Oral Surgery 2 Finals PDF

DOS 5101 bahia.daquigan.escober.federizo.geroleo.laus.nacu.quiambao.sanquina ORAL SURGERY 2 (FINALS) Structures to look for in a radiograph -​ crown...

DOS 5101 bahia.daquigan.escober.federizo.geroleo.laus.nacu.quiambao.sanquina ORAL SURGERY 2 (FINALS) Structures to look for in a radiograph -​ crown, bone level, pdl space, continuity of lamina Dr. Glaiza L. Sarmiento dura (clinically, alveolar bone proper) CHRONIC INFLAMMATION RADICULAR CYST ❖​ Factors that can bring chronic conditions ❖​ from epitheliated 1.​ low virulence of bacteria granuloma 2.​ high tissue/body resistance — ❖​ Fatty degeneration = continuous growing but asymptomatic cholesterol crystals 3.​ presence of drainage — fistula ❖​ cholesteotoma → cysts ❖​ Types of Chronic Inflammation mostly made up cholesterin 1.​ Dental Granuloma ❖​ Pressure from cystic fluid a.​ closed granuloma → Compression of cystic b.​ discharging granuloma wall → Enlargement of c.​ epitheliated granuloma cystic cavity d.​ sclerosed granuloma 2.​ Radicular cyst a.​ residual cyst CONDENSING BONE OSTEITIS b.​ condensing osteitis 3.​ Chronic Periapical Abscess DENTAL GRANULOMA ❖​ mass of granulation ❖​ long standing irritation tissue at the periapical ❖​ abnormal thickening of the bone surrounding area the infected tooth ❖​ cause : mild irritation ❖​ bone sclerosis → stimulation of osteoblast ❖​ Etiology : seepage of formation toxic products from ❖​ increased bone trabeculae infected pulp ❖​ decreased marrow spaces ❖​ if not attached to the apex, do curette but be RESIDUAL CYST careful ❖​ Types: Epitheliated granuloma transform as cyst Closed Dischargin Epitheliate Sclerosed Granuloma g d Granuloma Granuloma Granuloma Inflammator Pus at the Granuloma Most have y infiltrates center of within an already ❖​ chronic periapical infection left in the socket confined at the epithelium disappeare after exo the center granuloma lining d ❖​ asymptomatic ❖​ may cause extensive resorption and destruction Within Perforating Epithelium Healed of the alveolar jaw bone fibrous wall the oral from the abscess ❖​ usually seen only in routine radiograph of the cavity epithelial granuloma rest of Granulatio Malassez n tissue → CLINICAL CONSIDERATIONS collagen fiber ❖​ Asymptomatic → transient uneasiness ❖​ Nodule → healed sinus or fistula ❖​ Acute DOS 5101 bahia.daquigan.escober.federizo.geroleo.laus.nacu.quiambao.sanquina ​ Gumboil → small spherical mass of HISTORY gum with fistula ❖​ Chronic ❖​ time of injury ​ tooth is sensitive to percussion ❖​ Mode of injury (assault or fall) ​ gingiva is swollen and red ❖​ Loss of consciousness ❖​ Radiolucent except for Condensing Osteitis ❖​ Treatment prior to admission MANAGEMENT PRELIMINARY TX ❖​ RCT provided that they are not cystic in origin ❖​ establish and maintain the airway ​ apicoectomy if cyst is still there after ❖​ Arrest hemorrhage RCT ❖​ Initiate resuscitation ❖​ exo, curette, irrigate ❖​ Provide pain relief ❖​ enucleation, may add marsupialization ❖​ Institute infection control measure ❖​ Examine and dress open wounds ❖​ Immobilize suspected cervical spine injuries CHRONIC PERIAPICAL ABSCESS ❖​ Origin: periapical abscess or CLINICAL EXAM granuloma ❖​ has to have a fistula ❖​ lacerations ❖​ opening to the labial or ❖​ Swelling lingual mucosa = fistula ❖​ Ecchymosis ❖​ GP tracing is done ❖​ Visible or