Extraction Complications 4 Flashcards
what is an OAC
oral antral communication
what is an OAF
oral antral fistula
how do you diagnose an OAC
size of tooth
radiographic position of roots
bone at trifurcation
bubbling of blood
nose holding test
direct vision
good light and suction
blunt probe
what do you do if a small OAC happens
encourage clot
suture margins
post op instructions
possible antibiotic
what do you do if a large OAC happens
close with buccal advancement flap
antibiotics, decongestants and nose blowing instructions
how do you manage a chronic OAF
excise sinus tract
buccal advancement flap
buccal fat pad with advancement flap
palatal flap
bone graft/collagen membrane
how do you retrieve a foreign body from the antrum
flap design
open fenestration with care
suction
small curettes
irrigation or ribbon gauze
close like OAC
what is the caldwell luc approach for root in antrum retrieval
go in through buccal sulcus/buccal window
what is osteomyelitis
infection of the bone
what do patients experience in osteomyelitis
systemically unwell/raised temperature
extraction site tender
altered sensation due to pressure on IAN
what is the progression of osteomyelitis
begins in medullary cavity in cancellous bone and spreads to cortical bone and then periosteum
soft tissue inflammation
increased tissue hydrostatic pressure
compromised blood supply so soft tissue necrosis
why is mandible more likely to experience osteomyelitis
poorer blood supply and more likely to become ischaemic and infected
what are the major predisposing factors of osteomyelitis
odontogenic infections and fractures of mandible
compromised host defence
what does chronic osteomyelitis look like
bony destruction in area of infection
increased radiolucency on radiographs
in osteomyelitis, why would there be an increase in radiodensity surrounding the radiolucent area
bone production is increased as a result of inflammatory reaction
how do you treat osteomyelitis
medical and surgical treatment
investigate host defences with blood and glucose levels
what antibiotic is prescribed for osteomyelitis
penicillin
what is the surgical treatment for osteomyelitis
drain pus
remove non-vital teeth in area
remove loose pieces of bone
remove any wires/plates
remove bony cortex
excise necrotic bone
who do you refer osteomyelitis people to
local OS or OMFS
who is ORN seen in
patients who have received radiotherapy of head and neck to treat cancer
what happens to the bone with ORN
bone becomes non-vital and causes endarteritis
turnover of remaining bone is slow
gets worse with time and dose
what jaw is more commonly affected for ORN
mandible
how do you prevent ORN
scaling/chlorhexidine before extraction
careful extraction technique
antibiotics, chlorhexidine and review
hyperbaric oxygen before and after extraction
take advice/refer patient for extraction
what does hyperbaric oxygen do
increase local tissue oxygenation and vascular ingrowth to hypoxic areas
