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4th yr- CAD- Oral surgery > Intro to minor surgical techniques > Flashcards

Intro to minor surgical techniques Flashcards

1
Q

What is oral surgery

A

The diagnosis and management of pathology of the mouth and jaws that requires surgical intervention

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2
Q

What are the key steps we take before carrying out oral surgery

A
  1. Diagnosis
  2. Evaluation
  3. Planning
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3
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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4
Q

How can tissues get damaged chemically

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

Talk through the 4 stages of acute wound healing

A
  1. Haemostasis
  2. Inflammatory phase
  3. Proliferatie phase
  4. Remodelling
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6
Q

What happens 1 week post extraction

A
  1. What blood cells remove bacteria
  2. breakdown of debris
  3. Fibroplasia begins
  4. Ingroth of fibroblasts and capillaries
  5. Epithelium migrates down socket wall
  6. Osteoclasts accumulate along crystal bone
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7
Q

What happens 2 week post extraction

A
  1. Granulation tissue fills the socket
  2. Osteoid deposition along alveolar bone lining socket
  3. Smaller sockets form
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8
Q

What happens 3-4+ week 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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9
Q

Name the 2 basic methods of healing

A

Primary and secondary intention

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10
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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11
Q

What is secondary intention

A

Implies a ‘gap’ is left between edges of incision/ laceration
Tissue loss has occurs around the wound edges
Significant amount f epithelial migration
Slower healing that forms a scar

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12
Q

List the different types of bones cells

A
  1. Osteogenic cells
  2. Osteoblast
  3. Osteocyte
  4. Osteoclast
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13
Q

What are osteogenic cells

A

Stem celss

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14
Q

What are osteoblast

A

They are bone healing cells that form the bone matrix

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15
Q

What are osteocytes

A

They maintain bone tissue

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16
Q

What are osteoclasts

A

They resorb bone

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17
Q

Patient on ___________ may have complex healing

A

Bisphosphonates

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18
Q

Name the two components that make up the inflammatory phase

A
  1. Cellular Phase

2. Vascular phase

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19
Q

What triggers the cellular phase

A

Triggered by activation of serum compliment via tissue trauma

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20
Q

What happens in the vascular phase of inflammation

A

Initially vasoconstriction occurs of the disrupted vessels

This slows the blood flow into the injured area and promotes co agualion

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21
Q

What is the outcome of the cellular phase of inflammation

A

Neutrophil activation

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22
Q

List the characteristics of inflammation

A
  1. Redness
  2. Swelling
  3. Heat
  4. Pain
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23
Q

What is released in the vascular phase of inflammation

A

Histamines
Prostogladins
White blood cells

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24
Q

How long does the inflammatory phase last

A

2-5 days

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25
Q

What follows the inflammatory phase

A

Proliferative phase

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26
Q

When does the proliferative phase begin

A

2-3 weeks

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27
Q

What happens in the proliferative phase 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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28
Q

Which phase follows the proliferative phase

A

Re modelling

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29
Q

How long does the re modelling phase last

A

Continues indefinitely

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30
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
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31
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. Women tension
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32
Q

List the modifiable factors we need to be aware of when considering healing

A
  1. Age
  2. Medical history
  3. Technique
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33
Q

What foreign material can be present in the wound site

A
  1. Bacteria
  2. Dirt
  3. Suture material
  4. Anything not natural
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34
Q

What can happen if there is foreign material present in the wound site

A

Chronic inflammatory reaction

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35
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 stage for white blood cells
  3. Can be nutrients for bacteria
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36
Q

What is ischaemia

A

Reduction in blood supply affecting healing

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37
Q

Why is ischaemia bad

A
  1. Further tissue necrosis occurs

2. Reduction in the delivery of wound antibiotics WBCs and antibiotics

38
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
39
Q

When can tension occur in the wound site

A

If sutures are too tight

40
Q

Why is tension bad

A

Can cause schemata and excessive scar formation as well as would contraction

41
Q

What patient factors might affect wound healing

A
  1. Age
  2. Medical history
  3. Drug history
  4. BMI
  5. Social history
  6. Anxiety
42
Q

How can age affect wound healing

A

Increased age:

  1. increased complication s
  2. More medical complexity EG DIABETES
  3. Neoplasia
43
Q

Which drugs can affect wound healing

A
  1. Anticoagulants
  2. Steroids
  3. Bisphosphonates
  4. Immunosuppressive
44
Q

How can BMI affect healing

A

Higher BMI:

  1. Smaller mouths harder to access
  2. Bigger necks so airway problems
  3. May have additional; medical problems
45
Q

What operator factors might affect wound healing

A

1 . Competence

  1. Experience
  2. Environment
  3. Assistance
46
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
47
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
48
Q

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

A
  1. Structured approach
  2. Soft tissue assessment t
  3. Hard tissue assessment
49
Q

Once you’ve carries out baseline investigations and examinations what should you have

