Surgical Principles Flashcards
0
Q
What can we use to remove bone?
A
Chisels
Burrs
1
Q
What are the principles of flap design?
A
Broad base Avoid critical structures Include interdental papilla Full thickness Sufficient surgical access
2
Q
In Which direction should you cut when using a scalpel?
A
Left to right
3
Q
When using scissors which direction should you cut?
A
Right to left
4
Q
When are blunt ended scissors used?
A
Ligature cutting
5
Q
When are chamfered ended scissors used?
A
For dissection
6
Q
When would you use toothed forceps?
A
For grasping tissues which are slippery
7
Q
When would you use non Toothed forceps?
A
When you want to compress structure
Blood vessels or encapsulated organs
8
Q
What type of needles are there?
A
Cutting-triangular or flat
Round bodied
Atraumatic eyless
9
Q
When would you use cutting needles?
A
Resistant tissue eg Mucoperiostium or skin
10
Q
When would you use round bodied needles?
A
For fragile tissues
11
Q
How should you suture?
A
Free to fixed
Fore handed
Perpendicular to surface
Pronation followed by supination
12
Q
What should you do to the skin edges before suturing?
A
Evert to prevent dead keratinised surfaces from being in contact
13
Q
What type of suturing methods are there?
A
Interrupted Vertical mattress Horizontal mattress Continuous Sub cuticular Sling suture: good when right contacts
14
Q
What types of suture materials are available?
A
Resorb able vs Non
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
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
17
Q
What size suture would you use on the oral mucosa?
A
3/0
18
Q
What size suture would you use on facial skin?
A
5/0 synthetic
19
Q
What size suture would you use on scalp and eye lid?
A
3
6
Both synthetic
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
21
Q
How should you excise circular lesions?
A
Using an ellipse and undermine the edges
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
23
Q
What is a graft?
A
Tissue that is freed from donor site and placed at recipient site to restore a defect
24
Where does a graft derive it's nourishment from?
Tissue bed at the recipient site
25
How should the recipient site be prepared ?
Freed from infection and bleeding to avoid haematoma
26
Name the types of skin grafts available?
Split skin graft
| Full thickness Wolfe
27
What is a split skin graft?
Superficial skin and germinal cells some germinal cells left at donor site
28
What should you place over the SSG?
A mesh and pressure dressing to allow exudate to escape and prevent haematoma
29
What are the advantages of a full thickness graft?
Better aesthetics compared to SSG
30
What is a full thickness graft? what are common types of these? How does it get it bloods supply?
All skin layers and fat
Common sites are supraclabicular and retro auricular
Blood supply from wound edges
31
How is the donor site closes in FTSG?
Undermining edges and primary linear closure
32
What is a flap?
Retains it's blood supply through a Pedicle
33
What are common types of flaps used?
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
34
What are the principles of a random pattern flap?
No specific blood supply
Length not greater than width
Local transposition
35
What are the principles of an axial flap and myocutaneous?
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
36
What biopsies are available for diagnostic purposes?
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
37
What are the principles of free flaps?
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
38
What types of nerve injury can occur?
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
39
How can we control bleeding?
```
Pressure
Ligation
Diathermy
Surgicel
Bone wax
Posture
Trans examic acid
```
40
When would you consider using a drain?
Empty fluids and project tissues from compression and risk of ischemia
Place drain at most dependant site and suture to skin
41
When would you use a vacuum drain?
To drain blood at wound closure and prevents haematoma forming
42
When would you use a corrugated sheet drain?
Passive drainage for infrctjon and drainage of abscess or fascisial space
43
When would you consider steroid cover for a patient?
More than 10mg prednisalone or equiv daily or within last three months
Addison's disease
44
What are the three main steps of haemostasis?
Vasoconstriction
Platelet adhesion due to exposure of sub endothelial surfaces
Fibrinogen converted to stable fibrin clot
45
What should be administered in patients undergoing emergency treatment and on steroids?
100mg hydrocortisone hemisuccinate IV
46
What are the three main categories re haemostasis disorders?
Vessel wall: HHt, scurvy, Ehlos danlos syndrome
Clotting cascade
Platelets
47
Where are the clotting factors produced?
In the liver
48
Where two groups of clotting problems exist?
Inherited and acquired
49
What inherited clotting problems exist?
Haemophilia A and B
| VWD
50
What aquired clotting problems exist ?
Drugs: warfarin, heparin, aspirin
Liver disease and DIC
51
What three categories of platelet dysfunction exist?
Thrombocytopenia
Decreased production
Dysfunction
52
How can thrombocytopenia arise?
Heamorrhage
| Destruction
53
How can there be a reduction in production of platelets?
Aplastic anemia
Leukaemia
Drugs and radiation
54
How can function of platelets be impaired?
Aspirin or VWD
55
What level of platelets should you not do an IDB?
<50
56
What level should you not do an infiltration?
Less than 30
57
What level of platelets can you do dento alveolar surgery?
<75
58
What level can we take teeth out on ppl on warfarin?
Less than 4
59
Which patients should a FBC be performed?
