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Oral Surgery > Surgical Principles > Flashcards

Surgical Principles Flashcards

0
Q

What can we use to remove bone?

A

Chisels

Burrs

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1
Q

What are the principles of flap design?

A 
Broad base
Avoid critical structures
Include interdental papilla
Full thickness
Sufficient surgical access
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2
Q

In Which direction should you cut when using a scalpel?

A

Left to right

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3
Q

When using scissors which direction should you cut?

A

Right to left

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4
Q

When are blunt ended scissors used?

A

Ligature cutting

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5
Q

When are chamfered ended scissors used?

A

For dissection

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6
Q

When would you use toothed forceps?

A

For grasping tissues which are slippery

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7
Q

When would you use non Toothed forceps?

A

When you want to compress structure

Blood vessels or encapsulated organs

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8
Q

What type of needles are there?

A

Cutting-triangular or flat

Round bodied

Atraumatic eyless

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9
Q

When would you use cutting needles?

A

Resistant tissue eg Mucoperiostium or skin

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10
Q

When would you use round bodied needles?

A

For fragile tissues

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11
Q

How should you suture?

A

Free to fixed

Fore handed

Perpendicular to surface

Pronation followed by supination

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12
Q

What should you do to the skin edges before suturing?

A

Evert to prevent dead keratinised surfaces from being in contact

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13
Q

What type of suturing methods are there?

A 
Interrupted 
Vertical mattress
Horizontal mattress
Continuous
Sub cuticular
Sling suture: good when right contacts
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14
Q

What types of suture materials are available?

A

Resorb able vs Non

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15
Q

What types of Resorb sutures are there? And how are the resorbed

A

Polyglactin (vicryl) : made From glycolyide and L lactide resolves by hydrolysis, multifilament, strong but slow to Resorb. NOT TO BE USED in cardiovascular and neurological tissue. 2-3 weeks to resorb

Polygycolic: DExon

Polydiaxanone: PDS: degraded by hydrolysis this is a monofilament so less tissue response. Stronger and slower to resorb

Catgut: not used anymore

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16
Q

What types of non Resorb materials are there?

A

Synthetic: nylon , it is monofilament therefore has a reduced tissue reaction , hard to tie

Silk: multifilament so has more tissue reaction

Prolene

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17
Q

What size suture would you use on the oral mucosa?

A

3/0

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18
Q

What size suture would you use on facial skin?

A

5/0 synthetic

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19
Q

What size suture would you use on scalp and eye lid?

A

3
6
Both synthetic

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20
Q

How should you suture head and neck skin?

A

Along natural skin and tension lines
Make incisions parallel to tension lines
Draw out planned incision and landmarks for would closure

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21
Q

How should you excise circular lesions?

A

Using an ellipse and undermine the edges

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22
Q

What is an adverse effect of surgery relating to eyelid?

A

Can create an ectropian

Eyelid that turns outward

May lead to corneal abrasions

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23
Q

What is a graft?

A

Tissue that is freed from donor site and placed at recipient site to restore a defect

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24
Q

Where does a graft derive it’s nourishment from?

A

Tissue bed at the recipient site

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25
Q

How should the recipient site be prepared ?

A

Freed from infection and bleeding to avoid haematoma

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26
Q

Name the types of skin grafts available?

A

Split skin graft

Full thickness Wolfe

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27
Q

What is a split skin graft?

A

Superficial skin and germinal cells some germinal cells left at donor site

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28
Q

What should you place over the SSG?

A

A mesh and pressure dressing to allow exudate to escape and prevent haematoma

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29
Q

What are the advantages of a full thickness graft?

A

Better aesthetics compared to SSG

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30
Q

What is a full thickness graft? what are common types of these? How does it get it bloods supply?

A

All skin layers and fat

Common sites are supraclabicular and retro auricular

Blood supply from wound edges

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31
Q

How is the donor site closes in FTSG?

A

Undermining edges and primary linear closure

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32
Q

What is a flap?

A

Retains it’s blood supply through a Pedicle

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33
Q

What are common types of flaps used?

A

Random
Axial
Myocutaneous
Free : axial pattern flap with it’s named blood vessel is attached to donor site via micro vascular anastomoses eg radial forearm

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34
Q

What are the principles of a random pattern flap?

A

No specific blood supply
Length not greater than width

Local transposition

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35
Q

What are the principles of an axial flap and myocutaneous?

A

Axial: Specific blood supply and accompanying venue comitans

Myo: skin over muscle will survive as long as pedicel to muscle is not divided

Eg Pec major, latissmi Doris

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36
Q

What biopsies are available for diagnostic purposes?

