Lectures on Various minor Oral Surgical procedures , delivered by Dr Arun George MDS during minor oral Surgical workshop conducted at Mar Baselios Dental College, Kerala, India for more information regarding the procedures mail to -
drarun1g@gmail.com
2. Like every proffessional man I am very much
indebted to my seniors and colleagues who
taught me the practice of oral and maxillofacial
surgery…..
3. Pre Surgical Care…………
Stress Reduction
Morning Apointment
Pre Medication
Vocal, Music, Aroma
Eye contact on
communication
Deep Breathing
Pain less local anaesthesia
Hypnosis
4.
5. So that you guys don’t end up like this !!!
“Minor oral Surgery
is defined as a surgical
procedures which can be
comfortably completed by
a dentist in not more than
30 minutes”
6. over view of Minor oral Surgeries
Endodontic Surgeries
Surgery & Maxillary Sinus
Biopsy
Incision & Drainage
Preprosthetic
Complicated Exodontia
Recent advances in minor surgery
Simple
things may
not be so
simple !...
18. Oro antral Communication
Is an unnatural
communication between oral
cavity and the maxillary sinus
Nose blowing
Clinical diagnosis for OAF
Displace cotton wool
Never let the oral fluids to go
inside the sinus
19. Oro antral Communication
Management Protocol
Newly created or
Chronic
Less than 2mm go in for a primary
closure
5mm – Closure with reduction of the
socket walls
Give acrylic splint
If larger – approximation of the wound by
use of flaps for coverage.
20. Flaps
Buccal Advancement
Palatal
Combination of Buccal and Palatal
Buccal Pad of Fat
Tongue
Temperomyofascial Flap
24. Caldwell- Luc Operation-
•George Caldwell - 1893 [Newyork]
•Henry Luc – 1897 [Paris]
Indications :
Removal of displaced teeth,
foreign body from sinus
Post traumatic Hemorrhage
Chronic Sinusitis
Along the closure of OAF associated with chronic sinusitis
32. INTERNAL DERANGMENT
Localized disturbance & uncoordinated
movement between the disc and the head of the
condyle
Disc displacement with reduction
With out reduction
Adhesions
Alteration
Various arthritis
33. MANAGEMENT
Medical (muscle relaxant, anti depressent )
Functional correction of the occlusion
Soft Splint
Arthrocentesis & lavage ( release of the
adhesion )
Arthroscopic surgery
Open joint surgery
Discectomy
Meniscoplasty
37. Abscess don’t wait for the sun set
.
EMPIRICAL ANTIBIOTIC
THERAPY
*
CULTURE AND
SENSITIVITY
* APPROPRIATE
ANTIBIOTIC THERAPY
REMOVAL OF THE CAUSE
( teeth if odontogenic )
*
SUPPORTIVE THERAPY
* PHYSIOTHERAPY
(to improve mouth opening)
38. Hiltons Method
Anesthesia
Stab Incision with 11no
blade
Burst all the locules with sinus
forceps
Abscess I & D only fluctuant,
Rubberdrain- 24 hrs
Ribbon Gauze wth whiteheads
varnish i/o
42. Laser Frenectomy
Z- plasty- for broad frenum
and short vestibule
Cross Diamond Excision-
For excess tissue
V-Y type of incision – For
lengthening
52. Impacted canines
Position assessment – Tube shift
technique (Clark’s rule)- SLOB
Field & Ackerman classification (1935)
Labial position
Palatal position
Intermediate position
Unusual position
Let me introduce my self……..I am Dr Arun..i represent dpt of Oral and Maxillofacial surgery. Once again warm regards to all the delegates who all present here for STOMA 2014………..Dentistry has changed a lot in recent years from treatment to prevention……..
Oral and maxillofacial surgery is basically divided in to two groups.Minor oral surgeries and major surgeries.
Most of the patiens who present with these conditions remediable by means of oral surgery are usually first seen by general dental practitioner.
There is even evidence that small cystic lesion may resolve after non surgical endodontic therapy….
Intentional opening….Abnormal opening…
Nose blowing test is carried out by compression of the anterior nares followed by gentle blowing of the nose with mouth open.
