What is the scope of treatment of oral and maxillofacial surgery?
Maxillofacial surgery mainly includes dental and alveolar surgery, pre-prosthetic surgery, temporomandibular joint disease, maxillofacial injury, salivary gland disease, maxillofacial plastic surgery, microsurgery, head and neck tumor surgery, as well as cardiac monitoring of tooth extraction, oral and maxillofacial trauma, infection, tumor, temporomandibular joint disease, orthognathic surgery, and cleft lip and palate repair.
What are the general anesthesia methods used for tooth extraction?
There are three methods of local anesthesia: surface anesthesia, infiltration anesthesia and block anesthesia. Currently, infiltration anesthesia and block anesthesia are more frequently used in dental extraction clinics.
What are the contraindications and indications for tooth extraction?
Contraindications for tooth extraction are relative. The main ones are severe heart disease, hypertension, hematopoietic disorders, diabetes, hyperthyroidism, kidney disease, hepatitis, pregnancy, menstruation, acute inflammatory period, malignant tumor, long-term anticoagulant medication, long-term adrenal corticosteroid treatment, neuropsychiatric disorders, etc. Patients should carefully explain their previous conditions to the doctor before tooth extraction.
Indications for tooth extraction are also relative. The main ones are severe caries, periapical disease, periodontal disease which is ineffective by conservative treatment, certain hidden cracked teeth, traumatized teeth, intra-pulpal resorption, buried teeth, blocked teeth, extra teeth, fused teeth and duplex teeth, lagging milk teeth, misaligned teeth, teeth involved in fractures as needed for treatment.
What should I pay attention to after tooth extraction?
Do not rinse your mouth or brush your teeth on the day of tooth extraction to avoid excessive bleeding; do not touch the wound with your hand or other objects after tooth extraction and do not suck repeatedly to protect the clotted blood in the extraction wound; you can eat soft food on the day of tooth extraction, the food should not be too hot or irritating and avoid chewing on the side of tooth extraction; if there is mild bleeding or pain after tooth extraction, you can apply cold compress on the face of the side of tooth extraction; If there is excessive bleeding or other accidents after tooth extraction, you can go to the hospital for examination at any time.
Why do wisdom teeth obstruction occur in humans?
There are many reasons for the formation of dental obstruction, mainly because the jaw bone is underdeveloped and lacks sufficient space to accommodate all the erupted teeth. As human germline occurs and evolves, changes in food types bring about degeneration of the masticatory organs, resulting in a mismatch between the length of the jawbone and the required length of the dental row, leading to wisdom teeth obstruction.
Why does dry socket occur?
The etiology of dry socket is a combination of factors. Currently, the main theories are infection, trauma, anatomy and fibrinolysis. In addition, chronic systemic wasting diseases and malnutrition also increase the chance of dry socket due to low resistance to infection.
How to treat tongue not sticking out of the mouth and lips?
The tongue cannot stick out beyond the mouth and lips mainly because the tongue ligament is too short, which shows that the tongue cannot be freely extended forward, and the tip of the tongue is in the shape of “W” when the tongue is extended. In infants, due to nursing and sucking, friction between the tether and lower incisors can form decubitus ulcers, and in adults, it affects the issuance of tongue-palatal sounds and tongue-rolling sounds. Surgical treatment is needed for short tethering, and surgical correction is best done at the age of 1 to 2 years old, before young children learn to speak. However, the lingual tethering is often attached higher in infancy due to developmental reasons, and will gradually decrease with pronunciation, so there is no need to rush to surgery.
In adults, we can also see that the lingual ligament is too high due to the resorption of alveolar bone, which affects the prosthesis and should be corrected surgically.
How to deal with bleeding after tooth extraction?
Bleeding after tooth extraction can be divided into primary and secondary. Primary bleeding is bleeding that did not stop at the time of tooth extraction; secondary bleeding is bleeding that has stopped at the time of tooth extraction but occurs later due to other reasons. Generally, a small amount of blood will appear in the wound after tooth extraction, and due to the mixture with a large amount of saliva (saliva secretion will increase due to reflexive factors), patients often mistakenly think that there is too much bleeding and are nervous and afraid, which is a normal phenomenon and there is no need to panic.
