Oral Surgery Flashcards by encoring Unknown

Principles of surgery

Use sharp blade
Firm and continuous stroke
Avoid cutting vital structures
Blade held perpendicular to epithelial tissues
Incisions properly placed

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Commonly cut vital structure

IAN

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Blade for extraoral incision or skin

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Blade for stabbing or incison and drainage

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Blade for distal areas with hook

Commonly used in max tuberosity

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Blade for intraoral incision

Commonly used in mandible

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Major organ responsible for hemostasis

Liver

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Common problems in hemostasis

Loss of visibilty

Hematoma

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Major problem in hemostasis

Hypovolemic and hemorrhagic shock

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Earliest sign of hemorrhagic shock

Tachycardia or nervousness

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FBS used to

Assess good or poor wound healing

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INR used to

Check the viscosity of blood

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Normal INR

2 to 3

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INR of px taking anticoagulant

3 to 4

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Test for px with insulin-dependent DM

Glucose sensitivity test

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Test for px taking aspirin

Bleeding time

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Test for px taking dicumarol

Prothrombin time

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Test for px undergoing heparin therapy

PTT

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Ways to obtain hemostasis

Place pressure
Use of heat
Suturing
Pressure dressing
Vasoconstrictive agents

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Place pressure on the area of bleeding
Small vessels
Latge vessels

20 to 30 seconds

5 to 10 minutes

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Use of heat

Mosquito hemostat

Electrocautery

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Best way to obtain hemostasis

Pressure dressing using surgicel

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Vasoconstrictive agents for 7 minutes

Epinephrine
Thrombin
Collagen

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Stages of wound healing

Inflammatory
Fibroplastic or Proliferative
Remodelling or Wound Maturation

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Inflammatory stage

2 to 5 days | Fibrin

Proliferative stage

2 days to 3 weeks Granulation tissue Fibrinolysis Fibronectin

Responsible for fibrinolysis

Plasmin

Fibronectin

High molecular weight glycoprotein Stabilize fibrin Recognize foreign materials Chemotactic factor for fibroblast Guides macrophages

Components of granulation tissue

Fibroblast - 3rd day after injury Endothelial cells Angioblast

Wound maturation

Replaced by new collagen to resist tensile force Elastin- scar Collagen- keloid

Highest chance to form scar

Frenum

Healing No tissue loss Odontectomy

Primary intention

Healing Gap between edges Extraction socket Deep ulcers

Secondary intention

Healing | Uses tissue grafts

Tertiary intention

Concussion of nerve

Neuropraxia

Damaged to epineural sheath

Axonotmesis

Complete loss of nerve continuity

Neurotmesis

Disintegration of the distal part of the nerve via phagocytosis

Wallerian degeneration

Best time to remove impacted teeth

2/3 root formed because less bone reduction

Lower MA Horizontal Vertical DA

Upper DA Vertical Horizontal MA

Anterior border of Ramus

Class I Class II Class III

Occlusal of adjacent tooth

Class A Class B Class C

Winter Classification

White line Amber line Red line

Highest point of impacted in relation to adjacent tooth

White line

Portion of impacted exposed to external oblique ridge

Amber line

Refers to level of access for elevating the impacted

Red line

Pre-surgical procedures

Scrub technique Surgical drapping Eye patch

Surgical Procedures

Reflecting adequate flaps for accessibility Removal of overlying bone Sectioning the tooth Delivery of the sectioned tooth with elevator Debridement of wound and wound closure

MPE

Molt #9 Prying motion: pointed-end to elevate the ST Push stroke: broad-end to slid under the flap Pull stroke: shred the periosteum

Austin and Minnesota

Flap retractors

For removal of bone

Surgical bur 8 Chisel with mallet Bone rongeur

Bur for sectioning the tooth

Bur 703

Objectives for sectioning the tooth

Shorten the procedure Minimize the amount of bone removal Minimize the exertion force necessary to remove the tooth

Principles of elevator

Lever- most common Wedge Wheel and axle- for multiple exo

Done by irrigating the wound during surgery and closure by forcing large volume of fluid under pressure on the wound

Decontamination

Done with careful removal from injured tissue of necrotic, foreign and severely ischemic material that would impede wound healing

Debridement

Used to mecahnically debride both the superior aspect of the socket and inferior edge of the reflected soft tissue

