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Successful enucleation of radicular cyst after prophylaxis in a hereditary angioedema patient

Yıl 2019, Cilt: 2 Sayı: 2, 53 - 56, 29.06.2019
https://doi.org/10.33204/mucosa.579448

Öz

Hereditary angioedema (HAE) due to C1-INH deficiency (C1-INH-HAE) is an autosomal dominant inherited disease characterized by recurrent skin and mucosa swellings that commonly involve the extremities, intestines, face, genital area and upper airways. Dental procedures are important attack triggers in C1-INH-HAE patients. Attacks following dental procedures are commonly localized to the face and larynx. Laryngeal edema can cause death by asphyxiation.
A 48-year-old female patient was admitted to our hospital because of the excessive accumulation of calculus on the teeth which was noticed during routine dental examination. At the oral examination calcified dental plaque, bleeding by gingival probing, and discoloration of the teeth #31-32 were detected. By radiographic and clinical findings radicular cyst pre-diagnosis was made, and it was decided to enucleate the cyst.However, the patient’s medical history revealed that she was diagnosed with C1-INH-HAE at the age of 40. To prevent possible facial and laryngeal edema, 1000 units of C1 inhibitor concentration was given 1 hour before the procedure. Under local anesthesia, the lesion was totally enucleated with its capsule. The risk of having attack after tooth extraction is about 37.5% and nearly 1/3 of these attacks are associated with laryngeal edema in patients with C1-INH-HAE. However, prophylaxis with C1 inhibitor concentration led to a 44.1% reduction in angioedema attacks on a per-patient basis. With this case, we wanted
to draw attention to the importance of questioning the patient and his/her family for recurrent nonpruritic skin and mucosa swelling and abdominal pain attacks before surgical interventions to the mouth, neck, and throat area.

Kaynakça

  • 1. Longhurst H, Cicardi M. Hereditary angio-oedema. Lancet 2012;379:474-81.
  • 2. Zuraw BL, Bernstein JA, Lang DM, et al. American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology. A focused parameter update: hereditary angioedema, acquired C1 inhibitor deficiency,and angiotensin-converting enzyme inhibitor-associated angioedema. J Allergy Clin Immunol 2013;131:1491-3.
  • 3. Bork K, Hardt J, Staubach-Renz P, et al. Risk of laryngeal edema and facial swellings after tooth extraction in patients with hereditary angioedema with and without prophylaxis with C1 inhibitor concentrate: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:58-64.
  • 4. Martin L, PM Speight Odontogenic cysts: an update. Diagnostic Histopathology 2017;23:260-5.
  • 5. Bork K, Barnstedt SE. Laryngeal edema and death from asphyxiation after tooth extraction in four patients with hereditary angioedema. J Am Dent Assoc 2003;134:1088-94.
  • 6. Richards R, Crombie HM. Familial angioneurotic oedema: two fatal cases after dental extractions. BMJ 1960;2:1787.
  • 7. Winnewisser J, Rossi M, Spath P, Burgi H. Type I hereditary angio-oedema. Variability of clinical presentation and course within two large kindreds. J Intern Med 1997;241:39-46.
  • 8. Atkinson JC, Frank MM. Oral manifestations and dental management of patients with hereditary angioedema. J Oral Pathol Med 1991;20:139-42.
  • 9. Sheffer AL, Fearon DT, Austen KF, Rosen FS. Tranexamic acid: preoperative prophylactic therapy for patients with hereditary angioneurotic edema. J Allergy Clin Immunol 1977;60:38-40.
  • 10. Van Sickels NJ, Hunsaker RB, Van Sickels JE. Hereditary angioedema: treatment, management, and precautions in patients presenting for dental care. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:168-72.
  • 11. Jaffe CJ, Atkinson JP, Gelfand JA, Frank MM. Hereditary angioedema: the use of fresh frozen plasma for prophylaxis in patients undergoing oral surgery. J Allergy Clin Immunol 1975;55:386-93.

