Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Oral Surgery > Post op complications 4 (Longer term post-operative) > Flashcards

Post op complications 4 (Longer term post-operative) Flashcards

1
Q

What can fall under these complications: Longer term post-operative

A

Acute oral antral communication

Chronic oral antral fistula

Root in antrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are less common post operative complications

A

Osteomyelitis

Osteoradionecrosis (ORN)

Medication induced
osteonecrosis (MRONJ)

Actinomycosis

Bacteraemia/Infective endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can you diagnose a OAC

A

By:
Size of tooth

Radiographic position of roots in relation to antrum

Bone at trifurcation of roots

Bubbling of blood

Nose holding test (careful as can create an OAF)

Direct vision

Good light and suction - echo

Blunt probe (take care not to create an OAF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do you manage a OAC

A

Inform patient

If small or sinus intact:
-Encourage clot
-Suture margins
-?Antibiotic
-Post-op instructions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How would you manage a larger acute OAC

A

Close with buccal advancement flap

Antibiotics, decongestants, and nose blowing instructions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How would you manage a chronic OAF

A

Excise sinus tract
Buccal Advancement Flap
Buccal Fat Pad with Buccal Advancement Flap
Palatal Flap
Bone Graft/Collagen membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are roots in antrum confirmed

A

Radiographically by OPT occlusal or periapical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How would you retrieve a forgein body in antrum

A

OAF type approach/through the socket:

-Flap Design
-Open fenestration with care
-Suction – efficient and narrow bore
-Small curettes
-Irrigation or ribbon gauze
-Close as for OAC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the caldwell luc approach and what is it used for

A

To retrieve forgein bdy in antrum

The procedure involves creating an incision in the gum line above the upper teeth, and then creating a window in the bone of the maxillary sinus to access and remove any foreign objects that may be present

Performed under GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does FESS stand for

A

Functional Endoscopic Sinus Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is osteomyelitis

A

The term means inflammation of the bone marrow

Clinically the term implies an infection of the bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where is Osteomyelitis normally affecting

A

The mandible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the symptoms of Osteomyelitis

A

Patient often systemically unwell/raised temperature

Site of extraction often very tender

In deep seated infection may see altered sensation due to pressure on IAN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where does osteomyelitis start and spread to

A

Usually begins in medullary cavity involving the cancellous bone

Then extends and spreads to cortical bone

Then eventually to periosteum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does osteomyelitis happen

A

Invasion of bacteria into cancellous bone causes soft tissue inflammation and oedema in the closed bony marrow spaces

Oedema in an enclosed space leads to increased tissue hydrostatic pressure – higher than blood pressure of feeding arterial vessels

Compromised blood supply results in soft tissue necrosis

Involved area becomes ischaemic & necrotic

Bacteria proliferate because normal blood borne defences do not reach the tissue

The osteomyelitis spreads until arrested by antibiotic and surgical therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why does osteomyelitis happen usually in themandible over the maxilla

A

Mandible has a poorer blood supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the predisposing factors to osteomyelitis

A

Odontogenic infections & fractures of mandible

Compromised host defence

-(Diabetes/ Alcoholism/ IV Drug Use/ Malnutrition/ Myeloproliferative Disease, chemo etc)

18
Q

How can you identify osteomyelitis in a radiograph

A

Areas of radiopacity may occur within the radiolucent region

In long-standing chronic osteomyelitis there may be an increase in radiodensity surrounding the radioluscent area – an involucrum

increased radiolucency (uniform or patchy with a ‘moth-eaten appearance)

19
Q

how would treat osteomyelitis

A

Antibiotic/ surgical treatment

20
Q

how would treat osteomyelitis

A

Antibiotic/ surgical treatment

21
Q

What is the antibiotic treatment for osteomyelitis

A

penicillins generally 1st line drug – effective against odontogenic infections & good bone penetration

Longer courses than normal

Often weeks in acute osteomyelitis (some suggest at least 6 weeks after resolution of symptoms)/months in chronic osteomyelitis (in some cases up to 6 months)

Severe acute osteomyelitis may require hospital admission and IV antibiotics (if systemic symptoms)

22
Q

What is the surgical treatment for osteomyelitis

A

Drain pus if possible

Remove any non-vital teeth in the area of infection

Remove any loose pieces of bone

In fractured mandible – remove any wires/ plates/screws in the area

Corticotomy – removal of bony cortex

Perforation of bony cortex
Excision of necrotic bone

23
Q

What is osteoradionecrosis (ORN)

A

Seen in patients who have received radiotherapy of the head & neck to treat cancer

The bone within radiation beam becomes virtually non-vital

Endarteritis – reduced blood supply

Turnover of any remaining viable bone is slow

Self-repair ineffective

Worse with time and dose

24
Q

What is more likely to be affected by ORN and why

A

Mandible due to poor blood supply

25
Q

How could you prevent ORN

A

Scaling/Chlorhexidine mouthwash leading up to extraction

Careful extraction technique

Antibiotics, chlorhexidine mouthwash and review

Hyperbaric oxygen (to increase local tissue oxygenation & vascular ingrowth to hypoxic areas) before and after extraction

