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    © All Rights Reserved
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    16 views52 pages

    Chapter 16. Oral Surgery 3

    Uploaded by

    Mehak Khalid

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 52
    ona SS SAMSONPLAB ACADEMY 44.20 0 to enone. Th Gt tS a Me Pl +44 0794 0433 068 / 07436582971 QUESTIONS BANK LECTURE NOTES REPORTS MANAGER ADMINISTRATION SIGN OUT Resource view crc ceaton Ths we non ot ae Stone inh dete noi mice Asepsis: 's avoidance of pathogenic organisms. Antisepsis + fig an appliation of. nt when ins the grentn of mero-organiams. 9, seruboin Proparailh sf opersive foe iv eee a Antiseptic + Inhibits growth by inhibiting their actly or destruction + Usual bacteriostatic + Usect on Iving tissue &glodophor most etective antiseptic Disinfection + Is nhibtlon er destruction oF pathogens Disinfectant + Reauces growth by kling or inactivating but does not cause destruction of spore or viruses + Use on non-ital objects, hence mare harsh and stronger ag. gluta aldehyde 2% fore ‘te sen spae tenes sue + Can be usec on matal instruments, rubber, plas, porcelain + Hypochtote @ rapid acon (2 inves) 1 ar of 8% wih 9 parts of water but is righ Sterilisation + le the destueton or removal of al forms of ie 128° for 45 minutes or 124° for 2 minutes + 1s the rat and only choie for resteri¢able equipment Forceps Inporan to recsgnie ne ert fens Maxillary extraction forceps Inga ens te nanle and beak ae at 10° tach otter ie. na Maxillary anterior forceps + Thay have identical beaks that ae closed staght, fat and broad | + Used for upper incisors and canine + Movement @ rotational Maxillary premolar (bicuspid) forceps + They have identical beaks that are concave onthe side facing the operator + Beaks are bros and open + Movement limited buccal and palatal Maxillary Molars + The beaks ofthese forceps are not identical. Once beak ls founded and otter Is pointed ~ Tes peels evga ste tration berayaten ees sores bea oat + Movernent @ buccal Mandibular extraction forceps «Thay ate designed such hat tha handles an beaks are a ight angle to each cher Mandibular anterior forceps + They have identical broad, shor, closed boaks + Used for nego and canine in mandible + Movement @ buccal Mandibular premolar (bicuspid) forceps «= Have idencal broad open beaks that are long than baak of anterior forceps + Movement @ rotational Mandibular molar forceps + They are identical, broad, open beaks witha pointed tp + Movernent @ buccal Universal forceps + Ave stralght bladed, can be used in any of four quadrants Eagle beak + eer ype ang owes mpi wen engage the nteaton of mol ae lowing @ ‘Cowhorn Forceps + They are designed to penetate the molar bturcation + Use ina figure of eight movements lone has a single paint top an atner bits + Mata counoms have u-denical be Baas + Mandibular cowhoms @ they have iemtca, open, pointed beak Elevators + Curved chiseled shaped instruments that fi the curvature of tooth rents tha ingle beds ‘Couplands [A sraight blade in ine withthe handle, avalable in thes sizes Ww Warwick James ‘A smal blade that s rounded at stp rater than pointed + Also called Hockey stick of London Hospital elevator Work principle of elevation 4. Lever principle @ most commen used 2. Wedge principle 3. Wheel and axle principle Cryers Elevator ‘A tiangular lade at ght angles to handle Luxators ‘Similar to alavators but tne blade Ipel No 15 blade le the usual Extraction + NICE guidelines currerty state that patents at rak