Oral and Maxillofacial Surgery Chapter 56 Copyright 2009

Oral and Maxillofacial Surgery Chapter 56 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Chapter 56 Lesson 56. 1 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Learning Objectives Pronounce, define, and spell the Key Terms. Describe the specialty of oral and maxillofacial surgery. Discuss the role of an oral surgery assistant. Identify specialized instruments used for basic surgical procedures. (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Learning Objectives (Cont’d) Discuss the importance of the chain of asepsis during a surgical procedure. Prepare a sterile field. Perform a surgical scrub. Perform sterile gloving. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Introduction Oral and maxillofacial surgery is the specialty of dentistry involving the diagnosis and surgical treatment of diseases, injuries, and defects. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Indications for Maxillofacial Surgery Extractions of decayed teeth that cannot be restored Surgical removal of impacted teeth Extraction of nonvital teeth Preprosthetic surgery to smooth and contour the alveolar ridge Removal of teeth for orthodontic treatment Removal of root fragments Removal of cysts and tumors Biopsy (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Indications for Maxillofacial Surgery (Cont’d) Treatment of fractures of the mandible or maxilla Surgery to alter the size or shape of the facial bones Surgery of the temporomandibular joint Reconstructive surgery Cleft-lip and cleft-palate repairs Salivary gland surgery Surgical implant procedures Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

The Surgical Assistant Must have advanced knowledge and skills in: Patient assessment and monitoring Ø Specialized instruments Ø Surgical asepsis Ø Surgical procedures Ø Pain-control techniques Ø Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

