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Textbook of Oral and Maxillofacial Surgery
Neelima Anil Malik
SECTION 1: PRINCIPAL OF ORAL AND MAXILLOFACIAL SURGERY
1:
Introduction to Oral and Maxillofacial Surgery
DEFINITION
SCOPE
MULTIDISCIPLINARY TEAM APPROACH
Cleft Lip and Palate
Craniofacial Syndromes
Trauma Unit
NEWER ADVANCES
2:
Art of Diagnosis
HISTORY TAKING
Art of History Taking
Steps in History Taking
Obtaining General Information
Chief Complaints
Past/Present Medical History
Personal and Family History
CLINICAL EXAMINATION
Extraoral Examination
Inspection
Palpation
Auscultation
Intraoral Examination
Inspection
Palpation
CLINICAL DIAGNOSTIC AIDS
Radiological Examination
Conventional Radiography
Intraoral Radiographs
Extraoral Radiographs
Specialized Imaging
Tomogram
Ultrasonography
Magnetic Resonance Imaging
Radionuclide Imaging
Sialography
Arthrography
Angiography
Electrocardiogram
DIAGNOSTIC INVESTIGATIONS
Routine Hematological Investigations
Hemoglobin
Complete Blood Count
Coagulation Tests
Biochemical Analysis
Renal Function Tests
Serum Electrolytes
Liver Function Tests
Specific Investigations
ELISA for HIV 1 and 2 Antibodies
Australia Antigen Test
Urine Analysis
Bacterial Culture and Antibiotic Sensitivity tests
Histopathological Evaluation
Exfoliative Cytology
Fine Needle Aspiration Cytology
BIOPSY
Punch Biopsy
Incisional Biopsy
Excisional Biopsy
3:
Diagnostic Imaging
FUNDAMENTAL TENET OF IMAGING MODALITY
DIAGNOSTIC IMAGING—AS LOW AS REASONABLY ACHIEVABLE PRINCIPLE
SELECTION OF IMAGING MODALITY
Plain Conventional Radiography
Shortfalls
Magnetic Resonance Imaging (Figs 3.1 to 3.8)
Limitations of MRI
Radionuclide Bone/Skeletal Scan or Scintigraphy (Figs 3.9 to 3.16)
Indications of Scintigraphy
Clinical Applications
Advantages of Scintigraphy
Ultrasonography (Figs 3.17 to 3.23)
Advantages
Limitations
Ultrasonography Procedure
Application
Computed Tomographic Scan (Figs 3.24 to 3.34)
CT Scan
Techniques
Newer Advanced Softwares for CT Scans
Advantages
Disadvantages
Acquisition of Axial CT Scan
4:
Management of Medically Compromised Patients in Oral Surgery
CLASSIFICATION OF PHYSICAL STATUS
Cardiac Diseases
Preoperative Investigations
Preoperative Medication
Intra- and Postoperative Management
Indications for Prescribing Anticoagulant Drugs
Oral Anticoagulant Drugs
Protocols for Treating the Patients on Anticoagulants
Antiplatelet Drugs
Dose Regulation
Hypertension
Preoperative Investigations
Preoperative Medication and Management
Intra- and Postoperative Management
Respiratory Diseases
Preoperative Investigations
Intra- and Postoperative Management
Renal Diseases
Preoperative Investigations
Intra- and Postoperative Management
Hepatic Diseases
Preoperative Investigations
Intra- and Postoperative Management
Diabetes Mellitus
Preoperative Investigations
Intra- and Postoperative Management
Thyroid Disorders
Preoperative Investigations
Intra-and Postoperative Management
Adrenal Diseases
Preoperative Investigations
Intra- and Postoperative Management
Neurological Disorders
Preoperative Investigations
Intra- and Postoperative Management
Disorders of Hemopoietic System
Preoperative Investigations
Intra- and Postoperative Management
Management of a Hemophiliac Patient
Immunocompromised Patients
Preoperative Investigations
Intra- and Postoperative Management
Autoimmune Disorders
Patients Undergoing Radiation Therapy
Management
Treatment Planning
Dental Management of Patient Undergoing Chemotherapy
Pregnancy and Lactation
Food and Drug Administration Categories
CONCLUSION
5:
Armamentarium Used in Oral and Maxillofacial Surgery
INSTRUMENT USED FOR PICKING UP STERILE INSTRUMENTS
Cheatle's Forceps (Fig. 5.1A)
INSTRUMENT USED FOR PREPARING THE SURGICAL FIELD
Swab Holder (Fig. 5.1B)
Uses
INSTRUMENT USED FOR HOLDING THE DRAPES
Towel Clips (Figs 5.1C and D)
Uses
INSTRUMENTS USED FOR INCISING THE TISSUES
Scalpel
Bard Parker Blade Handle (Fig. 5.2A)
Blades (Figs 5.2B to E)
Dissecting Scissors (Fig. 5.2F)
INSTRUMENTS USED FOR RETRACTING TISSUES
Langenbeck's Retractor (Figs 5.3A and 5.4A)
C-shaped Retractor
Austin's Retractor
Obwegeser's Ramus Retractor (Figs 5.3B and C)
Uses
Condyle Retractors (Fig. 5.4B)
Weider's Retractor
Cat Paw Retractor (Fig. 5.4C)
Tongue Depressor (Fig. 5.4D)
Uses
Seldin's Retractor
INSTRUMENTS USED FOR REFLECTING THE MUCOPERIOSTEAL FLAP
Moon's Probe (Fig. 5.5A)
Uses
Periosteal Elevators (Molt No. 9, Howarth's, Dial's) (Figs 5.5B,C,E and F)
Uses
Methods of Reflecting the Periosteum from the Flap
Cleft Palate Raspatory (Fig. 5.5D)
Hemostatic Forceps (Spencer Wells, Kelly's, Halstead)
Types of Hemostats (Figs 5.6A and B)
Uses
INSTRUMENTS USED FOR HOLDING THE SOFT TISSUES
Tissue Holding Forceps
Allis Tissue Holding Forceps (Fig. 5.7A)
Babcock's Tissue Holding Forceps (Fig. 5.7B)
Lane's Tissue Holding Forceps (Fig. 5.7C)
Tongue Forceps
Swab Holder Variety
Towel Clip Type
Gland Holding Forceps
Swab Holder Variety
Kocher's Variety
INSTRUMENTS USED TO KEEP THE MOUTH OPEN
Mouth Prop (Fig. 5.8A)
Heister's Jaw Stretcher (Fig. 5.8B)
Uses
Mouth Gag (Doyen's, Fergusson's) (Fig. 5.8C)
INSTRUMENTS USED TO DRAIN AN ABSCESS
Lister's Sinus Forceps (Fig. 5.9A)
Uses
Hemostatic Forceps
INSTRUMENTS USED TO REMOVE PATHOLOGIC TISSUE
Curette (Lucas) (Figs 5.9B and C)
Uses
Volkmann's Scoop (Fig. 5.9D)
Uses
INSTRUMENTS USED TO HOLD THE BONE
Crocodile Bone Holding Forceps (Figs 5.10A and B) Fergusson's Lion Jaw Bone Holding Forceps
Uses
Kocher's Toothed Heavy Artery Forceps
Uses
Sequestrum Holding Forceps
Uses
INSTRUMENTS USED TO CUT OR REMOVE BONE
Rongeurs Forceps (Blumenthal, Jensen Middleton) (Fig. 5.10C)
Uses
Miller and Colburn Bone File (Fig. 5.10D)
Bone Cutter
Uses
Osteotome (Fig. 5.11A)
Uses
Chisel (Figs 5.11B to D)
Uses
Bone Gouge (Fig. 5.11E)
Uses
Nasal Rasp (Fig. 5.11F)
Mallet (Fig. 5.11G)
Hand Piece, Burs and Saws
Uses
Gigli's Saw (Fig. 5.12)
INSTRUMENTS USED TO SUTURE THE TISSUES
Mayo-Hegar Needle Holder (Fig. 5.13A)
Suture Cutting Scissors (Dean's) (Fig. 5.13B)
Tissue Holding Forceps
Tissue Holding Forceps (Micro Adson, Gillie's, Adson's) (Figs 5.13C and D)
MISCELLANEOUS INSTRUMENTS
Skin Hook (Fig. 5.13E)
Uses
INSTRUMENTS USED TO MAINTAIN A CLEAN SURGICAL FIELD
Suction Apparatus (Fig. 5.14A)
Suction Tip (Frazier, Nuober) or Cannula (Fig. 5.14B-I)
Suction Tubing (Fig. 5.14B-II)
INSTRUMENTS USED FOR THE TREATMENT OF FRACTURES OF THE JAW BONES
Rowe's Disimpaction Forceps (Fig. 5.15A-I)
Uses
Hayton William's Forceps
Walsham's Forceps
Asche's Forceps (Fig. 5.15A-II)
Wire Holder (Hayton William) (Fig. 5.15B-I)
Wire (Fig. 5.15B-III)
Uses
Bone Plates (Fig. 5.15B-V)
Erich's Arch Bar (Fig. 5.15B-VI)
Uses
Tracheostomy Set
Tracheostomy Tube
Blunt Hook
Sharp Hook
Tracheal Dilator
Nerve Hook
Uses
Aneurysmal Needle (Fig. 5.16)
Bone Spreader (Fig. 5.17)
DRAINS USED IN ORAL AND MAXILLOFACIAL SURGERY
Need for Establishing Drainage
Indications for Drainage
Functions
Types of Drains (Figs 5.18A and B)
Penrose Drain
Nasogastric Tube (Ryle's Tube) (Figs 5.18A and B-IV)
Foley's Self-retaining Catheter (Fig. 5.18B-III)
Infant Feeding Tube (Fig. 5.18 B-I)
Corrugated Rubber Drain (Fig. 5.18 B-II)
INSTRUMENTS USED FOR THE EXTRACTION OF THE TEETH AND ROOT REMNANTS
Elevators
Work Principles of Elevation (Fig. 5.19)
Indications for the Use of Elevators
Rules to be Followed While Using the Elevators
Commonly Used Elevators
Straight Elevators (Coupland, London Hospital Pattern) (Fig. 5.20A-I)
Hockey Stick or London Hospital Elevator (Fig. 5.20A-II)
Apexo Elevators (Fig. 5.20A-III)
Cryer's Elevator
Winter's Elevator
Winter Cryer's Elevator (Fig. 5.20B)
Extraction Forceps
Maxillary Extraction Forceps (Fig. 5.20C)
Maxillary Molars (Right and Left)
Mandibular Forceps (Fig. 5.20D)
SURGICAL DIATHERMY (CAUTERY, ELECTROCAUTERY) (FIG. 5.21)
Monopolar Diathermy
Principles
Precautions
Bipolar Diathermy
CRYOSURGERY (FIGS 5.22A AND B)
6:
Suturing Materials and Techniques
HISTORICAL BACKGROUND
PRINCIPLES OF SUTURE MATERIAL SELECTION
Biological Response of the Body to Suture Materials
