oral and maxillofacial surgery chapter 56 copyright © 2009, 2006 by saunders, an imprint of...

Oral and Oral and Maxillofacial SurgeryMaxillofacial Surgery

Chapter 56Chapter 56

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


Lesson 56.1Lesson 56.1


Learning ObjectivesLearning Objectives

Pronounce, define, and spell the Key Terms.Pronounce, define, and spell the Key Terms. Describe the specialty of oral and Describe the specialty of oral and

maxillofacial surgery.maxillofacial surgery. Discuss the role of an oral surgery assistant.Discuss the role of an oral surgery assistant. Identify specialized instruments used for Identify specialized instruments used for

basic surgical procedures. basic surgical procedures. (Cont’d)(Cont’d)



(Cont’d)(Cont’d)

Discuss the importance of the chain of Discuss the importance of the chain of asepsis during a surgical procedure.asepsis during a surgical procedure.

Prepare a sterile field.Prepare a sterile field. Perform a surgical scrub.Perform a surgical scrub. Perform sterile gloving. Perform sterile gloving.


IntroductionIntroduction

Oral and maxillofacial surgery is the Oral and maxillofacial surgery is the

specialty of dentistry involving the specialty of dentistry involving the

diagnosis and surgical treatment of diagnosis and surgical treatment of

diseases, injuries, and defects. diseases, injuries, and defects.


Indications for Maxillofacial Surgery Indications for Maxillofacial Surgery

Extractions of decayed teeth that cannot be restored Extractions of decayed teeth that cannot be restored Surgical removal of impacted teeth Surgical removal of impacted teeth Extraction of nonvital teeth Extraction of nonvital teeth Preprosthetic surgery to smooth and contour the Preprosthetic surgery to smooth and contour the

alveolar ridge alveolar ridge Removal of teeth for orthodontic treatment Removal of teeth for orthodontic treatment Removal of root fragments Removal of root fragments Removal of cysts and tumors Removal of cysts and tumors Biopsy Biopsy (Cont’d)(Cont’d)


Indications for Maxillofacial SurgeryIndications for Maxillofacial Surgery


Treatment of fractures of the mandible or Treatment of fractures of the mandible or maxillamaxilla

Surgery to alter the size or shape of the facial Surgery to alter the size or shape of the facial bones bones

Surgery of the temporomandibular joint Surgery of the temporomandibular joint Reconstructive surgery Reconstructive surgery Cleft-lip and cleft-palate repairs Cleft-lip and cleft-palate repairs Salivary gland surgery Salivary gland surgery Surgical implant procedures Surgical implant procedures


The Surgical Assistant The Surgical Assistant

Must have advanced knowledge and skills in:Must have advanced knowledge and skills in: Patient assessment and monitoringPatient assessment and monitoring Specialized instrumentsSpecialized instruments Surgical asepsisSurgical asepsis Surgical proceduresSurgical procedures Pain-control techniques Pain-control techniques


The Surgical Setting The Surgical Setting

Dental operatoryDental operatory Surgical suite Surgical suite Operating room Operating room


Dental InstrumentsDental Instruments

It is critical for the surgical assistant It is critical for the surgical assistant

to have a working knowledge and to have a working knowledge and

understanding of surgical understanding of surgical

instruments. instruments.


Elevators Elevators

Used to apply leverage against the tooth to Used to apply leverage against the tooth to loosen it from the periodontal ligament and loosen it from the periodontal ligament and ease extraction.ease extraction.

TypesTypes Periosteal elevatorPeriosteal elevator Straight elevatorStraight elevator Root-tip pickRoot-tip pick


Fig. 56-2 Periosteal elevator. Fig. 56-2 Periosteal elevator. (Courtesy of Miltex, Inc, York, Pa.)(Courtesy of Miltex, Inc, York, Pa.)


Fig. 56-3 Straight elevator. Fig. 56-3 Straight elevator. (Courtesy of Miltex, Inc, York, Pa.)(Courtesy of Miltex, Inc, York, Pa.)


Fig. 56-4 Root-tip picks.Fig. 56-4 Root-tip picks. (Courtesy of Miltex, Inc, York, Pa.)(Courtesy of Miltex, Inc, York, Pa.)


Fig. 56-5 Commonly Used Forceps. Fig. 56-5 Commonly Used Forceps. (Courtesy of Miltex, Inc, York, Pa.)(Courtesy of Miltex, Inc, York, Pa.)


Surgical InstrumentsSurgical Instruments Surgical curetteSurgical curette

Used to clean and scrape the interior of the tooth Used to clean and scrape the interior of the tooth socket to remove diseased tissuesocket to remove diseased tissue

RongeurRongeur Used to trim alveolar boneUsed to trim alveolar bone

Bone fileBone file Used to smooth rough margins of the alveolusUsed to smooth rough margins of the alveolus(Cont’d)(Cont’d)


Fig. 56-6 Surgical curettes. Fig. 56-6 Surgical curettes. (Courtesy of Miltex, Inc, York, Pa.)(Courtesy of Miltex, Inc, York, Pa.)


