1/2. laryngeal edema and death from asphyxiation after tooth extraction in four patients with hereditary angioedema.BACKGROUND: Recurrent angioedema is the hallmark of various inherited or acquired angioedema diseases. Hereditary angioedema, or HAE, due to C1 inhibitor, or C1NH, deficiency has considerable implications for dental health care providers because dental surgery may trigger distressing and even life-threatening episodes. CASE DESCRIPTION: The authors reviewed the literature, focusing on the pathogenesis, clinical signs and treatment of HAE. They also provided case reports of four patients who died from laryngeal edema induced by tooth extraction. In patients with HAE, dental surgery--including tooth extraction--may be followed by self-limiting edema episodes, including lip swelling, facial swelling, tongue edema and laryngeal edema with upper airway obstruction. Preoperative prophylaxis has been performed with attenuated androgens, fresh frozen plasma, C1NH concentrate and antifibrinolytics. The four patients described underwent tooth extraction, which, after a symptom-free latency of four to 30 hours, provoked laryngeal edema. Three of the patients died of asphyxiation the night after surgery, and the fourth died on the second night. In three of the patients, laryngeal edema had not occurred previously. CLINICAL IMPLICATIONS: Before undergoing dental surgery, patients with a history of recurrent angioedema should be evaluated for C1NH deficiency. If it is present, they are at risk of developing life-threatening laryngeal edema.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/2. Management of oral surgery in patients with hereditary or acquired angioedemas: review and case report.Angioedemas are a rare but significant event in simple oral surgery because they can cause an acute life-threatening laryngeal edema. We report a case of a tooth extraction in a patient with hereditary angioedema, for which the C1-inhibitor (C1-INH) concentration administered effectively controlled edema during and after extraction. We also review case reports of oral surgery management in patients with hereditary and acquired angioedemas. In 2 of 36 cases, laryngeal edema occurred after teeth extraction. One was considered to be a type 2 acquired angioedema, which tolerates replacement therapy with fresh frozen plasma. The other case was managed only with danazol, and it was suggested that this was on occasion insufficient. safety of oral surgery on patients with angioedema depends on the type of angioedema and the availability of C1-INH concentration. An exact diagnosis of the type of angioedema is needed to know the effect of replacement therapy with C1-INH.- - - - - - - - - - ranking = 0.42857142857143keywords = extraction (Clic here for more details about this article) |