Professional Documents
Culture Documents
ُ بسم ال الح
Surgery lec #7 5.4.09
:Nerve Injuries
What are the injuries? How do they occur? How do we
?treat them
1
Ex: when the mental nerve is very superficial and when
you raise a flap and you didn’t observe the nerve you
.might easily damage it
Ex: when raising a flap and its not adequate, so you start
pulling and tearing the flap causing injury to the nerve. We
need to raise an adequate sized flap to decrease pressure
.on the nerve
Ex: Flap retractors used during surgical procedures also
.may cause tearing
When you are sectioning a lower 3rd molar, the drill or bur
will sometimes go deeper into the canal and cut the ID
nerve in a similar fashion and if you go lingually the lingual
.nerve will also get injured
See the curved root & the root is displaced to the ID canal
leading to injury of the ID canal and the removal of this
.tooth will also lead to injury of the ID nerve
2
Some patients might bleed during the oral surgery and ..
some might bleed postoperatively when they leave the
.clinic
:TYPES OF BLEEDING
.REACTIONARY BLEEDING: 1
Is the bleeding that occurs in the first 24hrs following
surgery. The factors that provoke bleeding in these
:patients are
Exercise..
Sometimes local anesthesia which contains a..
vasoconstrictor which helps in the control of bleeding but
the effect is minimal
Application of heat to the wound..
Mechanically with the tongue..
Sometimes when patients are under general anesthesia ..
the anesthetist lower the blood pressure of the patient to
3
control the bleeding. Once the patient is awake and during
recovery the blood pressure will return to normal and
.leads to bleeding
Coughing..
.Smoking because of the negative pressure..
:SECONDARY HEMORRHAGE .2
Bleeding that happens after 10 days from the surgery
.usually due to infection and sepsis at the site of surgery
:Secondary
Coagulation time: which are affected by thombin,
prothrombin, fibrin, collagen, extrinsic and intrinsic
4
factors. We should know these and we will be asked about
.them
5
flap you will injure the blood vessel and you will have
.bleeding
6
of delayed healing.
Some people say that you can put a tea bag after soaking
it in water and bite on it for 30 min, because in tea we
have tannic acid which will help in controlling the bleeding,
but the doctor does not recommend this because it is not
hygienic and it is not proven clinically.
7
Despite these measures if the bleeding can not be
controlled then the patient should be referred to a hospital
for further investigations. Sometimes we get patients who
bleed for a long time, ex: Bleeding for 2 weeks
(continuous oozing)!!
DRY SOCKET
Localized osteitis meaning inflammation of the bone or of
the socket. Usually it's painful when you are examining the
patient there is no blood clot only bare bone. Their
incidences are 3% of all extractions and between 14-37%
of lower 3rd molar extractions are complicated or will have
dry socket.
Clinically the patient on the 2nd or 3rd day after the
extraction they start to complain of pain, this pain is
continuous and it is moderate to severe throbbing pain,
sometimes radiating to the ear, and also patient might
complain of bad taste and bad odor. However, the etiology
is not known!
But we have predisposing factors like infections,
smoking, excessive physical force during extractions, and
vasoconstrictor of local anesthesia.
In certain patients they have increased fibrinolytic activity,
also certain type of bacteria will have high activity might
cause dry socket. Pregnant women have increased risk of
dry socket but no one knows why!!
8
Dislocation of TMJ
When do we have dislocation of the TMJ?
-Trauma
-Difficult extraction
-Prolonged Endo-treatment or prolonged surgical
treatment.
TRISMUS
Limited mouth opening due to muscle spasm.
Can be caused by many ID injections given, excessive
force, infection etc.
Treatment of Trismus
If there is a cause we have to identify it.
Tell the patient to apply heat on the affected area.
Rinse with warm water and salt, and perform some
exercise to increase mouth opening (physiotherapy).
9
Infection in the wound
Is a complication which can be caused if used
instruments are not sterile, or if the procedure we did is
not correct or if the patient has a systemic disease etc.
We treat the infection by Cleaning and debriding the area
infected.
10
MI - medical emergency [patients need to go to the
hospital.]
Your
Colleague
Lamiya
Hassan Ramadan
11