Are there difficulty variables in maxillary third molar surgery? A prospective observational cohort study.

BACKGROUND: The main aim of the present study was to assess which factors were related to surgical difficulty in maxillary third molar extraction. Intra- and postoperative complications were also evaluated. METHODS: A prospective observational cohort study was performed on out-patients who underwent impacted maxillary third molar extraction. Principal component analysis and multiple linear regression were used to assess the correlation among variables as well as the influence of different preoperative variables on surgical difficulty, suture duration and risk of intraoperative complications. RESULTS: Eighty-six teeth were extracted. There was a positive correlation between pre- and postoperative evaluations and surgery duration. Available space for surgical access in the upper fornix, second molar contact, crown palatal position, depth of the elevation point and surgeon's seniority had a significant effect on the overall difficulty index. Risk of intraoperative complications increased considerably as the percentage of reduction of maximum mouth opening increased (2.03±0.98) as well as in cases in which ostectomy and tooth sectioning were performed (7.02±2.68). The surgeon's seniority was associated with a decreased risk of intraoperative complications (-1.52±0.72). Surgeons were able to predict the difficulty of surgery only to a limited extent. CONCLUSIONS: The percentage of maximum mouth opening reduction with an object in the fornix, crown palatal position, and contact with the second molar were found to be related to surgical difficulty.

A Prospective Observational Study on the Variables Affecting the Risk of Inferior Alveolar Nerve Damage During Lower Third Molar Surgery With Nerve/Root Proximity.

PURPOSE: The present study aimed to evaluate which factors were statistically associated with a greater probability of inferior alveolar nerve (IAN) damage during lower third molar surgery. METHODS: A prospective observational study was performed at the Oral Surgery Unit of the Umberto I Hospital on 92 patients who underwent surgical extraction of a lower third molar that was radiographically overlapped with the mandibular canal. All surgeries were performed by the same expert surgeon. A principal component analysis and the exact 2-tailed Fisher exact test were used. RESULTS: Temporary IAN damage occurred in 10 cases (10.9%). Symptoms lasted from 18 to 180 days (73 ± 49.15). IAN damage was more frequent in difficult and long-lasting surgeries, in the presence of many risk factors and in patients with a reduced maximum mouth opening. CONCLUSION: Such factors should be accurately evaluated before surgery to assess and discuss the overall surgical risk of IAN damage with the patient especially when they are over the maximum limit of their significant variability range found in the present study, that is, >12 for difficulty index, >2 for number of orthopantomography risk markers and <3.7 cm for maximum mouth opening.

A complex case of fatal calciphylaxis in a female patient with hyperparathyroidism secondary to end stage renal disease of graft and coexistence of haemolytic uremic syndrome.

BACKGROUND: Calciphylaxis is a potentially fatal complication of persistent secondary hyperparathyroidism; its cause is still not clear. Unfortunately there is no close relation in severity of clinical picture, serological and pathological alteration. For this reason the prognosis is difficult to establish. Administration of sodium thiosulphate may reduce the precipitation of calcium crystals and improve the general clinical conditions before surgical parathyroidectomy, which seems the only therapeutic approach able to reduce the mortality risk in these patients. METHODS AND RESULTS: A 60 year old female patient suffering from End Renal Stage Disease, on haemodialysis from 2001 due to the onset of haemolytic uremic syndrome, underwent a kidney transplant in April 2008. After transplantation there was a recurrence of the haemolytic uremic syndrome, with temporary worsening of the graft. Six months later there was a definite loss of graft and return to dialysis treatment. On April 2010 a severe systemic calciphylaxis related to secondary hyperparathyroidism was diagnosed. The patient underwent parathyroidectomy but, because of the unimproved clinical picture, treatment with sodium thiosulphate was initiated. There was only improvement in cutaneous lesions. The worsening general clinical condition of the patient caused death due to general septic complications. CONCLUSIONS: The coexistence of haemolytic uremic syndrome and secondary hyperpathyroidism makes the prognosis poor and, in this case, therapy, which counteracts calcium crystals precipitation, has no effect. Preventive parathyroidectomy can be considered as the only possible treatment.