After a tooth was pulled, the 5-year-old girl suffered a severe bleeding and died...

In this case, multidisciplinary cooperation, be cautious.
Recently, a number of media reported that a 5-year-old girl in Nanning had a tooth loosened while playing with children in a kindergarten
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Later, he went to the hospital for treatment.
After the tooth was extracted, the wound hemorrhages more and more, showing jet-like gushing
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After being sent to the ICU, he has not been able to wake up, eventually leading to brain death
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On May 31, the day before Children's Day, Kiki had the last surgery in her life
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The parents reluctantly donated their children's organs, Qiqi's liver and two kidneys, saving the lives of three children
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Why can tooth extraction lead to such a tragic end? According to relevant reports, dental extraction by dentists has appropriate indications, and the operation is also in compliance with the norms
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But why did the child still have heavy bleeding and eventually have unbearable consequences? Take a closer look at the report.
It says: There are some red spots on the child's face
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The author shares some humble opinions, which are not necessarily correct: the problem is most likely to be in these erythema-invisible or hidden hemangioma under the skin, but it has not attracted the attention of the dentist or did not know the danger under these erythema
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The meaning of "erythema on the face" The high probability of "erythema on the face" is a capillary malformation, usually called port-wine spot or flaming nevus.
It is the most common type of vascular malformation and a congenital superficial vascular malformation of the skin.
, Often exists at birth and grows with the size of the child
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Capillary malformations exist for life, and there is no tendency to degenerate
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According to the classification of the International Society for the Study of Vascular Malformations (ISSVA), vascular malformations are classified according to their main blood vessel types, such as arteries, veins, lymphatics, capillaries or complexes (combination of different blood vessels) [1]
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Capillary malformations are characterized by papillary capillaries and post-capillary venules that expand in the dermis.
There is often an increase in blood vessel density without obvious vascular proliferation
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Isolated capillary malformations do not seem to cause an increase in mortality, but the development of lobular capillary hemangioma in capillary malformations often leads to bleeding
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It should be noted in clinical work that any diseases related to capillary malformations may be related to more extensive vascular malformations.
Therefore, it is necessary to be more cautious when performing related operations on patients with capillary malformations
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Capillary malformations often appear at birth, but due to reasons such as neonatal anemia, it may not be obvious during physical examination
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Mainly affects the head and neck
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Most facial capillary malformations are confined to the area supplied by the trigeminal nerve
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Figure 1: Some capillary malformations in port wine stains may change from pink in infancy to red in early adulthood to deep purple in middle age
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The surface will become as thick as pebbles[2]
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Figure 2: A patient who has never received treatment has developed from a young pink port wine stain to a red port wine stain, and then develops thickening, nodules, and sinusoids
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When capillary malformations involve the eye of the fifth trigeminal nerve and the skin of the upper jaw, some patients will develop glaucoma
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Figure 3: Port wine stains around the eyes capillary malformations are some syndromes.
Skin manifestations 1Sturge-Weber syndrome Sturge-Weber syndrome (brain-facial hemangiomatosis): The main lesions are pial hemangioma and the capillaries of the cavity Vascular malformations, patients are prone to cerebral hemorrhage and cerebral infarction and other cerebrovascular diseases
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It is characterized by the triad of capillary malformations involving the upper facial dermis, ipsilateral pia mater, and ipsilateral cerebral cortex
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Figure 4: Sturge-Weber syndrome
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Source: Baidu Encyclopedia There is no obvious relationship between the size of facial capillary malformations and the severity of central nervous system involvement, and a small proportion of Sturge-Weber syndrome patients do not have any skin involvement [2]
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Generally, the capillary malformations associated with Sturge-Weber syndrome are more extensive than the capillary malformations alone, and sometimes involve both sides of the face
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Complications include glaucoma, seizures, hemiplegia, mental retardation, brain calcification, subdural hemorrhage and so on
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2Klippel-Trenaunay syndrome Klippel-Trenaunay syndrome (congenital venous malformation limb hypertrophy syndrome) is manifested as capillary malformations, congenital varicose veins and bone and soft tissue hypertrophy, especially bone overgrowth [3]
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Figure 5: Patients with Klippel-Trenaunay syndrome
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Source: Hemangioma Forum 3 Parkes-Weber Syndrome Park-Weber Syndrome (vasodilatory hypertrophy syndrome) has clinical features: hypertrophy of the affected limb, superficial varicose veins, skin vascular nevi, and arteriovenous fistula
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The typical clinical manifestations are as follows: ① Increased skin temperature means that the skin temperature of the affected limb is higher than that of the healthy side
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Almost all patients have an enlarged, warm limb during childhood
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②The affected limb grows and swells
