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Contents

Section1:PrinciplesofOralandMaxillofacialSurgery

1. Introduction to Oral and Maxillofacial Surgery ........................................................................3 • Scope 3 • MultidisciplinaryTeamApproach 4 • NewerAdvances 4

2. Art of Diagnosis ...............................................................................................................................5 • HistoryTaking 5 • ClinicalExamination 7 • ClinicalDiagnosticAids 10 • DiagnosticInvestigations 14 • Biopsy 18

3. Diagnostic Imaging .......................................................................................................................19 • FundamentalTenetofImagingModality 20 • DiagnosticImaging—AsLowasReasonablyAchievablePrinciple 20 • SelectionofImagingModality 20

4. Management of Medically Compromised Patients in Oral Surgery ...................................36 • ClassificationofPhysicalStatus 36

5. Armamentarium Used in Oral and Maxillofacial Surgery ....................................................48 • InstrumentUsedforPickingUpSterileInstruments 48 • InstrumentUsedforPreparingtheSurgicalField 48 • InstrumentUsedforHoldingtheDrapes 48 • InstrumentsUsedforIncisingtheTissues 49 • InstrumentsUsedforRetractingTissues 49 • InstrumentsUsedforReflectingtheMucoperiostealFlap 51 • InstrumentsUsedforHoldingtheSoftTissues 52 • InstrumentsUsedtoKeeptheMouthOpen 53 • InstrumentsUsedtoDrainanAbscess 53 • InstrumentsUsedtoRemovePathologicTissue 54 • InstrumentsUsedtoHoldtheBone 54 • InstrumentsUsedtoCutorRemoveBone 55 • InstrumentsUsedtoSuturetheTissues 57 • MiscellaneousInstruments 57 • InstrumentsUsedtoMaintainaCleanSurgicalField 57 • InstrumentsUsedfortheTreatmentofFracturesoftheJawBones 58 • DrainsUsedinOralandMaxillofacialSurgery 60

Textbook of Oral and Maxillofacial Surgeryxviii

• InstrumentsUsedfortheExtractionoftheTeethandRootRemnants 62 • SurgicalDiathermy(Cautery,Electrocautery) 66 • Cryosurgery 67

6. Suturing Materials and Techniques ...........................................................................................68 • HistoricalBackground 68 • PrinciplesofSutureMaterialSelection 69 • SutureNeedles 71 • NonabsorbableSutures 73 • NaturalAbsorbableSutures 74 • SyntheticAbsorbableSutures 74 • CoatedVicryl-Polyglactin910BraidedSutureMaterial 75 • SuturingTechniques 77 • SutureRemoval 79 • MechanicalWoundClosureDevices 79

7. Asepsis and Sterilization ..............................................................................................................80 • DefinitionsofVariousTerminologies 80 • TransportofUsedItems 81 • CleansingofInstruments 82 • PackagingorWrappingInstrumentsforAutoclaving 83 • MethodsofSterilization 85 • StorageofSterileGoods 88 • Disinfection 92 • Disinfectants 93 • Antiseptics 94 • OperatingRoomProcedures 95

8. Infection Control ..........................................................................................................................102 • Infection 102 • InfectionControl 102 • CrossInfection 102 • RoutesofTransmission 103 • InfectiousDiseasesofConcerninDentistry 103 • GeneralPrinciples 107 • WasteDisposalinaHealthCareSetting 117

9. Antimicrobial Therapy ...............................................................................................................119 • PrinciplesofAntibioticTherapy 120 • RemovalofSourceofInfection 122 • Beta-LactamAntibiotics 123 • AntiviralAntibiotics 130 • AntimycoticAgents 132 • LincomycinandClindamycin 135 • GuidelinesforAntibioticProphylaxis 136

Contents xix

10. Minor Oral Surgical Procedures ...............................................................................................138 • MinorOralSurgery 138 • BasicPurposeofSurgery 138 • PrinciplesofOralSurgery 138 • SurgicalManagementofImpactedTeeth 145 • ClassificationofImpactedTeeth 145 • SurgicalRemovalofImpactedTeeth 152 • Complications 158 • SurgicalEndodontics 159

Section2:GeneralAnesthesiaandSedationinOralandMaxillofacial

11. Introduction to General Anesthesia and Sedation ................................................................165 • ProblemsofGeneralAnesthesiainaDentalChair 166

12. Preanesthetic Evaluation ............................................................................................................167 • PurposeofPreoperativePreanestheticEvaluation 167

13. Preoperative Anesthetic Preparation and Premedication ....................................................172 • BasicPlanofPreoperativeAnestheticPreparation 172

14. Anesthetic Equipment .................................................................................................................180 • AnesthesiaandResuscitationEquipment 180 • MonitoringEquipment 190 • OxygenTherapyEquipment 192 • IntravenousInfusionEquipment 193

