Download Contemporary Oral and Maxillofacial Surgery 6th Edition PDF Free. Description. A comprehensive guide to oral surgery procedures, Contemporary. Contemporary Oral and Maxillofacial Surgery, 6e to download this book the link is on the Description A comprehensive guide to oral surgery. Contemporary. Oral and Maxillofacial. Surgery. Larry J. Peterson, Edward Ellis III, James R. Hupp,. Myron R. Tucker. St. Louis: C.V. Mosby Co., , pages.
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Contemporary Oral and Maxillofacial Surgery, Sixth Edition- Hupp, James R - Ebook download as PDF File .pdf), Text File .txt) or read book online. Cirugía. Contemporary Oral and Maxillofacial Surgery, Sixth Edition- Hupp, James R BAB 22 & 23 - Free download as PDF File .pdf), Text File .txt) or read online for. Download Contemporary Oral and Maxillofacial Surgery 7th Edition PDF Free. One of the most respected dental surgery books in the world, Contemporary Oral .
Personal information is secured with SSL technology. Free Shipping No minimum order. Description A comprehensive guide to oral surgery procedures, Contemporary Oral and Maxillofacial Surgery, 6th Edition enhances your skills in evaluation, diagnosis, and patient management. Full-color photographs and drawings show how to perform basic surgical techniques, and an overview of more advanced surgical procedures includes guidelines on when to refer patients to specialists and how to provide supportive postoperative care. This edition also includes the latest developments in dental implants, instrumentation, and current technology. Hupp, Myron R.
If the arterial O2 concentration is ele- the potential adrenal suppression in patients receiving corticosteroid vated by the administration of O2 in a high concentration. Defer dental treatment until the asthma is well controlled and 1.
Keep a bronchodilator-containing inhaler easily accessible. Defer treatment until heart function has been medically improved the patient has no signs of a respiratory tract infection.
Patients restrictive pulmonary diseases are usually grouped together under the with orthopnea should not be placed supine during any procedure. Elective oral surgery should be deferred if a respiratory tract hypoxia-based respiratory stimulation is removed. CHF include weight gain and dyspnea on exertion. Airways are inflamed and disrupted.
These patients should be questioned specifically about aspirin allergy In the dental management of patients with COPD who are receiv- because of the relatively high frequency of generalized nonsteroidal ing corticosteroids. Only in the most severe chronic cases is supple- by the need for emergency room visits and hospital admissions.
An anxiety. If the patient is or has been chronically taking corticosteroids. The severity of attacks can often be gauged given corticosteroids. Emphasize the importance of oral hygiene. This allows the heparin used during dialysis Elective oral surgery for patients with severe hypertension i. The patient with severe liver damage resulting from infectious disease. Consider use of prophylactic antibiotics. Mild or moderate hypertension i.
Listen to the chest bilaterally with stethoscope to determine 2. Watch for presence of cyclosporine A—induced gingival supplemental oxygen therapy. Modify the dose if such drugs are necessary. Avoid the use of drugs that depend on renal metabolism or may cause otherwise self-limiting infections to become severe. Do not fore. Avoid the use of nephrotoxic drugs such as nonsteroidal Cyclosporine A. Drugs that depend on renal metabolism or excretion should be Emergency oral surgery in severely hypertensive patients should be avoided or used in modified doses to prevent systemic toxicity.
The altered appearance of bone caused by secondary hyperparathyroid. Defer dental care until the day after dialysis has been given. Take 4. Drugs performed in a well-controlled environment or in the hospital so that removed during dialysis will also necessitate special dosing regimens.. Schedule afternoon appointments to allow for clearance of secretions. There- excretion.
Avoid the use of nephrotoxic drugs. Closely monitor respiratory and heart rates. Most of these patients also receive immunosuppressive agents that 1.
Monitor blood pressure. Monitor blood pressure and heart rate. Patients who have received renal transplants occasionally have 5.
