INDIAN DENTAL ACADEMY
Leader in continuing dental education
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Principles of maxillofacial surgery
Painless surgery
Asepsis & sterilisation
Adequate access
Arrest of haemorrhage
Debride...
Principles of maxillofacial surgery
Painless surgery
Pre-medication
Anaesthetic considerations
Local
Local and sedation
Ge...
Principles of maxillofacial surgery
Goals of Pre medication
Sedation
Amnesia
Analgesia
Drying of airway secretions
Prevent...
Principles of maxillofacial surgery
Selection of appropriate drugs
Considerations Psychological condition
Physical status
...
Common pre-operative drugs
Drug
Diazepam
Midazolam
Pentobarbitol
Morphane
Meperdine
Atropine
(Anticholinergic)
Scopolamine...
Principles of maxillofacial surgery
Painless surgery
Local Anaesthesia Majority of the minor oral surgical procedures
Are ...
Principles of maxillofacial surgery
Painless surgery
Local anaesthesia with sedation In apprehensive patients minor surgic...
Principles of maxillofacial surgery
Indications for general anaesthesia
Acute infections
Surgery in several parts of the m...
Principles of maxillofacial surgery
Asepsis & sterilisation
Asepsis
Method of surgery designed to prevent
introduction of ...
Principles of maxillofacial surgery
Sources of infection during surgery
Patient himself
Operator
Instruments & materials u...
Principles of maxillofacial surgery
Minimising infection from the patient
Attention to oral hygiene
Oral prophylaxis
Chlor...
Principles of maxillofacial surgery
Minimising infection from the operator
Wearing mask & head cap
Keeping finger nails sh...
Principles of maxillofacial surgery
Preventing infection from instruments

Using only sterilised instruments and
materials...
Principles of maxillofacial surgery
Methods of sterilisation
Moist heat -

autoclave

Dry heat

hot air oven

-

Boiling w...
Principles of maxillofacial surgery
What is the reliable method of Sterilisation?
Moist heat (autoclave)
Types

-

high va...
Principles of maxillofacial surgery
Hot air oven sterilisation
Temperature

-

160 to 183° c

Time

-

one hour

Mode of a...
Principles of maxillofacial surgery
Minimising iatrogenic infection

Clean environment
Regular microbiological monitoring ...
Principles of maxillofacial surgery
Access

Oral cavity

Mucoperiosteal flaps

Face

Skin incisions

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Principles of maxillofacial surgery
Access - intra oral

Principles of muco periosteal flaps
Visibility
Vascularity
Healin...
Principles of maxillofacial surgery
Access – intra oral
Muco periosteal flap
Flap consisting mucosa and periosteum
Design
...
Access – intra oral

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Access – intra oral

Labial Approach

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Palatal Approach
Incisions for caldwell-luc operations

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Degloving incision for maxilla

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Degloving incision for mandible

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Access – extra oral

Submandibular incision

Risdon incision
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Weber-fergusson incision

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Temporal incision (Gillies)

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Bicoronal incision

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Skin incisions around the eye
Lateral Eyebrow
Medial Eyebrow
Temporal
(Gillies)

Medial Canthus

Subciliary
(Blepharoplast...
Principles of maxillofacial surgery
Access
Removal of bone
Bone is removed either by using surgical
burs or chisel

www.in...
Principles of maxillofacial surgery
Access
Instruments for bone removal
1. Chisel
2. Osteotome
3. Gouge
4. Ronguers
5. Bon...
Principles of maxillofacial surgery
Control of haemorrhage
Mechanism of haemostasis
Vasoconstriction
Platelet aggregation
...
Principles of maxillofacial surgery
Arrest of haemorrhage- Methods used by surgeons
Soft tissue –
Digital pressure
Pressur...
Principles of maxillofacial surgery
Debridement of wound
Removal of
Devitalised tissue
Granulation tissue
Bone pieces
Hang...
Principles of maxillofacial surgery
Drainage of wounds to prevent haematoma
Drains –
Corrugated rubber
Polythene tube

