Management of complications in oral and maxillofacial surgery

Cover
Title Page
Copyright Page
Contents
Preface
List of Contributors
Chapter 1 Ambulatory Anesthesia
	Introduction
	Prevention of Complications in Ambulatory Anesthesia
		Patient Characteristics/Selection
		Procedure Characteristics/Selection
		Patient Screening
		Intraoperative Patient Monitoring
		Personnel Preparedness
		Equipment and Emergency Supplies
		Postoperative Monitoring
	Incidence of Complications in Ambulatory Anesthesia
	Neurological Complications
		Syncope
		Oversedation
		Seizures
	Cardiopulmonary Complications
		Respiratory Depression and Respiratory Arrest
		Laryngospasm, Bronchospasm, and Acute Asthma
		Aspiration
		Preoperative Fasting Period (NPO Guidelines)
		Acute Vascular Events
		Cardiac Arrhythmias
		Hypertension and Hypotension
	Gastrointestinal Complications
		Nausea and Vomiting
	Endocrine Complications
		Hypoglycemia
		Adrenal Crisis
	Immunological Complications
		Hypersensitivity Reactions
	Psychiatric and Emotional Complications
	Complications Related to Patient Positioning
	Complications Related to IV Line Placement
	Anesthetic Complications in Pediatric Patients
		Pediatric Respiratory Complications
		Pediatric Cardiovascular Complications
		Other Pediatric Complications
	Prevention and Management of Pediatric Anesthetic Complications
	References
Chapter 2 Third Molar Surgery
	Introduction
	Management of Complications in Third Molar Surgery
		Alveolar Osteitis
		Infection
		Bleeding/Hemorrhage
		Mandibular Fracture
		Oral–Antral Communication
		Injury to Adjacent Teeth/Wrong Tooth Extraction
		Injury to Adjacent Osseous Structures
		Pain and Swelling
		TMJ Injury
		Displacement of Teeth
		Aspiration/Ingestion
		Neurological Complications
		Osteomyelitis
		Instrument Breakage/Foreign Body Displacement
	Conclusions
Chapter 3 Implant Surgery
	Introduction
	Pre-Operative Planning
		Patient Assessment
		Clinical Examination
		Virtual Surgical Planning
		Prosthodontic and Surgical Treatment Planning
	Intra-Operative Complications
		Nerve Injury
		Damage to Adjacent Teeth
		Implant Displacement and Migration
		Dental Implant Aspiration
		Dental Implant Ingestion
		Bleeding
		Air Embolism
		Mandible Fracture
	Post-Operative Complications
		Infection
		Peri-implantitis
		Implant Fracture
	Zygomatic Implant Complications
	Conclusions
	References
Chapter 4 Technology and Navigation in Oral and Maxillofacial Surgery
	Introduction
	Data Acquisition Phase Complications
		Preoperative CT Not Taken Using Correct Parameters/Incorrect Postprocessing
		Inadequate/Incorrect Records
	Preoperative Planning Complications
		Complications from Errors Made During Preoperative Planning Phase
	Manufacturing Complications
		Inaccurately Manufactured 3D Materials
	Surgery Phase Complications
		Patient-Specific Cutting Guide or Splint Does Not Fit
		Patient-Specific Implant Does Not Fit
	Intra- and Postoperative Assessment Complications
	Intraoperative Imaging Complications
		Intraoperative CT Does Show Area of Interest
	Navigation Complications
	Position of Virtual Pointer on Monitor Does Not Reproduce the Position of Instrument on the Patient
	Dental Implants, Technology, and Associated Complications
		Unstable or Uncomfortable Fit of Patient Tracker
		Inaccurate Fit of Patient Tracker
		Line-of-Sight Between Cameras and Tracking Arrays Is Blocked
		Dislodgement of Restorations, Including Crowns, Bridge, or Fillings
		Dislodgement of Patient Tracker
		Implant or Osteotomy Is Poorly Positioned
		Direct Injury to Inferior Alveolar Nerve
		Injury to Adjacent Soft Tissues
		Poor Bone Quality at Implant Site
	Conclusions
	References
Chapter 5 Maxillofacial Trauma
	Soft Tissue Injuries
		Animal Bites
		Parotid Duct Injury
		Peripheral Facial Nerve Injury
		Nasolacrimal Injury
		Ectropion
		Entropion
	Hard Tissue Injuries
		Mandibular Fractures (Symphysis, Body, Angle)
		Principles of Rigid Internal Fixation
		Teeth in the Line of Mandible Fractures
		Infection
