Extraction Complications 4 Flashcards
what is the main long term post extraction complications?
Chronic oroantral fistula/root in antrum
What are less common post-op complications?
- osteomyelitis
- osteoradionecrosis (ORN)
- medication induced osteonecrosis (MRONJ)
- actinomycosis
- bacteraemia/infective endocarditis - note current guidance
Which of the following are acute or chronic?
Oral antral communication
Oral antral fistula
Whats the difference between the two?
OAC - acute
OAF - chronic
OAF has epithelial lining that covers the inside of the fistula
how do you diagnose an OAC?
- size of tooth
- radiographic position of root in relation to antrum
- bubbling of blood
- nose holding test
- direct vision
- blunt prove
how do you manage acute OAC?
- inform pt
- if small/sinus intact;
-> encourage clot, suture margins,
what do you do if an acute OAC is large?
- close with buccal advancement flap
- antibiotics, decongestants, and tell them not to blow their nose
how do you manage a pt with chronic OAF?
- remove the sinus tract
- buccal advancement flap
- buccal fat pad with buccal advancement flap
- palatal flap
- bone graft
what is osteomyelitis?
inflammation of the bone marrow, its rare and usually the MANDIBLE
site of extraction - VERY TENDER
starts central to the bone and extends outwards eventually to the periosteum & overlying mucosa red/tender
why is osteomyelitis more likely to occur in mandible vs the maxilla?
maxilla has rich blood supply compared to the mandible.
therefore mandible more likely to become ischaemic & infected
what are the major predisposing factors for getting osteomyelitis?
trauma/injury/fractures of mandible
odontogenic (around teeth/jaw) infection
compromised host defence (diabetes, alcoholism, drug use, leukaemia, chemo etc)
how do you treat osteomyelitis using antibiotics?
penicillin (antibiotics)
- longer course than usual and keep taking after resolution of symptoms to make sure it fully clears
- if severe acute osteomyelitis, may require hospital admission
what is the surgical treatment for osteomyelitis?
- drain pus if possible
- remove any non-vital teeth in area of infection
- remove any necrotic bone
- clean out anything necrotic
what is osteoradionecrosis (ORN)?
affects bones of jaw, complication of radition therapy for head & neck cancers. Radiation damages blood vessels leading to bone death/necrosis
What are the symptoms of osteoradionecrosis?
- pain discofort,
- redness, exposed bone
- drainage or pus from site
how can you prevent osteoradionecrosis?
- scaling/Chlorhexidine mw leading up to XLA
- careful xla technique
- antibiotics & review
what is treatment for osteoradionecrosis?
- irrigation of necrotic tissue
- antibiotics
- hyperbaric oxygen therapy (improves blood flow & promotes healing)
What does MRONJ stand for?
medication related osteonecrosis jaw
what actually is MRONJ?
a condition which jaw bone is exposed & becomes to become necrotic due to certain medications.
Such as BISPHOSPHONATES
what are symptoms of MRONJ
- Pain, swelling, numbness, exposed bone
what are bisphosphonates and how do they work?
class of drugs used to treat OSTEOPOROSIS, Paget’s disease & malignant bone metastases
inhibit osteoclast activity and so inhibit bone resorption and new bone formation
bisphosphonates may remain in the body for years
what are names of some bisphosphonates? are they IV, oral?
alendronate (alendronic acid) [oral]
Etidronate [oral]
Zoledronate [IV]
what other concurrent medication increases the risk of MRONJ?
Use of steroids + antiresorptive drugs (bisphosphonates)
antiresorptive (bisphosphonates) + angiogenic drugs (formation of new blood vessels)
what makes a patient low risk for MRONJ?
patients taking bisphosphonates for less than 5 years and NOT taking steroids or angiogenic drugs concurrently
What makes a patient high risk for MRONJ?
if they have been taking bisphosphonates for more than 5 years.
Any patient taking bisphosphonates with steroids or angiogenic drugs
