Surgery lec 12

ORAL SURGERY 3rd grade
INSTRUMENTS FOR BASIC ORAL SURGERY II
6-Instruments for suturing:

At the end of the procedure the mucoperiosteal flap must be returned
back to its original place or position by sutures, the instruments used to
do any suturing may include the followings:
A-Needle holder
the needle holder is an instrument with a locking handle device the
handle is long and the beaks are short ,stout for intraoral suturing, a 15
cm handle length needle holder is often recommended the beaks of the
needle holder are shorter and stronger than the beaks of the haemostat,
the inner surface of the beaks is crosshatched to provide good surface
for grasping of the needle and to prevent its rotation or movement
during suturing while in haemostat the inner surface has parallel
grooves which differentiates it from the needle holder, so haemostat
should not be used for suturing but preserved for its original work to
control bleeding during surgery.
Needle holders
1
B-Needles :
Most sutures come fused to needles in a pre-sterilized package, suture needles
differ according to the shape of their cross section and their length, there are
generally two types:
1-cutting needle, have a triangular cross section
2-taper point, which are round or oval in cross section.
According to the shape of the needles, straight needles are only used where tissues or
areas of surgery are easily accessible and therefore they are not used in oral cavity
because of the limitation of space in oral cavity, so curved needles are mostly used of
a length of 21-25 mm or 3/8 or 1/2 (half circle) and this design allows the needle to
pass through the limited area of suturing easily, the cutting needle(triangular cross
section ) also called traumatic needle but it has a good advantage of being able to
enter the tissues easily during suturing specially in tout areas like mucoperiosteum of
the hard palate( keratinized mucosa ) or skin where the tissue is difficult to penetrate
the tapered needle is generally used for closing muscle or fascia that are easily
penetrated.
C-Suture material:
many types of suture materials are available and could be classified by size , resorb
ability ,and whether or not they are monofilament or poly filament .Sutures are made
of wide variety of materials and come in several sizes, each designed for a particular
purpose
1-size
Sutures are available in various sizes that range from one zero ( 1/0) to (1 l/0)eleven
zero, increasing number of zeros means decreasing the suture diameter, the most size
used in oral and maxillofacial surgery is size 3/0 and 4/0 ,the size of the suture usually
expressed on the package e.g. 3/0 ,4/0, 2/0....the size 3/0 used most commonly in
suturing oral mucosa, which is enough to prevent tearing of the oral mucosa and strong
to withstand the tension placed on them intraorally.
2.Resorbability:
Sutures may be resorbable or non-resorbable, resorbable sutures are made of materials
that the body is capable of easily breaking them down, like catgut sutures and this is used
for suturing deep structures like muscles, fascia, so these sutures does not require
removal, while non resorbable sutures like black silk sutures ,nylon, stainless steel, those
need removal of the suture postoperatively..
For the resorbable sutures we have two types. Plain gut and chromic gut ,the plain gut is
subjected to rapid resorption or digestion by the proteolytic enzymes produced by the
inflammatory cells ,while the chromic catgut is treated with special chromic salts ,to
provide resistance for the proteolytic enzymes.
2
D-Scissors:-
the final instrument necessary for placing sutures are suture scissors ,the suture scissor
usually have long handles, short cutting edge or beaks because main purpose is to cut
suture during suturing or on the removal of sutures postoperatively, other types of
scissors used in oral surgery are called soft tissue scissors or operating scissors: these
scissors are used for cutting of tissues and for dissection or undermining of tissues
during surgery , we mainly have two types of operating scissors..
1-small,sharp,delicate ones used for fine work
2-blunt nosed scissors: used for undermining soft tissues as well as for
Blunt tissue scissors
notice that these operating scissors should not be used for cutting sutures or other
material because these materials make them blunt ,and it became less effective for
cutting tissues.
3
7-instruments for retraction of soft tissues:
These instruments may be held by the surgeon or his assistant to help the surgeon to
have a clear field or area during his work so that it will provide accessibility to the
working field and in addition to that it will help in the protection of surrounding
tissues from trauma or injury during surgery
There are many types and varieties of retractors ,that have been designed to retract the
cheek ,tongue ,lips and mucoperiosteal flaps ,so we have ..
A-Cheek retractor:
from its name its used to retract the cheek ,the most popular one is the kilner retractor,
its double ended with different sizes and widths ,and it's held against or at the angle of
the mouth ,to retract the cheek away from the operative area .
cheek retractors
B-Mucoperiosteal flap retractor:

it is used to retract the flap away from the operative area ,to provide good vision for
the surgeon and to help protect the flap from trauma ,it should be held against the bone
and not on the flap ,there are many retractors of different shapes and designs
especially made for flap retraction and even periosteal elevator (Howarth 's ) may be
used as a retractor for the flap ..
4
There is also special retractors for the tongue but usually the mouth mirror is the most
common instrument used for tongue retraction and lip retraction
8-insrument for irrigation and suction

A-instrument for suction:
These instruments used to provide good visualization of the operative field by

aspirating the blood ,saliva and the irrigating solution (e.g. saline , distilled water)
used during operation . in oral surgery a fine metal suction tips on vacuum pressure
most used to perform such duty . the use of suction also is very important and most be
used when we are working under general anaesthesia to prevent the possibility of
aspiration of blood and other fluids by the patient.
5
B-Instruments for irrigation:
When we use hand piece and bur to remove bone its necessary to use irrigating
solutions like normal saline to cool the bur and prevent bone damage by the heat
generated during cutting of bone ,also irrigation will clean the area of surgery from
small debris and chips during the surgical procedure and after finishing before
suturing the area ,large plastic syringe with blunt 18 gauge needle is used for
irrigation purposes ,the needle should be blunt and smooth so that no damage to the
vital organs or soft tissues can occur ,the needle also preferable to be angled to have
good and efficient direction of the irrigation fluid .
Irrigation set:

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ORAL SURGERY 3rd grade

INSTRUMENTS FOR BASIC ORAL SURGERY II

6-Instruments for suturing:

1-small,sharp,delicate ones used for fine work

B-Mucoperiosteal flap retractor:

8-insrument for irrigation and suction

These instruments used to provide good visualization of the operative field by

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