Comprehensive Approach in “Liver Clot” Management Case Report

The purpose of this article is to discuss the management of postoperative complications such as bleeding and the “liver clot” formation. The diagnosis of “lover clot” is based on the clinical appearance, due to the similarity to the tissue of the liver. Minor bleeding post extraction is a common occurrence in oral surgery. This event might occur during the procedure, immediate after the extraction or about 1-3 days post-surgery. However, significant bleeding is an unusual, if not rare event encountered post treatment, in dental practice, even for patients without any known risk factors. A review of the medical and dental literature revealed only ten reports of excessive bleeding, drug-abuse related following dental procedures [1]. To achieve a proper hemostasis, a certain protocol should be followed. Detailed review of patient's medical history is imperative in preventing any post extraction complications. In some cases consultation with patient's physician is necessary. Certain conditions such as liver disease, cancer, congestive heart failure, antiplatelet agents, anticoagulants and pain management medications, as well as advanced age can contribute to excessive post extraction bleeding. In some extreme cases (lower than 20000 platelets per microliter), platelets transfusion is indicated. On the other hand, several observational studies demonstrated the safety in performing invasive procedures for patients with thrombocytopenia whom did not receive any prophylactic PLT transfusions. These findings support the notion that in patients with INR < 3.0, it is relatively safe to perform tooth extraction without a significant increase in the risk of bleeding [2]. However if a patient with blood clotting problems presents for an emergency visit, the decision to provide treatment might be based on dentist's level of comfort in performing the surgical procedure. The utilization of certain local measures: local infiltration anesthesia in addition to inferior alveolar nerve block, placement of Gelfoam, careful suturing, Ice pack utilization, etc., will contribute to a successful outcome.