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