The document outlines the instruments used in maxillofacial surgery, categorized into various functions including surgical asepsis, access, retraction, and wound debridement. Each category details specific instruments, their uses, and characteristics, such as scalpel types, retractors like the Langenbeck and Austin, and tools for bone removal and management of fractures. The comprehensive list serves as a guide for practitioners in the field, providing essential information for surgical procedures.

1. Instrumentation in Maxillofacial Surgery
Presenter – Dr. Kamini Dadsena.
Moderator – Dr. Rohit Chandra.
Department OF PLASTIC SURGERY
Max Hospital Patparganj

2. Instruments
A. Instrument for gaining surgical
asepsis and art preparation
1. Cheatle’s forcep
2. Swab holder
3. Towel clip
B. Instrument for gaining surgical
access -
1. Scalpel (Blade handle, Blade)
2. Dissecting scissors
C. Instrument for reflection of
mucoperiosteum flap –
1. Periosteal elevator/ strippers
2. Cleft palate Rasparatory
D. Instrument for Retraction –
1. Langenbeck Retractor
2. C shaped retractor
3. Austin retractor
4. Cat’s paw retractor
5. Seldin’s retractor
6. Obwegessor’s retractor
7. Skin hook
8. Tongue depressor
9. Cheek retractors

3. Instruments
E. Suction apparatus -
1. Suction tubing
2. Suction tip
F. Instrument for wound
debridement –
1. Curette
2. Bone scoop
3. Lister’s sinus forcep
4. Drains
G. Instrument for holding tissues
and materials –
1. Needle holder
2. Artery forceps
3. Kocher’s artery forceps
4. Allis forceps
5. Tissue holding forcep
6. Babecock’s forcep
7. Bone holding tissue forcep
H. Instrument for management of
fractures / osteotomies –
1. Hayton – William’s forcep
2. Rowe’s disimpaction forcep
3. Walsham’s forcep
4. Asche’s forcep
5. Nasal rasp
6. Bone awl
7. Rowe’s modification & Bristow’s
zygomatic elevator
8. Smith’s bone spreader

4. Instruments
I. Instrument for bone removal –
1. Bone Rongeur
2. Chisel & Mallet
3. Osteotome
4. Gigli’s saw
5. Bone file
6. Bone gouge
7. Handpiece & bur
J. Miscellaneous instruments –
1. Mouth prop
2. Mouth gag
3. Instruments for trauma and
osteotomies
4. Instruments for cleft surgery

5. Instrument for gaining
surgical asepsis

6. Cheatle’s Forceps
• Used for picking up
sterile instruments
from trays and linen
from drums.
• Stored in a container
containing antiseptic
solution.

7. Swab Holder
• Uses :
• To hold swab/sponge and
scrub/clean the skin/ mucosa in
the area of operative field.
• To swab the throat in
unconscious patients under GA
• To hold tongue and give
anterior traction….

8. Towel Clips
• Two types:
• Pinchter type (Jones)
• Forceps type (Beckhaus)
• Uses
• To hold drapes
• stabilize suction tubes,
motor cables, tongue etc.

9. Instrument for gaining surgical access

10. Scalpel
• Bard Parker blade
handle
• Various sizes available,
most commonly used
one is
• No.3 – blade 10, 11, 12,
15
• No.4 (similar but bigger)
-- blade 22, 23
• No.7 (longer and more
slender) - blade 15

11. Scalpel
• Commonly used
• No.10 – Skin incision
• No.11 – Sharp pointed,
for stab incision
• No.12 – Hooked, for
mucogingival procedures
• No.15 –for intraoral use
• No 20- for skin incision in
orthopaedic and gen
surgery
• No 22- for skin incision in
cardiac and thoracic
surgery

12. Dissecting Scissors
• Iris scissor- fine work
• Metzenbaum scissor
• Mayo curved heavy duty
dissecting scissors

13. Dissecting Scissors
• Micro scissor-
Scissor with
spring action
(provides fast
cutting and
dissection)

14. Suture Cutting Scissors
• They have long
delicate handles and a
short blade with
cutting edge and
striations.
• Can be
• straight / curved
• angulated / non
angulated
Heath’s suture
cutting scissor

15. Instrument for reflection of
mucoperiosteum flap

16. Periosteal Elevators
• Used in “push” stroke.

17. Molt’s No. 9 Periosteal Elevator
• Uses
• Pointed end : to release
dental papilla around
teeth (by prying motion).
• Broad end : for elevating
the mucoperiosteal flap
from bone (by push
stroke).
• Can be used as soft tissue
retractor

18. Obwegeser’s
Howarth’s

19. Joseph periosteal elevator
19

20. Cleft palate Rasparatory
• Broad, flat elevator
used to elevate
mucoperiosteum
while mobilizing the
flaps for cleft palate
repair.

