complications of dentoalveolar surgery
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5 ways to prevent complications of surgery are
- Medical History
- Adequate Radiographs
- Prep of a surgical plan
- Pre-op and Post-op instructions
- Adherence to basic surgical principles
Adherence to basic surgical principles includes
- Clear visualization and adequate access (lighting, suction, tissue reflection)
- Controlled force
- Atraumatic handling of tissues
What is the most common dentoalveolar surgery injury and what are two causes of it?
- Soft tissue injuries
- Caused by inadequate attention and excessive force
Abrasions and burns can be caused by rotary instruments and excessive retraction. What are 2 steps you can do in the management of abrasions and burns, and how long of a healing period can you tell the patient to expect?
- Antibiotic topical ointment
- Suture if necessary
- 5-10 days healing
Situation: you have not followed principles of controlled force and attention and you slipped with the straight and periosteal elevators during surgery, puncturing soft tissue. Bleeding resulted.
What is your first step?
Should you suture the wound closed or let it heal by secondary intention?
- 1st step: apply pressure to achieve hemostasis
- No sutures; let heal by secondary intention
Most likely areas for Alveolar bone fracture include:
Buccal cortical plate of m____ canine
Buccal cortical plate over m___ m____, particularly the __ m___.
Portions of the f____ of m____ ______
______ bone of the _______ incisors
- buccal of max canine
- buccal of max molars, particularly 1st molar
- floor of maxillary sinus
- maxillary tuberosity
- labial bone of mandibular incisors
Excessive force with forceps obviously can lead to inuring osseous structures. What 4 factors of the patient and/or their anatomy predispose the surgery to osseous injury?
- Proximity of roots to the sinus
- widely divergent roots
- thick labial cortical bone
- old age of patient means less flexible aveolus
In preventing fracture of large portions of cortical bone what are two factors before the surgery starts, and two principles of the surgery that help prevent fracture?
- PreOp: radiograph and clinical assessment
- Surgery: avoid excessive force
- Perform open extraction and/or section teeth
What factor determines if fractured alveolar bone should be saved?
if it is attached to the periosteum should be saved, if not, discard
An Oro-antral communication can be diagnosed by a nose blowing test. What are two possible outcomes of and oro-antral communication?
- Maxillary Sinusitis
- Oro-antral fistula
Name the 3 factors that determine the probability that either a sinusitis or oro-antral fistula will occur.
- SIZE of the O-A communcation
- Previous infection (sinus or dental)
- Management of the exposure
If an Oro-antral communication is less than ___ mm no additional surgery is needed
In addition to the usual sinus precautions (no sneezing, straws, smoking, nose blowing), what additional steps of management should you do for a OA communication 3-6mm?
Hint: meds and clotting
- Sinus Meds: Abs (pen, or erythromycin)
- nasal spray (Afrin)
- oral decongestant (Actifed)
Assure clot by using gel foam, or avitene, surgicel, or topical thrombin
For OA communication greater than 6 mm what additional step must occur?
A fractured mandible during oral surgery usual occurs during removal of _______ with excessive force of _____ (instrument)
impacted 3rds, elevator
The most commonly displaced root during extraction is of a _____ _______, so beware of apical pressure.
Under what criteria may a displaced root be left in the sinus?
- less than 3mm
- no history of sinus or dental infection
Which nerve has the worst prognosis if injured?
Name the 5 drug categories a patient can be using that potentiate post - op bleeding
- Anti-cancer drugs
- Broad-spectrum antibiotics
After extracting the tooth, what 3 things can you do to minimize post op bleeding?
- Remove granulomatous tissue
- Smooth sharp bony spicules and edges
- Inspect wound for any bleeding arterioles
List 4 hemostatic agents available to use in the OMFS clinic
- Gel foam
- Topical Thrombin- converts fibrinogen to fibrin
PT measures _____ coagulation while PTT measures ____ coagulation.
- PT extrinsic
- PTT intrinsic
Von Willebrands disease is characterized by a deficiency of factor ____
_________ is bleeding into adjacent soft tissues, seen more in elderly.
Two possible causes of wound dehiscence include _______ soft tissue flap and _____ under _____.
unsupported, suturing under tension
Dry Socket (Alveolar Osteitis) usually develops on the ___ or ___ post operative day. The most common site for dry socket is ___.
- 3rd or fourth.
- mand. 3rd molar
The three phases of informed consent are:
- discussion - the specific problem, tx, side effects, anesthesia, tx alternatives, etc
- written consent- given in patients language if don't speak english
- documentation in the patients chart
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