LONG ESSAYS
Question 1
What is oral maxillofacial surgery? What are its indications and what are the specialised instruments used?
Answer
Oral and maxillofacial surgery is that branch of dentistry that is involved in the diagnosis and surgical treatment of injuries, diseases and defects.
Indications of Oral and Maxillofacial Surgery
- Extraction of impacted teeth
- Extractions of decayed teeth
- Non-vital tooth extraction
- Pre-prosthetic surgeries
- Implants
- Orthodontic extractions
- Root fragment removal
- Removal of cysts and tumours
- Biopsy
- Mandibular and maxillary fractures
- Temporomandibular joint surgery
- Reconstructive surgery
- Treatment of cleft lip and palate
- Surgery of salivary gland diseases or tumours.
Specialised Instruments used for Oral Surgery
- Elevators are used to ease the procedure of extraction by loosening the periodontal ligament by applying leverage against the tooth. Various kinds of elevator are as follows:
- Periosteal elevator
- Straight elevator
- Root tip picks.
- Surgical curettes are used to clean and scrape the interior of the tooth socket to remove diseased tissue
- Rongeurs are used to reshape the bone
- Bone file are used to smoothen the rough margins of the alveolar bone
- Scalpel is a surgical knife used to give incisions
- Haemostat is used to hold or grasp things. It can also be used to control the bleeding
- Needle holder is used to hold the suture needle
- Surgical scissors used for trimming the tissues
- Suture scissors is used for cutting the suture thread
- Retractors are used to hold or retract tissue during surgery
- Mouth prop is also known as a bite-block. It allows the patient to rest and relax the jaw muscles during surgery
- Chisel helps in bone removal or in splitting teeth
- Mallet is the pressure source used on the chisel handle
- Surgical burs:
- They are used to remove the bone or to cut or split the crowns of the teeth
- They have an extra-long shank.
Question 2
What are the preparations done for the surgery? Enlist the various surgical procedures along with the post-operative care procedures?
Answer
The preparations done for the surgery are as follows:
- Advanced preparations:
- Radiographs and records should be in order
- Consent form signed by the patient should be there
- All laboratory tests should be performed
- Surgical setup should be prepared and sterilised
- If giving any premedication, proper instructions should be given.
- Preparation of treatment room:
- There should be placement of protective barriers
- Surgical instruments should be kept in sterile wraps
- Post-operative instructions should be ready to provide to the patient.
- Patient preparation:
- Medical history and laboratory reports should be updated
- Radiographs should be placed on view box
- Vital signs should be recorded properly
- Patient should be properly seated and draped
- Chair should be positioned properly
- At the time of surgery:
- ➢ Proper asepsis should be maintained
- ➢ Instruments should be transferred and received
- ➢ Aspiration and retraction should be done when needed
- ➢ Operating field should be clean and should have a proper light
- ➢ Patient's vital signs should be monitored properly
- ➢ Patient's head and mandible should be positioned in the correct manner.
- Post surgery:
- ➢ Patient should not be left alone
- ➢ Post-operative instructions should be given verbally as well as in written
- ➢ A post-operative visit should be scheduled
- ➢ Patient's treatment records should be updated
- ➢ Treatment area should be disinfected post surgery
- ➢ Follow-up appointment should be given.
Various Surgical Procedures
Forceps Extraction
- It is the surgical removal of a fully erupted tooth which has an intact crown and can be grasped firmly with the forceps
Multiple Extractions and Alveoloplasty
- In cases of multiple extraction procedure, generally contouring and smoothening of the alveolar ridge is required, which is known as alveoloplasty
Impacted Teeth Removal
- It is a complex extraction of a tooth which has not erupted completely or fully:
- Soft tissue impaction
- Hard tissue impaction.
Biopsy
- It is the surgical removal and examination of lesions of the oral cavity:
- Incisional biopsy
- Excisional biopsy
- Exfoliative cytology.
Post-operative Care Procedure
Control of Bleeding
- In order to control bleeding, clot formation should be encouraged, and a gauze piece is folded and placed at the bleeding site to control bleeding
- At least 30 minutes gauze should be placed
- In case bleeding does not stop, then inform to the dentist
- Clot should not be disturbed
- Strenuous work or physical activity is restricted that day
- Avoid drinking with straw as the clot may dislodge
- Ask the patient to take ice cream half an hour post-extraction as it will constrict blood vessels
- Advice semi solid or soft diet
- Prescribe an analgesic SOS.
Control of Swelling
- Ibuprofen should be given before and after surgery
- During the first 24 hours, a cold pack is placed
- External heat is applied to the area of the face after the first 24 hours to increase circulation in the tissues and to promote healing
- Patient can begin gently rinsing the oral cavity with warm saline solution, after the first 24 hours.