Post-Extraction Complications 2 Flashcards
What are some less common post-operative complications?
- MRONJ (medication induced osteonecrosis)
- ORN (osteoradionecrosis)
- osteomyelitis
- actinomycosis
- infective endocarditis/bacteriaemia
what are some treatment options for chronic OAF management?
- excise sinus tract
- buccal advancement flap
- buccal fat pad with buccal advancement flap
- palatal flap
- bone graft/collagen membrane
what is osteomyelitis?
infection of the bone (the term means inflammation of the bone marrow)
- patient often systemically unwell
- site of extraction very tender
- rare
How does osteomyelitis work?
Invasion of bacteria into cancellous bone causes soft tissue inflammation and oedema in the closed bony marrow spaces
- this leads to increased tissue hydrostatic pressure that is HIGHER than blood pressure of feeding arterial vessels
- compromised blood supply leads to soft tissue necrosis
Where does osteomyelitis tend to occur & why?
The mandible due to poorer blood supply vs the maxilla
What are predisposing factors for development of osteomyelitis?
- odontogenic infections
- fractures of mandible
- compromised host defence
How does chronic osteomyelitis present on radiographs?
increased radiolucency which can be uniform/patchy with a moth-eaten appearance
what bacteria are involved in development of osteomyelitis?
- streptococci
- fusobacterium
- prevotella
How is osteomyelitis treated?
- Antibiotics (penicillins 1st line drug)
- Drain any pus if possible
- Remove non-vital teeth in area of infection
- Remove any loose pieces of bone
- Excision of necrotic bone
How can osteoradionecrosis be prevented?
- scaling/chlorhexidine mouthwash leading up to extraction
- careful extraction technique
- antibiotics
How is osteoradionecrosis treated?
- irrigation of necrotic debris
- loose sequestra removed
- small wounds usually heal in weeks/months
What are some drugs to look out for in relation to MRONJ?
- alendronate
- clodronate
- etidronate
- ibandronate
- pamidronate
“DRONATE” ending of drug !!!!!!
what is actinomycosis?
Bacterial infection that erodes through tissues and causes a thick lumpy pus
How is actinomycosis treated?
- drainage of pus
- excision of chronic sinus tracts
- excision of necrotic bone & foreign bodies
- high dose antibiotics for initial control
- long term oral antibiotics to prevent recurrence
