・27年ぶりに、母校である愛知学院大学歯学部の歯学会誌に共同で症例報告を投稿し、掲載されました。
堀田久斗，堀田康記；上顎前歯部GBRで広範な顔面腫脹および眼瞼部皮下出血斑を生じた１症例：愛知学院大学歯学会誌，63(3):152～158，2025
In cases of severe anterior maxillary bone resorption, guided bone regeneration
(GBR) is commonly used to achieve functional and esthetic outcomes. Postoperative
swelling is usually mild and self-limiting; however, extensive facial swelling
with periorbital ecchymosis is extremely rare.
We report a 54-year-old non-smoking female with severe periodontal disease
affecting teeth 11–22. Tooth 12 had been previously extracted. Her medical
history included obsessive–compulsive disorder treated with long-term bromazepam.
After extraction of 11–22, GBR was performed using carbonate apatite
(Cytrans®) mixed with platelet-rich fibrin (PRF) and covered with PRF membranes.
Primary closure was achieved with periosteal-releasing incisions, and intraoperative
bleeding was minimal. The following day, the patient developed diffuse
facial swelling and extensive ecchymosis extending to both upper and lower
eyelids. No signs of arterial bleeding, infection, or visual disturbance
were noted. Swelling improved by day 2, and facial appearance was largely
normal by day 9. Blood tests showed mild inflammatory changes without coagulation
abnormalities.
At 5 months, CBCT confirmed sufficient bone regeneration, and four implants
(Straumann Bone Level Tapered, Ø3.3 × 10 mm) were placed uneventfully.
The extensive ecchymosis was likely multifactorial, involving benzodiazepine-related
muscle relaxation, NSAID-induced platelet dysfunction, psychological stress,
and anatomical spread through the SMAS.
Despite its dramatic presentation, the hemorrhage was likely venous
and self-limiting. This case highlights the need for careful preoperative
assessment and awareness of rare but significant postoperative swelling,
particularly in patients with complex medical backgrounds.