Postoperative complaints following impacted mandibular third molar surgery in Ile-Ife, Nigeria.

An investigation into the pattern of complaints lodged by patients after impacted mandibular third molar surgery was done in a Nigerian teaching hospital over a period of 3 years. One hundred and twenty seven records were retrieved. Pericoronitis (71.2%), pulpitis (17.6%) and periodontitis (11.2%) were the reasons for surgery. No third molar surgery was done for prophylactic or orthodontic reasons. Sixty-one complaints were lodged by 49 (38.6%) patients on day 1, and 37 complaints by 35 patients on day 7. These complaints were verified by the findings of the examining clinician. Pain, swelling and trismus were the commonest complaints. A significant association (P = 0.042) was found between patients' complaints on the first postoperative day and the drug combination given. Similarly, there was a significant relationship (P = 0.0055) between the type of analgesics prescribed and the presence of postoperative pain. No significant relationship was however found between the complaints and patients' age, indication for extraction, impaction type and method of impacted tooth removal. Although the findings of this retrospective study are limited in their comparability, they suggest the need for an appraisal of pain management in patients undergoing mandibular third molar surgery in our hospital. Consequently, there should be a reduction in complaint rate thereby making selective review appointment on the first postoperative day feasible.

Necrotising fasciitis of the head and neck: a review of the literature.

Necrotising fasciitis is a severe life threatening bacterial infection of the fascial planes which is relatively rare in the head and neck region. The hallmark of the disease is selective necrosis of the fascia overlying skin and adjacent vasculature. Primary odontogenic infection due to aerobes and obligate anaerobes and trauma amongst other factors, are frequently responsible for this condition. Similarly, affected individuals often have an underlying systemic disease, the most common of which is diabetes mellitus. Treatment usually involves appropriate antimicrobial therapy, control of systemic disease, thorough surgical debridement, gamma globulin administration and hyperbaric oxygen where facilities exist. Significant morbidity and mortality attends necrotising fasciitis when treatment is delayed due to toxaemia, dehydration and severe biochemical disturbances. Prompt diagnosis, adequate resuscitation, thorough and frequent surgical debridement remains the cornerstone to a successful outcome.