Complicaciones postoperatorias asociadas a la cirugía del tercer molar inferior retenido / Postoperative complications associated with impacted lower third molar surgery

Antecedentes: La cirugía del tercer molar inferior retenido es unprocedimiento de rutina en la práctica de la cirugía bucal. Varias complicaciones surgen como resultado de esta intervención quirúrgica. Entre las más frecuentes se encuentran: dolor, infl amación, trismo, hemorragia, equimosis, alveolitis, infección, parestesia y dificultad para comer. Objetivos: El propósito de este estudio fue evaluar la incidencia de complicaciones postoperatorias en la cirugía del tercer molar inferior retenido en pacientes de la Unidad Académica deOdontología de la Universidad Autónoma de Nayarit a fin de tenerlas en cuenta y tomar las respectivas precauciones, ya sea para tratar de evitarlas en lo sucesivo o bien, para reconocerlas y darles tratamiento. No se incluye dolor, infl amación ni trismo. Material y métodos: Este estudio fue longitudinal y prospectivo de siete días consecutivos y de 30 días en total en 38 pacientes entre 16 y 38 años de edad. Se evaluaron las complicaciones postoperatorias relacionadas con la cirugía del tercer molar inferior. Resultados: Participaron 38 pacientes; 29 del género femenino (76.3 por ciento) y 9 del masculino (23.7 por ciento) de entre 16 y 38 años, con un promedio de edad de 23.16 ± 5.2 años. La complicación más frecuente fue la difi cultad para masticar seguida de equimosis...

Background: Impacted lower third molar surgery is a routine pro-cedure in the practice of oral surgery. However, there are various complications associated with the extraction of impacted mandibular third molars, the most common being pain, swelling, trismus, hemor-rhaging, ecchymosis, dry socket, infection, paresthesia, and diffi culty with chewing. Objectives: The aim of this study was to evaluate the incidence of postoperative complications following impacted lower third molar surgery in patients at the Academic Unit of Dentistry of the Autonomous University of Nayarit, so as to ensure these are taken into account and that the respective precautions are taken, either by attempting to avoid them in the future or to recognize and treat them. Pain, infl ammation and trismus are not analyzed in this paper. Material and methods: A longitudinal prospective study of 38 patients between the ages of 16 and 38 years old (with an average age 23.1) was carried out over seven consecutive days, with follow up examination performed at 15 and 30 days. The postoperative complications associated with lower third molar surgery were assessed. Results: 38 patients took part; 29 females (76.3%) and 9 males (23.7%) between the ages of 16 and 38 years, with a mean age of 23.16 ± 5.2 years old. The most common complication was diffi culty with chewing followed by ecchymosis...

"Liver clot"-A rare periodontal postsurgical complication.

Bleeding is a common sequela of oral and periodontal surgery. Generally, bleeding is self-limiting. Following traumatic injury or surgical procedures, hemorrhage can range from a minor leakage or oozing at the site, to extensive bleeding leading to complete exsanguinations. Significant postsurgical hemorrhage following periodontal surgery is uncommon due to the primary closure of the soft tissues. This case report describes the unique formation of a "liver clot" or "currant jelly clot" following periodontal flap surgery. The likelihood of this may be attributed to many factors, like infection, intrinsic trauma, presence of foreign bodies like splinter of bone, a fleck of enamel, or a piece of dental restorative dressing material that may cause repeated, delayed organization of blood coagulum.

Hemorragia incoercible por trauma maxilofacial: experiencia del Hospital del Trabajador / Management of intractable bleeding facial trauma

Introduction: The aim of this paper is to show our experience in the management of intractable bleeding facial trauma during the past 10 years to determine its impact on our environment and outline the basic principles of treatment. Methods: A retrospective study of all patients with maxillofacial trauma and uncontrollable bleeding from 1999 to 2009. Inclusion criteria were oro-nasal bleeding secondary to maxi-llofacial trauma requiring emergency treatment by a specialist, without other associated lesions that could be a source of bleeding. We obtained demographic information, mechanism of injury, diagnosis of injury, hemodynamic status, type and timing of tamponade, definitive surgical treatment, results and evolution. Results: 21 patients in the study period, a true incidence of 0.002 percent. 7 patients (33.3 percent) with trauma naso-septal; 5 (23.8 percent) with panfacial fractures, and 7 (33.3 percent) with variable involvement of the upper and middle face. Nine patients (42.9 percent) had isolated facial injuries. Only 5 patients (23.8 percent) had hemodynamic compromise. Thirteen patients (61.9 percent) required posterior nasal packing with or without another procedure to control bleeding. Eight patients (38.1 percent) required early reduction and internal fixation as definitive treatment. Conclusions: Maxillofacial trauma uncontrollable bleeding is uncommon and rarely is the primary cause of hypovolemic shock. It should be suspected in patients with facial injuries from hours bleeding. The packing, suturing of wounds and reduce/OTS are the mainstays of early treatment.

