Wednesday, May 17, 2017

Dentoalveolar injury related to general anesthesia: A 14 years review and a statement from the surgical point of view based on a retrospective analysis of the documentation of a university hospital.

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Amir Yavari                                                                                   Date: 5/18/2017

Article Title:  
Dentoalveolar injury related to general anesthesia: A 14 years review and a statement from the surgical point of view based on a retrospective analysis of the documentation of a university hospital.
Author(s):  Adolphs N, Kessler B, Heymann C, Achterberg E, Spies C, Menneking H, Hoffmeister B
Journal:  Journal of Dental Traumatology
Date: 2011
Type of Article: Systematic review and meta-analysis

Main Purpose: Evaluate dentoalveolar injury related to general anesthesia.


Introduction:
Damage to dentoalveolar structures related to general anaesthesia is a well-known complication and may represent a relevant morbidity for affected patients. Central documentation of perioperative dentoalveolar injuries was performed since 1990 in the Department of Anaesthesiology in cooperation with the Department of Oral and Maxillofacial Surgery at the Charité Universitätsmedizin Berlin. Documentation of perioperative dentoalveolar injury consisted of anaesthesia charts, reports of the anaesthesiologists and consultant maxillofacial surgeons.

Materials And Methods:
Retrospective analysis of the data from 1990 to 2004 was performed according to this documentation with respect to incidence, matter, distribution of dental injury and therapeutic consequences.

Results:
In 14 years 82 dental injuries were documented for 375,000 general anesthesia:
32 for luxation,
23 for crown fractures,
17 for extraction (Avulsion),
3 for minor damage (like infarctions)
2 for alveolar fracture.
Incidence of 0.02% was very constant with an average of 5.5 events/year. Only 32.9% of injuries took place during endotracheal intubation. In 80% the anesthesiologist state it was “unavoidable”. In 83% pre-existing affection or structural injury of intraoral tissues was documented. In 32.7% of the affections sufficient therapy could be provided during in-hospital stay.

CONCLUSION:
Perioperative dentoalveolar injury is surely an annoying complication of general anaesthesia. However incidence is rare and seems to be unavoidable. Pre-existing damage to dentoalveolar structures is the main risk for additional injuries related to general anaesthesia. Adequate therapy can be provided by interdisciplinary concepts. There should be a fair balance between the benefit of the surgical procedure and the risk of dental injury related to general anaesthesia. Awareness of the problem and proper documentation are important factors for adequate management in liability cases.

Assessment of Article:  Level of Evidence/Comments: II

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