Diagnosis- Nose Blowing test, Closure-Reduce the height of the alveolus and suture with collagen sheet. Chronic fistula- Antral wash 2-3 times a week, well fiting denture or acrylic plate is given, broad spectrum antibiotic wait for 3 months some times fistula may heal spontaniously , for persistant fistula go for surgery
The mucoperiosteal flap becomes elastic once the periosteum is transversely cut. Buccal advancement flap is the most satisfactory method of closing oroantral fistula. In situations where the buccal mucoperosteal flap falls short of covering the fistula, the flap can be advanced.A horizontal incision is made in the mucoperosteum as high as possible.This will allow the advancement of the buccal periosteal flap.
If the OAF is seen after 24 hrs, the soft tissue margins of the fistula often get infected. It is preferable to defer the surgical closure until gingival edges show sound healing, approximately 3 weeks.
Pedicled flap, based on Greater palatine vessel. When the palatal flap is rotated over the fistula , an area of denuded bone is left in the anterior part of the palate. This is temporarily packed with gauze pack soked with whiteheads varnish.The denuded area gradually gets covered with granulation tissue.
Tooth pushed inside the sinus, antral pathology, Foreign body, Orbital floor fracture, Can be practiced under G A or L A.Semilunar incision is planned in the buccal vestibule from canine to second molar area ,just above the gingival attachment. Mucoperiosteal flap is raised till the infraorbital ridge.Care is taken to prevent the injury to infraorbital nerve. Opening is made in the anterior wall of the maxillary sinus with the help of chiesels,gouges or dental drills , the opening is enlarged with the use of bone rongeur forceps. opening should be made in the size of an index finger. This opening can be used for the removal of tooth or foreign bodies in the sinus.
aspiration biopsy biopsy in which tissue is obtained by application of suction through a needle attached to a syringe.
brush biopsy biopsy in which cells or tissue are obtained by manipulating tiny brushes against the tissue or lesion in question (e.g., through a bronchoscope) at the desired site.
cone biopsy biopsy in which an inverted cone of tissue is excised, as from the uterine cervix.
core biopsy , core needle biopsy needle biopsy with a large hollow needle that extracts a core of tissue.
endoscopic biopsy removal of tissue by appropriate instruments through an endoscope.
excisional biopsy biopsy of tissue removed by surgical cutting.
incisional biopsy biopsy of a selected portion of a lesion.
needle biopsy biopsy in which tissue is obtained by puncture of a tumor, the tissue within the lumen of the needle being detached by rotation, and the needle withdrawn. Called alsopercutaneous b.
percutaneous biopsy needle b.
punch biopsy biopsy in which tissue is obtained by a punch.
shave biopsy biopsy of a skin lesion in which the sample is excised using a cut parallel to the surface of the surrounding skin.
stereotactic biopsy biopsy of the brain using stereotactic surgery to locate the biopsy site.
sternal biopsy biopsy of bone marrow of the sternum removed by puncture or trephining.
Specimen taken using a punch useful for mucosal lesions from in accessible areas.
10 % formalin, 10 times volume, 24 hrs time period, wedge incision, When ther is a large diffuse lesion a representative section of the lesion is incised with normal tissue. Usually an elliptical , wedge shaped tissue is obtained with the V of the wedge converging in to the deeper tissues.
B lock anesthesia is preferred toinfiltration
When blocks are not possible distantinfiltration may be used
Suction devices should be avoided
Gauze compresses are usually adequat
ever inject directly into the lesion
Excisional biopsy is taken if the lesion is extremely small in size. It’s a combination of diagnostic and ablative procedure.
Internal derangement is a disruption of the internal aspects of the TMJ ,in which an abnormal relationship exists between the disc and the condyle,fossa and articular eminence.
Aetiology of Internal derangement –
Microtrauma – overloading from bruxism and other parafunctional habits, hypermobilyty of the joint
Macrotrauma – Obvious history of trauma and osseous morphologic changes
Disc displacement with reduction
With out reduction
Adhesions
Alteration
Various arthritis
Irrigation of the upper joint cavity.
Improves disc mobility
Eliminate Joint inflammation
Remove resistance to condyle translation
Eliminate pain.
The surgery avoids the spontaneous drainage and the resultant cutaneous fistula.I and D relieves pressure and pain caused by the accumulation of the pus
Success depends on the timing of the procedure.