The Surgical Setting Dental operatory Surgical suite Operating room Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Dental Instruments It is critical for the surgical assistant to have a working knowledge and understanding of surgical instruments. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Elevators Used to apply leverage against the tooth to loosen it from the periodontal ligament and ease extraction. Types Periosteal elevator Ø Straight elevator Ø Root-tip pick Ø Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 56 -2 Periosteal elevator. (Courtesy of Miltex, Inc, York, Pa. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 56 -3 Straight elevator. (Courtesy of Miltex, Inc, York, Pa. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 56 -4 Root-tip picks. (Courtesy of Miltex, Inc, York, Pa. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 56 -5 Commonly Used Forceps. (Courtesy of Miltex, Inc, York, Pa. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Surgical Instruments Surgical curette Ø Rongeur Ø Used to clean and scrape the interior of the tooth socket to remove diseased tissue Used to trim alveolar bone Bone file Ø Used to smooth rough margins of the alveolus (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 56 -6 Surgical curettes. (Courtesy of Miltex, Inc, York, Pa. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 56 -8 Bone file. (Courtesy of Miltex, Inc, York, Pa. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Surgical Instruments (Cont’d) Scalpel Ø Hemostat Ø Surgical knife used to make precise incisions into soft tissue Used to grasp and hold things Needle holder Ø Used to firmly grasp a suture needle (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 56 -9 Scalpel handle and blade. (Courtesy of Miltex, Inc, York, Pa. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 56 -10 Hemostat. (Courtesy of Miltex, Inc, York, Pa. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 56 -11 Needle holders. (Courtesy of Miltex, Inc, York, Pa. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Surgical Instruments (Cont’d) Surgical scissors Ø Suture scissors Ø Used to trimm soft tissue Used to cutt suture material Retractors Ø Used to hold or retract tissue during surgery (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Surgical Instruments (Cont’d) Mouth prop Ø Also known as a bite-block; allows the patient to rest and relax the jaw muscles during surgery Chisel Ø Either in a single-bevel or bi-bevel design; singlebevel type used for removing bone, bi-bevel for splitting teeth (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Surgical Instruments (Cont’d) Mallet Ø Source of pressure used on the chisel handle Surgical burs Ø Used to remove bone or to cut or split the crowns or roots of teeth Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Surgical Asepsis Because surgical procedures invade open tissue, the surgical team must follow sterile technique. (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Surgical Asepsis (Cont’d) Sterile field Ø Surgical scrub Ø Site where surgical instruments and accessory items are placed during the surgery Type of hand wash used to lessen the chance of infection Sterile gloving Ø Required for assistance in an invasive procedure Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Preparing for Surgery Advance preparation Have all patient records and radiographs in order. Ø Have consent forms signed and available. Ø Information requested from the patient’s physician must have been received. Ø Check for laboratory cases. Ø Ensure that surgical setups have been prepared and sterilized. Ø Provide preoperative instructions for any premedication. Ø (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Preparing for Surgery (Cont’d) Treatment-room preparation Place protective barriers. Ø Keep surgical instruments in their sterile wraps until they are to be used. Ø Have the appropriate pain-control medications set out and ready for administration. Ø Have the postoperative instructions ready to provide to the patient. Ø (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Preparing for Surgery (Cont’d) Patient preparation Update the medical history and laboratory reports. Ø Confirm with the patient that any prescribed premedication was taken as directed. Ø Place the radiographs on a view box. Ø Take vital signs for a baseline. Ø Seat and drape the patient. Ø Position the chair. Ø (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Preparing for Surgery (Cont’d) During surgery Maintain the chain of asepsis. Ø Transfer and receive instruments. Ø Provide aspiration and retraction as needed. Ø Maintain a clear operating field with light. Ø Monitor the patient’s vital signs. Ø Steady the patient’s head and mandible if necessary. Ø Observe the patient’s condition and anticipate the surgeon’s needs. Ø (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Preparing for Surgery (Cont’d) After surgery Stay with the patient. Ø Give verbal and written postoperative instructions. Ø Schedule a postoperative visit. Ø Update the patient’s treatment records. Ø Return the patient’s records to the business assistant. Ø Break down and disinfect the treatment area. Ø Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Chapter 56 Lesson 56. 2 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Learning Objectives Describe surgical procedures typically performed in a general practice. Assist in a simple extraction. Assist in a multiple-extraction procedure with alveoplasty. Assist in the removal of an impacted tooth. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Forceps Extraction Forceps extraction is the surgical removal of a tooth that is fully erupted and has a solid, intact crown that can be grasped firmly with the forceps. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Multiple Extractions and Alveoloplasty Multiple extraction procedure involving the contouring and smoothing of the alveolar crest of the surgical site. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Removal of Impacted Teeth A complex extraction of a tooth that has not erupted Soft-tissue impaction Ø Hard-tissue impaction Ø Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Biopsy The surgical removal and examination of lesions in the oral cavity Incisional biopsy Ø Exfoliative cytology Ø Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Chapter 56 Lesson 56. 3 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Learning Objectives Assist in suture placement. Perform suture removal. Describe the postoperative care given to a patient after a surgical procedure. Discuss the possible complications of surgery. Assist in the treatment of alveolitis (dry socket). Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Sutures are the stitches placed to control bleeding and promote healing. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Types of Sutures Absorbable Plain catgut provides the fastest healing for mucous membranes and subcutaneous tissues. Ø Chromic catgut provides a much slower healing, allowing the internal tissues to heal first. Ø Vicryl is a synthetic absorbable material. Ø Nonabsorbable Silk is used for its strength and ease of use. Ø Polyester fiber is one of the strongest sutures. Ø Nylon is used for its strength and elasticity. Ø Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Suture Removal When nonabsorbable sutures are placed, the patient is scheduled to return to have them removed in approximately 5 to 7 days. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Postoperative Care Control of bleeding Ø A 2 × 2 -inch piece of gauze is folded and placed to control bleeding and encourage clot formation and healing. • Keep gauze in place for 30 minutes. • If bleeding does not stop, call the dental office. • Do not disturb the clot with your tongue or by rinsing your mouth vigorously. • Strenuous work or physical activity is restricted that day. (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Postoperative Care (Cont’d) Control of swelling Ibuprofen is used before and after surgery. Ø During the first 24 hours, a cold pack is placed in a cycle of 20 minutes on/20 minutes off. Ø After the first 24 hours, external heat is applied to the area of the face in question to increase circulation in the tissues and to promote healing. Ø After the first 24 hours, the patient may begin gently rinsing the oral cavity with warm saline solution. Ø Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Postsurgical Complications Alveolitis (dry socket) Causative factors Ø Inadequate blood supply to the socket Ø Trauma to the socket Ø Infection within the socket Ø Dislodgment of the clot from the socket Ø Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.