Instrumentation and suturing Flashcards
How is a surgical tray set up (broadly)?
from left to right
The order of the surgical tray is set up from left to right with what 9 goals in mind?
- examine
- anaesthetise
- cut (incise)
- raise (reflect)
- retract
- remove (Bone)
- remove (tooth)
- refurbish
- suture
What are these?
towel clips
What are towel clips for?
- 2 on the surgical tray
- sharp tips that clip together to hold a set of drapes
- used for holding a piece of tubing to a patient’s sterile drape in order to keep them together
- commonly used in theatres for draping of the patient’s head
- very sharp so be careful!!
What is this?
McKessons mouth prop
What is a McKessons mouth prop for?
- used to prop the mouth open
- anytime during the procedure particularly when patient’s jaw is getting tired
How is the McKessons mouth prop used?
- inserted with smaller end posteriorly
- bigger side (with writing) tends to sit towards cheek to keep it out of the way
- cerrated areas between the teeth
- chain up and out of the mouth
What is this?
scalpel handle no. 3
What is this?
Most no.9 periosteal elevator
What is the Molt no. 9 periosteal elevator used for?
elevating flaps from the bone
How is the Molt no. 9 periosteal elevator used?
- double ended
- works under the incision to get under the gingivae and periosteum to gently elevate the flap
- must be careful, used with tip against bone rather than dragging them towards yourself through gingivae as could lacerate or macerate mucosa if not used properly
- held in pen grip
What is this?
Mitchell’s trimmer
What is a Mitchell’s trimmer used for?
elevating flaps
How is a Mitchell’s trimmer used?
double ended
- small spoon end mimics molt no. 9, used in same fashion with concave aspect going towards bone under periosteum and the convex surface used to push mucosa out of the way
- other end triangular and pointy and at 90 degrees to the handle, more often used for stripping attachments from bone, must be very careful with this as very easy to perforate through flap
What is this?
Howarth’s nasal rasp/periosteal elevator
What is the Howarth’s nasal rasp/periosteal elevator used for?
- an ENT instrument
- in MOS used to retract/reflect the periosteal flap
How is the Howarth’s nasal rasp/periosteal elevator used?
primarily used the soft end (right image)
- introduced under periosteum and flap elevated
other end more aggressive, curved and sharp (middle image)
- used to strip things from bone
- won’t raise/reflect flaps with it
What end of this instrument is usually the only one used?
end on right hand side - soft end
(Howarth’s nasal rasp/periosteal elevator)
What instruments may be used to raise/reflect?
- Molt no.9 periosteal elevator
- Mitchell’s trimmer
- Howarth’s nasal rasp/periosteal elevator
What is this?
Minnesota retractor
What is a Minnesota retractor used for?
used to introduce under the periosteum and retract tissues while operating
How is a Minnesota retractor used?
- slightly raised sides towards operative site
- curvature is to overcome the cheeks
- put the instrument in with the tip on the left curving up and out of the mouth
What is this?
Bowdler-Henry rake retractor
What is a Bowdler-Henry rake retractor used for?
retraction of flap
How is a Bowdler-Henry rake retractor used?
- teeth of instrument sit gently on the bone with the flap retracted behind it
- curvature (right image) rests up and over the cheek
- long handle which you can hold and keep non-dom hand out of the operating site
- in concavity there is a channel where you operate burr/spinning handpiece with cheeks retracted away
How is Bowdler-Henry rake retractor held?
with finger tips at top of handle
What instruments can be used to retract?
- Minnesota retractor
- Bowdler-Henry rake retractor
What is this?
straight handpiece
What max. speed does a straight handpiece run at?
approx. 40,000 rpm
What is a straight handpiece irrigated with?
sterile saline
What are the standard burs used during MOS?
- round bur - classically for removing bone around teeth
- fissure bur - classically for sectioning teeth
(but can be used for either reason)
Why is it possible for soft tissue to be easily burnt/damaged by the spinning burs?
they are long so the soft tissues can accidentally be touched by the spinning shank of the bur if not retracted properly
What is this?
irrigation tubing/saline