1. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 1

2. 2 CHAPTER 18 Oral and Maxillofacial Surgery

3. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 3 Objectives After studying this chapter, you will be able to: –Recognize the anatomy relevant to specific procedures in oral and maxillofacial surgery –Summarize the pathology that prompts oral and maxillofacial surgery and the related terminology –Determine special preoperative diagnostic procedures/tests pertaining to oral and maxillofacial surgery

4. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 4 Objectives (cont’d.) –Determine special preoperative preparation procedures related to oral and maxillofacial surgery –Indicate the names and uses of oral and maxillofacial instruments, supplies, and drugs –Indicate the names and uses of special equipment used for oral and maxillofacial surgery

5. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 5 Objectives (cont’d.) –Determine the intraoperative preparations of the patient undergoing an oral or maxillofacial procedure –Summarize the surgical steps of oral or maxillofacial procedures –Assess any specific variations related to the preoperative, intraoperative, and postoperative care of the surgical patient

6. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 6 Introduction to Oral and Maxillofacial Surgery Preoperative factors for patients undergoing oral surgery –Fear and concerns Aesthetic outcomes Pain –Special needs Children Patients already in the hospital for other concerns (e.g., transplant recipients)

7. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 7 Introduction to Oral and Maxillofacial Surgery (cont’d.) Each patient should be interviewed and the chart examined –Specific regard to the history, physical, NPO status, allergies, diagnostic, and laboratory results –Helps provide accurate, efficient assistance

8. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 8 Introduction to Oral and Maxillofacial Surgery (cont’d.) Additional preoperative considerations –X-rays should be readily available to the team –Consultation with the surgeon in advance of the procedure will help the team prepare for the wide range of possibilities

9. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 9 Diagnostic Tests Patient with possible maxillofacial defects –Physical examination should be done carefully Several types of imaging help diagnose maxillofacial fractures –Radiographic techniques Computed tomography (CT) scans Magnetic resonance imaging (MRI)

10. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 10 Diagnostic Tests (cont’d.) Plain films –Suspected type of fracture dictates the type of view or views to be taken Waters view Caldwell view Lateral facial view Basal view Panoramic

11. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 11 Diagnostic Tests (cont’d.) CT scans –Show the facial structures in different planes Hard palate Mid-maxillary Mid-orbital MRI –Best defines soft tissue injuries or congenital defects –Limited uses and time-consuming

12. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 12 Diagnostic Tests (cont’d.) Three-dimensional imaging –Also used for reconstructive procedures –Involves use of computers with three- dimensional programming and CT scans CT scans can be projected onto the computer screen in a three-dimensional fashion Any anatomy that interferes with viewing can be eliminated Before-and-after models can be generated

13. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 13 Tooth Extraction/Odontectomy Routine instruments, equipment, and supplies –Most craniofacial and dental procedures use instruments from a dental instrument set and a basic plastic instrument set Not every instrument from each tray will be used, but wise to have both sets available –Refer to Table 18-1 Procedure: refer to text

14. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 14 Maxillofacial Procedures General considerations –Maxillofacial injuries can inhibit speech –Facial imaging studies, dental impressions, or preoperative photographs should accompany the patient to the OR –Surgeon will typically stand at the head of the OR bed –Maxillofacial procedures can be lengthy

15. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 15 Maxillofacial Procedures (cont’d.) –Blood loss should be measured closely, especially in children –Maxillofacial surgery involves manipulation of the bones near the patient’s airway –Surgical personnel should be prepared to handle a variety of situations concerning airway management –Care should be taken to avoid an intraoperative fire

16. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 16 Maxillofacial Procedures (cont’d.) –Surgical site is prepared by carefully removing any gross debris –Maxillofacial reconstructions usually involve several procedures –Dural tear may be repaired by placing a suture or sealing off the cerebrospinal fluid (CSF) leak with a fat, fascia, or muscle graft –Open reduction techniques often require the use of internal fixation devices and can involve a variety of graft materials

17. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 17 Maxillofacial Procedures (cont’d.) –Surgical technologist may be expected to fill the role of the surgical assistant –Several basic techniques will be used repeatedly –Lubricate and protect patient’s eyes; corneal shield may be used –Local anesthetic with epinephrine may be used alone or in conjunction with general anesthesia

18. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 18 Maxillofacial Procedures (cont’d.) –Patient is supine, with head positioned to provide maximum exposure –Operative area may be outlined with towels –Controls on power equipment must be in “safe” position when preparing the tool for use or when it is not in operation

19. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 19 Repair of Mandibular/Maxillary Fractures Several basic techniques will be used repeatedly –Placement of arch bars, wires, and plates and screws, and/or the use of graft material Several techniques may be used in the correction of one problem

20. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 20 Repair of Mandibular/Maxillary Fractures (cont’d.) Craniofacial fractures –Most common repair technique: rigid fixation by plates and screws, or screws alone Bone plates are available in L, Y, H, and T shapes and range in thickness from 0.5 to 3.00 mm Screws come in diameters of 1.0 to 4.0 mm –Implant materials: absorbable or nonabsorbable –Titanium is often used

21. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 21 Repair of Mandibular/Maxillary Fractures (cont’d.) Arch bars –Used to immobilize the jaw following mandibular and/or maxillary fracture –Advances in rigid fixation have decreased the necessity for and/or amount of time arch bars are required

22. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 22 Procedures Include: –Application of arch bars –Plate and screw fixation of maxillary and mandibular fractures –Orbital floor fracture repair –Le Fort I fracture repair –Le Fort II and III fracture repair

23. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 23 Summary This chapter reviewed: –The pathology that prompts oral and maxillofacial surgery –Special preoperative diagnostic procedures/tests pertaining to oral and maxillofacial surgery –Special equipment used for oral and maxillofacial surgery –Oral and maxillofacial procedures