EXAM I Basic Surgical Principles

Question 1

developing a surgical diagnosis is a culmination of what 6 diagnostic steps?

Answer 1

1. signs
2. symptoms
3. relevant history
4. patient data
5. scientific data
6. logical reasoning and experience

Question 2

you should never accept a diagnosis in which 3 cases?

Answer 2

• diagnosis made by another individual
• diganosis made using poor radiographs
• diagnosis made with inaccurate information

Question 3

what are 7 basic necessities for surgery?

Answer 3

• adequate lighting
• adequate access
• adequate visibility
• appropriate patient positioning
• assistance
• surgical field free from blood
• aseptic technique

Question 4

when making an incision, what kind of stroke should you use?

Answer 4

firm, continuous stroke, with the blade held perpendicular to the epithelial surface

Question 5

when making an incision, what should you avoid?

Answer 5

injuring vital strucures, such as nerves, vessels, lips, adjacent tissues, etc.

Question 6

what are halstead’s principles (7)?

Answer 6

1. gentle handling of tissue
2. meticulous hemostasis
3. preservation of blood supply
4. strict aseptic technique
5. minimum tension on tissues
6. accurate tissue apposition
7. obliteration of dead-space

Question 7

to avoid flap necrosis, the apex of the flap should never be ___ than the base. what are the exceptions?

Answer 7

• wider
• unless a major artery or other major structure is present

Question 8

a flap should always converge from the ___ to the ___, or parallel if required due to ___

Answer 8

• base to the apex
• major structures

Question 9

to prevent flap necrosis, the ___ should be no more than twice the ___ of the base

Answer 9

length, width

ideally, the base is greater than the lengh

Question 10

is axial blood at the apex or the base of the flap?

Answer 10

base

Question 11

because axial blood supply is at the base of the flap, the base should be handled with care to avoid what?

Answer 11

twisting, stretching, or injury to the blood supply

Question 12

what is a possible complication with button hole flaps?

Answer 12

you can get an area of necrosis coronal to the flap, in the area where blood supply has been cut off by the button hole

Question 13

to avoid flap dehiscence, incisions must be made over ___

Answer 13

intact bone

Question 14

to avoid flap dehiscence, if the pathological condition has eroded the buccocortical plate, the incision must be ___mm away from it

Answer 14

6-8

Question 15

to avoid flap dehiscence, the incision must be ___mm away from the bony defect created by surgery

Answer 15

6-8mm

Question 16

gentle handling of flap edges and avoiding placing flap under tension can help avoid flap ___

Answer 16

dehiscence

Question 17

to avoid flap dehiscence, you should never cross ___ if possible

Answer 17

bony prominences (like the canine eminence)

Question 18

T or F:

short incisions heal faster than long incisions

Answer 18

false

if properly repaired, a long incision will heal just as quickly as a short one

Question 19

what can you do at the beginning of surgery to avoid flap tearing?

Answer 19

create a flap at the onset of the surgery that is large enough for the surgeon to avoid tearing it or interrupting surgery to lengthen it

Question 20

what are the 3 main types of mucoperiosteal flaps?

Answer 20

• envelope/sulcular incision
• envelope with one releasing incision (3-corner flap)
• envelope with two releasing incisions (4-corner flap)

Question 21

in creating a standard envelope flap with no releasing incisions, how many teeth should be anterior and posterior to the tooth being worked on? where is it placed in an edentulous arch?

Answer 21

• 1 tooth posterior and 2 teeth anterior to the one being worked on
• in an edentulous arch, it should be placed at the crest of the ridge

Question 22

in creating an envelope flap with 1 vertical releasing incision, how many teeth should be anterior and posterior to the tooth being worked on?

Answer 22

1 tooth anterior and 1 posterior

Question 23

in creating an envelope flap with 2 releasing incisions, how many teeth should be anterior and posterior to the tooth being worked on?

Answer 23

1 anterior and 1 posterior

Question 24

it is important to handle tissue carefully during surgical procedures. what are some things that can damage tissues?

Answer 24

excessive pulling, crushing, extremes of temperature, desiccation, or chemicals

Question 25

what type of tissue forceps are good for delicate manipulation of tissues?

Answer 25

toothed forceps or tissue hooks

Question 26

to avoid tissue damage, you should use copious irrigation when ___

Answer 26

cutting bone

Question 27

patients whose tissue has been handled gently and physiologically will experience wounds that heal with less frequenty ___

Answer 27

complications

Question 28

what are some issues caused by uncontrolled bleeding?

Answer 28

• decreased visibility
• hematomas
  
  • decreased vascularity
  • wound dehiscence
  • infection

Question 29

what are some things you can do to promote wound hemostasis?

Answer 29

• natural hemostatic methods
  
  • gauze (dab) and pressure
• heat
  
  • electrocautery
• suture ligation
• hemostatic agents
• vasoconstrictive substance

Question 30

what is a concern with dead space?

Answer 30

it will usually fill with blood, resulting in a hematoma

Question 31

what are some ways to prevent dead space?

Answer 31

• suture tissue planes together
• direct pressure
• packing the surgical site
• drains

Question 32

when assessing a patient for oral surgery, what are some important general health concerns that can affect the surgery?

Answer 32

• conditions that establish a catabolic state of metabolism, that impeded oxygen or nutrient delivery to tissues, or that require administration of drugs or physical agents that interfere with immunologic or wound-healing cells
• uncontrolled diabetes
• end-stage renal or hepatic disease
• malignant diseases
• severe COPD
• poorly compensated congestive heart failure
• drug addictions such as ethanolism (alcoholism)
• medications
• long-term corticosteroid therapy, malignancies, cytotoxic agents, and irradiation