Below complications does not constitute an exhaustive list but does highlight some of the most common complications. If you require more information, please ask your Maxillofacial and Oral Surgeon directly.
Implant related complications can largely be categorized as biological vs. mechanical or early vs late.
Early Biological Complications:
1. Infection (1%)
Infections result in pain and swelling, mostly >7-days after surgery but it may develop weeks / months after surgery. We follow the American College of Surgeons Antibiotic prophylaxis protocol. Infections can be local and result in systemic infection with fever. Infections may lead to implant loss.
2. Failure of osteointegration (1%)
Implants may not fuse to the surrounding bone. Failure of osteointegration is more common among smokers, poorly controlled diabetics, bone disease of very thin osteoporotic bone. In some cases, no clear cause can be identified. Multiple failures may necessitate your surgeon doing an allergy test to some of the most common metals in implants.
3. Nerve injury (<1%)
The inferior alveolar nerve is at risk of injury during lower jaw implant placement of sulcus deepening surgery. Modern 3D-imaging hugely reduces the risk as correct implant length can more accurately be planned. Such injury may result in loss of feeling of half the lip and chin on the affected side. This could be temporary but in some cases it may be permanent.
4. Sinus complications (5%)
Implant placed in the upper jaw are close to the maxillary sinus. Implants that involve the sinus may result in sinusitis or may even result in implant loosening and subsequent loss.
Late Biological Complications:
1. Periimplantitis
Periimplantitis is a form of gum disease that results in progressive bone loss around dental implants. Patients that have active or previous gum disease are at higher risk than others. Poorly made dental crowns or bridges may contribute to periimplantitis. Poor oral hygiene is a common cause of periimplantitis.
Mechanical Complications:
1. Screw loosening
The screws that hold the crown onto the implant may occasionally become loose. This can easily be treated by your dentist / prosthodontist that can re-tighten the screw. Untreated screw loosening may lead to screw fracture or periimplantitis as the loose crown will irritate the surrounding gum.
2. Hardware failure / implant fractures (Rare)
Very high biting forces, poor crown design or poor implant placement may all contribute to implant fractures. Implants that have fractured need to be removed and replaced.
3. Crown / bride or denture fracture.
How to care for your dental implant(s):
- Floss around your implant daily
- Brush your teeth twice daily
- Rinse your mouth with a chlorhexidine mouth rinse weekly.
- Biannual dental checkup visits with your Dentist
- Annual recall with your Oral Surgeon
Below complications does not constitute an exhaustive list but does highlight some of the most common complications. If you require more information, please ask your Maxillofacial and Oral Surgeon and Plastic and Reconstructive Surgeon directly.
1. Nerve injuries 10%
Removal of a cancerous tumor and affected lymph glands may injure the following nerves. Most injuries are temporary, but some injuries may result in long term dysfunction:
- Facial nerve (Movement of same side of face)
- Lingual nerve (Numbness of same side of tongue)
- Hypoglossal nerve (Movement of same side of tongue)
- Accessory (Weakness in shrugging shoulders / shoulder pain)
- Phrenic nerve (Irregular breathing)
- Other sensory nerves (Loss of feeling over neck / chin and lips / cheek and / or earlobe)
2. Major bleeding or Seroma (<1%)
Major bleeding is defined as bleeding that either requires blood transfusion or surgery to stop the bleeding. Seroma is a abnormal collection of tissue fluid that causes a swelling an may require surgical drainage.
3. Surgical Site Infection (3-5%)
Infections result in pain and swelling, mostly >7-days after surgery but it may develop weeks / months after surgery. We follow the American College of Surgeons Antibiotic prophylaxis protocol. Infections can be local and result in systemic infection with fever.
4. Chyle leak (Lymph duct leak) (<1%)
The lymph system of the human body drains via two ducts into large veins in the neck. Due to their thin walls, they are at risk of injury during neck dissection. Most chyle leaks are treated conservatively with local pressure or medicine. Approximately 10% of chyle leaks require further surgical exploration.
5. Dysphagia / Difficulty swallowing (Common)
The jaw does not always break (split) where we would like it to. This may result in a poor occlusion / bite that could be corrected with further orthodontics or surgery.
6. Scaring (Common)
Scarring from head and neck cancer surgery is more common when patients develop infection after surgery, repeat surgery or receive radiotherapy after surgery.
7. Positive margins / marginal resections (Common)
Head and neck cancers are not symmetrical or linear tumors. They are complex 3D tumors and are hence at risk of incomplete excision. We attempt to limit this by asking pathologists to test tumor margins for cancer which allows us to remove more tissue until we are fairly certain all tumors have been removed.
8. Hardware failure (1-2%)
Plate, screws, or implants may all fail due to infection or radiotherapy.
9. Non-surgical complications (Common)
Hospital acquired infections, lung or other organ injuries from central lines, drips, or ancillary procedures.
