2. Unintended consequences of surgery that causes harm to patient.
Occurs either
Intra operatively (or)
Post operatively
Complications in the oral and maxillofacial injuries occur regularly, even
in the most experienced of hands and should be expected.
Asok kumar RS OMFS
4. FRACTURE OF THE TEETH /ROOT DURING EXTRACTION
Causes
Application of the wrong forceps
Improper application of the forceps
Improper application of force
Prevention
Proper radiographic assessment of the degree of carious
involvement .root of the teeth and the condition of the
surrounding bone.
Proper application of the forceps and proper application of the
force.
Forceps with slender beaks and reamers used to retrieve roots
Asok kumar RS OMFS
5. FRACTURE OF THE ALVEOLUS
PREVENTION
Proper radiographic assessment of the tooth and the surrounding alveolar
structure.
Proper application of the forceps and elevators.
Avoid exertion of excessive force.
FRACTURE OF TUBEROSITY
PREVENTION
Take radiographs before extraction to assess the condition of the third
molar and surrounding structures.
Avoid the exertion of inadvertent force.
Support the alveolus during extraction
Asok kumar RS OMFS
6. EXTRACTION OF WRONG TEETH
MANAGEMENT
Inform the patient
Replace the tooth inside the socket as soon possible and splint.
If immediate replacement is not possible, place the tooth in a proper medium
like saliva, milk or water.
Follow up as for re-implantation.
INSTRUMENT BREAKAGE
Prevention
Proper selection of the instrument
Proper handling and usage Asok kumar RS OMFS
7. Prevention
Proper radiographs should be taken before the extraction to assess the proximity of
the root tip to the sinus
Application of appropriate force to teeth.
Avoid injudicious instrumentation to remove a broken root tip.
Support the jaw and the alveolus adequately before extraction.
Management
Confirm the presence and location of the tooth or root tip in the sinus using
radiograph and retrieved by
Powerful suction devise at the entrance of the fistula to recover tooth
Caldwell-Luc operation.
Asok kumar RS OMFS
9. FRACTURE OF MANDIBLE
Causes:
Atrophic mandible as in old age.
Existence of any bony pathology.
Excessive force application
In case of removal of vertically impacted third molar.
Prevention:
Inform and reassure the patient
Proper preoperative assessment of the type of impaction and the density of the bone before
extraction
Proper support of the jaw during extraction
Application of adequate force
Management:
ORIF of the fracture Asok kumar RS OMFS
10. LUXATION OFADJACENT TOOTH
Prevention
Proper technique and careful handling of the instruments
Support the adjacent teeth adequately before extraction
INJURY TO INFERIOR ALVEOLAR NERVE
DISLOCATION OF CONDYLE
Prevention
Proper exertion of adequate force
Support the mandible during extraction
Management
Nilaton’s technique
Barton bandage
Luxation of adjacent tooth Nerve injury
Nilaton’s technique Barton bandage
Asok kumar RS OMFS
11. Transient loss of consciousness associated with inability to maintain postural tone.
Asok kumar RS OMFS
13. Abrasions or burns of lips and corners of mouth usually occurs due to rotating
shank of the burs Management
MANAGEMENT
Application of petroleum jelly or topical antiseptic/analgesic.
Duration to heal :5 to 10 days
Tearing of Mucosal Flap Puncture wound of soft tissue Abrasion injury
Asok kumar RS OMFS
14. Type of bleeding:
i. Primary Hemorrhage: Occurs at the time of trauma or surgery.
ii. Reactionary Hemorrhage: Occurs within 24 hours of trauma or operation.
iii. Secondary Hemorrhage: Occurs after 7 – 14 days of trauma oroperation.
Prevention
Proper medical history of the patient should be taken
Investigations such as prothrombin time (PT), partial thromboplastin time
(PTT),INR, bleeding time, clotting time should be performed.
MANAGEMENT:
Mechanical method
Firm pressure
Hemostat
Suture and ligation Asok kumar RS OMFS
15. Local Hemostatic agent
Absorbable gelatin sponge. (e.g.Gelfoam)
Oxidized regenerated cellulose.(e.g. Surgicel)
Liquid preparation of topical thrombin.
Adrenaline , Tranexmeic acid
(prepared from bovine thrombin)
Collagen. (e.g. micro collagen- Avitene, plug type
collagen-Collaplug, tape type collagen- Collatape)
Damp tea bag. (tannic acid in tea stops bleeding)
Bone wax (Bleeding from bone)
Asok kumar RS OMFS
16. WOUND DEHISCENCE
Separation of the layers of a surgical wound
It may be partial or complete with separation of all layers and total
disruption.
PREVENTION OF WOUND DEHISCENCE
Use aseptic technique.
Perform atraumatic surgery.
Close incision over intact bone.