15. Pharmacology of Commonly Used Anesthetic Drugs .........................................................195 • Intravenous(IV) Induction Agents 195 • InhalationalInductionAgents 195 • MuscleRelaxants 199

16. Sedation Techniques for Dentistry ..........................................................................................201 • SedationTechniques 201

17. Short Anesthesia in a Dental Chair ..........................................................................................206 • DefinitionofGeneralAnesthesia 207 • History 207 • Equipment 207 • IndicationsforGeneralAnesthesia 208 • DayStaySurgery 209 • PositioninDentalChair:Horizontal/Sitting 209 • PreoperativeConsiderations 209 • InductionofAnesthesia 210 • MaintenanceofAnesthesia 210 • EndotrachealAnesthesia 211 • Recovery 211 • ComplicationsofDentalAnesthesia 212

Textbook of Oral and Maxillofacial Surgeryxx

18. Tracheal Intubation for a Patient Undergoing Oral and Maxillofacial Surgery .............214 • IndicationsforTrachealIntubation 214 • ArmamentariumRequiredforIntubations 214

19. Complications of General Anesthesia .....................................................................................221 • AnestheticComplications 221 • Complications 222 • PostoperativeAnestheticComplications 226

20. Cardiopulmonary Resuscitation ...............................................................................................229 • CardiacArrestanditsTreatment 229

Section3:TemporomandibularJointDisorders

21. Temporomandibular Joint: Afflictions and Management ...................................................239 • AnatomyoftheTemporomandibularJoint 239 • TemporomandibularJointDisorders 245 • SurgicalApproachestoMandibularCondyleanditsNeck 254

22. Ankylosis of the Temporomandibular Joint and its Management ....................................261 • ClassificationofAnkylosis 261 • Etiopathology 262 • Pathogenesis 263 • Diagnosis 263 • ClinicalManifestations 263 • ManagementofTemporomandibularJointAnkylosis 266

23. Myofascial Pain Dysfunction Syndrome ................................................................................275 • ClinicalCharacteristics 276 • Pathophysiology(Etiology) 276 • Symptoms 277 • HistoryofthePatient 277 • ObjectivesofTreatmentinMyofascialPainDysfunctionSyndrome 284

Section4:OrthognathicSurgery

24. Introduction to Orthognathic Surgery, Diagnosis and Treatment Planning ...................297 • TypesofSevereSkeletalDentofacialDeformitiesandAssociatedProblemList 305 • TreatmentOptions 305 • FacialEstheticAnalysis 307 • A“QuickCeph”DentofacialPlannerforOrthognathicSurgery 312 • FinalTreatmentPlan 316

25. Presurgical Orthodontic Phase ..................................................................................................317 • PresurgicalOrthodonticsObjectives 318 • PostsurgicalOrthodonticsObjectives 323 • HistoricalDevelopmentofOrthognathicSurgery 325

Contents xxi

26. Orthognathic Surgery: Osteotomy Procedures ......................................................................325 • ProtocolforOsteotomies 326 • OsteotomyProcedures 326 • MaxillaryOsteotomyProcedures 342

Section5:MaxillofacialTrauma

27. Basic Principles for the Management of Maxillofacial Injuries .........................................357 • GeneralCareoftheInjuredPatient 357 • BasicPrinciplesofTreatmentofaSevereMaxillofacialInjuries 358 • BasicABCs to be Followed for Preservation of Life 358 • SoftTissueInjuries 361

28. Injuries of the Maxillofacial Skeleton .....................................................................................365 • EtiologyofMaxillofacialInjuries 365 • LocalClinicalExaminationofMaxillofacialInjuries 367

29. Fractures of the Middle Third of the Facial Skeleton ...........................................................394 • MiddleThirdoftheFacialSkeleton 394 • ClassificationofFracturesofMiddleThirdofFacialSkeleton 399 • FracturesoftheZygomaticComplex 403 • Diplopia 406 • Enophthalmos 408

30. Principles of Treatment of Midfacial Fractures .....................................................................410 • MethodsofReductionforMidfaceFractures 410 • TreatmentofFracturesoftheZygomaticBone 415 • FracturesoftheNasalBoneandTreatment 421

31. Applied Surgical Anatomy of the Mandible and Classification of Mandibular Fractures ...................................................................................425 • AnatomyoftheMandible 425 • MandibularFractures 428

32. Management of Mandibular Fractures ....................................................................................433 • MandibularFracturesinChildren 433 • ManagementofMandibularFracturesinAdults 434 • SurgicalApproachestotheMandible 435 • BonePlatinginMandibularFractures 442

33. Fractures of the Condylar Process and its Management ......................................................452 • ClassificationofCondylarFractures 452 • DiagnosticFindingsofCondylarFractures 457 • TreatmentofCondylarFractures 458