SUTURE NEEDLES
Needle Eye
Advantages of Eyeless Needles
Needle Body (Fig. 6.2)
Needle Point (Fig. 6.2)
NONABSORBABLE SUTURES
Perma-Hand Surgical Silk
Linen
Cotton
Polyamides
Polyesters
Polypropylene
Stainless Steel
NATURAL ABSORBABLE SUTURES
Surgical Gut
SYNTHETIC ABSORBABLE SUTURES
COATED VICRYL - POLYGLACTIN 910 BRAIDED SUTURE MATERIAL
Principles of Suturing
Surgical Knot Tying
Secure/Square Knot
Surgeon's Knot (Fig. 6.3B)
Granny's Knot or Slip Knot (Fig. 6.3C)
SUTURING TECHNIQUES
Interrupted Suture-Sling Suture (Fig. 6.4)
Advantages
Continuous Over and Over Suture (Fig. 6.5A)
Continuous Locking Suture (Fig. 6.5B)
Mattress Suture
Horizontal Mattress Suture (Fig. 6.6)
Vertical Mattress Suture (Fig. 6.7)
Figure of 8 Suture (Fig. 6.8)
Subcuticular Sutures (Fig. 6.9)
SUTURE REMOVAL
MECHANICAL WOUND CLOSURE DEVICES
Ligating Clips
Surgical Staples
Tissue Adhesives
Dermabond Topical Skin Adhesive
7:
Asepsis and Sterilization
INTRODUCTION
DEFINITIONS OF VARIOUS TERMINOLOGIES
Classification of Instruments and Equipment in Surgery
TRANSPORT OF USED ITEMS
Instrument Processing Area
CLEANSING OF INSTRUMENTS
Cleansing Agents
Mechanism of Action
Drug Concentration and Therapeutic Index
Temperature and Duration of Contact
PACKAGING OR WRAPPING INSTRUMENTS FOR AUTOCLAVING (FIGS 7.2A TO G)
Marking of Packs
METHODS OF STERILIZATION
Principles
Moist/Steam Heat Sterilization: Autoclave (Figs 7.4A to D)
Steam Sterilizers (Autoclave) with Pre- and Post-Vacuum Processes
Precautions
Tests for Efficiency for Heat Sterilization—Sterilization Monitoring
STORAGE OF STERILE GOODS
Dry Heat Sterilization
Hot Air Oven (Figs 7.6A and B)
Glass Beads Sterilizer (Fig. 7.7)
Ethylene Oxide Gas Sterilization
Sterilization by Low-Temperature Steam and Formaldehyde (LTSF) (Chemical Vapor Sterilization/Unsaturated Chemical Vapor Sterilization)
Irradiation
Ionizing Radiation
Nonionizing Radiation
Boiling Water
Oil
DISINFECTION
Methods of Disinfection
Disinfection by Cleaning
Disinfection by Heat
Low Temperature Steam
Disinfection by Boiling Water
Disinfection by Chemical Agents (Figs 7.9 and 7.10)
DISINFECTANTS
Alcohols—Low Level Disinfectant
Aqueous Quarternary Ammonium Compounds
Phenolic Compounds—Intermediate Level, Broad Spectrum Disinfectant
Aldehyde Compounds—High Level Disinfectant
Formaldehyde
Glutaraldehyde
ANTISEPTICS
Alcohols
Aqueous Quarternary Ammonium Compounds
Hexachlorophene Compounds
Iodophor Compounds—Intermediate Level, Broad spectrum
Chloride Compounds
OPERATING ROOM PROCEDURES (FIGS 7.11 AND 7.12)
Relative Humidity
Temperature
Formaldehyde Levels in the Air in the Operation Theatre
Masks (Figs 7.13A and B)
Eye Protection (Fig. 7.14)
Hair/Beard Cover
Footwear
Antiseptic Environment
Hand Scrub Techniques
Hand Disinfection (Figs 7.15 and 7.16)
Gloving
Preparation of the Surgical Site (Fig. 7.17)
Other Precautions
Common Disinfectants
8:
Infection Control
INTRODUCTION
OBJECTIVE
INFECTION
INFECTION CONTROL
CROSS INFECTION
Pathways of Cross Infection
ROUTES OF TRANSMISSION
INFECTIOUS DISEASES OF CONCERN IN DENTISTRY
Bacterial Infections
Viral Infections
Revised Classification of HIV-associated Oral Lesions (1990)
Group I: Lesions Strongly Associated with HIV Infections
Group II: Lesions Less Commonly Associated with HIV Infection
Group III: Lesions Possibly Associated with HIV Infection
Signs and Symptoms of HIV Disease
Earlier Signs of HIV Infection
Late Signs of HIV Infection
Certain Tumors
GENERAL PRINCIPLES
Universal Precautions
Handwashing and Care of Hands
Personal Protection: Protective Attire
Prevent Environmental Contamination (Fig. 8.3)
Use of Sharp Instruments and Needles (Figs 8.4A to C)
Patient Management
Sterilization and Disinfection of Instruments
Disposal of Waste/Infected Materials (Fig. 8.5)
Handling Biopsy Specimens
Prosthodontics
Dental Radiography
Intraoral Techniques
Other Precautions
Rubber Dam Isolation
Minimizing Dental Aerosols and Splatter
Needle Stick Injury
Measures for Prevention
Postaccidental Management—Chemo-prophylaxis
HIV Infection Control
Measures at the Time of Surgery
Measures for Health Care Workers
WASTE DISPOSAL IN A HEALTH CARE SETTING
Classification
Aims of Waste Treatment
Segregation (Fig. 8.6)
Disposal of Hospital Waste (Table 8.4 and Fig. 8.7)
Disposal of Infected Waste
9:
Antimicrobial Therapy
INTRODUCTION
CLASSIFICATIONS
PRINCIPLES OF ANTIBIOTIC THERAPY
Selection of Antimicrobials
Antimicrobial Combinations
Antimicrobial Prophylaxis
Bacterial Resistance
REMOVAL OF SOURCE OF INFECTION
Principles of Antibiotic Administrations
Dosage
Duration
Route and Frequency of Administration
Use of Narrow Spectrum Antibiotic
Antibiotic Prophylaxis
Collaboration between Clinician and Bacteriologist
BETA-LACTAM ANTIBIOTICS
Penicillins
Classification
Administrations
Oral Administration
Length of Course
Measurements of Penicillin (Units and Micrograms)
Toxic Effects
Anaphylaxis
Other Effects
Cephalosporins
Tetracyclines
Classifications
Mechanism of Action
Mechanism of Resistance
Antibacterial Spectrum
Pharmacokinetics
Formation of Metal Chelates
Indications
Cautions, Contraindications, Side Effects
Other Uses
Administration
Preparations
Precautions
Adverse Reactions
Erythromycin
Preparation
Mode of Action
Pharmacology
Absorption
Excretion
Toxic Effects
Interactions
Use during Pregnancy and Lactation
Concomitant Use of Other Antibiotics
Sulfonamides and Trimethoprim
Absorption, Distribution and Excretion
Toxic Effects
Pregnancy and Lactation
Oral Contraceptives
Sulfadiazine
Cotrimoxazole (Combination of Sulfamethoxazole and Trimethoprim)
Quinolones
Mechanism of Action
Nalidixic Acid
Fluoroquinolones
ANTIVIRAL ANTIBIOTICS
Acyclovir (Cyclovir, Zovirax)
Valacyclovir and Famciclovir
Ganciclovir
Aminoglycosides
Gentamycin
Vancomycin
ANTIMYCOTIC AGENTS
Polyenes
Amphotericin B
Nystatin
Azole Antifungal Agents
Clotrimazole
Miconazole
Ketoconazole
Fluconazole
Itraconazole
Metronidazole
LINCOMYCIN AND CLINDAMYCIN
GUIDELINES FOR ANTIBIOTIC PROPHYLAXIS
10:
Minor Oral Surgical Procedures
BASIC PURPOSE OF SURGERY
PRINCIPLES OF ORAL SURGERY
Developing a Surgical Diagnosis
Clinical Characteristics of Lesion
History of Lesion
Transalveolar Extraction (Open or Surgical Extraction)
Pre-extraction Radiological Evaluation (Fig. 10.1A)
Multiple Extractions
Order of Multiple Teeth Extractions
Difficult Extraction/Breakage of the Root
Surgical Extractions (Complicated Extractions)
Postage Stamp Technique for Transalveolar Extraction (Fig. 10.1B)
Three Basic Principles
Basic Necessities for Surgery
Adequate Access
Patient
Equipment
Assistant
Surgeon's and Assistant's Preparation
Aseptic Technique
Planning of an Incision
Incisions in the Oral Cavity
Contraindications for Placement of Incision Lines
Types of Incisions
Flap Design
Main Complications of Flap Surgery
Principles of Flap Designing
Indications
Types of Flaps (Fig. 10.1D)
Envelope Flap (Fig. 10.1E)
Tissue Handling
Hemostasis
Hemostasis can be Achieved by
Dead Space Elimination
How to Avoid a Dead Space
Decontamination and Debridement
Suturing
CLASSIFICATION OF IMPACTED TEETH
Causes of Impaction of Teeth
Inadequate Space in the Dental Arch for Eruption
Indications for Removal of Impacted Teeth
Risk of Nonintervention
Risk of Intervention
Benefits of Nonintervention
Benefits of Intervention
Classification of Impacted Teeth
Difficulty Index
Winter's Classification (Fig. 10.2A)
Pell and Gregory Classification (Fig. 10.2C)
Maxillary Third Molars’ Classification (Fig. 10.2D)
Classification of Impacted Maxillary Canines (Fig. 10.2E)
Classification for Impacted Mandibular Canine (Table 10.3)
Factors Responsible for Increasing the Difficulty Score for Removal of Impacted Teeth
Radiological Examination
Intraoral X-ray
Extraoral X-rays (Figs 10.2G 1, 2, 3)
SURGICAL REMOVAL OF IMPACTED TEETH
Isolation of Surgical Site
Local Anesthesia
Incision (Flap Design)
For Mandibular Molars (Fig. 10.2J)
For Maxillary Molars (Fig. 10.2K)
For Maxillary Canines
For Mandibular Canines
Bone Removal
Aim
How much Bone is to be Removed?