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It usually occurs after birth and gradually worsens
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③ Varicose veins; ④ Skin changes
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Large wine stains on the affected limb, often on one side of the limb, can also be distributed on both sides of the trunk
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⑤ Congenital arteriovenous fistula [4]
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Figure 6: Parkes-Weber syndrome
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Source: Chinese Journal of Neonatology 4 Diffuse capillary malformation with overgrowth This is a newly proposed name that describes the patient's extensive, diffuse, reticulated capillary malformation, which can become proportional hypertrophy, but without any major Complications
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The capillary malformations are reticular, spot-like, uneven in color, and have no obvious boundaries
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5 Cobb syndrome Cobb syndrome (Cobb syndrome, skin-meninge-spinal hemangiomatosis) is a skin vascular disease located on the skin of the spine, which is related to vascular malformations (venous or arteriovenous) of the meninges under the spine
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Complex vascular malformations, including spinal cord, epidural space, vertebral body, paraspinal soft tissues, muscles, subcutaneous tissues, and skin involvement in the same segment of the spine
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Figure 7: Capillary malformations formed on the back of patients with Cobb syndrome at the level of the C4-C7 dermatome (shown by the black arrow)
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Source: AJNR Journal 6 Wyburn-Mason Syndrome Wyburn-Mason Syndrome, clinical manifestations include monocular amblyopia, mild protrusion, and conjunctival vasodilation
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Capillary malformations can occur in any part of the same side (not just the eyelids or periorbital), they may be accompanied by facial hypertrophy or occasionally involving the optic chiasm, hypothalamus, midbrain and basal ganglia, and associated mental retardation Or neurological signs and symptoms
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Figure 8: Facial telangiectasia in children with Wyburn-Mason syndrome
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A: The right side face is rough and raised
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B: Dilation of cheek capillaries
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Source: Chinese Journal of Experimental Ophthalmology 7 Capillary malformation-arteriovenous malformation (CM-AVM) syndrome CM-AVM syndrome is an autosomal dominant genetic disease
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Most patients can see multifocal, small, round to oval, pink to red skin capillary malformations, and some patients can see pinpoint red spots with pale halos
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These skin capillary malformations can be accompanied by internal or skin arteriovenous malformations or arteriovenous fistulas
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Figure 9: Capillary malformations-arteriovenous malformations in children with skin port wine stains, increased skin temperature, and proliferative edema caused by abnormal lymphatic vessels
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8Microcephaly-capillary malformation (microcephaly-capillary malformation syndrome) syndrome MIC-CAP syndrome is an autosomal recessive congenital neurocutaneous disease that seriously affects the central nervous system
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It is characterized by obvious microcephaly, seizures, psychomotor disorders and multiple skin capillary malformations [5]
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9 Midline venous malformations are also called salmon spots, stork bites or angel kisses
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The lesions are located in the midline, the nape is the most common, followed by the forehead, between the eyebrows, and the lips
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It usually appears as light pink spots, which can merge with each other and the boundaries are clear
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The midline lesions on the front of the body often do not merge, while the midline lesions on the back are often fused
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Histologically, the midline venule malformation is the expansion of the posterior capillary venules due to the delayed innervation (or development) of the autonomic nervous system
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Figure 10: The author's recent outpatient clinic encounter: midline venous malformation
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Figure 11: Midline superficial venous malformation at the back of the neck
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10 Proteomorphic syndrome Proteomorphic syndrome is a rare congenital hamartoma disease.
Its biggest feature is that it only invades one side of the body, but its symptoms are diverse
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It is characterized by asymmetric and irregular overgrowth of a variety of tissues, gyrus-like connective tissue nevi, epidermal nevi, vascular malformations and adipose tissue abnormalities [6]
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Figure 12: Proteus syndrome, with the left image: A large area of ​​irregular erythema with clear boundaries can be seen on the outside of the left thigh
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Picture on the right: a connective tissue nevus on the plantar gyrus
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In this case, if you need invasive operation, be cautious when you encounter this situation.
If you need invasive operation, be cautious, often requiring multidisciplinary cooperation, such as pediatrics, dermatology, ophthalmology, imaging, neurology, surgery, etc.
Consult and perform related examinations.
Sometimes even CT or MRI cannot get a positive result, and further examinations such as angiography are needed to know
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It is very dangerous to blindly or ignore the existence of possible hemangioma
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Even for nursing puncture operations, these erythema areas should be avoided—really minefields
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Source: Medical Pediatrics Channel Author: Zhang Guangcheng Responsible Editor: Since childhood Proofreading: Zang Hengjia Plate-making: Shu Qian's wonderful review of the past, family members demanded compensation of 21 million! Boao Super Hospital responded to the postoperative brain death incident of the "Beer King".
My friend was in his 30s and died of a stroke.
China's "brain death legislation" is expected to come true!