Alcoholics
60
When can you perform an apicectomy?
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
What are the contra indication to apicectomy?
No/ poor Orthograde RCT
62
What are the NICE guidelines re extraction of third molars?
Pub 2000
Revised 2003
```
Recurrent episodes of periocoronitis
Perio
Unrestorable caries
Resorption
Jaw fracture
Orthognathic surgery
Radiotherapy
```
63
What should you warn a pt re surgical extraction of wisdom teeth?
Pain swelling trimsus infectjon
| Nerve damage
64
How can you assess the difficulty of extracting 8's?
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
At what figure would you consider GA for extraction of 8's?
More than 5mm red line
66
What features on xray show intimate relationship between IDN and tooth?
Loss of tramlines
Narrowing of lines
Sudden change in direction
Radiolucency across root
67
How do we remove cysts?
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
What are the indications for removing parotid gland?
Severe cases of chronic recurrent siladenitis
| Benign or malignant tumor
69
What are the complications arising from parotid excision?
```
Facial nerve damage
Haematoma
Infectjon
Swelling
Freya syndrome 60% re innervation by ps
Numb ear
Salivary fistula
Wound simple
```
70
What are the indication for removing the SM gland?
Siliadenitis
Calculi in promixal gland
Tumour
71
What are the complications arising from removal of SM gland?
Damage to facial artery or vein
Lingual nerve and hypoglassal and marginal mandibular nerve damage
SL duct damage
72
When is the best time to carry out treatment in someone pregnant?
2nd trimester
73
What complications may arise during operation of a pregnant person?
Supine hypotension syndrome
When laid too flat uterus compresses
IVC and impedes venous return to heart
74
What are the contents of LA?
```
Base
HCL salt
Vasoconstrictor
Buffering agent
Preservatives
```
75
How much lidocaine is in a 2.2ml cartridge?
44mg
76
What is the max dose of lidocaine 2% with adrenaline?
7mg/kg
77
What are the ASA grades?
1: normal healthy
2: mild systemic disease ( preg/ well controlled asthma/ type 2 diabetes)
3: severe systemic disease affects life
4: life threatening
78
What are the most commonly used flap designs for surgical endo?
Semilunar
Leubke- oscheinbein flap
Full flap
79
What is the purpose of root apex resection?
Remove granulation tissue to send for histopathology
Remove resorption, anatomical variation, perforations and blockages
Evaluate and create apical seal
80
How much of the root should be removed in apicectomy?
3mm
81
Why is 3mm removed?
To remove apical delete
82
What are the aims of retrofillijg the root canal?
Clean and prepare apical 3mm and hermetically seal the apex
83
What are the ideal properties of a root end filling material?
Biocompatible
Non resorbable
East to place
Radiopaque
84
Which materials are used as root filling materials?
```
Amalgam
ZincPhosphate
Zinc Polycarboxylate
Super EBA
MTA
```
85
What is in MTA?
Tricalcium Silicate, aluminate, oxide
Silicate oxide
Bismuth oxide powder
86
What are the advantages of MTA?
Hydrophilic
Sets in 3 hours
PH 12.5
Stimulates hard tissue genesis
87
What should the patient take to help with pain following apicectomy?
NSAIDS from before
| Dexamethasone 8mg orally at op and 6-8 post op
88
What percentage of teeth are affected by dry socket?
3%
89
What are the causes of dry socket?
```
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
How do we manage dry socket?
Alvogel
| Irrigate
91
How long does it take for an OAC to become an OAF?
48hrs
92
What are the causes of an OAC?
```
Roots close to the sinus
Bulbous curved roots
Traumatic extraction
Hypercementosis
Pericapical patho
Large sinus
Neoplasms
```
93
How to diagnose an OAC?
```
Bubbling
High pitches sound
Bad taste in mouth
Sinusitis
Can't suck through straw
```
94
How do you treat an OAC?
Buccal advancement flap (plus fat pad)
| Palatal rotation flap
95
What regimen of medication should someone following OAC closure follow?
Tetracycline
Analgesics
Decongestion
Mucolytics
96
When using a palatal rotation flap to heal an OAC what vessel is taken with it?
The greater palatine vessel
97
What complications may arise from xla upper posterior teeth?
OAC
| Tuberosity fracture
98
How can a tuberosity fracture arise?
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
How would you mange a fractured tuberosity?
If bone still attached to Mucoperiostium then can splint and surgical Xla in 6 weeks
100
When would you continue with xla of the tooth with a fractured tuberosity?
When the tooth is causing pain and is infected and very loose.
Give an an astral regimes after
101
How would you manage a tooth that has been displaced into the Antrum?
Cald well luc!
102
What must you do once you have removed tissue for a biopsy?
Label specimens for orientation if required
Label samples in appropriate recipiticsls
Consider fixative
Marke patient name etc
103
What are rh two types of diathermy?
Mono polar and bipolar
104
When is monopolar used?
Coagulation and cutting
NOT IN PACEMAKER
105
When is bipolar used?
Coagulation only especially good for pin point coagulation
Can be used in people with Pacemaker
Current only passes between the two electrodes