of bacterial endocaris, do not require nibctie [Nationa Insite of heath and Care Excelence} Positioning of patient For maxillary ‘the patent moutn must be athe same height asthe dentst elbow and angle between dental chair and herizonta (eer) must be approximately 120% The patent isn supine postion For mandibular ® the chair is postioned loner, so than the angle between the chair and horizontal (oor is 110°. The patient isin siting postion. Sutures ‘Types of needles + Round ots, tng or eure citing + Stag, curved shaped + For alintra.oal work, 18 22 mm curved eutng oF reverse cuting ‘Suture materials Resorbable used for deep tissues) Non-resorbable (used for shin) Vrery Nylon Monefiament raicea © shin @ ayn, prone, novell © Mucona and dcp tissues © absorb esrb © Vessels @ rescrbatle © Ora cavity 0,40 Suture Strength ‘A Othctest {0 or 310 intraoral use G10 henest or merorascuar use Types of stitch © Simple teased © Herzen mates © Vera! mats © Conus sueueuar © erence number of knot tension ‘Suture Remoral © vcd dragging suture cing removal to avid tact cragoing long © catgut is no more used In UK es ck of Bovine sponser encephalpaty Complications of extraction 1c pn gt ig nn ty = ajay 4. Frac often Fis accepablo to ave mandibular second premolar > manny Later Incitors . r Impacted tooth: an mpaciod tooth swhon is etely covered by sof tissue and partly or ‘Completely covered by bone wn te bony aos Party erupted: wren th ha ale out ne norma unctona poston Indication for removal of third molar © Percornts (ee than ne epee) © Unrest canes © Nentooiabis publ petapicapatioboay © cotuts!asoasses!ostomeits © esompbon of eth oacacent tea © Face of ot © Disease of fle, incng eysttumaur “Toot mpending suger or reconstcvejam sugeny “Toot ives in tumour or fl of tour “Tho crowding is eta ndaton fo removal ftir molar Assessment for extraction © wanes © Weta ine @ passes trough occlusal surac of and 2 melr, extending posta, indented aerance m our lve! © | A@ amber ne @ represents bone levels, passes ugh cesta sptum and extends Ata © R.redine @ imagnary pat of appeain of lotr indested amu of bane need to be Tomoved.y daving a perp fem arb Ino. © long of edi is moe than Sr extracton i fil Redline © Assses anavaton @ dsloanmlor is most cl annabon for ema! of oth Wharf's assesment ‘The six factors chosen for scoring are: + Winters dassfication + Height of the mandible + Angulation of the 2nd molar + Root shape & morphology + Polcle development + Path of Bait ofthe tooth during removal 2nd Molar ‘rd Molar / ‘ Wisdom Tooth Coronal 5 “Easy Middle '/, Moderate : Paint of Aviad Sica NEW) NV pcan Complications of treatment © At complication of sme exracton ana rk mane to gual ox wer aoe are Tsung ated snsiten oftongus or Sn owe ip and chin © Taso sensation may bo impaired © Itean be temporary, which recovered in 46 6 months (nelence Ot 28%) or eranentnedence 0 2%) © ticouel couse reduced sensation (hypastesa), abnormal sensation (praestesia) ndunpleasant sensation «sel © Formaciary @ rk of facie of maxary Mberosy, alt bone Facts Coronectomy An aerate to conentona urgcal methnd of renova Indications © 1008 ot ower 8 ae n cose aperoxiaon o ore dont cana Radiographic signs of increased risk of nerve damage © Procmty tans canal © Narrowing or ers of ear (© Deteton of et, raoning of ot, dak andi apex, double POL menbrane © Darening of ot srusing white ies of cana © torupton a amine cia © Traine appearance Procedures Teansctn of tooth 3-4 mm below CE, pub il ueatad Contraindications © monic tecn © Predisposition