THE hemophilic child is in constant danger from hemorrhage. There is, however, one type of bleeding in hemophilia when the danger does not lie primarily in blood loss. This bleeding is that which occurs into the sublingual, retropharyngeal, and paratracheal areas. There is extravasation of blood along the fascial planes that surround the larynx, pharynx, and trachea. This may lead to increasing respiratory distress and finally to asphyxia before blood loss in itself is significant. The bleeding in these instances may arise from the tongue, from a tooth socket, or from the peritonsillar area. Extension of the hematoma downward along and above the mylohyoid muscle to the tissues about the larynx and trachea results in respiratory obstruction. When a large hematoma occurs, there is grave risk of death from asphyxia. Biggs and MacFarlane1 regard this complication as the most dangerous that can occur in hemophilia.
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