Suture without tension
Asok kumar RS OMFS
17. Preventive measures
Preoperative oral hygiene measures to reduce plaque levels.
Avoid extracting lower third molars in the presence of active infection or
ulcerative gingivitis.
Appropriate antibiotic prophylaxis should be administered
Advised to avoid vigorous mouth rinsing for the first 24 hr post extraction
and to use gentle tooth brushing and mouth rinses for 7 days post
extraction.
Intra-alveolar pastes consisting of zinc oxide eugenol paste, anaesthetic
and an antibiotic (metronidazole) can be placed
Asok kumar RS OMFS
18. INFECTION
Prevention
Antibiotic prophylaxis has been shown to decrease the risk of infection in certain types of
surgery
Use disposable needles
Avoid repeated use of the same needle
Aseptic preparation of the surgical site
Management
Empirical therapy should be primarily directed against Staphylococcus (common bacterium
in the oral cavity).
Deep-seated infections require broad-spectrum antibiotics and investigation for possible
surgical intervention (incision and drainage Asok kumar RS OMFS
22. Treatment
1. Removal of the bacterial biofilm and
conditioning of the surface of the implant with
local drug delivery system(Chlorhexidine chips
(PerioChips), Local doxycycline or
metronidazole gel application).
2. Adequately maintained by oral hygiene
measures.
3. Establishment of an effective plaque control
regime.
4. Reosseointegration
Clinical features:
1. Poor oral hygiene
2. Cement retained in the subgingival
area
3. Microscopic gaps between implant
components
4. Soft tissue inflammation
5. Wide saucerization areas of bone loss
on the radiograph Asok kumar RS OMFS
30. Failure to recognize underlying skeletal
abnormality
Lack of patient co-operation
Unsatisfactory bite registration
Discrepancy in mounting the cast
Improper model surgery
Splint warpage
Management of Complications in Oral and Maxillofacial Surgery. Michael Miloro . Pg no 109-136
Asok kumar RS OMFS
31. Management of Complications in Oral and Maxillofacial Surgery. Michael Miloro . Pg no 109-136
Asok kumar RS OMFS
32. Hemorrhage –Damage to Inferior alveolar, Descending palatine,
Pterygoid plexus, facial, and sublingual vessels.
MANAGEMENT:
Bleeding can be stopped by
1. Applying pressure,
2. Bone wax
3. Resorbable hemostatic materials,
4. Epinephrine impregnated gauze packing or electrocautery.
5. Vessel ligation or angiography must be performed for large
vessel injuries to prevent secondary delayed hemorrhage
Complications associated with orthognathic surgery Young-Kyun Kim, J Korean Assoc Oral Maxillofac Surg 2017;43:3-15
Asok kumar RS OMFS
33. BAD SPLIT/SEGMENT FRACTURES
Approximately 2.3% reported during sagittal split ramus osteotomy (SSRO).
Proximal segment - buccal plate fracture
Distal segment- lingual plate fracture
Fracture frequently occur during SSRO
CAUSES AND RISK FACTORS OF SEGMENT:
1. Inadequate vertical osteotomy at the inferior border,
2. Horizontal osteotomy performed too high above the lingula,
3. Exertion of excess force and
4. Impacted third molars.
PREVENTION
Impacted teeth should be extracted 6-9 months before SSRO
Complications associated with orthognathic surgery Young-Kyun Kim, J Korean Assoc Oral Maxillofac Surg 2017;43:3-15
Asok kumar RS OMFS
34. Incidence of 1.6% reported during maxillofacial surgery
Stimulation of the maxillary branch of trigeminal nerve, greater
palatine nerve, or posterior superior alveolar nerve leads to vagus
nerve stimulation,
Bradycardia and cardiac dysrhythmia due to activation of
parasymphathetic system.
Lethal in rare cases
MANAGEMENT
Anticholinergic drugs and cardiac massage.
Prophylactic administration of 0.5 mg atropine IV, right before any
surgical manipulation known to be risky for is mandatory Asok kumar RS OMFS
35. Inappropriate separation of
the pterygomaxillary junction
Fractures extending to the
pterygoid plates, sphenoid bone,
orbital floor, optic canal
Optic nerve damage
Hemorrhage from the pterygopalatine
fossa enter the orbital cavity through the
inferior orbital fissure
Increase intraocular pressure (IOP).
VISUAL IMPAIREMENT
Asok kumar RS OMFS
36. Relapse
Neuropathic pain -21.4%
Neurologic injury
Hypoesthesia - inferior alveolar nerve, mental nerve,
incisive nerve, and the infra-orbital nerve
0.17% to 0.75%. - Facial nerve paralysis reported
Use of steroids during or after surgery can effectively
prevent temporary injuries by reducing pressure created by
edema.
