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8/8/2019 Instruments for Incising the Tissue1
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ARMAMENTARIUM USED IN ORAL SURGERY
Dr Sujata Mohanty
HOD ,Oral and maxillofacial Surgery
Dr Geeta
Dr Zainab
Dr Pankaj Sharma Moderated by
Dr K.Sri Ram Dr Rakesh Sharma
Dr Monika Kelkar
Presented by
Inderpreet Singh
Final year
CONTENTS
Instruments used for Picking up sterile Instruments
Instruments used for preparing the surgical fields
Instruments Used for Holding Drapes
Basic Surgical Instruments
To maintain clean surgical Field Forceps
Mucoperiosteal Elevators Hemostats
Needle Holders Elevators
Instruments for holding Soft Tissue Used in Irrigation
Removing pathological tissue Suture Needles and Materials
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ININSTRUMENTS USED FOR PICKING UP STERILE
INSTRUMENTS
CHEATLE’S FORCEPS
• Long angulated instrument
• Stored in container containing savlon
• Solution must be changed daily
INSTRUMENTS USED FOR PREPARING THE SURGICAL FIELDS
SWAB HOLDER
• Instrument with long blades with expanded ends forming an oblong tip
• Central fenestration
• Transverse serrations
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INDICATIONS
• 1.To hold the swab and clean the surfaces
• 2.To swab the throat when there are profuse secretions in an
unconscious patient or patients under GA
• 3.To press on the tonsillar bed to arrest haemorrhage
• 4.To hold the tongue and give anterior tract and thus preventing
tongue fall back and airway obstruction in unconscious patient
TOWEL CLIP
Functions:
1.To hold the corners of the draping sheets during the operation
2.To hold the tongue
3.To stabilize the suction tubes,motor cables and other fibre optic
instrument to the drapes
INSTRUMENTS USED TO MAINTAIN A CLEAN SURGICAL
FIELD
Suction Apaparatus(Vacuum Pump)
Electronically operated through a motor
Suction Tubing
Connected to the apparatus at 1 end and suction tip to the other
Indian Rubber or Silicone polymer
Suction Tip
Into the surgical field Blood, Debris, cystic contents
Straight or angulated tip
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No 4 or no 5 tip may be used in Oral Surgery
INSTRUMENTS USED FOR REFLECTING FLAPS
• Long angulated instrument
• Ends :
1.Sharp Pointed End – Reflect interdental papilla
2.Broader Flat End-Used for elevating soft tissue from the bone
• Stored in container containing savlon
• Solution must be changed daily
METHOD OF USE• Pointed end can be used in a Prying motion to elevate the soft tissue-
Most common and is used to elevate a dental papilla between the
teeth
• Push Stroke -Broad end of the instrument is slid underneath the flap
seperating the periosteum from the from the underlying bone-Most
efficient and results in clean reflection
• Pull or Scrape stroke-Uncommon and shear or tear the periosteum.
