Perio-operative Extraction complications Flashcards
Why would there be difficult access to the tooth when XLA? (3)
- Trismus
- Reduced mouth opening due microstomia
- Crowded or malpositioned teeth
You have a patient for extraction, during the procedure you notice abnormal resistance , what might this be due to? (4)
- Thick cortical bone
- Hypercementosis
- Ankylosis
- Number of roots and shape of roots
Why might a tooth or root fracture during XLA?
- Caries
- Poor alignment of tooth
- Small size tooth
- Root morphology - fused or convegent/divergent
How would you prevent a jaw fracture?
- do not put too much pressure
- take pre-op radiographs
Why might a jaw fracture occur during an extraction?
- Impacted tooth
- Large cyst
- Atrophic mandible
- Too much force application
A jaw fracture occur while you are extracting a tooth , what would be your management?
- Inform patient
- Post op radiograph
- Refer by phone call
- Ensure analgesia and stabilise
- If there is a delay in management consider ABs
What 3 ways can the maxillary antrum be involved during an extraction?
- Oroantral communication
- Loss of root in antrum
- Fractured tuberosity
2 ways to assess the risk of involvement in maxillary antrum?
- Size of tooth
- Radiographic position of roots in relation to antrum
5 ways to diagnose involvement of maxillary antrum?
- Bone at trifurcation of roots
- Bubbling of blood in the socket
- Nose holding test
- Direct vision with good light
- Echo sound of suction
- Using a blunt probe
What is the difference between OAC and OAF?
- OAC is an acute communication with the maxillary antrum whereas OAF is a chronic communication involving the formation of an epithelium
How to manage small maxillary involvement ?
- Inform patient
- Encourage clot formation and suture margins
- Prescribe antibiotic and give post-op instructions
How to manage large communication with maxillary antrum or torn lining between ?
- Close with buccal advancement flap
- ABs and nose blowing instructions
How would you manage lost root in antrum?
- Confirm radiographically by OPT , occlusal or PA
- Retrieve using ribbon gauze if possible
5 factors that may increase the liklihood of tuberosity fracture?
- Single standing molar
- Extracting in the wrong order
- Pathological gemination
- Inadequate alveolar support
- Unknown unerupted wisdom tooth
How would you clinically diagnose tuberosity fracture in 4 ways?
- Noise
- Movement noted both visually of with supporting fingers
- Tear on palate
- More than one tooth movement
7 management options for tuberosity fracture?
- Dissect out and suture
- Reduce and stabilise using fixation
- Remove or treat pulp
- Ensure occlusion is free
- ABS and antiseptics
- Post op instructions
- Remove tooth 8 weeks later
How would you reduce maxillary tuberosity fracture?
- Using fingers or forceps
What would you use for fixation of maxillary tuberosity fracture?
- Splints
- Orthodontic buccal arch wire
- Arch bar
You were extracting a tooth and suddenly it was lost , what would be your immediate management?
- Stop and inform patient
- Search for tooth
- Suction
- Take radiograph
How would you prevent soft tissue damage during an extraction?
- Correct placement using correct instrument
- Take time positioning instrument
- Good application point
- Controlled pressure
- avoid excessive force
2 ways you can cause damage to nerve?
La and surgery
What are the 3 types of nerve injuries?
- Crush injuries
- Cutting injuries
- Transection of nerve
What is neuropraxia?
Contusion of nerve with continuity of epieneural sheath and axons maintained
What is axonotmesis?
Continuity of axons disrupted but not epineural sheath
