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Oral surgery > 3. General surgical procedures - incisions, suturing, sewing materials, curettage, drainage, puncture. > Flashcards

3. General surgical procedures - incisions, suturing, sewing materials, curettage, drainage, puncture. Flashcards

1
Q

Primary purpose of surgical incisions

A

Gain access intraorally or extraorally, to site that is the object of the surgery

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2
Q

Role retractors play in surgical procedures

A
  • Pull the tissues aside to visualize the tissues exposed=>
  • Allows better access to the surgical site
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3
Q

How length of surgical incisions managed

A
  • No longer than necessary
  • Skin or mucosal incision the shortest
  • Incisions in deeper layers longer to allow the surface to be slid from side to side=>
  • maximal access without increasing the surface incision length
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4
Q

Types of blades are commonly used for incisions in oral and maxillofacial surgery

A
  • The #15 blade with its rounded tip is most popular
  • # 11 blade with its pointed tip
  • # 12C blade with its smaller rounded tip are also used for specific procedures
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5
Q

Recommended technique for making an incision

A
  • One single firm movement using the palm of the hand as support for the scalpel handle=>
  • To avoid undesirable instability
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6
Q

Alternative methods for making incisions besides using a scalpel

A
  • Electrosurgery or a laser
  • Combined instruments like a scalpel blade with electrosurgery capacity
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7
Q

Drawbacks of electrosurgical cutting

A
  • Produces bloodless field=> at the expense of surface cauterization=>
  • More wound breakdown, scarring, and wound contracture
  • Unsuitable for esthetic areas
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8
Q

Where skin incisions around the face placed for the best esthetic results

A
  • In established skin creases
  • Future skin creases (in young patients)
  • Or in the relaxed skin tension lines
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9
Q

Relaxed skin tension lines

A

Run at right angles to the direction of underlying musculature

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10
Q

Precautions taken when making facial incisions to minimize scarring

A
  • Follow relaxed skin tension lines
  • Avoid crossing natural crease lines at right angles
  • Consider underlying nerves, particularly branches of the facial nerve
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11
Q

How incisions be made on the oral mucosa

A

Full thickness over the mandible and maxilla, going down to the bone

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12
Q

Characteristics and indications of a straight vertical incision

A
  • Most esthetic result with minimal scarring
  • Indicated for obtaining access to deeper lesions
  • Tunneling procedures
  • Minimally invasive intraoral procedures, though access is limited
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13
Q

When a straight horizontal incision in the buccal sulcus indicated and its drawback

A
  • Management of periapical pathology
  • Impacted teeth
  • Tumors, and sinus procedures
  • Produces more scarring than a vertical incision.
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14
Q

Intrapapillary/sulcular/gingival margin incision and its potential problems.

A
  • Uses a scalpel at a reverse bevel
  • Sections interdental papillae and some supracrestal fibers
  • Excellent access with minimal scarring
  • Potential problems => Issues around crowns and bridges, gingival recession, root exposure, and occasional gingival problems
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15
Q

Purpose of releasing incisions at each end of a gingival margin incision

A
  • Releasing incisions( should be divergent)=> protect the vascularity of the flap and minimize visible scarring
  • especially when placed further back in the oral cavity
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16
Q

Winter type incision for third molars

A
  • Extends down the external oblique ridge to the disto-buccal line angle of the second molar=>
  • Continues around the gingival margin of the first and second molar
  • Good access but can be difficult to suture and may cause gingival recession
  • An alternative=> releasing incision terminating around the posterior edge of the first molar to avoid a small arteriole
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16
Q

Double Y-type incision and when it is indicated

A
  • For Palatal torus removal
  • Good blood supply for the palatal mucosa and allows excellent access for removal with drills and chisels
  • Can be followed by sharp or blunt dissection to avoid damaging important structures
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17
Q

Primary goal of suturing following a surgical incision

A
  • Close the wound, ensuring the best apposition of tissues and minimal scarring
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18
Q

Alternatives to traditional suturing

A

Stapling and the use of tissue adhesives.