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INDICATIONS
To achieve haemostasis-crushing or cauterization and ligature
Hold the ends of ligatures
To drain abcess by Hilton’s method
As tissue forceps for holding subcutaneous tissues,
aponeurosis
To pick up necrotic and granulation tissue and other foreign
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IN
A
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BA
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GIL
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TONGINSTRUMENTS FOR INCISING THE TISSUES
Scalpel
Used for making an incision
Two parts
1.Blade handle
2.Blades
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Correct way of loading of blades on Scalpel
Instruments used to remove pathological tissue
Curette (Lucas)
Volkmann’s Scoop
Curette
Exploratory instrument used to scrape a bony cavity or a soft tissue
tract in order to remove any pathological tissue present within it
Types: Single Ended
Double Ended
Working end may be in same plane or angled to the shank
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INDICATIONS
• Remove tooth particles from the socket
• Remove sequestra in healing sockets
• Enucleate cysts,PAG
• Remove infected clots
VOLKMAN’s SCOOP
Used to scrap the contents of the cavity
Similar to curette bt the concavity is more pronounced
Indications of Volkman’s Scoop
• To collect the contents from a sinus tract,chronic abcess or fist
• To scoop out the cancellous bone for grafting
• To scrape bony cavities due to cystic tumorous lesions or
osteomyelitic lesions
• Introduce graft material in surgical sites
ELEVATORS
1.Handle
a.Large enough to grip the instrument
b.May be 180 or 90(Cross bar-can generate more force)
2.Shank
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a.Connects handle to the blade
b.Should be strong enough to withstand and transmit forces to the
handle
3.Blade
a. It is the working tip which transmit
forces to the tooth, root and bone
b.Can vary in size and shape
INDICATIONS
1.To luxate multi rooted teeth prior to forceps application
2. To luxate, remove teeth that cannot be engaged by the beaks of the
forceps Eg badly carious teeth, malposed teeth and impacted teeth
3. To remove fractured root stumps and apical tips
STRAIGHT ELEVATORS
• The blade has a concave surface on one side that faces the tooth
to be elevator
• sometimes the blade can be at an angle to the shank, allowing
the instrument to reach the posterior areas of the oral cavity
easily
Eg-Pott's and Miller's elevator
CRYER ELEVATOR
Straight Elevator with a triangular blade. The working tip is angulated
with one convex and another flat surface
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Based on Lever and wedge principle
INDICATIONS
• 1.For extraction of root stumps of mandibular molars when 1 root
is removed and the other is to be removed
• 2.For extraction of mandibular molar root stumps when both the
roots are present but one is fractured at a lower level than the
other or when the bifurcation is intact
The working blade is introduced into the empty socket and
moved towards the remining root pieces
WINTER ELEVATORS
• Used to luxate mandibular molar teeth
• Cross bar elevator with a triangular blade
• Uses and application : Same as that of a Cryer elevator
•
Wheel and axis principle
APEXO ELEVATOR
• Straight elevator resembling Cryer but have a biangulated and
sharp straight working tip
• They are paired elevators for the mesial and distal roots
•
Use and Principle: Same as that of Cryer
• Can also be used to remove maxillary root stumps
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HOCKEY STICK ELEVATOR
Similar to cryer’s elevator with the working blade at an angulation
to the shank bt the blade is straight rather than triangular and has
a convex and a flat surface
Hockey shaped
Have transverse serrations for better contact with the root stumps
Principle and indications: Same as that of cryer elevtor
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M
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M
MAXILLARY MOLAR FORCEPS
Beaks non identical
Pointed tip: Engages the groove b/w the buccal roots and the
rounded tip engages the palatal surface above CEJ
Curvature like premolar forceps
Left curvature-right sided and vice versa
MAXILLARY ANTERIOR ROOT FORCEPS
• Identical straight slender and closed beaks
• Indications : Maxillary anterior root stumps
MAXILLARY POSTERIOR ROOT FORCEPS
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• Similar to the anterior forceps bt with curvature like the premolar
forceps-access posteriorly
• Indications : Maxillary posterior root stumps-single and premolar
root stumps
BAYONET FORCEPS
• Identical, pointed, angulated and closed beaks
• Types: Thick and thin
Long and short
• Thick-For maxillary posterior root stumps that are not seperated
• Thin –remove single roots
MANDIBULAR ANTERIOR FORCEPS
