Extraction Complications Flashcards
Define an OAC
Communications between maxillary sinus and oral cavity
Can lead to fistula if not healed
Define an OAF
Epithelial lined tract between the maxillary sinus and the oral cavity
How is an OAC diagnosed
Bubbling of blood
Bone at trifurcation of roots
Nose holding test
Good light direct vision - shimmer of sinus
Ech under suction
Blunt probe - can create OAC
Management of an OAC
Inform patient
If small <2mm leave or sinus intact
- Encourage clot to form
- Suture margins
- ABX
- Post op
- avoid smoking/using straw/singing/wind instruments/nose blowing
- Reassure that most small OACS <2mm heal with normal blood clot formation
- Review
If large or lining torn >2mm
- Close with buccal advancement flap or palatal flap
- ABx and nose blowing instructions
How is an OAC diagnosed postop based on pts symptoms?
Salty discharge
Fluid from nose when drinking
Non healing socket
Difficulty smoking
How is a root in sinus diagnosed
Checking sockets + apices (suction + irrigation)
Confirm radiographically by OPT, occlusal or PA (+/- CBCT to plan for removal)
Make decision on retrieval or refer
Management of a root in sinus
Inform patient
Refer pt - Caldwell luck approach + buccal advancement flap
CBCT (cilia can push root into diff place)
When can you leave a root in the sinus?
If it is wedged between the lining of the sinus and the alveolar bone
Aetiology of fractured tuberosity
Single standing molar
XLa in wrong order
Inadequate alveolar support
How is a fractured tuberosity diagnosed?
Noise - crack
Tear in paalte
Movement visually + with supporting fingers
Mobility of more than 1 tooth
Management of fractured tuberosity
Reassure
Reduce + stabilise with ortho buccal arch wire and composite
Ensure out of occlusion to avoid occlusal load
Postop instructions
ABX
Remove or tx pulp XLa after 8wks
How is a fracture of roots diagnosed?
Check apices + socket
Check radiographically
Management of fractured roots
Reassure + tell pt
Advise may come to surfacer
If <2mm can leave as may resorb
If >2mm or pathology related must remove
May attempt retrieval if visible and on surface
May require referral if chance may become surgical
Predisposing factors to a jaw fracture
Impacted wisdom teeth
On bisphosphonates/denosumab
Atrophic mandible
Large cyst
Management of a jaw fracture
Inform patient
Post op radiograph
Refer
Analgesia
Stabilise with ortho wire or splint wire
Tie around crowns of a few teeth
If delay give abx
Dont eat or wont get a GA
Keep it clean
What type of fracture are jaw fractures usually?
Compound fractures
Gum is ripped
Bacteria gets in to them
Why do we no longer squeeze a socket after an XLa?
Reduces bone vol for implants
How does damage to nerves occur?
Crushing
Cutting/shredding
Transection
Damage from surgery/LA
What can damage to nerves cause?
Anaesthesia
Paraesthesia
Hypoaesthesia
Hyperaesthesia
Dysaesthesia
Tx for dislocation of TMJ
Relocate immediately
Analgesia + advice on yawning
If unable to relocate try LA into masseter
If still unable to relocate - immediate referral
Tx of an OAF
LA, excise sinus tract, BAF
What post op for OAF/OAC
Avoid nose blowing/wind instruments/smoking
Steam inhalations
Analgesia
Will review
Management of ST bleeding
Pressure
Sutures
LA with adrenaline
Diathermy
Management of Bone bleeding
Pressure
LA into socket
Haemostatic agents (surgical, gelatine sponge, thrombin, fibrin)
Systemic (VitK,Tranexamic acid)
