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
What is neurotmesis ?
Complete loss of nerve continuity
5 types of nerve feelings?
- Anaesthesia - numbness
- Paraesthesia - tingling
- Dysaesthesia - pain
- Hypoaesthesia - reduced sensation
- Hyperaesthesia - heightened sensation
What 5 types of vessels that can be damaged during extraction?
- Veins - bleeding
- Arteriies - spurting and haemorrhage
- Arterioles - spurting and pulsating bleed
- Vessels in muscles
- Vessels in bone
4 causes of peri-operative haemorrhage?
- Local factors such as mucoperiosteal tears or alveolar plate fracture (most cases)
- Undiagnosed clotting abnormalities (haemophilia and von Willebrands)
- Liver disease (alcoholism)
- Medications such as antiplatelets and anticoagulants
2 examples of antiplatelet medication?
- Aspirin
- Clopidogrel
2 examples of anticoagulants other than Warfarin?
- Rivaroxaban
- Dabigatran
4 ways you can stop a haemorrhage during extraction in soft tissues?
- Pressure with damp gauze
- Sutures
- LA with VC
- Diathermy - burn vessels to form protein plug in vessels
- Ligatures and artery clips for larger vessels
6 ways to stop haemorrhages from bone?
- Pressure with swab
- La injected into socket or via swab
- Blunt instrument
- Bone wax
- Haemostatic agents
- Pack
During an extraction , the TMJ dislocated ,immediate management option?
- Relocate immediately
TMJ dislocated , you tried relocating it and was unable to , what would be your next step?
Try relocating with anaesthetic into the masseter intra-orally
You tried to relocate TMJ using anaesthetic into masseter and you could not , what would be your management?
Immediate referral
2 advice you would give a patient after relocating TMJ?
- Analgesia
- Supported yawning
3 ways you can damage adjacent teeth or restorations during an extraction?
- Hit opposing teeth with forceps
- Crack or move adjacent teeth with elevators
- crack or remove adjacent restorations
3 management options for damage to adjacent teeth/restorations?
- temporary dressing or restoration
- arrange appt for definitive restoration
- Warn patient about the risk before procedure
How would you manage if an instrument was broken during exrtraction and you could not locate it ? for example tips of elevators/luxators/burs ?
- Radiograph and retrieve
- If unable to retrieve -refer
5 ways you can determine that you are treating the correct tooth?
- Concentrate
- Check clinical situation against notes and radiographs
- Safety checks
- Count teeth
- Verify with someone else
- Contact defence unioin
List 10 peri-operative extraction complications?
- Damage to adjacent teeth and restoration
- Maxillary tuberosity fracture
- OAC
- treating the wrong tooth
- haemorrhage
- damage to soft tissue and bone
- TMJ dislocation
- Broken instruments
- Nerve damage
- Lost root in antrum
