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BDS3 Oral surgery > Minor oral surgery techniques > Flashcards

Minor oral surgery techniques Flashcards

1
Q

Patient warnings

A
  • explain procedure to pt
  • if tooth needs sectioning, describe
  • give the pt an idea of what to expect during the procedure in lay terms (pressure, no pain, lift the gum up, possible drilling, water from the drill, stitches)
  • if adjacent teeth are close warn of possible damage to these teeth
  • post operative complications
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2
Q

what are the post operative complications

A
  • pain
  • swelling
  • bruising
  • jaw stiffness
  • bleeding
  • dry socket
  • infection (unusual)
  • nerve damage (temporary, permanent, altered)
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3
Q

general surgical principles

A
  • maximal access with minimal trauma
  • bigger flaps heal just as quickly as smaller ones
  • wide-based incision (circulation)
  • use scalpel in one firm continuous stroke
  • no sharp angles
  • adequate sized flap
  • minimise trauma to dental papillae
  • flap reflection should be down to bone and done cleanly
  • no crushing
  • keep tissue moist
  • ensure that flap margins and sutures will lie on sound bone
  • make sure wounds are not closed under tension
  • aim for healing by primary intention to minimise scarring
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4
Q

how do you achieve soft tissue retraction

A
  • access to operative field
  • protection of soft tissues
  • flap design facilitates retraction
  • Howarth’s periosteal elevator or Bowdler-Henry Retractor (rake)
  • done with care
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5
Q

what is a two sided flap

A

Cervicular incision and distal releiving incision

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6
Q

what structure do we need to think about before making incision

A

mental foramen

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7
Q

what does a 2 sided flap look like

A
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8
Q

where do we suture in a 2 sided flap

A
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9
Q

how many sides is this flap

A

1 sided flap

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10
Q

why do we make the distal relieving incision against bone rather than on papilla

A

If made distal incision before papilla it could collapse into the hole

So this way it is resting on healthy bone

Flap needs to be wider than the size of defect youre going to create

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11
Q

how is debridement done

A
  • physical
    • bone file or handpiece to remove sharp bony edges
    • Mitchell’s trimmer or Victoria curette to remove soft tissue debris
  • irrigation
    • sterile salive/water into socket and under flap
  • suction
    • aspirate under flap to remove debris
    • check socket for retained apices etc
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12
Q

how is suturing done

A
  • approximate tissues
  • compress blood vessels
  • aims
    • reposition tissues
    • cover bone
    • prevent wound breakdown
    • achieve haemostasis
    • encourage healing by primary intention
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13
Q

what are the aims of suturing

A
  • reposition tissues
  • cover bone
  • prevent wound breakdown
  • achieve haemostasis
  • encourage healing by primary intention
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14
Q

what different types of sutures are there

A
  • resorbable
    • monofilament e.g. MONOCRYL
    • mulifilament e.g. VICRYL RAPIDE
  • non-resorbable
    • monofilament e.g. PROLENE
    • multifilament e.g. Mersilk
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15
Q

How to achieve haemostasis peri-operatively

A
  • LA with vasoconstrictor
  • artery forceps
  • diathermy
  • bone wax
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16
Q

how to achieve haemostasis post-operatively

A
  • pressure
  • LA with vasoconstrictor
  • diathermy
  • whitehead’s varnish pack
  • surgicel
  • sutures
17
Q

what different flap designs are there

A
  • semi-lunar (reduced access,only good for apical lesions, scarring, dysaesthesia, less gingvial retention)
  • triangular (2-sided)
  • rectangular (3-sided)
18
Q

why is imporant to not do the distal relieveing incision on an 8 too lingual

A

could injure the lingual nerve

19
Q

where should our distal relieveing incision be on an 8

A

follow the external oblique ridge

20
Q

what are the stages of surgery

A
  • consent
  • surgical pause/safety checklist
  • anaesthesia
  • access
  • bone removal as necessary
  • tooth division as necessary
  • debridement/wound
  • management
  • suture
  • achieve haemostasis
  • post-operative instructions
  • post-operative medication
  • follow-up
21
Q

what’s important to ensure with surgical access

A
  • wide-based incision-circulation/perfusion
  • use scalpel in one firm continuous stroke
  • no sharp angles
  • adequate sized flap
  • flap reflection should be down to bone and done cleanly
  • minimise trauma to dental papillae
  • no crushing
  • keep tissues moist
  • ensure that flap margins and sutures will like on sound bone
  • make sure wounds are not closed under tension
  • aim for healing by primary intention to minimize scarring
22
Q

Principles of elevator use

A
  • mechanical advantage
  • avoid excessive force
  • support the instrument to avoid injury to the patient should the instrument slip
  • ensure applied force is direct away from major structures e.g. antrum, ID canal, mental nerve
  • always use in direct vision
  • never use an adjacent tooth as a fulcrum unless it too is to be extracted
  • keep elevators sharp and in good shape. Discard if blunt or bent
  • Establish an effective and logical point of application
  • careful debridemnt after the use of elevators to remove any bone fragments that have been created
23
Q

Uses of elevators

A
  • To provide a point of application for forceps
  • To extract a tooth without the use of forceps
  • Removal of retained roots
  • To loosen teeth prior to using forceps
  • Removal of multiple rot stumps
  • Removal of root apices
24
Q

what are the different cross sections of suture needles

A
  • triangular
    • 3 cutting sides
    • the main cutting side is on the inside curve of the needle and that can lead to the suture passing through the tissues nice and easy.

Concern is you can tear through sutures when tieying off so some people use reverse cutting

  • round
    • cutting is on the point, the rest is just about dilation and stretching of the tissue, tends to be used for more fryable tisesues
25
Q

how to hold a suture needle

A

1/3 from the swaged end

26
Q

what are the main different types of suturing

A
  • Interrupted
  • Horizontal mattress
  • Continuous suture
  • Vertical mattress suture
27
Q

suturing for a 3 sided flap

A
28
Q
A
29
Q

what 4 nerves can be damaged during removeal of 3rd molars

A
  • lingual
  • inferior alveolar
  • mylohyoid
  • buccal
30
Q

where is the lingual nerve in relation to the 3rd molar

A

above lingual plate in 15-18% of cases

31
Q
A

BDS3 Oral surgery (5 decks)

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