Two Ways of Bone Removal (Fig. 10.2L)
Lingual Split Bone Technique (Fig. 10.2M)
Tooth Sectioning, Elevation and Extraction
Horizontal Impaction (Fig. 10.2N-1)
Mesioangular Impaction (Fig. 10.2N-2)
Vertical Impaction (Fig. 10.2N-3)
Distoangular Impaction (Fig. 10.2N-4)
Elevation
Debridement and Smoothening of Bone Margins
Closure
COMPLICATIONS
Intraoperative Complications
During Incision
During Bone Removal
During Elevation
During Debridement
Postoperative Complications
Indications
Contraindications
Procedure (Figs 10.3A to E)
Steps
Retropreparation (Fig. 10.3F)
Complications
Intraoperative
Postoperative
SECTION 2: PRINCIPAL OF ORAL AND MAXILLOFACIAL SURGERY
11:
Introduction to General Anesthesia and Sedation
PROBLEMS OF GENERAL ANESTHESIA IN A DENTAL CHAIR
12:
Preanesthetic Evaluation
PURPOSE OF PREOPERATIVE PREANESTHETIC EVALUATION
Routine Preoperative Anesthetic Evaluation
History
Physical Examination
Laboratory Tests
13:
Preoperative Anesthetic Preparation and Premedication
BASIC PLAN OF PREOPERATIVE ANESTHETIC PREPARATION
Patient Counseling/Psychological Preparation
Procedure Done under Local Anesthesia with or without Sedation
Hypersensitivity Reactions
Consent
Premedication
Premedicant Drugs (Table 13.3)
Other Sedative and Hypnotic Agents
Analgesic Agents
Anticholinergic Agents
Aspiration Prophylaxis
Premedication for Outpatient Dental Surgery
Premedication for Major Maxillofacial Surgery
Premedication for Children
Preoperative Instructions
Fasting Guidelines (Table 13.4)
Concurrent Medication or Pre-existing Drug Therapy (Table 13.5)
Concurrent Drug Therapy (Table 13.5)
Other Instructions
14:
Anesthetic Equipment
ANESTHESIA AND RESUSCITATION EQUIPMENT
Anesthesia Machine
Breathing System (Circuit)
Anesthetic Mask
Laryngoscope
Endotracheal Tubes
Airways
Oropharyngeal (Oral) Airway (Placed from Lips to Pharynx)
Nasopharyngeal (Nasal) Airway (Placed from the Nose to the Pharynx)
Laryngeal Mask Airway (LMA)
Magill's Forceps
Mouth Prop (Bite Block)
Resuscitation Bag
MONITORING EQUIPMENT
Blood Pressure Monitor
Cardioscope
Pulse Oximeter
Capnometer/Capnographs
Respiratory Gas Monitor
Oxygen Therapy Equipment
Oxygen Cylinder
Oxygen Flowmeter
Oxygen Mask
Nasal Catheter/Prongs
Intravenous Infusion Equipment
Scalp Needle
Intravenous Cannula
Bivalve (Three Way)
Infusion Set
Intravenous Fluids
15:
Pharmacology of Commonly Used Anesthetic Drugs
INTRAVENOUS (IV) INDUCTION AGENTS
INHALATIONAL INDUCTION AGENTS
Minimum Alveolar Concentration
Ideal Inhalational Agent
Ether (CH3CH2-O-CH2CH3)
Ethyl Chloride (C2H5Cl)
Halothane (Fluothane)
Nitrous Oxide
MUSCLE RELAXANTS
Reversal of Anesthesia
16:
Sedation Techniques for Dentistry
DEFINITIONS
Conscious Sedation
Deep Sedation
SEDATION TECHNIQUES
Intravenous Sedation
Advantages of Intravenous Sedation
Disadvantages of Intravenous Sedation
Drugs Commonly Available for IV Sedation
Other Commonly Used Sedative Techniques
Inhalational Sedation
Indications
Contraindications
Advantages
Disadvantages
Techniques of Administration
Clinical Indicators of Oversedation
17:
Short Anesthesia in a Dental Chair
INTRODUCTION
DEFINITION OF GENERAL ANESTHESIA
HISTORY
EQUIPMENT
Anesthetic Machine
Dental Chair
Breathing Circuits and Masks
Nasopharyngeal Airways
Mouth Props and Gags
Mouth Packs
Monitors and Resuscitation Equipment
INDICATIONS FOR GENERAL ANESTHESIA
DAY STAY SURGERY
POSITION IN DENTAL CHAIR: HORIZONTAL/SITTING
PREOPERATIVE CONSIDERATIONS
INDUCTION OF ANESTHESIA
MAINTENANCE OF ANESTHESIA
ENDOTRACHEAL ANESTHESIA
RECOVERY
COMPLICATIONS OF DENTAL ANESTHESIA
Hypoxia
Laryngospasm
Mouth Breathing
Contamination of Trachea
Apnea
Hypotension
Cardiac Dysrhythmias
Nausea and Vomiting
18:
Tracheal Intubation for a Patient Undergoing Oral and Maxillofacial Surgery
INDICATIONS FOR TRACHEAL INTUBATION
ARMAMENTARIUM REQUIRED FOR INTUBATIONS
Laryngoscope
Endotracheal Tubes (Figs 18.1A to F)
Procedure for Endotracheal Intubation
Ideal Position for Intubation (Figs 18.2A to E)
Awake Intubation
Complications Associated with Tracheal Intubation
Complications at Endotracheal Intubation
Complications During Intubation
19:
Complications of General Anesthesia
ANESTHETIC COMPLICATIONS
Preoperative Period (Related to Prior Drug Therapy)
COMPLICATIONS
Coughing
Hiccup
Wheezing
Cyanosis
Cardiac Arrhythmias
Fluctuations in Blood Pressure
Hypertension
Hypotension
Hypoxemia
Carbon Dioxide Status
Hypercarbia
Hypocarbia
Change of Body Temperature
Hypothermia
Hyperthermia
Malignant Hyperthermia
Laryngospasm
Signs
Life threatening Upper Airway Obstruction
Pulmonary Aspiration in the Anesthetized Patient
Cardiac Arrest during Anesthesia (Absent Carotid Pulse)
Severe Drug Reactions
Complications due to Improper Patient Position
Nerve Injury
Air Embolism
Awareness during General Anesthesia
POSTOPERATIVE ANESTHETIC COMPLICATIONS
Postoperative Nausea and Vomiting
Predisposing Factors that Increase Nausea and Vomiting
Postoperative Hypertension
Postoperative Respiratory Inadequacy
Failure to Wake-up
Postoperative Infection
Postoperative Restlessness
Respiratory Obstruction
Postoperative Shivering
20:
Cardiopulmonary Resuscitation
CARDIAC ARREST AND ITS TREATMENT
Etiology
Diagnosis of Cardiac Arrest
Treatment of Cardiac Arrest
Basic Life Support
Airway
Foreign Body Airway Obstruction
Mouth to Barrier Device
Mouth to Mask Breathing
Circulation Check
External Cardiac Compression (Figs 20.4A to C)
Advanced Cardiac Life Support
Key Points
Drug Therapy
Other Drugs Used in CPR
Postcardiac Arrest Complications
Outcome of Resuscitation
SECTION 3: TEMPOROMANDIBULAR JOINT DISORDERS
21:
Temporomandibular Joint: Afflictions and Management
ANATOMY OF THE TEMPOROMANDIBULAR JOINT
Articulatory System
Mandibular (Glenoid) Fossa (Cranial Component)
Mandibular Component
Mandibular Condyle
Temporomandibular Joint Capsule
Ligaments
Lateral or Temporomandibular Joint Ligament (Fig. 21.4)
Accessory Ligaments (Fig. 21.5)
Articular Disk or Meniscus (Figs 21.6A and B)
Blood Supply
Nerve Supply
Movements (Fig. 21.8)
TEMPOROMANDIBULAR JOINT DISORDERS
Classification
Disorders due to Extrinsic Factors
Disorders due to Intrinsic Factors
Dislocation, Subluxation, Hypermobility of Temporomandibular Joint
Causes of Acute Dislocation
Chronic Recurrent or Habitual Dislocation or Subluxation (Figs 21.15 to 21.17)
Indications
Eminectomy (Figs 21.20 and 21.21 and 21.22)
SURGICAL APPROACHES TO MANDIBULAR CONDYLE AND ITS NECK (FIGS 21.23 AND 21.24) (TABLE 21.1)
Postauricular Approach (Fig. 21.24)
Endaural Approach (Fig. 21.25)
Submandibular (Risdon) Approach (Fig. 21.26)
Postramal (Hind) Approach (Fig. 21.27)
Preauricular Approach (Figs 21.28 to 21.31)
Preparation of the Surgical Site
Marking the Incision
Infiltration of Vasoconstrictor
Skin Incision
Dissection to the TMJ Capsule
Exposing the Interarticular Spaces
Closure
Modifications of Basic Preauricular Incision (Figs 21.31 and 21.32)
A Surgical Approach Via Popowich Incision (Figs 21.33A and B)
Coronal Approach (Figs 21.34A to F)
22:
Ankylosis of the Temporomandibular Joint and its Management
CLASSIFICATION OF ANKYLOSIS
ETIOPATHOLOGY
PATHOGENESIS
DIAGNOSIS
CLINICAL MANIFESTATIONS
Unilateral Ankylosis (Fig. 22.3)
Bilateral Ankylosis (Fig. 22.4)
Diagnosis
Radiographic Findings
Fibrous Ankylosis (Fig. 22.1)
Bony Ankylosis (Fig. 22.2)
Sequelae of Untreated Ankylosis
MANAGEMENT OF TEMPOROMANDIBULAR JOINT ANKYLOSIS
Aims and Objectives of Surgery
Surgical Techniques
Condylectomy (Figs 22.8A to F)
Gap Arthroplasty (Figs 22.9 to 22.11)
Interpositional Arthroplasty (Figs 22.12 A to H and 22.13 A to H)
Artificial Replacement of the Joint
The Internationally Accepted Protocols for the Management of Temporomandibular Joint Ankylosis
Lining of the Glenoid Fossa Side by Temporalis Myofascial Flap (Figs 22.16 A to C)
Interposition Arthroplasty Using Autogenous Costochondral Graft (Figs 22.17 and 22.18)
Complications during Temporomandibular Joint Ankylosis Surgery
During Anesthesia
During Surgery
During Postoperative Follow-up
Frey's Syndrome (Figs 22.21A and B)
Treatment Options for Frey's Syndrome
Recurrence of Temporomandibular Joint Ankylosis
23:
Myofascial Pain Dysfunction Syndrome
HISTORY
CLINICAL CHARACTERISTICS
Trigger Points
PATHOPHYSIOLOGY (ETIOLOGY)
Psychogenic Cause
Persistent Tension Relieving Oral Habits
Occlusal Disharmony
SYMPTOMS
HISTORY OF THE PATIENT
Physical Examination
Articular or TMJ Function and Range of Motion
Muscular Examination
Dental/Occlusal Evaluation
Cervical Examination
Psychological Evaluation of a Patient
