surgery. Journal Of Istanbul University Faculty Of Dentistry 2013; 47(3): 33-40.
19. 19: Hsieh JT, Klein K, Batstone M. Ten-year study of postoperative complications following dental extractions in patients with inherited bleeding disorders. Int J Oral Maxillofac Surg 2017; 46(9): 1147-1150.
20. 20: Ak G, Unur M, Zulfikar B. Hemofili Hastalarında Ağız-Diş Sağlığı. Turkiye Klinikleri Journal Of Medical Sciences 1998; 18(2): 141-144.