		Malunion/Malocclusion
		Mandibular Angle Fractures
		Nonunion
		Atrophic Edentulous Mandibular Fractures
		Mandibular Widening
		Facial Asymmetry
		Mandibular Condyle Fractures
		Malunion/Malocclusion
		Facial Asymmetry
		Mandibular Hypomobility/Temporomandibular Joint Ankylosis
		Facial Nerve Injury with Approaches or Intraoral Approaches to the Mandible
		Trigeminal Nerve Injuries
	Frontal Sinus Fractures
		Principles of Frontal Sinus Management
		Infection/Sinusitis
		Complications of Sinusitis
		Frontal Osteomyelitis
		Cerebrospinal Fluid Leak
		Esthetic Deformity
	Orbital Fractures
		Orbital Blow-out/Blow-in Fractures
		Limitation of Extraocular Muscle Movements
		Enophthalmos
		Eyelid Malposition
		Cranio-orbital Fractures
	Orbitozygomaticomaxillary Complex Fractures
		Malar Flattening
		Neurosensory Complications
	Ocular Trauma
	Nasoorbitoethmoidal Fractures
		Telecanthus
		Nasolacrimal Duct Obstruction
		Cosmetic Deformity/Saddle Nose Deformity
	Nasal Fractures
		Septal Hematoma
		Epistaxis
		Cosmetic Deformities/Saddle Nose Deformity
		Nasal Airway Obstruction/Septal Deviation
		Scarring
	Maxillary Fractures
		Malocclusion
		Facial Widening
		Sinusitis
		Hemorrhage
	Temporal Bone Fractures
	Tracheostomy
	Conclusions
Chapter 6 Orthognathic Surgery
	Preoperative Complications
		Diagnosis
		Motivation
		Medical Issues
		Airway Issues
		Orthodontic Preparation
		Dental Issues
	Intraoperative Complications
	Maxillary Surgery: Intraoperative Complications
		Dental Trauma
		Soft Tissue Issues
		Fixation Issues
		Maxillary Downfracture
		Maxillary Mobilization and Repositioning
		Hemorrhage
		Nerve Injury During Le Fort Osteotomy
		Airway Compromise
	Genioplasty
		Preoperative Phase
		Perioperative Phase
		Postoperative Phase
	Mandible: Intraoperative Complications
		Intraoral Vertical Ramus Osteotomy
		Sagittal Split Ramus Osteotomy
	Variations of Mandibular Osteotomies
		“Midline” Split of the Mandible
		Anterior Segmental Osteotomy
		Intraoperative Anesthesia-Related Issues
		Airway Complications
		Hypotensive Anesthesia
		Emergence from Anesthesia in the Operating/Recovery Room
	Postoperative Complications of Orthognathic Surgery (Figure 6.15)
		Short Term
		In the Recovery Room
		Bleeding
		Blindness
	First Week Postsurgery
		Malocclusions
		Pain
		Edema
		Nausea and Vomiting
		Psychological
		Neurological
		Nutrition
		Wound Healing
	First Month
		Hardware Failure
		Bleeding/Hemorrhage
		Nasal and Sinus Complications
		Hearing
		Devitalized Teeth
		Range of Motion
		Splints
		Transverse Issues
		Sequestrum Formation
		Hardware
		Neural Issues
		Orthodontic Issues
		Patient Satisfaction
		Snoring and Obstructive Sleep Apnea
		Long-Term Complications
		Stability
		Permanent Cranial Nerve Damage
		Cranial Nerve VII
	The Temporomandibular Joint: Internal Derangement of the TMJ and Idiopathic Condylar Resorption
		Pitfalls of Virtual Surgical Planning for Orthognathic Surgery
	Conclusions
Chapter 7 Distraction Osteogenesis
	Introduction
	Preoperative Planning Phase
		Patient Selection
		Distraction Vector Planning
	Intraoperative Phase
		Neurological and Dental Injury
		Incomplete Osteotomy and Improper Device Placement
	Postoperative Phase
		Device Failure
		Inadequate Distraction
		Infection
		Inadequate Bony Regenerate
	Conclusions
	References
Chapter 8 Obstructive Sleep Apnea Surgery
	Introduction
	Complications with Palatal Procedures
	Complications with Genioglossus Advancement and Hyoid Suspension
	Complications with Maxillomandibular Advancement
	Intraoperative Complications in Maxillomandibular Advancement
		Excessive Bleeding
		Bad Split
		Malocclusion
	Postoperative Complications in Maxillomandibular Advancement
		Early Medical Complications
		Infections
		Malocclusion
		Hardware Failure/Malunion/Nonunion
		Paresthesia and Dysesthesia
		Temporomandibular Joint Disorders
		Facial Aesthetic Changes
	Transoral Robotic Surgery
	Distraction Osteogenesis
	Hypoglossal Nerve Stimulation
	Conclusions
