Oral and Maxillofacial Surgery for the Medically Compromised Patient : A Guide to Management and High-Quality Care

This book is a detailed guide to the identification and appropriate management of patients who represent a high risk when performing oral and maxillofacial surgery or the complex procedures that are increasingly attempted by general dental practitioners. Emphasis is also placed on evaluation of the medically compromised patient for outpatient anesthesia. The book is systematically divided into a series of chapters focusing on the medical conditions most commonly encountered in practice and on current treatment standards. Each chapter outlines evidence-based guidelines for evaluation of patients to establish whether they are suitable candidates for oral surgery. In addition, commonly encountered clinical management dilemmas are thoroughly explored. Lastly, this book will enable the provider to understand whether there is a need to seek medical clearance before proceeding. It will be an invaluable guide for both oral and maxillofacial surgeons and general dentists. Foreword Acknowledgements Contents 1: Introduction 1.1 Patient Safety and Safe Care 1.2 Goal of Medical Clearance 1.3 Preoperative Testing and Its Usefulness 1.4 Seeking Medical Clearance References 2: Management of the Cardiac Patient 2.1 Hypertension 2.1.1 Ischemic Heart Disease 2.2 Angina Pectoris 2.3 Myocardial Infarction 2.4 Perioperative Myocardial Infarction (PMI) 2.5 Local Anesthesia in Cardiac Patients 2.6 Cardiac Arrythmias/Implantable Electronic Cardiac Devices 2.6.1 Automated Implantable Cardioverter Defibrillators (AICD) and Pacemakers 2.7 Valvular Heart Disease 2.7.1 Recommendations for Endocarditis Prophylaxis [34] 2.8 Congenital Heart Disease 2.9 Anticoagulation 2.10 Perioperative Cardiac Risk Assessment and Testing References 3: Patients with Respiratory Disease: High Yield Concepts for Optimal Clinical Care 3.1 Introduction 3.2 Asthma 3.3 COPD 3.4 Tobacco 3.5 Vaping 3.6 Respiratory Infections 3.7 Premedication 3.8 Intraoperative Management 3.9 Conclusion References 4: Liver Diseases 4.1 Assessment of Liver Function 4.2 Acute Liver Failure 4.3 Liver Cirrhosis 4.4 Hepatic Encephalopathy 4.5 Portal Hypertension 4.6 Ascites 4.7 Hepatorenal Syndrome 4.8 Viral Hepatitis 4.9 Jaundice 4.10 Hematologic Consequences in Liver Disease 4.11 Management of Patients with Chronic Liver Disease Undergoing Oral Surgical Procedures References 5: Oral and Maxillofacial Surgical Management for the Renal Compromised Patient 5.1 Introduction 5.2 Definition 5.3 Epidemiology and Etiology 5.4 Pathophysiology 5.5 Complications and Clinical Manifestations 5.5.1 Sodium Balance and Volume Status 5.5.2 Potassium Balance 5.5.3 Acid-Base Balance 5.5.4 Vitamin and Bone Abnormalities 5.5.5 Cardiovascular and Pulmonary Abnormalities 5.5.6 Hematologic Abnormalities 5.5.7 Immunologic Suppression 5.5.8 Neuromuscular Abnormalities 5.6 Surgical Management and Considerations 5.6.1 Identification and Risk Assessment 5.6.2 Antibiotics 5.6.3 Bleeding 5.6.4 Blood Pressure 5.6.5 Soft Tissue and Bone Considerations 5.6.6 Drug Considerations 5.6.6.1 Antimicrobials 5.6.6.2 Analgesics 5.6.6.3 NSAIDS 5.6.6.4 Anesthetic Agents 5.6.6.5 Other Medications 5.6.7 Considerations of Patients with Kidney Transplantation References 6: The Immunocompromised Patient 6.1 Introduction 6.2 Rheumatologic Disease 6.3 Organ Transplantation 6.4 HIV 6.5 Cancer 6.6 Congenital (Primary) Immunodeficiencies 