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Module 6 - Oral Surgery > Post operative complications > Flashcards

Post operative complications Flashcards

1
Q

What happens when the TMJ is dislocated?

A

The condylar head is dislocated outside the glenoid fossa and over the articular eminence.

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2
Q

4 ways to prevent TMJ dislocation?

A
  • Support with NON-DOMINANT HAND.
  • McKesson’s Mouth Prop.
  • Alternative approach (ex. surgical).
  • General anesthesia.
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3
Q

What are the 2 functions of the McKesson’s Mouth Prop?

A
  • Holds mouth OPEN
  • Helps STABILIZE the mandible
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4
Q

What is another term for dry socket?

A

Alveolar Osteitis.

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5
Q

4 post operative complications involving bone?

A
  • Alveolar osteitis (dry socket).
  • Exposed bone.
  • Sequestrum.
  • MRONJ.
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6
Q

4 “categories” of post-operative complications?

A
  • Bone
  • Bleeding
  • Sepsis
  • Trismus
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7
Q

What is alveolar osteitis?

A

INFLAMMATION of the bone and alveolus rather than infection.

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8
Q

What percent of routine extractions does alveolar osteitis affect? What is its general prevalence?

A
  • 0.5% to 5% of ROUTINE extractions.
  • 0.5% to 68% range.
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9
Q

What teeth are most often affected by alveolar osteitis? What age?

A
  • MANDIBULAR MOLARS.
  • 40s.
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10
Q

What is the % of impacted 8s affected by alveolar osteitis?

A

1-37.5%.

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11
Q

What is the importance of fibrin deposition during clot formation?

A

Acts as a BARRIER to prevent the movement of bacteria into nearby tissues.

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12
Q

What causes clot breakdown?

A
  • The clot is broken down (fibrinolysis) through the release of tissue kinases.
  • Leads to PLASMIN formation and clot disintegration.
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13
Q

What are the 2 mechanisms thought to cause alveolar osteitis?

A
  1. Complete absence of a blood clot.
  2. Formation of an initial clot which is subsequently lysed.
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14
Q

How is the initial blood clot lysed during the process of alveolar osteitis?

A

Through the release of TISSUE ACTIVATORS which turn the plasmin precursor (plasminogen) into plasmin.

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15
Q

5 risk factors for alveolar osteitis.

A
  • Women
  • Smoking (vasoconstriction + sucking).
  • Trauma
  • Medications (OCP, antipsychotics, antidepressants).
  • Anatomy (mandibular 3rd molars).
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16
Q

How does smoking contribute to alveolar osteitis (2)?

A
  • Vasoconstrictor.
  • Negative pressure created from sucking.
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17
Q

3 types of drugs that increase alveolar osteitis risk?

A
  • OCP.
  • Antidepressants.
  • Antipsychotics.
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18
Q

6 patient related ACTIONS/ FACTORS that can increase risk of dry socket?

A
  • Infection
  • Inadequate OH
  • Poor after care
  • Spitting, sucking through a straw, coughing, sneezing.
  • Perioperative patient stress.
  • Focal fibrinolytic activity.
19
Q

3 OPERATOR related factors that can increase risk of dry socket?

A
  • Flap extent and design.
  • Surgical trauma.
  • Experience of surgeon.
20
Q

When do patients present with alveolar osteitis? What may the patient complain of?

A
  • Can present at any time, typically 2-3 DAYS following extraction.
  • Pain gets worse as days pass.
  • Pain resistant to analgesia.
  • Dull, aching, throbing pain (severe).
  • Bad taste.
  • Discharge.
  • Halitosis.
21
Q

What is the ideal management of dry socket?

A
  • LA ideally.
  • Explore socket with irrigating needle and sterile saline.
  • Place sedative dressing - ALVEOGYL.
22
Q

What is placed in dry socket after irrigation?

A

ALVEOGYL - sedative dressing.

23
Q

What is a sequestrum?

A
  • Small (usually) fragments of BONE lost from the extraction site.
  • May also be tooth fragments.
24
Q

Two common sites/ circumstances where we might see exposed bone?

A
  • Following SEVERE soft tissue trauma at the CREST.
  • At the LINGUAL POSTERIOR MANDIBLE due to prominence + thin mucosa.
25
Q

What is another term for MRONJ?

A

Phossy jaws.

26
Q

What are bisphosphonates? Name 4 examples (or at leas suffix).

A

ANTIRESORPTIVE medications.
- Alendronate, ibandronate, zolendronate, pamidronate.

26
Q

3 drug types that increase MRONJ risk?

A
  • Bisphosphoantes.
  • RANKL inhibitors
  • Anti-angiogenics.
27
Q

Name a RANKL inhibitor

A

denosumab

28
Q

3 antiangiogenic drugs?

A
  • Bevacizumab.
  • Sunitinib.
  • Aflibercep.
29
Q

What is ORN? Who is at risk?

A
  • Osteoradionecrosis.
  • IRRADIATED patients for H and N cancer.
30
Q

What is the risk of ORN following a procedure?

A

6%

31
Q

Is the maxilla or mandible more prone to ORN?

A

Mandible.

32
Q

What is the incidence of ORN?

A

5-15%

33
Q

What is a common cause of ORN? can it be healed?

A
  • IRREVERSIBLE.
  • Often SECONDARY TO TRAUMA although 10-35% of cases SPONTANEOUS.
34
Q

What will the patient complain of clinically when having ORN ?

A
  • Severe pain.
  • recurrent infection
  • Halitosis/ foul smell.
  • Oro-facial fistula.
  • Suppuration
  • Pathological fracture (if diseased bone becomes large).
35
Q

What is other management for ORN?

A
  • Resection of bone and replaced with graft (risks leading to 2 areas of ORN).
  • Hyperbaric oxygen (not much evidence + difficult to access).
  • Pentoxyphilline/Tocopherol
36
Q

What 2 drugs have been shown to reduce the incidence of ORN following extraction?

A
  • Pentoxyphylline.
  • Tocopherol.
37
Q

What is the usual management for ORN?

A
  • Analgesia
  • Irrigation
  • Antibiotics
  • Accept not union of the mandible (if fracture), hyperbaric oxygen therapy.
38
Q

What is trismus?

A

Limited mouth opening.

39
Q

What is normal mouth opening? Mild, moderate and severe trismus?

A
  • Normal: 30-40mm.
  • Mild: 20-30mm.
  • Moderate: 10-20mm.
  • Severe: less than 10mm.
40
Q

10 potential causes of trismus?

A
  • Pain.
  • Muscular.
  • Haematoma.
  • Infection.
  • Chronic limitation.
  • Trauma.
  • Neoplasia.
  • TMJ derangement/ osteoarthritis.
  • Soft tissue fibrosis.
  • Normal.
41
Q

What kind of neoplasia can lead to trismus?

A

Pharyngeal carcinoma.

42
Q

Infection of which spaces can result in significant trismus (3)?

A
  • Submasseteric.
  • Medial.
  • Pharyngeal.
43
Q

4 cases where bisphosphonates/antiresorptive drugs are prescribed?

A
  • Pagets disease.
  • Primary malignancy.
  • Osteoporosis.
  • Bone metastasis.

Module 6 - Oral Surgery (11 decks)

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