m


 


  m
  
  
! m
1) FOR PICKING UP STERILE
INSTRUMENTS AND PREPARING
THE SURGICAL FIELD

CHEATLE·S FORCEP AND THE SWAB HOLDER

m Long angulated instrument, used to pick sterile

instruments.
m The swab holder is an instrument with long
blades and is expanded at the ends forming
an oblong tip,, used to hold the swab and clean
the area of operation.
 „


„

TOWEL CLIPS

Types and Uses:

Pinchter type
Forceps type (Beckhaus towel clip)
Sharp points penetrate drapes, and locking
handles maintain it in position.

USES:
m To hold tongue.
m For stabilisation of the suction tubes, motor
cables to the drapes
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 SCALPEL DISSECTING SCISSORS

It has 2 parts: Bard parker blade 0 Used to perform soft

handle and the blades tissue dissection in the
deeper layers.
Sizes:
0 No.3 (most commonly used)

Blades:
0 No.10- for making skin
incisions.
0 No.11- for making stab
incisions.
0 No.12- for mucogingival
procedures.
0 No.15- for intraoral surgery.
Langenbeck·s Retractor:
(Commonly used)
Used to retract soft tissues, incision edges, to
allow the view of deeper tissues.

Obwegeser·s Ramus Retractor:

Used to retract soft tissues along the
anterior border of the ramus during
saggital split or ramus osteotomy.

 „!"#$

Periosteal Elevators: Moon`s probe:
Has a pointed end on one Used to elevate
side and a broader end mucoperiosteum
on the other side.
around tooth prior to
extraction.
Pointed end is used to
release dental papilla in
between teeth.

Broad end is used to elevate

mucoperiosteal flap from
the bone.
TISSUE HOLDING
FORCEPS
Allis·s Tissue Holding
Forceps
Used to hold delicate
tissues like peritoneum,
aponeurosis, soft muscles.
Babcock·s Tissue Holding
Forceps
To hold intestines and delicate
structures like peritoneum,
fascia, etc.
Adson Tissue Forceps
Used to gently stabilize soft
tissue for suturing.
Lister·s Sinus Forceps:
Used to dissect out sinus,
fistulous tracts in soft tissues ,
open an abscess by HILTON·S
METHOD to break the loculi

To Keep The Mouth

Open:
Mouth prop :-used to open
patient·s mouth when patient is
unable to cooperate such as during
sedation.
Mouth gag ( Fergusson·s):-
keep the mouth open in a patient
under GA during surgeries of the
oral
cavity, tonsils and pharynx.
 Curette
A) Used to remove
tooth particles ordebris
from the extraction
site.
B) To enucleate cysts,
dental granulomas,
intraosseous
tumours.
C) To remove infected
clot from the
extraction site.
Rongeur forceps Osteotome
used to nibble sharp bony margins
following extraction. Used in various osteotomy procedures.
Biopsy of bony lesions.
To trim sharp bony ridges during
alveloplasty procedures. Mallet
Used for giving controlled taps on
chisel, bone gouge or osteotome.
Miller Colbourn bone
file Bone gouge
Used to smoothen any sharp bony Used to remove cancellous
margins present in the surgical field. graft material during grafting
procedures and to remove irregular
pieces of bone.
Bone cutter Handpiece and burs,
Used to trim sharp bony margins
following extractions. saws
Used to round off sharp
margins after extractions.
Chisel To perform osteotomy cuts.
Used to remove chips of bone To release bony ankylosis.
as in transalveolar extractions and
to split tooth in difficult
extractions2 Gigli ¶s wire saw
Used to cut mandible
(hemimandibulectomy)
Mayo Hegar Needle
Holder
1) Straight instrument with short
working tip.
2) Blade is shorter and stronger
than hemostat.
3) Working tip has cross hatched
serrations with single vertical
serration to grip the needle.
4) Handle has a catch.
5) Most commonly used is 6-inch
needle holder.
SUCTION APPARATUS
Most commonly used is vacuum
pump suction apparatus.
Electrically operated with the help
of motor.
SUCTION TUBING
Connected to suction apparatus at
one end and suction tip on the
other end.
Made of India rubber or silicone
polymer. Latter is transparent and
can be autoclaved.
SUCTION TIP
Maintain a clean field by sucking
blood, flushing solution,
debris,cystic
fluid, pus and secretions.
No.4 or no.5 tip is most commonly
used.
ROWE`S DISIMPACTION
FORCEPS
Used to disimpact maxilla in
fresh
LeFoft fractures, malunited
fractures.
To check for free movements of
maxilla after LeFort osteotomy
procedure.
HAYTON WILLIAM`S FORCEP
0 Used in conjunction with
Rowe`s disimpaction forceps
to mobilize maxilla.
WALSHAM`S FORCEP
Used to manipulate fractured nasal fragments.
ASCHE`S FORCEP
Used to reduce fractures of nasal bone and to align nasal
septum.
ERICH`S ARCH BAR
Used to stabilize dentoalveolar fractures.
To stabilize mandibular or maxillary fractures that are to
be treated by closed reduction.
To provide means for intermaxillary ligation.
WIRE SPOOL
0 26 gauge wire spool is used.
0 Used to stabilize dentoalveolar fractures.
0 To perform intermaxillary ligation.
0 To splint arch bar to teeth.
BONE SPREADER
Used to separate bony
fragments after
completion of
osteotomy cuts.
0 Drainage is provision of
mechanical means for
removal contents of body
organs, cavities or tissues.
NEED FOR ESTABLISHING
DRAINAGE
0 Obliteration of dead space.
0 Removal of material foreign or
harmful to body tissues.
0 To evacuate fluid or urine
collection in any body cavity.
FUNCTIONS
0 To allow for pus, fluid
collection, blood to escape
from body cavities.
0 To allow for local introduction
of antibiotics, antimicrobials.
1) ENVELOPE FLAP:
Given by BP blade no.12

2) TWO SIDED
TRIANGILAR FLAP
3) THREE SIDED
RHOMBOIDAL FLAP

4) SEMILUNAR
FLAP
Given when periapical
area is required to
be exposed
5) PEDICLE FLAP
When a flap is based
on particular blood
vessel, it is called
pedicle flap.

