I read with great interest Dr. Timothy Isaacson’s excellent February JADA article, "Sublingual Hematoma Formation During Immediate Placement of Mandibular Endosseous Implants." During implant placement in the symphysis, a perforation of an artery can occur. The sublingual artery is a branch of the lingual artery. The sublingual artery usually anastomoses with its contralateral mate and the submental artery, a branch of the facial artery.
The terminus of the sublingual artery can enter the symphysis through the lingual foramen, and be severed during an osteotomy.1 The severed artery may then retract into the sublingual space. This may explain Dr. Isaacson’s inability to find a lingual perforation by an implant drill. The diameter of the sublingual artery here can be 0.18 to 1.8 millimeters, and have a blood flow of 0.7 to 3.7 milliliters per minute. Even though the sublingual artery may be small, the anastomoses may create a copious blood flow.
The submental artery, a branch of the facial artery, can be violated during implant placement. Usually a larger artery that can have a lumen of 2 mm, this artery can produce much more blood flow than the sublingual artery.
The submental artery may be located against the usually concave medial body of the mandible in older edentulous patients. At its terminal end, it courses anteriorly, and loops under the mandible at about the area of the cuspid to supply the labial area. Therefore, a drill perforation at the molar or cuspid areas can be a more serious complication than one in the symphysis.
There is much anatomical variation in this area, making identification of a bleeding artery difficult. Floor-of-the-mouth bleeding can be a life-threatening complication, one of which every implant surgeon should be aware.2
TOP
REFERENCES