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19
Q

Instruments commonly used for suturing

A

Needle holders, tissue forceps, and scissors

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20
Q

Main categories of sutures based on their resorption properties

A
  • Resorbable or non-resorbable
  • Resorbable sutures dissolve over time
  • Non-resorbable sutures need to be removed
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21
Q

Monofilament sutures

A
  • Tend to stay cleaner
  • Leave fewer suture marks on tissues
  • Harder to knot=>more likely to become unknotted
  • Can irritate the tongue and cheeks
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22
Q

Multifilament Sutures

A
  • Easier to knot
  • Lie flat, and are less irritating
  • Harder to keep clean
  • Tend to “wick,” attracting moisture and bacteria

  • Some synthetic sutures combine the benefits of both by being coated multifilaments
23
Q

Catgut suture, and its properties

A
  • Made from sheep intestine, 🐑
  • Proteinaceous product
  • Plain Catgut
  • Chromic Catgut
24
Q

Plain Catgut

A
  • Monofilament
  • Resorbs in 5-7 days via enzymatic action,
  • Often causes inflammatory response
25
Q

Chromic Catgut

A
  • Treated with chromic acid to improve handling properties=>
  • Reduce inflammatory response
  • Resorbs in about 2 weeks
  • Considered ideal for many intraoral suturing needs
  • Potential concerns regarding prion disease transmission
26
Q

Polyglycolic Acid and Polyglactin Sutures

A
  • Synthetic
  • Resorb in about 6 weeks through hydrolysis
  • Monofilament, multifilament or coated multifilament
27
Q

Polydioxanone (PDS) and polyglyconate sutures used for

A
  • Synthetic
  • Resorb in about 120 days 🕰️
  • used where long-term resorption is beneficial=>alar cinch sutures for LeFort orthognathic surgery
  • Monofilament, multifilament, coated multifilament
28
Q

Characteristics and uses of silk sutures

A
  • Natural product from silkworms
  • Non-resorbable
  • Always braided
  • Easy to knot
  • Lies flat
  • Needs removal
  • Prone to food sticking and wicking=> infection if not kept clean.

On the skin, they leave suture marks if not removed after a few days

29
Q

Properties and occasional uses of cotton sutures

A
  • Natural
  • Non-resorbable
  • Multifilament
  • knots easily
  • Occasionally used on the mucosa and tends to wick
30
Q

Advantages of nylon and polypropylene sutures

A
  • Synthetic
  • Monofilament
  • Non-resorbable
  • Extremely fine, non-irritant
  • often used in microsurgery and skin suturing
  • Polypropylene is especially benign for skin=>minimal suture marks
31
Q

Common characteristics and variations of surgical needles

A
  • Come ready-swaged to the suture
  • Vary in length
  • Diameter of a circle
  • Some in other shapes like a J shape
32
Q

Round-bodied needle and its typical use

A

Non-cutting and is generally used on friable internal organs

33
Q

Cutting needle and its application

A
  • Triangular in cross-section
  • One edge sharpened to cut through tissues
  • Necessary for mucosa, skin, and some fascial layers of the head and neck
34
Q

Difference between a forward-cutting and a reverse-cutting needle?

A
  • Forward-Cutting Needle=> The cutting edge is on the inside of the circle
  • Reverse-Cutting Needle=>The cutting edge is on the outside of the circle=>
  • Cuts away from the direction the needle is passed=>
  • Preferred in most oral surgical procedures to prevent cutting through the tissues too often
35
Q

Taper cut needle

A
  • Combines a reverse-cutting tip with a round-bodied portion
  • Makes initial incision with the cutting tip
  • Passes through tissues with the round-bodied part=>minimal damage
36
Q

How suture tied once it has been passed through tissues

A
  • Tied in a knot
  • Done with an instrument or by hand
  • A monofilament suture requires more knots than a braided suture to prevent it from becoming untied.
37
Q

