Incidence of complications following mandibular third molar extraction under day case general anaesthesia
Authors: Shane Higgins, Andrew Sidebottom
Journal: International Journal of Surgery (2013)

s / International Journal of Surgery 11 (2013) 589e685 645 ABSTRACTS loss and transfusion rates in neck dissections (ND) for head and neck squamous cell carcinoma. Method: Fifty four patients (27 HS group and 27 CTgroup) who underwent tumour resection and ND with primary head and neck cancer were enrolled in this study. The variables analysed wereHemoglobin and haematocritbpreoperatively, day 1 post operatively and day 7 postoperatively. Units of blood transfused. The results were analysed using the student t test Result: The drop in haemoglobin on 7th postoperative day in the HS group on average was 2.833 vs 2.648 in the CT group (p1⁄4 0.675) and there was no statistically significant difference in the haematocrit value between the HS group and the CT group 0.0782 vs. 0.0749 (p1⁄40.785). Conclusions: The HS is a relatively safe and effective alternative method for ND. The HS did not significantly reduce the blood loss or transfusion rates in our group of patients that underwent surgical treatment for head and neck squamous cell carcinoma. 0660: INCIDENCE OF COMPLICATIONS FOLLOWING MANDIBULAR THIRD MOLAR EXTRACTION UNDER DAY CASE GENERAL ANAESTHESIA Shane Higgins, Andrew Sidebottom. Nottingham University Hospitals NHS Trust, Nottingham, UK. Aims & Objectives: To audit the incidence of trigeminal nerve injury and dry socket following mandibular third molar surgery under day case general anaesthesia. Methods and Materials: A prospective audit was carried out over a 5 month period from July to November 2012. Eligible patients completed a telephone questionnaire 28 days following lower third molar extraction. Surgery was performed by consultant, staff grade and SHO staff. Criterion and Standard: For the purpose of this audit the acceptable incidence of IAN dysaesthesia was set at less than 1.5%, 1.8% for lingual nerve dysaesthesia and 11% for dry socket based on previous similar studies. Results: A total of 63 patients completed the telephone questionnaire over the audit period. This included a total of 89 mandibular wisdom teeth. At 28 days post operatively, no patients had reported IAN injury and 1 patient had lingual nerve paraesthesia. A total of 4 patients were diagnosed with dry socket. This represents a 0% incidence of IAN paraesthesia, 1.12% incidence of lingual nerve paraesthesia and 6.3% incidence of dry socket. Conclusions: The incidence of complications following mandibular third molar extraction under day case GA is less than has been reported in our unit. 0664: REFERRAL PATTERNS TO SECONDARY CARE IN THE ABSENCE OF A COMMUNITY BASED ORAL SURGERY SERVICE Shane Higgins, El Mustafa, Dilip Srinivasan. Nottingham University Hospitals NHS Trust, Nottingham, UK. Aims: An analysis of the referrals to the department of OMFS from GDP's in a region where there are no community based oral surgery services. Material and Methods: A prospective audit was carried out on 193 consecutive referrals made to the department of OMFS in Kingsmill Hospital between September and November 2012. Results: Referrals were received from 29 dentists working in corporate dental practices and 33 dentists working in privately owned practices. 13.6% of dentists in corporate practices obtained their primary qualification in the UK compared to 78.8% of privately owned. 55% of referrals came from corporate practices whose dentists had an average of 10.6 years post qualification experience compared to 15.6 years for privately owned. 24% of all referrals received were for simple or failed simple extractions. All referrals for simple extractions and 69% of referrals for failed simple extractions were sent by corporate practices. Conclusion: In our setting corporate dental practices contribute the majority of referrals. Many of these referrals are suitable for treatment in primary care. This is partly due to the lack of a community based oral surgery service but may be due to other reasons such as the policies employed by these practices. 