A

Differential diagnosis

50
Q

How do we confirm our differential diagnosis

A

Special tests and imagine

51
Q

What are the 4 broad categories we look at in a radiograph fro oral surgery

A
  1. Overview
  2. Analysis
  3. Abnormality
  4. Red flag
52
Q

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

A
  1. Radiograph quality
  2. Contrast and dentist
  3. Region of interest clearly visible
  4. Surrounding tissue
  5. No distortion
53
Q

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

A
  1. Note normal anatomy
  2. Variations in notmal anatomy
  3. Pathology
54
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
55
Q

What are some red flags we may see on a radiograph

A
  1. Loss of symmetry
  2. Distorted anatomy eg displaced teeth
  3. Boen erosion
  4. Teeth floating in air
56
Q

What is trismus

A

Reduced mouth opening

57
Q

What analgesia do we give for extractions and oral surgery

A

Ibuprofen or paracetamol should be enough

58
Q

List some anaesthetic options we have on oral surgery

A
  1. Local anaesthesia
  2. LA and conscious sedation (inhalation or IV)
  3. LA and GA
59
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
60
Q

What are the 2 chemical structures LA can be made of

A
  1. Esters

2. Amides

61
Q

Name the 2 components that make up LA

A
  1. Drug

2. Vasoconstrictor

62
Q

Why does LA contain vasoconstrictor

A
  1. Increased speed of onset
  2. Extends duration
  3. Increased depth of anaesthesia
  4. Reduction of intra operative haemorrhage
63
Q

Name the most common vasoconstrictor we use

A

Adrenaline

64
Q

List the properties of adrenaline

A
  1. Naturally occurring
  2. Increases rate and force of contraction of heart
  3. Increased BP
  4. vasoconstrictor
65
Q

Other than adrenaline what other vasoconstrictor can we use

A

Felypressin

66
Q

List the properties of felypressin

A
  1. Anaoligue of naturally occurring peptide vasopressin

2. Vascular smooth muscle contraction

67
Q

Name the most common LA we use

A

2% lidocaine with 1:80,000 adrenaline

68
Q

What at the max dosage of lidocaine with 1:80,000 adrenaline can we give

A

4.4mg per kg

69
Q

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

A

44mg lidocaine

27.5mg adrenaline

70
Q

What is in a cartridge of 2% lidocaine with 1:80,000 adrenaline

A 
44mg lidocaine 
27.5mg adrenaline 
Sodium chloride
Sodium metabisulfite
Sodium hydroxide
Hydrochloric acid
Water
71
Q

Give examples of LA we give patents

A
  1. 2% lidocaine with 1:80,000 adrenaline

2. 4% articaine with 1:100,000 adrenaline

72
Q

What is the max dosage of 4% articaine with 1:100,000 adrenaline we can give

A

7mg per kg

73
Q

How much articaine and adrenaline is there in 4% articaine with 1:80,000 adrenaline

A

88mg articaine

22mg adrenaline

74
Q

What is in a cartridge of 4% articaine with 1:100,000 adrenaline

A 
88mg articaine
22mg adrenaline 
Sodium chloride
Sodium metabisulfite
Sodium hydroxide
Hydrochloric acid
Water
75
Q

Do we routinely give antibiotics in oral surgery

76
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
77
Q

In which patients might you consider antibiotics

A
  1. Diabetes
  2. ETOH
  3. Patient with renal failure
  4. Malignancy
78
Q

Which mouthwashes might we give patient sin oral surgery

A
  1. Chlorohexidine pre op

2. NaCl post op

79
Q

Why might we do surgery in the mouth

A
  1. Remove retain droots
  2. Complete a procedure
  3. Access pathology
  4. Impacted tooth
  5. Tissue sample
  6. Surgical endodontics
80
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
81
Q

Name the vital structure sin the mouth

A
  1. Inferior alveolar nerve
  2. Lingual nerve
  3. Greater palatine foramen
  4. Incisal foramen
82
Q

What is a flap

A

A section of soft tissue which:

  1. Is outlined by a surgical incision
  2. Carries its own blood supply
  3. Allows access to underlying tissues
  4. Can be replaced to original position
  5. Can be maintained with surfaces
  6. Has full thickness mucoperiosteal
83
Q

How do we ensure we down damdge 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
84
Q

Which instrument do we use to make the incision

A

15/15C blade with number 3 handle

85
Q

Which hand piece do we not use on ADC

A

Air roter handpiecies

86
Q

Why dont we any Air roter handpiecies in oral surgery

A

Can cause surgical emphysema

87
Q

What is the purpose of suturing

A

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

88
Q

Why os suturing important

A

Activates haemostasis

89
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
90
Q

Name the 3 basic suturing techniques used in oral surgery

A
  1. Simple interrupted
  2. Continuous suture
  3. Mattress

4th yr- CAD- Oral surgery (8 decks)

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