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Oral Surgery > Surgical Techniques > Flashcards

Surgical Techniques Flashcards

1
Q

what are the basic principles of minor oral surgery

A
  • Risk assessment (good planning, medical history, considering anatomical structures)
  • aseptic technique
  • minimal trauma to hard and soft tissues
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2
Q

What are the stages of surgery

A
  1. Consent
  2. Surgical pause/ safety checklist
  3. Anaesthesia
  4. Access
  5. Bone removal as necessary
  6. Tooth division as necessary
  7. Debridement/wound management
  8. suture
  9. Achieve haemostats
  10. Post-operative instructions
  11. Post-operative medication
  12. Follow up
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3
Q

What are the two important points of the surgical technique

A
  1. Administering local anaesthetic - it is important that site you’re operating on has adequate anaesthesia
  2. Lift a mucoperiosteal flap to give surgical access
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4
Q

What are the aims when lifting a flat

A
  • maximal access with minimal trauma
  • preserve adjacent soft tissues
  • consider post operative aesthetics
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5
Q

what is a mucoperiosteal surgical flap?

A
  • when the periosteum between the bone and mucosa is raised along with the mucosa when creating a flap
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6
Q

What are the aims of surgical access

A
  • wide-based incision
  • use scalpel in one firm continuous stroke
  • no sharp angles
  • adequate flap size
  • flap reflection should be done cleanly
  • minimise trauma to the dental papillae
  • no crushing
  • keep tissues moist
  • ensure that flap margins and sutures will lie on sound bone
  • make sure wounds are not closed under tension
  • aim for healing by primary intention to minimise trauma
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7
Q

what are two flap designs

A
  • 3 sided flap

- envelope flap

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8
Q

describe a 3 sided flap for wisdom tooth removal

A
  • distal relieving incision
  • crevicular incision around the tooth
  • medial relieving incision between 7 and 8
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9
Q

what is important to remember when making a flap for removal of a wisdom tooth

A

do not make the distal incision too lingual as it risks damage to the lingual nerve

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10
Q

describe an envelope flap for wisdom tooth removal

A
  • distal relieving incision

- a crevicular incision that extends to mid way on the 7 or medial end of 7

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11
Q

what do you do once you have incised the flap?

A

retract the tissues

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12
Q

what are the aims when retracting soft tissues

A
  • aim to access the operative field
  • protect soft tissues
  • ensure flap design facilitates retraction
  • retract using a howarth’s periosteal elevator or rake retractor
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13
Q

how do you remove bone/ divide teeth or roots

A
  • using an electrical straight handpiece with a saline or sterile water cooled bur
  • use round or fissure tungsten carbide burs
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14
Q

what can happen if you use an air driven handpiece to remove bone

A

can lead to surgical emphysema (air or gas in subcutaneous tissues)

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15
Q

what are the uses of elevators

A
  • provide a point of application for forceps
  • extract a tooth without the use of forceps
  • remove retained roots
  • loosen teeth prior to forceps
  • removal of multiple root stumps
  • removal of root apices
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16
Q

What is involved in wound management

A
  • debridement and curettage

- suturing

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17
Q

describe the stages of debridement and curettage

A
  • physical: using a bone file or handpiece to remove sharp bony edges. Use a mitchell’s trimmer of victoria curette to remove soft tissue debris
  • Irrigation: sterile saline into the socket and under the flap
  • Suction: aspirate under the flap to remove debris
  • check socket for retained root apices
18
Q

what do we do when suturing

A
  • approximate tissues

- compress blood vessels

19
Q

what are the aims of suturing

A
  • reposition tissues
  • cover bone
  • prevent wound breakdown
  • achieve haemostats
  • encourage healing by primary intention
20
Q

Define the ways that sutures can be categorised

A
  • non absorbable
  • absorbable
  • monofilament
  • polyfilament
21
Q

Describe non absorbable sutures and give examples

A
  • sutures which must be removed postoperatively
  • used if extended retention periods are required (closure of OAF)
  • Examples are Mersilk, praline and ethilon
22
Q

Describe absorbable sutures and give examples

A
  • used if the removal of a suture is not possible or desired
  • holds the tissues together temporarily
  • examples are Vicryl and velosorb
23
Q

how do absorbable sutures breakdown

A

Vicryl breakdown via absorption of water into the filaments which causes the polymer to degrade