These patients receive corticosteroids Insufficiency and Patient Receiving and may need supplemental corticosteroids in the perioperative Hemodialysis period see discussion on adrenal insufficiency later in this chapter.
Consider the use of supplemental corticosteroids. Defer treatment until lung function has improved and treatment 1. Hg should be postponed until the pressure is better controlled. Metabolic ethanol abuse. Hepatic Disorders ing renal dialysis. Keep a bronchodilator-containing inhaler accessible. The dentist 3. Vital signs should be obtained 6.
Consider screening for hepatitis B virus before dental treatment. The dentist should never use the Epinephrine-containing local anesthetics should be used cautiously.
Because of the higher incidence of hepatitis in patients undergo. Renal transplantation and transplantation of other organs. Chronically elevated blood pressure for which the cause is unknown is called essential hypertension. Take the necessary precautions if unable to screen for hepatitis.
If the patient chronically receives corticosteroid therapy. Chronic dialysis treatment typically requires the pres. If the patient requires chronic oxygen supplementation. An alteration of dose Look for signs of secondary hyperparathyroidism. Consider screening for hepatitis B virus before dental care.
If the patient does not require 6. The serum glucose rises above the level at which renal reabsorption of all glucose can take place. The major problem in this form of diabetes is an most commonly NPH normally taken in the morning should be underproduction of insulin. If intravenous IV sedation is not being lowed blood may cause encephalopathy.
Any decrease in regular using tests for determining platelet count. I NPH 8—12 24 3. Long L Protamine 16—24 36 5. Lente 8—12 24 4. Ambulatory oral liver dysfunction may require hospitalization for dental surgery surgery procedures should be performed early in the day. Insulin is required necessary. This device may avoid the need insulin-dependent type I and non—insulin-dependent type II dia.
Avoid drugs requiring hepatic metabolism or excretion. Consider referral to an oral-maxillofacial surgeon for emergent problems. Screen patients with severe liver disease for bleeding disorders by caloric intake.
It is not necessary to defer needed dental care. Endocrine Disorders hunger. Attempt to learn the cause of the liver problem. Diabetes mellitus is caused by an underpro. The osmotic effect of the glucose solute results in polyuria.
This can lead to ketoacidosis and its attendant tachypnea with 2. Severe hyperglycemia in VII. Avoid administration of sodium-containing intravenous solutions. Persons with type I diabetes must strike a balance with regard to 3.
Attempt to avoid situations in which the patient might swallow Patients with type II diabetes usually produce insulin but in insuf- large amounts of blood. This form of diabetes typically begins in adult- hood. If the patient will be betes. Avoid rapid posture changes in patients taking drugs that cause vasodilation. Portal hypertension caused nificant problem for persons with diabetes. Type I diabetes usually begins during childhood or adoles.
Finding a prolonged bleeding glycemia rather than hypoglycemia. Insufficiency stimulating thirst and causing polydipsia frequent consumption of liquids in the patient. Fast F Regular 2—3 6 2. Patients with severe excessive insulin dose and to give a glucose source.
X may be depressed in severe liver disease. This form of diabetes is treated by weight control. Defer surgery until the diabetes is well controlled. Persons with well-controlled diabetes are no more susceptible to 4. Patients sus- is not recognized early. Schedule an early morning appointment.
If severe hyperthyroidism is suspected although not invariably. Later thyroidism Box Atropine and have a thyrotoxic crisis caused by the sudden release of large quanti. Monitor pulse. The dentist can play a role in the initial recog- eventually. The thyroid gland problem of primary signifi. If hyperthyroidism because that manipulation alone can trigger a crisis. If allowed. Thyro- toxicosis is the result of an excess of circulating triiodothyronine and thyroxine.
Watch for signs of hypoglycemia. Their inability to increase endog. Diseases of the adrenal cortex may cause 9. Patients frequently. Maintain verbal contact with the patient during surgery. Difficulty in containing infections is more significant in have difficulty eating after surgery.
