8.Accidente si Complicatii ale Extractiei

Question 1

Fractura tuberozitatii maxilare

Answer 1

1. fragm os atasat de periost =>repozitionare + sutura
2. tuberoz mobila + dd de extr = corp comun => reatasare + monitoriz 6-8 sapt ; apoi extr dd prin alveolotomie
3. tuberoz detasata de periost=> indep tuberoz , sutura primara

daca exista sinus desch => plastie intr-un plan sau in doua planuri + monitoriz

daca apar semne sinuzita => cura radicala sinus

Question 2

Impingerea M3sup in sp.pterigomax

Answer 2

in sp.infratemporal-complicatii septice =abces sp.I.T / flegmon hemifacial

se asoc frev cu fract tuberoz max

preventie:pres digitala D de M3

localizare dd impins:

• intre lama lat. pterig si m.pterig ext sau
• medial de ram mand=>tulb deschidere gura

Question 3

Impingere M3inf in planseu

Answer 3

corticala L subtire/absenta

localizare dd impins: deasupra/sub m.milohioidian

OMF-abord oral - deasupra m.

abord cutanat -sub m.

Navigatie chir- CTpreop

model virtual

localizare 3D cu raze infrarosii / unde electromagnetice

Question 4

Fact.generali in hemoragia postextr

Answer 4

Tulb in hemostaza:

Vasculopatii (↑ fragilit cap si permeab vasc)

Alergie Citostatice

(-) vitaminice; Endocrine; fact plasmatici

Infectii ac/cronic ; Insuficienta hep

HTA ; Menstruatie

Trombocitopatii si coagulopatii congenital sau dobandite

Trombocitare cant si calitative

elem figurate (leucemii, trombocitopenii, agranulocitoza

Anticoagulante/Antiagregante

Question 5

Pacienti cu risc-hemoragic postextr

Answer 5

• se vor tine sub supraveghere 30-60min
• extr atraumatica;fara sfacelizari/dilacerari p.moi
• hemostaza prin compresie e deobicei suficienta
• se sutureaza
• pansament supraalv compresiv

In unele situatii-gutiere conformatoare real in prealabil - rol de compresie mecanica si limitare hemoragie/hematom

Question 6

Trat.local hemoragie postextr precoce

Answer 6

indep cheaguri; irig cu ser

introd in alv:

1.) ag.hemostatici activi: pulbere trombina 125/250 U.I. se dizolva in 2ml ser

se inj lent fara pres printre per alv si cheag

2. ) ag.hemostatici pasivi(colagen):
   - celuloza ox(Surgicel)
   - bureti resorb din gelatina(Gelfoam, Surgifoam)

Question 7

Protejeaza cheagul (de act fibrinolitica a plasmei)

Answer 7

analogi de Lizina:

1.) acid tranexamic(Ugurol,Exacyl):

umezire bureti hemostatici/pansament compresiv cu sol 5%

C.I.- contact direct cu nerv expus

2.) acid aminocaproic: imbibitie mesa sterila necompresiva cu sol 5%

se inlocuieste de 4-5 ori/zi

La nevoie - sutura plaga

Question 8

Extractii in spital

Answer 8

• hemofilia A, B
• boala von Wilebrand
• deficit plachetar
• deficit factori plasmatici (transfuzii cu factor)

hemoragii tardive-transfuzii

Question 9

Trat.general hemoragie postextr

Answer 9

i.m. 1-2 fiole 2ml Etamsilat sol 12,5%

se poate repeta la 4-6 ore- cate 1 fiola

sau 2 comprimate 500mg (Dicynone)

act asupra hemostazei primare (↑rezist capilara si fav adez T)

hemoragii grave-spitalizare

Question 10

Alveolita - osteita locala fav de:

Answer 10

tulb vasomotorii regionale (traum; vasoconstr)

activitate fibrinolitica ↑ (infect.ac; infl sp medular osos)

pansament intraalv prelungit

subst antiseptice/hemostative intraalv care interfera cu cheagul

infectii preex ac/cronice

persist eschile osoase

extr labor cu traum muc +os

Question 11

Alveolita uscata

Answer 11

flora saprofita

incidenta 0,5-5%

dupa odontectomii - 30%

↓incidenta -aplicare fibrina cu T (PRF) / gel cu CHX 0,2%

frev la pac cu imunitate<<

os alv ± saliva - act fibrinolitica=>liza cheagului

dureri intense

2-3 zile postextr

gingivomuc atona

ameliorate partial de antialgice

x adenita

x semne gen de infect sist

lipsa cheag organizat

fara tendinta sangerare

pac tarati - compl cu osteomielita in unghiul mand (dupa odontect M3inf)

Trat simpt (antialgic, biostimulator nespecific)

irig cu sol slab antiseptice

chiuretaj alv

conuri cu Antib + anest loc

Primele semne vindec - 10-14 zile

Question 12

Alveolita umeda

Answer 12

durere moderata

tes granulatie >>

cheag fetid (suprainf) - uneori polip

gingivo-muc infl,congest

intraalv-rest rad/corpi strain

per. ososi moi, osteici

Trat=chiuretaj + regularizare os +avivare marg muc

conuri Antib+anest - amelioreaza simpt

Antialgice + AINS

Nu se impune antibioterapie , decat in fen.infect gen (febra)

Question 13

Vindecarea intarziata-factori

Answer 13

Radioterapia

Varsta

Malnutritia

Dehiscenta plagii

Boli gen.asoc + medicatie cronica specif