complications of extractions 3 Flashcards
(57 cards)
how can TMJ dislocation be prevented
Hold mandible with non-dominant hand
McKesson’s mouth prop - put on contralateral side, props the mouth open for visual access and allows the pt to stabilise their mandible and prevent dislocation
what is another name for dry socket
Alveolar osteitis
what is alveolar osteitis
Inflammatory process of the bone in the alveolus
what are the 2 causes of alveolar osteitis
Clot related - absence of clot or initial clot formed but subsequently lysed and lost
Bone related - Inflammation of alveolar bone releases tissue activators resulting in plasmin which destabilises the clot
what medications are risk factors for alveolar osteitis 3
oral contraceptive pill, antipsychotics and antidepressants
presentation of alveolar osteitis 5
Post extraction - may be days or immediate
Worsening pain
Severe dull ache/throb
Bad taste, halitosis, discharge
Analgesics don’t work
management of alveolar osteitis 3
LA and explore the socket with an irrigating syringe and saline
Pack with a sedative dressing
If did nothing would heal after 6-8weeks
what are sequestrum
Fragments of bone lost from the extraction site
clinical presentation of sequestrum
Post extraction - may be days or immediate
Worsening pain
Severe dull ache/throb
Bad taste, halitosis, discharge
Analgesics don’t work
treatment of sequestrum
Topical or LA and remove fragment
if not removed symptoms will persist
treatment of exposed bone
May require reduction may be left alone
Need to monitor as can become mobile
what medications are linked to MRONJ
bisphosphonates
long acting nitrogen containing drug - alendronate
RANKL inhibitors - denosumab
anti-angiogenic
how can MRONJ be visualised
On CT scan can see disruption in the mandibular cortex of that site
what is osteoradionecrosis ORN
Occurs in pt who have had radiotherapy for head and neck cancer
Results in avascular bone which is at risk of necrosis
clinical presentation of osteoradionecrosis
Non-healing bone
severe pain
recurrent infection
halitosis/foul smell
oro-facial fistula
suppuration
pathological fracture
how is osteoradionecrosis treated
Resect necrotic bone and replace with a graft, can lead to loss of graft and natural mandible
Symptom management
how is osteoradionecrosis prevented (tho there is little evidence)
HBO - hyperbaric oxygen therapy before surgery
Reduce likelihood of it with drugs - Pentoxyphylline and Tocopherol
what is a haematoma
soft tissue swelling of clotted blood
treatment for haematoma
if small monitor, if large remove
if platelet numbers are 50x10*9L what is likely
petechial haemorrhage likely - small vessel bleed under skin, very small red mark
if platelet numbers are 20-50x10*9L what is likely
ecchymosis likely - bruise, rupture of small blood vessels
if platelet numbers are <20x10*9L what is likely
internal bleeding, GI, stools, urine
what indicates a problem with blood clotting mechanism
initial clot then subsequent bleed
what is Haemophillia VIII & IX
deficiency in clotting factors
