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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