Oral surgery sheet # 3 - Haitham Alnoti

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Oral surgery sheet # 3 - Haitham Alnoti

Post by Shadi Jarrar on 11/10/2011, 1:10 am


By the name of God

Surgical instruments and principles of exodontia

Note: this lecture is very important in the practical final exam.

The surgical instruments (that you must be familiar with them by the end of this course) include the following:

# surgical blade and scalpel handle.

Blades (that we are interested in ) are of four types:

- Size 15 : the most common one , used intraorally

- Size 10 : almost the same (shape) ,but it is larger than size 15 and used for extraoral skin (or any skin ).

- Size 11 : like poniard ( $ebryeh ) ,used for stab incisions (26a3n )… with abscess collection usually in the oral cavity ( abscess in the skin is not your major as an oral surgeon( it needs a plastic surgeon ) except if it has an odontogenic origin…… so you must know your specialty limits ,otherwise you may cause problems to the patient like cosmetic problem in the facial lesion ….etc. ) .

- Size 12 : hook shape blade ,used to reach inaccessible areas like the vault of palate ( in the case of cleft lip\palate, we may make incision for flap or something else ) .

Note: - you should distinguish between scalpel handle and surgical blade.

- There are two types of extraction :

· Closed extraction which we will do as beginners (we use local anesthesia and forceps) .

· Opened extraction or surgical extraction.

· Teeth may fracture during extraction (especially with wisdom teeth)…… don't panic. It usually occurs.. Just try to use elevator.. if this doesn't succeed ,you needs to make flap( we incise the mucoperiosteal membrane to reach the periosteam …. Anyway, there are different designs of flaps ….

# fryer

- After incise the flap, we need something to elevate the flap which is the fryer or mucoperiosteal elevator (or retract the flap if I don't have retractor ).

- It has two ends; + the first looks like spoon (with concave side toward the bone and convex side toward the periosteam since it is smooth) .. We must carry the fryer in a way enable us to keep the periosteam intact .why?!!

Because it contains the blood supply for the flap , so if we injure it … tissue necrosis may occur in our flap due to the absence of blood supply .

+ The other end is pointed …. It is used to elevate the interdental papillae after making the incision.

- There are modified forms of fryers like + the one with handle (has one end) … the addition of handle is for force delivery ( we need controlled force ) .

+ Specialized fryer called Mitchell fryer used in the cleft lip\ palate repair (scoring of cleft as the problem in this case is the absence of tissues ).

# Retractor (right angle retractor)

Used to retract the flap .there are other retractors for cheek (to open the mouth widely), and tongue (called malleable retractor …it must be smooth).

Note: there is special retractor (with two angles) to reach the highly impacted upper molars (wisdom)…… so we have different designs of retractors to reach different areas.

# Forceps

This is different from the forceps used in cons (tweezer) ….it may have notches at its' ends and this is called tooth forceps … or without these extensions, and this is called surgical forceps.

- Tooth(tissue ) forceps is used to grasp the tissue ruminants or the tooth itself from the socket after extraction

- Tissue forceps is also used to catch the tissue (flap) during suturing after the extraction completion (has notches).

# Clip

Which has a joint that can be opened and closed…..Used in toweling (of the patient) in both major and minor surgeries.

- As you know, in minor surgery we need clean protocol in sterilization …. So it is best to cover the patient mouth with towel …. Then we use clip to fix(clip) it.

- We also use clips in major surgeries where sterilized environment is mandatory …. We use them to clip the different towels used in these surgeries.

Note: there is forceps with special working end ( smooth pointed) used to catch the tooth after extraction ( like open surgery for wisdom tooth ).

# Bone neplar (8are6 2l3a6'em)

It is also called Rongeur, used as bone cutting instrument (if you have a sharp specule after tooth extraction, it can be used to remove it ….. it is a non rotary instrument to remove bone… it has a string like design.

- So we can remove bone using; Rongeur, rotary instrument (fissure or round bur) , or bone file ( which has a rough working end to smoothen rough bone ( like mabrad ).

- Note the design of it's handle, joint , working end with tip or side cutting technique .

# another instrument to remove bone (old one) is surgical mallet and chisel (2zmeel , which can be bibeveled or unibeveled) …. It has a triangular cross section ( both types).

- It is not preferable to use it under local anesthesia, since it may cause panic to the patient …. Also it is not used in maxilla because it consist of soft bone (we use it in mandible).

Note: patient may return to you after extraction complaining the presence of tooth ( specially in the case of multiple teeth extraction) ….. Actually it is bony specule or septum … so just give LA and trim it …( trimming of bone is called alveoloplasty … that may be used before denture construction ).

# Rotary hand piece (almost straight ) that receive the bur to cut bone.

- An important thing here is irrigation from the hand piece itself or from another adjacent tool .. .to prevent overheating and the resultant necrosis ,dry socket ,or osteomyelitis .

# Curette.

It is a double ended instrument (spoon shaped instrument) used to remove soft tissue (granulation tissue) from bony cavities (tooth socket after extraction), or for necrotic tissue debridement. (It has a concave side, and convex side).

# Needle holder

It has a locking handle …. Criss- cross pattern in it's working end to grasp the needle ( intra and extra oral needle ) firmly in suturing process .

- We also have what is called hemostat or artery holder (with just one serration pattern ( there are multiple types of designs) to grasp the artery during surgery ( in the head and neck surgeries ) …. So it achieves hemostat (this is the origin of its name ) .

# Mouth prop

It can be used to open patient's mouth when he is unable to cooperate (in case of trismus ,sedation ,general anesthesia ) to the desired width then you can stop and fix it .

# Elevators

We have three types of elevators:

- Straight elevator: consist of handle , shank ,working end (blade with concave side toward the tooth and convex side toward the bone )

- Triangular elevator : has triangular tip

- Crane pick elevator : used for remaining tips ( not roots )

· The handle is important to bring force (there is what is known as T-bar or cross bar handle that is used to bring large amount of force).

· Triangular one (Cryer ) is used in (lets say ) lower six if we removed the distal root and we want to remove the mesial one… or in the case of lower wisdom as it the only instrument that can be used by making support on the buccal shelf ( in a way by which the tip engages the bifurcation and pushes it out ).

· The function of elevator is : tissue detachment around the root , luxation of tooth(most important ) , removal of remaining root .

· Cryer (there is right and left one …. So you must distinguish between them) has two sides: concave toward tooth; convex toward bone.

· Crane pick (apexo ???) one is used to remove tips ( we may remove or leave it ….. we will discuss this later ) .

· In the previous point case, we may use surgical procedure to remove the tip (after taking radiograph) ….. you make an opening in the buccal bone using round bur and makes a hole in the root.

· As a conclusion, surgery is not a traumatic procedure … if you understand this you will be a clever surgeon .

· Finally, in doc sukaynah sessions , you cannot use tweezer to detach tissue ( tweezer in her session = zero ).

True Friends
There are many people
that we meet in our lives
but only a very few
will make a lasting impression
on our minds and hearts
It is these people that we will
think of often
and who will always remain
important to us
as true friends

Done by: haitham alnoti
Shadi Jarrar
مشرف عام

عدد المساهمات : 997
النشاط : 12
تاريخ التسجيل : 2009-08-28
العمر : 27
الموقع : Amman-Jordan


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