Exodontia.Info
Soft Tissue Damage

Careless tissue retraction with a tissue retractor (such as
an
Austins or Rake Retractor) can lead excoriation and
swelling, mainly around the lips and especially at the
commissure.

This is more likely to occur under
general anæsthesia
than
local anæsthesia.

This commonly occurs when the lips and
commissures
are trapped between a (
periosteal) elevator (used as a
flap retractor) and the neck of the elevator being used to
extract
wisdom tooth (third molar), especially if the
extraction is difficult (poor visibility and surgical access).  
It is all too easy to get carried away with the extraction
and neglect the soft tissues.

Lacerations to the soft tissues can be caused by
careless handling of scalpels, elevators, forceps scissors
and sutures.
Abrasion of the lower lip as a result of contact with the
rotating shank of a
bur (surgical drill) during the surgical
removal of an impacted lower 3rd molar
Vaseline or moisturising cream should be applied to the
lips, pre-operatively and peri-operatively.


Thermal Trauma

This happens with surgical drills that are not serviced
regularly and properly maintained.  These can be prone
to bearing failure resulting in the drills overheating in
normal use, especially if old burrs are used (in an attempt
to save money and excess pressure is applied to the
blunt bur because it cuts inefficiently).  The hot drill then
comes into contact all with the patients’ soft tissues
resulting in a deep burn.

This is an indefensible disaster and the cosmetic results
can be truly appalling (suitable photo)

If a surgical drill is ‘running hot’, it should be immediately
discarded and sent for repair or condemned.
If a surgeon injures a patient with an instrument that is
known to be defective, then they will only have
themselves to blame when they are sued for negligence.

Poor vigilance while using an electrical cautery
(
diathermy) or laser is another indefensible cause of
damage to surrounding soft tissues.

When these instruments are in use, non-conducting and
non-reflective retractors should be used and in the case
of lasers all surrounding areas should be protected by
wet swabs.  Extreme care should be used when using
monopolar cautery to coagulate a blood vessel via a
non-insulated pair of tissue forceps in case they should
come into contact with the surrounding soft tissues.
Burn to Lower Lip from a Surgical Handpiece
Last Updated 11th August 2010