Periaoical curette

Used to smoothen any sharp, rough edges of bone in pulling action

Bone file

Failure to remove dental sac

Residual cyst

Used to remove any remnants of the dental follicle

Mosquito hemostat

Absorbable sutures absorb via

Proteolytic activity

Best suturing material

Vicryl

Most common intraoral non-absorbable suture

Silk

Main function of suturing

Stabilize tissue flap

Most common suturing technique

Interrupted suture

Most common suturing material

3-0 silk

Soft tissue forceps

``` Adsons Stillies Allis Russian Semkin-taylor Babcocks ```

Forceps used to hold small tissue flaps

Adson

Long adson's forcep

Stillies

Forcep used to remove EPULIS FISSURATUM and LARGE tissue flap

Allis

Forcep used to hold cystic lining

Babcock

Forcep used to hold tissue flap during suturing

Semkin-taylor

Used to cut excessive tissues

Metzenbaum

Most common post-operative condition

Pain and edema

Most common surgical complication

Root displacement

Impacted maxillary 3rd molar displaced into

Infratemporal space

Impacted mandibular 3rd molar

Submandibular space

Caldwell-luc approach

Buccal plate of canine | To access max.sinus

2 to 6mm oroantral communication

Figure of eight suture without gel foam

More than 7mm oroantral communication

Pedicle or BERGER'S flap

Happens when suturing the wound under tension or too tight

Wound dehiscence- internal oblique ridge (common)

Most common complication of traumatic tooth extraction

Dry socket 3rd or 4th day after

Most common complaint of patient with dry socket

Pain | Fetid odor

Treatment for dry socket

Eugenol Benzocaine Balsam of Peru

Most accurate temperature

Rectal

Least accurate temperature

Axilla

Most common sign of end-stage renal disease

UREMIA Waste products is in the blood (urea) Complaint: Metallic Taste

Surgery in patients with renal disease undergoing dialysis

1 day after dialysis

Drugs avoided with ESRD

Nsaid Meperidine Morphine

Marasmus

Monkey fish | Deficient in all nutrients

Kwashiorkor

Moon face | Deficient in protein

Most common cause of hypoglycemia in the clinic

Skipped breakfast

Management for hypoglycemia not caused by DM

Liquid sugar

Severe jaw trismus

Masticator space infection

Tx for mild cellulitis

Massive antibiotic

Severe cellulitis

I & D with massive antibiotic | Penrose stent

Severe cellulitis

I & D with massive antibiotic | Penrose stent

Abscess

I & D with massive antibiotic

Abscess

I & D with massive antibiotic

Used to drain abscess without damaging the neurovascular tissue using LISTERS sinus forcep

Hilton's method

Cellulitis caused by

Aerobic

Abscess caused by

Anaerobic

Antibiotic of choice in cellulitis

Pen VK

Cellulitis caused by staphylococcus

Cephalexin

Most common cause of failure in treating abscess

Wrong choice of antibiotic

Antibiotics for odontogenic infections

``` Penicillin Erythromycin Clindamycin Cephalexin Metronidazole Tetracycline ```

Earliest sign of allergy to penicillin

Dyspnea

Most common macrolide

Eryhtromycin

Most common adverse effect of erythromycin

GI upset

Cross-allergy to cephalosporin

Penicillin

Px required to take prophylaxis

ABE- Staph aureus SBE- Strep viridans Rheumatic heart disease- Strep pyogenes Atrial septal defect

Antibiotic prophylaxis for adult

Amoxicillin: 1000 to 2000mg Clindamycin: 600mg

Antibiotic prophylaxis for children

Amoxicillin: 50mg/kg Clindamycin: 20mg/kg

Lifeline of the practice

Recall

Primary maxillary spaces

Canine Buccal Infratemporal

Most dangerous space infection

Canine space

Result from superior spread of infections via hematogenous route of canine space infection