palpable deformity ❖​ no need for anes ❖​ Abnormal mobility and crepitus ❖​ Palpable tenderness –-------------------------------------------------------- ❖​ Impaired function (trismus) ❖​ Malocclusion ❖​ Nerve injury: loss of sensation in cheeks, lips, chin FRACTURE ❖​ a pathological discontinuity in bone RADIOGRAPHS USED FOR FX ❖​ Traumatic Fractures ​ cause by an external force ❖​ Panoramic ​ fracture travels along a line (fracture ❖​ Mandibular series line) ❖​ Occlusal radiography ❖​ Non-Traumatic Fractures ❖​ Lateral oblique views ​ caused by metabolic imbalance ❖​ CT scan (osteoporosis) or by weakness due to ​ see soft tissue landmarks undermining of the bone by ❖​ Periapical radiography pathologic lesions (cysts, tumors) ​ to see if until socket yung fracture ​ Pathologic fractures ❖​ Posteroanterior view ​ ❖​ Towne’s view ​ Spontaneous fractures ​ Indication: max fracture ❖​ Mandible : vertical and oblique ❖​ Maxilla : horizontal and transverse MANDIBULAR FRACTURES ❖​ Most common site: angle of the mandible CLINICAL PRESENTATION ❖​ Favorable : normal muscle pull brings fracture ❖​ pain together; displacement unlikely ❖​ Swelling ❖​ Non-favorable : in normal muscle pull fracture ❖​ Loss of function (truisms and diplopia) is more separated; displacement likely ❖​ Malocclusion ❖​ Altered sensation DOS 5101 bahia.daquigan.escober.federizo.geroleo.laus.nacu.quiambao.sanquina ❖​ Types ​ simple comminuted ​ compound comminuted COMPLICATED FRACTURE ❖​ many different fractured parts in the bone unfavorable favorable (nerve, vessel, pleura or other organs) FREQUENCY GREENSTICK FRACTURE – not updated acc to ma'am – ❖​ body (29%) ❖​ Condyle (26%) ❖​ Angle (25%) ❖​ Symphysis (17%) ❖​ Ramus (4%) ❖​ Coronoid Process (1%) ❖​ one side of the bone is broken and the other side is bent CLASSIFICATION ❖​ common in children ❖​ no continuous fracture; no discontinuity in the bone SIMPLE FRACTURE FRACTURE SITES thickest and strongest area: fx Symphysis usually travels to the other side and rarely occurs in the midline ❖​ a break in the bone that does not produce an open wound in the skin Symphyseal Fx occurs w/ bilateral condylar fxs (Guardsman Fx) COMPOUND FRACTURE Incisor region usually oblique Fx geniohyoid displaces fragments lingually: mylohyoid pulls fragments mesially so anterior teeth overlap Canine weakest due to thick and long root Body Region weakest at all site of the mental foramen ❖​ a break in the bone with an external wound extending to the bone Angle often due to indirect force COMMINUTED FRACTURE NORMAL MUSCLE PULL four muscles of mastication ❖​ Temporalis m. ❖​ Internal Pterygoid m. ❖​ Masseter m. ❖​ External Pterygoid m. ❖​ the bone is splintered into three or more fragments or is crushed DOS 5101 bahia.daquigan.escober.federizo.geroleo.laus.nacu.quiambao.sanquina ❖​ Le Fort III Fracture (i.e. Craniofacial separation) MUSCULATURE ​ complete separation of midface at level of naso-orbital-ethmoid complex and zygomaticofrontal suture area JAW ELEVATORS (CLOSE) ​ fracture also extends through orbits ❖​ Masseter bilaterally ​ arises from zygoma and inserts into the angle and ramus —------------------------------------------------------- ❖​ Temporalis ​ arises from the infratemporal fossa and inserts onto the coronoid and BIOPSY ramus ❖​ removal of tissue from a living individual for ❖​ Internal / Medial