OS - complications in oral surgery Flashcards
how may TMJ dislocation arise during xla?
leaning on the mandible - distract TMJ from glenoid fossa
what can you do to prevent TMJ dislocation during xla?
McKesson’s mouth prop
Alternative approach
General anaesthesia
list postop/ special complications associated with bone?
alveolar osteitis (dry socket)
sequestrum
exposed bone
MRONJ
ORN
list postop/ special complications associated with bleeding?
haematoma
list postop/special complications not associated with bone or bleeding?
sepsis
trismus
what is the clinical term for dry socket?
alveolar osteitis
what is alveolar osteitis?
inflammation of the bone - not infection
how does alveolar osteitis occur?
complete absence of the blood clot
or
formation of initial clot subsequently lysed
alveolar bone becomes inflamed due to no barrier between tissues and bacteria
release of tissue activators - plasmin
how common is alveolar osteitis
0.5-68%
what teeth commonly present with alveolar osteitis?
mandibular molars
what are the risk factors for alveolar osteitis?
women
smoking
trauma
medications: OCP, antipsychotics, antidepressants
third molars
why is smoking a risk factor for dry socket?
vasoconstrictor
sucking motion may dislodge clot
along side risk factors, what are additional factors that contribute to dry socket?
inadequate oral hygiene
poor after care
spitting, sucking through a straw, coughing or sneezing
how does alveolar osteitis present?
onset 2-3 days
worsening pain
analgesics dont work
dull aching throb (severe)
bad taste
discharge
halitosis
what is the management of dry socket?
LA
explore socket - if debris or a void it is dry socket
ensure no sequestrum
irrigate socket with saline
pack socket with alvogel
does dry socket heal itself?
yes, but will take 6-8 weeks and is very uncomfortable
what is a sequestrum?
free floating fragment of bone lost from extraction site
how do you manage sequestrum?
topical anaesthesia and then alleviate with tweezers
what are signs and symptoms of sequestrum?
similar to dry socket (as it is also an alveolar driven process)
what may cause sequestrum?
response to trauma
commonly from severe soft tissue trauma crest
where are sequestrums most commonly found?
lingual posterior mandible
prominences
thin mucosa
why do bisphosphonates cause MRONJ?
they are antiresorptive
list some names of bisphosophonates?
alendronate
ibadronate
zolendronate
pamidronate
what is denosumab?
RANKL inhibitor
list names of some anti-angiogenics?
bevacizumab
sunitinib
afibercep
what is ORN?
a serious irreversible side effect to receiving radiation for head and neck cancer
secondary to trauma
sometimes spontaneous
what is the incidence of ORN?
5-15%
6% following xla
where do you more commonly find ORN?
mandible
what are symptoms of ORN?
non-healing bone
severe pain
recurrent infections
halitosis
orofacial fistula
suppuration
pathological fracture
how do you manage ORN?
resection
HBO
pentoxyohylline/ Tocopherol
what is the range for normal mouth opening?
30-40mm
what are the ranges of mouth opening in trismus pts?
mild - 20-30mm
moderate - 10-20mm
severe - less than 10mm
what are the mechanisms of trismus?
pain
muscular
haematoma
infection
chronic limitation
trauma
neoplasia
TMJ derangement/ osteoarthritis
soft tissue fibrosis
in what scenario would you be able to deliver an IDB with closed mouth technique in a pt with painful trismus?
there is a gap between medial aspect of ascending ramus and lateral aspect of maxilla
