Management of pain and sublingual hematoma caused by suture irritation after implant surgery: a clinical report.

Hematoma in the sublingual region is an adverse consequence of implant surgery in the mandibular posterior region. Improved knowledge and understanding of the anatomy as well as the use of advanced radiographic imaging have all contributed to minimizing adverse surgical complications in this region. Delayed sublingual hematoma caused by suture irritation after implant surgery has not previously been reported. This article describes the management of a patient with a delayed sublingual hematoma after implant surgery in the posterior mandible had been performed. No evidence of encroachment of the vascular structures was noted at the time of implant surgery. However, at a 48-hour follow-up, the patient presented with severe pain and irritation of the sublingual mucosa, along with extravasation and a collection of blood in the sublingual region. Based on the patient's symptoms and clinical signs, the source of the problem was determined to be the stiff tags of polypropylene suture, which had been used to attain primary closure of the surgical flaps. The situation was conservatively and successfully managed by the use of a custom soft tissue guard to protect the patient's sublingual mucosa and the tongue from the stiff suture tags. Various suture materials and measures for preventing and managing similar situations are discussed in this article.