Asphyxial death caused by postextraction hematoma

A 71-year-old man was admitted to an emergency room because of postextraction hemorrhage and died of asphyxia caused by airway obstruction. About 40 days earlier, he had had 11 carious teeth removed without postextraction bleeding. At autopsy, liver cirrhosis was found, but examination of his previous extractions and postmortem external findings did not show a general hemorrhagic tendency. The surgical incision in the gingiva had been sutured, and no damage to the bony socket or large vasculature was found. We could not determine the etiologic source of the decedent's rapidly increasing hematoma. Postextraction hemorrhage or hematoma is a common complication in routine dental extraction, but marked hematoma formation around the airway may cause critical respiratory problems in the short run. In such cases, the maintenance of the airway, including control of hemorrhage, is necessary at an early stage.