Psychological Symptoms
Internal Derangement of the Temporomandibular Joint
Internal Derangements
Anterior Disk Displacement with Reduction
Anterior Disk Displacement without Reduction
Systemic Joint Diseases Causing Internal Derangement
OBJECTIVES OF TREATMENT IN MYOFASCIAL PAIN DYSFUNCTION SYNDROME
Technique for Auriculotemporal Nerve Block
Treatment of MPDS
Medications
Physiotherapeutic Modalities
Stress Management
Intra-articular Injections
Occlusal Splints (Fig. 23.15)
1. Stabilization splint
2. Relaxation Splints
Temporomandibular Joint Arthrocentesis
Arthrocentesis (Lavage or Irrigation of the Upper Joint Cavity)
Hypothesis
Postarthrocentesis Medication
Advantages
Temporomandibular Joint Arthroscopy
Arthroscopic Techniques
Arthroscopic Anatomy (Fig. 23.23)
Postoperative Care
Surgical Treatment of Temporomandibular Joint Dysfunction Disorders
SECTION 4: ORTHOGNATHIC SURGERY
24:
Introduction to Orthognathic Surgery, Diagnosis and Treatment Planning
TYPES OF SEVERE SKELETAL DENTOFACIAL DEFORMITIES AND ASSOCIATED PROBLEM LIST
TREATMENT OPTIONS
Growth Modification
Orthodontic Camouflage
Orthognathic Surgery
Collecting Patient's Data
FACIAL ESTHETIC ANALYSIS
Frontal View Analysis (Fig. 24.16)
Profile or Lateral View Analysis (Fig. 24.17)
Oral Examination
Dental Model Analysis
Cephalometric Analysis
Soft Tissue Landmarks (Fig. 24.20)
Cephalometric Prediction Tracing (Figs 24.21A to C)
Posteroanterior Cephalometric Analysis (Fig. 24.22)
A “QUICK CEPH” DENTOFACIAL PLANNER FOR ORTHOGNATHIC SURGERY
Natural Head Position (NHP) (Fig. 24.18)
Case Evaluation (Table 24.15)
FINAL TREATMENT PLAN
CONCLUSION
25:
Presurgical Orthodontic Phase
PRESURGICAL ORTHODONTICS OBJECTIVES
Presurgical Intra-arch Objectives
Time Estimation
Presurgical Orthodontic Objectives for Antero-Posterior—Sagittal Plane (AP)
Presurgical Orthodontic Objectives for Transverse Plane
Presurgical Orthodontic Objectives for Vertical Plane
To Relieve Arch Crowding by Presurgical Orthodontics
Extraction Pattern for Presurgical Orthodontics
Selection of Orthodontic Appliance
Fixed Orthodontic Appliance System
Anteroposterior Sagittal (AP-Sagittal) Plane Presurgical Orthodontic Objectives
Presurgical Orthodontics Objectives for Transverse Plane
Presurgical Orthodontics Consideration for Vertical Plane
Skeletal Deep Anterior Overbite Pattern
Root Positioning at the Planned Osteotomy Sites and Retaining the Extraction Spaces
Completion of Presurgical Orthodontic Phase
POSTSURGICAL ORTHODONTICS OBJECTIVES
Objectives
Model Surgery (Mock Surgery)
Aims of Model Surgery
Hand Articulation
Protocol for Mock Surgery
Marking Procedure for Models
26:
Orthognathic Surgery: Osteotomy Procedures
HISTORICAL DEVELOPMENT OF ORTHOGNATHIC SURGERY
Biological Basis for Orthognathic Surgery
PROTOCOL FOR OSTEOTOMIES
OSTEOTOMY PROCEDURES
Mandibular Osteotomies can be Divided Into
Soft Tissue Incisions for Osteotomies (Figs 26.2 to 26.6)
Mandibular Body Osteotomy
Anterior Body Osteotomy (Figs 26.7 and 26.8)
Posterior Body Osteotomy (Fig. 26.9)
Midsymphysis Osteotomy (Fig. 26.10)
Segmental Subapical Mandibular Surgeries
Anterior Subapical Mandibular Osteotomy (Figs 26.11 to 26.13)
Posterior Subapical Mandibular Osteotomy Procedure (Fig. 26.14)
Total Subapical Mandibular Osteotomy (Fig. 26.15)
Genioplasties
Augmentation Genioplasty (Figs 26.17 to 26.23)
Reduction Genioplasty (Fig. 26.24)
Straightening Genioplasty Procedure
Lengthening Genioplasty
Mandibular Ramus Osteotomies
Subcondylar Vertical Osteotomy
Intraoral Vertical Ramus Osteotomy (IVRO) and the Inverted L Osteotomy (Fig. 26.32)
Intraoral Modified Sagittal Split Osteotomy (Figs 26.33 to 26.40)
MAXILLARY OSTEOTOMY PROCEDURES
Segmental Maxillary Osteotomy: Surgical Procedures
Surgical Procedure—(Followed at Our institution) (Figs 26.44A to G)
Posterior Maxillary Osteotomy (Fig. 26.48)
LeFort I Osteotomy (Figs 26.49 to 26.61)
Maxillary Advancement
Inferior Positioning of Maxilla (Fig. 26.50)
Leveling of Maxilla
Superior Repositioning of the Maxilla (Figs 26.51 to 26.54)
Superior Positioning of the Entire Maxilla—LeFort I Osteotomy (Figs 26.51 to 26.56)
Superior Positioning of the Maxilla Leaving the Nasal Floor Intact (Figs 26.57 to 26.61)
Superior Positioning of Maxilla—Leaving the Nasal Floor Intact (Horseshoe-shaped Osteotomy) (Figs 26.57 and 26.59)
SECTION 5: MAXILLOFACIAL TRAUMA
27:
Basic Principles for the Management of Maxillofacial Injuries
GENERAL CARE OF THE INJURED PATIENT
General Considerations
BASIC PRINCIPLES OF TREATMENT OF A SEVERE MAXILLOFACIAL INJURIES
BASIC ABCS TO BE FOLLOWED FOR PRESERVATION OF LIFE
A: Maintenance of Patency of Airway
Clinical Signs and Symptoms of Respiratory Distress (Obstruction)
Causes of Respiratory Obstructions Related to Maxillofacial Injuries (Fig. 27.2)
Treatment for Airway Maintenance (Nonsurgical) (Figs 27.3 and 27.4)
Surgical Treatment
B: Bleeding or Hemorrhage Control
C: Consciousness Restoration/Circulation Maintenance
SOFT TISSUE INJURIES
Wound Management
Types of Soft Tissue Wounds and Management (Figs 27.7 and 27.8)
Abrasions
Contusion
Hematomas
Lacerated Wounds
Incised Wounds
Penetrating and Punctured Wounds
Crushed Wounds
Gunshot Injuries (High Velocity Missile)
Treatment of Lacerated Wounds
Supportive Therapy
Factors Modifying Wound Healing or Leading Towards Failure
28:
Injuries of the Maxillofacial Skeleton
ETIOLOGY OF MAXILLOFACIAL INJURIES (table 28.1)
Preliminary Examination
History of the Injury to the Patient
LOCAL CLINICAL EXAMINATION OF MAXILLOFACIAL INJURIES
Extraoral Examination
Inspection
Palpation (Figs 28.1A to H)
Intraoral Inspection
Intraoral Palpation
Radiological Examination
Fractures of the Jaw Bones
Classical Clinical Signs and Symptoms of Fracture of the Jaws
Basic Principles of Treatment of a Fracture
Different Types of Dental Wiring Techniques (Figs 28.4 to 28.8)
Armamentarium for Wiring
Essig's Wiring (Fig. 28.4)
Gilmer's Wiring (Fig. 28.5)
Risdon's Wiring (Fig. 28.6)
Ivy Eyelets Wiring (Figs 28.7A to C)
Col. Stout's Multiloop Wiring (Figs 28.8A to C)
Arch Bars (Fig. 28.9)
Custom Made Splints
Acrylic Splints
Wiring Procedure
Peralveolar Wiring Procedure (Fig. 28.12)
Circumferential (Circummandibular) Wiring Procedure (Figs 28.13 and 28.14)
Methods of Fixation
Treatment without any Form of Fixation
Treatment with Intraoral Fixation Alone
External Fixation (Figs 28.16 to 28.19)
Internal Fixation
Construction of Plaster of Paris Headcap
Armamentarium
Procedure
Antral Approach
Internal Fixation by Means of Bone Plate Osteosynthesis
Bone Plate Osteosynthesis (Figs 28.29A to C)
AO System (Figs 28.30 to 28.33)
Miniplate Osteosynthesis (Noncompression Monocortical Screw System)
Anatomy and Biomechanics of the Mandible
Champy's Ideal Osteosynthesis Lines (Figs 28.34 to 28.37)
29:
Fractures of the Middle Third of the Facial Skeleton
MIDDLE THIRD OF THE FACIAL SKELETON
Bones Constituting the Middle Third of the Face (Fig. 29.1)
Physical Characteristics of the Midfacial Skeleton
Applied and Surgical Anatomy
Supporting Vertical and Horizontal Pillars of the Maxillary Skeleton (Figs 29.6 and 29.7)
Horizontal Pillars
Nerve Supply
Important Blood Vessels
Surgical Anatomy
CLASSIFICATION OF FRACTURES OF MIDDLE THIRD OF FACIAL SKELETON (FIGS 29.9 to 29.18)
LeFort I Fracture (Low Level, Subzygomatic Fracture) (Fig. 29.12)
Clinical Signs and Symptoms of LeFort I Fracture
LeFort II (Pyramidal or Subzygomatic) Fracture (Fig. 29.13)
Clinical Signs and Symptoms of LeFort II Fracture
LeFort III Fracture (Transverse or Suprazygomatic) Fracture (Fig. 29.14)
Clinical Signs and Symptoms of LeFort III Fracture
Midline Separation of the Maxilla (Figs 29.8 and 29.15)
Modification of LeFort‘s Fracture Classification
Rowe and William's (1985) Classification
FRACTURES OF THE ZYGOMATIC COMPLEX
Applied Anatomy
Classification of the Zygomatic Complex Fracture (Rowe and Killey 1968) (Figs 29.16 and 29.17)
Signs and Symptoms
DIPLOPIA
Monocular Diplopia
Binocular Diplopia
Physical Interference
Functional Interference
Neurological Causes
Testing the Motions of the Eye and Diplopia (Fig. 29.20)
Differentiating Points for Etiology of Diplopia
ENOPHTHALMOS
Clinical Features of Enophthalmos
Blindness
30:
Principal of Treatment of Midfacial Fractures
METHODS OF REDUCTION FOR MIDFACE FRACTURES
Manual Reduction
Reduction by Traction
Conservative Treatment
Supervised Spontaneous Healing
Open Reduction (Figs 30.3 to 30.6)
Fracture of the Floor of the Orbit (Blow-out Fracture)
