Oral and maxillofacial surgery

Lec. 3

سامي 0د محمد سهى

والفكين- – والوجه الفم جراحة ماجستير

Case history

Signs:-Means (objective an abnormal presentation detectable by the clinician e.g. swelling, ulcers.

Symptoms: -

Means a (subjective problem that a patient describes e.g. pain, parasthesia. Diagnostic instruments includes-:

- Dental mirror - Dental probe

- Twizer

In clinical practice, examination of patient involves four routine procedures-:- Inspection

- Palpation- Percussion

- Auscultation

Clinical Examination:-

II-Inspection visual-: 1-facial appearance

2-skin color 1-cyanosis bluish

2-jaundice yellow 3-anemia pale

3-eye 1-cornea scarring 2-sclera bleeding

3-eye lid ptosis 4-pupil squint 5-occular pain

4-swelling5-fluctuation

Percussion:-Is the technique of striking the tissue with fingers or and instrument e.g., handle of the mirror. The examiner listens to the resulting sounds and observes the response of the patient, percussion used extra- orally to detect tenderness in the frontal and maxillary sinuses by tapping the finger tips against a finger placed over the sinuses.Percussion used intra orally to evaluate the teeth by tapping the teeth with the mirror handle; this technique may induce pain in the area of inflammation from periodontal diseases or peri apical abscess.

Regarding to dentistry Probing-:

Is the palpation with an instrument and is the most important diagnostic techniques, the teeth are probe for caries with the dental probe and periodontal probe is used to measure the periodontal sulcus depth.

Auscultation:-It is the act or process of listening for sounds within the body.E.g. Auscultation to the clicking in the tempromandibular joint TMJ by the use of stethoscope. Auscultation techniques are rarely in dentistry.Extra Oral Examination-:

*Examination of the patient including his posture, gaits, facial form, nutritional status, habits, speech, skin, hair, nails, and all exposed part of the body.*Examination of head includes TMJ, lymph nodes submandibular, sub mental, salivary glands parotid, submandibular gland, and bones of skull, sinuses, maxillary sinus, ears, eyes, and peri oral tissues.*Examination of neck include thyroid gland, lymph nodes {cervical node, anterior and posterior} The neck should be inspected for midline or lateral swelling, scar or any inflammatory lesions, palpated for thyroid enlargement or cervical lymph node enlargement.*TMJ palpated for any clicking or pain and asks the patient to open (truisms) or deviation of mandible.

Examination of eyes for the exophthalmoses or proptosis, pallor of conjunctiva may indicate anemia. Sclera of the eye should be also examined; yellow discoloration may indicate hepatitis or obstructive jaundice.

Intra oral examination:-Consists of evaluation of lips, labial and buccal mucosa, mucobucal folds, and floor of mouth, tongue, and hard and soft palate oropharynx, muscle of mastication {lateral and med. Ptrygoid m.} Teeth, gingiva, orifice of the ducts of the parotid and submandibular glands.We use the mouth mirror to reflect the check and lips with the good light to evaluate the condition of the vestibules, floor of the mouth, ventral surface of

the tongue avoid any over-looking of these hidden areas also the opening of

the salivary glands ducts examined for enlargement tenderness, discharge.

•Mucosa-:•Mucosal changes may be observable in association with leukoplakia,

tobacco irritation, and pigmentation. The gingival examined for the healthiness, the color, size of inter dentally papillae, Any cause of food impaction, the presence of the calculus, sinuses, retained roots, pocket.

APeriodontium: - Appear uniform, non compressible contours, typical

homogenous, stippling, healthy gingival sulcus depth normally between 1-2 mm without bleeding.Lips:-Appear pale, pink, homogenous in color, common abnormality of the lip

includes ulcer, rouge surface texture, homogenous white thickening.

Occlusion: - over jet and over bite between upper and lower anterior teeth should be 2 mm.

Floor of the mouth - :

Swelling or enlargement at one side or both due to ranula.

Teeth examination -:

The presence, absence, appearance, mobility of teeth, retained roots, retained deciduous teeth, malposed teeth, mobility of teeth.

Exposed roots, carious lesions. The teeth might be per cussed or probed with our instrument to see any tenderness or sensitivity of the teeth. Any edentulous area should be dried with a piece of cotton and examined for the presence of the retained root or discharging sinuses. Occlusion should be examined in closed and rest positions the presence of the open bite.

Investigation-:

Some time of the clinician determines that the additional tests are needed to clarify some aspects of the diagnosis such as tests include radio (Biopsy), cytology, Aspiration, laboratory studies.

Vitality Tests-:

Hot application e.g. hot instruments

Cold application e.g. ethyl chloride application

Electrical pulp tester used to check the vitality or response of teeth .

Aspiration: - it is withdrawal of fluid from the lesion may aid in diagnosis e.g. aspiration of pus indicates an inflammatory process like abscess or infected

cyst. Aspiration yellow fluid may indicate cystic lesion, Aspiration of blood may indicate vascular lesion like heamangioma.

Laboratory test like- Bacteriological examination Hematological examination General urine examination Blood chemistry and serological examination

Culture and sensitivity test

All these tests and investigation might be ordered to aid as in confirming our diagnosis

:

Medical record Case sheet Radiographs Investigations Referring papersObjective of the medical record:- It assists in diagnosis of the disease, for follow up and future checking, for statistical analysis, for studies and education and for medico legal purpose.

Diagnosis-:

It is the process of evaluating the patients' health as well as the resulting opinion formulated by clinician diagnostic method.

Clinician diagnostic method it is the application of the scientific method to clinical decision which consists

of-:

Collection of information as history of the case.

Evaluation of information organizes the information and compare it with the basic knowledge such as anatomy and physiology and observation from past clinical experiences.Diagnostic Decisions the clinician formulates opinions concerning the nature of unusual finding which is the explanation for an element of the patient's status that is most consistent with the available information. Reassessment of the abnormality after treatment.

Treatment Planning-: Every treatment plan must be designed suit the particular dental,

medical and economic needs of the individual patient .Successful treatment planning must be based upon a careful pre-operative assessment of any difficulties which may be encountered any possible complications which might occur together with both the advantages and disadvantages, in broad terms only three