Oral and Maxillofacial Surgery

Terms	Definitions
Lips	Also known as labia, helps with facial expressions, food retention and mastication.
Teeth	Deciduous (baby teeth) and permanents.
Each individual tooth is embedded in a socket of the________ ________ of each jaw.	Alveolar process.
Palate	Roof of the mouth. Hard palate (anterior portion) is formed by the maxillary and palatine bones. Helps with word formation and the breakdown of food. The soft palate (posterior portion) aids with closing off the nasal passages during the act of swallowing, and also for closing off the airway.
Cheeks	Also called Buccal, they are the lateral walls of the oral cavity. During chewing, they serve to keep the food between the teeth.
Tongue	A thick muscular organ covered with mucous membrane that contain chemoreceptors for taste. It is attached at the floor of the buccal cavity by a structure called the lingual frenulum.
Facial bones	There are 14: 2 nasal, 2 maxillary, 2 lacrimal (smallest), 2 zygomatic (malar), 2 palatine, 2 inferior nasal turbinate, 1 mandible, and 1 vomer.
T or F: The mandible is the strongest facial bone.	True; it articulates with the glenoid fossa of each temporal bones to form a synovial joint, referred to as the temporomandibular (TMJ).
The skull is comprised of _____ bones and divided in 2 catergories: _______ and ________.	22; facial and cranial.
Facial muscles
Facial muscles assist with:	smiling, frowning, chewing, and speaking.
Facial nerve	7th cranial nerve, innervates ALL of the facial muscles of the lower jaw.
Orbital Bones	Frontal, lacrimal, ethmoid, maxilla, zygomatic, sphenoid, and palatine.
Orbital bones and muscles	Support and protect the eyes, there are 7 craniofacial bones, contain fat for protection from shock, contain the optic nerve.
Orbicular	is oculi, covers a circular path around the eye. The action of this muscle closes the eye.
Masseter	Closes the mouth and protrudes the chin.
Dental caries	Decay of tooth enamel. The bacteria in the mouth, creates an acidic environment, lowering the pH level.
Malocclusion	Misalignment of the alveolar process of the jawbones resulting in over/under bite.
Orbital fractures	Have several characteristics. Diplopia (double vision) and enophthalmos (sagging of the eye) are the most common.
Midfacial fractures	Le Fort I, is the most common type. The alveolar process of the maxilla is horizontally separated from the base of the skull.
Craniofacial deformities	Craniosynostosis, premature closure of the cranial sutures of an infant.
Other oral/maxillofacial pathologies...	fractures of the teeth, cysts/cancer, trauma, congenital deformities, mandibular fractures, frontal fractures, and zygomatic fractures.
Micro/Macrognathia	Micro: Abnormally small lower jaw. Macro: Abnormally large jaw.
Diagnostics used	Physical exam, CT scans (provide important info about possible bony defects), MRI, X-ray (should be in the OR with the patient during sx), Waters view, and palpitation.
Waters view	Is similar to the Calwell view. Both are anteroposterior projections, but in this case the nose and forehead are placed against the cassette. View shows the hard palate, nasal septum, orbital floor, and zygoma.
________ and _________ prevents drying and cracking of lips for the patient during surgery.	Cream and ointment.
T or F; During maxillofacial surgery vomiting can lead to aspiration and in the maxillofacial trauma patient, it can also lead to infection that may interfere with fracture/wound healing.	True.
Flexible Fiberoptic Laryngoscope	Will allow the anesthesia provider to advance an oral or nasal endotracheal tube (intubation) under direct visualization and provides access to oral cavity during arch bar application.
T or F; Maxillofacial procedures have a high risk of an intraoperative fire.	True: Since the surgeon is working by the face, O2 in the ET tube can cause sparks from the electrosurgical unit which can cause ignition of O2 from the ventilation system. A closed ventilation system, use a fire retardant ET tube, and careful use of electrosurgery unit can reduce the potential for fire. ALWAYS HAVE SALINE ON YOUR BACK TABLE!
Throat packs	Consist of rolled gauze that contain a radiopaque marker. It is moistened and any excess fluid is squeezed out prior to insertion. A throat pack SHOULD be included in the formal count. To reduce the risk of aspiration, a throat pack is used to prevent oral secretions, irrigation fluid, blood, and bone or tooth fragments from becoming lodged in the pharynx.
Restoration of teeth	Involves the removal of diseased or broken portions of a tooth and refurbishing the look into a working element.
Bone healing	Is expected in 4-6 weeks.
Bone grafts	Graft material can be used to fill defects from bone loss, fill cavities to promote osteogenesis, or support a week reduction.
Autogenous	Harvested from the patient.
Homogenous/Allograft	From the same species.
Heterologous/Xenograft	From a dissimilar species (coral).
Synthetic	Man made, silastic.
Dural Tears	May be repaired by the maxillofacial surgeon by placing a suture or sealing off the leak with fat, fascia, or muscle graft.
Symphysis fracture
Frontal Fracture Repair	A coronal incision (the most common approach to frontal fixtures) is made following the patient's natural hairline; it can be extended anterior to the tragus if needed.
Mandibular fracture
Zygomatic arch fracture
Orbital floor fracture
Le Fort I	Bilateral horizontal fractures of the maxilla immediately above the teeth and palate.
Le Fort II	Referred to as "panfacial" fractures. Extends from dorsum of nose, across medial walls of orbit across maxilla below the zygomatic bone. Can be unilateral or bilateral in nature.
Le Fort III	Facial bones, including the Zygomas are detached from the anterior cranial base. Fracture lines extends from the dorsum of the nose and cribriform plate along the medial tip of the lateral wall of the orbit.
Fracture of the orbital floor	Indications for surgery: Large defect in orbital floor, Enophthalmos (sagging of the eye), and diplopia on up/downward gaze which indicates muscle entrapment and double vision. .
Maxillomandibular fixation (Arch bar application)
Arch Bar Application	Immobilization of the jaw following mandibular and/or maxillary fracture. Thin strips of metal that have small intermittently placed hooks. The strips are malleable and the hooks should be placed pointing downward on the lower jaw and upward on the upper jaw. This placement allows for mandibulomaxillary elastic band or wire fixation.
After a Arch Bar application, why should the patient have wire cutters at all times?	In case access to an air way is needed.
Plate and Screw Fixation
Rigid Fixation	Done by plates and screws, or screws alone, is the most common repair technique for mandibular fractures. Used to maintain proper bone alignment and approximate and maintain the position of bone edges that have been cut.
Mouth props (bite block)
Bite block	Is placed and the cavity is removed using the dental drill. Mouth prop is placed between the upper and lower teeth of the unaffected side to maintain the patient's mouth in an open position during surgical interventions to facilitate visualization and prevent injury to the surgical staff.
Plastic cheek retractor
Minnesota retractor
Temporomandibular Joint Procedures	TMJ can undergo several procedures. Arthroscopy, meniscal repairs, and joint replacements are the most common. The meniscus lies over the mandibular condyle. The meniscus is attached to the condyle by the external pterygoid muscle and the capsule.
Kefzol	Antibiotic: facial lacerations.
Clindamycin	Antibiotic: oral cavity lacerations.
Amoxicillin	Antibiotic: communicating fractures of the sinus.
Vancomycin	Antibiotic: dural tears or CSF leaks.
Xylocaine	With or without epinephrine (minimizes postoperative pain and causes vasoconstriction).
Hemostasis	Gelfoam and bone wax are used.
Anesthesia considerations	Closed ventilation, fire retardant ET tube, and endotracheal versus nasal tube.