There are many complications that can occur as a result of wisdom teeth removal. Such complications from wisdom teeth removal are discussed on this website at http://www.teethremoval.com/complications.html. One complication that does not receive much attention, perhaps because it does not occur much, is a pseudoaneurysm or false aneurysm. A pseudoaneurysm usually occurs from an aterial breach or rupture in an artery which leads to a leakage of blood and a resulting hematoma. One case of this occurring in a 25 year old man is on the complications page. The pseuodoaneurysm and adjacent parent artery were occluded through the use of cannulization aided by computed tomographic angiography.
Another more recent case of pseuodoaneurysm occuring after wisdom teeth removal is described in an article by Rawat et al., titled “Traumatic Pseudoaneurysm: A Life-Threatening Complication After Surgical Extraction of Impacted Maxillary Third Molar,” appearing in the Journal of Oral and Maxillofacial Surgery (vol. 18, no. 1, pp. 57–60, January – March 2019, Published Online May 12, 2018). A 24 year old man in India had an impacted upper right wisdom tooth extracted under local anesthesia. Seven days after surgery the man began to bleed from his nose and a nasal pack was given along with 24 hours of observation. Fourteen days after surgery the man began to again bleed from his nose. Blood work was performed and revealed a fall in his hemoglobin level. This prompted a CT scan to be performed which showed a defect in his right maxillary sinus. Angiography was then performed which revealed a pseuodoaneurysm in the right upper jaw. Embolization of the internal maxillary artery was then performed using acrylic glue to occlude the vessel. After this he stayed in a hospital for a week until his hemoglobin levels began to return to normal.
The authors in the article by Rawat et al. also discuss how there are different embolization agents that can be used including metallic coils, polyvinyl alcohol particles, n-butyl cyanoacrylate, polymers, and absorbable sponge gel. In the case of the 24 year old man described n-butyl cyanoacrylate was used for embolization which was also the same agent used for the case of the 25 year old man mentioned earlier. Previous research has shown that n-butyl cyanoacrylate is effective for pseuodoaneurysm because embolization is completed more quickly than other agents which is because the primary hemostasis rate is higher and the recurrent hemorrhage rate is lower.
The authors state
“[pseuodoaneurysm] can be life threatening if not diagnosed and treated soon. We recommend maintaining a level of suspicion for occult vascular injuries in patients with recurrent nasal bleeding episodes after such procedures even beyond the perioperative period.”
Thus if you have wisdom teeth removed and then experience nasal bleeding many days later you should not just sit home and take it lightly. You may require further evalulation to see if a pseuodoaneurysm has developed through the use of contrast-enhanced CT and catheter angiography. If so then it appears n-butyl cyanoacrylate should be used to occlude the artery. Pseuodoaneurysm can be life threatening because the hematoma that develops over the course of a week or many weeks can rupture and trigger severe hemorrhage or thromboembolism.