basic principles
TRANSCRIPT
Basic Principles Of Oral SurgeryCO-ORDINATED TO:DR.SIMAR
PRESENTED BY:HARKIRAT KAUR INTERNMAY-JUNE BATCH
ARMAMENTARIUM FOR BASIC ORAL SURGICAL PROCEDURE
1) FOR PICKING UP STERILE INSTRUMENTS AND PREPARING THE SURGICAL FIELD
CHEATLE’S FORCEP AND THE SWAB HOLDER
Long angulated instrument, used to pick sterile instruments.
The swab holder is an instrument with long blades and is expanded at the ends forming an oblong tip,, used to hold the swab and clean the area of operation.
2) FOR HOLDING THE DRAPES TOWEL CLIPS
Types and Uses:Pinchter typeForceps type (Beckhaus towel clip)
Sharp points penetrate drapes, and locking handles maintain it in position.
USES:To hold tongue.For stabilisation of the suction tubes, motor
cables to the drapes
CHEATLE FORCEPS
A) CHEATLE FORCEPS B) SWAB HOLDER C) PINCHTER TYPE TOWEL CLIP D) BECKHAUS TOWEL CLIP
3) FOR INCISING THE TISSUES
SCALPEL
It has 2 parts: Bard parker blade handle and the blades
Sizes: No.3 (most commonly used)
Blades: No.10- for making skin incisions. No.11- for making stab incisions. No.12- for mucogingival procedures. No.15- for intraoral surgery.
DISSECTING SCISSORS Used to perform soft
tissue dissection in the deeper layers.
4) FOR RETRACTING THE TISSUES Langenbeck’s Retractor: (Commonly used) Used to retract soft tissues, incision
edges, to allow the view of deeper tissues.
Obwegeser’s Ramus Retractor:Used to retract soft tissues along the anterior border of the ramus during saggital split or ramus osteotomy.
A)Langenbecks Retractor, B) and C) Obwegeser’s Ramus
Retractor
5) FOR REFLECTING THE MUCOPERIOSTEAL FLAPPeriosteal
Elevators:Has a pointed end on
one side and a broader end on the other side.
Pointed end is used to release dental papilla in between teeth.
Broad end is used to elevate mucoperiosteal flap from the bone.
Moon`s probe:Used to elevatemucoperiosteum around tooth prior toextraction.
6) FOR HOLDING THE SOFT TISSUESTISSUE HOLDING
FORCEPSAllis’s Tissue Holding
ForcepsUsed to hold delicate tissues like peritoneum,aponeurosis, soft
muscles.Babcock’s Tissue
Holding ForcepsTo hold intestines and
delicate structures like peritoneum, fascia, etc.
Adson Tissue Forceps
Used to gently stabilize soft tissue for suturing.
7) TO DRAIN AN ABSCESS AND TO KEEP THE MOUTH OPENLister’s Sinus
Forceps:Used to dissect out sinus, fistulous tracts in soft
tissues ,open an abscess by
HILTON’SMETHOD to break the loculi
To Keep The Mouth Open:
Mouth prop :-used to open
patient’s mouth when patient is
unable to cooperate such as during
sedation.Mouth gag
( Fergusson’s):-keep the mouth open in a
patientunder GA during surgeries of
the oralcavity, tonsils and pharynx.
8) TO REMOVE PATHOLOGIC TISSUECurette
A) Used to removetooth particles
ordebrisfrom the extractionsite.B) To enucleate
cysts, dental granulomas, intraosseous tumours.C) To remove
infected clot from theextraction site.
9)TO REMOVE OR CUT BONERongeur forceps used to nibble sharp bony marginsfollowing extraction.
To trim sharp bony ridges duringalveloplasty procedures.
Miller Colbourn bonefileUsed to smoothen any sharp bonymargins present in the surgical field.
Bone cutterUsed to trim sharp bony marginsfollowing extractions.
ChiselUsed to remove chips of bone as in transalveolar extractions
and to split tooth in difficult extractions.
OsteotomeUsed in various osteotomy procedures.Biopsy of bony lesions.
MalletUsed for giving controlled taps on chisel,
bone gouge or osteotome.
