Peri-Operative Complications

Question 1

list them

Answer 1

difficult access
jaw ±
tooth/root ±
alveolar bone ±
tuberosity ±
loss of tooth
damage to vessels
damage to adjacent
abnormal resistance
maxillary antrum involvement
haemorrhage
soft tissue damage
broken instrument
TMJ dislocation
XLA perm tooth germ
wrong tooth

Question 2

why may there be abnormal resistance

Answer 2

thick cortical bone [U6’s]
shape/form of roots
hypercementosis
ankylosis

Question 3

how would you manage alveolar bone fracture

Answer 3

buccal plate

molars = periosteal attachment, suture, dissect free

canines = stabilise, free mucoperiosteum, smooth edges

Question 4

discuss tuberosity fracture

Answer 4

risks = single standing molar, unknown unerupted wisdom, pathological gemination, XLA wrong order, inadequate alveolar support

diagnose = noise, movement, >1 tooth, palate teat

management =
dissect out + close wound or reduce + stables wound
reduction with fingers/forceps
fixation - ortho buccal arch wire, ach bar, splint

remove/tx pulp, ensure occlusal free
antiseptics/abx, POI

xla 8 weeks after stabilisation

Question 5

discuss maxillary antrum involvement

Answer 5

diagnose = tooth, radiograph, bone @ trifurcation of roots, bubbling blood, nose holding test, direct vision, good light + suction, blunt probe

risks = pre/molar, close xray relationship, last standing molars, large/bulbous roots, older, previous OAC. recurrent sinusitis

management =
inform
small/sinus intact - encourage clot, suture margins, ABX, POI
large/lining torn - close with buccal advancement flap, abx, nose blowing instructions

abx - prevent sinusitis/chronic infection
root in antrum - xray, retrieval

Question 6

discuss haemorrhage

Answer 6

cause = mucoperiosteal tears, fracture, liver disease, warfarin, anti platelets, DOAC

soft tissue = pressure, sutures, LA w adrenaline, diathermy [proteins form proteinaceous plug], ligatures, haemostatic forceps, surgicel

bone = pressure, LA on swab/injected, haemostatic agents, blunt instrument, bone wax, pack

Question 7

discuss neuropraxia, axonotmesis, neurotmesis

Answer 7

neuropraxia =
contusion of nerve, axons maintained

axonotmesis =
continuity of axons, epieneural sheath interrupted

neurotmesis =
complete loss of nerve continuity

Question 8

why may soft tissue / nerve damage occur

Answer 8

crush injury
shredding/cutting
LA
incorrect instrument placement/application point
excessive force

Question 9

describe anaesthesia, paraesthesia, dysaesthesia

Answer 9

anaesthesia - numbness
paraesthesia - tingling
dyseaesthesia - unpleasant/pain

Question 10

describe hypoaesthesia and hyperaesthesia

Answer 10

reduced sensation

increased sensation