10. Death(Rare)
Below complications does not constitute an exhaustive list but does highlight some of the most common complications. If you require more information, please ask your Maxillofacial and Oral Surgeon directly.
1. 5-8% % Inferior alveolar nerve injury
This may lead to numbness of the same half of the lower teeth, lip and chin. Numbness could be temporary or may lead to some degree of persistent numbness. The affected lip moves normally.
2. Major bleeding
Major bleeding is defined as bleeding that either requires blood transfusion or surgery to stop the bleeding.
3. 3-5% Infection
Infections results in pain and swelling, mostly >7-days after surgery but it may develop weeks / months after surgery. We follow the American College of Surgeons Antibiotic prophylaxis protocol. Infections can be local and result in systemic infection with fever.
4. Unfavorable splits with malocclusion
The jaw does not always break (split) where we would like it to. This may result in a poor occlusion / bite that could be corrected with further orthodontics or surgery.
5. Surgical relapse
Surgical relapse mostly occurs because of continued growth but could be the result of resorption of temporomandibular joint bone and/or other bony growths or abnormalities.
6. Less common complications (<0.1%)
- Avascular necrosis of the jaw
- Plate fracture or loosening (requiring removal)
- Injury to tooth roots resulting in tooth infection or loss
- Temporomandibular joint problems
Below complications does not constitute an exhaustive list but does highlight some of the most common surgical complications. If you require more information, please ask your Maxillofacial and Oral Surgeon directly.
1. Nerve injuries (Approximately 5%)
Removal of a salivary gland may injure the following nerves. Most injuries are temporary, but some injuries may result in long term dysfunction:
- Facial nerve (Movement of same side of face)
- Lingual nerve (Numbness of same side of tongue)
- Hypoglossal nerve (Movement of same side of tongue)
- Other sensory nerves (Loss of feeling over neck / chin and lips / cheek and / or earlobe)
Facial nerve injury is most common with parotid gland surgery. This is because the main trunk of the facial nerve needs to be identified and carefully dissected out during parotid surgery.
The lingual, hypoglossal and one branch of the facial nerve (marginal mandibular) are at risk during submandibular gland surgery. This is particularly true for patients with longstanding infection of the gland or previous radiation therapy to the neck.
The lingual nerve is the only nerve at risk during sublingual gland removal.
2. Major bleeding or Seroma (<1%)
Major bleeding is defined as bleeding that either requires blood transfusion or surgery to stop the bleeding. Seroma is a abnormal collection of tissue fluid that causes a swelling an may require surgical drainage.
3. Surgical Site Infection (3-5%)
Infections result in pain and swelling, mostly >7-days after surgery but it may develop weeks / months after surgery. We follow the American College of Surgeons Antibiotic prophylaxis protocol. Infections can be local and result in systemic infection with fever.
4. Frey Syndrome (5%) or Salivary Fistula (Rare)
Frey Syndrome results from abnormal healing of injured nerve ends overlying the skin of the parotid gland. It is related to parotid surgery only. The symptoms are cheek sweating when hungry and flushed skin over cheek. Salivary fistula results in salivary draining from pinpoint of skin where cut was made.
5. Scaring (<5%)
Scaring from head and neck cancer surgery is more common when patients develop infection after surgery, repeat surgery or receive radiotherapy after surgery.
6. Death (Rare)
Below complications does not constitute an exhaustive list but does highlight some of the most common complications. If you require more information, please ask your Maxillofacial and Oral Surgeon directly.
1. Facial Nerve injuries (2-3%)
The facial nerve passes over the temporomandibular joint and are at risk of injury. Injuries will result in weakness of frowning, blinking, pouting, smiling and grimacing. Most injuries are temporary, but some injuries may result in long term dysfunction.
2. Auriculotemporal nerve injury (Common)
The auriculotemporal nerve passes behind and over the temporomandibular joint. It provides sensation to the earlobe and area of skin in front of the ear. Injury will result in numbness of the skin in these areas. Numbness largely resolves after 6-months but could be permanent and related with a burning pain (neuralgia)
3. Major bleeding or Seroma (<1%)
Major bleeding is defined as bleeding that either requires blood transfusion or surgery to stop the bleeding. Seroma is an abnormal collection of tissue fluid that causes swelling and may require surgical drainage.
4. Surgical Site Infection / prosthesis injection (<1%)
Infections results in pain and swelling, mostly >7-days after surgery but it may develop weeks / months after surgery. We follow the American College of Surgeons Antibiotic prophylaxis protocol. Infections can be local and result in systemic infection with fever.
5. Malocclusion (<1%)
Changing the structure of the joint may directly change the way teeth bite on top of each other. Careful planning largely limits this risk, but inaccuracies in planning or operation execution may result in malocclusion. This could be corrected via fillings, orthodontic treatment, jaw movement surgery or joint reoperation.
