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Oral Surgery > Extraction Complications > Flashcards

Extraction Complications Flashcards

1
Q

What are the different subheadings for extraction complications?

A
  1. Immediate:
    intraoperative + perioperative
    couple of hours following XLa
  2. Immediate post op:
    short term postoperative
    hours/days following XLa
  3. Long term:
    postoperative
    weeks/months
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2
Q

List examples of peri-operative complications (10)

A

Difficulty of access + Abnormal resistance (can’t move this tooth) CAN LEAD TO COMPLICATIONS

  1. Fracture of:
    - Tooth/root
    - Alveolar plate
    - Max tuberosity
    - Jaw (common in mandible)
  2. Involvement of maxillary antrum
  3. Loss of tooth
  4. Damage:
    - Soft tissue
    - Nerve
    - Adjacent teeth
  5. Haemorrhage
  6. Dislocation of TMJ
  7. Extraction of permanent tooth germ (v rare)
  8. Broken instruments
  9. Wrong tooth
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3
Q

What to do if a primary tooth breaks and roots are retained? (2)

A

Leave the little primary roots to resorb away on their own

If we go digging we may damage the permanent tooth germ

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4
Q

What are some causes of difficulty of access + vision? (3)

A
  1. Trismus
    - Limited mouth opening
  2. Reduced aperture of mouth
  3. Crowded/malpositioned teeth
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5
Q

What can abnormal resistance be caused by? (4)

A
  1. Thick cortical bone
  2. Shape/number of roots
    - Divergent or hooked
  3. Hypercementosis
  4. Ankylosis
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6
Q

Factors that can contribute to a tooth fracture (3)

A
  1. Caries
  2. Out of alignment
    - Crowded etc harder to remove
  3. Size
    - Tiny crown, big sturdy roots more likely to break crown off
  4. Root
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7
Q

List some root problems (6)

A
  1. Fused
  2. Convergent or divergent
  3. Extra roots
  4. Morphology
  5. Hypercementosis
  6. Ankylosis
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8
Q

Whats a sequestrum

A

Dead bit of bone

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9
Q

What part of the alveolar bone do we normally end up breaking?

A

Buccal plate

Mostly canines or molars

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10
Q

Course of action if canine alveolar bone broken (3)

A
  1. Stabilise
  2. Free mucoperiosteum
  3. Smooth edges
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11
Q

Course of action if molar alveolar bone broken (3)

A
  1. Is there still periosteal attachment?
    - If so has a BS so leave it
  2. Suture
  3. Dissect free
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12
Q

What are some examples that can lead to a fractured jaw? (3)

A
  1. Impacted wisdom tooth
    - Undermining the bone under the angle region
  2. Large cysts
    - Weakening the jaw
  3. Atrophic mandible
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13
Q

Management of a jaw fracture (6)

A
  1. Inform patient
  2. Post-op radiograph
  3. Refer (phone call)
  4. Ensure analgesia
    - Advice about pain
    - Chlorrhexidine mouthwashes - Warm salty water rinse
  5. Stabilise fracture
    - If wobbly stabilise with ortho wire or splinting wire
    AVOID around periodontally compromised teeth
  6. If delay, antibiotics
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14
Q

What can an OAC develop in to?

A

OAF - epithelial lined tract between the mouth and max sinus
Chronic

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15
Q

What does involvement of the maxillary antrum cause? (3)

A
  1. OAF
  2. Loss of root into max antrum
  3. Fractured tuberosity
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16
Q

Define OAC

A

Communication between mouth and max sinus

More common with molars

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17
Q

How do we diagnose an OAC? (7)

A
  1. Size of tooth
  2. Radiographic position
    - Of roots in relation to max sinus
  3. Bone at trifurcation of roots
  4. Bubbling of blood
    - Check when patient talks + breathes
  5. Nose holding test
    - Careful as can create an OAC
  6. Direct vision + good light + suction
  7. Blunt probe
    - Careful as can create an OAC
18
Q

Management of OAC if small (2)

A
  1. Inform patient
  2. If small or sinus intact:
    - Encourage clot
    - Suture margins
    - Antibiotics
    - Post-op instructions
19
Q

Management of OAC if large/lining torn

A
  1. Close with buccal advancement flap
  2. Antibiotics + nose blowing instructions
    - Use steam inhalations
20
Q

What flap is used most commonly to close an OAC?

