Preoperative management aspects of medically complex patients diagnosed with maxillofacial infections

Abstract

Introduction. Inflammatory processes in the maxillofacial region are a pressing problem in a specialist surgeon’s daily work due to the high number of patients with this diagnosis, but also because of the life-threatening complications that may occur - airway compromise, cavernous sinus thrombosis, mediastinal spread of infection, and even death. These complications occur even at “healthy” patients, with no other comorbidities. what about medically complex patients, who besides the current infection have multiple chronic diseases? Aim of the study. Identify the differences in the preoperative management of medically compromised patients and review the literature to gather up-to-date solutions and protocols for the better management of various patient categories. Materials and methods. A retrospective epidemiological study was conducted on 50 patients diagnosed with maxillofacial infections, who were hospitalized in the maxillofacial department of the IMSP IMU during 2015-2017 and 28 out of 50 have been found to have comorbidities. A review of the literature was done and there were systematized protocols for each chronic condition, with an emphasis on drug interactions and possible complications. Results. The research conducted confirmed the initial hypothesis that medically complex patients require a different approach while treating maxillofacial infections. Preoperative evaluation is of extreme importance and the oral surgeon should possess good clinical skills and knowledge of internal medicine, as there is a large number of patients who are unaware of their chronic medical conditions. A complete blood count, bleeding time and complete metabolic panel are crucial prior to the surgical intervention, as well as an electrocardiogram and blood pressure monitoring. Based on lab results, the operator will assess the risks and follow an individual protocol, altering the medication dosage or prescribing medication that would diminish possible surgical complications. Knowledge of drug interactions with agents used in oral surgery has been proven to be of great importance and have been systematized in this study, allowing clinicians to prevent further side effects. Conclusions. Most chronic diseases have a significant impact on the evolution of maxillofacial infections and every oral surgeon should always follow individualized protocols in order to prevent complications. For a better patient care, the operative team is encouraged to request the consultation of internists in every complex case.