• Identical, broad, short, closed beaks
• Joint is a rivet joint(Not a box joint)
• Indications : Mandibular anterior teeth extraction
MANDICULAR PREMOLAR FORCEPS
Identical, broad , open beaks that are
longer than anterior forceps beaks
Indications : Extraction of mandibular premolar
MANDIBULAR MOLAR FORCEPS
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Identical, broad , open beaks with a pointed tip
Indications : Extraction of mandibular molar teeth
COWHORN FORCEPS
• Identical, open, short, pointed beaks that resemble the horns of a
cow
• Beaks are rounded and tapered to a point
• Grip at the bifurcation area b/w the mesial and the distal roots
• When pressure is applied and beaks are closed and tooth is
luxated out
• Indications : grossly carious mandibular molares with excessive
destruction
MANDIBULAR ROOT FORCEPS
• Identical , slender beaks that are closed
• Beaks are longer than that of premolar forceps to enable the
forceps to take a deep grip of the root stump
• Indications : For removal of root stumps of mandibular teeth
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INSTRUMENTS USED TO DRAIN AN ABCESS
1.Lister’s Sinus Forceps
2.Haemostatic Forcep
LISTER SINUS FORCEP
The forcep is used in case of Abcess eg mastoid abcess
It is introduced into the abcess with its ends closed
The ends are opened and all the loculi are broken down and cause
fresh bleeding for healing to take place
HEMOSTATS
• Catch both bleeding arteries as well as veins
• Unidirectional, transverse serrations on the blades of the
haemostat which prevent the vessel from slipping
• Blade-for crushing the vessel
Handle-Clamp for holding the crushed vessel
TYPES
•
Large
• Medium
• Small
• Staright
• Curved
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IN
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NEEDLE LL
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‘
SUTURING MATERIAL
CLASSIFICATION
Absorbable and Non absorbable
Mono filament and multifilament
Coated or Non Coated
Based on the dimater of the thread
NON ABSORBABLE
Perma Hand Surgical Silk
Protein
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Encapsulation : 14-21 days
Good handling properties, sterilised by gamma radiations
Disadvantages: Foreign body reactions
LINEN
Twisted to form a fibre and fibres are used to make a suture
Gains 10% T.Stength when wet
Used in tying pedicels and ligatures
COTTON
Twisted to form suture
Foreign body reaction
Weaker as compared to linen
POLYAMIDES(Nylon)
Low coefficient of friction,hence easily passes through the tissue
Stiff and hence difficult to handle
Memory-hence less secure
POLYESTERS(Dacron)
Extremely high tensile strength-can be retained indefinitely(CVS)
May be Teflon coating reduces the cutting through the tissues
POLYPROPYLENE(Prolene)
Monofilament
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Can extend by 30% before breakingSterilized by ethylene oxide
Non bio degradableIndication : Dental Implant surgery and bone grafting
STAINLESS STEEL
Good strength and Low tissue reaction
Needs very exacting technique as can pull the tissue and can cause necrosis
Barbs can Tear the gloves
INSTRUMENTS USED IN IRRIGATION
INDICATIONS FOR DRAINAGE
• Abcess cavities-To collapse and make the healing possible from
deepest portions
• Surgical cavities where post operative collection of fluid/pus is
expected
• Osteomyelitis lesions where drainage is established for
inflammation. Exudates and necrotic tissues
Types Of Drains
• Simple rubber catheter
• Corrugated rubber drain
• Nasogastric tube/Ryles tube
• Foley’s catheter
• Infant feeding tube
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• Simple rubber catheter
Penrose Drain-Simple rubber drain
Open at both ends
Indications : Drainage of abcess and haematomas
• Corrugated rubber drain
Sheet of rubber with corrugations on its surface
Multiple holes-Prevent obstruction
Drain inserted with one end in the cavity and other is kept out of
skin or mucosa
Secured by sutures and is left in place for 3-5 days
• Nasogastric tube/Ryles tube
Long hallow tube
Made of PVC
USES:
1.Feeds patients who cannot feed themselves
2.Provides gastric lavaage post operatively to flush out
blood,fluids ingested
3.Gastric lavarge-Poisoning
• Foley’s catheter
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Self retaining for evacuating the bladder
Mechanism : In the balloon near its tip
Indications in oral and maxillofacial surgery
For evacuation of bladder in long cases under GA
For evacuation of the bladder in unconscious patients
Post operative urinary retention
Retention stent in comminuted zygomatic complex fractures
• Infant feeding tube
Non toxic,PVC made long tube with blunt tip and multiple openings
Inserted into the dead space and removed through the incision line
or a separate incision made for the same purpose
Sutured for 3-5 days
Syringe emptied at regular intervals
Also used for Local instillation of antibiotic solution