1 / 35

Mucocoeles & Prescription Writing

Mucocoeles & Prescription Writing. April 11, 2008. Mucocele. A patient presents with a lesion on the lip The lesion is said to “go up and down” The only thing it can be is a Mucocele

abba
Download Presentation

Mucocoeles & Prescription Writing

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Mucocoeles & Prescription Writing April 11, 2008

  2. Mucocele • A patient presents with a lesion on the lip • The lesion is said to “go up and down” • The only thing it can be is a Mucocele • A mucous cyst (MC) is a benign, common, mucus-containing cystic lesion of the minor salivary glands in the oral cavity-(mucocele)

  3. Mucocele • A mucocele can be created by • Trauma • Ortho Brackets • Anything that severs the duct of a minor salivary gland • The gland continues to produce saliva yet it has nowhere to go except into the connective tissue creating a Mucocele

  4. Mucocele • The mucocele will rupture, then return • Surgical removal of a mucocele is never a guarantee • You may sever another duct and create a new mucocele

  5. Mucocele • Do not distort the anatomy while anesthetizing for excision • Lasers will work very well for this type of procedure • In the absence of a laser: • Make a wedge-shaped incision around the mucocele and remove it without causing it to leak out • “Picking strawberries” you must remove all of the accessory glands once you’ve removed the initial large gland • Use the Adson Tissue Pick-ups to do this

  6. Mucocele • A very large mucocele will be too large to excise completely • The procedure of choice in this circumstance is called Marsupialization • Open it up inside-out and let it granulate and destroy itself

  7. Marsupialization • The surgical formation of a pouch to treat a cyst when simple removal would not be effective. • Under anesthesia, the cyst sac is opened and emptied. • Its edges are sutured to adjacent tissues, and a drain is left in place. • Over a period of several months, secretions will decrease and the sac space will be reduced until it is completely filled

  8. Marsupialization • This technique involves the placement of a 4.0 silk suture through the widest diameter of the lesion (dome of the lesion) without engaging the underlying tissue. • A surgical knot is made, and the suture is left in place for 7 days. • Patients need to be educated about suture replacement; they must return to have the suture replaced if it should be lost during the 7-day period. • The idea behind this alternative treatment for mucoceles of minor salivary glands is that re-epithelization of the severed duct occurs or a new epithelial-lined duct forms, allowing egress of saliva from the minor salivary gland.

  9. Hard Palate Lesion • Example of a pedunculated lesion on the lateral portion of the hard palate • Place a suture through the lesion and create tension • Incise to bone and remove entirely

  10. Verrucous Carcinoma • Underside of tongue • Palpate to see how deep it is • When incising, follow the muscle pull (especially in the tongue) • It is the ONLY place in the mouth where you place extra knots due to the muscularity of the tongue • Make an Elliptical incision around the lesion  excise  Use Adson Tissue Pick-ups to remove the lesion muscular bed  sutures in to close • Only anatomy to be concerned about are the vein, and nerve in the posterior region

  11. Epulis Fissuratum • Created by the body’s reaction to stabilize ill fitting dentures • The bone changes with repeated wear and the bone resorbs, creating more give, more space, and the body tries to fill the space in to make the denture more stable • The problem with granulation tissue is it is movable

  12. Epulis Fissuratum • If you remove the epulis the tissue will relapse • After removal, suture the flap lower and extend the border of the denture to hold down the tissue • This will prevent loss of vestibular depth • Anything taken out, biopsy it because there is a 1% chance that it could be more than it seems

  13. PDR • Physician’s Desk Reference (PDR) • Written by the manufacturers • All of the drug inserts placed in one book • Comprehensive indexing (4 sections) • Manufacturer index (Gray Section) • Generic/chemical index (non-trademark common drug names • Products/Category index (i.e. antihistamines) (Gray Section) • Color images of medications

  14. Schedule III • Mix a peripheral acting analgesic with a central acting analgesic to avoid addiction • We don’t use Schedule II drugs in the clinic • When a patient comes in with a bombed out tooth and prefers drugs to extraction, they are a crack addict (PC) on the block

  15. Narcotics • Schedule 3 drugs can be called in over the phone • Schedule 2 drugs CANNOT be called in • PERCODAN, PERCOCET, TYLOX • These are more potent • Narcotics are scheduled based on addiction potential • Vicodin is the most abused drug in country

  16. Narcotics • Vicodin 5mg Hydrocodone and 500 acetaminophen • Vicodin ES (Extra Strength) 7.5 mg and 750 acetaminophen • If Vicodin 5mg doesn’t “work” take one and a half (like taking 7.5mg)

  17. Vicodin 5mg

  18. Vicodin ES 7.5mg

  19. Narcotics • Tylenol with codeine • Review the handout • Aspirin and oxycodone • Percodan • Acetominophen and Oxycodone • Percocet, Tylox, etc • Synalgos DC • Aspirin, Caffeine, Dihydrocodeine

  20. Tylenol #2 with Codeine 15mg

  21. Tylenol #3 with Codeine 30mg

  22. Tylenol #4 with Codeine 60mg

  23. Percodan

  24. Percocet

  25. Tylox

  26. Narcotics • ex: Synalgos DC • A synthetic narcotic • The only difference to Vicodin is that it is Tylenol based • Synalgos DC contains aspirin • Be careful with patients on coumadin or have bleeding ulcers • It has little bit of caffeine in it; DC=dihydrocodeine (synthetic narcotic) • Same equivalents

  27. Synalgos DC

  28. Narcotics • If the patient is allergic to codeine and is a drug addict, what do you give? • NSAID (like Motrin; Motrin 800-prescription-can only take 1 tab q6h prn pain; equivalent to Tylenol #3) • At night, a patient will call in and give a perfect academy award on phone to get narcotics • They’ve never been seen in practice • Give no one a narcotic, only a non-steroidal unless you know them for sure • They can take 4 OTC Motrin (each 200 mg) • They will be fine until can see them in morning

  29. Prescription Writing • RX: What you are going to give patient • ex: Vicodin-500 mg less problems than with tylenol 3 like vomiting, diarrhea; this has synthetic codeine), cottage cheese or something to coat stomach  very FEW problems with vicodin • DISP: How many give patient • For a single tooth extraction  12 -15 enough); • When you go to Highland  write out the number (spell it!!) • Sig: What pharmacist translates into English for patient; • Pain pills dose at 1 tab q3-4h prn pain (q3-4 generally recommended for pain), dose every 3-4 then patient stay above the threshold and remains comfortable

  30. Prescription Writing Alex Isom 867-5309 ? Eddy & Leavenworth Barely Legal Rx: Vicodin 5mg Disp: 12 (twelve) tabs Sig: 1 tab p.o. q3-4h prn pain

  31. Motrin • 3200 mg/day maximum • Rx: Motrin 800mg • Disp: 20 • Sig: 1 tab p.o. q6h prn pain

More Related