Transcatheter arterial embolization against bleeding from a pseudoaneurysm developing after extraction of an impacted mandiblar third molar: a case report

Postoperative bleeding is a frequent complication of tooth extraction, and rupture of pseudoaneurysms formed in the extraction socket sometimes causes uncontrollable massive arterial bleeding. In this paper, we describe a case of successful hemostasis by transcatheter arterial embolization against bleeding from a pseudoaneurysm after lower third molar extraction. The patient was a 24-year-old man who was referred to us because of arterial bleeding from the lower gingiva. He had undergone extraction of the left lower third molar by a dental general practitioner 57 days before the first visit to our hospital. Angiography revealed pooling of contrast agent in the end of a branch of the inferior alveolar artery, suggesting the rupture of a pseudoaneurysm. The branch was completely embolized with NBCA-lipiodol to achieve hemostasis. The subsequent course was uneventiful with no further bleeding, except for incomplete paralysis of the left mental nerve region, which disappeared 2 months after embolization.