to lc intacon © Medical compromised © Nona rd motor Maxillary antrum TER EG Be © They ar pesto fur pared paranasa a snusos © Lyng ineach tat of maxi betneenaeDUs, Ineo, nasal cavty edly and ots ‘supanoay 1s pyramial i shape Smid Santa” ng of mary sme © Distance foo of sins and com apices of maxlary loth s128em © Root of socond molar closest 24 molar» 1% moar» 3 molar > 24 promolar > 1° premolar ‘The dstance botwoen sinus floor nd ret p was lonast forthe fst reel root Hp and store! forthe second mel Surcodstal ot or bth nat anal sae Aetiology © 198 como of evel lod colmna ptslam kh mas suing Gb © Lamina poprinis composed of ose connectives, mucous, seromucos, srs lands. Chronic Maxillary sinusitis Causes © Potion © stotog © Nasa sires © Dscamion an pressure to ita oi! aea © Post nasal asehage Beep) Radiological © Thickonng of mucous ining he antun usualy oepiomerta) © Orturey sop ickning is seen Histopathology © Dense nate oF imphocytes, plasma cls ant macrophages © Eosnops oe often preset, especialy in aagie dsonders ‘Treatment © No westment may be nacesary © Drainage is gol of toatent & operated & window tr dainage by Caldwell ue Acute Sinusitis Causes © Occurs assocatod wih cot orinlance, user respon taco infecbon Signs and symptoms © Tecmacne pe pan, tunes nase dscnawe © Terdomess of postr tat on alte side © Walaiso © Lyonasencpsty Radiologi © itd tve on ray © Hallairis plod, antrum appears cpoave Histopathology © Accuruiaion of rftarematery exdats an neuropil osiophis ‘Treatment © bie stam alton. © smn or Goxyycine st cose of amis © Oecongestnts Oral antral fistul © Patologia ope ret between mouth and malian Diagnosis © Post xtaxton rex of fds to rose oF minor nose Besa © Ar babble evident in sockot © Ar passing in epost dracon i pant ams to bw to nos ‘Treatment |_Chsur tdiagnsad at ve of exracon o> 2 days of suture by bucalavancerant tp, Preset antbitcs and decongestants. Adwce net to How hose, Reve ar 6 Wook is Io closure afer 8 wosks it shoul be sunicaly dosed witha boca fap, tho opal tet ut be ramoved pala sion Rt fy Aciy) Buca savanna fapener ean) Warfarin Note © __ Patents on waren, thir NR ntrnatonal nomad at) should ba checked, the test shod be conducted at ss than 72 ours ofthe panned extacten apoents © Extraction can be cared forward INR ss than & © INR an nomal nual ist © INR-=(Pretrombin paten!Pratrambin nome) ‘© Patents on waren cay @ yeow book cle al enenapuans meapy record book {© _Wararin should not be dlacontinued anak of thromboemballam afer temporary vwithraval outweighs ik of ral bleeding fllowing dental surgery © Drug interaction @ metonidarole enphvomycin, bupofen, spin, defense, se contateeatea wi ose ef warfarin A enngals ae fconazae and Mcenezae aswel © Pareetamal if anasi is reaited The us of hysrocodsine conseod as a second ino os pan valet Bisphosphonate Note © _Ssphosphonao aro drugs at educs bone resorption by hndor tho fomaton, rscratmant and nebo oesoncts © However, ney do accumu at sles ah Bone move uC 5 Low risk © ators bout stat bisphosphorate therapy for any conden © Paton stating bsphosphonao to provet or mana teas) stgporsts (witout ghor sk ‘Treatment © Peron eration oral super rsd hat may impact on bane in primary are as ‘@avaurateay® as possible, avo asin fap, achieve good haomostu “© Review heating at 4 week anor conying ou any mvs Heat © super ses tao neal wtin 4 6 weeks retort al Sugoon specs Higher risk © Prowous aognoss of BON! © Onbisphaspheate to manage a migrant cindion © Non-atignant systomic conaton Panels dsease) © Rare