TREATMENT OF FRACTURES OF THE ZYGOMATIC BONE
Operative Technique
Gillies Temporal Approach (Figs 30.11 to 30.13 and 30.19)
Intraoral Procedure (Figs 30.15 and 30.16)
Malunion of the Zygomaticomaxillary Complex
FRACTURES OF THE NASAL BONE AND TREATMENT (FIGS 30.24 TO 30.28)
Diagnosis of Fractures of Nasal Bones
Radiographic Evaluation
Management
31:
Applied Surgical Anatomy of the Mandible and Classification of Mandibular Fractures
ANATOMY OF THE MANDIBLE
Areas of Weakness (Vulnerable for Fracture)
Blood Supply
Nerve Supply
Muscle Action
Factors Influencing Displacement of a Mandibular Fracture
Symphysis Fracture
Canine Region Fracture
Body Fracture of the Mandible
Fractures of the Edentulous Mandible
MANDIBULAR FRACTURES
Number of Fractures Per Mandible
Classification
1. Kruger's General Classification (Figs 31.3A to E)
2. Anatomical Location
3. Relation of the Fracture to the Site of Injury
4. Completeness
5. Depending on the Mechanism
6. Number of Fragments
7. Involvement of the Integument
8. Shape or Area of the Fracture
9. According to the Direction of Fracture and Favorability for Treatment
10. According to Presence or Absence of Teeth in Relation to the Fracture Line
11. AO Classification (Relevant to Internal Fixation)
Fracture Formula
32:
Management of Mandibular Fractures
MANDIBULAR FRACTURES IN CHILDREN
Conservative Therapy
Conservative Treatment with Splints
Open Reduction
MANAGEMENT OF MANDIBULAR FRACTURES IN ADULTS (TABLE 32.1)
Closed Reduction
Indications
Advantages of Open Reduction and Direct Fixation
Indications for Open Reduction
Contraindications for Open Reduction
SURGICAL APPROACHES TO THE MANDIBLE (FIGS 32.3 TO 32.13)
Intraoral Approach—Symphysis and Parasymphysis Region (Figs 32.4A and B)
Intraoral (Body, Angle, Ramus Region): Transbuccal Incision (Figs 32.5A to D)
Extraoral Submandibular Risdon's Incision (Fig. 32.6)
Transosseous Wiring (Intraosseous Wiring)
Intraoral Transalveolar or Upper Border (Superior Border) Wiring (Figs 32.12A and B)
Extraoral Lower Border (Inferior Border) Transosseous Wiring (Figs 32.10, 32.11 and 32.13)
BONE PLATING IN MANDIBULAR FRACTURES
Advantages
Simple Noncompression Bone Plates
Miniplate Osteosynthesis
Compression Plates
Reconstruction Plates
33:
Fractures of the Condylar Process and Its Management
CLASSIFICATION OF CONDYLAR FRACTURES (FIGS 33.1 TO 33.10)
Etiological Factors Leading to Condylar Fractures
DIAGNOSTIC FINDINGS OF CONDYLAR FRACTURES
TREATMENT OF CONDYLAR FRACTURES
Nonsurgical Management of Condylar Fractures
Surgical Correction of Condylar Fractures
Absolute Indications for Open Surgery
Relative Indications (Figs 33.8 to 33.13)
Surgical Approach to the Condyle
Methods of Fixation of Condylar Fractures (Figs 33.14 and 33.15)
Malunion (Dysarthrosis or Meta-arthrosis) and Pseudoarthrosis
SECTION 6: PREPROSTHETIC SURGERY
34:
Preprosthetic Surgery
ORAL AND MAXILLOFACIAL PROSTHETICS
Objective of the Preprosthetic Surgery
Denture Base Areas of Concern
Pathophysiology of Edentulous Bone Loss
Causes of Bone Loss
Patterns of Bone Loss
Characteristics of Ideal Denture Base Area
Aims of Preprosthetic Surgery
Treatment Planning and Examination
Facial Esthetic Examination
Intraoral Examination
Supporting Soft Tissue Examination
PREPROSTHETIC SURGICAL PROCEDURES
ALVEOLAR RIDGE CORRECTION (TABLE 34.3)
Alveolectomy (Labial) (Figs 34.1A to E)
Alveoloplasty (Fig. 34.2)
Simple Conservative Alveoloplasty with Multiple Extractions (Fig. 34.2)
Intraseptal Alveoloplasty—Dean's Alveoloplasty with Repositioning of Labial Cortical Bone (Figs 34.3A to D)
Obwegeser's Modification for Intraseptal Alveoloplasty
Alveoloplasty after the Postextraction Healing
Excision of Tori
Technique for Excision of Palatal Torus (Figs 34.6 and 34.7)
Mandibular Torus Removal
Maxillary Tuberosity Reduction and Exostosis Removal (Figs 34.8 and 34.9)
Soft Tissue Surgeries for the Correction of Alveolar Ridge
Frenectomy
Lingual Frenectomy (Figs 34.12 and 34.13)
RIDGE EXTENSION PROCEDURE
Labial Vestibular Procedures
Kazanjian Technique (1924): Oldest Technique (Figs 34.14 and 34.15)
Godwin's Modification (1947)
Clark's Technique (Figs 34.17A to D)
Obwegeser's Modification (1959)
Lingual Vestibuloplasty
Trauner's Technique
Caldwell's Technique
Obwegeser's Technique (Combination of Buccal and Lingual Vestibuloplasty) (Figs 34.18A to C)
Submucosal Vestibuloplasty Technique (Figs 34.19A to D)
Maxillary ‘Pocket Inlay’ Vestibuloplasty (Obwegeser)
Mental Nerve Transposition
RIDGE AUGMENTATION PROCEDURES
Aims
Limitations
Mandibular Augmentation
Disadvantages
Advantages
Interpositional Bone Grafts (Sandwich Grafting) (Fig. 34.22)
Advantages
Onlay Grafting
Advantages
Visor Osteotomy
Modified Visor Osteotomy (Fig. 34.23)
Disadvantages
Sinus Lift Procedure or Sinus Grafting
Augmentation in Combination with Orthognathic Surgeries
Problems Encountered with Augmentation Technique
SECTION 7: CYSTS AND TUMORS OF THE OROFACIAL REGION
35:
Cysts of the Jaws and Oral/Facial Soft Tissues
CYST FORMATION
Cyst Initiation
Cyst Enlargement
Increase in the Volume of its Contents
Secretions
Epithelial Proliferation
Bone Resorption
Cyst Regression
INTRAOSSEOUS CYSTS
Odontogenic Epithelial Origin
Primordial Cyst
Dentigerous (Follicular) Cyst
Developmental Lateral Periodontal Cysts
Botryoid Odontogenic Cyst
Calcifying Epithelial Odontogenic Cyst (CEOC): Gorlin Cyst (Figs 35.7A to F)
Inflammatory (Periodontal) Radicular Cysts (Fig. 35.8)
Residual Cyst (Figs 35.9A to F)
Multiple Cystic Lesions of the Jaws
Intraosseous Cyst of Nonodontogenic Epithelial Origin
Developmental Fissural Cysts (Fig. 35.11)
Median Mandibular Cyst
Median Palatal Cyst
Globulomaxillary Cyst
Nasopalatine Duct Cyst
Nonodontogenic Nonepithelial Bone Cysts (Cyst like Conditions)
Solitary Bone Cyst
Stafne's Idiopathic Bone Cavity (Mandibular Salivary Gland Depression)
Aneurysmal Bone Cyst
Cysts Associated with the Maxillary Antrum
Surgical Ciliated Cyst of the Maxilla
Benign Mucosal Cyst of the Maxillary Antrum
SOFT TISSUE CYSTS OF THE ORAL CAVITY
Odontogenic (Developmental) Cysts
Gingival Cysts
Gingival Cyst of the Adult
Gingival Cyst of Infants
Nonodontogenic Fissural Cysts
Anterior Median Lingual Cyst
Nasolabial Cyst
Retention (Salivary Glands) Cysts
Mucocele
Ranula
Nonodontogenic (Developmental) Cysts of the Soft Tissues
Dermoid and Epidermoid Cysts
Lymphoepithelial Cysts
Branchial Cleft Cyst (Cervical/Intraoral)
Thyroglossal Duct Cyst
Cystic Hygroma
Parasitic Cysts
Heterotopic Cysts
Oral Cysts with Gastric or Intestinal Epithelium
General Principles of Treatment of Cysts of the Oral Cavity
Reasons for Treatment of Benign Cysts of the Oral Cavity
Clinical Presentation (Summary of Signs/Symptoms)
Vitality of Teeth
Radiographic Examination
Radiopaque Dyes
Aspiration
Biopsy
Operative Procedures
Marsupialization (Decompression)
Surgical Technique
Modifications of Marsupialization
Marsupialization by Opening into Nose or Antrum
Enucleation
Enucleation with Primary Closure
ACKNOWLEDGMENT
36:
Benign Tumors of the Jaw Bones
ODONTOGENIC TUMORS
Classification of Benign Odontogenic Tumors
NONODONTOGENIC TUMORS
GENERAL PRINCIPLES OF MANAGEMENT OF A JAW LESION
History of the Lesion
Recurrence
Habit
CLINICAL EXAMINATION OF THE LESION
Inspection
Palpation
Imaging
Biopsy
Selection of a Biopsy Technique
PRINCIPLES OF SURGICAL MANAGEMENT OF JAW TUMORS
Enucleation with or without Curettage
Indications
Marginal Resection or Resection without Continuity Defect/Peripheral Osteotomy/ En Block Resection
Segmental Resection of the Jaw (Intraoral Approach) (Fig. 36.4)
Disadvantages of Intraoral Procedure
Maxillectomy
Modifications
Reconstruction
Need for Reconstruction
Timing of Reconstruction
ODONTOGENIC TUMORS OF VARIOUS ORIGINS
Tumors Arising from Odontogenic Epithelium without Odontogenic Ectomesenchyme
Ameloblastoma
Classification
alcifying Epithelial Odontogenic Tumor (CEOT) (Pindborg Tumor)
Squamous Odontogenic Tumor
Clear Cell Odontogenic Tumor (CCOT)
Tumors Arising from Odontogenic Epithelium with Odontogenic Ectomesenchyme with or without Dental Hard Tissue Formation
Ameloblastic Fibroma
Ameloblastic Fibro-odontoma
Ameloblastic Fibrodentinoma
Adenomatoid Odontogenic Tumor (AOT) (Figs 36.34A to P)
Odontoma
Reasons for Excision
TUMORS ARISING FROM ODONTOGENIC ECTOMESENCHYME WITH OR WITHOUT INCLUSION OF ODONTOGENIC EPITHELIUM
Odontogenic Fibroma
Myxoma (Odontogenic Myxoma or Myxofibroma) (Figs 36.41 and 36.42)
Benign Cementoblastoma (Cementoblastoma, True Cementoma) (Figs 36.43A to F)