Fig. 56-8 Bone file. Fig. 56-8 Bone file. (Courtesy of Miltex, Inc, York, Pa.)(Courtesy of Miltex, Inc, York, Pa.)


Surgical Instruments Surgical Instruments


ScalpelScalpel Surgical knife used to make precise incisions into Surgical knife used to make precise incisions into

soft tissuesoft tissue HemostatHemostat

Used to grasp and hold thingsUsed to grasp and hold things Needle holderNeedle holder

Used to firmly grasp a suture needleUsed to firmly grasp a suture needle(Cont’d)(Cont’d)


Fig. 56-9 Scalpel handle and blade. Fig. 56-9 Scalpel handle and blade. (Courtesy of Miltex, Inc, York, Pa.)(Courtesy of Miltex, Inc, York, Pa.)


Fig. 56-10 Hemostat.Fig. 56-10 Hemostat. (Courtesy of Miltex, Inc, York, Pa.)(Courtesy of Miltex, Inc, York, Pa.)


Fig. 56-11 Needle holders. Fig. 56-11 Needle holders. (Courtesy of Miltex, Inc, York, Pa.)(Courtesy of Miltex, Inc, York, Pa.)




Surgical scissorsSurgical scissors Used to trimm soft tissueUsed to trimm soft tissue

Suture scissors Suture scissors Used to cutt suture materialUsed to cutt suture material

Retractors Retractors Used to hold or retract tissue during surgeryUsed to hold or retract tissue during surgery(Cont’d)(Cont’d)




Mouth propMouth prop Also known as a bite-block; allows the patient to Also known as a bite-block; allows the patient to

rest and relax the jaw muscles during surgeryrest and relax the jaw muscles during surgery ChiselChisel

Either in a single-bevel or bi-bevel design; single-Either in a single-bevel or bi-bevel design; single-bevel type used for removing bone, bi-bevel for bevel type used for removing bone, bi-bevel for splitting teethsplitting teeth





Mallet Mallet Source of pressure used on the chisel handleSource of pressure used on the chisel handle

Surgical bursSurgical burs Used to remove bone or to cut or split the crowns Used to remove bone or to cut or split the crowns

or roots of teeth or roots of teeth


Surgical Asepsis Surgical Asepsis

Because surgical procedures invade Because surgical procedures invade

open tissue, the surgical team open tissue, the surgical team mustmust

follow sterile technique. follow sterile technique.

(Cont’d)


Surgical AsepsisSurgical Asepsis


Sterile fieldSterile field Site where surgical instruments and accessory Site where surgical instruments and accessory

items are placed during the surgeryitems are placed during the surgery Surgical scrub Surgical scrub

Type of hand wash used to lessen the chance of Type of hand wash used to lessen the chance of infectioninfection

Sterile glovingSterile gloving Required for assistance in an invasive procedureRequired for assistance in an invasive procedure


Preparing for Surgery Preparing for Surgery

Advance preparationAdvance preparation Have all patient records and radiographs in order. Have all patient records and radiographs in order. Have consent forms signed and available. Have consent forms signed and available. Information requested from the patient’s physician Information requested from the patient’s physician

must have been received. must have been received. Check for laboratory cases.Check for laboratory cases. Ensure that surgical setups have been prepared Ensure that surgical setups have been prepared

and sterilized. and sterilized. Provide preoperative instructions for any Provide preoperative instructions for any

premedication. premedication. (Cont’d)(Cont’d)


Preparing for SurgeryPreparing for Surgery


Treatment-room preparationTreatment-room preparation Place protective barriers. Place protective barriers. Keep surgical instruments in their sterile wraps Keep surgical instruments in their sterile wraps

until they are to be used. until they are to be used. Have the appropriate pain-control medications set Have the appropriate pain-control medications set

out and ready for administration. out and ready for administration. Have the postoperative instructions ready to Have the postoperative instructions ready to

provide to the patient.provide to the patient.(Cont’d)(Cont’d)




Patient preparationPatient preparation Update the medical history and laboratory reports. Update the medical history and laboratory reports. Confirm with the patient that any prescribed Confirm with the patient that any prescribed

premedication was taken as directed. premedication was taken as directed. Place the radiographs on a view box. Place the radiographs on a view box. Take vital signs for a baseline. Take vital signs for a baseline. Seat and drape the patient. Seat and drape the patient. Position the chair. Position the chair. (Cont’d)(Cont’d)




During surgery During surgery Maintain the chain of asepsis. Maintain the chain of asepsis. Transfer and receive instruments. Transfer and receive instruments. Provide aspiration and retraction as needed. Provide aspiration and retraction as needed. Maintain a clear operating field with light. Maintain a clear operating field with light. Monitor the patient’s vital signs. Monitor the patient’s vital signs. Steady the patient’s head and mandible Steady the patient’s head and mandible

if necessary. if necessary. Observe the patient’s condition and anticipate the Observe the patient’s condition and anticipate the

surgeon’s needs. surgeon’s needs. (Cont’d)(Cont’d)




After surgery After surgery Stay with the patient. Stay with the patient. Give verbal and written postoperative instructions. Give verbal and written postoperative instructions. Schedule a postoperative visit.Schedule a postoperative visit. Update the patient’s treatment records.Update the patient’s treatment records. Return the patient’s records to the Return the patient’s records to the

business assistant.business assistant. Break down and disinfect the treatment area. Break down and disinfect the treatment area.