Introducción: El objetivo del presente trabajo es mostrar nuestra experiencia en el manejo de la hemorragia incoercible por trauma facial durante los últimos 10 años, para determinar su incidencia y delinear los principios básicos del tratamiento. Material y Método: Estudio retrospectivo de todos los pacientes con hemorragia incoercible por trauma maxilofacial entre 1999 y 2009. Criterios de inclusión fueron hemorragia oro-nasal secundaria a traumatismo maxilofacial, sin otras lesiones asociadas que pudieran ser fuente de hemorragia, que requirió de tratamiento de urgencia por un especialista. Se obtuvo información demográfica, mecanismo de injuria, diagnóstico del traumatismo, estado hemodinámico, tipo y momento del tratamiento especializado, tratamiento quirúrgico definitivo, resultados y evolución. Resultados: 21 pacientes en el período de estudio, con incidencia real de 0,002 por ciento. Destacan 7 pacientes (33,3 por ciento) con trauma nasoseptal, con o sin heridas faciales; 5 (23,8 por ciento) con fracturas panfaciales; 7 (33,3 por ciento) con compromiso variable del tercio superior y medio de la cara. Nueve pacientes (42,9 por ciento) presentaron lesiones faciales aisladas. 5 pacientes (23,8 por ciento) presentaron compromiso hemodinámico. Trece pacientes (61,9 por ciento) necesitaron un taponamiento nasal posterior, asociado o no a otro procedimiento para el control de la hemorragia. Ocho pacientes (38,1 por ciento) necesitaron reducción y osteosíntesis precoz como tratamiento definitivo. Conclusiones: La hemorragia incoercible por trauma maxilofacial es poco frecuente y rara vez es la causa primaria de shock hipovolémi-co. Se la debe sospechar especialmente en pacientes con lesiones faciales que llevan horas con sangrado, aún de poca cuantía, pero persistente. El taponamiento, sutura de heridas y reducción/OTS precoz son los pilares de su tratamiento.

Post extraction bleeding associated with long term maintenance dose of aspirin 75-150mg

The objective of this study was to see post extraction bleeding associated with long term maintenance dose of aspirin 75mg-150mg without discontinuation. This study was conducted at Lady Reading Hospital Peshawar from January 2009 to June 2010. Patients for simple single tooth extraction and on aspirin [75-150 mg] were included. Patients with systemic disease like hematologic, renal, or liver disease, bone marrow disorders, alcoholism, or any concurrent medication affecting hemostasis such as anticogulants or anti-inflammatory drugs and patients who needed extractions of deciduous teeth, surgical extractions, extractions in different quadrants, or multiple extractions [>1 tooth] were excluded. Patients were evaluated for immediate and late post extraction bleeding. A total of 254 patients were studied. Patients were categorized into two groups with equal number of patients in each group i.e. 127 each. Group 1 [study] on maintenance dose of Aspirin 75-150mg while group 2 [control] were not taking aspirin. In aspirin group 05 [03.93%] patients had post extraction prolonged immediate bleeding while 03 [02.36%] were in control group. This difference was not statistically significant [p=0.722]. In aspirin group 02 [01.57%] patients had late bleeding at 12 hour post extraction while one [0.78%] patient suffered in control group [p=1.00]. The bleeding was successfully controlled with pressure on gauze and no patient required suturing or re-hospital visit. There was no bleeding in post extraction period at 24 and at 48 hours. It was concluded that simple tooth extraction in patients on long term maintenance dose of 75-150mg aspirin without discontinuation is safe as far as post extraction bleeding is concerned

Ligature of external carotid artery as an optional technique in a patient with von Willebrand disease

The von Willebrand disease (vWD) is a hereditary coagulopathy. There is no gender predilection. Clinically characterized by mucocutaneous bleeding, especially nose bleeding, menorrhagia and bleeding after trauma. This article reports a case of a 52-year-old Caucasian male patient with vWD, who presented with extensive bleeding in the tongue after a lacerating injury caused by accidental biting, and describes some clinical, pathological and treatment aspects of vWD. After repeated attempts to suture the wound and replace clotting factors, a decision was made to perform the ligature of the external carotid artery ipsilateral to the injury. There was favorable resolution of the case, with a good aspect of the scar 2 months after ligation. This case reinforces that it is extremely important to make a thorough review of medical history of all patients, searching for possible bleeding disorders or previous family history.