24
Q

Describe a monofilament and give examples

A
  • single strand
  • pass easily through tissue
  • resistant to bacterial colonisation
  • proline and ethilon
25
Q

Describe a polyfilament suture and give examples

A
  • several filaments twisted together
  • easy to handle
  • can cause wicking (oral fluids and bacteria move along the length of the suture and can result in infection)
  • Vicryl, velosorb and mersilk
26
Q

where would you place sutures on a 3 sided flap

A
  • 1 suture distal, and 2 sutures buccally
27
Q

where would you place sutures on a envelope flap

A
  • 1 suture distal to 8 and 1 suture distal to 7
28
Q

How do you control haemostasis perioperatively

A
  • use La with a vasoconstrictor
  • Artery forceps
  • Diathermy
  • Bone wax
29
Q

how do you control haemostasis post-operatively

A
  • use pressure
  • La infiltration
  • Diathermy
  • Sutures
30
Q

when removing third molars, what 4 nerves can be damaged

A
  • lingual
  • inferior alveolar
  • mylohyoid
  • buccal
31
Q

When is the lingual nerve at risk and why

A
  • it is above lingual palate in many patients

at risk when

  • incision of flap
  • raising buccal and lingual flaps
  • retraction of flap
  • bone removal
  • extraction with forceps
32
Q

what are the potential complications of lower third molar removal

A
  • pain
  • swelling
  • bruising
  • bleeding
  • trismus
  • infection
  • dry socket
  • paraesthesia
33
Q

why do teeth fracture during surgery?

A
  • thick cortical bone
  • root shape
  • root number
  • hypercementosis
  • ankylosis
  • caries
  • alignment
  • poor technique
34
Q

what should you warn the patient about prior to oral surgery

A
  • explain the procedure
  • explain any expected complications
  • give the patient an idea of what to expect in lay terms
  • if adjacent teeth are close then warn of possible damage
  • explain post operative complications
35
Q

what are the general surgical principles

A
  • maximal access with minimal trauma
  • bigger flaps heal just as quickly as smaller flaps
  • wide-based incision
  • used scalpel in one firm continuous stroke
  • no sharp angles
  • adequate flap size
  • minimize trauma to the dental papillae
  • flap reflection should be down to bone and done cleanly (mucoperiosteal flap)
  • no crushing
  • tissues kept moist
  • ensure that flap margins and sutures will lie on sound bone
  • make sure wounds are not closed under tension
  • aim for healing by primary intention to minimise scarring
36
Q

Describe the flap technique of extracting a 45 with a fractured crown (root only)

A
  • create a 2 sided flap with a crevicular incision extending from the medial of the 44 (first premolar) to the distal of the 45
  • Create a distal relieving incision beginning at the medial of the 6
  • Ensure the distal relieving incision extends beyond the junction of the attached and unattached mucosa (not enough access in unattached)
37
Q

describe the bone removal needed when extracting a 45 with a fractured crown

A
  • easiest area of bone to remove is buccally
  • create a gutter between the buccal cortex of bone and the buccal surface of the root, being careful not to drill into the root
38
Q

describe the suturing required when extracting a 45 with a fractured root

A
  • would likely need 3 sutures
  • first suture at the distal papillae
  • second suture at the medial papillae
  • third suture at the distal relieving incision site
39
Q

Describe the flap design for extraction of a lower 6 with a broken crown

A
  • a one sided flap with a long crevicular incision extending from the medial of the 4 to the distal of the 7
40
Q

What are the benefits of a long crevicular incision when removing a lower 6

A
  • less swelling and bruising as a one sided crevicular incision does not extend into the attached gingivae which is more vascular and thus would result in more bleeding
  • less likely to damage a nerve as there is no distal relieving incision which may come into contact with a nerve
41
Q

describe the bone removal needed when extracting a 46 with a fractured crown

A
  • drill buccal bone so that you can see the furcation of the roots
  • separate the two roots to create an application point for elevator
  • elevate the roots separately
42
Q

describe the suturing required when extracting a 46 with a fractured root

A
  • suture at mesial papillae of 6
  • suture at distal papillae of 6
  • suture at papillae between the 4 and 5

Oral Surgery (4 decks)

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