Textbook of Oral and Maxillofacial Surgeryxxii

Section6:PreprostheticSurgery

34. Preprosthetic Surgery ..................................................................................................................467 • OralandMaxillofacialProsthetics 467 • PreprostheticSurgicalProcedures 471 • AlveolarRidgeCorrection 471 • RidgeExtensionProcedure 479 • RidgeAugmentationProcedures 483

Section7:CystsandTumorsoftheOrofacialRegion

35. Cysts of the Jaws and Oral/Facial Soft Tissues ......................................................................491 • CystFormation 491 • IntraosseousCysts 493 • SoftTissueCystsoftheOralCavity 511

36. Benign Tumors of the Jaw Bones ..............................................................................................525 • OdontogenicTumors 525 • NonodontogenicTumors 526 • GeneralPrinciplesofManagementofaJawLesion 527 • ClinicalExaminationoftheLesion 528 • PrinciplesofSurgicalManagementofJawTumors 530 • OdontogenicTumorsofVariousOrigins 540 • TumorsArisingfromOdontogenicEctomesenchymewithorwithoutInclusionof

Odontogenic Epithelium 553 • NonodontogenicLesionsoftheJaws 556 • Non-neoplasticBoneLesions 563 • KeratocysticOdontogenicTumor 572

Section8:SalivaryGlandDisorders

37. Diseases of the Salivary Glands ................................................................................................583 • SalivaryGlands:Anatomy 583 • SalivaryGlands:Physiology 585 • ClassificationofSalivaryGlandDiseases 586 • SalivaryGlandDysfunction 586 • Sialolithiasis 588 • CystsoftheSalivaryGlands 592 • TumorsoftheSalivaryGlands 595 • NecrotizingSialometaplasia 597 • Sialadenosis 598 • DiagnosticImaging 599 • SalivaryAnalysis 605 • ClinicalExamination:DifferentialDiagnosis 606 • SurgicalManagement 607 • ComplicationsofSurgeryofSalivaryGlands 610

Contents xxiii

Section9:OrofacialClefts

38. Cleft Lip and Cleft Palate Management ..................................................................................615 • Incidence 616 • Etiology 616 • EmbryologicalAspects 617 • Classification 619 • AssociatedDeformitiesandProblems 620 • AimsandObjectivesofManagementofCleftLipandPalate 622 • GeneralManagementProtocolfortheCleftPatient 622 • ManagementofCleftLip 622 • BilateralCleftLip 626 • CleftPalate 628 • CompleteCleftLipandPalateDeformity 631 • OrthodonticsinCleftLipandPalate 632

Section10:MaxillarySinusanditsImplications

39. Maxillary Sinus and its Implications .......................................................................................635 • GeneralConsiderations 635 • ClinicalExaminationofMaxillarySinus 640 • RadiologyofMaxillarySinus 640 • InfectionsofMaxillarySinus 641 • OroantralCommunicationandFistula 644 • FunctionalEndoscopicSinusSurgery 655

Section11:OrofacialandNeckInfections

40. Orofacial and Neck Infections and their Management ........................................................661 • Etiology 661 • PathwaysofOdontogenicInfection 662 • Microbiology 665 • SpreadofOrofacialInfection 668 • EvaluationofthePatientwithOrofacialInfection 670 • PotentialSpaces 678 • ClassificationofFascialSpaces 680 • PossibleUntowardorLifeThreateningComplicationsofOrofacialInfection 701

41. Osteomyelitis and Osteoradionecrosis of the Jaw Bones ....................................................713 • OsteomyelitisoftheJawBones 713 • TypesofOsteomyelitis 730 • TuberculousOsteomyelitisoftheJawBones 736 • OsteoradionecrosisoftheFacialBones 740

Textbook of Oral and Maxillofacial Surgeryxxiv

Section12:FacialNeuropathology

42. The Trigeminal Nerve (V) ..........................................................................................................751 • Functions 751 • Attachment 751 • Course 751 • Divisions 751 • TrigeminalGanglion 751

43. Orofacial Region Pain .................................................................................................................760 • Incidence 760 • BasicClassificationofPain 761 • NeurophysiologyofPain 761 • TransmissionofImpulsesintheCNS 762

44. Trigeminal Neuralgia and its Management ............................................................................764 • EtiologyandPathogenesis 764 • GeneralCharacteristics 765 • ClinicalCharacteristics 766 • Diagnosis 766 • Treatment 768

45. Sensory Disturbances of Face and Jaws ..................................................................................781 • ImpairedSensation 781 • Etiology 782 • Incidence 782 • ClassificationofMechanicalNerveInjuries 782 • Evaluation 786 • Management 788

46. Facial Nerve and Motor Disturbances of Face and Jaws ......................................................792 • FacialNerve 792 • MotorDisturbancesofFaceandJaws 797

