Oral surgery - Perioperative Complications Flashcards
List the possible peri-operative complications that can occur during surgery. (10)
fracture of tooth and root
fracture of alveolar plate
fracture of the maxillary tuberosity
jaw fracture
OAC/F
Loss of tooth
soft tissue damage
damage to nerves&vessels
haemorrhage
TMJ dislocation
damage to adjacent teeth
broken instruments
wrong tooth
What can creat difficult access? (3)
trismus
congenital conditions = reduced aperture of the mouth i.e. microstomia
crowded/malposition dentition
List reasons for abnormal resistance of a tooth (4)
Thick cortical bone
The shape and the number of the roots
Hypercementosis (those with acromegaly, goitre, Padgets disease, vitamin A deficiency)
Ankylosis of the tooth - fused to the bone
What factors are likely to result in fracture of the crown?
Carious teeth
Malalignment
Teeth with small crown
What factors are likely to result in fracture of the roots? (5)
fused roots
convergent/divergent roots
abnormal morphology
Hypercementosis
Ankylosis
What part of the alveolus usually fractures in tooth removal and near what teeth?
commonly the buccal plate of the canines and molars
What are your next steps if the fractured bone still has periosteal attachment?
the bone still has a blood supply and can just be put back into place and suture around it (if you think the bone will stay in place)
How would you manage a small OAC? (5)
Inform the patient
Encourage the clot
Suture the margins
Give antibiotics - since the oral fluids have breached the sinus.
Give post-op instructions - don’t blow noise and use steam/menthol inhalation
How would you manage a large OAC? (3)
Inform the patient
Close with buccal advancement flap - have to release the underlying periosteum to be able to advance the flap over the communication.
Give antibiotics and nose blowing instructions as with small opening.
Large openings can breakdown again even although sutured (especially if closed under tension)
What must you remember to do if the OAC has now formed a fistula?
remember to cut out the epithelial lined tract too in order to prevent breakdown
What are causes of a fractured maxillary tuberosity? (5)
high risk = single standing molars
unerrupted 3rd molar
pathological germination
extracting in the wrong order
inadequate alveolar support
What is the correct order to extract teeth?
from back to front
i.e. 8, 7, 6
How do we identify a fractured maxillary tuberosity? (3)
Key indicator: Tear on the palate
Noise
Movement of More than one tooth movement - both visually or with supporting fingers
How do we manage a fractured tuberosity? (6)
Dissect out the tooth with a scalpel. Do not just try to pull the tooth out as the gum will rip.
Close the word
Reduce, putting it back in the correct position ]
Stabilise with orthodontic buccal arch wire and weld with composite, arch bars or rigid splints - splint the fractured area to stable bone/lots of stable teeth
Give antibiotics, antiseptic mouth rinses and give instruction on how to keep the area clean.
if oedema occurs and leads to interference of the occlusion - reduce cusp height of the tooth being extracted
How would you remove roots from the antrum? (6)
locate the root
create a buccal advancement flap
Use an electrical instrument to cut bone
(Ensue you have efficient suction)
To remove the roots use curettes, then ribbon gauze and lastly irrigation to retrieve.
Then close as you would an OAC
Prescribe antibiotics.
