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Fracturas da mandíbula e extracção de terceiros molares
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A prática de cirurgia oral e maxilofacial contemporânea deve sempre incluir o uso de um consentimento detalhado e informado, designado para instruir o paciente acerca dos riscos e complicações e possibilitar que este contribua para o processo de tomada de decisão da cirurgia, também prevenir uma litigação de má conduta. A discussão de riscos e complicações, embora pouco comuns, devem ser incluídas tanto nas discussões de riscos/ benefícios antes da operação, como nas instruções após a operação. Embora outras complicações tenham sido extensivamente estudadas e relatadas, a incidência e causas das fracturas mandibulares após a extracção de terceiros molares não o foram, principalmente as fracturas mandibulares tardias. Uma fractura mandibular patológica, depois da remoção do terceiro molar, é uma complicação rara. Mas são várias as razões que podem levar à fractura da mandíbula aquando da extracção dos terceiros molares, tais como: O enfraquecimento do osso mandibular com o decréscimo da elasticidade durante o avançar da idade, a elevada força com que se morde/mastiga, o tipo de impactação do terceiro molar, a idade do paciente, o sexo, o uso de instrumentos inapropriados, uma má panificação do caso clínico, o descuido e não seguimento dos conselhos por parte dos pacientes. A fractura mandibular é, entre todas as fracturas faciais, a mais frequente e pode ser causada por várias razões entre as quais a remoção de dentes que na maioria dos casos se encontram inclusos. Os princípios básicos para o tratamento da fractura mandibular consistem em redução, contenção e imobilização dos segmentos fracturados. A escolha terapêutica depende da severidade do caso e domínio da técnica escolhida pelo profissional.
Contemporary oral and maxillofacial surgery practice must always include the use of a detailed and informed consent designed to educate the patient about the risks and complications and enable him to contribute to the decision-making process about surgery, as well as to prevent malpractice litigation. Discussion of late risks and complications, though relatively uncommon, should be included both in the preoperative risk/benefit discussions and in the postoperative instructions. Although other complications have been extensively studied and reported, the incidence and causes of mandibular fractures following the removal of third molar have not, specially late mandibular fractures. A pathological mandibular fracture following third molar removal is a rare complication. However, the reasons that can lead to the fracture of the mandible when extracting third molars are various: weakening of the mandibular bone as a result of the decrease in its elasticity during advancing age, enhanced biting force, type of impaction, the pacient’s age and gender, the use of inappropriate instruments, a miss planning of the clinical case, the patient failing to follow the instructions and recommendations of the surgeon after the operation. The mandibular fracture is, of all the facial fractures, the most frequent and can be caused by several reasons, among which the removal of teeth that in most cases are enclosed. The basic principals for the treatment of mandibular fractures consist in reduction, contention and immobilization of the fractured segments. The therapeutic choice depends on the severity of the case and domination of the technique chosen by the professional.
Contemporary oral and maxillofacial surgery practice must always include the use of a detailed and informed consent designed to educate the patient about the risks and complications and enable him to contribute to the decision-making process about surgery, as well as to prevent malpractice litigation. Discussion of late risks and complications, though relatively uncommon, should be included both in the preoperative risk/benefit discussions and in the postoperative instructions. Although other complications have been extensively studied and reported, the incidence and causes of mandibular fractures following the removal of third molar have not, specially late mandibular fractures. A pathological mandibular fracture following third molar removal is a rare complication. However, the reasons that can lead to the fracture of the mandible when extracting third molars are various: weakening of the mandibular bone as a result of the decrease in its elasticity during advancing age, enhanced biting force, type of impaction, the pacient’s age and gender, the use of inappropriate instruments, a miss planning of the clinical case, the patient failing to follow the instructions and recommendations of the surgeon after the operation. The mandibular fracture is, of all the facial fractures, the most frequent and can be caused by several reasons, among which the removal of teeth that in most cases are enclosed. The basic principals for the treatment of mandibular fractures consist in reduction, contention and immobilization of the fractured segments. The therapeutic choice depends on the severity of the case and domination of the technique chosen by the professional.
Descrição
Monografia apresentada à Universidade Fernando Pessoa para obtenção do grau Licenciado em Medicina Dentária.