4.2 Article

Mandibular Fracture in a Patient Taking a Direct Oral Anticoagulant

Journal

JOURNAL OF CRANIOFACIAL SURGERY
Volume 32, Issue 4, Pages 1421-1422

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/SCS.0000000000007162

Keywords

Airway obstruction; direct oral anticoagulant; direct oral anticoagulants; mandibular fracture; novel oral anticoagulants; rivaroxaban

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A 74-year-old man presented with hemorrhage from the mandible after an injury caused by a metal square column. He underwent open reduction and internal fixation for a comminuted fracture of the right mandibular body, and restarted rivaroxaban 3 days after surgery.
A 74-year-old man presented with hemorrhage from the mandible after an injury caused by a 5 x 3 x 3-cm metal square column flying from a 45-ton press machine that struck the right side of his face. He is a known atrial fibrillation patient and is on rivaroxaban, a direct oral anticoagulant. An approximately 8-cm Y-shaped wound with persistent hemorrhage was observed in the right mandible, and the mandible was displaced between the right mandibular canine and first premolar. Although the patient showed no dyspnea, the sublingual region showed a slight dark purple swelling; fiberoptic nasal intubation was performed. Computed tomography at 3.5 hours after the injury revealed a comminuted fracture of the right mandibular body, edema at the floor of the mouth, nasal cavity, upper pharynx to hypopharynx, and the pharyngeal airway around the endotracheal tube. Open reduction and internal fixation were performed. Rivaroxaban was started again 3 days after surgery.

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