Chapter 9 Cleft and Craniofacial Surgery
	Introduction
	Complications in Cleft Lip and Nose Repair
		Early Complications
		Late Complications
		Cutaneous Lip Problems
	Complications in Palatoplasty Procedures
		Palatoplasty Procedures and Outcome Differences
		Perioperative Complications of Cleft Palate Repair
		Management of Palatal Fistulas
		Operative Techniques for Closure of Palatal Fistulas
		Growth After Palatoplasty
		Management of Velopharyngeal Dysfunction
		Operative Techniques for Treatment of VPI
		Complications Related to Surgical Procedures for VPI
	Complications of Craniofacial Surgery
		Intraoperative Complications of Craniofacial Surgery
		Late Postoperative Complications of Craniofacial Surgery
Chapter 10 Minimally Invasive Cosmetic Facial Surgery
	Introduction
	Complications of Neurotoxins
		Bruising and Swelling
		Injection Site Pain
		Brow, Eyelid Ptosis, Oral Incompetence
		Immune/Allergic Reactions, Systemic Absorption
	Complications of Injectable Fillers
		Inappropriate Placement of Filler, Early and Late Visible Irregularities
		Tissue Necrosis/Blindness
		Discoloration and Granuloma Formation
		Chemical Peels and Laser Skin Resurfacing
		Erythema and Pruritis
		Scars
		Hyperpigmentation or Hypopigmentation
		Infection
		Milia and Acne Eruption
	Conclusions
Chapter 11 Cosmetic Facial Surgery
	Introduction
	Surgical Facial Cosmetic Procedures
		Blepharoplasty
		Edema, Ecchymosis, Conjunctival Irritation, and Corneal Abrasion
		Corneal Abrasion and Superficial Punctate Keratitis
		Ectropion, Entropion, Lid Shortening, Poor Lid Seal, and Ptosis
		Dry Eyes
		Acute Angle Glaucoma
		Retrobulbar Hematoma
		Blindness
		Infection
	Brow Lift Procedures
		Bleeding and Hematoma Formation
		Postoperative Pain
		Edema
		Neurosensory Disturbances
		Incisional Alopecia
		Facial Nerve Weakness
		Relapse of Brow Ptosis
	Facelift, Neck Lift, and Submental Liposuction Procedures
		Hematoma
		Facial Nerve Injury
		Superficial Epidermolysis
		Neurosensory Disturbances
		Contour Irregularities
		Pixie-Ear Deformity
	Facial Implant Procedures
		Infection
		Bone Resorption and Visible Implant
		Implant Mobility
		Neurosensory Disturbances
	Rhinoplasty
		Bleeding
		Infection
		Airway Obstruction
		Intracranial Communication
		Open Roof Deformity
		Saddle Nose Deformity
		Pollybeak Deformity
		Bossae and Unitip Deformity
		Rocker Deformity, “Inverted-V” Deformity, and “Keel” Deformity
	Conclusions
	References
Chapter 12 Temporomandibular Joint Surgery
	Introduction
	Preoperative Complications
		Inappropriate Diagnosis and Treatment
	Intraoperative TMJ Surgery Complications
		Minimally Invasive TMJ Surgery and Arthroscopic Complications
		Minimally Invasive – Instrumentation Complications
		Minimally Invasive – Neurological Injuries
		Open TMJ Arthroplasty Procedures
		Postoperative Complications
		Malocclusion (Algorithm 12.4)
		Implant Failure
		Hypomobility and Ankylosis (Heterotopic Ossification)
	Conclusions
	References
Chapter 13 Ablative Oral/Head and Neck Surgery
	Introduction
	Complications Related to Ablative Surgery for Malignant Tumors
		Predictive Factors
		Advanced Age
		Compromised Nutritional Status
		Medical Comorbidity
		Treatment-Related Factors
	Complications
		Treatment Failure
		Second Primary Disease
		Neurological Dysfunction
		Wound Infection
		Chylous Fistula
		Wound Dehiscence and Exposure of Reconstruction Bone Plates
	Complications Related to Ablative Surgery for Benign Tumors
		Predictive Factors
		Recurrence
		Nerve Injury
	References
Chapter 14 Lip Cancer
	Introduction
	Diagnosis/Staging
	Complications Associated with Lip Reconstruction
		Wound Dehiscence
		Microstomia
		Neurological Injury
	Scarring and Poor Cosmetic Outcome
	Complications Related to Radiation Therapy
	Conclusions
Chapter 15 Dermatopathology and Skin Cancer
	Introduction
	Management of Complications in the Acute Healing Stage
		Hematoma
		Infection
		Flap Failure
		Wound Dehiscence
		Tumor Recurrence
		Hyper/Hypopigmentation
		Surface Irregularities
