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4th yr- CAD- Oral surgery > 3rd molar surgery > Flashcards

3rd molar surgery Flashcards

1
Q

What are the standard problems for all patients undergoing surgery

A
  1. Pain
  2. Swelling
  3. Bleeding
  4. Bruising
  5. Infection
  6. Dry socket
  7. Difficulty opening
  8. Damage/ sensitivity to adjacent teeth
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2
Q

Which cranial nerve causes the most issues during third molar surgery

A

The trigeminal nerve

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3
Q

Other than the branches of the trigeminal nerve which other nerves cause problems in third molar surgery

A

Chorda tympani

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4
Q

Which branches of the trigeminal nerve cause the most issues

A

The lingual nerve

Inferior alveolar nerve

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5
Q

When is the lingual nerve at risk

A
  1. During the incision
  2. Flap retraction
  3. Lingual split porcedure
  4. Removal of fractured bone of socket
  5. Tooth sectioning
  6. Over aggressive removal of retained follicle
  7. Deep suturing
  8. Absent lingual plate
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6
Q

List somr specific risks for mandibular third malt surgery

A
  1. Temporary or permanently altered or loss of sensation to the: lower lip, skin of the chin, gums of the lower teeth, lower teeth, tongue and taste
  2. Trismus
  3. Time off work
  4. Significant swelling or bruising that can spread to the neck
  5. Rarely hospital admission required
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7
Q

What must you tel the patient before agreeing to cary out 3rd molar surgery

A

Must tell them of the risk and note down you have told them

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8
Q

What steps must you carry out before thinking of doing surgery

A
  1. History
  2. Assessment and examination
  3. Investigations
  4. Diagnosis
  5. Treatment plan
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9
Q

List the 4 basic surgical principles

A
  1. Good anaesthesia
  2. Minimal trauma
  3. Good planning
  4. anatomical knowledge
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10
Q

Why is important we follow the 4 princess of basic surgery

A
  1. Avoids physical and psychological stress
  2. Reduction in pain
  3. Lower risk of infection
  4. Reduced swelling
  5. Rapid healing
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11
Q

Which local anaesthetic techniques do we carry out on patients before 3rd moral surgery

A

Inferior alveolar dental block with lidocaine
AND
Long buccal with articaine

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12
Q

What is operculectomy

A

A surgical procedure to remove the affected soft tissue covering the partially erupted tooth

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13
Q

Why do we carry out an operculectomy

A

To improve oral hygiene

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14
Q

Which tissues do we have to be careful of when carrying out third molar surgery

A

Periosteum

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15
Q

What does the periosteum contain

A

Cells responsible for bone remodelling

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16
Q

What must we preserve when carrying out 3rd molar surgery

A

Consider bone and preserve it as much as possible

17
Q

What must we be careful of if we elevate the third molar

A

Could fracture the distal of the 7

18
Q

What pre op can you give patients before third molar surgery

A

Pre op 400mg ibuprofen

rarely pre op steroids

19
Q

Which local anaesthetic techniques do we carry out on patients before 3rd moral surgery

A

Inferior alveolar dental block with 2% lidocaine and 1:80,000 adrenaline
AND
Long buccal with 4% articaine 1:100,000 adrenaline

20
Q

What post op can you give patients following third molar surgery

A

Post op 400mg ibuprofen
1g paracetamol 4 times a day for 48 hours
Warm salt water rinse 4 times a day for a week

21
Q

What MUST we be careful of when carrying out third molar surgery

A

Make sure no air gets forced into soft tissues or sockets

NO AIR ROTERS

22
Q

What can happen if air gets forced into the soft tissues or socket

A

Patient can develop surgical emphysema leading to swelling of the face

23
Q

Talk through the basic principles of flap design

A
  1. Base bigger than free margin
  2. Width of the base should be bigger than the length of the flap
  3. Axial blood supply
  4. Margins on sound bone
  5. Preserve vital structures
  6. Access
  7. Uncomplicated closure
24
Q

When do we raise flaps

A

Usually in mandibular third molars not maxillary

25
Q

What post operative care must we tell the patient

A
  1. Expect the worst
  2. Regular analgesia
  3. No smoking or vaping for a week
  4. Post op next day
  5. Give written contact details to patient for advise and emergencies
26
Q

What complications can arise with third molar surgery

A
  1. LA
  2. Damage to adjacent teeth
  3. Extraction of th wrong tooth
  4. Displacement of root/tooth fragment
  5. Aspiration
  6. Instrument fracture
  7. Soft tissue damge
  8. TMJ dislocation
  9. Mandible fracture
  10. Nerve damage
  11. Fractured tuberosity
  12. Burn
27
Q

What is a coronectomy

A

Removal of the crown from the roots of a healthy tooth in healthy patients indicated to prevent inferior alveolar nerve injury in high risk patients

28
Q

Give some guidelines regarding which teeth can have a coronectomy

A
  1. Teeth with associated infection should be excluded

2. Teeth that are mobile should be excluded

29
Q

What can happen in some coronectomys

A
  1. Late migration of the root fragment may occur

2. Leaving the retained roots fragment at east 3mm inferior to the crest of the bone seems appropriate

30
Q

List soem contraindication for a coronectomy

A
  1. Caries with pulpal invovlement
  2. Apical disease
  3. Mobility of roots
  4. Association pathology
  5. Pre orthographic surgery
  6. Immunocompromsied
  7. Pre radiotherapy

4th yr- CAD- Oral surgery (8 decks)

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