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3. Oral Surgery > Basic Surgical Technique > Flashcards

Basic Surgical Technique Flashcards

1
Q

What can happens if tooth breaks during a simple XLA?

A

procedure can turn surgical

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2
Q

What is important if we consider a surgical extraction?

A

our own limitations - don’t do any surgical procedures we haven’t done before or haven’t done in years

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3
Q

What are the 3 basic principles of MOS?

A

Risk assessment

aseptic technique

minimal trauma to hard and soft tissues

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4
Q

What is risk assessment?

A

this is when we plan the surgery and how we plan to carry it out, the order of surgery and exactly what we want to do

med history - any medications that would affect surgery

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5
Q

What is aseptic technique?

A

the mouth is full of MOs however we want to create an environment where we dont introduce any new MOs that can lead to infection

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6
Q

What will minimal trauma to hard and soft tissues lead to?

A

Lower complications, less post op pain, bruising and swelling

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7
Q

What environment is minor oral surgery carried out in?

A

doesn’t have to be in theatre environment but we have large light, large room, surgical gown, cap and sterile gloves

we must use aseptic technique and minimise trauma to soft and hard tissues

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8
Q

What are the 12 stages of surgery?

A
  1. consent - written and verbal
  2. surgical safety checklist
  3. anaestheisa
  4. access
  5. bone removal
  6. tooth division if needed
  7. debridement and wound management
  8. suture
  9. achieve haemostats
  10. post op instructions
  11. post op meds
  12. follow up
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9
Q

What GDC standard is about consent?

A

3rd standard states we must obtain valid consent

must obtain verbal and written consent when tx involves conscious sedation or GA

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10
Q

What sort of consent do we get in oral surgery?

A

Written and verbal consent for surgical and non surgical procedures (we have a consent form that details and risks of tx and pt signs this)

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11
Q

What is a surgical safety checklist?

A

We use modified WHO guideline checklist for minor oral surgery

It includes sign in - who is treating pt, who pt is and what site were working on, pts tx plan, mh, allergies, radiographs

surgical pause

sign out

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12
Q

What must we do to gain surgical access?

A

Lift a mucoperiosteal flap

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13
Q

What is a mucoperiosteal flap?

A

flap of mucosal tissue, including the underlying periosteum, reflected from the bone during oral surgery

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14
Q

Do big flaps heal slower than smaller flaps?

A

No both take same time

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15
Q

What do we want in terms of flaps?

A

Maximal access with minimal trauma (wide flaps to allow access - will heal same rate as small flaps)

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16
Q

Where is the periosteum?

A

Between bone and mucosa is a connective tissue known as periosteum

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17
Q

How do we properly lift a flap?

A

We must lift the mucosal tissue and periosteum (if we leave periosteum attached to the bone this is wrong)

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18
Q

What if when we lift a flap we leave periosteum attached to bone?

A

This is wrong - for a mucoperisoteal flap we must raise mucosa and periosteum

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19
Q

When gaining surgical access why do we make a wide based incision?

A

we want to ensure the flap maintains good circulation/perfusion to prevent flap going necrotic and dying

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20
Q

What do we want to make sure we incise for flaps?

A

Mucosa and periosteum - we do this with one continuous firm stroke

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21
Q

What does a small thin flap have higher risk of?

A

necrosis and death

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22
Q

What must we ensure flap margins lie on?

A

Sound bone

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23
Q

flap margins on sound bone allows what?

A

support to the soft tissue and means they can heal properly preventing any wound breakdown

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24
Q

When we close wounds what is important?

A

that wound is tension free as if there is tension there will be breakdown of wound

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25
Q

What type of healing to we aim for?

A

healing by primary intention to minimise scarring

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26
Q

What happens if we cause more damage to periosteum?

A

More bruising and post op pain we get

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27
Q

What is a 3 sided flap?

A

This is where we make 3 incisions :

  • distal relieving incision
  • crevicular incision
  • medial relieving incision
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28
Q

What 3 incisions do we make for 3 sided flaps?

