5. Examination of patients in the oral and maxillofacial surgery - a goal of clinical examination, medical history, examination of the general status. Paraclinical tests - reference values. Flashcards
Steps in treating a patient in oral and maxillofacial surgery
- Diagnostic sequence divided into five levels:
1. History taking
2. Clinical examination
3. Radiological analysis
4. Laboratory investigations
5. Interpretation to arrive at a final diagnosis
Aims and objectives of preoperative assessment in oral and maxillofacial surgery
- Decide the choice of anesthesia.
- Determine if the patient can withstand general anesthesia
- Assess if the patient can withstand the trauma of surgery
- Identify any abnormalities in the patient’s general health that need to be addressed before surgery.
- Choose appropriate premedication.
- Develop a treatment plan that will benefit the patient the most.
Aims of history taking in oral and maxillofacial surgery
- Obtain a correct account of the patient’s problems
- Considering their symptoms
- General condition, lifestyle, and socioeconomic background.
Steps involved in history taking
- Obtaining general information
- Recording the chief complaint(morbi)
- Gathering past and present medical history (vitae)
- Collecting personal and family history
General information obtained during history taking
- Name
- Age
- Sex
- Marital status
- Address
- Race and occupation
Details recorded for the chief complaint
- All symptoms, chronologically, in the patient’s own words.
- The onset, duration, and progress of each symptom.
- Any previous treatment taken for the condition and the patient’s response.
- A history of similar symptoms and treatments, along with outcomes.
- Additional history regarding trauma, unconsciousness, vomiting, bleeding
Medical conditions covered in the past/present medical history
*Cardiovascular disorders, Respiratory diseases, Neurologic conditions
* Endocrine system disorders, Hematological disorders, Infectious diseases.
* Reproductive system,Gastric disorders, Renal pathologies.
* Liver disorders, Autoimmune disorders, Psychiatric ailments
* Digestive system issues, Drug allergies, Childhood illness/birth trauma
* Previous hospitalizations, blood transfusions, and surgeries
* Past/present radiation therapy
* Current/past medications
How medical conditions affect surgical management
- Can alter the patient’s response to surgery
- Influence anesthetic and surgical management
- Affect postoperative recovery and wound healing
What is covered in the personal history of a patient
- Habits like chewing tobacco
- Alcohol consumption
- Smoking, drug abuse, and exposure to commercial sex workers
Why family history important in patient examination
- Highlights any hereditary conditions=>
- Epilepsy, cardiac disorders, diabetes, bleeding disorders, Tuberculosis
- Relevant to the patient’s diagnosis and treatment outcome
Purpose of routine haematological investigations in oral and maxillofacial surgery
- Overall health status
- Detect infections
- Assess nutritional status
- Identify bleeding disorders and evaluate the immune response to facilitate postoperative recovery
What haemoglobin (Hb) indicates in a blood test
Indicates the oxygen-carrying capacity of the blood
Normal haemoglobin values for males and females
- Females: 12 to 16 g/dL
- Males: 14 to 18 g/dL
g/dL- grams per decilitre
Decreased haemoglobin value suggests
- Anaemia=>iron deficiency
- Decreased absorption of vitamins and minerals
- Bone marrow depression, increased blood loss
What should be done if a patient has low haemoglobin
Referred to specialists
What a complete blood count (CBC) includes
- Red blood cell count
- White blood cell count
- Differential white blood cell count
- Platelet number estimation, and a blood smear description
Benefits of performing a CBC
- Helps to determine nutritional status
- Detect infections
- Identify bleeding disorders
- Evaluate the patient’s immune response
Normal values for red blood cell count in males and females
- Females: 4.5 to 5.5 million cells per cu mm
- Males: 4.5 to 6.2 million cells per cu mm
cu= cubic millimetres (mm3)
Conditions are associated with decrease in red blood cell count
- Anaemia, pellagra
- Haemorrhage, and liver disease
Conditions associated with an increase in red blood cell count
- Polycythaemia and extreme dehydration
Normal values for white blood cell count in adults and children
- Adults: 5000 to 10000 cells per cu mm
- Children below 7 years: 6000 to 15000 cells per cu mm
Conditions that cause an increased white blood cell count (leucocytosis)
- Acute infections
- Uraemia, leukaemia, and steroid therapy
Conditions that cause a decreased white blood cell count (leukopenia)
- Aplastic anaemia, radiation therapy
- Infectious mononucleosis, malaria, AIDS
Physiological factors can cause an increase in WBC count
- Pregnancy, exposure to heat and cold
- Muscular exercise, and emotional stress
Normal distribution of polymorphonuclear leukocytes (neutrophils) in a differential white blood cell count
Neutrophils: 50 to 70 percent
Conditions that cause an increase in neutrophils
- Infections, granulocytic leukaemia
- Post-surgery, severe exercise
Conditions that cause a decrease in neutrophils
Aplastic anaemia, viral infections, and patients undergoing radiation
Normal distribution of lymphocytes
25 to 40 percent
Conditions that cause an increase in lymphocytes
Viral infections, tuberculosis, mononucleosis
Conditions that cause a decrease in lymphocytes
Stress, uraemia, and steroid therapy
Normal value for platelet count
150,000 to 400,000 cells per cu mm
Conditions that cause an increased platelet count
- Malignancy, post-surgery
- Iron deficiency anaemia, trauma
Conditions that cause a decreased platelet count
Viral infections, and infectious mononucleosis
Normal ESR values for males and females using Wintrobe’s method
- Females: 0-20 mm/hour
- Males: 0-10 mm/hour
What an elevated ESR indicates
Chronic infections, infarctions, trauma
Normal bleeding time by Duke’s method
3 to 5 minutes
Conditions that cause an increased bleeding time
- Thrombocytopenia
- Capillary wall abnormalities (vitamin C deficiency)
- Platelet abnormalities (drug-induced, e.g., aspirin, warfarin)
Normal clotting time by Lee-White method
4 to 10 minutes
Conditions that cause prolonged clotting time
Thrombocytopenia, clotting factor deficiency, and use of anticoagulants.
Normal prothrombin time
12-14 seconds
Sites bacterial cultures can be obtained from
Throat, sputum, draining pus,
How cultures from the oral cavity can be obtained
- Gathering exudative material=>by aspiration with a needle and syringe
- or by using a swab
Biopsy and why is it important
- Removal of tissue from a living subject for histological evaluation
Punch biopsy and when it is used
- Small part of the lesion is obtained using a punch
- Useful for mucosal lesions in inaccessible regions
- May cause crushing or distortion of the tissues
When an incisional biopsy performedand how it is done
- Large diffuse lesion
- Section of the lesion, along with normal tissue, is incised using a scalpel
Excisional biopsy and when it is appropriate
- Removal of the entire lesion
- Appropriate for extremely small lesions (less than 1 cm)
Normal range for fasting blood glucose values
Between 65 and 110 mg/100 ml of blood
Normal postprandial (after eating) blood glucose level
Between 120 and 160 mg/100 ml of blood.
Conditions associated with increased blood glucose levels
Diabetes mellitus, Cushing’s syndrome, pancreatitis
