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MOS Lecture Slides > Principles of MOS > Flashcards

Principles of MOS Flashcards

1
Q

What should tooth factors should you assess prior to undertaking minor oral surgery?

A
  • amount and position of caries
  • restorations in tooth or adjacent teeth
  • any associated acute infection
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2
Q

A radiographic assessment of a tooth prior to MOS should consider…

A
  • root morphology and number
  • bone density
  • loss of lamina dura
  • presence of cysts or pathology
  • location of maxillary antrum/vital structures
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3
Q

The loss of lamina dura is indicative of …

A

an infective process

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4
Q

How can we manage cross infection during minor oral surgery?

A
  • aseptic technique
  • hand washing
  • gloving
  • gowning
  • draping
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5
Q

What is the purpose of draping? Outline a potential benefit of draping

A
  • defines the operative field
  • it provides a psychological barrier- aids the operator to seperae themselves
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6
Q

Outline the components of the operative technique for MOS

A
  • soft tissue management
  • hard tissue management
  • debridement
  • closure
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7
Q

Soft tissue management involves…

A

flap design e.g. full or partial thickness flap

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8
Q

What is a full thickness flap?

A

this is where everything (to the level of the periosteum) is detached

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9
Q

What is a flap?

A

it is a section of soft tissue

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10
Q

What are the principles of a flap?

A
  • they are outlined by a surgical incision
  • they carry their own blood supply
  • they allow surgical access to the underlying tissues
  • they can be replaced in its original position
  • they can be maintained by sutures and are expected to heal
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11
Q

What is the main principle of flap design? What is the exception?

A

the base of the flap should be wider than the end

the base should be 2x the height

flaps used to close OACs are not wider at the base

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12
Q

What kind of surgical incision is used in order to aid closure of an OAC? Suggest a reason why this is the chosen sugircal incision

A

parallel incision between the 5 and 7 (this is in reference to the removal of a 6 which is mostly likely to be in a position that will lead to OAC)

this is to prevent the flap from going over the teeth

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13
Q

Give examples of full thickness, mucoperiosteal flaps

A
  • envelope flap- one sided
  • two sided flap- 3 cornered
  • three sided flap- 4 cornered
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14
Q

What is the reason for having a flap that is wider at the base?

A

ensures adequate blood supply to the margins of the incisions

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15
Q

How many incisions are required to create an envelope flap/

A

one, semi lunar incision

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16
Q

Briefly describe how an envelope flap is created

A

usually follows the gingival margins around the area of surgery

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17
Q

When is an enevelop flap appropriate?

A

removal of roots

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18
Q

____ incisions are required for a 2 sided flap. What are these incisions?

A

two

marginal incision and relieving incision

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19
Q

How many incisions are required for a 3 sided flap? What are these incisions ?

A

three incisons

marginal incision and 2 relieving incisions

(as 2 sided flap but with an additional relieving incision)

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20
Q

What are the indications of a 3 sided flap?

A
  • root removal
  • impacted tooth removal
  • apicectomy
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21
Q

What is the single use blade of choice when performing MOS?

A

blade No.15

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22
Q

Give an example of an appropriate elevator of choice for root removal following decoronation

A

couplands elevator

(may also use 3 curve luxator if appropriately trained.

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23
Q

Outline a summary of considerations to be made before surgical removal of a tooth

A
  • decide which elevator + direction of removal
  • decide where to take bone
  • decide how to divide tooth
  • decide if complications are envisaged
  • design flap to accomodate

flap design is last and not first!

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24
Q

Blood supply is essential for healing. What is the consequence of a compromised blood supply following oral surgery?

A

necrosis

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25
Q

Briefly describe the blood supply to the mandible and maxilla

A

it comes upwards and forwards

(so it comes from the carotid arteries!)

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26
Q

Margins of full thickness flaps should be on ____ bone

A

sound

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27
Q

Briefly describe how incisions for full thickness flaps should be made

A

the scalpel should be perpendicular to the mucosa, then incised down to the bone.

You should then start the reflection of the flap in the buccal sulcus

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28
Q

Where should you start reflection following the creation of a full thickness flap?

A

in the buccal sulcus

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29
Q

Two sided flaps are commonly used for …

A

impacted 8s

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30
Q

What is the consequence of having flap where the base is less than the height?

A

compromised blood supply

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31
Q

When is a lunar incison acceptable?

A

for an apicectomy

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32
Q

When is a Y incision acceptable?