NONODONTOGENIC LESIONS OF THE JAWS
Osteogenic Neoplasm
Ossifying Fibroma (Figs 36.44 to 36.46)
Juvenile Aggressive Ossifying Fibroma
Osteoma (Figs 36.48 and 36.49)
Benign Osteoblastoma (Figs 36.50A to F)
Osteochondroma (Figs 36.51 to 36.53)
NONNEOPLASTIC BONE LESIONS
Fibro-osseous Lesions of the Jaws
Fibrous Dysplasia of the Jaws (Figs 36.54 to 36.58)
Types
Cemento-osseous Dysplasias
Other Cemento-osseous Dysplasias (Giant Cell Lesions of the Jaw Bones)
KERATOCYSTIC ODONTOGENIC TUMOR
Historical Background
Etiology and Pathogenesis
Clinical Features
Histological Features (Tables 36.7 and 36.8)
Malignant Transformation
Genetics
Treatment
Basal Cell Nevus Syndrome (Gorlin's Syndrome)
Future Trends
SECTION 8: SALIVARY GLAND DISORDERS
37:
Diseases of the Salivary Glands
SALIVARY GLANDS: ANATOMY
Parotid Gland (Fig. 37.1B)
Clinical Considerations
Submandibular Gland (Fig. 37.2)
Clinical Considerations
Sublingual Gland (Fig. 37.3)
Minor Salivary Glands (Fig. 37.4)
Clinical Considerations
SALIVARY GLANDS: PHYSIOLOGY
Functions of Saliva
CLASSIFICATION OF SALIVARY GLAND DISEASES
SALIVARY GLAND DYSFUNCTION
Sialorrhea or Ptyalism
Suggested Surgical Treatment
Xerostomia
SIALOLITHIASIS (FIG. 37.5)
Sialadenitis
Viral Infections
Complications
Investigations
Bacterial Infection
Acute Bacterial Sialadenitis (Fig. 37.10)
Management
Chronic Bacterial Sialadenitis (Figs 37.12 and 37.13)
Management
CYSTS OF THE SALIVARY GLANDS
Mucocele
Types
Pathogenesis
Clinical Features (Figs 37.14A and B)
Differential Diagnosis
Treatment
Ranula (Figs 37.15 and 37.16)
Treatment
Differential Diagnosis
TUMORS OF THE SALIVARY GLANDS
Benign Tumors
Pleomorphic Adenoma
Warthin's Tumor (Papillary Cystadenoma Lymphomatosum)
Malignant Tumors
Mucoepidermoid Carcinoma
Adenoid Cystic Carcinoma
Other Malignant Tumors
NECROTIZING SIALOMETAPLASIA
Clinical Features
Differential Diagnosis
Management
SIALADENOSIS (FIGS 37.20A TO C)
Sjögren's Syndrome
Clinical Features
Laboratory Findings
DIAGNOSTIC IMAGING
Conventional Radiography
Sialography (Figs 37.21 and 37.22)
Indications
Contraindications
Phases of Sialography
Contrast Sialography
Technique
Equipment
Procedure
Radiographic Projections
Observations
Radionuclide Salivary Imaging
Procedure
Phases of Radionuclide Salivary Imaging
Gallium Scanning
Computerized Tomography and Magnetic Resonance Imaging
Techniques of CT Examination (Parotid and Submandibular Glands)
Ultrasound Evaluation of Major Salivary Glands
SALIVARY ANALYSIS
CLINICAL EXAMINATION: DIFFERENTIAL DIAGNOSIS (TABLE 37.6)
History
Duration, Nature and Rate of Growth
Examination
SURGICAL MANAGEMENT
PAROTID GLAND: SUPERFICIAL PAROTIDECTOMY (FIGS 37.23A TO C)
Indications
Approaches
Preventing Injury to the Facial Nerve
Complete Excision of Parotid Gland (Figs 37.25 and 37.26)
Incision and Dissection (Figs 37.27A to E)
Submandibular Salivary Gland (Figs 37.28 and 37.29)
Extra-oral Procedures
COMPLICATIONS OF SURGERY OF SALIVARY GLANDS
Intraoral Approach
Extraoral Approach
Auriculotemporal Nerve or Frey's Syndrome (see Figs 22.21A and B) Gustatory Sweating
Facial Nerve Paralysis
Salivary Fistulae and Sialoceles (Figs 37.30A and B)
SECTION 9: OROFACIAL CLEFTS
38:
Cleft Lip and Cleft Palate Management
INTRODUCTION
INCIDENCE
ETIOLOGY
Hereditary
Environmental Influence
EMBRYOLOGICAL ASPECTS
Formation of the Clefts (Figs 38.5A and B)
Medial Nasal Processes (MNP)
Lateral Nasal Processes (LNP)
CLASSIFICATION
ASSOCIATED DEFORMITIES AND PROBLEMS
Dental Problems
Feeding
Speech Problems
AIMS AND OBJECTIVES OF MANAGEMENT OF CLEFT LIP AND PALATE
GENERAL MANAGEMENT PROTOCOL FOR THE CLEFT PATIENT
MANAGEMENT OF CLEFT LIP
Timing of the Lip Surgery
Preoperative Evaluation
Feeding
Operative Procedure (Figs 38.9 to 38.11)
Unilateral Cleft Lip Repair: Millard's Rotation Advancement Principle
Primary Nasal Correction
Suturing
Postoperative
BILATERAL CLEFT LIP
Principles and Objectives of the Surgical Correction
Repair Both Sides Simultaneously
Technique of Bilateral Lip Repair (Figs 38.15 to 38.20)
Columellar Lengthening
CLEFT PALATE
Basic Functions of Palate
Sucking
Swallowing
Speech
Repair of the Cleft Palate (Figs 38.21 and 38.22)
Treatment Guidelines
Operative Procedure (Figs 38.23A to D)
Postoperative Management
COMPLETE CLEFT LIP AND PALATE DEFORMITY
ORTHODONTICS IN CLEFT LIP AND PALATE
SECTION 10: MAXILLARY SINUS AND ITS IMPLICATIONS
39:
Maxillary Sinus and its Implications
GENERAL CONSIDERATIONS
Anatomy
Blood Supply
Nerve Supply
Embryology (Growth of Maxillary Sinus)
Physiology
Functions
Applied Surgical Anatomy
Relation of the Root Apices with the Floor of the Sinus
Low Incidence of Oroantral Fistula in Children Under Fifteen Years
Circumstances with Increased Likelihood of Oroantral Fistula
Lining of Maxillary Sinus
Cracks and Fractures in the Bony Floor of Maxillary Sinus
Periapical Involvement
Pressure on the Nerves within the Antrum
Tumors Developing in Maxillary Antrum
Paresthesia in Maxillary Teeth Following Surgical Procedures
Mucous Membrane Lining of Antrum Affected by Infection
Antral Puncture
Canine Fossa
Fractures of the Middle Third of Face
Foreign Bodies in the Sinus
Transillumination
CLINICAL EXAMINATION OF MAXILLARY SINUS
RADIOLOGY OF MAXILLARY SINUS
Extraoral Views
Occipitomental View
Lateral Skull
Submentovertex View
Orthopantograph
Intraoral Views
Interpretations
INFECTIONS OF MAXILLARY SINUS
Odontogenic Sinusitis
Definition
Etiology
Spread of Infection to Maxillary Sinus, from Apical Abscess
Clinical Features
Diagnosis
Management
Acute Maxillary Sinusitis
Signs
Symptoms
Other Special Examinations
Management
Chronic Maxillary Sinusitis
Pathophysiology
Diagnosis
Management
Procedure for Surgical Drainage (Fig. 39.9)
OROANTRAL COMMUNICATION AND FISTULA
Definition
Etiology
Extractions
Symptoms: Fresh Oroantral Communication: Remember 5 Es
In Late Stage, Symptoms of Established Oroantral Fistula: Remember 5 Ps
Fate of Clot
Persistence of Fistula
Physical Signs of Established Oroantral Fistula
Signs of Acute Sinusitis
Possible Sequelae
Management
Purpose
Treatment of Early Cases
Supportive Measures
Temporary Therapeutic Measures before Surgical Closure
Treatment of Delayed Cases
Management
Surgical Procedures Used in Closure of Oroantral Fistula
Buccal Flap Advancement Operation
Intranasal Antrostomy
Ashley's Operation
Combination of Buccal and Palatal Flaps (Figs 39.18A and B)
Caldwell-Luc Operation
Caldwell-Luc Surgical Procedure (Figs 39.19A to D)
FUNCTIONAL ENDOSCOPIC SINUS SURGERY
Purpose
Historical Background
Endoscopic Sinus Surgery
Indications
Relative Indications
Diagnosis
Types of Functional Endoscopic Sinus Surgery
Surgical Technique
Sphenoid Sinus
SECTION 11: OROFACIAL AND NECK INFECTIONS
40:
Orofacial and Neck Infections and their Management
ETIOLOGY
PATHWAYS OF ODONTOGENIC INFECTION (FIG. 40.1)
Odontogenic Infections
Acute Stage
Acute Infection (Figs 40.2A to C)
Chronic Stage (Figs 40.3A and B)
General Course of an Odontogenic Abscess
Acute Periapical Abscess
Acute Dentoalveolar Abscess (Table 40.2)
Acute Periodontal Abscess
MICROBIOLOGY
Medical Therapy
Antibiotic Therapy
Choice of Antibiotic Therapy
Surgical Therapy
Surgical Technique for Incision and Drainage of an Abscess
Hilton's Method of Incision and Drainage (Figs 40.4A to H)
SPREAD OF OROFACIAL INFECTION
Routes of Spread
Factors Influencing Spread
General Factors
Local Factors
Pathways of Dental Infections (Fig. 40.5)
Anatomical Factors Influencing the Direction of Spread
Anatomical Considerations in Dentoalveolar Infections
Maxilla
Mandible
EVALUATION OF THE PATIENT WITH OROFACIAL INFECTION
History Taking
Physical Examination
General Examination
Regional Examination
Clinical Features
Clinical Symptoms of Possible Life Threatening Infections
Toxicity—Signs and Symptoms
Central Nervous System Changes Associated with Infection
Radiological Examination
Conventional Radiography
Other Diagnostic Aids
CT View of Various Spaces (Figs 40.6 and 40.7)
Submandibular Space
Sublingual Space
Masticatory Spaces
General Principles of Therapy for the Management of Acute Extensive Orofacial Infection
Antibiotic Therapy
Principles of Surgical Management
POTENTIAL SPACES
Organization of Cervical Fascia (Fig. 40.9)
Space of Burns: Suprasternal Space (see Fig. 40.9)
CLASSIFICATION OF FASCIAL SPACES
Based on the Mode of Involvement
Based on Clinical Significance
Potential Primary Spaces Related to Upper Jaw
Differential Diagnosis of Swellings of Upper Lip
Canine Fossa Involvement (Infraorbital Space)
