Oral and Maxillofacial Surgery

1314 Pages·2010·101.13 MB·English

by  Lars Andersson

Oral and Maxillofacial
Surgery

Oral and Maxillofacial
Surgery
Edited by
Lars Andersson
DDS, PhD, DrOdont
Professor, Oral & Maxillofacial Surgery
Chairman Department of Surgical Sciences
Faculty of Dentistry
Health Sciences Center
Kuwait University
Kuwait
Karl-Erik Kahnberg
DDS, PhD, DrOdont
Professor Emeritus, Oral and Maxillofacial Surgery
Institute of Odontology
The Sahlgrenska Academy
University of Gothenburg
Sweden
M. Anthony (Tony) Pogrel
DDS, MD, FRCS, FACS, Associate Dean for Hospital Affairs
Professor and Chairman, Department of Oral and Maxillofacial Surgery
University of California, San Francisco
USA
This edition first published 2010
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Library of Congress Cataloging-in-Publication Data
Oral and maxillofacial surgery / edited by Lars Andersson, Karl-Erik Kahnberg, M. Anthony (Tony) Pogrel.
p. ; cm.
Includes bibliographical references and index.
Summary: “Oral and Maxillofacial Surgery is the comprehensive reference for all trainees and
specialists in oral and maxillofacial surgery, oral surgery and surgical dentistry, including the current
research, practice and developments in the fi eld as expressed by world authorities. The Editors are joined
by over 50 international experts, offering a truly global perspective on the full spectrum of issues in oral
and maxillofacial surgery. The book’s coverage extends from basic principles such as patient evaluation,
dental anesthesia, would healing, infection control and surgical instruments to coverage of the complex
areas of dentoalveolar surgery, oral pathologic lesions, trauma, implant surgery, dentofacial deformities,
temporomandibular joint disorders and salivary gland disorders.” —Provided by publisher.
ISBN 978-1-4051-7119-9 (hardback)
1. Mouth--Surgery. 2. Maxilla--Surgery. 3. Face--Surgery. I. Andersson, L. (Lars), 1950–
II. Kahnberg, Karl-Erik. III. Pogrel, M. Anthony.
[DNLM: 1. Oral Surgical Procedures—methods. 2. Face—surgery. 3. Stomatognathic System—surgery.
WU 600 O634 2010]
RK529.O6624 2010
617.5’22—dc22
2010016813
A catalogue record for this book is available from the British Library.
Set in 9.5/12pt Palatino by Gray Publishing, Tunbridge Wells, Kent
Printed in Singapore
1 2010
Contents
List of Contributors xxxiii
Preface xxxviii
Part 1 Basic Principles 1
Section Editor: Tony Pogrel
1 Patient Evaluation 3
Alan S. Herford and Wayne K. Tanaka
Obtaining a patient history 3
Physical examination 5
Comorbidities/systemic diseases 6
Cardiovascular system 6
Pulmonary system 9
Endocrine system 10
Obesity 11
Other organ systems 11
Imaging 12
Laboratory studies 12
Arriving at a diagnosis 14
Assessing anesthetic/surgical risk 14
Office vs inpatient 14
Summary 15
References 15
2 Radiographic Imaging in Oral and Maxillofacial Surgery 17
Arne Petersson
Introduction 17
Computed tomography (CT) 17
Cone-beam computed tomography (cone-beam CT) 18
Magnetic resonance imaging (MRI) 18
Impacted teeth 18
Pathological conditions – inflammatory lesions, cysts, benign and malignant tumors 18
Inflammatory lesions 18
Cysts and benign tumors 21
Malignant tumors 22
Temporomandibular joint (TMJ) 24
Implant treatment 25
References 27
3 Medical Aspects – High-risk Patients 29
Earl G. Freymiller
Cardiovascular system 29
Ischemic heart disease 29
Valvular heart disease 30
Congestive heart failure 31
Respiratory system 31
Asthma 31
Chronic obstructive pulmonary disease 32
Renal system 32
Renal failure 32
Endocrine system 32
Diabetes mellitus 32
vi Contents
Gastrointestinal system 33
Liver failure 33
Hematologic system 33
Disorders of hemostasis 33
Immunologic system 34
HIV/AIDS 34
Neurologic system 35
Seizure disorders 35
Cerebrovascular accident 35
Musculoskeletal system 36
Bisphosphonate-related osteonecrosis of the jaws (BRONJ) 36
References 36
4 Medical Emergency Care 39
Zachary S. Peacock and M. Anthony Pogrel
Syncope 40
Management 40
Chest pain 40
Pathogenesis 40
Diagnosis and history 41
Management 41
Cardiac arrest 42
The automated external defibrillator 42
General approach to the collapsed patient 43
Considerations in transfer of the patient 43
Asthma 43
Pathophysiology 43
Prevention 43
Clinical presentation 44
Management 45
Hypoglycemia 45
