International Journal of Oral and Maxillofacial Surgery
Case ReportClinical PathologyAvascular necrosis of the midface secondary to disseminated intravascular coagulation
Section snippets
Case report
A 29-year-old male bricklayer, with no known co-morbidities, suffered an episode of ‘heat stroke’ while returning home on foot from a building site. He was found lying unconscious on the roadside with twitching limbs, and an initial Glasgow Coma Scale score of 3/15 was recorded. After transfer to a nearby tertiary hospital, a clinical, biochemical, and radiographic assessment indicated that he had suffered an anoxic brain injury with severe cognitive deficits. He was immediately intubated,
Discussion
DIC is a complex systemic disorder characterized by widespread activation of the coagulation cascade, resulting in thrombosis and ischaemia of organs and soft tissues. The depletion of clotting factors, fibrinogen, and platelets leads to extensive haemorrhage and secondary activation of the plasminogen pathway. This can occur through the extrinsic pathway via the activation of thromboplastin on factor VII. Tissue factor, or thromboplastin, is found in high concentrations in the heart and lungs.
Funding
None.
Competing interests
None.
Ethical approval
Not required.
Patient consent
Written patient consent was obtained.
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2021, International Journal of Oral and Maxillofacial SurgeryCitation Excerpt :This complication is a rare and potentially devastating outcome from maxillary surgery and is seen more frequently in the cleft population, but may also occur in patients with systemic diseases. Reported cases secondary to systemic diseases include a case report of non-surgical avascular necrosis of the midface following an episode of disseminated intravascular coagulation10, a case report of avascular necrosis following maxillary advancement in a patient with sickle cell disease11, and a case report of avascular necrosis following a routine single-piece maxillary advancement in a patient who was a heavy smoker12. Cleft orthognathic surgery has several unique challenges compared to surgery in the non-cleft patient, and these challenges may result in additional time and morbidity for maxillary procedures.
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