Bone gougeUsed to remove cancellous graft material during grafting
procedures and to remove irregular pieces of bone.
Handpiece and burs, saws
Used to round off sharp margins after extractions.To perform osteotomy cuts.To release bony ankylosis.
Gigli ‘s wire sawUsed to cut mandible
(hemimandibulectomy)
10) TO SUTURE THE TISSUES
Mayo Hegar Needle Holder
1) Straight instrument with short
working tip.2) Blade is shorter and
strongerthan hemostat.3) Working tip has cross
hatchedserrations with single
verticalserration to grip the needle.4) Handle has a catch.5) Most commonly used is 6-
inch needle holder.
12) TO MAINTAIN A CLEAN SURGICAL FIELD SUCTION APPARATUSMost commonly used is vacuum
pump suction apparatus.Electrically operated with the help
of motor.SUCTION TUBINGConnected to suction apparatus atone end and suction tip on theother end.Made of India rubber or siliconepolymer. Latter is transparent andcan be autoclaved.SUCTION TIP Maintain a clean field by suckingblood, flushing solution,
debris,cysticfluid, pus and secretions.No.4 or no.5 tip is most commonlyused.
13) FOR TREATMENT OF FRACTURES OF THE JAW BONESROWE`S DISIMPACTION FORCEPS Used to disimpact maxilla
in freshLeFoft fractures, malunitedfractures.To check for free
movements ofmaxilla after LeFort
osteotomyprocedure.HAYTON WILLIAM`S
FORCEP Used in conjunction with
Rowe`s disimpaction forceps to mobilize maxilla.
WALSHAM`S FORCEPUsed to manipulate fractured nasal fragments.ASCHE`S FORCEPUsed to reduce fractures of nasal bone and to
align nasal septum.ERICH`S ARCH BARUsed to stabilize dentoalveolar fractures.To stabilize mandibular or maxillary fractures
that are to be treated by closed reduction.To provide means for intermaxillary ligation. WIRE SPOOL 26 gauge wire spool is used. Used to stabilize dentoalveolar fractures. To perform intermaxillary ligation. To splint arch bar to teeth.
14) MISCELLANEOUS INSTRUMENTSBONE
SPREADERUsed to separate
bonyfragments aftercompletion ofosteotomy cuts.
DRAINS USED IN ORAL AND MAXILLOFACIAL SURGERY Drainage is provision of
mechanical means for removal contents of body organs, cavities or tissues.
NEED FOR ESTABLISHING DRAINAGE
Obliteration of dead space.
Removal of material foreign or harmful to body tissues.
To evacuate fluid or urine collection in any body cavity.
FUNCTIONS To allow for pus, fluid
collection, blood to escape from body cavities.
To allow for local introduction of antibiotics, antimicrobials.
INTRA ORAL INCISIONS
1) ENVELOPE FLAP:Given by BP blade no.12
2) TWO SIDED TRIANGILAR FLAP
3) THREE SIDED RHOMBOIDAL FLAP
4) SEMILUNAR FLAP
Given when periapical area is required to be exposed
5) PEDICLE FLAPWhen a flap is based on particular blood vessel, it is called pedicle flap.
SKIN INCISIONSSurgical incision is made along Langer`s lines
thereby minimizing tension while closing wound.
1) Submandibular incisionUsed for surgery of body and angle of mandible
andsubmandibular gland.
2) Preauricular incision
Provides acess to temporomandibular joint.
3) Gillie`s incisionUsed for reduction offractured zygoma4) Brow incisiongive access to
frontozygomatic suture area.
5) Lid incision and infraorbital incision
give access to zygomatico
maxillary suture area and floor of orbit.