Pterygoid diagnostic examination ​ arises from medial pterygoid plate and ❖​ Most effective of All Dx procedures performed pyramidal process and inserts into in the laboratory lower mandible ❖​ Mandatory in identifying lesions which cannot be diagnosed by less invasive procedures ❖​ Major Types of Biopsy JAW DEPRESSORS (OPEN) ​ aspiration biopsy ❖​ External/Lateral pterygoid ​ excisional biopsy ​ lateral pterygoid plate to condylar ​ incisional biopsy neck and TMJ capsule ​ cytology ❖​ Mylohyoid ​ exfoliative cytology ​ mylohyoid line to body of hyoid ​ oral brush cytology ❖​ Digastric ​ mastoid notch to the digastric fossa ❖​ Geniohyoid REMEMBER ​ inferior genial tubercle to anterior ❖​ Mandatory for clinically suspicious lesions hyoid bone ❖​ Indications per technique ❖​ DO NOT direct injection of local anesthetic solution into the lesion = distortion of tissue ​ Block technique so that epi will not MAXILLARY FRACTURES wrinkle or shrink the lesion? ❖​ Le Fort I Fracture ❖​ DO NOT use Electrosurgery = coagulation and ​ separates inferior destruction of tissues portion of maxilla ❖​ DO NOT grasp the biopsy specimen with tissue in horizontal forceps (ex. allis, russian tissue forceps) fashion, extending ❖​ Tissue specimen should reflect the lesion from piriform entirely aperture of nose ❖​ Large lesions → multiple tissue specimens from to pterygoid diff locations maxillary suture ❖​ Wide mouth bottle (10x the size of the area specimen) ❖​ Ideal fixative agent → 10% formalin ❖​ Le Fort II Fracture ❖​ Plastic container ​ separation of ❖​ Prepare the necessary information which will maxilla and nasal identify the specimen and patient from which it complex from was taken cranial base, zygomatic orbital rim area and pterygoid maxillary suture area DOS 5101 bahia.daquigan.escober.federizo.geroleo.laus.nacu.quiambao.sanquina ASPIRATION BIOPSY EXCISION BIOPSY ❖​ Removal of entire lesion, along with a border if ❖​ The use of a needle (ga 18 or 16) and syringe to normal tissues surrounding the lesion penetrate a lesion for sucking its contents ❖​ Both diagnostic and curative ❖​ For lesions suspected to contain liquid or air ❖​ Undermining tissue is for excisional only ❖​ For lesions not accessible for histopath exam like the parotid gland, lymph nodes, cysts, etc. ❖​ A radiolucent lesion in the jaw which yields straw colored fluid on aspiration is most likely CYSTIC ❖​ PUS → infected cyst, abscess ❖​ AIR → traumatic bone cavity ❖​ Indicated for ❖​ BLOOD → vascular formation in the jaw ​ Small lesions - few mm to 1-2 cm ❖​ NEGATIVE PRESSURE → tumor ​ Specific clinical signs and indications that the lesion is benign STEPS IN ASPIRATION BIOPSY ​ Lesions which may be removed at a dental clinic set up with the usual ❖​ anesthesia - block, topical armamentarium and w/ in the ❖​ Usa a gauge 18 needle connected to a 10ml competence of a general practitioner syringe. Insert needle into the center of the mass during aspiration to locate the fluid center ❖​ For bony lesions, if the cortex Has expanded HPI for soft tissue lesions -​ when or where did they first noticed the lesion and thinned, the Needle May Be inserted hanggang sa consultation Directly into the Mucoperiosteum To The Bone and twisted until it perforates the cortical plate Notes: -​ traction suture — used to pull the lesion so it can be FINE NEEDLE ASPIRATION