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CHAPTER 18

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

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  1. CHAPTER 18 Oral and Maxillofacial Surgery

  2. 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

  3. 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

  4. 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

  5. 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)

  6. 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

  7. 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

  8. 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)

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

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