Describe surgical procedures typically Describe surgical procedures typically performed in a general practice.performed in a general practice.

Assist in a simple extraction.Assist in a simple extraction. Assist in a multiple-extraction procedure with Assist in a multiple-extraction procedure with

alveoplasty.alveoplasty. Assist in the removal of an impacted tooth. Assist in the removal of an impacted tooth.


Forceps ExtractionForceps Extraction

Forceps extraction is the surgical removal Forceps extraction is the surgical removal

of a tooth that is fully erupted and has a of a tooth that is fully erupted and has a

solid, intact crown that can be grasped solid, intact crown that can be grasped

firmly with the forceps. firmly with the forceps.


Multiple Extractions and AlveoloplastyMultiple Extractions and Alveoloplasty

Multiple extraction procedure involving the Multiple extraction procedure involving the

contouring and smoothing of the alveolar contouring and smoothing of the alveolar

crest of the surgical site. crest of the surgical site.


Removal of Impacted TeethRemoval of Impacted Teeth

A complex extraction of a tooth that has not A complex extraction of a tooth that has not eruptederupted Soft-tissue impactionSoft-tissue impaction Hard-tissue impaction Hard-tissue impaction


BiopsyBiopsy

The surgical removal and examination of The surgical removal and examination of lesions in the oral cavitylesions in the oral cavity Incisional biopsyIncisional biopsy Excisional biopsyExcisional biopsy Exfoliative cytology Exfoliative cytology



Assist in suture placement.Assist in suture placement. Perform suture removal.Perform suture removal. Describe the postoperative care given to a Describe the postoperative care given to a

patient after a surgical procedure.patient after a surgical procedure. Discuss the possible complications of Discuss the possible complications of

surgery.surgery. Assist in the treatment of alveolitis (dry Assist in the treatment of alveolitis (dry

socket). socket).


Sutures Sutures

Sutures are the stitches placed to control bleeding Sutures are the stitches placed to control bleeding

and promote healing. and promote healing.


Types of SuturesTypes of Sutures

AbsorbableAbsorbable Plain catgut provides the fastest healing for Plain catgut provides the fastest healing for

mucous membranes and subcutaneous tissues.mucous membranes and subcutaneous tissues. Chromic catgut provides a much slower healing, Chromic catgut provides a much slower healing,

allowing the internal tissues to heal first.allowing the internal tissues to heal first. Vicryl is a synthetic absorbable material.Vicryl is a synthetic absorbable material.

NonabsorbableNonabsorbable Silk is used for its strength and ease of use.Silk is used for its strength and ease of use. Polyester fiber is one of the strongest sutures.Polyester fiber is one of the strongest sutures. Nylon is used for its strength and elasticity. Nylon is used for its strength and elasticity.


Suture Removal Suture Removal

When nonabsorbable sutures are When nonabsorbable sutures are

placed, the patient is scheduled to placed, the patient is scheduled to

return to have them removed in return to have them removed in

approximately 5 to 7 days. approximately 5 to 7 days.


Postoperative Care Postoperative Care

Control of bleeding Control of bleeding A 2 × 2-inch piece of gauze is folded and placed to A 2 × 2-inch piece of gauze is folded and placed to

control bleeding and encourage clot formation and control bleeding and encourage clot formation and healing.healing.• Keep gauze in place for 30 minutes. Keep gauze in place for 30 minutes.

• If bleeding does not stop, call the dental office. If bleeding does not stop, call the dental office.

• Do not disturb the clot with your tongue or by rinsing your Do not disturb the clot with your tongue or by rinsing your mouth vigorously.mouth vigorously.

• Strenuous work or physical activity is restricted that day. Strenuous work or physical activity is restricted that day. (Cont’d)(Cont’d)


Postoperative CarePostoperative Care


Control of swelling Control of swelling Ibuprofen is used before and after surgery.Ibuprofen is used before and after surgery. During the first 24 hours, a cold pack is placed in a During the first 24 hours, a cold pack is placed in a

cycle of 20 minutes on/20 minutes off.cycle of 20 minutes on/20 minutes off. After the first 24 hours, external heat is applied to After the first 24 hours, external heat is applied to

the area of the face in question to increase the area of the face in question to increase circulation in the tissues and to promote healing.circulation in the tissues and to promote healing.

After the first 24 hours, the patient may begin After the first 24 hours, the patient may begin gently rinsing the oral cavity with warm saline gently rinsing the oral cavity with warm saline solution. solution.


Postsurgical Complications Postsurgical Complications

Alveolitis (dry socket)Alveolitis (dry socket) Causative factorsCausative factors Inadequate blood supply to the socketInadequate blood supply to the socket Trauma to the socketTrauma to the socket Infection within the socket Infection within the socket Dislodgment of the clot from the socket Dislodgment of the clot from the socket


oral and maxillofacial surgery chapter 56 copyright © 2009, 2006 by saunders, an imprint of...

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