Retrobulbar hematoma after third molar extraction: case report and review.

A 19-year-old man was evaluated for extraction of third olar teeth. He was healthy with no history of medical roblems or bleeding disorders, and he was not taking any edications. The preoperative panoramic radiograph was nremarkable (Fig 1). He underwent uneventful extraction f all 4 impacted third molar teeth under local and deep onscious sedation. In the immediate postoperative period, while still in the urgical suite, the patient was noted to have increasing right eriorbital swelling and ecchymosis with evidence of proposis and moderate swelling of the right cheek (Figs 2, 3). In ddition, there was a right subconjunctival hemorrhage. allottement of the globes showed slight increased resisance to retropulsion on the right. Vision and range of otion were grossly intact. Given the high clinical suspiion of a retrobulbar hematoma, the decision was made to erform surgical exploration and drainage of any hemaoma. The patient was given a 12-mg dose of intravenous examethasone before exploration. Upon opening and extending the incision made for exraction of the right maxillary third molar, a moderate mount of blood and hematoma was evacuated. A bleeding essel was identified at the base, which was controlled with lectrocautery followed by packing with HemCon dental ressing (HemCon Medical Technologies, Portland, OR) nd gauze. Once it was confirmed that the bleeding was ontrolled, a Penrose drain was placed to allow dependent rainage, and the patient was taken to the recovery room. Close monitoring and observation were performed. The atient’s head was kept elevated, and ice was applied to the ight periorbital region. Aside from mild periorbital swelling nd ecchymosis, there were no residual deficits. The patient hen underwent an urgent computed tomography (CT)