Turkiye Klinikleri Journal of Dental Sciences

.: ORIGINAL RESEARCH
Improper Treatments in the Field of Oral and Maxillofacial Surgery: A Clinical Cohort Study of 55 Cases
Ağız, Diş ve Çene Cerrahisi Alanında Hatalı Tedaviler: 55 Olgunun Klinik Kohort Araştırması
Behçet EROLa , Sercan KÜÇÜKKURTa , Nima MOHARAMNEJADa
aDepartment of Oral and Maxillofacial Surgery, İstanbul Aydın University Faculty of Dentistry, İstanbul, Türkiye
Turkiye Klinikleri J Dental Sci. 2023;29(4):518-27
doi: 10.5336/dentalsci.2023-98880
Article Language: EN
Full Text
ABSTRACT
 Objective: To underscore the significance of dentistrybased education in oral and maxillofacial surgery (OMFS), fostering interdisciplinary communication and collaboration for effective treatments. Material and Methods: Fifty five improper OMFS treatment cases directed to us from different centers were investigated. Cases were categorized into dentoalveolar and maxillofacial interventions. Clinical records and patient files were analyzed for age, gender, etiology, improper treatment classification, treating clinician, previous interventions, complications, and orofacial outcomes. Results: During the 25-year survey (1990-2015), 55 out of 12,452 cases were studied. Case ages range from 3 to 70 years (Average: 33.4), with 33 (60%) males and 22 (40%) females. Dentoalveolar interventions accounted for 22 cases, while maxillofacial cases accounted for 33. Private practices performed 32 interventions, whereas state or university hospitals performed 23. Dentists carried out 22 procedures, plastic surgeons 22, and ear nose throat specialists 11. The most common improper treatments were tooth extraction-related (21 cases), followed by jaw fracture treatment (15 cases), and misdiagnosed odontogenic tumor as infection (8 cases). The top 3 reasons for patient referrals were facial asymmetry and malocclusion (21 cases), root migration to anatomical spaces (11 cases), and nerve injury (9 cases). The most common sequelae after the first intervention were facial asymmetry and malocclusion (24 cases), infection in the area (22 cases), and nerve injury (12 cases). Conclusion: Improper treatments are common in OMFS, necessitating awareness among all surgeons. Reducing such cases requires physicians to take responsibility throughout the preoperative, intraoperative, and postoperative phases, being fully aware of their authority and skills. Additionally, addressing authority conflicts, improving dentistry-based secondary education, and promoting specialization in the field are vital factors.

Keywords: Malpractice; oral surgery; oral pathology; oral surgical procedures; dentistry education
ÖZET
 Amaç: Bu çalışmanın amacı, ağız, diş ve çene cerrahisinde (ADÇC), diş hekimliği temelli yeterli ve kapsamlı eğitimin, disiplinler arası iletişimin ve uygun tedaviler için interdisipliner iş birliğinin önemini vurgulamaktır. Gereç ve Yöntemler: ADÇC alanında hatalı tedavi edilen 55 vaka incelenmiştir. Vakalar dentoalveolar ve maksillofasiyal girişimler olmak üzere 2 alt gruba ayrılmıştır. Veriler (klinik kayıtlar ve hasta dosyaları) yaş, cinsiyet, etiyoloji, hatalı tedavi sınıflandırması, ilgili klinisyen, önceki tedavi, komplikasyonlar ve orofasiyal sekellere olarak analiz edilmiştir. Bulgular: Yirmi beş yıllık (1990-2015) araştırma döneminde, 12.452 vakadan 55'i bu çalışmaya dâhil edildi. Vakalarda yaş aralığı 3-70 arasında (ortalama 33,4) değişmektedir. Elli beş hastanın 33'ü (%60) erkek, 22'si (%40) kadındır. Yirmi ikisi dentoalveolar, 33'ü çene-yüz müdahalelerinden kaynaklanmıştır. Ayrıca 32 adedi serbest muayenehanede, 23'ü devlet veya üniversite hastanesinde uygulanmıştır. Yirmi ikisi diş hekimi, 22'si plastik cerrah ve 11'i kulak-burun-boğaz tarafından yapılmıştır. İlk üçe giren hatalı tedavilerden 21'i diş çekimi sırasında, 15'i çene kırığı tedavisinde ve 8'i odontojenik tümörün yanlış teşhisi nedeniyledir. Hastaların yönlendirilmesine neden olan ilk 3 sorun; fasiyal asimetri ve maloklüzyon (21), kök migrasyonu (11) ve sinir yaralanmasıdır (9). En sık saptanan ilk 3 sekel fasiyal asimetri ve maloklüzyon (24), enfeksiyon varlığı (22) ve sinir yaralanmasıdır (12). Sonuç: Uygun olmayan tedaviler, günlük klinik pratiğin bir parçasıdır ve tüm çene cerrahlarının farkında olması gereken bir konudur. Hekimlerin ameliyat öncesi, sırası ve sonrasında hastaların sorumluluğunu üstlenmesi, yetki ve becerilerinin tam olarak farkında olması, yanlış tedavi vakalarını azaltabilir. Ayrıca çene cerrahisi alanında yetki çatışmasına çözüm bulunması, eğitimin uygun düzeyde ve kalitede olması, alanda uzmanlaşma ve branşlar arası iletişim ve hasta yönlendirilmesi katkı sağlayabilecek diğer faktörlerdir.

Anahtar Kelimeler: Malpraktis; oral cerrahi; ağız patolojisi; oral cerrahi işlemleri; diş hekimliği eğitimi
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