Intro to minor surgical techniques Flashcards
What is oral surgery
The diagnosis and management of pathology of the mouth and jaws that requires surgical intervention
What are the key steps we take before carrying out oral surgery
- Diagnosis
- Evaluation
- Planning
How can tissues get damaged physically
- Compromised blood flow
- Crushing
- Desiccation
- Incision
- Irradiation
- Overcooling
- Overheating
How can tissues get damaged chemically
- Agents with unphysiologic pH
- Agents with unphysiologic tonicity
- Proteases
- Vasoconstrictors
- Thrombogenic agents
Talk through the 4 stages of acute wound healing
- Haemostasis
- Inflammatory phase
- Proliferatie phase
- Remodelling
What happens 1 week post extraction
- What blood cells remove bacteria
- breakdown of debris
- Fibroplasia begins
- Ingroth of fibroblasts and capillaries
- Epithelium migrates down socket wall
- Osteoclasts accumulate along crystal bone
What happens 2 week post extraction
- Granulation tissue fills the socket
- Osteoid deposition along alveolar bone lining socket
- Smaller sockets form
What happens 3-4+ week post extraction
- Cortical bone resorbs from the crest and walls
- New trabecular bone is laid down
- Epithelium moves to crest
Name the 2 basic methods of healing
Primary and secondary intention
What is primary intention
Edges of wound places and stabilised in same anatomical position prior to injury and allowed to heal
What is secondary intention
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
List the different types of bones cells
- Osteogenic cells
- Osteoblast
- Osteocyte
- Osteoclast
What are osteogenic cells
Stem celss
What are osteoblast
They are bone healing cells that form the bone matrix
What are osteocytes
They maintain bone tissue
What are osteoclasts
They resorb bone
Patient on ___________ may have complex healing
Bisphosphonates
Name the two components that make up the inflammatory phase
- Cellular Phase
2. Vascular phase
What triggers the cellular phase
Triggered by activation of serum compliment via tissue trauma
What happens in the vascular phase of inflammation
Initially vasoconstriction occurs of the disrupted vessels
This slows the blood flow into the injured area and promotes co agualion
What is the outcome of the cellular phase of inflammation
Neutrophil activation
List the characteristics of inflammation
- Redness
- Swelling
- Heat
- Pain
What is released in the vascular phase of inflammation
Histamines
Prostogladins
White blood cells
How long does the inflammatory phase last
2-5 days
What follows the inflammatory phase
Proliferative phase
When does the proliferative phase begin
2-3 weeks
What happens in the proliferative phase of wound healing
- Fibrin strands form structure for fibroblasts to lay ground substance tropocollagen
- Capillary formation
- Collagen formation
Which phase follows the proliferative phase
Re modelling
How long does the re modelling phase last
Continues indefinitely
What happens in the remodelling phase
- Previous collagen fibres are destroyed and replaced by new collagen that is orientated better
- Wound strength slowly increases
- Vascularity decreases as does erythema
What considerations do we need to take for good healing
- Foreign material in wound site
- Necrotic tissue present
- Ischaemia
- Women tension
List the modifiable factors we need to be aware of when considering healing
- Age
- Medical history
- Technique
What foreign material can be present in the wound site
- Bacteria
- Dirt
- Suture material
- Anything not natural
What can happen if there is foreign material present in the wound site
Chronic inflammatory reaction
Why is necrotic tissue in the wound site bad
- As it acts as a barrier to ingrowth of reparative cells
- It also prolongs the inflammatory stage for white blood cells
- Can be nutrients for bacteria
What is ischaemia
Reduction in blood supply affecting healing