0734: A COMPARATIVE STUDY OF MINI ARTHROSCOPY USED IN THE MANAGEMENT OF TEMPOROMANDIBULAR DISORDER Stephanie Weedon, Andrew Sidebottom, Nabeela Ahmed. Nottingham University Hospital, Nottingham, UK. Aim: This Audit looked at 115 arthroscopic procedures using a 1.2mm disposable arthroscope, to assess it's effectiveness and reliability. Patients included in the study had a variety of TMDs but all had failed o improve under conservative management options. The aim of the arthroscopy was to reduce pain and increase mouth opening, and subsequently allow the patient to be discharged. Discharge was classed as a successful outcome. Method: All the procedures were performed by the same surgeon and in the same manner as a previous study, which used a 1.9mm scope. The only difference between the studies was that the 1.2mm scope didn't need an incision and was directly inserted into the superior joint space. The two papers were then compared and critically analysed. Results: The 1.2mm disposable scope saw improvements in pain scores andmouth opening of 68.5% and 118.8% retrospectively and overall success rates of 75.6%. The 1.9mm scope was shown to be more successful but the 1.2mm scope gave fewer complications. Conclusion: Overall both techniques are safe and effective and should be considered as treatment options for TMD when non-operative techniques fail. The 1.2mm scope causes less trauma and has more potential for use under local anaesthetic. 0800: ASIT-BAOMS PRIZE WINNER: LENGTH OF STAY FOLLOWING ORTHOGNATHIC SURGERY Reena Raithatha, El Mustafa, John Rowson, Dilip Srinivasan. Nottingham University Hospitals NHS Trust, Nottingham, UK. Aim: To analyse the length of stay following orthognathic surgery at Nottingham University Hospitals. Method: We reviewed the length of stay of the last 115 patients who underwent orthognathic surgery at Nottingham University Hospitals, Nottingham.78patients had single jawsurgeryofwhich50hadmaxillaryosteotomy and 28 had mandibular surgery. 37 patients had bimaxillary osteotomies. Results: The average hospital stay was 1.3 days. 87 out of 115 patients stayed one night. 81% of patients who had single jaw surgery stayed one night as did 65% of patients who had bimaxillary osteotomies. 91% of patients were discharged by the second postoperative day. Discussion: Oneway of reducing cost of orthognathic surgery is by reducing the length of stay. World wide there is a great variation in length of stay following orthognathic surgery. In the United Kingdom, a recentmulticentre trial set the benchmark for hospital stay following orthognathic surgery. It is reported that following single jaw surgery, between 45% and 50% of patients stayed one night as did 34% of patients following bimaxillary surgery. The length of hospital stay is less for our patients compared to the national average. We will discuss the reasons that contribute to this. 0881: CLINICAL JUSTIFICATION FOR THE REMOVAL OF NON-NICE COMPLIANT THIRD MOLARS IN THE ORAL SURGERY DEPARTMENT AT GUYS DENTAL HOSPITAL Reena Raithatha , Sanjeev Sharma , Vinod Patel , Chris Sproat . Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK. In March 2000 the National Institute of Clinical Excellence (NICE) published guidance on third molars outlining reasons to consider extractions. However these guidelines are contentious and there remain scenarios where clinicians may choose to act outside them. Here it is important from a good clinical practice point of view, as well as for medico-legal protection that clinicians justify and record their reason. Local guidance allows removal of certain non-NICE compliant wisdom teeth and it is important to ensure that such decisions are made correctly and recorded. Method: We prospectively audited 50 patients who underwent removal of non-NICE compliant third molars. The first cycle included 87 third molars. Results: 54% of third molars had documented reasons for removal. Results were presented at audit meetings and changes were implemented. A reaudit of 50 cases was carried out, which yielded 82 teeth. There was a significant improvement with 74% of teeth having the reason for removal recorded. The third cycle is currently in motion. Conclusion: The department are pleased at the progress shown in the second cycle, however further improvement is required to reach 100% compliance. By highlighting a contentious area and focusing on record keeping, this audit has significantly improved our clinical standards.