21. Instruments for Retraction

22. Langenbeck Retractor
• Common types are
• Standard (edge of the
blade points towards
handle)
• Reverse (edge of the blade
points away from the
handle), edge of the blade
can take support to retract
tissues

23. Langenback Retractor
• Uses
• To retract incised edges.
• To retract soft tissue mass.
• To allow visualisation of
deeper tissues

24. C - Shaped Retractor
• Mostly used in abdominal surgeries.

25. Deaver retractor
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• Used to hold abdominal wall during abdominal and
thoracic surgery.

26. Austin’s Retractor
• Short right angled
retractor used for
retracting cheek,
tongue and
mucoperiosteal flaps.
• Working end - forked

27. Kilners Cat’s Paw Retractor
• Used for retracting
small amount of soft
tissues.
• Care should be taken
not to apply
excessive force.

28. Obwegessor’s Ramus Retractor
• Similar to Langenback
except that the edge of
the blade is forked
forming V shaped
notch so as to engage
the anterior border of
ramus of mandible.
• Uses :
• During sagittal split
osteotomy
• During
coronoidectomy

29. Channel Retractor
• Used to engage the
inferior border of the
mandible on the
buccal side to assist
in the osteotomy
and also to protect
the facial vessels and
nerves.

30. Tongue Depressor
• Uses :
• To depress tongue during
endotracheal intubation and
extubation
• To depress and move it
anteriorly to check for
airway obstruction
• To retract the tongue during
surgical procedure

31. Skin Hook
• Types
• Single prong – Gillies
• Double prong - Kilner
• Uses –
• To hold and retract skin
edges during cutting,
dissection and suturing.
• To retract small amount of
soft tissues

32. Vein Hook (Desmarre’s)
• Used to retract
vessels during
dissection
(especially for
major vessels
during neck
dissection)

33. Nerve Hook (Dandy’s)
• A small instrument
with a broad curve at
the tip, tip is relatively
blunt.
• Used in neurectomy
procedures for nerve
identification and in
nerve repositioning
procedures.

34. Copper Malleable
• A universal kind
of retractor made
of copper, can be
molded into any
shape according
to the need.

35. Self Retaining Retractors
(Weitlaner)
• An instrument
with long curved
blades.
• Blades have
multiple prongs.
• Ratchet to hold
tissue apart

36. Suction apparatus

37. Suction Tip (Fraizer, Yankauer)
• To maintain a clean field
by sucking away blood,
flushing solutions, debris,
cystic fluid, pus and
secretions.
• No 3 and 4 are commonly
used
• Yankauer – rigid hollow
tube made up of metal or
disposable plastic with a
curve at the distal end to
facilitate removal of thick
pharyngeal secretions

38. 38

39. Instrument for suturing

40. Needle Holder
• Working tip has cross
hatched serrations with
a single vertical
serration to grip the
needle.
• The handle has a catch.
• Usually a 6 inch needle
holder is used.

41. INSTRUMENTS FOR SUTURING
MUCOSA

42. Instruments for haemostasis
42

43. Artery Forceps
• Can be
• straight / curved
• large / medium / small
• Mosquito are small
curved artery forceps
which have smaller finer
tips

44. 44

45. Artery Forceps
• Uses
• To achieve hemostasis by catching blood vessels
(by crushing / ligating / cauterizing)
• To drain an abscess ( by Hilton’s method).
• As tissue forceps for holding subcutaneous tissue
and aponeurosis (but not skin or nerves).
• To pick up necrotic tissues, granulation tissues,
foreign bodies, bone fragments

46. Kocher’s toothed Artery Forceps
• Uses
• Specially designed to
hold the coronoid
process during
coronidectomy
procedures.
• Can be used like other
bone holding forceps
for stabilization of bony
fragments

47. Instruments for holding tissues
47

48. Adson’s Tissue Forceps
• Delicate forceps, used to
hold tissues during
process of dissection /
suturing.
• Two types
• Plain / non toothed-, used
to hold delicate structures
• Toothed –to hold tough
structures like skin, coarse
muscle and fascia

49. Babcock’s Tissue Forceps
• Instrument with broad
flared blades with
fenestrations and
without teeth.
• More delicate and less
traumatic than Allie’s
forcep.
• Used to hold enlarged
lymph nodes or any
glandular tissue or
appendix

50. Allis Tissue Forcep
• A forceps with locking
handle, blades have
delicate teeth.
• Uses
• To hold and retract tissues
(generally for tissues that
will be excised).
• To provide tension during
tissue dissection.
• Should never be used to
hold the skin directly.

