Dentoalveolar injury related to general anaesthesia: 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.
BACKGROUND
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 and Intensive Care Medicine in cooperation with the Department of Oral and Maxillofacial Surgery at the Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum. Documentation of perioperative dentoalveolar injury consisted of anaesthesia charts, reports of the anaesthesiologists and consultant maxillofacial surgeons.


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
Within 14 years 82 'dental injuries' with 103 affected teeth were documented in calculated 375,000 general anaesthesias. Incidence of 0.02% was very constant with an average of 5.5 events/year. Eighty-nine percent of the documented injuries occurred during scheduled operative procedures. Only 32.9% of the injuries took place during endotracheal intubation. In about 50% the injury was not related to intubation or extubation but happened during general anaesthesia. In 80% the dental injury was estimated by the anaesthesiologist as 'not avoidable'. In 83% pre-existing affection or structural injury of intraoral tissues was documented, in 32.7% of the affections sufficient therapy could be provided already during inhospital stay.


CONCLUSIONS
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.
Department of Oral and Maxillofacial Surgery, Charité Centrum 7 für Anästhesiologie, Op-Management und Intensivmedizin, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Charité Mitte, Berlin, Germany. nicolai.adolphs@charite.de
Nicolai
N
Adolphs
Bernhard
B
Kessler
Christian
C
von Heymann
Eveline
E
Achterberg
Claudia
C
Spies
Horst
H
Menneking
Bodo
B
Hoffmeister
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects* / Q000295:instrumentation; D001291:Attitude of Health Personnel; D001604:Berlin / Q000453:epidemiology; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008334:Mandible; D008437:Maxilla; D008446:Maxillofacial Injuries / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D010519:Periodontium / Q000293:injuries*; D059035:Perioperative Period / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018677:Tooth Injuries / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D055815:Young Adult