www...
Principles of maxillofacial surgery
Closure of wounds - reasons for suturing
To get close approximation of wound margins
T...
Principles of maxillofacial surgery
Closure of wounds -types of sutures
Interrupted suture
Most commonly used to close
muc...
Principles of maxillofacial surgery
Closure of wounds
Mattress suture - horizontal
Tissues under tension
To get slight eve...
Principles of maxillofacial surgery
Closure of wounds
Mattress suture - Vertical
Tension in tissues
Eversion of wound marg...
Principles of maxillofacial surgery
Closure of
wounds

Sub cuticular

To prevent dead space and for
cosmetic reasons
Conti...
Principles of maxillofacial surgery
Closure of wounds
Suture materials - Requirements
Adequate tensile strength
Knot reten...
Principles of maxillofacial surgery
Closure of
wounds
Suture materials - Classification
Natural
Non absorbable
Synthetic
A...
Principles of maxillofacial surgery
Suture Materials

- Black braided silk

Most commonly used in minor oral surgery 3.0
A...
Principles of maxillofacial surgery
Suture materials -Cat gut
Prepared from submucosal layer of small
intestines of sheep
...
Principles of maxillofacial surgery
Suture material
Disadvantages of cat gut Early loss of tensile strength
Poor knot rete...
Principles of maxillofacial surgery
Post Operative care
Pain
Infection
Bleeding
Diet
Sutures
Review

www.indiandentalacade...
Principles of maxillofacial surgery
Post operative pain

Pain Mechanisms
Peripheral tissue injury
Transmission through the...
Principles of maxillofacial surgery
Post operative pain

Target areas for pain control
Blockade of Prostaglandin synthesis...
Principles of maxillofacial surgery
Post operative pain
Strategies Mild pain - Pre and post operative NSAIDS,
Regular LA a...
Principles of maxillofacial surgery
Antibiotic Prophylaxis
Who needs it?
Patients with impaired host defense.
Patients und...
Principles of maxillofacial surgery
Use of antibiotics
Guidelines
No routine use of post operative antibiotics
Acute infec...
Principles of maxillofacial surgery
Antibiotic prophylaxis
What should be the duration of administration?
A study conducte...
Principles of maxillofacial surgery
Antibiotic prophylaxis