Section13:OralMalignancies

47. Oral Cancer ....................................................................................................................................809 • Incidence 809 • AnatomicalSubsitesofCancerintheOralCavity 810 • Etiology 811 • SpreadofSquamousCellCarcinomasoftheOralCavity 811 • OralPrecancer 812 • RiskofMalignantTransformationofOralPremalignantLesions 812 • DiagnosisandStagingofOralCavityCancer 815 • Management 817

Contents xxv

• ManagementoftheNeckLymphNodes 821 • LymphNodeLevels 822 • ClassificationofNeckDissection 823 • SurvivalandPrognosis 824 • RoleofDentalPractitionerinOralCancerManagement 824

Section14:ImplantologyinOralandMaxillofacialSurgery

48. Dental Implants ............................................................................................................................829 • ImplantMaterials 829 • TitaniumImplants 830 • ClassificationsofDentalImplants 830 • BiologicParametersforImplantsAcceptance 832 • IndicationsandContraindications 833 • PresurgicalInvestigations 834 • Anesthesia 834 • InsertionofImplant 834 • Complications 836 • AilingV/SFailingImplant 837 • ClinicalPhotographs 842

49. Implants—An Overview .............................................................................................................843 • Implantation 843 • OsseointegrationorOsseousIntegration(1993)GlossaryofProsthodonticTerms-8 843 • RationaleforImplantTreatment 845 • ClassificationsforImplantTreatment 845 • AdvantagesofDentalImplants 849 • AnatomyorPartsofanImplant 850 • PatientSelectionCriteria 852 • ComputedTomography 853 • ArmamentariumforImplantSurgery 854 • BasicFactorsinImplantSurgery 855 • PlacementoftheImplantinanAcceptablePosition 856 • PreoperativeCare 856 • Anesthesia 856 • Incisions 857 • BasicFlapDesignandSoftTissueHandling 857 • PostoperativeInstructions 857 • AbutmentConnection 858 • SurgicalComplicationsofImplantTherapy 858 • NonsurgicalManagementofPerimplantitis 860 • SurgicalManagementofPerimplantitis 861 • AbsoluteIndicationforExplantation 861 • LongTermMaintenanceProtocolforImplants 861

Textbook of Oral and Maxillofacial Surgeryxxvi

Section15:HemorrhageandShock

50. Hemorrhage and Shock: Its Management in Oral Surgery .................................................865 • Hemorrhage 865 • Shock 877

Section16:Miscellaneous

51. HIV Disease—An Overview ......................................................................................................883 • HistoryandOrigin 883 • RateofProgression 885 • ViralLesions 889 • BacterialLesions 891 • Mycobacterium avium-intracellulare 892 • NeoplasticLesions 893 • Lymphoma 893 • OtherLesionsAssociatedwithHIV Disease 894 • SalivaryGlandDiseaseandXerostomia 894 • ManagementofOccupationalExposureandPostExposureProphylaxis 895 • HIV Testing and Counseling 896 • ProtocolforTreatingHIV Positive Patients 897 • Disinfectants 898

Section17:RecentAdvancesinOralandMaxillofacialSurgery

52. Recent Advances in Oral and Maxillofacial Surgery ............................................................901 • IntraoperativeNavigationandRoboticSurgery 904 • BuccalPadofFatinTMJ Reconstruction 910 • LockingPlatesandScrewsSystem 914

53. Cone Beam Computed Tomography ........................................................................................920 • TechnicalBasisofCBCT 921 • ApplicationofCBCT Imaging to Clinical Dental Practice 927 • RoleofCBCT in Dental Implantlogy 927 • AdvantagesofCBCT 929 • WordofCaution! 930 • BasicPrinciplesforuseofDentalConeBeamCT 931

54. Lasers in Oral and Maxillofacial Surgery ...............................................................................933 • PhysicalPropertiesofLaser 937 • CharacteristicsofLaser 937 • LaserInteractionwithOralBiologicTissues 940 • ClassificationofLasers 947 • AdvantagesofLaser 951 • ApplicationsofLaserinOralandMaxillofacialSurgeryandDentistry 952

Contents xxvii

• TechniquesforuseofLasersinOralandMaxillofacialSurgery 954 • ScarRevisionwithLaser 957 • UseofEr:YAG Laser 958 • LowLevelLaserTherapy 958 • ConnectionsandTraffic 961 • SterilizationandInfectionControlofLaserUnit 961

55. Piezosurgery ..................................................................................................................................962 • WhatisPiezosurgery? 962 • PiezosurgeryDevice 963 • Technique 966 • AdvantagesofPiezosurgery 966 • BiologicalEffectsonBoneCutbyPiezosurgeryDevice 968

Appendices ............................................................................................................................................973

Index .......................................................................................................................................................991