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5th yr- Finals- CAD revision > Intro to minor oral surgery > Flashcards

Intro to minor oral surgery Flashcards

1
Q

How can tissues get damaged physically

A
  1. Compromised blood flow
  2. Crushing
  3. Desiccation
  4. Incision
  5. Irradiation
  6. Overcooling
  7. Overheating
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2
Q

How can tissues get damaged chemically

A
  1. Agents with unphysiologic pH
  2. Agents with unphysiological tonicity
  3. Proteases
  4. Vasoconstrictors
  5. Thrombogenic agents
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3
Q

Talk through the 4 stages of acute would healing

A
  1. Haemostasis
  2. Inflammatory phase
  3. Proliferative phase
  4. Remodelling
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4
Q

What happens 1 week post extraction

A
  1. What blood cells remove bacteria
  2. Breakdown of debris
  3. Fibroplsia begins
  4. Ingrowth of fibroblasts and capillaries
  5. Epithelium migrates down socket wall
  6. osteoclasts accumulate long crestal bone
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5
Q

What happens 2 weeks post extraction

A
  1. Granulation tissue fills the socket
  2. Osteoid deposition along alveolar bone lining socket
  3. Smaller socket forms
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6
Q

What happens 3-4 weeks post extraction

A
  1. Cortical bone resorbs from the crest and walls
  2. New trabecular bone is laid down
  3. Epithelium moves to crest
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7
Q

Name the 2 basic methods of healing

A

Primary and secondary intension

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8
Q

What is primary intention

A

edges of wound places and stabilised in same anatomical position prior to injury and allowed to heal

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9
Q

What is secondary intention

A

Implies a gap is left between edges of incision/ laceration
tissue loss has occurred around the wound ages
Significant amount of epithelial migration
slower healing that forms a scar

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10
Q

List the different types of bone cells

A
  1. Osteogenic cells
  2. Osteoblast
  3. Osteocyte
  4. Osteoclast
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11
Q

What are osteogenic cells

A

Stem cells

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12
Q

What are osteoblast

A

They are bone healing cells that form the bone matrix

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13
Q

What are osteocytes

A

They maintain bone tissue

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14
Q

What are osteoclasts

A

They resorb bone

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15
Q

Patients on which medication may have complex healing

A

Bisphosphonates

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16
Q

Name the 2 components that make up the inflammatory phase

A
  1. Cellular phase
  2. Vascular phase
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17
Q

What triggers the cellular phase

A

Triggered by activation of serum compliment via tissue trauma

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18
Q

What happens in the vascular phase of inflammation

A

Initially vasoconstriction occurs of the distributed vessels
This slows the blood flow into the injured area and promotes co angulation

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19
Q

What is the outcome of the cellular phase of inflammation

A

Neutrophil activation

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20
Q

List the characteristics inflammation

A
  1. Redness
  2. Swelling
  3. Heat
  4. Pain
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21
Q

What is released in the vascular phase of inflammation

A
  1. Histamines
  2. Prostogladins
  3. White blood cells
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22
Q

How Long does the inflammatory phase last

A

2-5 days

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23
Q

What follows the inflammatory phase

A

Proliferative phase

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24
Q

When does the proliferative phase begin

A

2-3 weeks

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25
Q

What happens in the proliferative paste of wound healing

A
  1. Fibrin strands form structure for fibroblasts to lay ground substance tropocollagen
  2. Capillary formation
  3. Collagen formation
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26
Q

Which phase follows the proliferative phase

A

Re modelling

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27
Q

How long does the remodelling phase last

A

Continues indefinitely

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28
Q

What happens in the remodelling phase

A
  1. Previous collagen fibres are destroyed and replaced by new collagen that is orientated better
  2. Wound strength slowly increases
  3. Vascularity decreases as does erythema
29
Q

What considerations do we need to take for good healing

A
  1. Foreign material in wound site
  2. Necrotic tissue present
  3. Ischaemia
  4. Wound tension
30
Q

What foreign material can be present in the wound site

A
  1. Bacteria
  2. Dirt
  3. Suture material
  4. Anything not natural
31
Q

What can happen if there is foreign Materia present int eh wound site

A

Chronic inflammatory reaction

32
Q

Why is necrotic tissue in the wound site bad

A
  1. As It acts as a barrier to ingrowth of reparative cells
  2. It also prolongs the inflammatory state for white blood cells
  3. Can be nutrients for bacteria
33
Q

What is ischaemia

A

Reduction in blood supply affecting healing

34
Q

Why is ischaemia bad

A
  1. Further tissue necrosis occurs
  2. Reduction in the delivery of wound antibiotic white blood cells and antibiotics
35
Q

Why can ischaemia occur

A
  1. Sutures
  2. Poor flap design
  3. Excessive external pressure
  4. Internal pressure
  5. Systemic BP Issues
  6. Peripheral vascular disease
  7. Anaemia
36
Q

When can tension in the would site occur

A

If sutures are too tight

37
Q

Why is tension bad

A

Can cause ischaemia and excessive scar formation as well as wound contraction

38
Q

What patient factors might affect wound healing

A
  1. Age
  2. Medical history
  3. Drug history
  4. BMI
  5. Social history
  6. Anxiety
39
Q