BIOPSY cut from the base (beyond the base) -​ always include sound soft tissue when sending the specimen to a pathologist Tongue Fibroma ❖​ Aspirates cells from solid lesions which can be useful for accessible swellings or lumps such as salivary glands or the neck ❖​ Recommended for suspected malignant lesions ❖​ Used With cytology Traumatic Fibroma -​ Cause: cheek biting, ill-fitting denture, etc. -​ Tx: remove cause or excisional biopsy DOS 5101 bahia.daquigan.escober.federizo.geroleo.laus.nacu.quiambao.sanquina ❖​ For multiple incisional biopsy sites, get sample for all sites or area ​ Ex ameloblastoma halo ng soft and hard tissue, some parts may be red, pink, brown — be sure to include all ❖​ Avoid necrotic tissue ❖​ Deep, narrow biopsy → superficial changes Incisional biopsy up to muscle when labial to buccal Palatal Swelling Notes: -​ Infiltration, lots of bleeding is expected -​ Allis tissue is only used to hold the base, not the lesion mismo kasi maddamage -​ Goldman fox tissue scissors -​ 10% formalin to store tissue sample -​ Use saline if u can send to the lab within 24 hs INCISIONAL BIOPSY EXFOLIATIVE CYTOLOGY ❖​ Removal of only a part of a large lesions ❖​ Lesions showing characteristics of neoplasms such as differentiation, invasiveness, etc. ❖​ the lesion is scraped using a tongue depressor ❖​ indicated for ❖​ The superficial cells scraped ​ Lesions larger than 1-2 cm ❖​ Fix the smear with 95% ethyl alcohol and 5% ​ Location of lesion is hazardous and ether or use hair spray inaccessible ❖​ Ex. For px complaining multiple white plaque ​ lesions which are suspected to be ​ Brush cytology malignant ​ Moth eaten appearance ❖​ A wedge shaped specimen → representative part of the lesion ❖​ Areas from the edge of the lesion to include some normal tissue ❖​ The specimen should include areas which show complete tissue changes DOS 5101 bahia.daquigan.escober.federizo.geroleo.laus.nacu.quiambao.sanquina ORAL BRUSH CYTOLOGY ❖​ a small round brush is allowed to run over the suspicious lesion ❖​ The brush can penetrate and get better ❖​ Kerrison Forceps sampling of cells than the scraping technique ❖​ The sample is Then sent To the lab Where it is scanned using an advanced Computer technology ❖​ suspicious slides are tagged for further evaluation by a technician ❖​ The oral brush can obtain cellular samples from ❖​ Trephine each of the 3 layers of a lesion: basal, intermediate, and superficial. Previous cytology instruments were able to obtain only the exfoliated superficial cells ❖​ No need for anesthetics, no bleeding PUNCH BIOPSY BIOPSY ARMAMENTARIUM (SOFT TISSUE) ❖​ Local anesthetic equipment ❖​ Scalpel #15 ❖​ Scissor with pointed tip ❖​ Fine tissue forceps ❖​ Small hemostat ❖​ punch a hollow trephin of 3-4 mm in diameter ❖​ Gauge sponge (suction) ❖​ remove a small “core” of soft tissue ❖​ Needle holder, needle, suture ❖​ May or may not require suturing ❖​ Biopsy bottle with 10% formalin ❖​ More convenient ❖​ Biopsy data sheet ❖​ Downside: Has to Be over sound bone for you to be able to punch it ADDITIONAL INSTRUMENTS ❖​ Toluidine blue staining ❖​ Soft Tissue within bone ​ Periosteal Elevator ​ Rongeur ​ Bur and rotary handpiece ​ Sterile saline irrigation ​ Curette ❖​ Aspirating Intraosseous Lesions ​ Syringe (5 or 10 ml) ​ Needle (gauge 18) ❖​ Biopsy Devices ​ Blade ​ Trephine brush : for