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Oral Surgery Intro

Oral Surgery Intro. Jan 11, 2008. Lacerations vs. Burns. If a person goes through a windshield, gets cut by an axe or a machete, it’s easier to fix than a gunshot victim Gunshot wounds will burn the tissue and necrosis will ensue. Fractures of the Face.

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Oral Surgery Intro

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  1. Oral Surgery Intro Jan 11, 2008

  2. Lacerations vs. Burns • If a person goes through a windshield, gets cut by an axe or a machete, it’s easier to fix than a gunshot victim • Gunshot wounds will burn the tissue and necrosis will ensue

  3. Fractures of the Face • French army surgeon Rene Le Fort (1869-1951) studied patterns of facial fractures by throwing cadavers off buildings and observed how the skull fractured. • Categorized into three patterns • Le Fort I (horizontal) • Le Fort II (pyramidal) • Le Fort III (transverse)

  4. Le Fort I, II, III

  5. Le Fort I

  6. Le Fort II

  7. Le Fort III

  8. #10 Surgical Blade Used ONLY for extra-oral incisions Least likely to be used in general practice

  9. #11 Surgical Blade Long sharp edge Used for Incision and Drainage (I & D) Get in and get out quickly

  10. #12 Surgical Blade Used to raise flap distal to max. second molars Use on tuberosity to expose max. third molars

  11. #15 Surgical Blade The Workhorse of Oral Surgery Used anywhere intraorally

  12. InfectionsAbscess vs. Cellulitis • Abscess • Collection of pus that is walled off • If body can’t wall it off, it may become systemic • I & D to treat the infection, MUST have PUS • Contains loculations, must break it up with blunt dissection • Many infections are subperiosteal, cut to the bone and score the periosteum • Rinse the wound with saline, place a drain with sterile piece of rubber dam • No longer than 2 days, otherwise can develop a tract

  13. InfectionsAbscess vs. Cellulitis • Cellulitis • Diffuse infection in tissue • Rock hard swelling • No place to I & D • Empirically place on antibiotics • Get a temperature • Localized vs. systemic spread detected this way • Culture the bacteria • Clindamycin kills most everything • It may collect to a point, then I & D

  14. Culture and Sensitivity • This test allows a better description of the specific type of bacterial infection • Anaerobic vs. aerobic infection • Send to the lab • 95-96%- Empirical antibiotics work • Sometimes not, therefore, use specific antibiotics • Remember- Facial vein-opthalmic vein-brain= death!

  15. Treat the Source! • Amoxicillin and Penicillin- 1st choice • Allergic to those- Clindamycin • Amoxicillin and Penicillin not good against bacteroides gram (-) anaerobic • Clindamycin kills most everything and can cause C. dificile-pseudomembranous colitis • Remember to eat yogurt to replenish intestinal bacteria

  16. Pseudomembranous colitis • Treat with Metronidazole (Flagyl®)

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