SUTURING MATERIALS AND TECHNIQUES
SUTURE It is strand of material used to
ligateblood vessels and to approximate
tissuestogether.SUTURE MATERIALS Requisites for suture materials1. Adequate strength2. Low tissue irritation and
reaction3. Low capillarity4. Good handling and knotting
properties5. Sterilization without
deterioration in properties
CLASSIFICATION
Absorbable sutures
1. Catgut 2. Collagen sutures3. Synthetic polymer
suturesNon-absorbable sutures
4. Nylon 5. Cotton sutures6. Silk sutures7. Stainless steel
sutures8. Dacron
Further divided into:-
1. Monofilamentous2. Multifilamentous
Also classified as:-
3. Natural 4. synthetic
SUTURE NEEDLES(MADE OF STAINLESS STEEL OR CARBON STEEL)COMPONENTS:- EYE:- Can be closed or
swaged BODY:- Needle
grasping area POINT:-Extreme tip of
needle to maximum cross-section of body.
TYPESA) 1. Straight needles 2. curved needles ¼ circle 3/8 circle ½ circle ¾ circleB. 1. Round body
needles 2. Cutting needles 3. Reverse cutting
needles.C. 1. Traumatic needles 2. Atraumatic
needles
PRINCIPLES OF SUTURING Needle should grasped at 1/3rd distance from eye
and 2/3rd from point. Needle should enter tissues perpendicular to tissue surface. Needle should passed through tissues along its
curve. Suture should passed at an equal depth and
distance from incision on both sides. Needle always passes from movable tissue to fixed tissue. Needle always passes through thinner tissue to thicker tissues. Needle always passes from deeper tissue to superficial tissue Tissues must never be closed under tension.
Suture should tied only to approximate tissues, not to blanch.
Knot should never lie on incision line. Sutures should be placed at greater depth
than distance from incision, so as to evert wound margins.
Sutures on skin are usually removed in 5 days and intraoral sutures in 7 days. If there is tension / stress while suturing, sutures may be kept for 10 days.
KNOT TYINGTied using needle holder or
with hand.TYPES:-Square knotFormed by wrapping suture
aroundNeedle holder once in
oppositedirections between the ties.
Surgeon`s knotFormed by 2 throws of
suturearound needle holder on1st tie and 1 throw in
oppositedirection in 2nd tie.
Granny`s knotInvolves a tie in 1 direction followed by a tie in same direction and a 3rd tie in opposite direction to square the knot and hold it permanently. SUTURING TECHNIQUES 1) INTERRUPTED SUTUREPass through both edges at an equal depth and distance from incision and knot is tied.
ADVANTAGES:- Strong and can be used
in area of stress. Successive sutures can
be placed according to individual requirement.
2) CONTINOUS SUTURE
ADVANTAGES:- Provides rapid
technique forclosure and distributes
tensionuniformly over suture
line. Offers more water tightclosure.
3) CONTINOUS LOCKINGADVANTAGE:- Provides continous tightening of suture during wound closure. Used for closure of wound area when time is limited.
MATTRESS SUTURESHORIZONTAL MATTRESS SUTURE Provides broad contact of wound margins, e.g. closure of extraction socket wounds.
VERTICAL MATTRESS SUTUREUsed for closing deep wounds.
REMOVAL OF SUTURES Suture is grasped with an instrument and lifted above epithelial surface.
A scissors or B.P. Blade No.-11 should be used to cut one side of loop as close to surface as possible.
Skin sutures are removed after 7-10 days and mucosal sutures are removed between 5 and 7 days.
DRAINS AND PACKINGDRAINSUSES:- To prevent formation
of hematomas or seromas within soft or hard tissues.
Provide an exit for pus and infection to outside surface.
Glove drains or rubber drains are commonly used.
Tubular drains with cuts made in it are used for irrigating wounds.
PACKING OF WOUND
USES:- To permit healing by
secondary intention. For applying topical
medication to surgical wound.
Materials used are:- Iodoform gauze Gauze soaked in antibiotic paste, betadine.
DRESSING OF WOUND After suturing the skin should be cleaned with gauze soaked in saline to clear all blood stains. Wound is covered by sterile sponges. Dressing is used to cover and protect wound. Provides support and pressure to area to
prevent hematoma formation. Aerosol sprays are used for wound protection. Dressing should be changed after 24- 48 hours.
REFERENCES Contemporary oral and maxillofacial
surgery by PETERSON
Textbook of oral and maxillofacial surgery by NEELIMA ANIL MALIK
Textbook of oral and maxillofacial surgery by VINOD KAPOOR