Cavernous sinus thrombosis

Route of infection spread from canine space to cavernous sinus

Inferior ophthalmic veins

Route from cavernous sinus to the brain

Emissary vein

Buccal space infection

Molars infections Structures: buccal fat pad, stensen's duct and facial artery

Canine space to INFERIOR OPHTHALMIC VEIN cause CST

Infratemporal space to PTERYGOID PLEXUS OF VEIN cause CST

Submandibular spaces

Submental Sublingual Sunmandibular/ submaxillary

Due to infection of man premolars | Above mylohyoid

Sublingual space

Due to infection of man molars | Below mylohyoid

Submandibular

Palpable soft tissue that appears hard and dense

Induration

Movable mass and compressible that appears soft

Fluctuant

Infection from buccal space and mandibular 3rd molar with pericoronitis

Masseteric space

Infection from submandibular and sublingual spaces

Pterygomandibular space

When infection is severe and gives dumb-bell appearance

Temporalis space

Masseteric, pterygomandibular and temporalis spaces | Trismus

Masticator space

Infected 3rd molar Tonsillar infections Pharyngitis Parotitis Hot potato voice

Lateral pharyngeal space

Extends from skull base superiorly to diaphragm inferiorly

Prevertebral space | Primary concern: mediastinitis

Lincoln highway of the neck

Visceral vascular space

Maxillary sinus

``` Schneiderian membrane/ PCCE with Goblet cells AP: 34mm Height: 33mm Width: 23mm Volume: 15cc ```

Acute maxillary sinusitis

No teeth involved

Odontogenic sinusitis Tx:

Involves non vital tooth Max 1st molar Co-amociclav or Ampicillin for 14 days Caldwell Luc

Tumor of maxillary sinus

Overflow of tears due to pressure on nasolacrimal duct

Causative agents of sinusitis

Streptococcus pneumoniae | Haemophilus influenzae

Sign of precancerous lesion

Sialodenitis

Most common malignancy of major salivary gland

Mucoepidermoid carcinoma

Most common malignancy of minor salivary gland

Adenoid cystic carcinoma

Indication for enucleation

Unilocular Asymptomatic Less than 1cm cystic lesion

Removal of 1 to 2mm of bone around periphery of the cyst after enucleation

Enucleation with curettage

Total removal of a cystic lesion with ruptured cystic lining

Curettage

Main treatment for OKC and multilocular radiolucencies

Curettage

Creating a surgical window in the wall of the cyst To spare vital structures Symptomatic

Marsupialization | Partsch 1

Marsupialization with enucleation

Waldron's technique | Partsch 2

Mainly indicated for Ameloblastoma and CEOT

Resection

Oral manifestation 2 weeks after radiotherapy 3 weeks after

Mucositis | Dysgeusia

Earliest sign of overdose of radiation

Erythema of skin

Radiation administered interstitially through catheter

Brachytherapy

Radiation administered interstitially through catheter

Brachytherapy

Most common form of radiotherapy | From a distance by linear accelerator

Teletherapy

Radio-isotope

IV injection

Most common infection in radiotherapy

Endarteritis

Major adverse effect of radiation in the oral cavity

Osteoradionecrosis

Complications of chemotherapy

Infections | Bleeding

Facial fractures

Young male 17 to 24 years old

Condylar fracture

29.1%

Angle fracture

24.5%

Coronoid fracture

Least | 1.3%

Bilateral fracture of symphysis of mandible

Bucket-handle appearance

Common sign of mandibular fracture

Malocclusion

Common sign of malignancy in mandible

Paresthesia

Muscle involved in displaced mandibular fracture

Lateral pterygoid

Le Fort I

Floating jaw | PS: Geurin sign

Le Fort II

Pyramidal Fracture

Le Fort III

Dish-face | PS: Racoon eyes or Panda eyes

Zygomatic complex fracture

Tripod fracture Most common midface fracture Infraorbital nerve paresthesia

Radiographic technique recommended for LeFort midface fracture

Water's view

Best tool to diagnose midface fracture

CT Scan

Blow-in fracture

Enophthalmos | Fracture of orbital rim

Tx for greenstick fracture

Bringing the teeth into normal occlusion with interdental wiring

Fracture most common to have infection

Compound or open

Fracture most common to have blockage in breathing

Comminuted

Pulse to check in A. Adult B. Children

A. Radial | B. Carotid

Most common structure that blocks airway

Tongue

Tracheostomy location

Muscular triangle below cricoid cartilage

Debridement

0.9% NSS

``` Debridement Reduction Fixation Immobilization Functional Rehabilitation ```

True

Open reduction

Edentulous | Perform trephination

Close reduction

Dentulous | Insertion of wire in interdental papilla

Establishing a proper occlusal relationship by wiring the teeth together

MMF

Fixing the bone without space in between

Rigid

Fixing the bone with space allowing callus formation | Distraction osteogenesis

Non-rigid

Anchoring callus

Periosteum

Sealing callus

Endosteum

Utilizing callus

Distal ends of bone

Commonly used method of horizontal wire fixation

Risdon wiring

Most common wiring technique | Passing wires around a section of bone and intraoral splint

Circumferential wire

Embraces two adjacent teeth in posterior that provides two hooks for elastics

Ivy eyelet (loop) wire

Immobilization

Prevent dislocation of jaw Results to ankylosed TMJ

Simplest method of immobilizing the fractured bone of the head

Barton's bandage

Patients develops fever w/o local edema or tenderness

Due to DEHYDRATION

Bilateral sagittal split osteotomy

Mandible either move forward (advance) or backward (setback) WORKHORSE of surgery Class 2

Vertical ramus osteotomy

Mandibular prognathism

Genioplasty

Skeletal class 3

Frey syndrome

Sweat excessively while eating | Sometimes due to surgery in Parotid gland, AURICULOTEMPORAL NERVE damaged

Frenal correction used for post-operative orthodontic diastema Relapse

Miller's technique

Diastema but with hypertophic frenum

Z-plasty

Patients with bleeding disorder and non compliant

Electrocautery

Used for lengthening the frenum

V-Y plasty

For shortening the frenum

Y-V plasty

Rule of 10

10 weeks 10 lbs 10g of hemoglobin per dL of blood 10,000 WBC

Class 1

Cleft of SP

Class 2

Cleft of SP and HP

Class 3

Unilateral cleft lip and palate

Class 4

Bilateral cleft lip and palate

Velopharyngeal mechanism

Speech

Staphyloraphy

Closure of soft palate (1st) 8 and 18 months Hypernasal speech

Uranoraphy

4 to 5 years for development of mid-palatine suture

Alveolar cleft graft

Allogenic graft | 7 to 10 years old

Cheiloraphy

Deformed: NASAL | 3 to 6 months

Surgical obturator

Retained 3 to 4 months for complete wound healing

Interim (definitive) obturator

After surgery with artificial teeth

Early sign of TMD | Displaced articular disc

Clicking sound

Multiple scraping or grating sound | TMD is severe

Crepitus

Oral Surgery Flashcards

(217 cards)