51. Crocodile Bone Holding Forcep
• Used to hold the bony
fragments during manipulation
(fracture reduction and fixation
/ osteotomy / resection
procedures).
• When it comes without catch
in the handle, called as
Sequestrum holding forcep,
used to hold sequestrum

52. Instrument for bone removal

53. Bone Rongeur Forcep
• This forcep has curved
handles with spring
action.
• The tip of the blade is
angulated forward
towards the handle and
has a concave inner
surface.
• The beaks are sharp.
• They can be
• Both side and end cutting
• Only side cutting
(Blumenthal)

54. Bone Cutter
• shape of the blade is
different and have a side
cutting action only.
• Uses
• To cut sharp bony margins
following surgical
procedures.

55. Chisel
• They have a heavy round / square
handle and long flat working tip.
• Unibevelled
• To smoothen the bone bevel is kept
facing the bone whereas to cut the
bone it is kept facing away from the
bone.
• Available in various sizes of working
tips.

56. Osteotome
• Similar to chisel but ---
bibeveled.
• It splits bone rather
than cutting or chipping
it.
• Uses
• Various osteotomy
procedures.
• Removal / Recontouring
of bone.
• Biopsy of bony lesions

57. Pterygoid Osteotome
• It is designed in completing
osteotomy between the maxillary
tuberosity and pterygoid plates in
LeFort I osteotomy procedures.
• Curved end
• Placed between tuberosity and
pterygoid plates of sphenoid bone
• Advantages
• Narrow tip to minimize encroachment
upon BFP
• Narrow shank to minimize threat of
tearing mucoperiosteal flap
• Sharp edge with reverse bevel to aid
better seating of osteotome

58. Pterygoid Osteotome

59. Mallet
• Similar to hammer, made up of steel / lead /
wood.
• Used for giving controlled taps on the chisel /
osteotome.
• To be effective the mallet should be used
with a loose free swinging movements of the
wrist.

60. Bone Gouge
• It has a round handle and a
blade that has sharp working
tip that is concave on inner
side.
• Working tip is half round and
has a long working area.
• Uses
• To make a window in anterior
border of maxillary sinus.(in
Caldwell Luc)
• To remove cancellous bone
graft material / irregular
pieces of bone.

61. Gigli’s Wire Saw
• It has 2 components
1. Wire saw
• It is made by twisting a
few pieces of wire
together so that it
acquires a sharp barbed
cutting edge.
2. Handles
• At the end of the wire
there is a ring to which
the hook of the handles
can be fitted.

62. Handpiece & Bur
• It is a quicker method of bone removal.
• Micromotor straight Handpiece
• The handpiece should have relatively high speed (35-
40000 rpm) and torque which allows rapid bone
removal.
• Burs
• stainless steel / carbide and available in different shapes
and length.

63. Surgical Saw
• In handpieces speed of 10,000
– 1 lakh cpm can be achieved.
• Different kinds of saws
available for various type of
osteotomy.
• Sagittal saw moves side to side
(5 - 6° arc), used for wedge /
transverse osteotomy.
• Oscillating saw oscillates (5 - 6°
arc), used for curved / straight
osteotomy.
• Reciprocating saw moves to and
fro (2.4mm), used for short /
long osteotomy.

64. Instrument for wound debridement

65. Curette (Lucas)
• An exploratory instrument with
spoon shaped working tip, used
to scrape soft tissues from bony
defects.
• The working end may be in the
plain as the shank or at an
angulation for adequate access.
• It can be single / double ended.
• Always held in “thumb and palm”
grasp and used in “pull (scrape)”
stroke.
• Uses
• To enucleate cyst /granulomas /
intra osseous tumours / cystic
neoplasms.

66. Volkmann’s Bone Scoop
• Similar to curette but concavity
of the working edge is more
pronounced.
• Uses
• To collect the contents from sinus
tract / fistula / chronic abscess
cavity.
• To scrape bony cavities due to
cystic / tumorous / osteomyelitic
lesions.
• To scoop out cancellous bone for
grafting procedures.
• To introduce graft material or
antiseptic powder into the surgical
area.

