제목 : 발치시 합병증
------------------------------------------------------------------------------ complications of tooth extraction Complications of tooth extraction 1. operative complications 2. immediate complications 3. delayed complications 4. anesthetic complications 1. operative complications 1. fracture 2. dislocation of tooth 3. displacement of a root 4. excessive hemorrage 5. damage to adjacent tissue 6. oroantral fistula 1.1. fracture of tooth, alveolar bone, max.tuberosity and mandible 1.1.a. cause of fracture of tooth 1. devitalized tooth 2. improper adaptation of forceps 3. extensive density of surrounding bone 4. hypercementosis 5. abnormal curvature of roots 1.1.b. favorite site of fracture, alveolar bone 1. lingual plate of lower third molar 2. maxillary tuberosity 3. labial plate of canine 1.1.c. treatment of fracture, alveolar bone 1. remove the fragment 2. fixation and suture(5-6 weeks) 1.1.d. causes of fracture, max. tuberosity over push forces 1.1.e. prevention of fracture, max. tuberosity 1. repeated mild push force 2. delivary with pull force 3. frocep delivery 1.1.f. treatment of fracture, tuberosity 1. remove; avoid mucosal tearing 2. fixation if possible 1.2. dislocation 1.2.a. dislocation of adjacent tooth fulcrum of elevator slipping the beak 1.2.b. dislocation of tmj overforce 1.3. displacement of a root into the soft tissue into the maxillary antruum into the mandibular canal aspiration 1.4. excessive hemorrhage .inferior alveolar artery and vein .lingual side of lower third molars .nutrient canal .spongeous bone .mucoperiosteal margin 1.5. damage to . gum . lip . inferior alveolar nerve . lingual nerve . tongue . mouth floor 1.6. oroantral fistula (Killey & Kay, 1975,p40-70) . escape of blood from nostril . frothing blood from the tooth socket . air bubbles from the socket when close nasal blowing . regurgittation of liquids from the mouth into nose .infection, violent nose-blowing, over-vigorous gargle . a painless lump 2. immediate postopeartive complication 1. pain 2. hemmorrhage 3. swelling 4. prolonged anesthesia 5. trismus 6. dysphagia 7. pyrexia 2.1. pain 2.1.a. causes 1. surgical trauma 2. adjacent tooth trauma 3. hematoma 4. dry socket 5. infection 6. traumatic arthritis of TMJ 7. others 2.2. hemorrhage 2.2.a. causes 1. inadequate biting the gauze 2. eversion of gingival margin 3. postoperative exertion 4. injuries of surrounding tissue 5. remained granulation tissue 6. infection 7. blood dyscrasia 8. hypertension 9. menstruation 10. etc 2.2.b. bleeding from 1. socket( spongious bone) 2. gingival margin 3. arterioles on soft tissue 4. nutrient canal 5. inferior alveolar artery 2.2.c. systemic disorders of bleeding tendancy 1. aplastic anemia 2. agranulocytosis 3. leukemia 4. purpura 5. hemophylia 6. etc 2.2.d. treatment 1. rebiting the gauze 2. tight suture 3. burnishing the socket surface 4. packing the wound 5. recurettage on the remained granulation tissue 6. hemostatic drug 7. control of infection 8. control of systemic disorders (consult to I.M.) 9. hematologic examination 2.3. swelling( edema) increased vascular permeability due to histamine secretion after trauma to the blood vessels 2.3.a. causes 1. too tight suture 2. rough tissue handling 3. excessive retraction of badly designed flap 4. soft tissue entangled by bur 2.3.b. prevention 1. avoid the causes 2. cold pack 3. proteolytic enzyme therapy 2.4. trismus marked restriction in mouth opening occurs with hematoma formation or infection in the masseter muscle and submasseteric space 2.4.a. causes 1. postoperative edema 2. hematoma formation 3. inflammation of the soft tissue 4. traumatic arthritis of TMJ 2.4.b. treatment 1. intraoral heat . use of hot saline mouth baths . short wave diathermy 2. antibiotics 2.5. dysphagia due to simple edema of the pharynx, which may be exacerbated by hematoma formation 2.5.a. causes 1. simple edema of the pharynx 2. hematoma formation 3. infection to the pterygomandibular space or parapharyngeal space 2.6. pyrexia . return to normal in about 12 to 24 hours . if local and systemic infection has occured, pyrexia continued 3. late postoperative complication 1. secondary hemorrhage, hematoma,and eccymosis 2. pain 3. swelling 4. infection 5. dry socket 6. traumatic arthritis of TMJ 7. trismus 8. emphysema 3.4. infections . alveolar osteitis( dry