6. Perforation of the ear canal (<1%)
The external ear canal is situated behind and above the temporomandibular joint. The front wall of the canal can be injured during the operation, or the prosthesis could “migrate” into the ear canal over time.
7. Continued joint noises (>10%)
The jaw does not always break (split) where we would like it to. This may result in a poor occlusion / bite that could be corrected with further orthodontics or surgery.
8. Frey Syndrome or salivary fistulae (Rare)
Frey Syndrome results from abnormal healing of injured nerve ends. The symptoms are cheek sweating when hungry and flushed skin over cheek. Salivary fistula results in salivary draining from pinpoint of skin where cut was made.
9. Scaring (Rare)
Scaring from TM-joint surgery is uncommon due to the anatomical location of the incisions / cuts. They are placed in natural skin creases. Scaring is more common after infection, patients with previous surgical scaring or re-operations.
10. Hardware failure (Rare)
Plate, screws, or implants may all fail due to infection or mechanical breakage. This will require re-operation.
11. Death (Rare)
Below complications does not constitute an exhaustive list but does highlight some of the most common complications. If you require more information, please ask your Maxillofacial and Oral Surgeon directly.
1. 1% Inferior alveolar nerve injury
This may lead to numbness of the same half of the lower teeth, lip and chin. Numbness could be temporary or may lead to some degree of persistent numbness. The affected lip moves normally.
2. 0.1-0.3% Lingual nerve injury
This may lead to numbness of the same half of the tongue. Numbness could be temporary or may lead to some degree of persistent numbness. The tongue moves normally.
3. 2-3% Dry Socket (Alveolar Osteitis)
Dry socket (alveolar osteitis) is a condition where the blood clot inside the socket is lost resulting is exposed bone and severe pain not resolved by OTC painkillers. It becomes apparent during day 2-3 after surgery. More common is smokers and female patients. The condition is self-limiting and resolves within 10-14 days and treated with strong anti-inflammatories.
4. 3-5% Infection
Infections results in pain and swelling, mostly >7-days after surgery but it may develop weeks / months after surgery. We follow the American College of Surgeons Antibiotic prophylaxis protocol. Infections can be local and result in systemic infection with fever.
5. Uncommon complications:
- Jaw fracture
- Tooth displacement
- Persistent sinus opening
- Gum defects / recession
Below complications does not constitute an exhaustive list but does highlight some of the most common complications. If you require more information, please ask your Maxillofacial and Oral Surgeon directly.
Untreated, many facial fractures may result in functional and/ or esthetic defects. These can include an abnormal / skew bite or a sunken in eye (enophthalmos). The trauma itself may have resulted in injuries to other important structures such as nerves, the eye and brain. These injuries may be unrelated to the surgery the aims to correct other injuries.
1. Infection (5%)
Infections result in pain and swelling, mostly >7-days after surgery but it may develop weeks / months after surgery. We follow the American College of Surgeons Antibiotic prophylaxis protocol. Infections can be local and result in systemic infection with fever. Infections may lead to implant loss.
2. Malunion / non-union (1%)
During fracture repair, bones are realigned and kept in place with plates and screws (or wire). These bones might not “fuse” resulting in persistent movement between bony segments. Bones might not have been well aligned and could health in the abnormal position resulting in some deformity. Plates and screws may become loose before the bones have properly healed.
3. Scaring (Common)
Injuries affecting the skin and lips often result in some loss of tissue. Suturing is always done meticulously, but scarring is common. Some scars may result in functional problems to eversion of eyelids or oral incompetence (poor lip seal).
4. Nerve injury (2-3%)
Injury secondary to the initial trauma or surgery may result in numbness of the forehead, cheeks or lips. Injury to motor nerves such as facial and hypoglossal nerves may result in weakness or paralysis in facial movement (mimicry muscles) or tongue movement on the side of injury.
5. Eye injuries (Rare)
Fractures that involve the bones around the eye are complicated injuries to repair. Injuries to muscle surrounding the eye or nerves in the eye socket may result in abnormalities in eye movement with double vision (diplopia), sunken in eye (enophthalmos) or even blindness.
6. Mechanical Complications:
Screw loosening / Hardware failure / plate and screw fractures (Rare) Very high biting forces contribute to plate fractures. Plates and screws that have fractured or become loose need to be removed.
What to do after facial injury surgery?:
- Brush your teeth twice daily.
- Rinse your mouth with a chlorhexidine mouth rinse weekly.
- Keep dressings on the wound for 3-days after surgery.
- When dressings / plasters has been removed, clean wounds with clean water twice a day for 2-weeks after surgery.
- Only start using “scar” serums 6-weeks after surgery.
- Remember to follow up with your surgeon at 1-week, 3-weeks, 6- weeks and 6-months after surgery.