Has timing any influence?
Administration of antibiotic immedia...
Principles of maxillofacial surgery
Antibiotic combinations
Advantages
Broad Spectrum coverage
Poly microbial infections
E...
Principles of maxillofacial surgery
Antibiotic combinations
Disadvantages
Antagonism
Increased colonization with resistant...
Principles of maxillofacial surgery
Swelling or Oedema
Physiology of cold and heat
Cold application immediately
after Surg...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Principles of oral surgery.. (nx power lite) /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Principles of oral surgery.. (nx power lite) /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Principles of maxillofacial surgery Painless surgery Asepsis & sterilisation Adequate access Arrest of haemorrhage Debridement & drainage Closure of wounds Post operative care www.indiandentalacademy.com
  3. 3. Principles of maxillofacial surgery Painless surgery Pre-medication Anaesthetic considerations Local Local and sedation General www.indiandentalacademy.com
  4. 4. Principles of maxillofacial surgery Goals of Pre medication Sedation Amnesia Analgesia Drying of airway secretions Prevention of autonomic reflex responses Reduction of gastric secretions Antiemetic effects Reduction of anaesthetic requirements Facilitation of smooth induction of anaesthesia www.indiandentalacademy.com
  5. 5. Principles of maxillofacial surgery Selection of appropriate drugs Considerations Psychological condition Physical status Age Surgical procedures & its duration Out patient or in patient procedure Elective or emergency www.indiandentalacademy.com
  6. 6. Common pre-operative drugs Drug Diazepam Midazolam Pentobarbitol Morphane Meperdine Atropine (Anticholinergic) Scopolamine Metoclopramide (Antiemetic) Route Oral I.M. Oral, I.M. I.M. I.M. I.M., I.V. Dose 5 to 20 mg. 3 to 7 mg. 50 to 200 mg. 5 to 15 mg. 5 to 15 mg. 0.3 to 0.6 mg I.M.,I.V. Oral, I.M.,I.V. 0.3 to 0.6 mg 5 to 20 mg. www.indiandentalacademy.com
  7. 7. Principles of maxillofacial surgery Painless surgery Local Anaesthesia Majority of the minor oral surgical procedures Are carried out under local anaesthesia www.indiandentalacademy.com
  8. 8. Principles of maxillofacial surgery Painless surgery Local anaesthesia with sedation In apprehensive patients minor surgical procedures are carried out under local anaesthesia combined with intra-venous sedation using Diazepam 5 to 20 mg Midazolam 3 to 7 mg www.indiandentalacademy.com
  9. 9. Principles of maxillofacial surgery Indications for general anaesthesia Acute infections Surgery in several parts of the mouth Prolonged surgery Technically difficult surgery Extremes of age Very nervous patients www.indiandentalacademy.com
  10. 10. Principles of maxillofacial surgery Asepsis & sterilisation Asepsis Method of surgery designed to prevent introduction of infection into a wound at the time of operation Sterilisation Removal or disinfection of all micro organisms including bacterial spores and virus www.indiandentalacademy.com
  11. 11. Principles of maxillofacial surgery Sources of infection during surgery Patient himself Operator Instruments & materials used Operating area www.indiandentalacademy.com
  12. 12. Principles of maxillofacial surgery Minimising infection from the patient Attention to oral hygiene Oral prophylaxis Chlorhexidine mouth washes Preparation of the mouth prior to surgery www.indiandentalacademy.com
  13. 13. Principles of maxillofacial surgery Minimising infection from the operator Wearing mask & head cap Keeping finger nails short & clean Removing rings, watches, bangles Scrubbing the hands Wearing sterile gloves www.indiandentalacademy.com
  14. 14. Principles of maxillofacial surgery Preventing infection from instruments Using only sterilised instruments and materials during surgery www.indiandentalacademy.com
  15. 15. Principles of maxillofacial surgery Methods of sterilisation Moist heat - autoclave Dry heat hot air oven - Boiling water Chemicals Gamma radiation www.indiandentalacademy.com
  16. 16. Principles of maxillofacial surgery What is the reliable method of Sterilisation? Moist heat (autoclave) Types - high vaccum - Downward displacement Temperature required - 121° c Pressure - 15 to 20 pounds Time - 15 to 20 mts. Mode of action - coagulation of proteins www.indiandentalacademy.com
  17. 17. Principles of maxillofacial surgery Hot air oven sterilisation Temperature - 160 to 183° c Time - one hour Mode of action Due to oxidation www.indiandentalacademy.com