If there is excessive bleeding after tooth extraction, it is necessary to go to the hospital for examination in time, and the doctor can make horizontal mattress sutures on both sides of the gums to help stop the bleeding. After suturing, compress for 5-10 minutes, if the bleeding still cannot be stopped, try placing an iodoform sponge into the upper part of the alveolar socket and then compress with a gauze roll. If the bleeding still cannot be stopped, the blood clot and inflammatory granulation tissue should be removed from the alveolar sockets under local anesthesia, and then an iodoform gauze strip should be used, starting from the bottom of the sockets, filled in closely and then bitten into the gauze roll and pressurized, and the gauze strip should be removed at 1 week. The gauze is removed at the end of 1 week and replaced by a shorter one loosely placed, so replaced several times, the fossa is gradually healed by the growth of granulation tissue.
Secondary bleeding is mostly caused by damage to the blood clot in the alveolar socket. Patients should avoid repeated sucking on the extraction area, overheated diet, and repeated rinsing of the mouth.
The bleeding may form hematoma or bruise, and antibiotics should be given to prevent infection.
How to distinguish normal post-extraction pain from abnormal post-extraction pain?
Normal post-extraction pain starts on the day immediately after tooth extraction and is not serious and disappears in 3-5 days. The abnormal post-extraction pain is mostly due to dry socket, which often appears after 3-5 days, and the pain is severe and can spread to the ear and temporal area, and there are corrupt and smelly decomposition materials in the extraction wound, and the pain can last for more than 10 days.
What is congenital cleft lip?
Cleft lip, also known as “harelip”, is the most common congenital malformation of the oral and maxillofacial region, often associated with cleft palate. It is caused by the failure of the maxillary process to fuse with the globus pallidus on one side during the embryonic period, resulting in a unilateral cleft lip, or a bilateral cleft lip if it occurs on both sides.
What is the minimum age for surgery in patients with congenital cleft lip?
It is generally accepted that the most appropriate age for unilateral cleft lip revision is 3-6 months, and the most appropriate age for bilateral cleft lip revision is 6-12 months.
12. Is there any difference between congenital cleft lip surgery and a normal person?
There are differences between congenital cleft lip and normal people after surgery, mainly because the deformity itself is so severe that it is impossible to completely correct the deformity in the first surgery;
The age of the child is too young and the anatomical signs of the lip are not obvious, which affects the surgical results; there are shortcomings in the surgical method itself. Therefore, a second revision of the cleft lip is often required to achieve a more satisfactory result, and the timing is appropriate for the basic completion of development. Patients usually have high expectations, and the fibrous scar cannot disappear completely.
What is the correct way to feed a child with congenital cleft lip and palate?
The child should preferably be in a semi-sitting position, not lying down. The pacifier should be directed towards the normal palate, not towards the cleft palate, to avoid milk reflux, air swallowing and injury to the nasal mucosa. Feeding should be done in several times, with a brief exhibition hall in the middle, patting the back of the affected child’s shoulder and continuing to feed after the air has spilled out, otherwise it is easy to spit up after swallowing a large amount of air and cause insufficient feeding. It is normal for milk to flow back out of the nose during feeding, so there is no need to be alarmed – suspend feeding and continue after the child coughs or sneezes.
Is congenital cleft lip hereditary?
Congenital cleft lip is genetically related and similar deformities can be found occurring in the patient’s immediate or collateral relatives.
What is congenital cleft palate?
Cleft palate is a partial or complete cleft of the oral palate from the palatal lobe, soft palate, hard palate to the alveolar process, which communicates with the nasal cavity. This is due to the failure of the palatine process to fuse with the lateral palatine process on one or both sides during the embryonic period.
What is the minimum age for surgery in patients with congenital cleft palate?
The age of surgery for patients with congenital cleft palate is still controversial internationally, but the theory is that early surgery is good. In China, it is considered appropriate to perform the procedure at the age of 2 to 3 years.
Is there any difference between a normal person and a congenital cleft palate after surgery?
There are some differences between congenital cleft palate and normal people after surgery. It is difficult to completely eliminate the cleft palate speech in patients. Cleft palate speech is characterized by: when pronouncing vowels, airflow enters the nasal cavity and produces nasal resonance, resulting in vowels that are very unclear and have a strong nasal sound (hypernasality); when pronouncing consonants, airflow escapes from the nasal cavity and a certain strength of air pressure cannot be formed in the mouth, resulting in consonants that are very unclear and weak (nasal leakage).
