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Minor Oral Surgery > Surgical Technique > Flashcards

Surgical Technique Flashcards

1
Q

When making an incision, where should the operator start ?

A

the operator should start posteriorly and they should work towards the front of the flap

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2
Q

Describe how sulcular incisons should be done

A
  • the blade should be placed vertically into the gingival sulcus
  • following the shape of the tooth, keep the shapr edge of the blade against the tooth surface to prevent unnecessary damage to teh gingiva
  • interdental papilla should be preserved to ensure apposition of flap post-operatively
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3
Q

What should the operators supporting hand do when making the relieving incision?

A

it should be retracting the cheek to exert tension on the alveolar mucosa

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4
Q

What is the benefit of tension on the alveolar mucosa when making the relieving incision?

A

it ensures that the blade runs cleanly through the tissues

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5
Q

An incision should be made in a ________, ________ stroke

A

a single, smooth stroke

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6
Q

Where should an incision stop?

A

at the level of the apices of the teeth

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7
Q

Incisions should be made at ________ angle and must be straight down to the _________.

A

right angle
straight down to the bone

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8
Q

Why should incisions be made down to bone level?

A

this is to permit easy reflection of the flap without any soft tissue still being attached to periosteum and the bone

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9
Q

The periosteum plays an important role to the healing of the flap. True or false

A

True

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10
Q

Where does flap reflection begin?

A

it begins with the papillae

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11
Q

What instruments can be used to seperate and turn out a flap from the underlying bone?

A
  • warwick james elevator
  • Mitchells trimmer
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12
Q

How should a mitchells trimmer be used to seperate and turn out a flap from the underlying bone?

A
  • keep the smooth edge of the instrument against the soft tissue to prevent any unnecessary damage
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13
Q

List periosteal elevators that can be used to reflect a flap

A
  • Howarths
  • Symes
  • Molt No.9
  • Hu-friedy
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14
Q

Why are the Symes and Molt No.9 preferred over the howarths elevator?

A

the howarths elevator is blunt which can cause damage to the soft tissues

Symes and Molt No.9 are sharper

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15
Q

What elevator is preferred for use in periodontal surgery and why?

A

Hu-Friedy 24G
This is because they are sharp and small which minimises soft tissue damage

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16
Q

What is the hardest part of the flap to reflect?

A

the attached gingiva

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17
Q

What is a full thickness flap ?

A

a flap that includes both the mucosa and the periosteum

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18
Q

Why should we avoid putting tension on the flap?

A

to avoid tears

19
Q

Why must we take care not to strip the periosteum further than required?

A

this is because it reduces blood supply to the bone

20
Q

State one way which you can strengthen the flap and prevent tears

A

lengthening the flap

21
Q

Give examples of retractors that can be used

A
  • Morris rake
  • Minnesota
  • Lacks tongue retractor
22
Q

Before a retractor is placed, what must be created?

A

A pocket underneath the periosteum is created using a periosteal elevator. Care must be taken not to strip the periosteum further than required.

23
Q

Briefly describe how a retractor is placed

A

The chosen retractor is placed over the periosteal elevator into the pocket created and then the periosteal elevator is removed

24
Q

The retractor sits against the _______, protecting the soft tissues.

A

bone

25
Q

In the mandibilar premolar area, what must you be careful of when raising a flap?

A

you must be careful not to trap the mental nerve berween the retractor and the bone as damage could occur

26
Q

Give examples of braided resorbable sutures

A

Vicryl (polyglactin)
vicryl rapide

27
Q

Give an example of a braided non resorbable suture

A

silk

28
Q

Give examples of monofilament non- resorbable sutures

A
  • nylon
  • prolene
29
Q

What must be achieved before repositioning of the flap ?

A

Bony haemostasis

(area must also be thoroughly irrigated and debrided)

30
Q

What structure can be used as a guide to replace the flap to its original position?

A

interdental papillae

31
Q

Give examples of flaps that are placed in new positions

not the original position of the flap

A
  • buccal advancement flap
  • apically repositioned flap
32
Q

What are the aims of a suture?

A
  • approximate wound edges to maximise healing by primary retention
  • to cover bone as much as possible, preventing bony necrosis
  • hold the flap in the desired position
  • to aid soft tissue haemostasis
33
Q

Monofilament sutures required more ______ to ensure a firm knot

A

ties

34
Q

What instances can silk sutures be used ?

A

where the wound needs to be very firmly held together e.g. Oro-antral communications

35
Q

The more zeros in the number, the _______ the suture strand

A

smaller

Smaller in diameter

36
Q

00000 is referred to as …

A

5-0

(a 5-0 is a smaller suture strand than a 3-0)

37
Q

The higher the gauge (smaller the diameter), the lower the …

A

tensile strength

38
Q

How do you minimise excess tissue reaction when choosing suture diameter?

A

you should choose the smallest diameter suture with sufficient strength for the task

39
Q

Where is the sharp edge of a conventional cutting needle located ? What is the advantage of this?

A

on the inner curve of the needle

it is easier to pass through tissue (although there is an increased risk of tearing)

40
Q

Where is the sharp edge of the reverse cutting needle located?

A

sharp edge is located on the outer curve of the needle; directed away from the wound edge

it reduces the risk of the suture pulling through the tissue

41
Q

Where should the first suture always be placed? Why is this?

A
  • it should always be placed at the most anterior papilla of the flap
  • or the middle papilla if it is an envelope flap

It ensures that the rest of the flap lies correctlt

42
Q

How should the needle always enter the tissue?

A

at a right angle

43
Q

How long should intra-oral sutures be left in for?

A

5-7 days

44
Q

Briefly describe how you would remove a suture

A
  • pick up thhe knot of the suture using tweezers (in doing this, the part of the suture that has been within the mucosa and therefore “clean” is exposed)
  • cut the suture at the “clean” point using sharp scissors and pull the suture free
    (this technique prevent dragging the dirty part of the suture through the wound)

https://www.youtube.com/watch?v=OXuhMZ-4M1I

Minor Oral Surgery (36 decks)

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