Management of type 3 hereditary bradykinin angioedema in oral surgery

Abstract

Hereditary type 3 bradykinin angioedema (HAE-III) is a rare estrogen-sensitive condition characterized by recurrent angioedema episodes, triggered by factors such as trauma or stress, without C1-inhibitor deficiency. This case report illustrates the effective management of HAE-III in a dental setting, underscoring the importance of specialized care in preventing potentially life-threatening episodes during oral surgery. A 33-year-old female with a diagnosis of HAE-III presented with severe pain in the right hemiface related to an upper right wisdom tooth. Despite no significant family or personal medical history of note apart from symptoms initiated during her second pregnancy, the patient had experienced ineffective treatments with antihistamines and corticosteroids. Prophylactic measures, including the administration of danazol 600 mg daily started 10 days prior to and continued 5 days post-surgery, were instituted. An emergency plan with icatibant for acute crises was also prepared but was not required as the dental extraction was completed without complications. This case emphasizes the critical role of prophylactic strategies in managing patients with HAE-III undergoing dental procedures. Preoperative planning, interdisciplinary communication, and patient education are pivotal in preventing acute episodes of angioedema, particularly in surgical settings. The successful outcome of this case contributes to the growing body of literature on the management of bradykinin-mediated angioedema in specialized clinical scenarios.