A

for removal of palatal tori

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33
Q

Give an example of an instrument that can be used to lift/ reflect full thickness flaps

A

howarths periosteal elevator

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34
Q

The choice of flap design depends on …

A
  • personal preference
  • anatomical site
  • access required
  • bone removal required
  • ability to suture
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35
Q

Hard tissue management for MOS may involve …

A
  • bone removal
  • tooth sectioning
  • debridement
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36
Q

What are the main objectives for bone removal (the transalveolar approach) ?

A
  • achieve access
  • establish a point of application of elevators/luxators
  • removal of obstructions to tooth movement- this is important in the case of impacted 8s
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37
Q

What equipment is required for bone removal during MOS?

A
  • surgical bur - in a surgical slow speed hand piece
  • normal saline as coolant and irrigant
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38
Q

When a straight elevator is used as a shoehorn to luxate a broken root, what measure must be taken to prevent injurt to adjacent tissue?

A
  • the hand must be securely supported on adjacent teeth to prevent inadvertent slippage of instrument and subsequent damage/injurt to adjacent tissue
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39
Q

Why should the mesiodistal width of bone removal be approximately the same as the mesiodistal dimension of the tooth itself?

A

to allow an unimpeded path of removal of the root in the buccal direction

40
Q

Bone should be removed approximately ____________ the length of the tooth root

A

one half - one third of the length of the tooth root

41
Q

After bone has been removed and tooth root luxated with straight elevator, ________ can be used to remove the root.

A

forceps

42
Q

What is the purpose of tooth sectioning/division?

A

improve the path of withdrawal of the tooth

43
Q

Briefly outline how you would go about sectioning a tooth

A
  • envelope flap reflected
  • small amount of crestal bone is removed to expose bifurcation
  • drill is then used to section the tooth into mesial an distal halves
  • lower universal forceprs are used to remove two crown and root portions seperately
44
Q

Briefly describe how you would go about the removal of the remainder of a lower molar following the loss of the crown to fracture/caries

A
  • reflect a small envelope flap
  • remove a small amount of crestal bone
  • bur is then used to section tooth into individual roots
  • small elevator used to mobilise roots
  • cryer elevator used to elevate distal root (the tip of the elevator is placed into the slot prepared by the bur and the elevator is used to deliver the root)
  • opposite member of paired cryer elevators is then used to deliver the remaining tooth root with the same rotational movement
45
Q

What is the active area of coupland elevators?

A

the concave areas which engage with the teeth

46
Q

Outline the parts of an elevator

A
  • blade
  • shank
  • handle
47
Q

Outline the parts of a forcep

A
  • blade/beaks
  • hinge
  • handles
48
Q

The more steep the angle between the handle and the hinge of the forcep the more ________ it will be used

A

posteriorly

49
Q

What kind of movement should be applied with a luxator?

A

rotation movement

50
Q

What are the benefits of irrigation during MOS?

A
  • flushes out debris
  • improves field of view for evaluation of surgical site
51
Q

What are the potential consequences of leaving sharp edges behind?

A
  • poor wound apposition and tearing
  • can lead to delayed wound healing
52
Q

What is the consequence of excessive smoothing of sharp edges?

A

it can be traumatic

53
Q

What kinds of needles are used for suturing following MOS?

A

semi-circular, reverse cutting needles

54
Q

How should a needle enter the surface of the tissue?

A

at a right angle and it should be turned

55
Q

What is the consequence of a needle entering at an acute angle and being pushed through the tissue?

A

tearing of mucosa with the needle or with suture

56
Q

How can suturing a 3 cornered flap be made easier ?

A

(2 sided flap)

a periosteal elevator is used to elevate a small amount of fixed tissue so that the suture can be passed through the entire thickness of the mucoperiosteum

57
Q

Where is the first suture placed when a 3 cornered flap is repositioned?

A

it should be placed on the occlusal end of the vertical relieving incision (slide 70)

58
Q

Where are the 2nd and 3rd sutures placed folliwing the repositioning of the three cornered flap?

A

papillare are sutured sequentially

59
Q

Where is the final suture following repositioning of the three cornered flap placed?

A

the superior aspect of the relieving incision

60
Q

What are the benefits of using the horizontal mattress suture?

A
  • decreaes the number of individual sutures that have to be placed
  • compresses wound together slightly
  • everts wound edge
61
Q

What kind of suture can be placed when multiple sutures need to be placed?

A

running or continuous suture

62
Q

What should be included in the case notes following MOS?

A
  • description of operation
  • POI-pain swelling; include out of hours contact number
  • haemostasis achieved
  • medications prescribed
  • arrangements for review
  • signature of staff
63
Q

What are the classifications of wounds ?

A
  • clean
  • clean- contaminated
  • contaminated
  • dirty
64
Q

What is a clean wound?