Is congenital cleft palate hereditary?
Congenital cleft palate is genetically related and similar deformities can be found in the patient’s immediate or collateral relatives.
How can I train my speech after surgery for congenital cleft palate?
After the surgery of congenital cleft palate, you should train the articulation gradually under the guidance of the doctor. First, correct the abnormal movement of the articulatory organs; after that, guide the patient to practice consonant and vowel syllables, so that they can master the sliding of consonants to vowels and the accurate movement of the tongue body in the process of articulation; when 2/3 syllables can be pronounced correctly, you can gradually increase the practice of sentences and short texts, suitable poems, children’s songs and tongue twisters for children, and for adult patients, the form of dialogue can be adopted.
According to the characteristics of the patient’s voice disorder, one-on-one training is necessary, usually once a week for 20~30 minutes each time, and the parents cooperate for not less than 60~160 minutes a day to correctly master and consolidate the training content. The training can also be adjusted according to the age and acceptance ability of the child.
How can parents care for their children after surgery for congenital cleft palate?
First, closely observe the child’s breathing, pulse, temperature and bleeding after surgery and notify the doctor of any abnormalities.
Secondly, after the child is fully awake for 4 hours, a small amount of sugar water can be fed and observed for 0.5 hours, and when there is no vomiting, a liquid diet can be fed. The liquid diet should be maintained until 2~3 weeks after surgery, semi-liquid for 1 week, and general diet after 1 month.
Third, the mouth should be cleaned daily and the child should be encouraged to drink more water after eating and drinking to keep the oral hygiene and wounds clean. It is strictly forbidden for the child to cry loudly and to include income and expenses, toys and other things into the mouth to prevent the wound from cracking.
Fourth, antibiotics are routinely applied for 3 to 5 days after surgery to prevent infection of the trabeculae.
What is the pathogenesis of wisdom tooth pericoronitis?
During the occurrence and evolution of the human germline, as the type of food changes, it brings about the degeneration of the chewing organs, resulting in the reduction of the length of the jaws without a decrease in the number of teeth, and a dissonance is formed between the two. The mandibular third molar is the last tooth to erupt and can lead to different degrees of obstruction due to insufficient eruption position. During the eruption process, the crown can be partially or completely covered by the gum, forming a deep blind pocket between the two, where food and bacteria are easily embedded; in addition, the gum of the crown is often damaged by chewing food, forming ulcers.
When the systemic resistance is low and the local bacterial virulence is enhanced, it can cause an acute attack of pericoronitis. Therefore, pericoronitis mainly occurs in young people aged 18-30 years old with erupting wisdom teeth and in patients with incomplete eruption of blocked wisdom teeth.
What are the complications of pericoronitis?
In addition to the painful swelling and discomfort in the posterior region of the affected molar, as well as increased pain when eating and chewing, swallowing, and opening activities, patients may also feel radiating pain in the auriculotemporal region; varying degrees of mouth opening restriction or even dental closure; abscesses in the pharynx and around the tonsils; and interstitial infections in the jaw and face.
There may be varying degrees of chills, fever, headache, general malaise, loss of appetite and constipation throughout the body.
What is the disease that produces painful facial swelling after tooth pain and how should it be treated?
It is likely to be an infection in the maxillofacial space caused by periodontitis or periapical infection.
First, systemic antibiotics;
Second, local periodontal irrigation: repeatedly rinse the gingival pockets with saline, hydrogen peroxide, etc., and put in special lines by the doctor;
Third, dental open pulp treatment if necessary. If the infection is caused by mandibular blocked wisdom teeth, after the inflammation is eliminated, the blocked wisdom teeth are extracted to avoid the recurrence of pericoronitis.
Why is incision and drainage necessary after having septic interstitial infection?
Firstly, to drain the pus and necrotic material out of the body quickly to achieve the purpose of anti-inflammation and detoxification;
Secondly, to relieve local pain, swelling and tension in order to prevent asphyxia;
Third, drainage of peri-maxillary space abscess to avoid marginal osteomyelitis;
Fourth, to prevent the infection from spreading to the cranial and thoracic cavities or invading the blood circulation, causing serious complications such as cavernous sinus thrombophlebitis, mediastinitis and sepsis.
What is the “danger triangle” of the face?
