Perioperative and Postoperative Complications

Complications of extractions

“…Damage may consist of temporary interruption of nerve conduction (neuropraxia), degeneration of nerve axons (axonotmesis), or permanent interruption of nerve conduction (neurotmesis). 2 Signs of neuropraxia (sensory disturbances such as burning sensation, pins and needles, or numbness) usually resolve within a few days to weeks. Signs of axonotmesis are similar but of longer duration, lasting 6-8 weeks, with the potential for permanent sensory deficits.…”

“…In addition, suturing the wound will mechanically obstruct the severed end of the bleeding vessel. 2 Excessive hemorrhage may occur in patients with clotting disorders such as von Willebrand's disease, or those receiving fish oil supplements. Fish oil is high in eicosapentaenoic acid, which decreases platelet aggregation and results in prolonged clotting times.…”

“…The most serious nerve damage, neurotmesis, can be produced by ischemia due to prolonged compression, excessive traction on the associated soft tissues, or severance of the nerve fibers, and may result in permanent paresthesia or anesthesia. 2 If patients exhibit signs of persistent pain postoperatively (hiding, pawing at the face, difficulty prehending or masticating food, or reluctance to groom for more than 1 week after surgery) the extraction site should be examined clinically and radiographically. If there are no root fragments and the soft tissues have healed uneventfully, neuropathic pain should be considered.…”

“…In order to avoid displacing a root through its alveolus into the mandibular canal, nasal cavity or maxillary recess, | 16 | be repositioned with the flap and should be stable after the flap is sutured. 2 Prevention of this complication is achieved by adequate assessment of the tooth and its alveolus via intraoral radiographs, and by controlled removal of alveolar bone (using a round diamond bur on a dental handpiece with continuous irrigation) prior to luxation or elevation, and avoiding use of extraction forceps prior to sufficient loosening of the tooth by luxation and/or elevation. 1…”

“…16.6) may occur secondary to traumatic extraction techniques or excessive compression of tissues resulting in obstruction of lymph vessels. 2 When patient compliance permits, cold compresses may be applied for 10-15 minutes every half hour for the first 4-6 hours after surgery. 2 Administration of nonsteroidal antiinflammatory medications (if not contraindicated based on the patient's medical history and/or perioperative anesthetic complications) may help minimize the severity of the swelling and its associated discomfort.…”