		Hypertrophic Scars, Unaesthetic Scar, and Keloid
Chapter 16 Hard Tissue Reconstruction
	Introduction
	Patient Factors in Complications
		Perioperative Comorbidity
		Nutritional Status Issues
		Intraoral Wound Dehiscence
		Nasogastric Tube Placement Complications
		Effects of Diabetes Mellitus and the Use of Corticosteroids
		Nicotine Effects
		Risks of Blood Transfusion
	Hard Tissue Graft Options and Considerations
		Autogenous Bone
		Sinus Bone Graft Failure
		Allografts and Xenografts
	Bone Morphogenetic Proteins
		Swelling Associated with Bone Morphogenetic Proteins
	Specific Donor Site Morbidity and Complications
		Intraoral Donor Sites
		Intraoral Donor Site Wound Dehiscence
		Iliac Crest Harvest Site
		Infection at Iliac Crest Harvest Site
	Calvarial Bone Grafts
		Violation of the Inner Cortical Plate
	Costochondral Grafts
		Pain and Atelectasis
		Violation of the Pleura
		Tibial Bone Grafts
		Persistent Exposed Segment of Nonviable Bone Graft
	Hardware in Hard Tissue Reconstruction
		Distraction Osteogenesis
		Distractor Hardware Failure
		Fixation Schemes
		Fixation Hardware Failure
	Conclusions
	References
Chapter 17 Soft Tissue Reconstruction
	Introduction
		Total/Partial Flap Loss
		Infection
		Salivary Leak and Fistula
		Hematoma Formation
	Pedicled Soft Tissue Flaps
		Pectoralis Major Myocutaneous Flap
		Submental Island Flap
		Paramedian Forehead Flap
		Buccal Fat Pad
	Vascularized Soft Tissue Free Flaps
	Conclusions
	References
Chapter 18 Vascularized Reconstruction
	Introduction
	Fasciocutaneous and Osteocutaneous Radial Forearm Flap
		Hand Ischemia
		Radius Fracture
		Sensory/Motor Deficit
		Donor Site Skin Graft Failure
	Osteocutaneous Fibula Flap
		Foot Ischemia/Vascular Compromise
		Gait Disturbance
		Limited Great Toe Flexion
		Neurological Injuries
		Delayed Wound Healing
		Skin Paddle Loss
	Osteocutaneous Scapula Flap
		Shoulder Dysfunction
		Scapula Winging
	Osseous Iliac Crest Flap
		Ventral Hernias
		Contour Deformity
		Neurological Sequelae
		Ambulation/Gait Disturbance
	Flap Failure
		Surgical Management
		Leech Therapy
		Pharmacological Salvage
		Radiological Evaluation
	Conclusions
	References
Chapter 19 Head and Neck Radiotherapy
	Introduction
	Complications
		Xerostomia
		Trismus
		Dysphagia
		Osteonecrosis of the Mandible and Maxilla
		Soft Tissue Necrosis and Chondral Necrosis
	Conclusions
	References
Chapter 20 Microneurosurgery
	Introduction
	Lack of Functional Sensory Recovery After Nerve Repair
	Poor Patient Selection
	Difficult Surgical Access with Inability to Localize Nerve Stumps
	Iatrogenic Nerve Injury to the LN or IAN
	Inadequate Neuroma Resection
	Tension on Nerve Repair Site
	Fascicular Malalignment
	Poor Vascularity of Soft Tissue Bed
	Trismus After Nerve Repair
	Self-Induced Injury After Nerve Repair
	Iatrogenic Injury to Nerve(s)
	No Nerve Injury Identified
	Pathological Mandible Fracture
	Malocclusion and Temporomandibular Joint Issues
	Nerve Graft Complications
	Neuropathic Pain Development
	IAN Reconstruction in Ablative Mandibular Resection
	Miscellaneous Complications
	Conclusions
	Suggested Reading
Chapter 21 Transoral Robotic Surgery
	Introduction
	Sequelae and Complications: Pain
	Sequelae and Complications: Dysphagia
	Sequelae and Complications: Airway Edema
	Sequelae and Complications: Bleeding
	Sequelae and Complications: Iatrogenic Oral–Cervical Communication and Pharyngocutaneous Fistula Formation
	Sequelae and Complications: Aspiration Pneumonia
	Sequelae and Complications: Nerve Injury
	Sequelae and Complications: Others
		Trismus and Neck Spasm
		Cervical Spondylodiscitis
		Iatrogenic Dental, Corneal, and Soft Tissue Injury
	Airway Fire
	TORS “Failure to Cure”: Conversion to Open Approach or Abandon TORS Procedure
	TORS “Failure to Cure”: Inadequate Surgical Margin
		Conclusions
	References
Chapter 23 Salivary Gland Surgery
	Introduction
		Benign Conditions and Pathology
		Major Salivary Gland Surgery Complications
	Conclusions
	References
Index
EULA