Postoperative palatal hematoma management using a near-infrared laser: A case study.

Background: The subepithelial connective tissue graft (SCTG) is acknowledged as a reliable method for gingival/mucosal augmentation and the "gold standard" for gingival recession treatment. Excessive bleeding is a common complication of palatal soft tissue harvesting, and hematoma formation can occur deep to the primary palatal flap.

Methods: A male patient aged 55 years presented with dentinal hypersensitivity associated with gingival recession at mandibular left premolar sites. After receiving an SCTG with coronally advanced flap, the patient experienced extended intermittent bleeding from the palatal donor site, likely related to undisclosed dietary supplements. At postoperative week 6, a 10×12-mm hematoma had displaced the palatal wound margins.

Results: Near complete palatal healing was observed 14 days after application of photobiomodulation (PBM) using a neodymium-doped yttrium aluminum garnet laser and discontinuation of the dietary supplements.

Conclusions: Limited evidence indicates that near-infrared laser PBM may enhance patient-centric outcomes at palatal soft tissue donor sites. The presented case suggests that laser PBM/photocoagulation may also aid in the management of a postoperative palatal hematoma.

Key points: To the authors' knowledge, no prior report has documented use of a near-infrared laser in the treatment of a palatal hematoma. Utilizing appropriate irradiation parameters is important for safe and effective PBM application. Based on prior research involving treatment of oral vascular malformations, selecting laser settings that induce thermal effects may be appropriate in this clinical context. Noncontact laser PBM appears suitable in clinical scenarios involving pooled blood. However, the presented protocol may be of little use when establishment of hemostasis is needed at an actively bleeding site. Identifying and addressing underlying causes of delayed hemostasis is essential.

Plain language summary: In periodontics, harvesting soft tissue from the roof of the mouth (palate) is a procedure commonly performed to treat gingival recession (exposure of the root of a tooth) or improve the health of the soft tissue around teeth and dental implants. Bleeding from the palate after the procedure is one of the most common adverse events. Occasionally, blood can pool beneath the palatal soft tissue, resulting in a hematoma. This report illustrates a case in which a neodymium-doped yttrium aluminum garnet (Nd:YAG) laser was used to manage a palatal hematoma in a male patient aged 55 years. The lesion exhibited near complete resolution 14 days after laser use. Based on limited evidence, this laser may help stop the bleeding at the site of an injured vessel, favorably alter the local inflammatory response, and improve wound healing. Controlled clinical research to validate the protocol applied in this case appears warranted.