6.7 Summary References 7: Metabolic Disorders in the Oral and Maxillofacial Surgical Patient 7.1 Pituitary Gland Disorders 7.1.1 Anterior Pituitary Hyperfunction 7.1.2 Anterior Pituitary Hypofunction 7.1.3 Posterior Pituitary Disorders 7.2 Adrenal Gland Disorders 7.2.1 Adrenal Insufficiency 7.2.2 Adrenal Cortical Hyperfunction 7.2.3 Adrenal Medullary Hyperfunction 7.2.4 Thyroid Disease 7.2.4.1 Hyperthyroidism 7.2.4.2 Hypothyroidism 7.3 Parathyroid Disease 7.3.1 Hyperparathyroidism 7.3.2 Hypoparathyroidism 7.4 Diabetes Mellitus 7.4.1 Acute Complications of Diabetes 7.4.2 Chronic Complications of Diabetes Mellitus 7.4.3 Obstructive Sleep Apnea 7.5 Summary References 8: Psychiatric and Behavioral Disorders 8.1 Anxiety 8.2 Depression 8.3 Bipolar Disorder 8.4 Psychotic Disorders 8.5 Post-traumatic Stress Disorder 8.6 Gender Dysphoria 8.7 Eating Disorders 8.8 Summary References 9: Practice Considerations for Patients with Substance Use Disorder 9.1 Introduction 9.2 General Considerations 9.3 Cannabinoids: Marijuana 9.3.1 Introduction 9.3.2 Preoperative Assessment 9.3.3 Perioperative Management 9.3.3.1 Postoperative Challenges 9.4 Stimulants 9.4.1 Cocaine 9.4.1.1 Introduction Preoperative Assessment Perioperative Management 9.4.1.2 Postoperative Challenges 9.5 Methamphetamines 9.5.1 Introduction 9.5.2 Preoperative Assessment 9.5.3 Perioperative Management 9.5.4 Postoperative Challenges 9.6 Depressants 9.6.1 Alcohol 9.6.1.1 Introduction Preoperative Assessment Perioperative Management Postoperative Challenges 9.6.2 Opioids 9.6.2.1 Introduction Preoperative Assessment Perioperative Management 9.6.3 Postoperative Management 9.7 Other Drugs 9.8 Summary References 10: Oral and Maxillofacial Surgery and Hematologic Diseases 10.1 Introduction 10.2 Overview 10.3 Hematologic Malignancies 10.3.1 Leukemia 10.3.2 Lymphoma 10.3.3 Multiple Myeloma 10.4 Disorders of Platelets and Clotting Factors 10.4.1 Hemophilia 10.4.2 von Willebrand Disease 10.5 Disorders of Red Blood Cells 10.5.1 Sickle Cell Disease 10.5.2 Thalassemia 10.6 Summary References 11: Preoperative Evaluation of Patients with Neurological Disorders 11.1 Cerebrovascular Disease 11.2 Epilepsy/Seizures 11.3 Dementia 11.4 Movement Disorders 11.4.1 Parkinson’s Disease 11.4.2 Huntington’s 11.5 Neuromuscular Disorders 11.5.1 Myasthenia Gravis 11.5.2 Muscular Dystrophy 11.5.3 Amyotrophic Lateral Sclerosis 11.6 Demyelinating Conditions 11.6.1 Guillain-Barre Syndrome 11.6.2 Multiple Sclerosis References 12: Management Dilemmas 12.1 Treatment Dilemmas 12.2 Antiresorptive Drugs and Medication-Related Osteonecrosis of the Jaw (MRONJ) 12.2.1 Risk Factors 12.2.2 Signs and Symptoms 12.2.3 Radiographic Findings 12.2.4 Risk Reduction in the Development of MRONJ 12.2.5 Treatment of MRONJ 12.3 Osteoradionecrosis (ORN) 12.3.1 Definition 12.3.2 Pathophysiology 12.3.3 Incidence and Risk Factors 12.3.4 Signs and Symptoms 12.3.5 Radiographic Diagnosis 12.3.6 Staging 12.3.7 Risk Reduction 12.3.8 Patients Who Received Radiation to the Head and Neck Area and Require Dental Extractions 12.3.9 Treatment of ORN 12.3.10 Patients Who Received Radiation to the Head and Neck Area and Developed ORN 12.4 Antibiotic Prophylaxis 12.4.1 Infective Endocarditis 12.4.1.1 Recommendations 12.4.2 Prosthetic Joint Infections and Antibiotic Prophylaxis 12.4.3 Temporomandibular Joint Total Joint Replacement 12.4.3.1 Antibiotic Stewardship 12.5 Anticoagulation 12.6 Obesity 12.7 Postoperative Pain Management References