Advise patients not to resume normal insulin doses until they given routinely to patients with diabetes undergoing any surgical pro. Treat infections aggressively. Symptoms of primary adrenal insufficiency of the insulin regimen arise. Part I Principles of Surgery The patient should be advised to monitor serum glucose closely for the first 24 hours postoperatively and adjust insulin accordingly. Early symptoms of hypothyroidism and hypotensive.
In have difficulty eating after surgery. The diag. Regular insulin 1. Adrenal insufficiency. Non—Insulin-Dependent Type 2 Diabetes tion secondary adrenal insufficiency.
If the patient must not eat or drink before oral surgery and will consulted about the potential need for supplemental steroids. If the patient can eat before and after surgery. This is caused by altered leukocyte func. Patients with treated thyroid gland disease can safely undergo Thyrotoxic patients are usually treated with agents that block ambulatory oral surgery.
Consult the physician if any questions concerning modification adrenal insufficiency. If a patient with primary or secondary adrenal suppression 5.
Early symptoms of a thyrotoxic avoided if a patient is thought to have incompletely treated hyper- crisis include restlessness. If the patient must not eat or drink before oral surgery and will infection. Many clinicians also believe that prophylactic antibiotics should be 8. The patient becomes stuporous nition of hypothyroidism. The early manifestations The dentist may be able to diagnose previously unrecognized of excessive thyroid hormone production include fine and brittle hyperthyroidism by taking a complete medical history and perform- hair.
Once the patient has appointments. Have baseline coagulation tests. Local anesthesia should be given by local infiltration rather than by and spontaneous bleeding should alert the dentist to the possible field blocks to lessen the likelihood of damaging larger blood vessels.
Monitor pulse and blood pressure before. Schedule the surgery in a manner that allows it to be performed before. On the first 2 postsurgical days. On the second postsurgical day. To better standardize PT values within and between hospitals. If the patient is not currently taking steroids but has received at 4. This technique adjusts the actual PT once they have formed Box Platelet counts under If a coagulopathy is suspected.
See Chapter 11 for additional for variations in agents used to run the test. Specific factor deficiencies—such as hemophilia A. The clinician can cease administration of supplemental steroids 6 days after surgery.
The physi- surgery. Limit the amount of epinephrine used. Therapeutic anticoagulation is same laboratory. Instruct the patient to double the usual daily dose on the day 3.
Consideration should be given to the use of topical II. Instruct the patient on ways to prevent dislodgment of the clot 3. Defer surgery until a hematologist is consulted about the If the patient is currently taking corticosteroids: Patients with inherited bleeding postoperative bleeding occurs.
Patients who receive factor replacement some- times contract hepatitis virus or HIV. Counts must usually dip below A PT is used to test the extrinsic pathway factors formation. Quantitative modification of dental therapy is required. Patients with a Hematologic Problems chronically low platelet count can be given platelet transfusions. A history of epistaxis platelet transfusion or a delay in surgery until platelet numbers rise. If the platelet count is between disorders are usually aware of their problems.
Monitor the wound for 2 hours to ensure that a good initial clot 2.
Take precautions against contracting hepatitis during surgery. If the symptoms of hypothyroidism are mild. If the PT is still clot formation and retention. If the seizure disorder is well 2. This phenomenon may Pregnancy exhibit mild agitation. Take measures to avoid hypoglycemia and fatigue in the patient. Box On the the PT falls to 3. Obtain the baseline PT. Most physicians will allow the to step 6. Protamine sulfate. Defer surgery until the seizures are well controlled.
Take extra measures during and after surgery to help promote 2 and 3 INR. Hepatic insuf. If good control cannot be obtained. Ethanolism alcoholism. Check the PT daily. The interaction usually potentiates the level of sedation and suppresses the gag reflex. This decision should be made in consultation with the stopping the anticoagulant drug for several days. Liver function tests. The primary problems ethanol abusers medical consultation before surgery are desirable.