A

no inflammation

65
Q

What is a clean, contaminated wound?

A

infected clean wound, respiratory, GI, UG system is opened under aseptic conditions antibiotic prophylaxis is given in high risk patients

66
Q

What is a contaminated wound?

A

microorganisms involved in the infection were in the operation site before operation

67
Q

Give examples of contaminated wounds

A
  • acute accidental wounds
  • perforation
  • fistula
  • abscess
68
Q

What is a dirty wound ?

A

long time contact between contamination and the wound care

69
Q

Give examples of dirty wounds

A
  • war wounds
  • gangrene
  • tissue necrosis
  • abscess
  • organ necrosis
70
Q

What are the stages of wound healing ?

A
  • Coagulation
  • Inflammation
  • Fibroplastic/ proliferative (fibroblasts)
  • remodelling (collagen)

Haemostasis- inflammation Granulation- proliferation
Remodelling

71
Q

What occurs at the start of remodelling?

A

granulation- proliferation

72
Q

What occurs at the granulation- proliferation stage?

A
  • fibroblast migration
  • collagen deposition
  • angiogenesis
  • granulation tissue formation
  • epithelisation
  • contraction (loss of tissue)
73
Q

What occurs at the remodelling stage?

A
  • regression of many capillaries
  • physical contraction - myofibroblasts
  • collagen degeneration and synthetisation
  • new epithelium
74
Q

What is the tensile strength of remodelled tissue?

A

it is a maximum of 80% of the original tensile strength

75
Q

What are the types of wound healing?

A
  • primary intention
  • secondary intention
76
Q

How does primary intention occur?

A

fibrin fibres cover the wound and offer protection

linear wound healing

77
Q

Outline some causes of secondary intention

A
  • infection
  • dehiscence (marginal bone loss)
  • crush wound
  • surgical fault
78
Q

Outline local factors that can affect healing

A
  • wound sepsis
  • poor blood supply
  • wound tension
  • foreign bodies
  • previous irradiation
  • poor technique
79
Q

Outline systemic factors that can affect healing

A
  • nutritional deficiencies
  • systemic disease
  • therapeutic agents
80
Q

Give examples of complications of healing

A
  • infection
  • dehiscence - loss of tissue unnecesarily
  • hypertonic scarring- more in skin, less so in mucosa
  • keloid scarring
  • contractures
81
Q

When does a primary haemorrhage occur ?

A

occurs intraoperatively or is immediately post operative

82
Q

When does reactionary haemorrhage occur?

A

within 4-6 hours

83
Q

How can reactionary haemorrhages be managed ?

A

sutures
haemostatic agents

84
Q

When does a secondary haemorrhage occur?

A

after 24 hours

85
Q

What is the approximate volume of blood loss in class I haemorrhagic shock?

A

up to 750 ml

86
Q

What is the approximate volume of blood loss in class II haemorrhagic shock?

A

750-1500ml

87
Q

What is the approximate volume of blood loss in class III haemorrhagic shock?

A

1500 -2000ml

88
Q

What is the approximate volume of blood loss in class IV haemorrhagic shock?

A

> 2000ml

89
Q

Outline mechanical methods that can be used to achieve haemostasis

A
  • digital/direct pressure
  • tourniquet
  • ligation
  • suturing
  • preventive haemostasis
  • clips
  • bone wax
90
Q

Give an example of low temperature thermal methods used to achieve haemostasis

A
  • cryosurgery
  • hypothermia (e.g. for stomach bleeding?)
91
Q

How can low temperatures help control bleeding ?

A
  • dehydration and denaturation of fatty tissue
  • decreases the cell metabolism
  • vasoconstriction
92
Q

Give examples of high temperature thermal methods used to achieve haemostasis

A
  • electrosurgery- electrocauterisation
  • monopolar diathermy
  • bipolar diathermy
  • laser surgery- coagulation and vaporisation for fine tissues
93
Q

Give examples of haemostatic agents

A
  • cotton/gauze +/- vasoconstrictor
  • surgicel (oxycellulose)
  • bone wax
  • calcium alginate (kaltrostrat)- periodontal surgery
  • calcium sulphate
  • ferric sulphate - astringent ?
  • gelofoam- gelatin
  • collagen- collaplug
  • tranexamic acid - antifibrinolytic agent
94
Q

Extracellular fluid (outside of the cell) includes …

A
  • interstitial fluid
  • intravascular fluid
95
Q

What solutions can you use to resolve hypovolemic shock?

A
  • 5% glucose
  • hypertonic normal saline
  • ringers lactate/hartmanns solution
  • colloids
  • blood

MOS Lecture Slides (7 decks)

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