Herediter anjioödemli bir hastada profilaksi sonrasında radiküler kistin başarıyla çıkarılması

Yıl 2019, Cilt: 2 Sayı: 2, 53 - 56, 29.06.2019
https://doi.org/10.33204/mucosa.579448

Öz

Herediter anjioödem C1 inhibitör protein eksikliğine bağlı gelişen, tekrarlayan, kaşıntısız, deri ve mukoza şişkinlikleri ile karakterize genellikle, ekstremiteleri, barsak mukozasını, yüzü, genital bölgeyi ve üst hava yollarını tutan
otozomal dominant kalıtılan bir hastalıktır. Diş ve diş etine yapılan müdahaleler ile özellikle yüz ve üst solunum yollarına lokalize ataklar oluşabilmekte ve hayatı tehdit edici larinks ödemi gelişebilmektedir. 48 yaşındaki kadın
hastanın rutin kontrolünde diş etlerinde anormal tartar birikimi olduğu görüldü. Radyolojik incelemede 31 ve 32 nolu dişlerin apikal köklerinde 2x15 mm boyutlarında radyolüsen lezyon saptandı. Radiküler kist ön tanısı ile kist
enükleasyonu kararı verildi. Hastanın anamnezinde 40 yaşında herediter anjioödem tanısı konulduğu ve yılda 2 kez abdominal ve/veya ekstremite atağı geliştirdiği öğrenildi.
Yüzde ve larinkste gelişebilecek olası atağı önlemek amacı ile işlemden bir saat önce C1 inhibitör konsantresi 1000 ünite verildi. Lokal anestezi eşliğinde radiküler
kist kapsülü ile birlikte çıkarıldı, patolojik incelemede kapsülün epitel hücresi ile çevrili olduğu ve bu bulgunun da tanıyla uyumlu olduğu görüldü. Hastamızda
işlem sonrası atak oluşmadı. Herediter anjioödem hastalarında diş çekimi sonrası atak gelişme riski ortalama %37.5’dur ve gelişen her 3 ataktan biri larinks bölgesini
tutmaktadır. Diş çekimi sonrası gelişen ataklar işlemden ortalama 14.3 saat sonra ortaya çıkar (en erken 1 saat en geç 72 saat). C1 inhibitör konsantresi ile yapılan profilaksi
atak oluşumunu %44 oranında azaltmaktadır. Yüz, ağız, boğaz bölgesine yapılacak cerrahi girişimler öncesinde hastanın tekrarlayan anjioödem ve karın ağrıları
açısından sorgulanması gerekmektedir.

 

 





 

Kaynakça

  • 1. Longhurst H, Cicardi M. Hereditary angio-oedema. Lancet 2012;379:474-81.
  • 2. Zuraw BL, Bernstein JA, Lang DM, et al. American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology. A focused parameter update: hereditary angioedema, acquired C1 inhibitor deficiency,and angiotensin-converting enzyme inhibitor-associated angioedema. J Allergy Clin Immunol 2013;131:1491-3.
  • 3. Bork K, Hardt J, Staubach-Renz P, et al. Risk of laryngeal edema and facial swellings after tooth extraction in patients with hereditary angioedema with and without prophylaxis with C1 inhibitor concentrate: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:58-64.
  • 4. Martin L, PM Speight Odontogenic cysts: an update. Diagnostic Histopathology 2017;23:260-5.
  • 5. Bork K, Barnstedt SE. Laryngeal edema and death from asphyxiation after tooth extraction in four patients with hereditary angioedema. J Am Dent Assoc 2003;134:1088-94.
  • 6. Richards R, Crombie HM. Familial angioneurotic oedema: two fatal cases after dental extractions. BMJ 1960;2:1787.
  • 7. Winnewisser J, Rossi M, Spath P, Burgi H. Type I hereditary angio-oedema. Variability of clinical presentation and course within two large kindreds. J Intern Med 1997;241:39-46.
  • 8. Atkinson JC, Frank MM. Oral manifestations and dental management of patients with hereditary angioedema. J Oral Pathol Med 1991;20:139-42.
  • 9. Sheffer AL, Fearon DT, Austen KF, Rosen FS. Tranexamic acid: preoperative prophylactic therapy for patients with hereditary angioneurotic edema. J Allergy Clin Immunol 1977;60:38-40.
  • 10. Van Sickels NJ, Hunsaker RB, Van Sickels JE. Hereditary angioedema: treatment, management, and precautions in patients presenting for dental care. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:168-72.
  • 11. Jaffe CJ, Atkinson JP, Gelfand JA, Frank MM. Hereditary angioedema: the use of fresh frozen plasma for prophylaxis in patients undergoing oral surgery. J Allergy Clin Immunol 1975;55:386-93.
Toplam 11 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Case Reports
Yazarlar

İlkay Aydogdu Bu kişi benim

Gokten Bulut

Asuman Erden Camyar

Emine Nihal Mete Gokmen

Yayımlanma Tarihi 29 Haziran 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 2 Sayı: 2

Kaynak Göster

Vancouver Aydogdu İ, Bulut G, Erden Camyar A, Mete Gokmen EN. Successful enucleation of radicular cyst after prophylaxis in a hereditary angioedema patient. Mucosa. 2019;2(2):53-6.