67. Lister’s Sinus Forcep
• It has long narrow blades
which are serrated
transversely for only ½ an
inch at the tip.
• Tip is rounded and bulbous.
• Instrument does not have a
catch.
• Uses
• To open an abscess by Hilton’s
method.
• To dissect out sinus / fistulous
tract in soft tissues.
• To hold a small piece of gauze
between blades to clean a
cavity.

68. Instruments For Mangament Of
Fractures / Osteotomies

69. Hayton Williams Forceps
• 2 widely divergent curved beaks that
engage the maxilla behind the tuberosity.
• Used for mid – palatal fractures.

70. Rowe’s Maxillary Disimapction
Forceps
• Pair of this instrument for
disimpacting maxilla in LeFort
fractures
• Consists of a straight unpadded
blade and a curved padded
blade.
• The unpadded blade is passed up
a nostril and padded blade grips
the palate.
• The operator stands behind the
patient and manipulates the
fragment into position.

71. Asche’s Nasal Septum Forcep
• Used to reduce
and align
fractures of the
nasal septum.
• Blades are
passed on either
side of the
septum and
vomer and
perpendicular
plate of ethmoid
bone.

72. Walsham’s Nasal Bone Forcep
• For reduction of nasal fractures
• It has 2 blades – small blade is inserted into
the nose and larger is applied externally to grip
the side of the nose up to the medial canthus
and parallel to frontal process of maxilla.

73. Zygomatic Elevator
• Bristow’s elevator – flat
instrument of sufficient
rigidity and inserted into the
same plane to reduce
zygomatic arch fracture.

74. • Rowe’s modification – through Gille’s temporal
approach.
• The instrument has a blade and oval handle similar to
Bristow’s pattern as well as a lifting handle which is
attached by a strong hinge with a positive stop near the
origin of the other handle.
74

75. Stacey zygomatic bone hook
75

76. Trocar
• It is a sharp, pointed instrument with a sleeve or cannula.
• Used to gain entry into the surgical site through
percutaneous approach to avoid skin incision and scar.
• Example – transbuccal approach to ramus of mandible.

77. Nasal Septum Osteotome
• It is used to fracture the anterior nasal
spine and separate the nasal septum from
maxilla during LeFort I or premaxillary
osteotomy procedures.

78. Smith Spreader
• It has 3 blades that are separated by spring
action when the handles are compressed.
• Used to separate bony fragments after
completion of the osteotomy cuts mainly used
to check separation of fragments during
downward fracture of maxilla / SSO procedure.

79. Bone Awl
• Long slender instrument
provided with an eyelet
at tip through which the
wires are pushed in for
transosseous wiring.
• Used for placement of
circum-mandibular
wiring or can be passed
around the zygomatic
arch/ piriform as in
maxillary suspension
procedures.

80. Instruments for cleft palate
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81. Dingman’s Retractor

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87. 87

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91. Instruments for skin grafting
91

92. Skin Graft Set
• Contains following
instruments
• Dermatome
• Wooden plank, used to
stretch skin during
harvesting and to keep
graft over it for
manipulation.
• Spreader, used to stretch
the harvested graft over
wooden plank.

93. Dermatome
• It is a surgical instrument
used to produce thin slices
of skin from the donor site.
• Manual / electrical
• Manual – hand held knives
(Humby’s; Modified Watson
knife) possess adjustment
facility.
• Electrical dermatome –
operated by air pressure
(Brown / Zimmer
dermatome)

94. Instruments For Bone Grafting
• BONE TREPHINE
• Specially designed
instrument used to
obtain small diameter
trephines of bone for
grafting
• Has 3 parts
• Barrel with stands.
• Piston (working tip has
saw)
• Stylet

95. Instruments for opening mouth
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96. INSTRUMENTS FOR HOLDING THE
MOUTH OPEN
• Soft, rubberlike block- patient rests teeth
• Patient opens to comfortably wide position- block
inserted: holds in the position
• Protects patient’s TMJ, while mandibular teeth

97. Heister’s Jaw Stretcher &
Fergusson’s Mouth Prop
• Used to forcibly open the mouth
• Indications:
• Trismus due to infection, muscle spasm,
hemarthrosis of TMJ following surgery
• Post operative active jaw physiotherapy after
TMJ ankylosis, OSMF.

98. References
• Textbook of oral and maxillofacial surgery –
Neelima A Malik
• Peterson’s Contemporary Oral & Maxillofacial
surgery – James Hupp, Edward Ellis
• Rowe & William’s Maxillofacial injuries
• Textbook of Oral and Maxillofacial Surgery – Daniel
M Laskin
• Internet

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