minor oral surgical procedures -stoma 2014, lecture by dr arun george

Minor oral surgeries…

Dr Arun George MDSMaxillofacial Surgeon India

Like every proffessional man I am very much indebted to my seniors and colleagues who taught me the practice of oral and maxillofacial surgery…..

Pre Surgical Care…………

Stress Reduction Morning Apointment Pre Medication Vocal, Music, Aroma Eye contact on communication Deep Breathing Pain less local anaesthesia Hypnosis

So that you guys don’t end up like this !!!

“Minor oral Surgery

is defined as a surgical procedures which can be comfortably completed by a dentist in not more than 30 minutes”

over view of Minor oral Surgeries

Endodontic Surgeries Surgery & Maxillary Sinus Biopsy Incision & Drainage Preprosthetic Complicated Exodontia Recent advances in minor

surgery

Simple things may not be so simple !...

Surgery is a discipline

based on principles

that evolved from both basic

research and centuries of

trial & error

Apicoectomy & Curettage

ENDODONTIC SURGERY YES (OR) NO

THE CONCEPT IS WAIT AND WATCH – NO HURRY IF YOU HAVE A GOOD APICAL SEAL

Indications of Apicoectomy

Apical anomaly Accessory canals Perforations

Broken instruments Periapical granuloma/ Cyst Draining sinus tract/ non responsive to RCT Extension of RC sealent or cement

Indications

Broken instruments

Open Apex

Periapical granuloma/ Cyst

Dilaceration Calcified canal

Extension of RC beyond the apex

Apicoectomy & Curettage

Maxillary Sinus

Maxillary Sinus Acute Fistula

Chronic Fistula

Oro antral Communication

Is an unnatural communication between oral cavity and the maxillary sinus

Nose blowing Clinical diagnosis for OAF Displace cotton wool Never let the oral fluids to go inside

the sinus

Oro antral Communication Management Protocol Newly created or Chronic Less than 2mm go in for a primary

closure 5mm – Closure with reduction of the

socket walls Give acrylic splint If larger – approximation of the wound by

use of flaps for coverage.

Flaps

Buccal Advancement Palatal Combination of Buccal and Palatal Buccal Pad of Fat Tongue Temperomyofascial Flap

Buccal Advancement flap

CHRONIC OAF Antral Wash Antibiotics Decongestant

Spontaneous healing observed for smaller fistulas

Acrylic plate

Palatal Flap

Caldwell- Luc Operation- •George Caldwell - 1893 [Newyork] •Henry Luc – 1897 [Paris]

Indications : Removal of displaced teeth, foreign body from sinus Post traumatic Hemorrhage Chronic Sinusitis Along the closure of OAF associated with chronic sinusitis

Impacted Third molar

Diagnostic and Ablative

Biopsy

Biopsy

Punch Incisional Excisional

Incisional Biopsy

wedge incision

10 % formalin, 10 times volume, 24 hrs time period,

TAKE BIOPSY SPECIMEN ALONG WITH NORMAL TISSUE MARGIN

Excisional Biopsy

Temperomandibular Joint

INTERNAL DERANGMENT Localized disturbance & uncoordinated

movement between the disc and the head of the condyle

Disc displacement with reductionWith out reductionAdhesionsAlterationVarious arthritis

MANAGEMENT Medical (muscle relaxant, anti depressent ) Functional correction of the occlusion Soft Splint Arthrocentesis & lavage ( release of the

adhesion ) Arthroscopic surgery Open joint surgery

DiscectomyMeniscoplasty

1991- Nitzen

Single Puncture Arthrocentesis

Space Infections

Incision & Drainage

Abscess don’t wait for the sun set

. EMPIRICAL ANTIBIOTIC

THERAPY *

CULTURE AND SENSITIVITY * APPROPRIATE ANTIBIOTIC THERAPY

REMOVAL OF THE CAUSE ( teeth if odontogenic ) *

SUPPORTIVE THERAPY * PHYSIOTHERAPY (to improve mouth opening)

Hiltons Method Anesthesia Stab Incision with

11no blade Burst all the locules with sinus

forceps Abscess I & D only fluctuant,

Rubber drain- 24 hrs Ribbon Gauze wth

whiteheads varnish i/o

High frenal Attachment

High frenal Attachment- Complications

Denture displacement

Mid line Diastema Orthodontic

relapse

Laser Frenectomy Z- plasty- for broad frenum and

short vestibule

Cross Diamond Excision- For excess tissue

V-Y type of incision – For lengthening

“Tongue Tie”

Early Vs Delayed surgery

Z Plasty - Frenoplasty

Impacted Canines….

Impacted canines Position assessment – Tube shift

technique (Clark’s rule)- SLOB Field & Ackerman classification (1935)

Labial positionPalatal position Intermediate positionUnusual position

Cone Beam CT

Canine Impaction Palatal

Surgery Before Prosthodontics

Soft tissue Hard Tissue

Treatment Plan ?????Pre prosthetic????

Spacing

Periodontally Compromised

Low socio economic status

Not willing for Orthodontic & Orthognathic

Deans Alveoloplasty/ Intraseptal

Technique is to correct gross maxillary overjet

Severe Dentoalveolar proclination Spacing

Intraseptal Alveoloplasty with Repositioning of the Labial Cortical

Plate

Post op After 7 days

Deans Alveoloplasty

Pre Op Post treatment

Congenitally Missing Central Incisor

De cortication

Denture-induced fibrous inflammatory hyperplasia

Benign hyperplasia of fibrous connective tissue which develops as a reactive lesion to chronic mechanical irritation produced by the flange of a poorly fitting denture.

Benign hyperplasia of fibrous connective tissue

Corticotomy- Assisted orthodontics

Cortical Cuts weakens the bony resistance, Allowing the orthopedic movement of dentoalveolar segments there by improving the facial profile and lip competence

Surgical Aids to Orthodontics

1891

Kole called it enblock tooth movement

Corticotomy-facilitated orthodontic treatment was 66% more rapid than without surgery

Shortens the FOT Prevents relapse Indicated in young adults Gives good result in

periodontally compromised patients

corticotomycorticotomy

corticotomycorticotomy

. Bony cuts 2mm depth till reaching the cancellous bone, After a period of 3 weeks corticotomy on the labial side, Relapse is less with corticotomy

Abnormally Huge Sialolith

Trans Oral Sialolithotomy

Grow @ 1mm a year

“A good surgeon knows how to do surgery and an excellent surgeon knows when to do it”

Recent Advances in Minor Oral Surgery

Simple things may not be so simple !...

Definition•A PROCESS OF NEW BONE FORMATION

BETWEEN THE SURFACES OF BONE SEGMENTS GRADUALLY SEPARATED BY INCREMENTAL TRACTION.

Distraction

1992, McCarthy

1951- Ilizarov

Chin & Toth (1996): Kisnisci et al and Iseri et al (2002)

Orthodontic tooth movement rate= 1mm a month

Dentoalveolar Distraction movement rate= 1mm a day

Orthodontic movement Vs Distraction

Buccal cortex removed with extracted premolar

After 10 days

After 30 days

Surgical Tooth Retraction

Vertical Alveolar Distraction

Vertical Alveolar Distraction

For any queries

drarun1g@gmail.com

The Dental Horizon , Muvattupuzha, Kerala, India

http://www.facebook.com/groups/craniofacial1/