Surgical Complications MCQ

Even a routine extraction has recognized complications, and the difference between a confident operator and an anxious one is knowing the common ones, how to prevent them, and how to manage them. Dry socket is severe pain a few days later from a lost clot and is treated by irrigation and a dressing, not antibiotics. Bleeding is controlled by local measures first. Nerve injuries (the inferior alveolar and lingual nerves) are usually transient and observed. The maxillary sinus is at risk during upper molar extraction (oroantral communication and displaced roots), and a handful of other complications (tuberosity or mandible fracture, infection, and MRONJ at the extraction site) round out the list. Recognition and a calm, stepwise response are what matter.

Dry Socket (Alveolar Osteitis)

• Dry socket (alveolar osteitis) is the loss or breakdown of the blood clot, exposing the bony socket; it is not a true infection.
• It presents as severe, throbbing pain that begins a few days (classically 3 to 5) after the extraction, not immediately, often with a foul odor or taste and an empty-looking socket with exposed bone.
• Risk factors include mandibular third molar extraction, smoking, oral contraceptive use, traumatic extraction, and poor oral hygiene.
• Management is gentle irrigation and placement of a medicated (sedative) dressing with analgesics; antibiotics are not the primary treatment because it is not an infection, and prevention focuses on atraumatic technique and avoiding smoking and straws.

Bleeding and Hemorrhage

• Post-extraction bleeding is first managed with local measures: firm gauze pressure, sutures, and hemostatic agents (oxidized cellulose, gelatin sponge), with a tranexamic acid rinse if needed.
• Bleeding is described by timing: primary (during surgery), reactionary (within hours, as the vasoconstrictor wears off and vessels reopen), and secondary (days later, often associated with infection).
• Bleeding that is difficult to control should prompt consideration of an undisclosed bleeding disorder or anticoagulant use.
• Local control comes first; systemic workup and referral follow if local measures fail or a bleeding disorder is suspected.

Nerve Injury

• The inferior alveolar nerve (lip and chin) and the lingual nerve (tongue sensation and taste) are the nerves most at risk during lower third molar surgery.
• Injury is described as paresthesia (altered sensation), anesthesia (absent sensation), or dysesthesia (painful or unpleasant abnormal sensation).
• Most injuries are mild stretch or compression (neurapraxia) and resolve over weeks to months; management is reassurance, documentation, and monitoring.
• Persistent or severe sensory deficits (or a known transection) warrant referral for specialist evaluation and possible microsurgical repair.

The Maxillary Sinus: Oroantral Communication and Displaced Roots

• Extraction of maxillary posterior teeth, whose roots can lie close to or within the maxillary sinus, risks an oroantral communication (an opening between the mouth and the sinus).
• An oroantral communication is detected by the Valsalva (nose-blowing) maneuver showing air or bubbling at the socket, or by passage of fluid between the mouth and nose.
• Management depends on size: a small communication (about 2 mm or less) often heals under a stable clot, while a larger one needs primary closure or a flap; the patient is told not to blow the nose or probe the site, which can convert it into a chronic oroantral fistula.
• Over-aggressive root retrieval from an upper molar can displace a root into the maxillary sinus, which then must be retrieved (often with referral).

Other Complications: Fracture, Infection, and MRONJ

• A maxillary tuberosity fracture can occur during upper molar extraction, and a mandibular fracture is a rare complication of removing deeply impacted teeth; management ranges from stabilization to repair.
• Postoperative infection is relatively uncommon after routine extraction; a localized infection is managed locally, while a spreading infection may need drainage and antibiotics.
• A spreading infection involving the submandibular, sublingual, and submental spaces (Ludwig's angina) is an airway-threatening emergency that requires urgent recognition and referral.
• In a patient on antiresorptive therapy, a non-healing extraction site with exposed bone raises the concern of medication-related osteonecrosis of the jaw (MRONJ); the prevention and risk stratification are covered in the patient-evaluation module.