Our clinical negligence team has settled a claim against Mr Nadeem Saeed, an oral and maxillofacial surgeon, for inappropriate post-operative management following wisdom tooth extraction surgery.
The claimant had a long-standing history of infection and prior to his referral to Mr Saeed, had been diagnosed with primary immune deficiency. He presented to his dentist after experiencing recurrent pericoronitis and was subsequently referred to Mr Saeed at the Chiltern Hospital. During the initial consultation with Mr Saeed, it was agreed that the claimant would proceed with removal of both lower wisdom teeth. Complications were encountered during the surgery and a ‘crack’ was heard on the right side of the jaw. It was not clear on the peri-operative X-ray whether the jaw had in fact been fractured but Mr Saeed decided to insert a plate as a preventative measure. At the time of his discharge from hospital, the claimant was not advised of the implications of the suspected fracture or plate insertion aside from the fact he would be given antibiotics and would have a follow-up appointment with Mr Saeed.
A week later, the claimant saw Mr Saeed for a routine follow-up and it was noted he was healing well. Following this appointment, no further follow-up was arranged by Mr Saeed nor were any advice or instructions given as to the management of the suspected fracture and in what circumstances he should return to Mr Saeed for further review. In the immediate months following surgery, the claimant returned to a normal diet and normal use of his jaw. However, he subsequently developed discomfort in his jaw as well as an abnormal bite and therefore arranged to see Mr Saeed again. Mr Saeed confirmed there were signs of plate infection and X-rays showed non-union at the fracture site and clear evidence of a previous fracture which required further exploration.
Following these events, the claimant sought a second opinion from another oral and maxillofacial surgeon. He underwent further surgery under the care of this surgeon for removal of the old, infected plate and to insert a bigger locking plate. Subsequently, the claimant made a good recovery but continued to experience some residual symptoms.
We were instructed by the claimant to investigate a clinical negligence claim and, upon receipt of supportive expert evidence, prepared and served a formal letter of claim to Mr Saeed’s defence organisation. While it was accepted that fractures can occur during wisdom tooth extraction without representing negligent care, a claim was brought on the basis that in the context of a fracture occurring and the claimant’s history of primary immune deficiency which predisposed him to infection, there was a lack of appropriate post-operative advice and a failure to arrange adequate post-operative review, representing a breach of the duty of care owed to the claimant. It was alleged that these failures resulted in the non-union of the fracture and the requirement for more extensive surgery.
Mr Saeed’s defence organisation responded fairly quickly with an offer to settle the claim, without making any admissions in respect of liability, and this offer was subsequently accepted by the claimant.
Senior associate Amy Milner, who handled the case, said: “This was an interesting case where the claimant was not clear at the time of his initial discharge whether or not his jaw had been fractured during the wisdom tooth extraction or the implications for this in terms of his recovery. The case therefore highlights the importance of ensuring all patients are provided with the appropriate advice post operatively so that they are aware of any specific action that they should be taking to aid in their recovery.”