Normal physiological response to hypoglycemia 45
Signs and symptoms of hypoglycemia 46
Management 46
Anaphylaxis 47
Presentation 47
Differential diagnosis 48
Management 48
Seizures 48
Management 48
Status epilepticus 49
References 49
5 Local Anesthesia 51
John Gerard Meechan
Introduction 51
Mode of action of local anesthetics 51
Techniques of local anesthesia for oral and maxillofacial surgery 52
Topical anesthesia 52
Infiltration anesthesia 52
Regional block anesthesia 52
Supplementary intraoral techniques of local anesthesia 56
Local anesthetic drugs 57
Lidocaine 57
Mepivacaine 57
Prilocaine 57
Articaine 57
Etidocaine 58
Contents vii
Bupivacaine 58
Levobupivacaine 58
Ropivacaine 58
Complications of local anesthesia in the orofacial region 58
Localized complications 58
Systemic complications 59
References 60
6a Sedation and General Anesthesia in Oral and Maxillofacial Surgery:
A UK Perspective 61
C. Michael Hill
History 61
The role and scope of sedation 63
Inhalational sedation 64
Oral sedation 65
Intravenous sedation 65
General anesthesia 67
Conclusion 68
References 68
6b Sedation and General Anesthesia in Oral and Maxillofacial Surgery:
A US Perspective 69
Richard C. Robert
Historical perspective 70
The 19th century after Wells and Morton 70
The 20th century 72
The 21st century 75
Training, professional organizations, and standards 75
Goals and objectives in the administration of anesthesia 76
The initial intuitively derived concepts 76
The initial approach 77
Requisites for the ideal anesthetic in the modern era 77
The essential role of the basic sciences in the advancement of anesthesia 77
Areas of the brain affected by anesthetic agents 77
The critical realization that on a molecular basis all anesthetic drugs share a common
mechanism of action 81
Multiple sites of action and receptors in the CNS dictate a balanced approach 86
The current status of office anesthesia in the oral and maxillofacial surgery practice 87
Primary anesthetic agents 87
Ancillary agents 92
Balanced anesthetic approaches currently used in oral and maxillofacial surgery practices 96
Method of delivery 97
Total intravenous anesthesia (TIVA) 97
The author’s office-based anesthesia technique 98
Intravenous sedation 98
Local anesthesia 98
Perioperative management 101
Preoperative preparation 101
Delivery system 103
Airway management 104
Monitoring 105
Awareness during anesthesia 108
Intraoperative fluid management 108
Recovery and discharge 109
Special patient populations 109
Future trends and advancements – on the horizon 113
Conclusion 114
References 114
viii Contents
7 Dentofacial Infection 125
Ashraf Ayoub
Introduction 125
Dentoalveolar abscess 125
Radiographic appearance 126
Site and spread of infection 126
Microbiology of dental infections 129
Management of patients with orofacial infection 130
Ludwig’s angina 130
Osteomyelitis 130
Chronic sclerosing non-suppurative osteomyelitis (Garré’s osteomyelitis) 131
Diffuse sclerosing osteomyelitis of the mandible 131
Osteoradionecrosis 132
Osteonecrosis secondary to bisphosphonate therapy 132
Cavernous sinus thrombosis 132
Necrotizing fasciitis 133
Actinomycosis 133
Mycobacterium infection of the oral mucosa and jawbones 134
Syphilis 135
References 135
8 Armamentarium for Basic Procedures 137
Ala Al-Musawi
Basic instrumentation for soft tissue procedures 137
Basic hard tissue instrumentation 138
Drills 139
Dental elevators 139
Dental forceps 139
Ancillary instrumentation 140
Sterilization of instruments 141
Suture materials and needles 142
Resorbable and non-resorbable 142
Braided and solid 142
Naturally occurring materials or synthetic 143
Uses for the various suture materials 143
Suture needles 143
New innovations in surgical instrumentation 144
References 144
9 Basic Surgical Principles 145
M. Anthony Pogrel and Fabio Kricheldorf
Aseptic technique 145
Principles of surgical incisions 146
Types of intraoral incisions 146
Principles of soft tissue biopsy 148
Biopsy of the mucosal surface of the lip 149
Principles of suturing 150
Types of sutures 150
Types of needles 150
Suturing techniques 151
References 153
10 Complications Associated with Dentoalveolar Surgery 155
Srinivas M. Susarla, Ryan J. Smart, and Thomas B. Dodson
Side-effects of dentoalveolar procedures 155
Bleeding 155
Pain 156
Swelling 156