OS- basic surgical techniques

Question 1

What is a mucoperiosteal flap?

Answer 1

This is when we raise the periosteum and the muocsa as one.

Question 2

Discuss the width of the mucoperiosteal flap needed.

Answer 2

We need a wide flap as:

• This allows us to see better.
• It will heal just as quickly as a smaller flap.
• It allows the flap to maintain circulation and perfusion.

Question 3

What are the important aspects of cutting a flap?

Answer 3

• Clean flap reflection -perfusion is reduced for small bits of tissue so it is more likely to necrose.
• The wound should not be closed on tension- this causes the wound to break down.
• Ensure the flaps and wounds lie on sound bone to provide support to the soft tissue- This allows healing and prevents tissue breakdown.
• Precise cuts should be used so that healing is by primary intention (reducing scaring)

Question 4

Name this instrument and discuss it’s function

Answer 4

This is an outer henry rake retractor.

This is a broad instrument that reflects light in when you are removing bone.

Question 5

Name this instrument and discuss it’s function.

Answer 5

This is an ash periosteal elevator.

This pulls back the soft tissues to allow access

Question 6

Name this instrument and discuss it’s function

Answer 6

This is Howarth’s periosteal elevator.

This is used to lift the flap and protect the associated structures

Question 7

What type of handpeice do we use for bone removal and why?

Answer 7

We use an electric straight handpeice with a saline or sterile water-cooled burr.

Because if we used an air handpeice (normally used in clinic ) it would drive air under the mucosa or skin-leading to emphysema .

Question 8

How can we debride the area after oral surgery.

Answer 8

Physcially-

Bone debris- using a bone file

Soft tissue debris- Mitchel’s trimmer or victoria curette.

Irrigation- (sterile saline into the socket & under the flap)

Suctioning-

Aspirate under the flap to remove debris

Check socket for retained apices.

Question 9

Compare the two types of suture used for closing the flap.

Answer 9

Resorbable sutures-These hold tissue together temporarily but dissolve e.g. velosorb

Non-resorbable sutures- These are used when retention is required for extended periods of time & they have to be removed post-operatively e.g. mersilk

Question 10

Compare monofilament and polyfilament Sutures

Answer 10

Monofilament sutures- made of one strand.

Polyfilament sutures- made of multiple strands but prone to wicking. (oral fluids and bacteria can move along the suture causing infection)

Question 11

Compare the different suture needles- referring to their cross section.

Answer 11

Triangular cross section with inside cutting edge- Suture passes through without major trauama.

Triangular cross section with reverse cutting edge- prevents the needle tearing the suture when it is being tied

Round taper cutting edge- Cutting edge is on the point, this is more often used for friable tissue and is more dependent on tissue dilation.