Surgical Complications Flashcards
List 15 Postoperative complications
- Pain
- Swelling
- Trismus/TMD
- Hemorrhage
- Alveolar Osteitis/Dry Socket
- Wound dehiscence
- Infection
- Paresthesia
- Ecchymosis
- Jaw Fracture
- Alveolar bone fracture
- Aspiration or swallowing tooth or instrument
- Injury to adjacent teeth
- Sinus exposure
- Wrong tooth extracted
What are 4 General principles to consider with all surgery?
- Anticipate possible or likely complications
- Get informed consent
- Avoidance
- Empathy
When should meds be started?
B/f local anesthesia wears off
Should every bit of pain be treated with a narcotic?
No. choose drug appropriate for level of pain expected and don’t overprescribe either type or amount of drug
What is a non-medicine way to Control Post-operative swelling?
Ice intermittently 20 min on, 20 min off for first 24-48 hrs, moist heat thereafter
What is a medicine way to control post-operative swelling?
IV or IM steroids preoperatively (Decadron 8 mg)
Is a certain amount of trismus expected following more extensive surgery due to inflammation of the muscles of mastication?
Yes
What 2 things can be given for the management of post-operative trismus?
Moist heat and anti-inflammatory meds
What type of trismus should arouse suspicion post-operatively?
Delayed onset
What is the term for localized disintegration and loss of blood clot?
Dry Socket (Alveolar osteitis)
What gender Alveolitis or Localized Osteitis is more common in?
Females, especially if on oral contraceptives
What is a habit that increases risk for Alveolitis or localized osteitis?
Smoking
Can surgical trauma and the length of the procedure increase the risk of alveolitis or localized osteitis?
Yes
What location in head is where alveolitis or localized osteitis is more common?
Posterior mandible, especially 3rd molars
Pt complains of dull aching pain, esp 3-5 days after extraction that feels like a toothache. Clinically the ext site has no blood clot, or the blood clot looks necrotic, but there are NO SIGNS OF INFECTION(fever, increasing edema, drainage), and there may be a fetid odor. What is it?
Dry socket
How do you treat a dry socket?
- X-ray and check clinically for foreign body
- Give topical or local anesthetic
- Irrigate socket with saline
- Place anodyne sedative dressing
- Prescribe analgesics
- Follow up in 48 hrs and repeat until patient is comfortable
What 3 things can be used for dry socket dressings?
- Paste
- Gelfoam + Medication
- Strip Gauze + Medication
What are 5 commonly used medications in the dry socket?
- Eugenol
- Benzocaine
- Balsam of Peru
- Guaicol
- Chlorobutanol
What instructions should be given to the patient if they call complaining of post-operative bleeding?
If you have determined that the bleeding is not severe, instruct patient to place gauze directly over site (tea bag or gauze w/ hydrogen peroxide can help) and sit semireclined and undisturbed 45 mins. Follow up in 45 -60 mins.
What can minimize calls complaining of post op bleeding?
Good post-op instruction
What should first be done if patient is assessed in the office for post operative bleeding?
Quickly suction mouth, have pt bite on gauze, and assess their physical status
Once physical status is determined satisfactory, what is done next for in-office post-operative bleeding treatment?
Identify source of bleeding
How should you control gingival bleeding?
Sutures
How should you control bone bleeding?
- Add hemostatic packing
- Gelfoam (absorbable gelatin sponge)
- Surgicel (oxidized cellulose)
- Avatene (microfibrillar collagen)
What can aide in hemostasis, but may also give false security?
Local anesthetic with epinephrine
What should be done with the patient in the office after managing their bleeding?
Observe for sufficient time and reinforce instructions
What is a liver clot?
A dark clot in socket, but raised up out of socket due to continued bleeding in the socket
What should be done if patient has recurrent post op bleeding?
Must rule out systemic problem or coagulopathy w/ tests:
- CBC w/ platelet count
- PT and PTT
- Bleeding time
What are 5 causes of wound dehiscence?
- Soft tissue trauma
- Improper flap design
- Excessive tension on flap Infection
- Compromised host
What is the treatment when a sinus membrane is exposed but intact after surgery?
Suture over the socket
Possible antibiotic coverage
Sinus precaution instructions (don’t blow nose, no valsalva, etc)
What is the treatment if a sinus membrane is perforated w/ sinus- oral communication?
Flap advanced for primary closure Antibiotic coverage
Sinus precaution instructions
What should the patient be informed of when removing a tooth with an adjacent restoration, especially a restoration with a contact on the tooth to be extracted?
The remaining restoration may come out and need replacement or need to be replaced due to damage during extraction
What must be done if a tooth is swallowed?
Take abdominal film to confirm location. Should pass in 2-4 days
What usually precedes the patient aspirating something (e.g. a tooth)?
A cough
What is required if patient aspirates something?
A chest x-ray and a bronchoscopy to remove the object
What is the most frequent claim in oral surgery,but is entirely preventable?
Extraction of the wrong tooth
What are 5 things you can do to avoid extracting the wrong tooth?
- Obtain written consent
- Use “Time Out” procedures
- Have patient identify tooth
- Counterchecks, e.g mark X-ray
- Communication between patient and doctor, doctor and staff, general dentist and specialist
What should be done before any surgery to avoid postoperative complications?
Take a careful medical history
How should hard and soft tissues be handled in order to avoid postoperative complications?
Gently
What should be done to sharp bony edges to avoid postoperative complications?
Remove them
What should be done to any loose bone not attached to periosteum to avoid postoperative complications?
Remove it
Should a patient be dismissed before hemostasis has been confirmed?
No
Should sutures be used all the time in order to avoid postoperative complications?
No, but use them when indicated
When should the patient be started on analgesics in order to avoid postoperative complications?
Before pain begins
What should always be used during extractions to avoid swallowing or aspiration?
Throat-pack
What should be avoided when doing surgery to avoid postoperative complications?
Avoid excessive forces
Patient must be advised before surgery of the risk of what?
Paresthesia, not just at IAN, but also consider proximity of lingual nerve
If patient is on Coumadin, what should be anticipated as a post-operative complication?
Eccymosis: blood in submucosal and subcutaneous tissue that looks bad but does not increase pain or infection
Where are bone fractures common, and what tooth in particular should you be wary of on extraction?
Bone fractures are common in maxillary.
Beware the free standing maxillary molar.
The most common cause of bone fracture is excessive force with the forceps
