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Oral Surgery pt. 3 (Surgical Aids in Ortho (Impacted Teeth (Treatment…

- - - - Extraction
        
        Impacted tooth
        
        Tooth in poor position, assoc. pathology, relive crowding
        
        Financial, interfere w/ ortho tx
        
        Adjacent tooth
        
        create space in an arch, impacted tooth in the correct path of eruption
        
        Impacted tooth removal is difficult/destructive
      - Leave in situ
        
        Symptom-free tooth
        
        good contacts on other teeth
        
        Deciduous canine aestehtic w/ long roots
      - Surgical Exposure and Ortho Traction
        
        Clear path of eruption
        
        Requiring further ortho tx
        
        No pathology
        
        Surgical Exposure
        
        Gingivectomy (palatal impaction)
        
        Apically positioned flap (buccal impaction)
- - - - Radicular (55%)
        
        residual cysts
      - Inflammatory Collateral cysts
        
        Paradental
        
        Mdb buccal bifurcation cysts
    - - Lateral PD Cyst
        
        Botyroid Odont cyst
        
        Gingival Cyst
        
        Of adults
        
        Of infants
      - OKC (15%)
      - Dentigeruous (20%)
        
        Eruption cyst
    - - Mucocele
        
        Mucous retention cyst
        
        mucous extravasation cyst
      - Ranula (FOM)
      - Developmental
        
        Epidermoid/dermoid
        
        Nasiolabial
        
        Branchial
  - - - Enucleation w/ primary closure
        
        total removal of cystic lesion
        
        attempts to remove the cyst in one peice
        
        treatment of choice for jaw cysts that can be safely removed w/ minimal damage
        
        Advantages:
        may reduce the chance of recurrence, convenience, appropriate
        
        Disadvantages:
        risk of rupture/inadequate removal, infection, normal tissue jepoardized
      - Enculceation w/ packing
        
        If cysts large enough, need to be packed to avoid large blood clots
      - Marsupialization w/ packing
        
        decompression of the cyst
        
        a surgical window is created in the cysts, promoting shrinkage and bone infill
        
        Maintains continuity with oral cavity
        
        Indicated for:
        
        lesions proximal to vital structures
        
        access is difficult
        
        size of cyst increases risk of jaw fracture
        
        extent of surgery, ie unhealthy or debilitated pts
        
        Advantages:
        Simple, spares vital structures, can be the sole management
        
        Disadvantages:
        tissue left behind, possibly aggressive, cleaning difficult
      - Marsupialization w/ Enucleation
        
        when marsupialization alone is not adequate to decrease cavity size
        
        reduces morbidity and accelerates healing
        
        enucleation often easier
      - Resection
        
        full removal of cyst and surrounding tissues
        
        associative bony involvement
        
        lesions not suitable for enulceation or marsupilization
- - - - Lip Cancer
        
        I/O
        
        Tongue
        
        FOM
        
        Buccal mucosa
        
        Gingiva
        
        Pharyngeal
      - More posterior the location the poorer the prognosis
        Ex: Retromolar trigone "coffins corner", Ventral tongue + FOM
- - - - Aeitology:
        
        Can occur following exo of Mx teeth that roots project into the sinus
        
        Apical pathology
        
        fractured tuberosity
      - Clinically:
        
        Black hole at the apex of a socket
        
        Bubbling
        
        Post-Op "Foul Taste"
      - Management
        
        <5 mm w/ no sinus disease = heal uneventfully
        
        <5mm w/ disease = surgical repair
        
        >5 mm = surgical repair
        
        Immediate:
        
        Pack the socket with gel foam
        
        suture mucosa of the socket
        
        Rx sinus medication
        
        Review
        
        Precautions
        
        avoid nose blowing
        
        head elevated
        
        no smoking
        
        Medications
        
        Amoxicillin/Augmentin
        
        Nasal decongestants
        
        Surgical Techniques:
        
        Buccal Adv flap
        
        Palatal rotation flap
        
        Buccal fat-pat graft
        
        Muscle flaps (buccinator, temporalis)
    - - Long standing communications
      - Management: Needs flap reconstruction to close the defect
        
        control sinus disease
        
        excision of epithelial tract
        
        debridement of communication
        
        Raise flap and suture on good bone
    - - Displacement of dental materials into sinus
        
        LA
        
        Endo
        
        Necrotic tissue
        
        GP
        
        CaOH
      - Root Fragments displaced into the Mx sinus
        
        Root fragments <3mm may be left in situ, if there is no preexisting periapical infection
        
        Management:
        1.) attempt removal
        2.) or Refer
        
        pack w/ gel foam and suture
        
        sinus precautions and antibiotics
  - - - Most commonly caused by viral infections of upper respiratory tract (may also include bacterial, foreign bodies, OAC)
      - Symptoms:
        Increased pain on lowering of head
        Maxillary dental pain or pressure
        Nasal obstruction
      - Tx:
        Rest and recuperation
        Head elevation
        Medications
        Analgesics
    - - Pain, nasal congestion and abnormal secretions for 3 months (potential radiographic changes)
      - Symptoms:
        Facial pain
        Maxillary dental pain
        Nasal obstruction
        Rhinorrhoea
      - Tx:
        Long term antibiotics
        Surgical drainage
        Sinus irrigation
        Surgical debridement
        Mucosal stripping
    - - Arise due to thickened mucosa of chronic sinusitis
        
        isolated or multiple (homogenous)
        
        May cause bony destruction or displacement
        Management:
        
        Dx, biopsy, review or refer