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3 Oral Surgery > Extraction Complications 3 > Flashcards

Extraction Complications 3 Flashcards

1
Q

What are the main post-op complications?

A

Pain/swelling/ecchymosis
Trismus
Haemorrhage/post-op bleeding
Prolonged effects of nerve damage
Dry socket
Sequestrum
Infected socket
Chronic OAF/root in antrum

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2
Q

What are the less common post-op complications?

A

Osteomyelitis
Osteoradionecrosis (ORN)
Medication induced osteonecrosis (MRONJ)
Actinomycosis
Bacteraemia/infective endocarditis

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3
Q

What can cause post-op pain and what can be done?

A

Rough handling of tissues, laceration/tearing of soft tissues, leaving bone exposed, incomplete extraction of tooth
Warn patient/advise or prescribe analgesia

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4
Q

Why can swelling occur post-op?

A

Part of the inflammatory reaction to surgical interference
Increased by poor surgical technique

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5
Q

Why can ecchymosis occur post-op?

A

(Bruising)
Can be increased by rough handling of soft tissues
May be underlying medical issues

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6
Q

What can cause trismus post-op?

A

Related to surgery - oedema/muscle spasm
Related to giving LA - IDB medial pterygoid muscle spasm
Haematoma - medial pterygoid or less likely masseter - clot organises and fibroses causing damage to TMJ

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7
Q

How is trismus managed?

A

Monitor - may take several weeks to resolve
Gentle mouth opening exercises/ use wooden spatula and trismus screw

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8
Q

What should be done if a patient is on a vitamin K antagonist?

A

INR check within 24 hours prior to surgery
Check why they are on it and what their target INR is

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9
Q

What should be done if a patient is on an antiplatelet?

A

If aspirin alone - treat without interrupting medication
If any in combo with aspirin - treat without interrupting medication

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10
Q

What should be done if a patient is on a direct oral anticoagulant (DOAC)?

A

If low bleeding risk - treat without interrupting medication
If higher bleeding risk - advise patient to miss or delay morning dose before treatment

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11
Q

Describe haemorrhage immediately post-op

A

Reactionary bleeding
Occurs within 48 hours of extraction
Vessels open up and vasoconstriction effects of LA wear off
Sutures loose or lost and patient traumatises area with younger/finger/food

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12
Q

Describe secondary bleeding

A

Often due to infection
Commonly 3-7 days
Usually mild ooze but can occasionally be a major bleed
Can be medication related

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13
Q

How should haemorrhage be managed in soft tissues?

A

Pressure - biting on damp gauze
Sutures
LA with adrenaline
Diathermy

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14
Q

How should haemorrhage be managed in bone?

A

Pressure (via swab)
LA on a swab
Haemostatic agents
Blunt instrument
Bone wax
Pack and suture

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15
Q

Give examples of haemostatic agents

A

Adrenaline containing LA
Oxidised regenerated cellulose - equitamp - provides framework for clot formation
Haemocollagen sponge - absorbable mesh work for clot formation
Thrombin liquid and powder
Floseal

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16
Q

Give examples of systemic haemostatic aids

A

Vitamin K - necessary for formation of clotting factors
Anti-fibrinolytics eg - tranexamic acid
Missing blood clotting factors
Plasma or whole blood
Desmopressin

17
Q

What are the steps of managing post op bleeding?

A

Immediate pressure to arrest the bleed
Calm anxious patient
Clean patient up
Take a history while dealing with haemorrhage
Get inside mouth with good light and suction
Mouth often filled with large jelly-like clot
Remove clot
Patient may be vomiting if blood swallowed
Identify where bleeding is from

18
Q

How is haemorrhage prevented?

A

Thorough medical history
A traumatic extraction technique
Obtain and check good haemostasis at the end of surgery
Provide good instructions to the patient

19
Q

What are the post-op instructions?

A

Do not rinse out for several hours
Avoid trauma - do not explore socket
Avoid hot food that day
Avoid excessive physical exercise and excess alcohol

20
Q

What are the post-op instructions if bleeding occurs?

A

Bite on damp gauze/tissue
Pressure for at least 30 minutes (longer if bleeding continues)
Give points of contact if bleeding continues

21
Q

What are the types of sensory change in nerve damage?

A

Anaesthesia - numbness
Paraesthesia - tingling
Dysaesthesia - unpleasant sensation/pain

22
Q

What are the sensation changes in nerve damage?

A

Hypoaesthesia - reduced sensation
Hyperaesthesia - increased/heightened sensation

23
Q

What are the anatomical descriptions of nerve damage?

A

Neurapraxia - contusion of nerve/continuity of epineural sheath and axons maintained
Axonotmesis - continuity of axons but not epineural sheath disrupted
Neurotmesis - complete loss of nerve continuity/nerve transected

24
Q

How common is a dry socket?

A

Affects 2-3% of all extractions
Affects up to 20-35% of lower 8s

25
Q

What is a dry socket and when does it start and end?

A

Starts 3-4 days after extraction
Takes 7-14 days to resolve
Localised osteitis - inflammation affecting lamina dura

26
Q

What are the symptoms of a dry socket?

A

Dull aching pain - moderate to severe
Usually throbs/can radiate to patient’s ear/often continuous and can keep patient awake at night
The bone is sensitive and is the source of the pain
Characteristic smell/bad odour and patient frequently complains of bad taste

27
Q

What are the predisposing factors of a dry socket?

A

Molars more common - risk increases from anterior to posterior
Mandible more common
Smoking - reduced blood supply
Female
Oral contraceptive pill
Local anaesthetic - vasoconstrictor
Infection from tooth
Haematogenous bacteria in socket
Excessive trauma during extraction
Excessive mouth rinsing post extraction - clot washed away
Family history/previous dry socket

28
Q

How are dry sockets managed?

A

Supportive reassurance
Systemic analgesia
LA
Irrigate socket with warm saline
Curettage/debridement
Antiseptic pack (alvogyl)
Advise patient on analgesia and hot salty mouthwash
Review patient/change packs and dressings
Do not prescribe antibiotics as it is not infection
Remember to check initially that it is a dry socket and that no tooth fragments or bony sequestra remain

29
Q

What is sequestrum and what does it do?

A

Usually bits of dead bone
Can also be pieces of amalgam/tooth
Prevents and delays healing
Quite common

30
Q

Describe an infected socket

A

Infection is a rare complication
Mor common after minor surgical procedures involving soft tissue flaps and bone removal
Infection delays healing

31
Q

How is an infected socket managed?

A

Check for remaining tooth/root fragments/bony sequestra/foreign bodies
Get radiographs, explore, irrigate, remove any of the above
Consider antibiotics

3 Oral Surgery (7 decks)

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