Postoperative Complications Following Wisdom Tooth Extraction

Case Overview

This case study revolves around an adult patient who experienced facial swelling five days after a wisdom tooth extraction. The individual presented to the emergency room (ER) at approximately 1358, where an ER provider evaluated them and initiated an Oral and Maxillofacial Surgery (OMFS) consultation suspecting Ludwig’s angina.

A CT scan was conducted around 1500, read by 1545, and surgical intervention was decided by 1600. The patient was transferred to the operating room (OR) around 1730 with a multi-specialty team present, including OMFS, anesthesia, and trauma surgery specialists.

During the procedure, the anesthesia team encountered difficulties establishing an airway, necessitating an emergent tracheostomy. However, complications arose during this process as well, resulting in hypoxic arrest for the patient. Records indicate that the patient was pulseless for about five minutes before Return of Spontaneous Circulation (ROSC) was achieved.

Unfortunately, the patient suffered an anoxic brain injury and has since had a prolonged and complex clinical course. Allegations have been made that a delay in evaluation by oral surgery contributed to delayed interventions, including airway protection, leading to adverse outcomes.

An expert in Oral and Maxillofacial Surgery is sought to provide insights on the standard of care relevant to this case.

Questions to the expert and their responses

How often do you perform oral surgery and manage postoperative patients with complications, including facial swelling?

As a board-certified professional in dental anesthesia and oral and maxillofacial surgery, I frequently handle such cases and have extensive experience treating similar problems.

Briefly, what standards exist regarding prompt evaluation and management of a postoperative patient with facial swelling to prevent adverse outcomes?

The standards for prompt evaluation and management of a postoperative patient with facial swelling are multifaceted. It is crucial to understand why the treating oral surgeon was not involved initially as this could have led to delayed treatment.

What are the pertinent clinical considerations when evaluating a patient with facial swelling to prevent or mitigate airway compromise?

When evaluating a patient with facial swelling, pertinent clinical considerations include assessing the risk of airway compromise. Any delay in care can often be attributed to a diffusion of responsibility and lack of awareness about the critical nature of such problems.

Have you ever reviewed a similar case? If yes, please elaborate.

I have reviewed similar cases where delayed treatment led to adverse outcomes. The treating surgeon is primarily responsible, and they should be involved unless there are extenuating circumstances.

About the expert

This expert boasts over three decades of experience in oral and maxillofacial surgery, with a distinguished academic background from a renowned university. They are board-certified in both oral and maxillofacial surgery and dental anesthesiology, demonstrating their comprehensive expertise. Their career spans various roles, including clinical instruction at major medical centers, active participation in professional organizations, and contributions to academia through publications on relevant topics. Currently, they serve as an attending oral and maxillofacial surgeon at a private practice while also holding a position as a clinical associate instructor at a prominent university medical center.