A

Aspiration biopsy : FNAC for cytology
Needle: core of tissue taken
Punch biopsy
Excision : whole lesion wide margin for malignant biopsy
Incisional biopsy: part of lesion taken healthy and non healthy

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37
Q

What are the principles of free flaps?

A

An autotransplant
Axial pattern flap with named blood vessel and vein detached and placed at distant site and connects via micro vascular anastomoses

For complex wounds
Radial forearm and fibulae

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38
Q

What types of nerve injury can occur?

A

Neuropraxia: temp physiological block
Axontemesis: axon is divided but endoneuroum is intact , wallerian degeneration occurs in distal axon
Neurotemesis: nerve is divided may get early micro anastomoses but may need nerve graft

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39
Q

How can we control bleeding?

A 
Pressure
Ligation 
Diathermy
Surgicel
Bone wax
Posture 
Trans examic acid
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40
Q

When would you consider using a drain?

A

Empty fluids and project tissues from compression and risk of ischemia

Place drain at most dependant site and suture to skin

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41
Q

When would you use a vacuum drain?

A

To drain blood at wound closure and prevents haematoma forming

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42
Q

When would you use a corrugated sheet drain?

A

Passive drainage for infrctjon and drainage of abscess or fascisial space

43
Q

When would you consider steroid cover for a patient?

A

More than 10mg prednisalone or equiv daily or within last three months

Addison’s disease

44
Q

What are the three main steps of haemostasis?

A

Vasoconstriction
Platelet adhesion due to exposure of sub endothelial surfaces
Fibrinogen converted to stable fibrin clot

45
Q

What should be administered in patients undergoing emergency treatment and on steroids?

A

100mg hydrocortisone hemisuccinate IV

46
Q

What are the three main categories re haemostasis disorders?

A

Vessel wall: HHt, scurvy, Ehlos danlos syndrome

Clotting cascade

Platelets

47
Q

Where are the clotting factors produced?

A

In the liver

48
Q

Where two groups of clotting problems exist?

A

Inherited and acquired

49
Q

What inherited clotting problems exist?

A

Haemophilia A and B

VWD

50
Q

What aquired clotting problems exist ?

A

Drugs: warfarin, heparin, aspirin

Liver disease and DIC

51
Q

What three categories of platelet dysfunction exist?

A

Thrombocytopenia
Decreased production
Dysfunction

52
Q

How can thrombocytopenia arise?

A

Heamorrhage

Destruction

53
Q

How can there be a reduction in production of platelets?

A

Aplastic anemia
Leukaemia
Drugs and radiation

54
Q

How can function of platelets be impaired?

A

Aspirin or VWD

55
Q

What level of platelets should you not do an IDB?

A

<50

56
Q

What level should you not do an infiltration?

A

Less than 30

57
Q

What level of platelets can you do dento alveolar surgery?

A

<75

58
Q

What level can we take teeth out on ppl on warfarin?

A

Less than 4

59
Q

Which patients should a FBC be performed?

A

Alcoholics

60
Q

When can you perform an apicectomy?

A

Orthograde RCT been tried twice and failed
Extrusion of filling causing Orthograde infection
Root perforation / lateral perforation
Biopsy
Cannot get round hooked canals
Re apicectomy

61
Q

What are the contra indication to apicectomy?

A

No/ poor Orthograde RCT

62
Q

What are the NICE guidelines re extraction of third molars?

A

Pub 2000
Revised 2003

Recurrent episodes of periocoronitis
Perio 
Unrestorable caries 
Resorption 
Jaw fracture 
Orthognathic surgery 
Radiotherapy
63
Q

What should you warn a pt re surgical extraction of wisdom teeth?

A

Pain swelling trimsus infectjon

Nerve damage

64
Q

How can you assess the difficulty of extracting 8’s?

A

Winters lines
White line: occlusal surface if unetupted 6/7
Amber line: interdental bone between 6 and 7 along internal oblique ridge
Red line: perpendicular to white line to point of application of an elevator measured from amber line for depth

65
Q

At what figure would you consider GA for extraction of 8’s?

A

More than 5mm red line

66
Q

What features on xray show intimate relationship between IDN and tooth?

A

Loss of tramlines
Narrowing of lines
Sudden change in direction
Radiolucency across root

67
Q

How do we remove cysts?

A

Enucleatation: complete removal
Masuipilizastkon: cyst opened and stitched to the skin packed with whiteheads varnish slacked ribbon gauze which should be changed to allow healing

68
Q

What are the indications for removing parotid gland?

A

Severe cases of chronic recurrent siladenitis

Benign or malignant tumor

69
Q

What are the complications arising from parotid excision?

A 
Facial nerve damage
Haematoma 
Infectjon 
Swelling
Freya syndrome 60% re innervation by ps 
Numb ear
Salivary fistula
Wound simple
70
Q

What are the indication for removing the SM gland?