conation ihe osteogenesis inpertecta © Patent on systemic caticoserad ot ther nmunossppressat@e © Coagucpaty,chomomerary or adonerary Treatme © eck atuce tem eal suigeon specs wheter to West m primary creer any exrscton, a sarge orl Condition that may be treated by bisphosphonates © Nensmaignar @ ostopeross, Paget@s estoganessimpofeca frou dysplasia, primary Inpamoxis, cfc tov. © Maignant utes nylons, breast cancer, prota cance, ban mata sen, hyperucoms? cf msienancy. {© _The incidene of bisphosphonate cetcnscrsis of 644 1,080 f0 <1 in 60000 person per year (GUIDELINES rps wwedn ng 29=2087 Dentofacial infections Actinomycosis © Low grate mecton © Mute sinuses i soanst taatie © couse by Actinomyces israett Histopathology © tis characterised by presence of masses fflansntcusanacrotic baci, more ray ‘ostngsted by gram tg © The masses maybe partly cated © Seen a yellow granule euphay © eossen are acts infants elle Management © Diana ant amoxietin s90n9 TOS Cellulitis © rosacea osama © Soren nection of conte tissue cause by steptocoecal organsins Clinical features © Pain, tse, browns sling sen, nes, shiny © Airway maybe compromised ‘Treatment Ludwig®s Angin © | Coniston of abscss and caluitsafoctn subrandeulr and susingua space ‘ateray © Fim, ard swotng, tone i sod © Rees thor of oun and nave spusnad Back © Airway censco,sootog Sava ‘Treatment © Antics, v,ncaton, may eure wacnestony Straphylococcal Lymphadenitis © Soon especialy chieten © mncs sapped face ‘Treatment © Drainage ani Fhcoxaciin Atypical mycobacteria @ Lymphadonits wit no cause © Coto 0055, ron te patent Treatment © Chrtrorcin is most used for omental aii: Cryosurgery Definition © sa morapeutc uso of nem co © Eaupment @ attous oxi or Iquinitopen © Coolants notin det contact of tssue Mechanisms, © Col dat, alowed by necrosis by calla ssn, detain, eye inhtiton and ‘wat denateaton| Indications essa atinmation Hocmangioma Nonaignnt leuko. oe 2 8 © © Patt peta © Mococctes © nvaceabe fc! pon Lasers Definition ant ampitaten by stmdted enissn of adaton © Conse of crmapnate waves wile ght 400 @ 700%) © The curcenstes a ase oe determin by ate mada hate ae 2 rope Hard Laser Soft Laser Less pain and searring gberms KTP laser Eg. helium, neon, neodymlurn VAG Definition igs sample of sue ak om spat for nistpstnciogelexaminsion -rogrosontatve same of ge losan sake fer deans nro eatnent 4 of intsonal biog) te nea sopra punch Bopsy. tus ca nese Nopey © Used for goneralsed mucosal sores sch a hens planus red and whe paces, non ‘aing leer port fo clade margin of ere wth sme normal tissue Excisional biopsy etintion: ‘The ene lesions removed and sma for agnosie © Suiabiofor benan eos, porters, mucocoes,epuides © 4 eons n 1 mucosa and most whee aches sreu be Hops © Any norsneating ues or more an 3 week sto te refeed ue or psy © Usual preseetne's 1% tomaine © ech biopsy sample are requed fr veseulbullous disease where immuncluerescence ‘eroded Classification Lefort / Guerin fracture (© Ths fracture detaches the tot basting postin ofthe jaw via fracture ine fom snr ‘margin o he ner nasa aperture running ieee and bck oe loner 19 of enya pate @ | tisals cal ow vel or subzygeratc recur, Aso descrbod as ang fac ns Searatn cone dover pa mata an acto ob had yes Diagnosis: Upper nis motile © Bocca sles beng bintraly © Djstuted occsion and poster gaoaing of be © Blatea opstans © Semstimos upward spacoment of entre fenment sich is descited impactor lesconic © Classical attr epen bit © Parcssion ef manta tach proauce dul eracked cups sound © Guwrings