hard tissue punch biopsy DOS 5101 bahia.daquigan.escober.federizo.geroleo.laus.nacu.quiambao.sanquina ​ Electrocautery PREPROSTHETIC SURGERY (HARD TISSUES) ​ not recommended ❖​ Preprosthetic Surgery: eliminate certain lesions or abnormalities of the hard and soft HALLMARKS OF MALIGNANCY tissues of the jaws (BIG FEUD) ​ Support the best possible prosthetic should be ruled out from the hpi palang replacement ❖​ Bleeding ❖​ Hard tissues ​ (if not =benign) ​ alveoloplasty ​ lesion bleeds in gentle manipulation ​ Smoothen or recontour the ❖​ Induration / abnormal hardening of the tissue alveolar bone (parang bukol) ​ alveolectomy ​ lesion and surrounding tissue is firm ​ surgical excision of part of to touch the alveolar process ❖​ Growth rate ​ alveolotomy ​ rapid growth ​ Surgical opening into a ❖​ Fixation (pedunculated or sessile) dental alveolus to allow ​ Pedunculated is better drain of pus from a ❖​ Erythema (Erythroplasia) periapical or other ​ lesion is completely red or has intraosseous abscess speckled red and white appearance ​ Done during extraction, not ❖​ Ulcerations something you intend to do ​ more than 2 weeks persistence ​ Torus Palatinus ❖​ Duration ​ Torus Mandibularis ​ more than 2 weeks persistence ​ Bony Exostoses ​ repositioning of mental foramen ​ types and techniques of denture INDICATIONS FOR BIOPSY alveoloplasty ❖​ Any lesion that persists >2 weeks with no ​ maxillary tuberosity reduction apparent reason ​ retromolar pad reduction ❖​ Any inflammatory lesion which does not responds to local treatment after 2 weeks (after removing irritant) ALVEOLOPLASTY ❖​ Persistent hyperkeratotic changes in surface Alveoloplasty after extraction of single tooth tissue (crusting) ❖​ Inflammatory changes of unknown cause wc persist for long periods ❖​ Lesion which interfere with local function (fibroma) ❖​ Bone lesions not specifically identified by clinical and radiographic findings ❖​ ANy lesion that has the characteristics of malignancy —------------------------------------------------------- DOS 5101 bahia.daquigan.escober.federizo.geroleo.laus.nacu.quiambao.sanquina Alveoloplasty after extraction of 2 0r 3 teeth Alveoloplasty of edentulous ridge Alveoloplasty after extractions multiple Alveoloplasty of entire alveolar ridge DOS 5101 bahia.daquigan.escober.federizo.geroleo.laus.nacu.quiambao.sanquina TORUS MANDIBULARIS ❖​ Lingual aspect of the mandible ❖​ unilateral or bilateral ❖​ canine and premolar region ❖​ asymptomatic bony protuberances ❖​ covered by normal mucosa TORUS PALATINUS ❖​ Center of the hard palate ❖​ Cause: unknown ❖​ Asymptomatic bone protuberances ❖​ Covered by normal mucosa ❖​ Vary in size ❖​ Shape → single, multiloculated, irregular EXOSTOSES DOS 5101 bahia.daquigan.escober.federizo.geroleo.laus.nacu.quiambao.sanquina PREPROSTHETIC SURGERY (SOFT TISSUES) ❖​ Classifications ​ Congenital abnormalities: such as hypertrophic frenum, etc. ​ Abnormalities created after use of dentures (e.g. fibrous hyperplasia of the mucosa), and other causes FRENECTOMY (LABIAL) REPOSITIONING OF MENTAL FORAMEN FRENECTOMY (LINGUAL) DOS 5101 bahia.daquigan.escober.federizo.geroleo.laus.nacu.quiambao.sanquina FIBROUS HYPERPLASTIC RETROMOLAR TUBEROSITY DENTURE INDUCED FIBROUS HYPERPLASIA DOS 5101 bahia.daquigan.escober.federizo.geroleo.laus.nacu.quiambao.sanquina PAPILLARY HYPERPLASIA OF THE PALATE