Massive Hemorrhage

8

Eric J. Granquist and Peter D. Quinn

Introduction

Reconstruction of the temporomandibular joint (TMJ) requires careful preoperative planning, reasonable patient expectations, proper intraoperative technique, regimented postoperative physical therapy, close follow-up, and adequate pain management. The goals of TMJ reconstruction should include improved joint function and mastication, pain reduction, decreased morbidity, early rehabilitation, longevity of reconstruction, and cost consideration. Despite the best preoperative planning, intraoperative and postoperative complications will occur, and the temporomandibular joint surgeon should be well versed in the management and prevention of both common and catastrophic complications. The complication of massive hemorrhage is typically encountered intraoperatively but has been reported to occur up to 6 weeks postoperatively [1]. Along with several medium- and small-caliber arteries in close proximity to the temporomandibular joint, the parapharyngeal space and adjacent airway render even moderate swelling, a potential airway embarrassment. Therefore relatively easily managed complications such as an expanding hematoma may progress and compromise the airway or further complicate any potential reintubation. Fortunately, the complication of massive hemorrhage is relatively

E.J. Granquist, DMD, MD (*)

Director, Center for Temporomandibular Joint Disease, Oral and Maxillofacial Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine,

Philadelphia, PA, USA

e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

P.D. Quinn, DMD, MD

Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA

Vice Dean for Professional Services, University of Pennsylvania School of Medicine, Philadelphia, PA, USA e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer International Publishing AG 2017

G.F. Bouloux (ed.), Complications of Temporomandibular Joint Surgery, DOI 10.1007/978-3-319-51241-9_8

uncommon. Unfortunately, there is limited evidence-based literature to guide the prevention and management of massive hemorrhage. An understanding of the relevant anatomy, preoperative surgical planning, preventative surgical maneuvers, and techniques to control massive hemorrhage in the TMJ patient is paramount.

 
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