The facial danger triangle refers to the triangular area from the root of the nose to the corners of the mouth on both sides. There are many interconnected potential fascial spaces around the face and jawbone, which contain loose connective tissue, forming a channel for infection to spread easily, and because of the rich blood circulation in the face and the absence of valves in the nasolabial veins, infection in this area can easily spread intracranially, making it the “danger triangle” of the face.
What is osteomyelitis of the jaw?
Inflammatory lesions of the jaw bone caused by bacterial infection and physical or chemical factors are called osteomyelitis of the jaw. The inflammation covers the entire bone tissue components including the periosteum, bone dense and bone marrow, as well as the blood vessels and nerves within the marrow cavity. Clinically, purulent osteomyelitis of the jaws caused by odontogenic infections (acute periapical infection, periodontitis, pericoronitis of wisdom teeth, etc.) is the most common.
Why should boils and carbuncles on the face not be squeezed?
Because the pathogenic bacteria of boils and carbuncles are more virulent; the veins in the dangerous triangle of the upper lip and nose often have no valves; and the physiological activities of the facial expression muscles and lips tend to spread the infection, these reasons make boils and carbuncles the most likely complications of oral and maxillofacial infections, such as thrombophlebitis, sepsis or septicemia.
What serious systemic complications can be caused by acute inflammation of the oral and maxillofacial area?
Acute inflammation of the oral and maxillofacial region can spread along the nerves and blood vessels causing serious complications such as cavernous sinus thrombophlebitis, brain abscess, sepsis, and mediastinal barrier.
Why does otitis media cause mumps?
Because the middle ear and the parotid gland are in close proximity to each other, especially in children, and there is only a very thin soft tissue separating them, when a purulent otitis media develops, the pus can easily spread to the parotid gland and cause parotitis.
What oral and maxillofacial diseases can cause restricted opening?
Oral and maxillofacial diseases such as temporomandibular joint ankylosis, temporomandibular joint disorder syndrome, pericoronitis of wisdom teeth, maxillofacial interstitial infection, maxillofacial fracture, tumor, etc. can cause restricted opening.
Which oral and maxillofacial diseases can cause localized numbness in the oral and maxillofacial region?
Oral and maxillofacial diseases that invade the facial nerve, such as some benign and malignant tumors, trauma, tooth extraction and maxillofacial surgery can cause localized numbness in the oral and maxillofacial region.
Which oral and maxillofacial diseases can cause oral and maxillofacial masses?
Oral and maxillofacial inflammation (caused by odontogenic or facial interstitial infection), cysts, tumors and other diseases can cause oral and maxillofacial masses.
Which oral and maxillofacial diseases can cause asymmetrical oral and maxillofacial morphology?
Oral and maxillofacial diseases such as fracture, jaw cyst, soft tissue and bone tissue tumor, jaw developmental malformation, and temporomandibular joint ankylosis can cause oral and maxillofacial morphology asymmetry.
Which oral and maxillofacial diseases can cause speech disorders and slurred pronunciation?
Oral and maxillofacial diseases such as cleft lip and palate, short tongue ligament, certain oral tumors can cause speech disorders and slurred pronunciation.
What is the duration of suturing after oral and maxillofacial trauma?
Due to the rich blood flow and strong tissue regeneration ability of the oral and maxillofacial area, even within 24 hours or 48 hours after the injury, tight sutures can be performed after debridement; even beyond 48 hours, as long as the wound is not obviously septic infection or tissue necrosis, tight sutures are still feasible after adequate debridement.
Why do open trauma of the oral and maxillofacial area usually bleed more?
Because of more blood vessels and rich blood circulation in the oral and maxillofacial area, there is more bleeding after trauma.
What serious systemic complications can be caused by oral and maxillofacial trauma?
Oral and maxillofacial trauma can lead to serious complications such as asphyxia, bleeding, shock and cranio-cerebral injury, which can be life-threatening.
What are the types of traumatic dental injuries and how are they treated?
Dental trauma includes damage to the periodontium, damage to the hard tissues of the teeth, tooth dislocation and tooth fracture. The common acute dental injuries are.
1, dental shock.
The tonal injury occurs under the action of external force, mainly affecting the periodontal membrane and pulp. Mild can not be treated, temporarily without the affected tooth chewing food, can be restored to normal. Severe tooth loosening can be fixed by simple ligation of the affected tooth, if it is confirmed that there is pulpal necrosis, the affected tooth should be further root treatment.