If recovery does not occur within 4-8 months, re-
exploration with nerve grafting must be considered
Nerve injury
Asok kumar RS OMFS
37. NASAL MORPHOLOGY
Nose widening- Alar cinch suture technique
Nasal deviation- Managed by nasal reduction using
forceps, septoplasty, fixation of the septum caudal
portion to the anterior nasal septum through figure-of-
8 suturing
Necrosis of bony segment
Delayed union or non- union of osteotomy site
Non union
Septal deviation
Alar –cinch suture
Asok kumar RS OMFS
38. Infection
Sequestration of fragment
Temporomandibular disorder
Tooth injury
Tooth devitalisation
Sequestration of fragement
Condylar sag- Central Condylar sag- Peripheral
Asok kumar RS OMFS
39. Decrease in visual acuity
Epiphora
Extra ocular muscle
dysfunction
Neuroparalytic keratitis
Asok kumar RS OMFS
40. MAXILLARY SINUSITIS - Incidence of 0.5–4.8%
ASEPTIC NECROSIS
Avascular necrosis of the maxilla after lefort I osteotomy has been reported
Rupture of the descending palatine artery during surgery,
Postoperative vascular thrombosis,
Perforation of palatal mucosa
Stripping of palatal soft tissues to increase maxillary expansion may impair blood supply to the
maxillary segments. aseptic necrosis of the maxilla
MANAGEMENT:
Maintenance of optimal hygiene
Antibiotic therapy to prevent secondary infection
Heparinization
Hyperbaric oxygenation
Complications associated with orthognathic surgery Young-Kyun Kim, J Korean Assoc Oral Maxillofac Surg 2017;43:3-15
Asok kumar RS OMFS
41. Death (rare)- secondary hemorrhage, Venous thromboembolism, airway obstruction
Facial dysmorphia- Psychological counselling is mandatory prior to surgery
Button hole deformity in palate Inadervent fracture
Asok kumar RS OMFS
43. Surgical procedures that could lead to complications are:
1. Arthroscopic surgery
2. Open arthroplasty and
3. Total joint reconstruction.
Advent of 3-dimensional modeling, computed
tomography (CT) arteriograms, and MRI comlication of
TMJ surgeries can be minimized
Asok kumar RS OMFS
44. Branches of the superficial temporal artery
(Common), internal maxillary artery, pterygoid
plexus of veins and middle meningeal artery
(Rare) get injured during TMJ surgery
Control of hemorrhage includes direct pressure,
ligation, electrocautery, local anesthetics with
epinephrine, embolization and local hemostatic
agents.
Asok kumar RS OMFS
45. 1%- 25% - Injury to the branches of cranial nerves
V (temporal and then the zygomatic branches of
the facial nerve) and VII can take place in TMJ
surgery.
59% - Auriculotemporal nerve injuries were found
during TMJ arthroscopy.
Transient in nature resolves within 3 to 6 months.
Causes of neuropraxia include edema, excessive
flap retraction forces etc
Asok kumar RS OMFS
46. Post-arthroscopic infections includes
otitis media, joint infection and
infratemporal space infection
Laceration of the external auditory
canal, partial hearing loss ,vertigo and
perforation of the tympanic membrane
Otitis media
Perforation of tympanic
memebrane
Asok kumar RS OMFS
47. Fracture and Displacement of prosthesis
ALLERGIC REACTIONS- total joint
replacement
Fracture of prosthesis
Displacement of prosthesis
Ankylosis
Malocclusion
Asok kumar RS OMFS
52. Postoperative Complications in Head and Neck Cancer. Erikka Baehring and Ruth
McCorkle, Clinical Journal of Oncology Nursing;16(6):2012
Asok kumar RS OMFS
53. Suture line dehiscence (epidermolysis; and deep dehiscence);
Infection/suppuration;
Intraoperative and postoperative hemorrhage;
Subcutaneous emphysema;
Pneumothorax;
Salivary leakage;
Cephalic vein stasis , Bronchopneumonia
Intraoperative mortality
Arrhythmia
Prior radiotherapy affects healing. Higher doses result in more extensive fibrosis, hypoxia, and decreased
leukocyte migration.
Asok kumar RS OMFS
54. Chylous leakage : (rare) 1 to 2.5% mostly in the left side.
Nerve injuries
Accessory nerve injury - 1.68%;
Marginal mandibular nerve injury - 1.26%;
Hypoglossal nerve injury - 0.56%; and
Sympathetic cervical nerve injury - 0.42%
Mild Shoulder dysfunction: 54% Moderate shoulder
dysfunction - 15% and 8% reported Severe shoulder
dysfunction
Asok kumar RS OMFS
55. A surgeon who has not come to cross paths with complications, is
the one who has not operated enough
When a true complication occurs, early recognition, rapid response
and effective resolution is essential
Many, but not all, complications can be prevented by adherence to
proper surgical technique and established treatment protocols,
Asok kumar RS OMFS
