Oral & Maxillofacial Surgery



ORAL & MAXILLOFACIAL SURGERY

Terms

> Alveolar process

> Arthroscopy

> Calvarial

> Condyle

> Coronal flap

> Craniosynostosis

> Dentition

> Glenoid fossa

> Gnath-

> Labia

> Malar bone

> Malocclusion

> Maxillofacial

> Meniscus

> Mouth prop

> Orbicular

> Osteotomy

> Pan-

> Ramus

> Reduction

> Sagittal

> Symphysis

> TMJ

Anatomy

> Oral (Buccal) Cavity

• Lips (labia)

← Thermal receptors for protection from burns

← Muscles aiding in expressions, food retention, and mastication (chewing)

← Space between lips extending to the cheeks is the vestibule

• Teeth (Dentitions)

← Used for speech and mastication

← Deciduous (primary)

← appear during ages 6 mo to 4 yr, lose starting age 6

← 20 teeth (2 central incisors, 2 lateral incisors, 2 cuspids (canines), 4 molars per jaw)

← Permanent (secondary)

← 32 teeth (2 central incisors, 2 lateral incisors, 2 cuspids or canines, 4 bicuspids, 6 molars per jaw )

← 3rd molars or wisdom teeth appear age 17-25

← Rest in alveolar processes

← 3 regions

← Crown is above/outside gumline

← Enamel is the covering, is the hardest part, doesn’t reproduce, degenerates with age/injury

← Dentin is the majority of tooth, is harder than bone, encases pulp

← Pulp is core, contains nerves, blood vessels, connective tissue

← Neck: junction of crown and root

← Root

← Held by periodontal ligament

← Connects tooth to alveolar processes

• Palate: roof of the mouth

← Anterior portion is hard palate

← Posterior portion is soft palate

← Uvula is the most posterior part of the soft palate

← Soft palate separates mouth from nasopharynx

← Soft palate rises with swallowing to prevent food going into nasal cavity

• Cheeks: lateral walls of oral cavity

← Consist of major muscles for mastication

• Tongue

← Chemoreceptors for taste

← Attached to floor of buccal cavity by lingual frenulum

← Function in speech, propelling food through oral cavity and swallowing

> Skeletal System

• Appendicular Skeleton: everything hanging off the axial skeleton

← Limbs, pelvic and shoulder girdles

• Axial Skeleton: along or connecting to the midline of the body

← 80 bones incl skull, vertebral column, sternum, ribs

← Skull bones

← Frontal: protection

– Twice as thick as others.

– Supraorbital foramen allow for passage of blood vessels and nerves servicing the face and head

← Temporal: protection

– External auditory canal allows for sound to enter skull

– Openings at base for carotid arteries and jugular veins called carotid foramen and jugular foramen

– Mastoid process where sternocleidomastoid muscle attaches

← Occipital

– Forms posterior base of skull

– Large hole at base is foramen magnum where spine enters skull

– Occipital condyles are connections between skull and vertebrae

– C-1 vertebrae most superior (atlas) supports the skull/head

– C-2 is the axis which allows for movement of the head

← Sphenoid bone

– Center of base of skull

– Keystone of the skull (ties a lot of other bones together)

– Sella tursica is where the pituitary gland sits

← Ethmoid bone

– Forms part of nasal cavities

– Olfactory foramen open into nasal cavity

– Penetrates into frontal bone cribiform bone

– Cribiform plate is where sense of smell is delivered/received

← Maxilla

– Attachment for upper teeth (alveolar processes)

– Infraorbital foramen for vessels and nerves

– Attachment for zygomatic bones/cheek bones

← Mandible: lower jaw

– Largest and only moving bone in face

– Attachment for lower teeth (alveolar processes)

– Articulates with glenoid fossa of each temporal bone = TMJ (temporomandibular joint)

← Lacrimal bone

– Smallest bone in face, thin

– Small foramen become nasolacrimal ducts where tears drain

← Hyoid bone

– Only bone in body NOT connected directly to another bone

– Held in place by ligaments

– Holds tongue in place (tongue for swallowing and mastication)

← Orbital Bones: frontal, lacrimal, ethmoid, maxilla, zygomatic, sphenoid, palatine

• Facial Muscles – see pages 647-648

← For facial expressions, mastication, speech

Pathology

> Oral Cavity Pathology

• Fractures

• Dental caries

• Periodontal disease

> Mouth Pathology

• Cysts

• Cancer

> Jaw Bone Pathology

• Congenital malformations

• Malocclusion

• Micrognathia

• Retrognathism

• Fractures

> Mandibular Pathology

• Fractures

> Frontal Pathology

• Fractures

> Orbital Pathology

• Fractures (2 Types):

← Floor fractures

← Orbital blowout

> Zygomatic (Malar) Pathology

• Fractures

> Craniofacial Pathology

• Craniosynostosis or Crouzon’s disease

• Fractures

> Midfacial Pathology: LeFort fractures

← Le Fort I: Transverse fx of maxilla, through upper alveoli & palate

← Le Fort II: Pyramidal fx of frontal maxillae, nasal bones, orbital floor

← Le Fort III: Zygomas, maxilla, nasal bones; ethmoid, sphenoid, and other orbital bones

← Primary concerns are airway obstruction, cervical spine injury, and hemorrhage [Berry & Kohn’s (2004)]

Procedural prep

> Diagnostics

• Physical exam

• X-rays

• Plain films

• 3 dimensional images

• CT scans

• MRIs

> Supplies

• Raytex or plain 4 x 4s

• Dental packs

• Tonsil sponges

• Blades

• Cottonoids

• Absorbable suture

• Suction

Instruments see p. 654

• Mouth prop (wedge)

• Cheek retractor

• Periosteal elevators

• Dental mirrors

• Extraction forceps

• Gingival probes

• Minnesota retractor

• McGill

• Tissue forceps w/ & w/o teeth

• Probes

• Frazier tips

• #7 knife handle

• Needle holders

• Yankauer tips

• Scissors (straight, curved)

• Hemostats (straight, curved)

• Wieder tongue depressor

• Towel clips

> Equipment

• Power drills

• Plates and Screws

> Medications

• Local anesthetics: injectable and/or topical

• Antibiotics

> Anesthesia: local, MAC, or general

> Prep (surg pref.)

• Betadine scrub and paint

• Betadine dilute rinse for mouth

• Peroxide rinse

> Draping (surg pref.)

• Four towels

• Split sheet

Procedures

> Oral

• Tooth Extraction/Odontectomy

← Teeth cannot be salvaged by restoration procedures

• Tooth Restoration

← Refurbishing of tooth with fillings, crowns, caps

• Implantation

← Prosthetic tooth or teeth

> Maxillo-facial

• Repair materials

← Graft Materials

← Autogenous

← Homogenous (allograft)

← Heterogenous (xenograft)

← Synthetic

← Arch Bars

← Plates & Screws for Mandibular Fracture

• Procedures

← Frontal Fracture Repair

← Orbital Fracture Repair

← Reduction Zygomatic Fractures

← Le Fort I

← LeFort II and II Fracture Repair

← Retrognasthism or Prognathism Correction

← Temporomandibular Joint Repair or Replacement

← TMJ arthroscopy for meniscal repair

← TMJ replacement

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