Management of Complications

Overview

• Importance of recognizing that complications can occur in surgery.

  • Quote: "The only surgeon who has no complications is the one who does no surgery."

Preventing Complications

• Medical History Review

  • Importance of thorough review

  • Look for gaps or inconsistencies in the patient's history

  • Ensure all medications are confirmed/updated every visit

• Radiographs

  • Must be current (within one year) and properly mounted

  • Surgical site documentation is crucial

• Informed Consent

  • Must be explained thoroughly with questions answered before signing

Common Complications

• Types of Complications

  • Nerve injuries

  • Sinus perforation

  • Alveolar osteitis (dry socket)

  • Bleeding

  • Infection

  • Nausea and vomiting

  • Soft tissue and bony tissue injury

  • TMJ injury

  • Pain and swelling

  • Injuries to adjacent teeth

  • Tooth displacement

  • Mandible fracture (rare)

Nausea and Vomiting Management

• Common Causes

  • Pain medications and bleeding

• Treatment Options

  • Clear liquids, anti-emetics (e.g., Zofran) via multiple routes (oral, IM, IV, PR)

Alveolar Osteitis

Clinical Presentation

• Occurs 3 to 5 days post-surgery

• Symptoms include:

  • Increasing pain not relieved by medication

  • Pain radiating to the ear

  • No clot in socket

Differential Diagnosis

• Postoperative pain (general)

• Wound dehiscence/exposed bone

• Postoperative infection

• Myofascial pain dysfunction (MPD)

• Dental pain unrelated to surgery

Treatment

• Potential anesthetic prior to treatment

• NS irrigation and packing (Nu-Gauze, Gelfoam)

• Manage pain with OTC meds after initial packing

• Monitor and possibly change dressing every 2-3 days

Bleeding Management

Systemic Factors

• Review medical history for anticoagulants, bleeding disorders, etc.

Intraoral Factors

• Identify soft tissue/bone bleeding sources pre- and post-operation

Control Methods

• Use of pressure, hemostatic agents, ligation, cautery, suturing

• Application of local hemostatic agents like Gelfoam, Surgicel, CollaPlug, Bone Wax, and Topical Thrombin

Management of Displaced Teeth and Fragments

Submandibular Space

• Apply upward pressure on lingual cortex and refer if root fragments cannot be retrieved

Mandibular Canal

• Obtain periapical and occlusal radiographs; refer if suspected fragment displacement

Infratemporal Fossa

• Use caution in removal attempts; refer when necessary and expect healing time

Sinus Communication

• Prevent with careful technique; manage according to size of communication with appropriate treatment methods

Post-operative Care

• Sinus Precautions

  • Avoid activities that increase pressure (sneezing, bending, etc.)

• Incision Management

  • Considerations for dehiscence and proper management of wounds

Injuries and Contingencies

TMJ Injury

• Prevent through proper support and reduction methods

Soft Tissue Injuries

• Management includes communication with the patient and topical ointments

Wrong Tooth Extraction

• Prevention strategies are key; immediate care if recognized

Final Notes

• Specialist Referral

  • For severe complications, nerve injury, significant bleeding, etc.

• Emphasize the importance of consults when needed.