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BDS3 ORAL SURGERY > 3 - Basic surgical technique > Flashcards

3 - Basic surgical technique Flashcards

1
Q

What are the stages of surgery?

A
  • consent
  • surgical pause/safety checklist
  • anaesthesia
  • access
  • (bone removal)
  • (tooth divison)
  • debridement
  • suture
  • achieve homeostasis
  • POI
  • (post-operative medication)
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2
Q

Describe the consent required for oral surgery.

A
  • GA requires written consent
  • LA requires verbal consent although it is good practice to obtain written as well
  • consent must be obtained using simple language (no jargon)
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3
Q

What is involved in the surgical pause?

A
  • safety checklist
  • site marked
  • equipment checked
  • checked it is the correct patient
  • ensure patient knows what procedure is going to happen
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4
Q

Describe surgical access.

A
  • a larger flap gives better visualisation and large flaps heal at the rate as smaller ones
  • preserve adjacent soft tissues where possible
  • consider post-op aesthetics if in the anterior
  • wide base incision is better for circulation
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5
Q

How should you use a scalpel when making an incision?

A
  • one firm continuous stroke
  • no sharp angles
  • flap reflection should be down to the bone (periosteum)
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6
Q

How should you manage a flap during surgery?

A
  • keep tissue moist
  • do not crush tissues
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7
Q

How should flaps be closed?

A
  • using sutures
  • flaps should not be closed under tension as this will cause the flap to pull open during healing
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8
Q

Describe a 3 sided flap.

A

2 relieving incisions mesial and distal to the tooth being extracted

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9
Q

Describe a 2 sided flap.

A

1 relieving incision mensal OR distal to tooth being extracted (also known as an envelope flap)

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10
Q

What is the role of soft tissue retraction?

A
  • protection of soft tissues
  • gain better access to operative field
  • flap design facilities retraction
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11
Q

What should be used to retract soft tissues?

A
  • Howarth’s periosteal elevator
  • rake retractor
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12
Q

Why are air driven handpieces not used in oral surgery?

A

May lead to surgical emphysema (air driven into soft tissues, can be life threatening)

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13
Q

What is used for bone removal and tooth division?

A
  • electric straight handpiece with saline cooled bur
  • round or fissure tungsten carbide burs
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14
Q

Where do you remove bone during a surgical extraction?

A

Form a gutter around the buccal side of the tooth

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15
Q

How should you divide a tooth for extraction?

A

Remove crown and the divide the roots

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16
Q

What are the principals of elevator use?

A
  • avoid using excessive force
  • support instrument to avoid injuring soft tissues
  • force should be applied away from major structures
  • always use under direct vision
  • do not use adjacent tooth as fulcrum
17
Q

What can elevators be used for?

A
  • point of application for forceps
  • loosen teeth prior to forceps
  • extraction
  • removal of retained roots
  • removal of root apices
18
Q

What are the 3 actions when using an elevator?

A
  • wheel and axel
  • wedge
  • lever
19
Q

What are the different methods of bone debridement?

A
  • physical
  • irrigation
  • suction
20
Q

Describe physical debridement.

A
  • bone file or handpiece to remove sharp bony edges
  • Mitchell’s trimmer or Victoria curette to remove soft tissue debris
21
Q

Describe irrigation used for debridement.

A

Sterile saline injected into socket and under soft tissue using a blunt needle

22
Q

Describe suction used for debridement.

A

Aspirate under socket

23
Q

What are the aims of suturing?

A
  • compress blood vessel to achieve homeostasis
  • reposition tissues
  • cover bone
  • prevent wound breakdown
  • encourage healing by primary intention
24
Q

Define healing by primary intention.

A

When tissues are approximated to prevent loss of tissue, should heal with a thin, neat scar

25
Q

Describe non-absorbable sutures.

A
  • used when extended retention is required
  • must be removed post op
  • used to close OAF or exposure of ectopic canines
26
Q

Describe absorbable sutures.

A
  • hold tissues edges together temporarily
  • used when removal of suture is not possible or desirable
  • don’t usually require review
  • breakdown via absorption of water into filament to degrade polymer
27
Q

Describe monofilament sutures.

A
  • single strand
  • pass easily through tissue
  • resistant to bacterial colonisation
  • excellent for aesthetics
  • difficult to manage
28
Q

Describe polyfilament sutures.

A
  • several filaments twisted together
  • easier to handle
  • prone to wicking (oral fluid can move along suture and cause infection)
29
Q

What are the different suture types?

A
  • curved
  • triangular cross-section
  • round cross-section
30
Q

What are the most commonly used suture types in dentistry?

A
  • 1/2 circle
  • 3/8 circle
31
Q

What can be used peri-operatively to achieve haemostasis?

A
  • LA with vasoconstrictor
  • diathermy
  • bone wax
32
Q

What can be used post-operatively to achieve haemostasis?

A
  • pressure
  • LA infiltration
  • diathermy
  • surgicel sutured into socket
  • sutures
33
Q

What post op medication advice should you give?

A
  • analgesia advice not prescriptions
  • antibiotics occasionally but not routinely
34
Q

What nerve should be considered when removing lower third molars?

A
  • lingual
  • inferior alveolar
  • mylohyoid
  • buccal

BDS3 ORAL SURGERY (9 decks)

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