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
What is used for removal of bone?
- straight handpiece
- burs
- irrigation tubing/saline
What are these?
coupland elevators 1, 2 and 3
What are these?
Warwick James elevators S, L&R
What are these?
Cryers elevators L&R
What forceps are on the standard on a surgical tray?
- upper root forceps
- lower root forceps
can add to this as necessary but these are what’s included as standard
What is this?
surgical suction tip
What is this used for?
controlling level of suction
- hole not covered = lower volume of suction e.g. near soft tissues
- finger over hole = higher volume of suction e.g. against hard tissues, high volume of water
What is this used for?
to unblock the suction
What is this?
top - surgical suction
bottom - clearing stylus
What is this?
disposable surgical suction and stylus
What is this?
Spencer Wells forceps / artery forceps
What are Spencer Wells forceps used for?
grabbing on to things, good at crushing things e.g. arteries
- ratchet and close to hold onto things
What is this?
Ficklings forceps
What are Ficklings forceps used for?
‘rat-tooth’
- one sharp blade poking into a notch
- good for holding and manipulating soft tissue
What instruments are used for removal of teeth during MOS?
- elevators (couplands, warwick james, cryers)
- forceps
- surgical suction
- Spencer Wells forceps
- Ficklings forceps
What is this?
Rongeurs/Bone nibbler
What is a Rongeurs/Bone nibbler used for?
clips off little bits of bone
Why is there a concavity in the tips of the Rongeurs/Bone nibbler?
so when the bone is clipped off it stays in the forcep to remove from the mouth
What is this?
bone file
What is a bone file used for?
files bone, smooths down jagged bits of bone
When is a straight handpiece used during refurbishment/after removing tooth?
smoothing down bone with a bur rather than hand instruments
What is this?
irrigating syringe/needle
What is an irrigating syringe/needle used for during MOS?
- removing bone dust, debris, tooth fragments etc from the socket and under the flap
- flap elevated, retracted and irrigated underneath and in socket
What is this?
Lacks retractor
What is a Lacks retractor used for?
- can be used to retract mucoperiosteal flap
- commonly used by assistant to gently retract tongue
- must be careful to not let it drift down oropharynx, put too much pressure on it e.g. where lingual nerve is
- can use near surgical site when elevating teeth to protect the airway
What instruments are used during the refurbish stage of MOS?
- rongeurs/bone nibbler
- bone file
- straight handpiece and bur
- irrigating syringe/needle
- lacks retractor
What is this?
Kilners cheek retractor
What is a Kilners cheek retractor used for?
curvatures gently retract cheeks at commissure region to allow access
What is this?
toothed tissue forceps
What are toothed tissue forceps used for?
to manipulate and move soft tissues without crushing them
What grip are toothed tissue forceps held in?
pen grip
What is this?
McIndoe scissors
What is this?
Iris scissors
What are scissors used for?
primary for cutting sutures but can cut tissue as required
- McIndoe scissors - long with gentle curvature at tips used to cut sutures at back of the mouth without causing damage to surrounding soft tissues
- Iris scissors - sharp tips and short, used at front of the mouth
What is this?
needle holders
Why are needle holders easily differentiated from other similar looking instruments?
much finer tips
What are needle holders used for?
to hold the needle during suturing
What instruments can be used during suturing?
- Kilners cheek retractor
- toothed tissue forceps
- scissors (McIndoe and Iris)
- needle holders
Why may we place sutures?
- facilitates healing and repair of tissues
- closes dead spaces to prevent contamination of site
- facilitates haemostasis
- can improve aesthetic results
What instruments are required for suturing?
- tooth tissue forceps
- needle holder forceps
- scissors
- suture needle with thread (different sizes, shapes, threads)
How are tooth tissue forceps held?
pen grip in non-dominant hand
What are the needle holder forceps used for?
- for handling and driving suture needle
- ratchet (locking) mechanism to lock needle in place during suture manoeuvre
How are needle holder forceps held?
thumb and middle/ring finger in handles with dominant hand, allows control with forefinger and rotation of wrist
How are scissors held?
thumb and middle/ring finger of non-dominant hand in the handles, allows control with forefinger and rotation of wrist
Where should the suture needle be held?
at posterior 1/3 of its length
What are the types of suture needles?
- tapered
- blunt
- cutting
- reverse-cutting
- 1/2 circle
- 3/8 circle
- 1/4 circle
- 5/8 circle
- straight
What type of suture needle is less traumatic to the tissues?
reverse cutting - reduces risk of accidental tear, however puncture holes can be large
What types of suture thread are available?
- absorbable e.g. vicryl rapide and dextron
- non-absorbable e.g. back silk and prolene
How far from wound margins should sutures be placed?
3-5mm
Why should the knot of a suture not be placed directly over the wound?
to avoid risk of bacterial contamination
Why should sutures not be tied too tightly?
may restrict blood flow to wound margins and result in necrosis
