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Oral Surgery 1 > Prevention & management of extraction complications Part 2 > Flashcards

Prevention & management of extraction complications Part 2 Flashcards

1
Q

Do bacteria or salivary enzymes lyse blood clots prior to maturation/organization?

A

Salivary enzymes

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2
Q

What body part can you look at on a pt to see if bruising is a problem?

A

Hands

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3
Q

______ is a record of prothrombin time and a standardized control
(due to laboratory differences across nation)

A

International Normalized Ratio

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4
Q

What is the normal INR?

A

1

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5
Q

If INR is above _____, needs med consult

A

3

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6
Q

Direct pressure of socket with moistened gauze, folded to fit over socket
• Pressure for at least _____ -_____ min

A

30 – 45 mins

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7
Q 
• Absorbable gelatin sponge
• Acts as a physical tamponade, increases in size to exert internal 
pressure of bone
• Acts as lattice for clot to form on
• Liquefies in 2-5 days
• Least expensive
• Held in place with figure of eight suture
• Can be used with topical thrombin
A

Gelfoam

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8
Q

What other hemostatic measure can be used with gelfoam?

A

Thrombin

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9
Q

Can you use thrombin with surgicel?

A

Nope

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10
Q

• Oxidized regenerated cellulose
• Promotes coagulation better than gelfoam
• Can be packed into socket under pressure (does increase in size
but not to the extent of gelfoam)
• Acts as lattice for clot to form on
• Bactericidal due to low pH
• More expensive
• CAN NOT be used with topical thrombin →thrombin is
inactivated
• Packed into socket and stabilized with figure of eight suture

A

SURGICEL®, ACTCEL ®

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11
Q
  • Avitene®, CollaPlug®, Collatape®
  • Promotes platelet aggregation
  • Good for patients with qualitative platelet defects
  • Can be packed into socket
  • Very expensive
  • Figure of eight suture placed to stabilize
A

Collagen

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12
Q

• Comes in separate powder and liquid vials, mix together
and then placed
• Great for coagulation factor defects
• Thrombin bypasses extrinsic and intrinsic systems and
directly convert fibrinogen (factor 1) to fibrin (factor 1a)
• Used with gelfoam
• Inactivated by oxidized cellulose

A

Thrombin

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13
Q
  • Blood escaping into tissue spaces, more specifically subcutaneous tissue space
  • Usually seen in elderly patients, due to
  • Decreased tissue tone
  • Increased capillary fragility
  • Weaker cellular attachment
  • Is not dangerous, does not cause pain, does not increase risk of infection
A

ECCHYMOSIS!!!

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14
Q

What is sometimes dangerous, causes pain and can get infected unlike ecchymosis?

A

Hematoma

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15
Q

– original hole into the sinus through the socket

A

Perforation

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16
Q

– epithelialized tract that forms after the unsuccessful attempt at health of the
perforation, weeks out

A

Fistula

17
Q

Oroantral communications can result in what 2 things?

A
  • Oroantral fistulas (OAF)

* Chronic sinusitis

18
Q

CAUSES OF _________
• Severe pneumatization
• Should be caught on pre-operative radiologic evaluation in an attempt
to prevent
• Difficult or island maxillary molar extraction
• Bony floor of sinus comes out with tooth
• Inappropriate elevator technique with subsequent pushing root or
instrument through sinus
• Bur sectioning molar furcation

A

OA COMMUNICATIONS

19
Q

____ OA communication
• No additional treatment, good prognosis
• Place patient on “sinus precautions” – avoid pressure changes
• No blowing nose forcibly
• No sucking on straws
• No smoking
• Protect blood clot with figure of eight suture over socket
• Antibiotics for short duration (3-5 days)
• Nasal decongestants
• Saline nasal spray

A

< 2 mm opening

20
Q

____ OA communication
• Sinus precautions
• Pack gelfoam and secure with figure of eight suture over packing
• Antibiotics for 5-7 days
• Augmentin vs PCN vs amoxicillin
• Afrin (oxymetazoline) nasal decongestant
• Keeps sinus nasal ostium patent to allow normal sinus drainage through naris, thus prevent infection
• Careful as excessive use can lead to rhinitis medicamentosa
• Saline nasal spray

A

2 – 6 MM OPENING

21
Q 
\_\_\_\_ OA communication
• Sinus precautions
• Sinus medications
• Referral to OMS for closure
• Buccal mucosal advancement flap
• Palatal finger flap coverage
• Buccal fat pad advancement
A

> 6 MM OPENING

22
Q

• Causes:
• Excessive force with elevator, most often with
impacted third molar
• Straight elevator use, can also occur with cross
bar elevator
• Prevention:
• Controlled forces and finesse
• Attention to mandibular flexing during luxation
• Treatment:
• Refer to OMS for open reduction and internal
fixation vs closed reduction

A

Mandibular fracture

Oral Surgery 1 (11 decks)

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