A

medial RI

Crevicular incision

distal RI

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29
Q

what must we be careful with distal relieving incisions?

A

That it isn’t too lingually placed as it can risk the lingual nerve

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30
Q

What should distal RI be?

A

more buccal and follow external oblique ridge of mandible

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31
Q

What is an envelope flap?

A

This is a flap where we make two incisions

  • distal ri

crevicular RI that extends to tooth infront

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32
Q

What incisions do we Make when making an envelope flap?

A

DISTAL RI

CREVICULAR RI (extending to tooth infront)

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33
Q

Once we incise the flap what must we do?

A

lift flap back to provide access to operative field

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34
Q

What dow e use to lift flap back?

A

Howarth’s periosteal elevator

rake retractor

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35
Q

What must we then remove after lifting a flap?

A

bone

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36
Q

What do we use to remove bone?

A

electrical straight handpiece with sterile water cooled bur

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37
Q

Why do we not use air driven handpieces in oral surgery?

A

leads to surgical emphysema which is where gas or air is driven underneath mucosa or skin leading to many problems - may need hospital admission or antibiotics

38
Q

What burs do we use to remove bone or divide teeth to protect the teeth?

A

tUNGESTEN OR CARBIDE BURS

39
Q

What is a buccal gutter?

A

This is where we make an incision around he lower 8 to allow us to elevate the tooth or remove crown and split roots

40
Q

What can we use elevators for?

A

To deliver roots and sometimes teeth - loosen teeth by widening pdl and mobilise roots

41
Q

What are the 3 types of elevators?

A

couplands

Warwick James

cryers

42
Q

What are couplands elevators?

A

 3 sizes – narrowest to widest (1,2,3) and are used to split multi rooted teeth and are inserted between the bone and tooth roots to elevate them out the socket

43
Q

How do we identify right from left cryer?

A

old them to ceiling facing upwards and pointy bits should point at each other

44
Q

What do elevators do?

A

Give us mechanical advantage to remove teeth and roots and avoid excessive force which can lead to mandible fracture

45
Q

What are the 6 uses of elevators?

A

provide point of application for forceps

loosen teeth using forceps

extract tooth without forceps

removing Muti rooted stimos

removing retained roots

removing root apices

46
Q

What are point of applications of elevators?

A

Mesial

Distal

Buccal

Superior

47
Q

What is the most common motion when using elevators?

A

When and axle rotation movement

48
Q

How do we rotate elevators?

A

rotate the first to allow instrument to engage the tooth

49
Q

What movement should we avoid using?

A

Lever movement

50
Q

What must we do once procedure is finished?

A

clean and irrigate wound

51
Q

What are the 3 methods of debridement?

A

physical

irrigation

suction

52
Q

What is physical debridement?

A

this is where we use a bone file or headpiece to remove any sharp bony edges

victorias curette or Mitchells trimmer to remove soft tissue debris

53
Q

What do we use to remove any sharp bony edges?

A

bone file

handpiece

54
Q

What do we use to remove soft tissue debris?

A

victorias curette

Mitchell’s trimmer

55
Q

What is irrigation debridement?

A

This is where we put sterile saline into socket and under flap

56
Q

What is suction debridement?

A

tHIS IS WHERE we aspirate under flap to remove debris and check socket for retained apices

57
Q

When do we use sutures?

A

when we have lifted a flap and need to approximate tissues

if we want to compress BVs and gain haemostatic control

58
Q

What is the aim of sutures?

A

Reposition tisses

cover bone

prevent wound breakdown

achieve haemostasis

encourage healing by primary intention

59
Q

What are the two types of stitches?

A

Absorbable

Non absorable

and these can be monofilament or polyfialment

60
Q

What are non resorbable stitches?

A

Ones that dont dissolve and are used if needed for extended periods of time

61
Q

What are some examples of non-resorbale stitches?

A

Mersilk

Prolene

EThlon

62
Q

What are non absorbable sutures used for?

A

Closure of OAF

Closure of exposed canine

63
Q

What are absorbable stitches?

