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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

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chapter 18

CHAPTER 18

Oral and Maxillofacial Surgery

objectives
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
objectives cont d
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
objectives cont d1
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
introduction to oral and maxillofacial surgery
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)
introduction to oral and maxillofacial surgery cont d
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
introduction to oral and maxillofacial surgery cont d1
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
diagnostic tests
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)
diagnostic tests cont d
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
diagnostic tests cont d1
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
diagnostic tests cont d2
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
tooth extraction odontectomy
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
maxillofacial procedures
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
maxillofacial procedures cont d
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
maxillofacial procedures cont d1
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
maxillofacial procedures cont d2
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
maxillofacial procedures cont d3
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
repair of mandibular maxillary fractures
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
repair of mandibular maxillary fractures cont d
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
repair of mandibular maxillary fractures cont d1
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
procedures
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
summary
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