chapter 18

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CHAPTER 18

Oral and Maxillofacial Surgery

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Objectives

• After studying this chapter, you will be able to:– Recognize the anatomy relevant to specific

procedures in oral and maxillofacial surgery– Summarize the pathology that prompts oral

and maxillofacial surgery and the related terminology

– Determine special preoperative diagnostic procedures/tests pertaining to oral and maxillofacial surgery

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Objectives (cont’d.)

– Determine special preoperative preparation procedures related to oral and maxillofacial surgery

– Indicate the names and uses of oral and maxillofacial instruments, supplies, and drugs

– Indicate the names and uses of special equipment used for oral and maxillofacial surgery

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Objectives (cont’d.)

– Determine the intraoperative preparations of the patient undergoing an oral or maxillofacial procedure

– Summarize the surgical steps of oral or maxillofacial procedures

– Assess any specific variations related to the preoperative, intraoperative, and postoperative care of the surgical patient

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Introduction to Oral and Maxillofacial Surgery

• Preoperative factors for patients undergoing oral surgery – Fear and concerns

• Aesthetic outcomes• Pain

– Special needs• Children • Patients already in the hospital for other concerns

(e.g., transplant recipients)

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Introduction to Oral and Maxillofacial Surgery (cont’d.)

• Each patient should be interviewed and the chart examined – Specific regard to the history, physical, NPO

status, allergies, diagnostic, and laboratory results

– Helps provide accurate, efficient assistance

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Introduction to Oral and Maxillofacial Surgery (cont’d.)

• Additional preoperative considerations – X-rays should be readily available to the team– Consultation with the surgeon in advance of

the procedure will help the team prepare for the wide range of possibilities

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Diagnostic Tests

• Patient with possible maxillofacial defects– Physical examination should be done

carefully

• Several types of imaging help diagnose maxillofacial fractures– Radiographic techniques

• Computed tomography (CT) scans • Magnetic resonance imaging (MRI)

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Diagnostic Tests (cont’d.)

• Plain films– Suspected type of fracture dictates the type of

view or views to be taken• Waters view • Caldwell view • Lateral facial view • Basal view • Panoramic

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Diagnostic Tests (cont’d.)

• CT scans– Show the facial structures in different planes

• Hard palate• Mid-maxillary• Mid-orbital

• MRI – Best defines soft tissue injuries or congenital

defects– Limited uses and time-consuming

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Diagnostic Tests (cont’d.)

• Three-dimensional imaging – Also used for reconstructive procedures– Involves use of computers with three-

dimensional programming and CT scans• CT scans can be projected onto the computer

screen in a three-dimensional fashion• Any anatomy that interferes with viewing can be

eliminated• Before-and-after models can be generated

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Tooth Extraction/Odontectomy

• Routine instruments, equipment, and supplies– Most craniofacial and dental procedures use

instruments from a dental instrument set and a basic plastic instrument set

• Not every instrument from each tray will be used, but wise to have both sets available

– Refer to Table 18-1• Procedure: refer to text

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Maxillofacial Procedures

• General considerations– Maxillofacial injuries can inhibit speech– Facial imaging studies, dental impressions, or

preoperative photographs should accompany the patient to the OR

– Surgeon will typically stand at the head of the OR bed

– Maxillofacial procedures can be lengthy

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Maxillofacial Procedures (cont’d.)

– Blood loss should be measured closely, especially in children

– Maxillofacial surgery involves manipulation of the bones near the patient’s airway

– Surgical personnel should be prepared to handle a variety of situations concerning airway management

– Care should be taken to avoid an intraoperative fire

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Maxillofacial Procedures (cont’d.)

– Surgical site is prepared by carefully removing any gross debris

– Maxillofacial reconstructions usually involve several procedures

– Dural tear may be repaired by placing a suture or sealing off the cerebrospinal fluid (CSF) leak with a fat, fascia, or muscle graft

– Open reduction techniques often require the use of internal fixation devices and can involve a variety of graft materials

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Maxillofacial Procedures (cont’d.)

– Surgical technologist may be expected to fill the role of the surgical assistant

– Several basic techniques will be used repeatedly

– Lubricate and protect patient’s eyes; corneal shield may be used

– Local anesthetic with epinephrine may be used alone or in conjunction with general anesthesia

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Maxillofacial Procedures (cont’d.)

– Patient is supine, with head positioned to provide maximum exposure

– Operative area may be outlined with towels– Controls on power equipment must be in

“safe” position when preparing the tool for use or when it is not in operation

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Repair of Mandibular/Maxillary Fractures

• Several basic techniques will be used repeatedly– Placement of arch bars, wires, and plates and

screws, and/or the use of graft material

• Several techniques may be used in the correction of one problem

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Repair of Mandibular/Maxillary Fractures (cont’d.)

• Craniofacial fractures– Most common repair technique: rigid fixation

by plates and screws, or screws alone• Bone plates are available in L, Y, H, and T shapes

and range in thickness from 0.5 to 3.00 mm• Screws come in diameters of 1.0 to 4.0 mm

– Implant materials: absorbable or nonabsorbable

– Titanium is often used

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Repair of Mandibular/Maxillary Fractures (cont’d.)

• Arch bars – Used to immobilize the jaw following

mandibular and/or maxillary fracture– Advances in rigid fixation have decreased the

necessity for and/or amount of time arch bars are required

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Procedures

• Include:– Application of arch bars– Plate and screw fixation of maxillary and

mandibular fractures– Orbital floor fracture repair– Le Fort I fracture repair– Le Fort II and III fracture repair

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Summary

• This chapter reviewed:– The pathology that prompts oral and

maxillofacial surgery – Special preoperative diagnostic

procedures/tests pertaining to oral and maxillofacial surgery

– Special equipment used for oral and maxillofacial surgery

– Oral and maxillofacial procedures