A

Buccal advancement flap

21
Q

How long are sutures kept in for an OAC

A

10=14days

Non resorbing - prolene

22
Q

What should you avoid doing for a root in antrum

A
  1. Confirm radiographically by OPT, Occlusal or Periapical
  2. Decision on retrieval

DO NOT poke at socket or you will push root into max sinus

23
Q

Management if root in antrum (6)

A
  1. Flap design
  2. Open fenestration with care
    - Might need to open hole further
  3. Suction
    - Efficient + narrow bore
  4. Small curettes
  5. Irrigation or ribbon gauze
  6. Close as for OAC
24
Q

Why do we use an electric bur over an air router(cut cavities with?)

A

Danger of surgical emphysema
pushing air into max sinus

Electrical doesn’t blow air into the tissues

25
Q

How can a tuberosity fracture be diagnosed? (3)

A
  1. Noise
  2. Movement noted both visually or with supporting fingers
  3. Tear on palate
26
Q

Management of a fractured tuberosity

A
  1. If small enough dissect out + close wound (cant just pull the bone with forceps)

OR

  1. Reduction
    - Fingers or forceps

Fixation

  • Ortho buccal arch wire spot welded with composite
  • Arch bar
  • Splints
27
Q

Why do we not need to do a buccal advancement flap for a fractured tuberosity?

A

Lost tooth + bit of bone so flap closes quite easuly

28
Q

Whats the danger with making a splint for a fractured tuberosity?

A

Taking impressions for splint can end up ripping tooth out through gum

Need to put tooth back in position cover in vaseline then take impression so it comes out easily

> Send to lab to make quick splint
Fit it
Pt only takes it out to clean
Not ideal as will move when taking splint in and out

BETTER TO SPLINT WITH ORTHO WIRE

29
Q

How do we achieve rigid fixation

A

For a bone fracture we need the splint to be as rigid as possible - might include more teeth that are not MOBILE

30
Q

How do fractured mobile bones heal?

A

Not by bony unoin

Sometimes still heal but by fibrous union

31
Q

What do we need to remember to do when tx-ing a fractured tuberosity?

A
  1. Remove or tx pulp
  2. Ensure occlusion free
  3. Antibiotics + antiseptics
  4. Instructions post-op
  5. Remove tooth 8wks later
32
Q

When can damage to nerves occur?

A

Happens at time of injury (can be peri-op + post too)

As patient realises after op t
Can be longterm/permanent

33
Q

How can damage to nerves occur? (4)

A
  1. Crush injuries
  2. Cutting/shredding injuries
  3. Transection
    - Cut all the way through
  4. Damage from surgery or damage from LA
    - Can end up putting needle into ID nerve at lingual bit of mandible
    - If pt leaps/feel burning sensation take needle out and start again
    - Change needle
34
Q

DAMAGE TO NERVE:

Define neurapraxia (mildest)

A

Contusion(bruise) of nerve

35
Q

DAMAGE TO NERVE:

Define axonotmesis

A

Continuity of axons but epineural sheath not disrupted

36
Q

DAMAGE TO NERVE:

Define neurotmesis (severe)

A

Complete loss of nerve continuity

37
Q

Side effects of damage to nerves (5)

A
  1. Anaesthesia
    - Numbness
  2. Paraesthesia
    - Tingling
  3. Dysaesthesia
    - Unpleasant sensation/pain
  4. Hypoaesthesia
    - Reduced sensation
  5. Hyperaesthesia
    - Increased/heightened sensation
38
Q

Local factors that can lead to a dental haemorrhage (2)

A
  1. Mucoperiosteal tears
  2. Fractures of alveolar plate/socket wall

RARER

  1. Undiagnosed clotting abnormalities
    - Haemophilia
    - VWs
  2. Liver disease
  3. Meds
    - Warfarin
    - Antiplatelet agents (Aspirin/Clopidogrel)
39
Q

Management for bleeding from soft tissues (5)

A
  1. Pressure
  2. Sutures
  3. LA with adrenaline
  4. Diathermy
  5. Ligatures/haemosastic forceps
40
Q

Management for bleeding from bone (6)

A
  1. Pressure (via swab)
  2. LA on swab or injected into socket
  3. Haemostatic agents
    - Surgicel/Kaltostat
  4. Blunt instrument
  5. Bone wax
  6. Pack
41
Q

Management for dislocation of TMJ

A
  1. Relocate immediately
    - Analgesia + advice on supportive yawning etc
  2. If unable to relocate try LA into masseter intraorally
  3. If still unable to relocate immediately refer

Oral Surgery (6 decks)

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