A

These are sutures that dissolve after a period of time and hold tissue edges together temporarily

64
Q

How do absorbable stitches work?

A

break down via hydrolysis

polymer degrades and is metabolised by body

65
Q

How long do absorbable sutures last?

A

1-2 weeks

66
Q

What are some examples of absorbable sutures?

A

Vicryl

velsorb fast

67
Q

What are the two types of suture filaments?

A

Monofilament

Polyfilament

68
Q

What are monofilament sutures?

A

Single strand suture that passes easily through tissue and are resistant to bacterial colonisation

69
Q

What are some examples of

monofilament sutures?

A

praline

ethlon

70
Q

What is a polyfilament suture?

A

This is where there is several filaments twisted together (many strands) and the are easier to handle than monofilament suturs

71
Q

What is the issue with polyfilament sutures?

A

Prone to wicking which an allow oral fluids and bacteria to move along length of suture and result in infection

72
Q

Examples of polyfilmatent sutures?

A

vicryl

mersilk

73
Q

What two shapes of suture needles do we use?

A

1/2 circle

3/8 circle

74
Q

What size and length of suture needles do we have?

A

various

75
Q

What is the cross section of a suture needle like?

A

Triangular

round

76
Q

How does triangular cross section suture needle work?

A

If the tip of triangle is on the inside then suture passes through tissues easy with minimal trauma (however concerns we can tear suture through when tying off so some do reverse cutting with tip of triangle on outside)

77
Q

How do we hold a suture needle?

A

Grade suture needle with needle holder 1/3rd from wedged end and have body then point at top

78
Q

What are the main types of sutures?

A

interrupted

horizontal matress

continuous

vertical matress

79
Q

How do we suture a 3 sided flap?

A

suture across DRI

2 sutures across MRI

OR

1 SUTURE IN MRI
1 SUTURE IN DRI
1 SUTURE DISTAL TO 7 ONCE 8 HAS GONE

80
Q

How do we suture envelope incision?

A

One suture distal to 7

one on MRI

81
Q

How can we achieve haemostasis?

A

la with vasoconstrictor

artery forceps to clamp any large bleeding vessels

diathermy

bone wax if bleed from bone

pressure

sutures

82
Q

When removing lower 3rd molars what nerves can be damaged?

A

IAN

Buccal

lingual

Mylohyoid

83
Q

What must we inform pts with wisdom tooth removal?

A

Potential nerve damage

84
Q

Where is lingual nerve in 15-18% of cases?

A

Above lingual plate and means we are at risk so we would want to do surgical extraction

85
Q

Complications of wisdom tooth removal?

A

Pain

Swelling

Bruising

Bleeding

Trismus

Infection

Dry Socket

Paraesthesia/anaesthesia

86
Q

What is mucocele excision?

A

soft tissue procedure to remove sac of saliva created in response to trauma of lower lip or damage to minor salivary glands

87
Q

How do we excise a mucocele?

A

• WE USE BLUNT DISSECTION RATHER THAN SCALPEL TO AVOID RISKING ANY NERVE ENDINGS BEING DAMAGED

88
Q

What is preri-radicular surgery?

A

periradicular surgery is surgery to the external root surface. Examples of periradicular surgery include apicoectomy, root resection, repair of root perforation or resorption defects, removal of broken fragments of the tooth or a filling material, and exploratory surgery to look for root fractures.

89
Q

How do we design flap for peri-radicular surgery?

A

triangular flap - 2 sides

rectangular flap - 3 sides

90
Q

How do we do peri-radicular surgery?

A
  • The amount of bone removal depends on the extent of the lesion – try be conservative and still allow access - if infection is evident then we may not need to do any bone removal but in some cases we thin the bone
  • Then we remove the apex (3mm with fissure bur) at a minimal angle to allow visualisation and try to keep cut at RAs to root to minimise the surface area
  • Then we curettage
  • We take the ultrasonic to clean canal, creates 3mm prep within canal and removes contam root filling
  • We use a bur to prep usually out with confines of canal

the retrograde seal with MTA

close with sutures

3. Oral Surgery (9 decks)

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