A

Siliadenitis
Calculi in promixal gland
Tumour

71
Q

What are the complications arising from removal of SM gland?

A

Damage to facial artery or vein
Lingual nerve and hypoglassal and marginal mandibular nerve damage
SL duct damage

72
Q

When is the best time to carry out treatment in someone pregnant?

A

2nd trimester

73
Q

What complications may arise during operation of a pregnant person?

A

Supine hypotension syndrome

When laid too flat uterus compresses
IVC and impedes venous return to heart

74
Q

What are the contents of LA?

A 
Base
HCL salt
Vasoconstrictor 
Buffering agent
Preservatives
75
Q

How much lidocaine is in a 2.2ml cartridge?

A

44mg

76
Q

What is the max dose of lidocaine 2% with adrenaline?

A

7mg/kg

77
Q

What are the ASA grades?

A

1: normal healthy
2: mild systemic disease ( preg/ well controlled asthma/ type 2 diabetes)
3: severe systemic disease affects life
4: life threatening

78
Q

What are the most commonly used flap designs for surgical endo?

A

Semilunar
Leubke- oscheinbein flap
Full flap

79
Q

What is the purpose of root apex resection?

A

Remove granulation tissue to send for histopathology
Remove resorption, anatomical variation, perforations and blockages
Evaluate and create apical seal

80
Q

How much of the root should be removed in apicectomy?

A

3mm

81
Q

Why is 3mm removed?

A

To remove apical delete

82
Q

What are the aims of retrofillijg the root canal?

A

Clean and prepare apical 3mm and hermetically seal the apex

83
Q

What are the ideal properties of a root end filling material?

A

Biocompatible
Non resorbable
East to place
Radiopaque

84
Q

Which materials are used as root filling materials?

A 
Amalgam
ZincPhosphate
Zinc Polycarboxylate 
Super EBA
MTA
85
Q

What is in MTA?

A

Tricalcium Silicate, aluminate, oxide
Silicate oxide
Bismuth oxide powder

86
Q

What are the advantages of MTA?

A

Hydrophilic
Sets in 3 hours
PH 12.5
Stimulates hard tissue genesis

87
Q

What should the patient take to help with pain following apicectomy?

A

NSAIDS from before

Dexamethasone 8mg orally at op and 6-8 post op

88
Q

What percentage of teeth are affected by dry socket?

A

3%

89
Q

What are the causes of dry socket?

A 
Excess trauma
Decreased blood supply eg OCP, radiotherapy to jaw
Poor OH
Immunocom
Bone disease eg pagets 
Too much mouth washing
Infection prior to xla
90
Q

How do we manage dry socket?

A

Alvogel

Irrigate

91
Q

How long does it take for an OAC to become an OAF?

A

48hrs

92
Q

What are the causes of an OAC?

A 
Roots close to the sinus
Bulbous curved roots
Traumatic extraction
Hypercementosis 
Pericapical patho
Large sinus 
Neoplasms
93
Q

How to diagnose an OAC?

A 
Bubbling
High pitches sound 
Bad taste in mouth 
Sinusitis 
Can't suck through straw
94
Q

How do you treat an OAC?

A

Buccal advancement flap (plus fat pad)

Palatal rotation flap

95
Q

What regimen of medication should someone following OAC closure follow?

A

Tetracycline
Analgesics
Decongestion
Mucolytics

96
Q

When using a palatal rotation flap to heal an OAC what vessel is taken with it?

A

The greater palatine vessel

97
Q

What complications may arise from xla upper posterior teeth?

A

OAC

Tuberosity fracture

98
Q

How can a tuberosity fracture arise?

A

Usually associated with upper line standing molars where the maxillary sinus has be invaded by the Antrum and there has been ankylosis of the lone standing tooth and tuberosity

99
Q

How would you mange a fractured tuberosity?

A

If bone still attached to Mucoperiostium then can splint and surgical Xla in 6 weeks

100
Q

When would you continue with xla of the tooth with a fractured tuberosity?

A

When the tooth is causing pain and is infected and very loose.

Give an an astral regimes after

101
Q

How would you manage a tooth that has been displaced into the Antrum?

A

Cald well luc!

102
Q

What must you do once you have removed tissue for a biopsy?

A

Label specimens for orientation if required
Label samples in appropriate recipiticsls
Consider fixative
Marke patient name etc

103
Q

What are rh two types of diathermy?

A

Mono polar and bipolar

104
Q

When is monopolar used?

A

Coagulation and cutting

NOT IN PACEMAKER

105
Q

When is bipolar used?

A

Coagulation only especially good for pin point coagulation

Can be used in people with Pacemaker
Current only passes between the two electrodes

Oral Surgery (16 decks)

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