Pencillin is always the ideal choice of antibiotic, Recent studies shows that B lactamase producing organisms such as bacteroids are insensitive to pencillin. 30 % of the organisms are resistant to pencillin for anaerobic coverage pencillin can be supplimented with metronidazole. Other drug combsinations which are useful for orofacial infections are oral clindamycin, amoxicillin clavulenic acid, first and second generation cephalospoins..
Burst all the locules, Explore the cavity with gloved fingure, Temperature above 102 give antipyretic, Drain has to be retained for at least 24 hrs
Upper lip is held in extended position to make the frenum tense. Incision is placed on either side of the frenum deep in to the incisive pappillae. Z plasty procedure can be used when the frenum is broad and vestibule is short. Small defect on the alveolar crest can be left to secodary granulate.
A periapical radiograph often reveals the marked midline sture in these cases. The upper labial frenum may interfere with the formation of transeptal gingival,cervical and alveolar crest bundles of the periodontal ligaments. Denture displacement
Mid line Diastema
Orthodontic relapse.
If diastemas are large,associated with proclination of maxillary anteriors and lip incompetence, inter alveolar corticomy procedures are being performed with variable prognosis.
Frenoplasty is done for prosthetic reasons and frenectomy is done for orthodontic purpose.
Position assessment of the imp canine is already discussed.
Soft tissue
& Hard Tissue
Ridge augmentation for Implants
Epulis fissuratum (also termed inflammatory fibrous hyperplasia,[1] denture-induced fibrous inflammatory hyperplasia,[2] denture injury tumor,[1] denture epulis,[1] denture induced granuloma,[3] and granuloma fissuratum[4]:808) is a benign hyperplasia of fibrous connective tissue which develops as a reactive lesion to chronic mechanical irritation produced by the flange of a poorly fitting denture.[1] More simply, epulis fissuratum is where excess folds of firm tissue form inside the mouth, as a result of rubbing on the edge of dentures that do not fit well. It is a harmless condition and does not represent oral cancer. Treatment is by simple surgical removal of the lesion, and also by adjustment of the denture or provision of a new denture
Epulis
1891
, it was first defined as a linear
cutting technique in the cortical plates
surrounding the teeth to produce
mobilization of the teeth for immediate
Movement.
The apical ends of these cuts are joined by horizontal cuts through the compact bone alone thus leaving the teeth to be supported by cancellous bone only.
Cortical Cuts weakens the bony resistance, Allowing the orthopedic movement of dentoalveolar segments there by improving the facial profile and lip competence. Bony cuts 2mm depth till reaching the cancellous bone, After a period of 3 weeks corticotomy on the labial side, First 4 weeks movement is slow then movement wl be faster. Relapse is less wit corticotomy
Abnormally Huge Sialolith... Salivary stone is calcium phosphate.
Trans Oral Sialolithotomy
Formation of new bone is achieved by the Callus stretching. After osteotomy is performed, a hematoma begins to organize in the latency period. Pluripotential mesenchymal cells are activated into fibroblasts and osteoblasts, and type I collagen is laid down parallel to the vector of distraction. Bony trabeculae grow into the fibrous area from the periphery, parallel to the line of tension that occurs during the distraction phase. A bridge of immature bone forms across the distraction gap. During the consolidation phase, bony remodeling begins. The regenerate eventually matures into osseous tissue similar to the native bone. Soft tissue also has the ability to grow linearly along lines of tension. This is referred to as distraction histogenesis. Skin, muscle, nerves, and vascular tissue are generated, not stretched. The advantage is obvious, especially for severe retrognathia, in which the stretched soft tissue envelope can contribute to relapse when a traditional mandibular osteotomy is performed for a large (>10 mm) advancement.
Circa 1951- Ilizarov developed a technique for repairing complex fractures or non unions of the long bones.
While treating a patient with a short amputation stump, Ilizarov performed an osteotomy and applied an external fixator to lengthen the stump with the intention of placing a bone graft.
However, by chance, he discovered that the bone grew in the distraction gap, eliminating the need for a bone graft . Distraction osteogenesis decreases the need for bone grafting for large (>10 mm) mandibular advancements; one can achieve 20 mm or more of advancement without a bone graft and the associated donor site morbidity, scarring, and potential for infection
Distraction osteogenesis appears to have a decreased potential for relapse, especially with large advancements.
DAD is primarily indicated in adults presenting bimaxillary protrusion with maxillary dentoalveolar excess or anterior crowding.