A doença de von Willebrand (DvW) é uma coagulopatia hereditária. Não há predileção por sexo. Clinicamente caracteriza-se por hemorragias mucocutâneas, sobretudo nasais, menorragias e hemorragias pós-trauma. Este artigo relata um caso clínico de DvW em paciente de 52 anos de idade, leucoderma, do sexo masculino, que apresentou extensa hemorragia em bordo lateral de língua após ferimento lacerante, além de descrever alguns aspectos clínicos, patológicos e terapêuticos da DvW. Após repetidas tentativas de sutura do ferimento e reposição dos fatores de coagulação, optou-se pela ligadura da artéria carótida externa ipsilateral ao ferimento, com resolução favorável do caso, notando-se bom aspecto cicatricial 2 meses após a ligadura. Este caso reforça que é de extrema importância a realização de anamnese criteriosa, buscando-se identificar possíveis distúrbios hemorrágicos prévios ou antecedentes familiares.

Atypical lesion on soft palate: a curious case / Lesión atípica en el paladar blando: relato de caso

The aim of this work is to present a case of a 39-years-old man with a 2cm sized purple pedunculated tissue on the soft palate, next to upper right retromolar area, asymptomatic, with one day time evolution and vascular appearance. There was no trauma history or systemic diseases. Based on the clinical findings our previous diagnosis was traumatic granuloma, hemangioma or blood coagulum formation after local trauma. After one week, intraoral examination revealed absence of the lesion, which disappeared completely. This case illustrates that the absence of trauma history and atypical clinical characteristics can be a diagnostic defiance in the clinical routine.

El objetivo de este trabajo es presentar un caso de un hombre de 39 años de edad, con un tejido de 2 cm pediculado color púrpura en el paladar blando, junto al área retromolar superior derecha, asintomático, con un día de evolución y de aspecto vascular. No había historia de trauma o enfermedades sistémicas. Con base en los hallazgos clínicos nuestro diagnóstico previo fue granuloma traumático, hemangioma o la formación de coágulos sanguíneos, después de un traumatismo local. Luego de una semana, el examen intraoral reveló ausencia de la lesión, la que desapareció por completo. Este caso ilustra que la ausencia de historia de trauma y las características clínicas atípicas, puede ser un desafío diagnóstico en la rutina clínica.

Specialty dentistry for the hemophiliac: is there a protocol in place?

Restorative dental care for the hemophiliac patient is of paramount importance for the fact that advanced dental conditions and subsequent treatments prove to be more complicated and risky. Quite often, dental health is neglected by hemophiliacs for fear of bleeding during procedures. Surprisingly, even dental specialists avoid these candidates and contribute to the conversion ofa simple dental patient to an oral surgical patient. The complexities involved in diagnosing a bleeding disorder and the rarity of a standardized protocol to handle such patients contribute to this problem. This article prescribes a simple protocol to diagnose bleeding disorders and a modified scheme for endodontic and periodontal therapy in a hemophiliac patient.

Valoración por tomografía computada de los canales vasculares linguales de la mandíbula / Evaluation by computed tomography of lingual vascular canals of the mandible

Propósito: determinar la frecuencia, localización y posición de los canales vasculares linguales de la mandíbula mediante Tomografía Computada (TC) dentral y clasificarlos en base a su ubicación. Material y Métodos: se estudiaron en forma retrospectiva las TC dentales de 100 pacientes consecutivos solicitadas como evaluación previa a la colocación de implantes dentales con el fin de detectar canales vasculares linguales. Se los clasificó relacionando su localización en la mandíbula con el número de pieza dentaria presente o ausente en esa área. Resultados: todos los pacientes presentaron al menos un canal vascular lingual en la mandibula; 36 pacientes tuvieron dos, ocho pacientes tres y un paciente cuatro. La localización más frecuente fue entre las piezas 31 y 41. Dieciséis pacientes mostraton dos canales (superior e inferior) en esa ubicación. La segunda localizción por frecuencia fue entre las piezas 32 y 33 (nueve pacientes). Conclusión: la TC dentral es un excelente método para la identificación de canales vasculares linguales por su capacidad multiplanar y apropiada resolución de imagen. La caracterización y clasificación de estos conductos, mediante un método de fácil lectura para radiólogos y dentistas, aseguran una correcta valoración prequirúrgica evitando hemorragias durante la perforación de la mandíbula en la colocación de implantes dentales.

Local hemostatic technic using a celluloid splint in bleeding disorders.

Controlling hemorrhage from dental treatment in bleeding disorder patients is one of the most serious procedures encountered by the dentist. In the Dental Division, Ramathibodi hospital, dentists use local hemostatic technics combined with replacement therapy, local hemostatic agents and antifibrinolytics in the management of bleeding disorders in dental patients, such as leukemia, ITP, hemophilia. Celluloid splints as an adjunct therapy is very beneficial in controlling hemorrhage in dental procedures as shown by 5 years experience with 278 patients. The advantages are: less expensive, lesser days hospitalized, better outcomes. Presently it is used as a routine technic in dental treatment.