  18. 18. Principles of maxillofacial surgery Minimising iatrogenic infection Clean environment Regular microbiological monitoring of facilities www.indiandentalacademy.com
  19. 19. Principles of maxillofacial surgery Access Oral cavity Mucoperiosteal flaps Face Skin incisions www.indiandentalacademy.com
  20. 20. Principles of maxillofacial surgery Access - intra oral Principles of muco periosteal flaps Visibility Vascularity Healing www.indiandentalacademy.com
  21. 21. Principles of maxillofacial surgery Access – intra oral Muco periosteal flap Flap consisting mucosa and periosteum Design Visibility Large enough to provide adequate access Viability Broad base with narrow margin to provide proper blood supply Healing: Line of incision should be placed on sound bone www.indiandentalacademy.com
  22. 22. Access – intra oral www.indiandentalacademy.com
  23. 23. Access – intra oral Labial Approach www.indiandentalacademy.com Palatal Approach
  24. 24. Incisions for caldwell-luc operations www.indiandentalacademy.com
  25. 25. Degloving incision for maxilla www.indiandentalacademy.com
  26. 26. Degloving incision for mandible www.indiandentalacademy.com
  27. 27. Access – extra oral Submandibular incision Risdon incision www.indiandentalacademy.com
  28. 28. Weber-fergusson incision www.indiandentalacademy.com
  29. 29. Temporal incision (Gillies) www.indiandentalacademy.com
  30. 30. Bicoronal incision www.indiandentalacademy.com
  31. 31. Skin incisions around the eye Lateral Eyebrow Medial Eyebrow Temporal (Gillies) Medial Canthus Subciliary (Blepharoplasty) Infraorbital www.indiandentalacademy.com
  32. 32. Principles of maxillofacial surgery Access Removal of bone Bone is removed either by using surgical burs or chisel www.indiandentalacademy.com
  33. 33. Principles of maxillofacial surgery Access Instruments for bone removal 1. Chisel 2. Osteotome 3. Gouge 4. Ronguers 5. Bone file www.indiandentalacademy.com
  34. 34. Principles of maxillofacial surgery Control of haemorrhage Mechanism of haemostasis Vasoconstriction Platelet aggregation Clot formation Clot stabilisation Clot retraction www.indiandentalacademy.com
  35. 35. Principles of maxillofacial surgery Arrest of haemorrhage- Methods used by surgeons Soft tissue – Digital pressure Pressure packs Use of haemostat Ligation of blood vessels Electro cautery Bone – Burnishing Hot pack Use of bone wax Absorbable haemostatic agents www.indiandentalacademy.com
  36. 36. Principles of maxillofacial surgery Debridement of wound Removal of Devitalised tissue Granulation tissue Bone pieces Hanging bone margins Trimming of flap margins Proper irrigation www.indiandentalacademy.com
  37. 37. Principles of maxillofacial surgery Drainage of wounds to prevent haematoma Drains – Corrugated rubber Polythene tube www.indiandentalacademy.com
  38. 38. Principles of maxillofacial surgery Closure of wounds - reasons for suturing To get close approximation of wound margins To ensure healing by primary intension To minimise wound contamination To control post-operative haemorrhage www.indiandentalacademy.com
  39. 39. Principles of maxillofacial surgery Closure of wounds -types of sutures Interrupted suture Most commonly used to close mucoperiosteal flaps and skin Advantages Better in mobile areas Alternate sutures can be removed www.indiandentalacademy.com
  40. 40. Principles of maxillofacial surgery Closure of wounds Mattress suture - horizontal Tissues under tension To get slight eversion of wound margins To prevent scar contraction To control post extraction bleeding Does not cut through tissues Used for sectioned muscles www.indiandentalacademy.com
  41. 41. Principles of maxillofacial surgery Closure of wounds Mattress suture - Vertical Tension in tissues Eversion of wound margins Better adaptation Where healing is expected to be delayed Control of haemorrhage www.indiandentalacademy.com
  42. 42. Principles of maxillofacial surgery Closure of wounds Sub cuticular To prevent dead space and for cosmetic reasons Continuous suture Closing subcutaneous tissues Long mucosal & skin incisions Sectioned muscle Disadvantage - only two knots if one knot breaks failure of suturing www.indiandentalacademy.com
  43. 43. Principles of maxillofacial surgery Closure of wounds Suture materials - Requirements Adequate tensile strength Knot retension No tissue reaction Absorbability Ease of handling www.indiandentalacademy.com
