Iatrogenic injuries

10 Iatrogenic injuries

INITIAL PRESENTATION

Mandibular fracture.

PATIENT DETAILS

A 10-year-old, neutered male, shih-tzu.

CASE HISTORY

The dog was referred to us for management of an iatrogenic jaw fracture that had occurred the previous day during extraction of the left lower canine tooth. The referring veterinarian also indicated that he may have left a few root remnants from other extractions.

The dog had been discharged with analgesics overnight. He was extremely uncomfortable and the owners were most distressed. They had not been aware that there could be any complications associated with what they thought was a ‘simple dental cleaning and possibly a few teeth pulled’. The dog had received periodontal therapy and extraction (in fact, only a few teeth were remaining) several times during its life, with no complications. The dog had been discharged by one of the nurses and not by the veterinarian; in fact, the referring veterinarian had apparently refused to speak to the owners. In short, an unpleasant miscommunication had occurred.

ORAL EXAMINATION – CONSCIOUS

The dog was too uncomfortable for conscious oral examination to even be attempted.

ORAL EXAMINATION – UNDER GENERAL ANAESTHETIC

See the front page of the dental record (Fig. 10.1) for details of findings.

Figure 10.1 Dental record. All clinical findings are reported on the front page of the dental record. Normal periodontal probing depth (PPD) is not noted on the dental record to avoid clutter. However, when gingival recession is present, then PPDs are always recorded. True attachment loss is the sum of the recession and probing depth. Remember that periodontitis is a site-specific disease. PPD is recorded on the occlusal view of the tooth on the dental record so that you can easily identify the precise site of disease.

In summary, examination under general anaesthesia identified the following:

1. Fracture of the left mandible level with the apex of extracted 304.

2. Advanced periodontitis of 404 (gingival recession, increased PPD) and 409 (gingival recession, increased PPD, grade III furcation). Teeth 404 and 409 were the only ones remaining.

3. Extraction sockets (from surgery the day before) filled with coagulum (Fig. 10.2).

4. The mesial root of 309 still in the socket.

5. Lacerations of oral soft tissues, especially the ventral tongue (Fig. 10.2).

Figure 10.2 Occlusal photograph of the left mandible. The extraction sockets of 304, 308 and 309 are filled with coagulum, but the retained mesial root of 309 is evident. Note the lacerations on the tongue. These are likely to have been caused by slippage with a dental luxator or elevator.

FURTHER INVESTIGATIONS

Radiographs were taken of the right and left mandible. The upper jaw contained no teeth and the bone was covered by healthy mucosa, so radiographs were not indicated.

RADIOGRAPHIC FINDINGS

Eight films were required to visualize the left and right mandible.

The radiographs showed the following:

1. A fractured left mandible, with the fracture lines extending from the apical region of the extracted 304 to the ventral border of the mandible (Fig. 10.3).

2. A crown remnant of 305 (Fig. 10.3).

3. Partial extraction of 309; the mesial root was still in place in the socket (Fig. 10.4).

4. Partial extraction of 408; there were both mesial and distal root remnants (Fig. 10.5a, b).

5. Periodontitis (alveolar bone loss, furcation exposure) of 409 (Fig. 10.5b).

Figure 10.3 Radiograph of the left mandibular fracture. The fracture originates level with the apex of the extracted 304. There is one fracture line through the alveolar bone and two fracture lines extending to the ventral border of the mandible. Note the retained crown portion of 305.

Figure 10.4 Radiograph of the retained mesial root of 309. The retained mesial root was also evident on clinical examination.

Figure 10.5 Radiographs of partially extracted 408. While both mesial and distal root remnants are obvious in the view in (a), a second view (b) was taken to fully visualize the retained distal root. This view clearly depicts the retained distal root of 408 as well as tooth 409. Note the horizontal bone loss and furcation exposure of 409.

Tags: Saunders Solutions in Veterinary Practice Small Animal Dentistry

Sep 3, 2016 | Posted by admin in SMALL ANIMAL | Comments Off

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