The Debatable Dilemma- A Case of Anaesthetic Dental Trauma in a Syndromic Patient: Unavoidable or Negligence?

Case Report

Austin J Dent. 2016; 3(5): 1048.

The Debatable Dilemma- A Case of Anaesthetic Dental Trauma in a Syndromic Patient: Unavoidable or Negligence?

Pauly G*, Rao PK, Kini R, Kashyap RR and Bhandarkar GP

Department of Oral Medicine and Radiology, AJ Institute of Dental Sciences, India

*Corresponding author: Geon Pauly, Department of Oral Medicine and Radiology, AJ Institute of Dental Sciences, Kuntikana, NH-66, Mangaluru, PIN– 575004, Karnataka, India

Received: September 29, 2016; Accepted: October 24, 2016; Published: October 26, 2016


Perioperative tissue damage is one of the most common anaesthesia-related adverse events and is responsible for the greatest number of malpractice claims against anaesthesiologists. Damage to the teeth during general anaesthesia is a frequent cause of morbidity for patients and a source of litigation against anaesthetists. Mucopolysaccharidoses (MPSs) are a group of uncommon genetic disease of connective tissue metabolism. Hunter syndrome (HS), or mucopolysaccharidosis II (MPS II), is a lysosomal storage disease caused by a deficient or absent enzyme- iduronate-2-sulfatase (I2S). It is well established that the elective treatment of subjects affected by MPS is multidisciplinary and must be carried out by experienced personnel in highly specialist centres. A thorough evaluation may necessitate a dentist’s help, requiring that anaesthesiologists receive more formal training regarding oral and dental anatomy, and enables performing the treatments necessary to minimize the risks of dental injuries. Various attempts to produce guidelines have been made for MPS. We want to provide a summary of anaesthetic management for these high-risk patients, who require surgical procedures and diagnostic examinations under sedation with a higher frequency than the general population.

Keywords: Anaesthetic trauma; Mucopolysaccharidoses; Hunter syndrome


‘Iatrogenic injury’, it is a rather broad term that may be defined as ‘harm, hurt, damage or impairment that results from the activities of a doctor [1]. This includes physical injuries, surgical mishaps, adverse drug reactions, drug errors and adverse outcomes associated with equipment failure. Some causes of iatrogenic injury are difficult to avoid, in particular unexpected adverse drug reactions such as anaphylaxis. However, many are the result of human error and may be avoided through anticipation and high standards of practise [2]. Hunter syndrome or MPS II, an X-linked recessive disorder is a serious genetic disorder that primarily affects males, It interferes with the body’s ability to break down and recycle specific mucopolysaccharides; also known as glycosaminoglycan (GAG).

Hunter syndrome is one of several related lysosomal storage diseases called the MPS diseases [3]. The symptoms of HS are generally not apparent at birth, but usually start to become noticeable after the first year of life. Often, the first symptoms of Hunter syndrome may include ear infections, runny noses, colds and abdominal hernias [4]. In case of abdominal hernias, surgical intervention is indicated. Here we report a case of a 9 year old boy with Hunter syndrome.

Case Presentation

A 9 year old boy was referred from the hospital to our out-patient department, for general dental evaluation. Additionally, the patient’s parents gave a complaint of mobile teeth in upper front teeth region since one week. The patient was short in stature and was of asthenic built and moderately nourished (Figure 1A). The patient was a known case of hunter syndrome with a family history of having a sibling with the same condition. The patient had undergone surgery for umbilical hernia one week prior. On clinical examination, the shape of the head was acrocephalic (Figure 1B). The patient was not fully cooperative for intra-oral examination. On local examination, the left upper central incisor was slightly extruded, had distinct proclination, exhibited grade II mobility and was tender on palpation (Figure 1C). An intra-oral periapical radiograph was taken, which revealed complete crown formation with incomplete root formation (Figure 1D). The patient was further advised for splinting of maxillary left central incisor after suitable pulpal therapy, and further referred to department of pedodontics for the same. The patient has undergone oral prophylaxis, splinting has not been done yet ailing to patient’s non co-operation and is currently undergoing endodontic treatment.

Citation: Pauly G, Rao PK, Kini R, Kashyap RR and Bhandarkar GP. The Debatable Dilemma- A Case of Anaesthetic Dental Trauma in a Syndromic Patient: Unavoidable or Negligence?. Austin J Dent. 2016; 3(5): 1048. ISSN : 2381-9189