SKIN INCISIONS
Surgical incision is made along Langer`s lines thereby
minimizing tension while closing wound.

1) Submandibular incision
Used for surgery of body and angle of mandible and
submandibular gland.
2) Preauricular incision
Provides acess to
temporomandibular joint.
3) Gillie`s incision
Used for reduction of
fractured zygoma
4) Brow incision
give access to
frontozygomatic suture
area.
5) Lid incision and
infraorbital incision
give access to zygomatico
maxillary suture area and
floor of orbit.
SUTURE
It is strand of material used to ligate
blood vessels and to approximate tissues
together.
SUTURE MATERIALS
Requisites for suture materials
1. Adequate strength
2. Low tissue irritation and reaction
3. Low capillarity
4. Good handling and knotting
properties
5. Sterilization without deterioration in
properties
 Absorbable sutures Further divided
1. Catgut into:-
2. Collagen sutures 1. Monofilamentous
3. Synthetic polymer 2. Multifilamentous
sutures Also classified
Non-absorbable as:-
sutures 1. Natural
1. Nylon 2. synthetic
2. Cotton sutures
3. Silk sutures
4. Stainless steel sutures
5. Dacron
COMPONENTS:- TYPES
0 EYE:- Can be closed or A) 1. Straight needles
swaged 2. curved needles
0 BODY:- Needle grasping 0 ¼ circle
area 0 3/8 circle
0 POINT:-Extreme tip of 0 ½ circle
needle to maximum cross- 0 ¾ circle
section of body.
B. 1. Round body needles
2. Cutting needles
3. Reverse cutting
needles.
C. 1. Traumatic needles
2. Atraumatic needles
0 Needle should grasped at 1/3rd distance from eye and
2/3rd from point.
0 Needle should enter tissues perpendicular to
tissue surface.
0 Needle should passed through tissues along its curve.
0 Suture should passed at an equal depth and distance
from incision on both sides.
0 Needle always passes from movable tissue to
fixed tissue.
0 Needle always passes through thinner tissue to
thicker tissues.
0 Needle always passes from deeper tissue to
superficial tissue
0 Tissues must never be closed under tension.
0 Suture should tied only to approximate tissues, not
to blanch.
0 Knot should never lie on incision line.
0 Sutures should be placed at greater depth than
distance from incision, so as to evert wound
margins.
0 Sutures on skin are usually removed in 5 days and
intraoral sutures in 7 days. If there is tension /
stress while suturing, sutures may be kept for 10
days.
Tied using needle holder or with
hand.
TYPES:-
Square knot
Formed by wrapping suture around
Needle holder once in opposite
directions between the ties.

Surgeon`s knot
Formed by 2 throws of suture
around needle holder on
1st tie and 1 throw in opposite
direction in 2nd tie.
Granny`s knot
Involves a tie in 1 direction
followed by a tie in same
direction and a 3rd tie in
opposite direction to square
the knot and hold it
permanently.

SUTURING TECHNIQUES















 

 




2
ADVANTAGES:-
 Strong and can be used in
area of stress.
 Successive sutures can be
placed according to
individual requirement.

4
!!


ADVANTAGES:-
 Provides rapid technique for
closure and distributes tension
uniformly over suture line.
 Offers more water tight
closure.
G
!!

"! #$
ADVANTAGE:-
 Provides continous tightening
of suture during wound closure.
 Used for closure of wound
area when time is limited.

` 

HORIZONTAL MATTRESS
SUTURE
0 Provides broad contact of
wound margins, e.g. closure
of extraction socket wounds.
VERTICAL MATTRESS
SUTURE
 

 


% 2

`!& "
!'


 Suture is grasped with an instrument and lifted
above epithelial surface.
 A scissors or B.P. Blade No.-11 should be used to
cut one side of loop as close to surface as
possible.
 Skin sutures are removed after 7-10 days and
mucosal sutures are removed between 5 and 7
days.
DRAINS PACKING OF WOUND
USES:- USES:-
0 To prevent formation of 0 To permit healing by
hematomas or seromas secondary intention.
within soft or hard tissues. 0 For applying topical
0 Provide an exit for pus and medication to surgical
infection to outside wound.
surface. Materials used are:-
0 Glove drains or rubber 0 Iodoform gauze
drains are commonly used. 0 Gauze soaked in
0 Tubular drains with cuts
antibiotic paste,
made in it are used for
irrigating wounds. betadine.
0 After suturing the skin should be cleaned with
gauze soaked in saline to clear all blood stains.
0 Wound is covered by sterile sponges.
0 Dressing is used to cover and protect wound.
0 Provides support and pressure to area to prevent
hematoma formation.
0 Aerosol sprays are used for wound protection.
0 Dressing should be changed after 24- 48 hours.
0 Contemporary oral and maxillofacial surgery
by PETERSON

0 Textbook of oral and maxillofacial surgery by

NEELIMA ANIL MALIK

0 Textbook of oral and maxillofacial surgery by

VINOD KAPOOR