Complication 8s XLA Flashcards
What are the minor complications?
Pain, swelling, trismus, infection, fracture, bleeding, bruising, TMJ problems, temporary nerve damage, damage other teeth, OA communication
What can be done to reduce pain?
Guaranteed after surgical removal
Pre-op warn and give advice how to minimise/ NSAIDs
Analgesia prior to LA wearing off can be advantageous
How common is swelling following XLA?
Guaranteed after surgical removal
How common is infection following XLA?
Higher incident in lower 8s socket
Need good OH post-op
Should ab be used to stop infection following XLA?
No - not routine
If pt has co-morbidities may be acceptable
How to prevent damage to adjacent teeth?
Assess clinically and radiographically pre-op
Warn pt
Have plan to minimise risk and deal w/ complications
Who is more at risk of fracture of mandible?
Elderly pt - esp edentulous w/ atrophic mandible
Pre-existing bone pathology
Large bony defect
If excessive use of force is used
How common is it to displace the tooth during XLA?
Uncommon
Can happy upper 8s - very rare
Major complication of XLA lower 8?
Trigeminal nerve damage
What is the incidence of IAN damage?
5-7% is temporary
0.5-1% permanent
What is incidence of damage to lingual nerve?
3-7% temporary
0.3-0/5% permanent
Possible causes of IAN damage?
XLA 8’s, implantology, other surgery e.g orthographic, trauma, needle stick
Why is third molar XLA most common cause trigeminal nerve injury?
Due to anatomy
Mainly drill injuries
Lingual flaps raised
What is the anatomy of the trigeminal nerve?
Mandibular division of trigeminal branches into IAN and lingual branch
IAN runs through mandible exit at foramen near roots 3rd molar
Lingual nerve transverse mesial in soft tissue - height of crest on 3rd molars
What does IAN split into?
Mental and incisive branches
What is the effect of trigeminal nerve injury?
Loss of sensation anterior tongue/ lip/cheek Paraesthesia - reduced sensation Dysasthesia - pain, tingling Allodynia - painful response stimuli Loss of taste
What would pt w/ trigeminal injury complain about?
Pain Dribbling Don't enjoy kissing Tongue feels strange Don't enjoy eating
Surgical technique for lingual nerve injury?
Lingual flap raised - central and distal nerve stump identified
Damaged nerve excised
Direct reapposition
How to minimise lingual nerve injury?
Avoid lingual retraction -crush and drill injuries
How to measure outcome of management of nerve injuries?
Touch - two point discrimination
Subjective assessment
How effective is management of nerve injury?
Most pt regain some sensation
Pt consider it worthwhile - but won’t be back to normal
Should IAN be repaired at time of XLA?
Nerve is well supported in canal - primary repair not usually required
What is likely to be damaged if the IAN is damaged?
Inferior alveolar artery - get arterial bleed
but can damage artery w/o nerve damage
What should be avoided when managing IAN damage?
Diathermy
Whitehead varnhish
Surgical - potentially neurotoxic (only place top of socket)
Bone wax - stop nerve regeneration
