Oral Surgery Flashcards
management of acute OAC
inform patient
if small or sinus intact:
- encourage clot
- suture margins
- antibiotics?
- post-op instructions
management of chronic OAF
excise sinus tract
buccal advancement flap
OR
palatal flap
bone graft/collagen membrane
what are some peri-operative complications
haemorrhage
nerve/vessel damage
fractured root/tooth
abnormal resistance
dislocation of TMJ
Aims when retracting a flap
achieve maximal access w/ minimal trauma
protect soft tissues
no sharp angles
healing by primary intention to minimise scarring
wide based incision
factors influencing flap design
- base wider than flap
- trauma to interdental papilla should be minimal
- flap margins and sutures should lie on sound bone
- tissues should be kept moist
what instruments do you use to remove bone?
electrical straight handpiece w/ saline cooled bur (round or fissure/ tungsten carbibe)
motor driven - if turbine may lead to surgical emphysema
how to debride prior to a suture
- Physical
- bone file/handpiece to remove sharp bony edges
- mitchells/victoria currette to remove soft tissues - Irrigation
- sterile saline into socket and underflap - Suction
- aspirate under flap to remove debris
- check socket for retained apices
what much retained root can be safely left in aveolar bone?
3mm
what are predisposing factors to alveolar osteitis (dry socket)
lower extraction (molar)
smoker
female
oral contraceptive
LA w/ vasoconstrictor
what are the presenting signs and symptoms of dry socket
severe pain radiating to ear
c/o bad taste in mouth (+odour)
pt may think you’ve left tooth in
management of dry socket
- reassure pt & manage w/ pain relief
- give LA to help w/ pain relief & to allow you to carry out irrigation
-irrigate socket w/ warm saline (or sterile water) to wash out food/debris - encourage clot
- pack w/ antiseptic pack (BIP) OR alvogyl
- advise pt, salty mouthwashes
what are 3 nerve deficits
paraesthesia - tingly
dysaesthesia - unpleasnt/pain
hypo/hyperaesthesia
what are causes of nerve damage
- crushing injuries - from forceps
- cutting/shredding injuries - needle may hit nerve during LA
- transection injuries - nerve lacerated during incisions
flap design for a surgical extraction of 45
- distal relieving incision at 5 extending into attached gingivae
- cervicular incision extending form mesial of 4 to distal of 5
list haemostatic control
- use LA w/ vasoconstrictor
- pressure w/ finger OR damp gauze
- diathermy
- suture
- artery forceps
- bone wax
what can cause prolonged bleeding post XLA
- vasoconstricting effects of LA worn off
- sutures are loose
- Pt has traumatised area w/ tongue/finger/food
- Pt has bleeding disorder
what is surgicel?
a haemostatic agent.
it is an oxidised cellulose. it acts as a framework for clot formation
how would you management a maxillary tuberosity fracture?
If SMALL
- could potentially LEAVE IT
- remove fragement(s)
- reduce and stabilise
- close wound
- treat with ab
If LARGE
- stabilise mobile part(s) of bone w/ rigid fixation techniques e.g. splinting, arch bars for 4-6 weeks
- remove/treat pulp
- treat w/ ab
- remove tooth 8 weeks later
indications for extractions
gross caries
advanced perio
tooth/root fracture
severe tooth surface loss
pulpal necrosis
apical infection
symptomatic partially erupted
traumatic position
orthodontic purposes
interference with denture construction
what are the mechanical principles for tooth elevation. the 3 basic modes of action
wheel and axle
lever
wedge
what can cause difficult access during a XLA
- trismus
- reduced aperture of mouth (congenital/syndromes - microstomia; scarring)
- crowded/malpositioned teeth
what can cause abnormal resistance during XLA
- thick cortical bone
- shape/form of roots
- number of roots
- hypercementosis
- ankylosis
what are the most common places you can fracture of the alveolar bone
buccal plate
canine
molars
steps to follow, following a jaw fracture
inform pt
post-op radiograph
refer?
ensure analgesia
stabilise
if delay, antibiotic