Take advice/refer patient for extraction

26
Q

What is the treatment for ORN

A

Irrigation of necrotic debris

Antibiotics not overly helpful unless secondary infection

Loose sequestra removed

Small wounds (under 1cm) usually heal over a course of weeks/months

Severe cases – resection of exposed bone, margin of unexposed bone and soft tissue closure

Hyperbaric oxygen

27
Q

What are bisphonates used to treat and how

A

osteoporosis, Paget’s Disease & malignant bone metastases

They inhibit osteoclast activity and so inhibit bone resorption and therefore bone renewal

28
Q

How long do bisphosponates stay in the body for

A

10 years

29
Q

Name some bisphosphonates

A

Alendronate-Fosamax– Oral
Clodronate – Bonefos – IV
Etidronate – Didronel – Oral
Ibandronate – Boniva – Oral
Pamidronate – Aredia – IV
Risedronate – Actonel – Oral
Tiludronate – Skelid – Oral
Zoledronate – Zometa - IV

30
Q

Who has highr risk of MRONJ

A

Those that take IV bisphosphonates but theres still risk in others

31
Q

What other drugs could put a patient at risk of MRONJ

A

anti-angiogenic and anti-resorptive drug

32
Q

What are the SDCEP 2017 guidance on MRONJ incidence on thos who take anti-angiogenic and anti-resorptive drugs

A

cancer patients treated with anti-resorptive and anti-angiogenic drugs: 1.6-14.8%

osteoporosis patients treated with anti-resorptive drugs: 0.1-0.5%

33
Q

When would MRONJ occur and where

A

Occurs post extraction/following denture trauma/spontaneous

Exclusive to the jaws

Both mandible and maxilla

34
Q

What are the risk factors of MRONJ

A

Dental treatment:
-impact on bone(extractions)/ trauma from dentures/ infection/ perio

Duruation of bisphosphonate drug therapy

Dental implants
-General consensus is to avoid implant placement in high doses of anti-resoprtive or anti-angiogenic drugs for the management of cancer,
Its not contraindicated in patients with osteoporosis

Other concurrent drug use
-Concurrent use of steroids + anti-repsorptive drugs = increased risk of MRONJ
-Concurrent use of anti-resporptive and anti-angiogenic = increased risk of MRONJ

previous drug history

Drug holidays

35
Q

What puts a patient at low risk of MRONJ

A

PAtient being treated for osteoporosis or other nonmalignant disease of bone with oral bisphosphonates for less than 5 years who are not systemically being treated with glucocorticoids

Patients being treated for osteoporosis or other nonmalignant disease of bone with quarterly or yearly infusions of IV Bisph for less than 5 years who are not systemically being treated with glucocorticoids

Patients being treated for osteoporosis or other nonmalignant disease of bone with denosumab who are not systemically being treated with glucocorticoids

36
Q

What puts apatient at high risk of MRONJ

A

Patients being treated for osteoporosis or other nonmalignant disease of bone with oral BisPh or quarterly or yearly infusions of IV BisPh for more than 5 years

Patients being treated for osteoporosis or other nonmalignant disease of bone with BisPh or denosumab for any length of time who are currently being treated with systemic glucocorticoids

Patients being treated with anti resorptive or anti-angiogenic drugs as part of management of cancer

Patients with previous history of MRONJ

37
Q

How would you treat MRONJ

A

Treatment of Medication Induced / Related Osteonecrosis is not that successful

Manage symptoms/remove sharp edges of bone/chlorhexidine mouthwash/antibiotics if suppuration

38
Q

What is actinomycosis and what is it caused by and how

A

Rare bacterial infection

Actinomyces israelii/ A. naeslundii/ A. viscosus

The bacteria have low virulence and must be inoculated into an area of injury or susceptibility

-E.g. recent extraction/severely carious teeth/bone fracture/minor oral trauma

39
Q

What are symptoms of Actinomycosis

A

Multiple skin sinuses and swelling

Thick lumpy pus – colonies of Actinomyces look like sulphur granules on histology

Responds initially to antibiotic therapy/recurs when stop antibiotics

40
Q

How do you treat Actinmycosis

A

I&D of pus accumulation

Excision of chronic sinus tracts

Excision of necrotic bone & foreign bodies

High dose antibiotics for initial control (often IV)

Long-term oral antibiotics to prevent recurrence

Antibiotics: Penicillins, doxycycline or clindamycin

41
Q

With regards to Infective endocarditis what is an invasive dental treatment

A

Placement of matrix band/ subgingival rubber dam clamps

SubG resorations

Endo treatment before apical stop established

Preformed metal crowns

Full perio exam

RSB

Icision and drainage of abscess

Extractions

Surgergy involving flaps

Dental implants

42
Q

With regards to Infective endocarditis what is an non-invasive dental treatment

A

Infiltration or block

BPE screening

SupraG scale and polish

SupraG restoration

SupraG ortho bands and seperators

Removal of sutures

Radiographs

placement of ROA

Oral Surgery (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions