Oral Surgery Flashcards
Main function of FLAP
Access!
Right handed dentist’s static zone
12-2 o’clock
Right handed dentist’s transfer zone
4-7 o’clock
Right handed dentist’s Operation zone
7-12 o’clock
Right handed dentist’s assistant’s zone
2-4 o’clock
hand instrument that is semi-critical that do not penetrate tissue/soft tissue but contact oral tissues
Mouth mirror
non-critical instrument that do not come in contact with oral & body fluids
Liners and Bases, compo.. etc.
a category of instrument that has direct contact with soft tissue/bone
Critical Instrument
- forceps etc.
Grasp for Control
Pen Grasp
Grasp for Force
Palm Grasp
Preferred type of tissue handling/forcep
Hooks or toothed forceps
most commonly used irrigant
0.9%NSS
BOARDS: 0.85% NSS
Major organ for Clot formation
Liver
the mechanism that leads to cessation of bleeding from a blood vessel,
Clot formation is also called
Hemostasis
Primary method for achieving site hemostasis
PRESSURE
- Small Blood V: 20-30 sec
- Large BV: 5-10mins
tea bag promotes clotting mechanism because of its content
Tannic Acid
dead space management placement of pack pressure dressing called
Surgicel
careful removal of necrotic, foreign & severely ischemic material
Debridement
Most commonly used debridement
3% Hydrogen Peroxide
- used for mouthwash ANUG
- intracanal medicament
Abnormal accumulation of fluid, blood vessel leakage into nearby tissues
EDEMA
Areas of high blood vessel connective tissue in oral cavity
Lips & Flood of the mouth
px with recent heart attack, MI, will have a surgery after?
6 months
A patient is undergoing dialysis, surgery is scheduled
the day after dialysis
Main function of Flap
Access/Accessibility
Separation of flap, dead space
Dehiscence
flap that includes periosteum, mucosa, submucosa, and it is needed in any type of BONE surgery
Full-thickness flap
flap used in apicoectomy (very effective), small cysts and root tips. Bow-shaped and a curve incision. the lowest point of incision must be 0.5cm from free gingival margin
Semilunar Flap
the four corner flap. two oblique incision extending to buccal vestibule. The rule is 1 ant. and 1 posterior.
Trapezoidal Flap
- attached gingiva can have recession
the most commonly used flap in odon./ all procedure.
rule: 2 ant. 1 post.
also known as sulcular flap.
Envelope Flap
Pedicle and bergers flap is used in
Closure of oro antral fistula
a form of buccal mucosal flap and the most commonly used flap to close oro-antral fistula
Bergers Flap
a form of palatal mucosa flap to close oro-antral fistula
Pedicle Flap
Flap used in torus removal
Y flap tech.
Flap used in PFM
Ochsenbeinluebke / Alveolar -mucosal flap / Submarginal Flap
a form of open curettage procedure, debridement of root surface & rem. of granulation tissue. Indicated to all types of periodontal disease
Modified-Widman Flap
(not to eliminate pocket)
Used to stabilize flap
Suture
smallest suture available in the market
11-0
- for eyes
largest suture available in the market
7
most commonly used suture in dentistry
3-0 black silk
non-resorbable sutures is best used in
Multiple extraction
most intensive non-resorbable suture inflammatory response
Silk
-came from silk worm
-most economical.
1st synthetic suture
Nylon
a ____ suture is used in single exo, mentally handicapped children
Resorbable
Gut came from
Cattle intima
MC used knots in dentistry
Triple Throw Knots
Basic of most knots
Single Knot/Half Hitch
Removal of non resorbable suture intraoral
5-7 days
removal of suture in scalp
5-7
Resorbable suture that has high inflammatory response
GUT
Suture cut - mm from the knot
2-3
Suture placed 2-3 mm from the incision line - mm apart.
3-4
stitch technique used for closure of extraction sites
Figure of 8 / “Stitch Tie”
most commonly used drain
1/4 inch Penrose drain
most common reason of extraction
Caries
2nd most common reason of extraction
Necrotic pulp/Irreversible pulpitis
most commonly used Scalpel #
3
ends of Mucoperiosteal elevator/ Molt 9 for twisting, prying motion to elevate interdental papilla
SHarp end
ends of Mucoperiosteal elevator/ Molt 9 for push stroke to separate periosteum from the bone
Blunt End
most common retractor
Austin, Minnesota
Most commonly used tongue retractor
Mouth mirror
enucleation is also known as
Cystectomy
hold cyst during enucleation
Bobcock
most commonly used hemostat to control hemorrhages
Curved hemostat
most commonly used to remove bone
Rongeur
- side and end cutting most practical use
removes/smoothen rough edges of bone
Bone file
- always toward the operator
- pull stroke in general
Removal of cyst/granulation from socket, removes soft tissues from bony cavities
Curette
- Angled double ended most commonly used
most commonly used scissor to cut suture
Dean’s scissors
most commonly used needle holder
Meyo-hegar
most commonly used suture in oral mucosa
3-0 black silk
most commonly used irrigation
NSS 0.9%
BOARDS: 0.85%
extractions key instrument, loosen tooth from surrounding bone.
Elevators
most commonly used elevator
straight elevator
elevator follows the principle of
Lever
alveolar bone removal of an elevator-luxated teeth from socket
Forceps
tractional force of forceps
Passive
beak of the forceps should adapt
to the root as apical as possible
Forceps 69
Root fragment Max & Md.
Cowhorn
16 mandi molars
210s
max 2m.
positioning of mandibular extraction
Occlusal plane be parallel to the floor, patients mouth is at or slightly below the operator’s shoulder
positioning of maxillary extraction
Patient’s mouth is at the operator’s shoulder
occlusal plane be 45-60degree from the floor.
extraction sequence
Max Post, Max ant, max 1 m and max canine
Mand post, mand anterior, Mand 1m and mand canine
Most critical force/major motion in primary tooth
Lingual Force
Most important force in simple extraction
Tractional//Passive force
1st major motion in extraction, and expansion of socket
Apical
Sequence of Exo//Major motion
A
B
L
R
T
Apical
Buccal
Lingual
Rotational (Monorooted)
Tractional
most commonly used flap
Envelope flap
Most commonly used to incise flap
15 blade on scalpel 3
Most commonly used retractor
Austin and minnesota retractors
sequence of impacted tooth
3rd molar, max canine, mand. 2nd pm.
easy odontectomy
Mesioangular mandible
most common orientation in mandibular 3rd molar
Mesioangular
Most common orientation in maxillary 3rd molar
Vertical
mandibular 3rd molar ideal time to remove
2/3rds of the root is formed
main reason for delayed healing process
Infection
begins the moment tissue injury occurs
Inflammatory
1st stage of inflammatory
Hemostatis “clot”
Platelet adhere to collagen by
Von Willebrand factor
Platelet to platelet aggregation/adhesion
Thromboxane A2
Extrinsic pathway is measured by
Prothrombin Time
Intrinsic pathway is measured by
Partial thromboplastin time
Clotting factor number 2
Prothrombin
Major component of clot
Fibrin
___ converts fibrinogen to convert fibrin
Thrombin
Most common chief complaint
Dolor (Pain)
2nd most common chief complaint
Tumor
duration of less than 6 months inflammation is a __ inflammation
Acute
most abundant cell in pulp, PDL, connective tissue
Fibroblast
most abundant protein in the body
Collagen
basic unit of collagen
Tropocollagen
helps in the synthesis of collagen Vit _
C
component of granulation tissue
Endothelial cells, Fibroblasts
“Proud flesh” known as
Keloid
least severe nerve injury
Neuropraxia
Most severe nerve injury
Neurotmesis
2 factors for proper bone healing
Vascularity and mobility (immobile)
cells that is present for remodelling
Osteoblast and Osteoclast.
ability to form a new bone with the help of vital osteoblasts
Osteogenesis
from host-derived/transplanted osteoprogenitor cells along a biologic/alloplastic framework - scaffolding
Osteoconduction
from differentiation of osteopregenitor cells derived from primitive mesenchymal cells - osteoblasts production
Osteoinduction
no tissue loss, well repaired lacerations, well-reduced bone fractures is an example of what healing by intentions?
Primary healing
- Flap is a form of primary healing
Presence of gap, closes by re-epithelization, deep ulcers.
Secondary healing
Delayed wound healing, use of tissue Grafts is a form of what healing intention
Tertiary healing/Intention
most commonly used graft in oral and maxillofacial surgery, gold standard..
Autograft
most common extraoral site of autograft
ILIUM
most common intraoral site of autograft
Max. Tuberosity
- capable of hyperplasia
part of bone that has Structural capability; high bone morphogenic protein resulting to osteoinduction
Cortical Bone
part of bone that has rich cellular capability
Cancellous bone
graft; non identical same specie
Allograft
- cadaver
graft; identical graft
Isograft
most commonly used allograft
freeze-dried bone
together with autograft
synthetic graft/made
Alloplastic
Most common cause of post-exo bleeding
Failure to follow post-exo
Also known as contusion, happens after exo, blood vessel trauma, common in elderly, decreases with heat
Ecchymosis
Most commonly used & least expensive hemostatic agent absorbable gelatin sponge
Gelfoam
Gel foam is absorbed within
4-6 weeks
- scaffold of clot
- will not activate clotting factors
Patients who are taking prescribed medications should never stop during or after extraction to prevent:
Rebound thromboembolism
Oozing of blood 4-10 days after surgery, because of infection.
Secondary bleeding
Persistent bleeding even after completion of surgery
Primary bleeding
Common area affected in osteonecrosis, associated with biphosphonate related osteonecrosis of the jaw
Mylohyoid ridge
Nerve that is commonly located at buccal & apical of mandibular 3rd molar
Inferior alveolar nerve
Nerve that is located at medial to lingual plate of mandibular 2nd molar and 3rd molar
Lingual Nerve
Most commonly to be exposed in wound dehiscence. Wound under tension area.
Internal Oblique Ridge
Most common reason alveolar process fracture, common in elderly (brittle bone)
Use of excessive force with forceps
Abnormal communication between maxillary sinus and oral cavity
Oro-antral communication
Most common type of oro-antral communication
Alveolar Type
Tx for 2-6mm oro-antral communication
Gelfoam with fig. Of 8, antibiotics (5D or 7Days) and decongestant (nasal & oral)
Tx for >6mm oro-antral communication
Bergers flap
Root displacement location of maxillary 3rd molar
Infratemporal space
Root displacement location of mandibular 3rd molar
Submandibular space
Tx for Root tip inside sinus
Antral lavage
- packaging of iodoform gauze strips
Common injuries to
Toddler
M>F
Class 2 div.1
Anterior > Posterior
Dentoalveolar injuries
Any tooth that undergo recent trauma will have a result in electric pulp test?
False Negative pulp test
Ulceration to a patient within 10 days, what will be the treatment?
Observe
-ulceration of malignancy for biopsy is more than 14 days (2wks)
Biopsy with the use of blade to make a hole, less likely to use in oral cavity
Punch Biopsy
Adjunct follow-up of biopsy
Cytology
Entire removal of lesion including 2-3mm of normal tissue
EXCISIONAL BIOPSY
Surgical biopsy If >2cm diameter, narrow, deep than shallow and broad, central areas are non diagnostic, suspected malignancy or encapsulated lesions.
Incisional Biopsy
Biopsy in any fluid-filled lesion, with the use of g16-18 needle with syringe of 5-10ml. Rules out vascular origin in intraosseous radiolucency
Aspiration biopsy
- all lesion must have aspiration biopsy except Mucocele
FNAB means
Fine Needle Aspiration Biopsy
Choice of treatment for jaw cyst, entire cyst removal or shelling out w/out rupture
Enucleation “Cystectomy” / Partsch 2
Creating a surgical window in the cystic wall. decompression of vital structures.
Marsupialization “Cystotomy” / Partsch 1
Removal of a tumor by incising through uninvolved tissues around tumor
Resection
Chemotherapy and radiotherapy attacks what part of the cell
Nucleus / DNA
most commonly used radiotherapy method of the head and neck
Fractionation method
- 50-70 gray — 5-7weeks
- <3cm without necrotic areas
- small increments
- radiosensitive cancer – deterministic effect
Incision of the lingual frenum
Frenotomy or Frenectomy?
Frenotomy
Frenectomy - excision of the fibrous labial frenum
most common procedure that uses laser surgery
Gingivectomy
Removal of the alveolar bone
Alveolectomy
Recontouring of alv. bone
Alveoloplasty
reduction of labial bone maxillary
Dean’s technique alveoloplasty
reduction of both labial and palatal cortical bone in maxillary
Obwegesers technique alveoloplasty
most common site of torus
Palate
surgical tech used in torus palatinus
Double y flap
- incision 1-1.5 cm beyond torus
Small torus - round acrylic burs
Large - crosscut fissure
Osteotome - Sectioning/splitting bone
Stent before removal - Cast - Support flap, prevent hematoma
Nerve to block/anesthetize in torus palatinus
Greater palatine nerve/ anterior palatine nerve & nasopalatine nerve located in incisive foramen
Lowe: IAN & Lingual Nerve
most common serious congenital anomaly affecting orofacial region
CLEFT
mOST COMMON BIRTH DEFECT
CLUB FOOT
cleft lip is more common in
Male > Female
Cleft palate : F>M
Combination : M > F
Unilateral common in left side.
Old age: increased risk
Common in 1st born baby, Asian, Hispanic.
Rule of 10 of cleft
10 weeks of age, 10 lbs of weight , 10 dl/mg of HGB in blood and NOT more than 10,000 WBC count.
Forms the Upper Lip
Median Nasal Process + Maxillary Process
Closure of Cleft LIP
CHEILORRAPHY
CHEILOPLASTY - REPAIR/RECONTOURING
MOST COMMON TECHNIQUE FOR MANDIBULAR ADVANCEMENT
Bilateral Sagittal Split Ramus Osteotomy
“BSSO / SSRO”
- intraoral
- lingual bone cut only until lingula, to prevent relapse
Form of a controlled fracture
Osteotomy
Most common maxillary surgical procedure AP, transverse & vertical abnormality
LE FORT 1 surgery
- incision @level of apices - to prevent relapse
alloplasty a synthetic graft with the use of
Hydroxyapatite
Anterior mandibular horizontal osteotomy is also called
Done only for Esthetic purposes.
Genioplasty
Confirmatory test for max fracture
CT Scan
Essential feature in le fort for diagnosis is
Fracture of pterygoid
Most common mandibular fracture
CONDYLE
Least common: Coronoid Process
Fracture of body of mandible is the most common cause of Lip Paresthesia
Incomplete type of fracture , common in condyle and children
Greenstick Fracture
Simple Fx - Complete
Compound Fx - Communication to outside
Comminuted - in Pieces GUNSHOT
Most complication of a compound fracture
Infection
most common cause of displacement of fractured mandible
Lateral Pterygoid Muscle
MC pathognomonic sign of mandibular fracture: MALOCCLUSION
most common site of laceration of mandibular fracture
Under chin
Large laceration = Sublingual hematoma
SUNKEN EYES
Enophthalmos
radiograph: hanging drop appearance in max sinus, sunken eyes is a fracture of
Blowout fracture of Orbit
Airway opening 1st maneuver
Head tilt, Chin lift
Most vital part of the brain
Medulla Oblongata
- vital visceral activities
Breath rate
16-20 breaths/min
Most common type of shock
Hemorrhagic Shock
Pulse rate
60-100 Bpm
Pupillary constriction
Miosis
Open reduction internal fixation and gunning splint is used for
Edentulous Patient
Process of putting back/approximating bones edges together
Reduction
Anchoring of bone place in screws, rods.
Fixation
temporary stabilization of mandibular fracture
Barton Bandage
immobilization for children fracture
2 weeks
ADULT: 4-6 weeks
area of fracture bone that degenerate
Eburnation
failure to unite causes eburnation
Non-union