  44. 44. Principles of maxillofacial surgery Closure of wounds Suture materials - Classification Natural Non absorbable Synthetic Absorbable Natural Synthetic Silk Linen Cotton Polyamides Polyesters Catgut Polyglycolic acid Polyglactin 910 www.indiandentalacademy.com
  45. 45. Principles of maxillofacial surgery Suture Materials - Black braided silk Most commonly used in minor oral surgery 3.0 Advantages Knot retension is good Reasonable tensile strength Non capillary Cut ends are not irritant to soft tissues Easily seen and to handle Obtained from the cocoon of the silkworm larve www.indiandentalacademy.com
  46. 46. Principles of maxillofacial surgery Suture materials -Cat gut Prepared from submucosal layer of small intestines of sheep Chronic gut is treated with chromium salts Plain cat gut absorbed in 7 to 10 days, chronic in 21 to 28 days by proteolytic degradation Synthetic absorbable materials are absorbed by hydrolysis Polyglycolic acid is hydroxyacetic acid Polyglactin is hydroxyacetic acid and Lactic acid www.indiandentalacademy.com
  47. 47. Principles of maxillofacial surgery Suture material Disadvantages of cat gut Early loss of tensile strength Poor knot retension Results in local oedema Cannot be used in infected areas Cut ends are irritating to tissues Cat gut is almost replaced by synthetic materials due to their minimal tissue reactions and strength www.indiandentalacademy.com
  48. 48. Principles of maxillofacial surgery Post Operative care Pain Infection Bleeding Diet Sutures Review www.indiandentalacademy.com
  49. 49. Principles of maxillofacial surgery Post operative pain Pain Mechanisms Peripheral tissue injury Transmission through the nerves Perception within the brain www.indiandentalacademy.com
  50. 50. Principles of maxillofacial surgery Post operative pain Target areas for pain control Blockade of Prostaglandin synthesis Intervening peripheral nerve conduction Suppression of higher sites in CNS www.indiandentalacademy.com
  51. 51. Principles of maxillofacial surgery Post operative pain Strategies Mild pain - Pre and post operative NSAIDS, Regular LA agent Moderate pain – Pre and post operative NSAIDS Long acting LA agent. Severe pain – Pre and post operative NSAIDS Long acting LA agent Centrally acting analgesics (codine) www.indiandentalacademy.com
  52. 52. Principles of maxillofacial surgery Antibiotic Prophylaxis Who needs it? Patients with impaired host defense. Patients undergoing surgical procedures where the risk of infection is small but consequences are very serious e.g., infective endocarditis. Patients undergoing surgical procedures which have a high rate of infections (normal host defense mechanisms), but the nature of surgery vulnerable to infection. www.indiandentalacademy.com
  53. 53. Principles of maxillofacial surgery Use of antibiotics Guidelines No routine use of post operative antibiotics Acute infections Penicillin group Subacute infection Penicillin and Metranidazole Chronic infection Metranidazole www.indiandentalacademy.com
  54. 54. Principles of maxillofacial surgery Antibiotic prophylaxis What should be the duration of administration? A study conducted using three different antibiotic regimens suggested that a single dose of preoperative antibiotic is Sufficient for prophylaxis when surgery is completed within 3 hours. Antibiotic coverage should extend for operations of longer duration. No value of antibiotic after the operation. www.indiandentalacademy.com
  55. 55. Principles of maxillofacial surgery Antibiotic prophylaxis Has timing any influence? Administration of antibiotic immediately prior to surgical Incision should be effective prophylaxis for surgical wound infections. www.indiandentalacademy.com
  56. 56. Principles of maxillofacial surgery Antibiotic combinations Advantages Broad Spectrum coverage Poly microbial infections Enhancement of antimicrobial effect Decreased emergence of resistant strains www.indiandentalacademy.com
  57. 57. Principles of maxillofacial surgery Antibiotic combinations Disadvantages Antagonism Increased colonization with resistant organisms Increased toxicity Increased cost www.indiandentalacademy.com
  58. 58. Principles of maxillofacial surgery Swelling or Oedema Physiology of cold and heat Cold application immediately after Surgery Warmth after oedema has occured Prevents oedema Resolves oedema Use of antiinflammatary agents www.indiandentalacademy.com
  59. 59. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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