Process of tying a secure surgical knot

A
  1. Start with a double overhand or double thumb knot=> prevents slipping
  2. Follow with another thumb knot=> If tied in the same direction=>it forms a surgeon’s knot (secure)
    * =>If tied in the opposite direction, it forms a granny knot (adjustable).
  3. The final knot converts the previous knot to a reef or square knot to prevent loosening.
38
Q

Simple interrupted sutures, and recommended density

A
  • Common sutures with each stitch tied separately
  • Around three sutures per centimeter of length is a good balance=>
  • Minimize stitch marks and infection while preventing a widened scar
39
Q

Horizontal and vertical mattress sutures

A
  • Horizontal Mattress Sutures: Used for watertight closure
  • Vertical Mattress Sutures: Provide watertight closure and everted suture line=>
  • Ideal for suturing over dead spaces like cyst cavities or oroantral fistulas
40
Q

Continuous locking and non-locking sutures

A
  • Non-Locking Sutures: Often used on the skin for better cosmetic results.
  • Locking Sutures: Used in the oral cavity for better closure and waterproofing
  • The risk with continuous sutures=>one part breaks=>suture line can fail
  • Interrupted sutures =>doesn’t compromise the entire line
41
Q

Curettage, and how it is performed

A

Use of an instrument to remove tissue by scraping or scooping

42
Q

Dental procedure in which curettage used

A
  • Teeth affected by periodontitis. Specifically
  • Gingival curretage=>removes soft tissue lining of the periodontal pocket with a curet=>
  • leaves only a gingival connective tissue lining.
43
Q

Goal of gingival curettage

A
  • Promote new connective tissue attachment to the tooth=>
  • Removal of pocket lining and junctional epithelium
44
Q

Primary purpose of drainage by incision in the case of pus-producing infections

A

Resolve the infection by incising the abscess cavity and draining the pus.

45
Q

Pus components, and why its drainage is important

A
  • Dead leukocytes (neutrophils) and causative bacteria
  • Drainage reduces tissue tension=>
  • Improves local blood supply
  • Changes the local environment by increasing oxygenation=»>
  • Resolve the infection
46
Q

How a clinician detects an abscess

A
  • Carefully palpate swollen areas to detect fluctuance=>
  • Indicates abscess formation
47
Q

When an abscess should be incised

A
  • When pus has accumulated within the cavity
  • Infections usually start with cellulitis=>
  • Soft, doughy, and diffuse swelling=>
  • May not respond to surgery
48
Q

Considerations for anesthesia during incision and drainage of an abscess

A
  • Conventional local infiltration=>superficial and well-localized abscesseS
  • Greater volumes of anesthetic=>extensive infection=>
  • Inferior alveolar nerve block, sedation, or general anesthesia

inflammation creates an acidic environment, slowing the onset of action and reducing effectiveness

49
Q

Why aspiration of pus prior to incision recommended, and how it should be performed

A
  • Sterile syringe with a large-gauge needle is for pus accumulation
  • Localize the abscess=> collect pus for bacteriologic examination
  • Mucosa or skin disinfected before aspiration to avoid contamination
50
Q

Precautions taken to avoid damaging important structures during incision

A
  • Avoid damage to salivary gland ducts and nerves
  • Placed parallel to the facial nerve branches
  • Consider structures like the marginal mandibular branch of the facial nerve and mental nerve
  • Avoid damaging greater palatine artery and lingual artery
51
Q

Where incision made to minimize cosmetic and functional issues

A
  • Placed in esthetically acceptable areas
  • Intraoral incisions minimal and careful to avoid future functional problems
52
Q

How an incision made to maximize drainage efficiency

A
  • Should encourage gravity drainage
  • Made with blunt dissection to minimize injury to vital structures
  • Ensure adequate opening of the abscess cavity.
53
Q

Role irrigation plays in the treatment of large abscesses

A

Irrigation with saline helps reduce residual contamination in large abscesses

54
Q

How drains managed post-insertion

A
  • Shortened over the next few days to ensure complete drainage
  • Removed when drainage stops to avoid delaying the normal wound healing process.

Oral surgery (105 decks)

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