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MODULE 6 > OS - complications in oral surgery > Flashcards

OS - complications in oral surgery Flashcards

1
Q

how may TMJ dislocation arise during xla?

A

leaning on the mandible - distract TMJ from glenoid fossa

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2
Q

what can you do to prevent TMJ dislocation during xla?

A

McKesson’s mouth prop
Alternative approach
General anaesthesia

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3
Q

list postop/ special complications associated with bone?

A

alveolar osteitis (dry socket)
sequestrum
exposed bone
MRONJ
ORN

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4
Q

list postop/ special complications associated with bleeding?

A

haematoma

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5
Q

list postop/special complications not associated with bone or bleeding?

A

sepsis
trismus

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6
Q

what is the clinical term for dry socket?

A

alveolar osteitis

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7
Q

what is alveolar osteitis?

A

inflammation of the bone - not infection

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8
Q

how does alveolar osteitis occur?

A

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

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9
Q

how common is alveolar osteitis

A

0.5-68%

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10
Q

what teeth commonly present with alveolar osteitis?

A

mandibular molars

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11
Q

what are the risk factors for alveolar osteitis?

A

women
smoking
trauma
medications: OCP, antipsychotics, antidepressants
third molars

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12
Q

why is smoking a risk factor for dry socket?

A

vasoconstrictor
sucking motion may dislodge clot

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13
Q

along side risk factors, what are additional factors that contribute to dry socket?

A

inadequate oral hygiene
poor after care
spitting, sucking through a straw, coughing or sneezing

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14
Q

how does alveolar osteitis present?

A

onset 2-3 days
worsening pain
analgesics dont work
dull aching throb (severe)
bad taste
discharge
halitosis

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15
Q

what is the management of dry socket?

A

LA
explore socket - if debris or a void it is dry socket
ensure no sequestrum
irrigate socket with saline
pack socket with alvogel

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16
Q

does dry socket heal itself?

A

yes, but will take 6-8 weeks and is very uncomfortable

17
Q

what is a sequestrum?

A

free floating fragment of bone lost from extraction site

18
Q

how do you manage sequestrum?

A

topical anaesthesia and then alleviate with tweezers

19
Q

what are signs and symptoms of sequestrum?

A

similar to dry socket (as it is also an alveolar driven process)

20
Q

what may cause sequestrum?

A

response to trauma
commonly from severe soft tissue trauma crest

21
Q

where are sequestrums most commonly found?

A

lingual posterior mandible
prominences
thin mucosa

22
Q

why do bisphosphonates cause MRONJ?

A

they are antiresorptive

23
Q

list some names of bisphosophonates?

A

alendronate
ibadronate
zolendronate
pamidronate

24
Q

what is denosumab?

A

RANKL inhibitor

25
Q

list names of some anti-angiogenics?

A

bevacizumab
sunitinib
afibercep

26
Q

what is ORN?

A

a serious irreversible side effect to receiving radiation for head and neck cancer
secondary to trauma
sometimes spontaneous

27
Q

what is the incidence of ORN?

A

5-15%
6% following xla

28
Q

where do you more commonly find ORN?

A

mandible

29
Q

what are symptoms of ORN?

A

non-healing bone
severe pain
recurrent infections
halitosis
orofacial fistula
suppuration
pathological fracture

30
Q

how do you manage ORN?

A

resection
HBO
pentoxyohylline/ Tocopherol

31
Q

what is the range for normal mouth opening?

A

30-40mm

32
Q

what are the ranges of mouth opening in trismus pts?

A

mild - 20-30mm
moderate - 10-20mm
severe - less than 10mm

33
Q

what are the mechanisms of trismus?

A

pain
muscular
haematoma
infection
chronic limitation
trauma
neoplasia
TMJ derangement/ osteoarthritis
soft tissue fibrosis

34
Q

in what scenario would you be able to deliver an IDB with closed mouth technique in a pt with painful trismus?

A

there is a gap between medial aspect of ascending ramus and lateral aspect of maxilla

MODULE 6 (69 decks)

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