chapter 18
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CHAPTER 18. Oral and Maxillofacial Surgery. 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 - PowerPoint PPT PresentationTRANSCRIPT
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 1©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 2©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.
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