Buccal Space Involvement (Figs 40.16 and 40.17)
Infratemporal Fossa Space (Fig. 40.19)
Incision and Drainage
Potential Primary Spaces Related to Lower Jaw
Submental Space
Surgical anatomy
Clinical Features (Figs 40.22 and 40.23)
Submandibular Space
Spread
Sublingual Space
Surgical anatomy (Fig. 40.28)
Secondary Potential Fascial Spaces
Temporal Space (Fig. 40.31)
Parotid Space (Figs 40.33 and 40.34)
Masticatory Spaces (Figs 40.35 and 40.36)
Submasseteric Space
Pterygomandibular Space (Table 40.4)
Parapharyngeal Spaces
Lateral Pharyngeal Space (Figs 40.39 and 40.40)
Retropharyngeal Space: Prevertebral Space
Peritonsillar Abscess (Quinsy) (see Fig. 40.39)
Pericoronitis/Pericoronal Abscess
POSSIBLE UNTOWARD OR LIFE THREATENING COMPLICATIONS OF OROFACIAL INFECTION
Ludwig's Angina
Surgical Decompression
Antibiotic Therapy
A Simple Prototype Protocol
Involvement of Carotid Sheath
Brain Abscess
Meningitis
Mediastinitis
Cavernous Sinus Thrombophlebitis: Intracranial Complication (Figs 40.51A and B)
41:
Osteomyelitis and Osteoradionecrosis of the Jaw Bones
OSTEOMYELITIS OF THE JAW BONES
Definition
Predisposing Factors (Table 41.1)
Etiology
Pathogenesis
Osteomyelitis in Maxilla
Microbiology
Classification and Staging
Acute Pyogenic OML (Acute Suppurative OML)
Microbiology
Chronic Osteomyelitis
TYPES OF OSTEOMYELITIS
Infantile OML (OML Maxillaries Neonatorum, Maxillitis of Infancy)
Garre's Sclerosing Osteomyelitis
Chronic Sclerosing OML (Focal and Diffuse)
Actinomycotic OML of Jaws
TUBERCULOUS OSTEOMYELITIS OF THE JAW BONES
Etiopathogenesis
Clinical Presentation of Tuberculous Osteomyelitis of the Jaw Bones
Closed Lesions (Lumpy Jaw) (Fig. 41.22)
Open Lesions (Fig. 41.23)
Diagnosis and Treatment
10-point Protocol Formulated for the Management of Tuberculous Osteomyelitis of the Jaw Bones (Figs 41.24 and 41.25)
OSTEORADIONECROSIS OF THE FACIAL BONES
Definition
Incidence
Etiopathology (Pathological Changes)
Mechanism
Pathological Changes
Factors Involved in Reduction of ORN
Clinical Features
Radiological Features
Treatment
Staging and Treatment Algorithm
Prevention of ORN
Pre-irradiation Dental Care
Post-irradiation Dental Care
SECTION 12: FACIAL NEUROPATHOLOGY
42:
The Trigeminal Nerve (V)
FUNCTIONS
ATTACHMENT
COURSE
DIVISIONS
Type of Fibers
TRIGEMINAL GANGLION
Motor Root
Sensory Root
Ophthalmic Nerve (V1)
Functions
Origin, Course and Branches
Maxillary Nerve (V2)
Functions
Origin, Course and Branches
Branches
Branches Within the Cranium: Middle Meningeal Nerve
Branches in the Pterygopalatine Fossa
Branches in the Infraorbital Canal
Branches on the Face
Mandibular Nerve (V3)
Origin, Course and Branches
Branches
Branches from Undivided Nerve
Branches from Anterior Trunk
Branches of Posterior Trunk
Mylohyoid Nerve
43:
Orofacial Region Pain
INCIDENCE
DEFINITION
BASIC CLASSIFICATION OF PAIN
NEUROPHYSIOLOGY OF PAIN
Pain Perception
Pain Reaction
Noxious Stimuli Causing Pain
TRANSMISSION OF IMPULSES IN THE CNS
Pain Pathways
44:
Trigeminal Neuralgia and its Management
DEFINITION
ETIOLOGY AND PATHOGENESIS
GENERAL CHARACTERISTICS
CLINICAL CHARACTERISTICS
DIAGNOSIS
Protocol for Diagnostic Local Anesthetic Peripheral Nerve Blocks
Material Required
Procedure
TREATMENT
Medicinal Management
Medicinal Line of Treatment (Modification of the Paroxysmal Pain at Cortical Level)
Multiple Drug Therapy
Surgical Treatments (Fig. 44.2) (Peripheral Nerve Surgical Treatments)
Peripheral Nerve Injections
Peripheral Neurectomy (Nerve Avulsion)
Cryotherapy or Cryoneurolysis for Peripheral Nerves
Peripheral Radiofrequency Neurolysis (Thermocoagulation)
Gasserian Ganglion Procedures
Technique for Percutaneous Approach to the Gasserian Ganglion: Anesthesia Protocol
Advantages
Indications
Procedure
Open Procedures (Intracranial Procedures)
Trigeminal Root Section
Update
45:
Sensory Disturbances of Face and Jaws
IMPAIRED SENSATION
ETIOLOGY
INCIDENCE
CLASSIFICATION OF MECHANICAL NERVE INJURIES
Seddon's Classification (Table 45.1)
Tinel's Sign
Neuritis
Neuromas
EVALUATION
MANAGEMENT
Surgical Approach
Nerve Regeneration: New Concept (Fig. 45.12)
Postoperative Management
Long Term Prognosis
46:
Facial Nerve and Motor Disturbances of Face and Jaws
FACIAL NERVE
Anatomical Course and Relationship (Fig. 46.2)
Branches of Distribution of the Facial Nerve
Ganglia
Applied Anatomy
Motor Control
Supranuclear Facial Paralysis
Nuclear Paralysis
Melkersson-Rosenthal Syndrome (Orofacial Granulomatosis)
Crocodile Tear Syndrome
MOTOR DISTURBANCES OF FACE AND JAWS
Etiology Classification
Management
Goals in the Treatment
Evaluation of Facial Nerve Functions
Prognosis
House-Brackmann (1985) Classification
Treatment
Neurorrhaphy Procedures
Factors Influencing the Results of Extracranial Facial Nerve Repair
Technique of Nerve Grafting
Bell's Palsy
Clinical Features
SECTION 13: ORAL MALIGNANCIES
47:
Oral Cancer
INCIDENCE
ANATOMICAL SUBSITES OF CANCER IN THE ORAL CAVITY
Lip Mucosa
Buccal Mucosa
Lower Alveolar Ridge
Upper Alveolar Ridge
Retromolar Gingiva (Retromolar Trigone)
Floor of the Mouth
Hard Palate
Anterior Two-thirds of the Tongue
ETIOLOGY
Tobacco
Alcohol
Tobacco and Alcohol Synergism
Viruses
Poor Dental Hygiene, Constant Chronic Trauma to Mucosa Due to Dental Cause
SPREAD OF SQUAMOUS CELL CARCINOMAS OF THE ORAL CAVITY
ORAL PRECANCER
Definitions (WHO, 1972)
Premalignant Lesion
Precancerous Condition
RISK OF MALIGNANT TRANSFORMATION OF ORAL PREMALIGNANT LESIONS
Trismus can Present in One of the Following Four Groups
Malignant Transformation Rate of OSMF (Fig. 47.7)
Management of OSMF
Chemoprevention for Oral Premalignant Lesions (Table 47.1)
DIAGNOSIS AND STAGING OF ORAL CAVITY CANCER
Clinical Features (Fig. 47.8)
Biopsy
Imaging for Oral Cavity Cancers
Imaging for Assessing Mandibular Involvement (Table 47.2)
Imaging to Assess the Extent of Soft Tissue Spread
FNAC of Neck Nodes
TNM Staging (Table 47.4)
MANAGEMENT
Principles of Management of Early Stage Cancer
Advantages of Surgery
Disadvantages of Radiotherapy
Radiotherapy in Early Oral Cavity Cancer
Brachytherapy
Postoperative Radiation Therapy to the Neck is Indicated
Surgical Technique for Resection of Early Oral Cancers
Approaches to Oral Cavity
Marginal Mandibulectomy
Types and Indications for Marginal Mandibulectomy
Principles of Management of Locally Advanced Oral Cavity Cancers
Surgery for Locally Advanced Cancer
Types of Segmental Resections of the Mandible
Principles of Reconstruction (Table 47.7)
Mucosal Defects can be Delt with Following Modalities
Reconstruction of Mandibular Defects
MANAGEMENT OF THE NECK LYMPH NODES
Clinical Examination of Neck Lymph Nodes
Clinical Signs of Extracapsular Spread
Assessment of the Extend of Involvement of Clinically Negative Lymph Nodes
LYMPH NODE LEVELS (FIGS 47.16A AND B)
Nodal Metastasis
CLASSIFICATION OF NECK DISSECTION (Figs 47.17A TO C)
Radical Neck Dissection (RND)
Modified Radical Neck Dissection (MRND)
Selective Neck Dissection (SND)
Extended Neck Dissection
Adjuvant Treatment
SURVIVAL AND PROGNOSIS
ROLE OF DENTAL PRACTITIONER IN ORAL CANCER MANAGEMENT
Preoperative Dental Work-up
SECTION 14: IMPLANTOLOGY IN ORAL AND MAXILLOFACIAL SURGERY
48:
Dental Implants
IMPLANT MATERIALS
TITANIUM IMPLANTS
CLASSIFICATIONS OF DENTAL IMPLANTS (FIG. 48.2A)
Based on Shape and Form
Post or root form implants
Blade implants
Based on Surface Characteristics
Based on Implant Tissue Interface
Based on Foundation
Based on Mode of Retention of Prosthesis
Based on Various Systems
Immediate Implants
Transient Implants for Immediate Loading
Parts of Implant
BIOLOGIC PARAMETERS FOR IMPLANTS ACCEPTANCE
Material Biocompatibility
Implant Design
Implant Surface
Host Site
INDICATIONS AND CONTRAINDICATIONS
PRESURGICAL INVESTIGATIONS
ANESTHESIA
INSERTION OF IMPLANT
Surgical Steps
Incision
Drilling into Bone
Drilling
Drilling Speed
Insertion
Irrigation
Closing the Wound
COMPLICATIONS
AILING V/S FAILING IMPLANT
Healing Period
Impressions for Loading
CLINICAL PHOTOGRAPHS
49:
Implants—An Overview
IMPLANTATION
Dental Implant (According to Glossary of Prosthodontic Terms, 8th Edition)
OSSEOINTEGRATION OR OSSEOUS INTEGRATION (1993) GLOSSARY OF PROSTHODONTIC TERMS-8 (FIGS 49.1A AND B)
1. Brånemark's Theory of Osseointegration
2. Weiss’ Theory of Fibro-osseous Integration
Osseointegration Process
RATIONALE FOR IMPLANT TREATMENT
CLASSIFICATIONS FOR IMPLANT TREATMENT
ADVANTAGES OF DENTAL IMPLANTS
ANATOMY OR PARTS OF AN IMPLANT (FIG. 49.15)
PATIENT SELECTION CRITERIA
Indications (Adell, Zarb and Lindquist)
