instruments for incising the tissue1

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



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



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



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.



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



IN

A



BA



GIL



TONGINSTRUMENTS FOR INCISING THE TISSUES

Scalpel

Used for making an incision

Two parts

1.Blade handle

2.Blades



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



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



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



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



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



M



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



• 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



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



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



IN



NEEDLE LL



‘

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



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



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



• 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



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

instruments for incising the tissue1

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