Post-op Complications Flashcards
Give some common post extraction complications
Pain and swelling
Trismus / limited mouth opening
Ecchymosis - bruising
Post-op bleeding
Dry socket or infected socket
Sequestrum
OAF
Give some less common post op complications
Osteomyelitis
Osteoradionecrosis - necrosis due to radiotherapy
MRONJ
Bacteraemia or infective endocarditis
How to advise a patient on pain?
- most common complication
- advise take analgesia before LA wears off
- warn of pain
How would you advise on swelling or oedema
- occurs due to inflammatory reaction to surgical interference
- wide variation individual to individualWorse with poor surgical technique
How advise on ecchymosis?
Can be expected
- variation person to person
Again worse with poor surgical technique
Why might trismus occur post op?
Surgical trauma causing muscle spasm or oedema
Giving LA - IDB causing medial pterygoid muscle spasm
Haematoma in the medial pterygoid
Damage to TMJ
How would one advise or treat trismus
Monitor over weeks
Gentle mouth opening exercises using a trismus screw
Why might immediate post-op bleeding occur?
(Occurs 48 hours after XLA)
Reactionary bleeding
Sutures loose or lost
Patient traumatises area themselves
LA vasoconstrictor wears off
Why might secondary bleeding occur?
(Occurs 3-7 days post-op)
Often due to infection
Usually mild ooze but can be major bleed
- can be medication related
How treat soft tissue post-op haemorrhage?
Pressure with gauze
Sutures
More LA with epinephrine
Cautery
How stop post op bleeding in bone
Pressure with swab
LA with vaso
Haemostatic agents
Blunt instrument
Bone wax
Pack and suture
What is a haemostatic agent
Give examples
Agent that promotes haemostasis
LA with vaso
Surgicel (oxidised regenerated cellulose) - busty be careful in lower 8 as can damage IDN
Haemocollagen sponge
Thrombin liquid and powder
Floseal
Give some systemic haemostatic aids and why they work
Vit K - necessary for clotting factors
Anti-fibrinolytic e.g. tranexamic acid - prevents clot breakdown
Desmopressin
Manage a post operative bleed
Get inside mouth and get good suction and light
Find the bleed
Get pressure immediately if severe bleeding
Calm anxious patient and clean them
Inject more LA with vaso
Use haemostatic aid such as surgicel or bone wax
Suture socket
Diathermy of vessel if possible
If not working then refer
Give the clinical names for:
Numbness
Tingling
Unpleasant sensation / pain
Reduced sensation
Increased sensation
Anaesthesia
Paraesthesia
Dysaesthesia
Hypoaesthesia
Hyperaesthesia