2.Tooth dislocation.
The tooth is dislocated from the alveolar socket by external force, which can be divided into incomplete dislocation and total dislocation. The treatment of tooth dislocation is based on the principle of tooth preservation. For partial dislocation such as tooth displacement, semi-dislocation or embedding in the deep, the tooth should be fully reset first and then fixed for 2-3 weeks. If the tooth has been completely lost, but not long enough to leave the body, the dislocated tooth can be reimplanted. The fixed method of tooth dislocation is long with arch splinting method, metal wire ligature method and nylon wire ligature bonding method, etc.
3.Tooth fracture.
It can be divided into three categories: crown fracture, root fracture, and crown-root fracture, which are caused by direct impact of external force. Crown fracture: if the defect is small and only involves the enamel, the sharp edge can be polished; if the dentin is exposed and mildly sensitive, desensitization treatment; if the sensitivity is heavy, calcium hydroxide bedding to have sufficient restorative dentin formation and then use composite resin to repair the crown form; if the pulp is injured, the pulp should be preserved as much as possible, and root treatment should be performed after the formation of the root, and finally repair with composite resin or porcelain crown. Root fracture: For apical 1/3 fracture, in many cases, only splinting is required without endodontic treatment. For mid-root 1/3 fracture, repositioning is performed before splinting. For cervical 1/3 fracture and communication with the gingival sulcus, periodontal condition can be restored with a pile crown 3 months after gingivotomy, orthodontic retraction, and intra-alveolar tooth displacement.
Combined crown-root fracture.
Any posterior crown-root fracture that can be done root treatment and has the evidence for pile crown restoration should be preserved by all means.
Should a tooth be preserved after a tooth loss due to trauma? How should it be preserved?
The treatment of tooth dislocation is based on the principle of tooth preservation. In case of partial dislocation such as tooth displacement, semi-dislocation or embedded deep, the tooth should be fully reset first and then fixed for 2-3 weeks. If the tooth has been completely lost, but not long enough to leave the body, the dislocated tooth can be reimplanted. The method of fixing dislocated teeth is long with arch splinting, metal wire ligature method and nylon wire ligature bonding method, etc.
How to protect the affected tooth after the tooth is reset by treatment?
After the tooth is reset, the tooth should be ligated and adjusted first, and then the patient should be instructed to eat soft things without force and avoid chewing.
What are the types of soft tissue trauma in the oral and maxillofacial area?
Oral and maxillofacial soft tissue trauma can be divided into abrasions, contusions, cuts, puncture wounds, contusions, bite wounds, and firearm wounds according to the cause of the injury and the condition of the injury.
Why is infection easy to occur after oral and maxillofacial trauma?
There are many oral and maxillofacial cavities and sinuses, including oral cavity, nasal cavity, paranasal sinus and orbit. In these sinuses, there are a large number of bacteria. If they are connected to the wound, they are prone to infection. During the debridement process, the wounds connected with these sinuses should be closed as early as possible to reduce the chance of infection.
Why does facial trauma easily cause facial muscle movement disorders?
The facial nerve innervates the facial expression muscles and the third branch of the trigeminal nerve innervates the masticatory muscles, so when facial trauma occurs, it is possible to damage these two nerves and cause facial muscle movement disorders.
What are the frequent sites of mandibular fracture?
Fractures of the mandible often occur in the median joint, chin hole area, angle of the mandible, and condyle.
How are maxillary fractures classified?
Le Fort classifies them into three types according to the high and low position of the fracture line: Le Fort type I fracture: also known as a low maxillary fracture, or horizontal fracture.
Le Fort type II fracture: also known as a median maxillary fracture, or tapered fracture. le Fort type III fracture: also known as a high maxillary fracture, or suprazygomatic arch fracture.
What is the most important manifestation of jaw fracture?
The most important manifestations of jaw fracture are local swelling and pain; presence of fracture line; displacement of fracture segment; misalignment of occlusal relationship; and functional impairment.
Can the teeth located on the fracture line be retained after a jaw fracture?
After jaw fracture, the teeth located on the fracture line should be preserved as much as possible, but if the tooth decay is serious, it may lead to bone wound infection and affect the fracture healing, it should be extracted.