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Oral surgery > Complications during tooth extraction > Flashcards

Complications during tooth extraction Flashcards

1
Q

Perioperative complications

A
  • Crown fracture of adjacent tooth
  • Soft tissue injury
  • Fracture of alveolar process/maxillary tuberosity/Mandible
  • Broken instrument in tissues
  • Displacement of root tip into soft tissues
  • Displacement of impacted tooth or root into maxillary sinus
  • Dislocation of TMJ
  • Subcutaneous or submucosal emphysema
  • Haemorrhage
  • Oroantral communication
  • Nerve injury
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2
Q

Causes of fracture of crown or luxation of adjacent tooth

A

Excessive force and adjacent tooth used as fulcrum

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3
Q

Causes of soft tissue injury during extraction

A

-Improper instrument use(slippage)

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4
Q

Causes of fracture of alveolar process

A
  • Improper extraction technique
  • Ankylosis of tooth in alveolar process
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5
Q

Treatment of fracture of alveolar process

A
  • Small→ broken parts of alveolar process removed w/forceps
  • Sharp bone edges smoothed
  • Saline irrigation and suturing
  • Broken parts still attached to soft tissues may remain after stabilisation and suturing
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6
Q

Causes of fracture of maxillary tuberosity

A
  • Maxillary sinus pneumatising into alveolar process
  • Ankylosis of maxillary molars(resistance to movement great)
  • Decreased resistance of bone in area
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7
Q

Treatment of fracture of maxillary tuberosity

A
  • Repositioning of fractured segment and suturing when fractured segment not reflected from periosteum
  • Tooth removed, bone smoothing and suturing when segment reflected→ Broad spectrum antibiotics and nasal decongestants
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8
Q

Causes of mandible fracture

A
  • Excessive force with elevator
  • Inadequate pathway for impacted tooth removal
  • Ankylosed tooth
  • Atrophic mandible
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9
Q

Treatment of mandibular fracture

A
  • Removal of tooth first
  • Stabilisation→ intermaxillary fixation or rigid internal fixation
  • Broad spectrum antibiotics
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10
Q

Causes of broken instrument in tissue

A
  • Excessive force during luxation
  • Anaesthesia needle may break
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11
Q

Treatment of broken instrument in tissue

A
  • Radiographic localisation
  • Broken pieces surgically removed during same appointment
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12
Q

Causes of TMJ dislocation

A
  • Shallow mandibular fossa or temporal bone
  • Low anterior articular tubercle
  • Round head of condylar process
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13
Q

Unilateral dislocation of TMJ results in

A

Mandible deviation to healthy side

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14
Q

Bilateral dislocation of TMJ results in

A

-Mandible sliding forward in prognathic position

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15
Q

Methods to avoid TMJ dislocation

A
  • Firmly support mandible during extraction
  • Avoidance of excessive mouth opening
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16
Q

Treatment of TMJ dislocation

A
  • Thumbs placed on occlusal surfaces of teeth and rest of fingers around left and right body of mandible
  • Simultaneous downward thumb pressure and upward posterior pressure w/ fingers until condyle in original position

Post op -Limitation of excessive opening movements for afew days

17
Q

Clinical presentation of subcutaneous emphysema

A
  • Swelling extending to neck and facial area
  • Crepitus→ crackling sound during palpation
18
Q

Treatment of subcutaneous emphysema

A
  • No specific treatment
  • Paracentesis may help remove air if large
  • Antibiotics sometimes
19
Q

Causes of haemorrhage

A
  • Vessel trauma or Coagulation problems
  • Severe haemorrhage→ severance of inferior alveolar vessels or palatal artery
  • Haemorrhage diathesis(haemophilia)
20
Q

Treatment of haemorrhage

A
  • Compression(10-30 mins)
  • Ligation (hemostat)
  • Suturing
  • Haemostatic materials (vasoconstrictors, alginic acid, desiccated alum)
21
Q

Cause of displacement of root or root tip into soft tissues

A
  • Eroded buccal/lingual cortical plate and region of root tip
  • Perforation of bone
22
Q

Treatment of displacement of root or root tip into soft tissues

A
  • Palpation to locate and removal
  • Clinical and radiographic examination to locate
23
Q

Causes of Displacement of impacted root or root tip into maxillary sinus

A
  • Commonly maxillary third molar→ impacted
  • Close to sinus
  • Procedure not properly planned
24
Q

Treatment of Displacement of impacted root or root tip into maxillary sinus

A

Immediate(avoid infection)

  • Radiographic assessment
  • Removal by trephination using Caldwell luxe approach
25
Q

Signs of oroantral communication

A
  • Instrument enters greater depth than normal
  • Valsalva test→ bubbling blood from post extraction socket when breathing through nose
26
Q

Prevention of oroantral communication

A
  • Radiographic assessment
  • Careful instrument manipulation
  • Avoid luxation of root tip if visualisation of area hindered by haemorrhage
27
Q

Treatment of oroantral communication

A

Small communication→ suture gingiva after filling alveolus w/ collagen

-Large communication→ closure w/ flap

28
Q

Most common nerves injured

A

Inferior alveolar, Mental and lingual

29
Q

Symptoms of nerve injury

A

Burning sensation

  • Pins and needles
  • Biting of tongue and lips
  • Abnormal chewing
  • Burns when consuming food
30
Q

Conditions of nerve trauma

A
  • Anaesthesia
  • Hypesthesia
  • Paraesthesia
  • Dysesthesia
31
Q

Classifications of nerve injury

A
  • Neurapraxia
  • Axonotmesis
  • Neurotmesis

-

32
Q

Neurapraxia

A
  • Small contact w/ nerve
  • Favourable prognosis
  • Complete recovery→rapid
33
Q

Axonotmesis

A
  • Injury without anatomic severance of endoneurium
  • Slower recovery than neurapraxia(paraesthesia 6-8 weeks after injury)
  • Risk of remaining sensory disturbance

Oral surgery (106 decks)

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