socket) . osteomyelitis . Vincent's infections . actinomycosis 3.5. dry socket 3.5.a. prevention 1. treatment of gingival inflammation 2. minimum local anesthetics 3. extraction as atrumatically as possible 3.5.b. treatment 1. remove the all degenerating blood clot 2. remove the sharp bony spurs 3. warm saline irrigation 4. locally packing with ZOE 5. medication 3.6. traumatic arthritis of TMJ may complicate difficult extraction if the jaw is not supported 3.6.a. prevention rigid holding the mandibular body with left hand 3.6.b. symptoms 1. limitation of mouth opening 2. pain 3. swelling 4. clicking sound 3.6.c. treatment 1. anagesics 2. rest 3. torn ligament and displaced meniscus-- surgical intervention and repair 4. ankylosis-- condylectomy 3.8. emphysema due to the air being forced into the subcutaneous tissue 3.8.a. causes 1. tooth extraction 2. blowing air from high speed air turbine 3. patient's breathing actions following some type of surgical procedure 3.8.b. symptoms 1. rapid unilateral swelling 2. bubbling sensation or cracking sound when palpation 3. painful especially during first few days 3.8.c. treatment 1. no active treatment 2. spontaneously absorbed 3. aspiration & pressure dressing 4. anesthetic complications 4.1. due to needle insertion a. syncope b. pain c. infection d. hematoma e. prolonged anesthesia f. motor paralysis g. broken needle h. trismus 4.1.a. syncope neurogenic shock caused by cerebral ischemia secondary to a vasodialtion or an increase in the peripheral vascular bed sign pallor cold sweating dizziness nausea decreased blood pressure loss of consciousness treatment Trendelenburg position loosen the tight clothing reflex stimulation check the vital sign oxygenetion prevention adequate premedication shock position prior to the injection 4.1.b. pain causes dull blunt needle rapid injection too hot or to cold solution no isotonic solution 4.1.c. infection needle has not been properly sterilized or infection is carried from the mucosa 4.1.d. hematoma caused by injury of blood vessel and extravasation of blood most commomly associated with the posterior superior alveolar nerve block or high tuberosity block due to the laceration of pterygoid venous plexus wiil resolve spontaneously in 7-10 days 4.1.e. prolonged anesthesia occurs if a nerve is traumatized by the needle point neuropraxia; return within 2 weeks neurotmesis; delayed about 18months 4.1.f. motor paralysis causes; too deep injection ischemic paralysis in the region of styoimastoid foramen 4.1.g. broken needle . due to unexpected movement of patient . greatly reduced by use of stainless steel needle 4.1.h. trismus due to tearing of a masticatory muscle medial pterygoid m. during inf.alv.n. block muscle relaxants and use of moist heat may last up to 2 months in severe case 4.2. due to anesthetic solution a. toxicity b. idiosyncrasy c. allergy d. anaphylactoid reactions e. infection f. local irritation 4.2.a. toxicity cause; inadvertent intravascular injection too large volume of anesthetics too great a percentqge strength rapid absortion into the blood stream prevention; aspiration smallest voluume weakest percentage slowly injection 4.2.b. idiosyncrasy 4.2.c. allergy symptoms; rash urticaria angioneurotic edema mucous membrane congestion rhinitis asthmatic symptom prevention; adequate preanesthetic evaluation consult to allergist treatment; antihistaminic agents epinephrine aminophylline oxygen 4.2.d. anaphylactoid reactions . a form of allergy associated with a sudden loss of vasomotor tonus 4.2.e. infection 4.2.f. local irritation symptoms of cerebral cortical stimulation a. talkativeness b. restlessness c. apprehension d. excitement e. convulsion symptoms of medullary stimulation a. increased blood pressure b. increased pulse rate c. increased respiration d. possible nausea and vomitting treatment of C.N.S. stimulation a. discontinuing futher use of the anesthetic drug b. barbiturate c. inhalation of oxygen d. succinylcholine chrolide symptoms of cortical depression letharcy sleepness unconsciousness symptoms of medullary depression decreased blood pressure weak thready pulse shallow and slow respiration treatment of C.N.S. depression suport respiration nd artificial ventilation maintain adequate cardiovascular function avoid analeptic drug
Back to prev.Page
Back to Korean or English homepage