Absolute Contraindications/Medical/Systemic Factors
Relative Contraindications
Intraoral Examination of a Partially Edentulous Patient
Intraoral Examination for Completely Edentulous Patients
Radiographic Assessment
Periapical Radiographs Aids in Assessing
Cephalometric Radiograph
COMPUTED TOMOGRAPHY
Cone Beam Computer Tomography
Interactive Computer Tomography
Basic Treatment Order
ARMAMENTARIUM FOR IMPLANT SURGERY (FIG. 49.25)
BASIC FACTORS IN IMPLANT SURGERY
Avoidance of Thermal Injury to the Bone
PLACEMENT OF THE IMPLANT IN AN ACCEPTABLE POSITION
PREOPERATIVE CARE
ANESTHESIA
INCISIONS
BASIC FLAP DESIGN AND SOFT TISSUE HANDLING
POSTOPERATIVE INSTRUCTIONS
ABUTMENT CONNECTION
SURGICAL COMPLICATIONS OF IMPLANT THERAPY
Diagnosis and Management of Complications
Wound Dehiscense
Early Implant Failure
Damage to Neurovascular Structures
Fractures
Soft Tissue Complications
Spiekermann's Classification of Defects Following Periimplantitis (Figs 49.31A and B)
NONSURGICAL MANAGEMENT OF PERIMPLANTITIS
SURGICAL MANAGEMENT OF PERIMPLANTITIS
ABSOLUTE INDICATION FOR EXPLANTATION (TABLE 49.2)
Prosthetic Complications
LONG TERM MAINTENANCE PROTOCOL FOR IMPLANTS
Patient's Role
Dental Hygienist's Role
Dentist's Role
SECTION 15: HEMORRHAGE AND SHOCK
50:
Hemorrhage and Shock: Its Management in Oral Surgery
HEMORRHAGE
Types of Hemorrhage
Depending on the Type of Blood Vessel Involved
Primary, Reactionary, Intermediate Bleeding and Secondary Bleeding
Internal or External Bleeding
Spontaneous Bleeding
Hemostasis
Primary Hemostasis
Secondary Hemostasis
Clinical Evaluation of the Bleeding Patient
Laboratory Tests for Screening
Bleeding Time
Platelet Count
Prothrombin Time
Partial Thromboplastin Time
Local Hemostatic Measures
Mechanical Methods
Thermal Agents
Chemical Methods
Control of Hemorrhage from Major Arteries
Greater Palatine Artery
Sublingual Artery
Ligation of Lingual Artery
Ligation of Facial Artery
Ligation of Maxillary Artery
Superficial Temporal Artery
External Carotid Artery
Ligation of External Carotid Artery in Carotid Triangle
Ligation of External Carotid Artery in Retromandibular Fossa
Hereditary Coagulopathies
Hemophilia A
Hemophilia B
Management of Patients with Von Willebrand's Disease
Three Main Roles of VWF in Hemostasis
Acquired Coagulation Factor Disorders
Vitamin K Deficiency
Coagulopathy Associated with Liver Diseases
Concept of International Normalized Ratio and Management of a Patient on Oral Anticoagulants
SHOCK
Classification
Hypovolemic Shock
Monitoring
Treatment
Cardiogenic Shock
Septic Shock
Neurogenic Shock
SECTION 16: MISCELLANEOUS
51:
HIV Disease— An Overview
HISTORY AND ORIGIN
Structure
Human Cells/Cell lines and Tissue Susceptibility to HIV
Susceptibility
Global Scenario
Indian Scenario
Epidemiological Features
Agent Factors
Host Factors
Modes of HIV Transmission
RATE OF PROGRESSION
Viral Transmission
Primary HIV infection
Seroconversion
Early HIV Disease
Window Period of HIV Infection
Asymptomatic Infection
Oral Lesions and their Management
Fungal Lesions
Candidiasis
Clinical Features
Pseudomembranous Candidiasis (Thrush)
Erythematous Candidiasis
Angular Cheilitis
Hyperplastic Candidiasis (Fig. 51.2)
Differential Diagnosis
Diagnosis
Histoplasmosis
Cryptococcus Neoformans
VIRAL LESIONS
Herpes Simplex
Clinical Features
Differential Diagnosis
Prognostic Significance
Herpes Zoster (Shingles)
Clinical Features
Differential Diagnosis
Treatment
Human Papillomavirus Lesions
Clinical Features
Differential Diagnosis
Prognosis
Treatment
Cytomegalovirus Lesions
Hairy Leukoplakia and Ebstein-Barr Virus
Hairy Leukoplakia and Progression of HIV Disease
Clinical Appearance and Manifestations
Differential Diagnosis
Diagnosis
Treatment
BACTERIAL LESIONS
Periodontal Disease
Clinical Features
Differential Diagnosis
Treatment
Different Course in HIV Infection
MYCOBACTERIUM AVIUM-INTRACELLULARE
NEOPLASTIC LESIONS
Kaposi's Sarcoma
Clinical Features
Differential Diagnosis
Treatment
LYMPHOMA
Clinical Features
Differential Diagnosis
Treatment
OTHER LESIONS ASSOCIATED WITH HIV DISEASE
Oral Ulceration
Diagnosis
Treatment
Idiopathic Thrombocytopenic Purpura
Clinical Features
Differential Diagnosis
SALIVARY GLAND DISEASE AND XEROSTOMIA
Management
MANAGEMENT OF OCCUPATIONAL EXPOSURE AND POST EXPOSURE PROPHYLAXIS
HIV TESTING AND COUNSELING
Different HIV Antibody Assays
Rapid Tests
Western Blot
Transfusion Safety
Diagnosis of HIV in the newborn
Goals of HIV Pretest Counseling
Aims ofpost testcounseling
Reproductive Health Services
PROTOCOL FOR TREATING HIV POSITIVE PATIENTS
Theatre
Personnel
Spillage
Instruments
Sharps
Laboratory Specimens
DISINFECTANTS
SECTION 17: RECENT ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY
52:
Recent Advances in Oral and Maxillofacial Surgery
INTRAOPERATIVE NAVIGATION AND ROBOTIC SURGERY
Minimal Invasive Surgery and Role of Endoscopes in Oral and Maxillofacial Region
Tissue Regeneration/Engineering in Oral and Maxilla-Facial Surgery
Approaches to Tissue Engineering
Advances in Local Anesthetics
Articaine
Reversing Effects of Local Anesthesia
Local Anesthesia Delivery Devices
Advances in General Anesthesia Technique
Submental Intubation in Maxillofacial Trauma Patients
Retromolar Intubation Technique
Advances in TMJ Surgery
Advances in TMJ Arthroscopy and One Point Arthroscopy
BUCCAL PAD OF FAT IN TMJ RECONSTRUCTION
Recent Advances in Maxillofacial Trauma Management
Intermaxillary Fixation Screws
Rapid IMF
SonicWeld Treatment
Self-Drilling, Self-Tapping Screws
LOCKING PLATES AND SCREWS SYSTEM
3D plates
Trapezoidal Condylar Plates
Delta Plate Fixation for Condylar Fractures
Porous Polyethylene Implants (Figs 52.24A to D)
Advances in Topical Hemostatic Agents
Ostene
ActCel
Gelitacel
Chitosan Products
HemoStase
Quikclot
Floseal
Fibrin Sealants
Artiss
Feracrylum
53:
Cone Beam Computed Tomography
HISTORY
TECHNICAL BASIS OF CBCT
Multiplanar Reformation
Radiation doses for CBCT
3D image construction in CBCT
1st Step—Thresholding Step
2nd Step
3rd Step—Acquisition Stage—Image Collection
4th Step
Image Formatting/reporting
CBCT Indications (Table 53.5)
APPLICATION OF CBCT IMAGING TO CLINICAL DENTAL PRACTICE (TABLE 53.2)
ROLE OF CBCT IN DENTAL IMPLANTLOGY (FIGS 53.14 TO 53.17)
ADVANTAGES OF CBCT (TABLE 53.4)
Drawbacks
WORD OF CAUTION! (TABLE 53.5)
Requisite for Clinicians
3D C arm
BASIC PRINCIPLES FOR USE OF DENTAL CONE BEAM CT
54:
Lasers in Oral and Maxillofacial Surgery
INTRODUCTION
Fundamentals of Laser Operation
Laser Physics
Components of Laser System (Figs 54.1 A and B)
PHYSICAL PROPERTIES OF LASER
Monochromaticity
Directionality
Coherence
Brightness
CHARACTERISTICS OF LASER
Electromagnetic Spectrum
Photobiology of Lasers
LASER INTERACTION WITH oral BIOLOGIC TISSUES
Absorption
Transmission
Reflection
Scatter
Photocoagulation
Photodynamic Therapy (PDT) with Lasers
Final Laser Delivery Mechanisms to the Tissues (Figs 54.14 to 54.16)
Noncontact Laser System (Free Beam Lasers)
Modification of Free Beam Laser Surgery
CLASSIFICATION OF LASERS
General Classification of Lasers
Class 1 Laser
Class 1 M Laser
Class 2 M Laser
Class 3B
Class 4 Lasers
Laser Classification as per the Medium Used
Semiconductor Lasers
Classification Based on Applications
Classification Based on Mode of Action
Classification Based on Radiant Energy Generation
Classification Based on Wavelength and Medium (Table 54.7)
Medical Laser Classification Based on Level of Energy Emission
ADVANTAGES OF LASER
APPLICATIONS OF LASER IN ORAL AND MAXILLOFACIAL SURGERY AND DENTISTRY (TABLE 54.8)
Factors Affecting the Lateral Zone of Necrosis Include
TECHNIQUES FOR USE of lasers IN ORAL AND MAXILLOFACIAL SURGERY
Technique for Incisional Biopsy (Figs 54.21A to C)
Ablation and Vaporization Procedures (Figs 54.24A to D)
Use of the Holmium Laser in Temporomandibular Joint Surgery
SCAR REVISION WITH LASER
USE OF ER: YAG LASER
LOW LEVEL LASER THERAPY
Laser Safety
Primary Hazards
Secondary Hazards
Duration of Exposure and Eye Protection
Maximum Permissible Exposure (MPE-Values)
Operating Room Safety
Patient Safety
Personnel Safety
CONNECTIONS AND TRAFFIC
STERILIZATION AND INFECTION CONTROL OF LASER UNIT
55:
Piezosurgery
WHAT IS PIEZOSURGERY?
PIEZOSURGERY DEVICE
Piezosurgery Device is an Ultrasound Machine
TECHNIQUE
ADVANTAGES OF PIEZOSURGERY
Maximum Safety
BIOLOGICAL EFFECTS ON BONE CUT BY Piezosurgery device
Disadvantage/Limitation
Clinical Success
Benefits for Patients
Recent Developments (Fig. 55.17)
56:
Appendices
INDEX
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