Oral Surgery Techniques and Complications

Needle Insertion and Retrieval

• If a needle is not fully embedded, retrieve it with a hemostat.
• Otherwise, refer the patient to an oral and maxillofacial surgeon for OPG or CT scan to locate and remove the fragment.
• Avoid inserting the needle until the hub is fully in place.
• Use a suitable gauge needle.
• Be aware of patient movement, especially children and uncooperative patients.

Intravascular Injection

• Take short notes on what was learned in the lecture and practical sessions.

Complications Associated with Jet Injectors

• Take short notes on what was learned in the lecture and practical sessions.

Neurotrophic Ulcers

• Lip mucous membrane ulcers after mandibular injection due to vasoconstrictor effects.
• Often caused by prolonged ischemia from a concentrated vasoconstrictor (epinephrine 1:50,000 or higher).
• Nor-epinephrine can also cause ulcers.
• Abscesses may form on the palate.

Desquamated Ulcers

• Resulting from superficial injections that damage the mucous membrane's upper layer forming ulcers.
• Common in areas with thin mucoperiosteum like the lingual mandible and anterior palate.

Traumatic Ulcers

• Caused by lip biting, especially in children, mentally handicapped or psychiatric patients.
• Typically self-limiting, resolving within 3 to 10 days.

Self-injuring of Lower Lip/Tongue

• Take short notes on what was learned in the lecture and practical sessions.
• Self-inflicted injuries may involve the lower lip or tongue.
• A cotton placed to protect the lip is a common solution..

Needle Breakage

• A rare complication with modern, flexible disposable needles.
• Broken needles can damage tissue or migrate (less common).
• Causes often include using old or bent needles, or jerky needle movements.

Visual Disturbances: Facial Nerve Paralysis

• Take short notes on what was learned through the lecture and practical sessions.
• Conditions like facial or partial nerve paralysis can result from anaesthetic solution reaching the facial nerve.
• This may cause symptoms such as difficulty closing the ipsilateral eye or a drooping ipsilateral upper lip.

Nausea and Vomiting

• May occur if the lesser palatine nerve is affected by the anaesthesia.
• Block the greater palatine nerve anterior to the foramen to limit this effect.

Ischemia (Bleaching)

• Take short notes on what was learned through the lecture and practical sessions.
• Bleaching of tissues at or distal to the injection site might be observed. Take notes .

Sloughing of Tissues and Ulcers

• Possible causes include allergic reactions (cotton roll), excessive cleaning, or topical anaesthetic intolerance using tinctures of iodine.

Failure to Obtain Anaesthesia

• Infiltration: solution deposited too far from the bone, or penetrating deeply into soft tissues.
• Intra-block (block LA): problems similar to infiltration, but also include insufficient anatomy knowledge, individual variations, or inappropriate insertion site.

Prolonged Anaesthesia (Paresthesia)

• Take notes on what was learned through the lecture and practical sessions.
• Abnormal sensation including tingling, pricking, or numbness.
  • Can last for one to three months.
  • If ongoing, surgical repair might be necessary.

Facial Nerve Paralysis

• Take short notes on what was learned in the lecture and practical session.
• Facial nerve may damage from incorrect insertion or contaminated materials causing nerve paralysis

Hematoma

• Take short notes on what was learned in the lecture and practical session.
• May result from traumatic injection, contaminated solution, or allergic mechanisms.

Infection

• Can be caused by a contaminated needle or injecting into an inflamed area.
• Trismus (difficulty opening the mouth) may result.
• Antibiotics should be given.

Postanesthetic Lesions

• May include recurrent aphthous ulcers. Take notes

Local Complications of Local Anaesthesia

• Pain or burning during injection
• Swelling (edema)
• Take notes on what was learned in lecture and practical sessions.
• Classification of complications (primary/secondary, mild/severe, transient/permanent).
• Factors attributed to solution (toxicity, allergy, idiosyncrasy, etc), or to needle insertion (pain, swelling, haematoma, ecchymosis, nerve damage etc.)
• Steps to avoid complications.