sion 6 by echymoss in oxon of rater plate vss Lefort IW’ pyramidal fracture (© Detaenes he te i cen a pyran nape © occurs n conta ren of mits thio ail sklton and possos tough brie f rose ana ochwatds Helou sypomate bane © _ Step detomity ac nasal Benes ao tpcaly to mobile along wih es of yam segrans Diagnosis: ‘oss ootoma of mid thi of face frown as Ballooning or Moan Face (© Bloeal crcam-otal edema ad wectymocs lack se) ° Blea subconuentonalbasmortags © Flat ace (depressed nasal bridge) © tt ngaciono ramen aps he cai base, en eres shoring foe nd anterit open be © ross sownvard ant nacivald dspacomont of Yagmet tov is eongaton or entening oe ah porter gagging on antes epen be (ah shaped face) © CSF ak © Pupticilisatered © etrarttal nerve paraesthesia Lefort Ill/ high level fracture/ transverse fracture © The entiestakton detached fom rani base Diagnosis © Pants ace © Racoon oe tera ota cenyes) © Bloea sub compacta smornoge © Dish face (characteiti © Eps, diplopia, mparoment of vsion © Fatorng of nasal bone © CSF tinonhosa (CSF leak) © Pocuar to Loto i re tenteross and sapetaton of rntozyomai suite, detormiy of Zagora ates basal Diagnosis: ea Leto | ©: OM, 30: true ater Left 0M, 30-, ateral skull (brow. Left | 0M, 90-M, rue ater sku, CT Management of midtacal fractures Lert: Facto @ INF fison by 2ygometic arch suspension, necessary adstena suspension at Prom apts etre Zigomatc ach suspension o font bone suspension Left etaosseous wing st 2ygomstcofental sures and biatal tenner suspansion ate ‘spptcabon of arch ats Define Enophthalmos “dowrmard sinking ef eye, sequel to face mobing zygomatic congioe Clinical features © Accenmaten oF upper avoid Reosna © Pater projection e late Diplopia: ‘Blur double vison, seve to zygomatic cael Face Zygomatic fracture (malar) © commen race Clinical presentation (© tering of sted cheek © Urata © Creumeria ccyrass © subconfunctval haemorrhage (unatera © Depression of cel ve © Pros, done (© Aresheso chock, nso and tp © ste deomey © ropa © Ecxyosisn uper Buca sus ‘Management |@ Gilles approach bone hook supers wth ital ator Radiograph 00M, 3001, submentovertox (S41) Orbital fracture © socalled eri ow out rate © Clasical xray Gnenging deop sign, otctusn at hang fom anu Diagnosis: ‘Confmed by coronal CT ‘Signs and symptoms. Satorto malar Hace. Late sign ate enoptnaas an dplpla ‘Management © Sura exploration of ital Foor and reconstruction fob oor by Bone a, bon ‘pp or rtoon gauze ‘Radiograph. 00M, tue ara PA 258, CT Nasal fracture © Devaton at septa © Nasa tari cr depressed beige © Epstons © Nesa ostcton © Loss of smal snsaten © CSF mnonoea maybe present Radiographic view Lateral view, 15 or 900 octamer preectons Management: Manpdaton of nasal one wn thumb an sping Nasoethmoidal fracture Consists of nasal bane, onal process of mad, latina bore, eri plate o moi and “ssfacomeat clad canus of ye @ _Bitra back eye © Nasa etry, cepression of nasal ioe © Sept devison © epstoes © csF beak Management: ‘Open reduction Fractures In children Pent ean <10 yrs requ «frm f gunning pln (or ined dentin) tres cient alos green atc ature Somaications © Postoperative detoriy © Epihora draning ves) © Dptp © Late Eophatnos © Aoosma © Maunen Malar © Diep © Retour nesmorage © Enoptnainos © Parestosia © Detormty © Nasal stun Mandibular fractures “© Glasstcaon cout betas on se of uy © _Condyarracture are mest common, cen fund win facture st ena er canine region ot opposte sto 4 biota conor toca sound wth a symphysea! Hocus (© Guardians tractre occurs rom fling on hep of hin © Aral facture ons eemmeniy tough hed mela sock Diagnosis © cecton ss © Ung mucosa nant (et pt) © Leeson © Gagang on posterior teeth Hanging mou © Boot stanes saa © Parzestesia in dsturbance o ON © Sep dotoamty © Tens Radiograph © Rotated PA (nel fr facts beeen smphsis ad canna gon) © DPTand pettanea! te essentat © Conia race @ ir tl peeapcal,occsal DFT, everse towns Management ‘Complication Mandible © ection © Parasia © Damage oteth © mipan © Bony soqvesaton © Plato ant wo nection Edentulous Mandible © Gunning splints (cic denies) © Resorbod edentulous manabls managod by ick (2 Ane pals with Bicol screws. Fracture Ste ‘Commonly used radiographs ‘ae eee, amon Sgrgmn tema rb ntoalveolar surgery ‘nevable broken erent in canal Post cow on tot wih ep patty ct persica Fractured and inc pia 1391 ors infecton de to apical cyst tor osion “The apical 2mm exis and cst or arnt suo fs cuted ‘Seale wit TA Loner ines present onan aezess prota eased by elon incon ‘Rect nemsecton usualy performed fr ietivebe broken nstument ‘emo of extruded part (endesotic) nasal feor_aproaced by subabiay er nba ‘Anim cave ue appa 1D cana bocca cones f Rendle ly, oe ee ee © eo oe TMJ disorder Tmeps Most commen dere, 40% of population, F> cr Headete Luton! devon fio nt sounes Pain on palpation of TAY and associated muscles Sof tana jaw rest Ho fermentation ‘Analgesics and enintanmatory Mout quod SOFT SPLINT Muscle reson © Relove symptoms m 80% of patents © symptoms do no imgxove in 3 months, cecusladusnet, suger rte {Internal derangement © Aeros csplocements most conmon cerngement Diseisplecement with recuction © Clckng on opening ad sing (© _Transent jw deviation aunng opting and claing | No epparent atnormalty on plan raoarach © Reassurance © Prysiterany © couse spins ‘Disc displacement without reduction © so etucton, dsc romans in siaced postion roparess of ooning oe © Reduction in apeing © Unio! cases lasing devaton en opning © Nock © Pani tonto ear Radiology © Pain Sins showing nating © Discinagng @ stnarmal disc posten pera of asco adesins Management © Reassurance © Priory © Manipulation and Ta surgery uenscosy 5 smal procedures rated fx nema detengenen. Vous cas scat ree cara 9 al nas " Ankylosis “True Ankylosis © Patologeal act condiion © Lita jot movement © Rbrous aon @ R, exarien © Fbony anion @ R, errotonal atopy. or condectomy False Ankylosis © © Exaricaarpatooay © Ry depends upon cause © Causes stoke, psynogent, thous adhesin €9, post rune and nection unas Condylar Hyperplasia © Rave © nigh condecemy ace or wa bua Men deve suey Facial space infection axa teeth ‘SIF of intraoral space © Swotng of eck and sro © Obie of Neon ld © drooping of angle of mouth © Dodane of over ea Palatal abscess “© From pasta ros of poster tea at ocasonly ral marons © Fucuant swans seen Manabe teeth ‘Buccal space involvement “Pott space betwcenbucciators and masseter muscle (© Toot mone are maxilry and mandbuiar promolas arias rE: © eum baie invosibus © Excl swing tom ower border of mani nor meron ‘nfratemporal space infection © Sung ot tempecais muscle © Marked swoling of aceon acd sie mn Roto ear © Eyes olen cose and propos Potential primary space related to lower jaw ‘A. Submentl space © wsuay angina fom six ater mensbuer teeth or © Extra sine fe swoting in midine banesth chin © Overyng skins toa ho and wut Fluctuation may be present © noo! 6 patent may experience dscontt en swallowing Submandibuar space @ mosty involves by mendbuls molar or infected submandibul

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