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Oral and General Surgery Facts
Oral and General Surgery Facts
PAIN
In Gate Control theory Larger nerve fiber impulses INHIBIT the impulses of the
smaller ones
In Tracheostomy,
1. Indicated in Ludwigs Angina in cases oedema of the glottis
2. Entry through 2nd – 4th Tracheal rings (entry through 1st ring tracheal stenosis and
through 5-7th is very difficult)
3. In elective Tracheostomy, entry should be made “below the cricoid”
General Medicine
Broncheictasis Dialation of bronchi???
Pulmonary emphysema Alveoli distended
Coronary Heart Diseases: Angina, MI, Heart Failure, Card. Arrhythmias, Sudden
death
Boundaries:
Laterally Medial of Ramus
Medially Lateral of Medial Pterygoid
Posteriorly Deep portion of parotid
Anteriorly Pterygomandibular raphe
Roof Lateral Pterygoid muscle (******)
Contents:
Lingual n
Mandibular n
Mylohyoid n
Drainage:
PM into Pre-tracheal and Retro pharyngeal
SM and SL into Lateral / Para-Pharyngeal (Lateral Pharyngeal communicate with SM
and SL antero-inferiorly)
Masticator space
1. Sub-Massetric space (Muscles of mastication – Mass, MP, LP, Temporalis insertion)
2. PM space (Predominant)
3. Superficial Temporal
4. Deep Temporal
1. Trismus is characteristic
2. Masticator space (technically PM space) Supero-posteriorly Parotid and
Infero-posteriorly Lateral Pharyngeal
Para-mandibular space
1. Submandibular
2. Submental
3. Sublingual
Missing Roots
DB root of maxillary 3rd molar may ONLY be found in Maxillary sinus / between PO
and buccal plate
Missing mandibular root may be displaced into Mandibular canal / Through
lingual cortical plate [X Cannot be located adjacent to masseter]
Maxillary impactions, most likely to be displaced into ANTRUM / IT Fossa with
incorrect techq DISTO-ANGULAR
CPR Facts
Victim is unresponsive Lie him in SUPINE position
Primary airway hazard for unconscious Tongue
First step in CPR Establish responsiveness (*)
Triple manoeuvre for airway maintenance Open-Release airway, Head-Chin lift, Jaw
thrust
Early signs of OXYGEN WANT Cyanosis, ↑ Pulse and Tachycardia
Important signs of AIRWAY OBSTRUCTION Stertorous breathing, Pronounced
retraction of chest spaces, Hands over throat (Universal sign)
External Cardiac Compressions
o Lower half of sternum
o Compressions 60-80 / min in adults and 100 / min in children
[*****Even if that is performed by TWO RESCUERS]
o Compression-relaxation cycle 60 / minute repetitions
o Sternum depressed approx 1½ to 2 inches
An important assessment should see PUPILLARY CONSTRICTION
Complications **** Incorrect compressions over Xiphoid process LIVER
damage
Artificial ventilation – exhaled air cycle 5 / sec
Interruptions in cardiac compressions result in reduction in blood flow and BP
becoming zero
In most medical emergencies, the easiest techq to open victim’s airway TILT his
head back
Muscles Involved
Muscle encountered during aspiration of pus from PM space intra-orally
Buccinator
Muscle penetrated during IAB Buccinator
In IAB, trismus is usually due to needle injury to Medial Pterygoid
Incorrect Infra-orbital block Quadratus Labii Superioris encountered
MOST difficult tooth to anesthetize by infiltration alone Maxillary 1st Molar [MB
Root]
Lingual nerve
Sensory fibres to Tongue Floor Lingual surface of mandible
Should be protected when manipulating MYLOHYOID ridge
Extra-oral techq’s
Mandibular block Needle direction to Lat. Pterygoid Plate POSTERIOR
Maxillary block Needle direction to Lat. Pterygoid Plate ANTERIOR
*** Teeth that can be removed after IAB and Lingual block All lowers anterior to 2nd
PM
*** Mandibular canal location Between first and second PM’s, below root apices
*** Extra-oral Infra-orbital block DOES NOT block sphenopalatine n
***Nerves anesthetized for Max Laterals Nasopalatine & Superior alveolar
Hypovolemic Shock
Hypotension
Tachycardia
Low pulse pressure
N2O - O2 Sedation
Main route of elimination Lungs
CONTRA_INDICATIONS:
o Hemoglobinopathies
o Emphysema
o Emotional instability
o URT obstruction
Common side effects:
o Nausea
o Diffusion Hypoxia
o Behavioural problems (***)
*** Low blood solubility
***Absorbed and excreted in LUNGS
***Readily diffuses into alvelolar membrane
***Sedative doses of N2O depress bone marrow & WBC after prolonged use
*** In a central N2O system, the main pressure reduction device is located between
pressure gauge and analgesia machine
Local Anesthesia
** nerve membrane stablization action prevents Na ions influx
*****LA produce anesthesia by preventing Na ions influx****
***LA efficacy is REDUCED in the presence of Acute Infection and Inflammation
[Has NO bearing with AB administration]
** Initial repolarization is due to efflux of K ions to outside
*****MOST alarming respiratory condition during patient sedation Apnoea
Syncope questions [ Select airway / O2 if available]
Syncope worsening, pulse and respiration becomes weak and cyanotic support
respiration with oxygen through an open airway
Patient under syncope fails to regain consciousness even after supine position and
ammonia inhalation Check pulse and support respiration through patent airway
*** Oxygen is strongly indicated in short, convulsive attacks as a result of a toxic reaction
***Supporting respiration with Oxygen also indicated Overdose of DIAZEPAM
Fractures
Most common site for dental fractures Maxillary incisors
Lefort II paresthesia’s are generally distributed over “Infra-orbital” nerve
Paresthesias following fratures MOST common Zygomaticomaxillary complex
[IO nerve]
Piercing IAN with 27 guage needle mild temporary paresthesia of lower lip
Paresthesia of lower lip may be due to removal of mandibular 3rd molar
Loss of sensation of lowerlip
Metastatic tumour of mandible
CNS Tumour [Pontine]
Fracture in Mndibular 1st molar region
Mental Anesthesia # body / angle
Facial paralysis most common in Condylar neck #
***Oral surgical procedures generally require Medical H Physical
examination CBC Urinalysis
Principles of fracture management RFI
MOST pathognomonic features of mandibular fractures
SL Hematoma/ecchymoses Deranged Occlusion (most common)
Facial paralysis most common in Condylar neck #
Most COMMON pathognomonic sign of a mandibular fracture
MALOCCLUSION
Cleft Palate
25% alone
Females
Inability of palatal shelves to fuse during 9th week in utero
Prevents normal speech and swallowing [SpeechInability of soft palate to close
airflow to Nasopharynx]
Rx:
Surgical repair of palate
Orthognathic surgery [deficient midface]
Ortho Rx [MO]
Speech therapy
Psychogenic Reaction
Nausea
Pallor and cold perspiration
Widely dialated pupils, eyes rolled up
Brief convulsion
Biopsy care
General practitioner should avoid performing biopsy for
Large bluish/reddish lesion that blanches [Hemangioma]
Large suspected cancerous lesion
Isolated pigmented lesion [non-amalgam]
General Questions
Followup care and discharge instructions are recorded, written and
explained orally but not the responsibility of the nurse
Dictation following an operation, NEED NOT include a detailed
RECOVERY room record
Purpose of taping the eyes shut prior to draping a patient prevent
corneal abrasion