How can age affect wound healing

A

Increased age:
1. Increased complication
2. More medical complexity
3. Neoplasia

40
Q

Which drugs can affect wound healing

A
  1. Anticolagualnts
  2. Steroids
  3. Bisphosphonates
  4. Immunosuppressive
41
Q

How can BMI affect healing

A

Higher BMI:
1. Smaller mouths so harder to access
2. Bigger necks so airway problems
3. May have additional medical problems

42
Q

What operator factors might affect wound healing

A
  1. Competence
  2. Experience
  3. Environment
  4. Assistance
43
Q

What surgical factors might affect wound healing

A
  1. Diagnosis
  2. Access
  3. Imaging
  4. Pathology
  5. Bone
  6. Surgical site
  7. Mouth opening
44
Q

What do we look at when carrying out our extra oral examination

A
  1. Structured aaporach
  2. Cervical lymphadenopathy
  3. Mouth opening
  4. TMJ
  5. Facial symmetry
  6. Facial swelling
  7. Other significant finding
  8. VII and V nerve
45
Q

What do we look at when writing our abnormalities for a radiograph

A

If you spot something abnormal note down STOP:

  1. Site
  2. Translucency
  3. Outline
  4. Previous imagine
46
Q

What are some red flags we may see on a radiograph

A
  1. Loss of symmetry
  2. Distorted anatomy
  3. Bone erosion
  4. Teeth floating in air
47
Q

What is trismus

A

Reduced mouth opening

48
Q

What are the key properties of LA

A
  1. Specific action
  2. Reversibel
  3. Rapid onset
  4. Non irritant
  5. No permanent damage
  6. No systemic toxicity
  7. Chemically stable
  8. Can be sterilised
  9. hypo-allergic
  10. Non addictive
49
Q

What are the 2 chemical structures LA can be made up of

A
  1. Esters
  2. Amides
50
Q

Name the 2 components that make up LA

A
  1. Drug
  2. Vasoconstrictor
51
Q

Why does LA contain a vasoconstrictor

A
  1. Increased speed of onset
  2. Extends duration
  3. Increased depth of anaesthesia
52
Q

List the properties of adrenaline

A
  1. Naturally occurring
  2. Increases rate and force of contraction of heart
  3. increased BP
  4. Vasoconstriction
53
Q

List the properties of felypressin

A
  1. Anaoligue of naturally occurring peptide vasopressin
  2. Vascular smooth muscle contraction
54
Q

Name the most common LA we use

A

2% lidocaine with 1:80,000 adrenaline

55
Q

What is the max disease of 2% lidocaine with 1:80,000 adrenaline can we give

A

4.4mg per kg

56
Q

how much lidocaine and adrenaline is there in 2% lidocaine with 1:80,000 adrenaline

A

44mg lidocaine
27.5mg adrenaline

57
Q

When might we prescribe antibiotics in oral surgery

A
  1. To prevent post operative infection
  2. In a compromised host
  3. Before placement of a foreign object/ material
  4. Acute infection where you are unable to remove cause
  5. Rapidly spreading infection
  6. persistent recurring infection
58
Q

In which patients might you consider antibiotics

A
  1. Diabetes
  2. ETOH
  3. Patient with renal failure
  4. Malignancy
59
Q

Why might we do surgery in the mouth

A
  1. Remove retained roots
  2. Complete a procedure
  3. Assess and access pathology
  4. Impacted tooth
  5. Tissue sample
  6. Surgical Endodontics
60
Q

List the key principles of oral surgery

A
  1. Sufficient access
  2. Preserve vital structures
  3. Incisions on sound bone
  4. Protect soft tissue
  5. Minimise tissue damdage
  6. Preserve blood supply
  7. Closure of sound bone
61
Q

Name the vital structures in the mouth

A
  1. Inferior alveolar nerve
  2. Lingual nerve
  3. Greater palatine foramen
  4. Incisal foramen
62
Q

What is a flap

A

A section of soft tissue which:
1. Is outlined by surgical incision
2. Caries its own blood supply
3. Allows access to underlying tissues
4. Can be replaced to its original position
5. Can be maintained with surfaces
6. Has full thickness mucoperiosteal

63
Q

How do we ensure we dont damage tissues when making a flap

A
  1. Have firm controlled movements
  2. Careful tissue handling
  3. Ensure cooling when using rotary motors
  4. Clear away debridement
  5. Follow principles fo suturing
64
Q

Which instrument do we use to make the incision

A

15/15C blade with number 3 handle

65
Q

Which hand piece do we not use on ADC

A

Air rotor hand pieces as they can cause surgical emphysema

66
Q

What is the purpose of suturing

A

To hold the tissues in placer to permit healing by primary intention and to control bleeding

67
Q

Why is suturing important

A

Activates haemostasis

68
Q

List the key properties of suturing material

A
  1. Adequate tensile strength
  2. Functional strength
  3. Non capillary
  4. Non reactive
  5. Flexible and easy to knot
  6. Sterilisable
  7. Smooth
  8. Resorb-able

5th yr- Finals- CAD revision (4 decks)

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