Stop warfarin approximately 2 days before surgery. Warfarin has a 2. In patients who have in relation to dental care are hepatic insufficiency.
Defer surgery until at least 6 hours after the heparin is stopped or reverse heparin with protamine. Although not a disease state. Seizures can result from ethanol withdrawal. Patients Receiving Heparin stances.
Patients with a history of seizures should be patient must be hospitalized for conversion from warfarin to heparin anticoagulation during the perioperative period. Restart drug therapy on the day after surgery if no bleeding is given subcutaneously. Platelet-Inhibiting Drugs When elective oral surgery is necessary. Ethanol interacts closely for signs of oversedation.
Part I Principles of Surgery as prosthetic heart valves. Patients may Therapeutically Anticoagulated also take drugs with anticoagulant properties such as aspirin.
Drugs such as low-dose aspirin do stopped for 5 days. Warfarin therapy can be resumed the day of surgery stopping heparin for the perioperative period. Patients should stop 5. The INR is used to gauge 3. Seizure Disorder surement of serum levels.
Take extra measures during and after surgery to help promote taking heparin usually can have their surgery delayed until the circu- clot formation and retention. May take a few days. Patients Receiving Warfarin Coumadin Patients on warfarin for anticoagulation and who need elective 1.
Surgical wounds should be dressed with thrombogenic sub. INR to drop to about 2 during the perioperative period. Consider having serum levels of antiseizure medications controlled.
Patients 3. Restart heparin once a good clot has formed. Patients volunteering a history of Patients requiring oral surgery who exhibit signs of severe alco- ethanol abuse or in whom ethanolism is suspected and then con. Restart warfarin on the day of surgery. Avoid the use of drugs with teratogenic potential. Use local and there is no evidence of a risk in later trimesters.
Category D: Positive evidence of human fetal risk exists. Drugs in this to prevent vena caval compression. If radiographs must be adverse effect other than decreased fertility that was not taken.
Category X: Either studies in animals or human beings have Aspirin and Other Nonsteroidal Anti-inflammatory demonstrated fetal abnormalities. Category C: Either studies in animals have revealed adverse fetal 5. Potential Fetal Risk Category A: Category B: Either animal reproduction studies have not 2.
Defer elective surgery until after delivery. Avoid keeping the patient in the supine position for long periods. Avoid dental radiographs unless information about tooth roots or pregnant women. It is virtually impossible to perform an oral Allow the patient to take trips to the restroom as often as available and if the potential benefit justifies the known fetal risk needed. Part I Principles of Surgery surgical procedure properly without using radiography or medica.
Information about some drugs is provided in Table Frequent this Figure When required to give a medication to a However. For purposes of oral surgery. All sedative drugs are best avoided in pregnant patients. Before believed least likely to harm a fetus when used in moderate amounts: The patient may need to be in a more upright position or periapical films of only the areas requiring surgery can accomplish have her torso turned slightly to one side during surgery.
Pregnancy can be emotionally and physiologically stressful. Patient vital A patient after delivery to avoid fetal risk. The list of drugs thought to pose little risk to the breaks to allow the patient to void are commonly necessary late in fetus is short.
Although aspirin is otherwise safe to use. Nitrous oxide should not be used during the first trimester but. The drugs that are known to enter breast milk and to be potentially U.
Studies reveal that hyperventilation. These are followed in frequency by vasovagal syncope. Serious medical emergencies in the dental office are. Prevention is the cornerstone of management of medical emer- The primary reason for the limited frequency of emergencies in gencies. Vital signs should necessary. The first step is risk assessment. This begins with a careful dental practice is the nature of dental education that prepares prac. Preparation to handle office.
Office Staff Training cies in the dental office. This should anxiety are listed in Box Preidentifying individuals with training that would make them emergencies includes four specific actions: Equipping office with supplies necessary for emergency care of automated external defibrillator units Box Once those patients who are likely to include reinforcement by regular emergency drills in the office and have medical emergencies are recognized.
Pulling tongue forward. Auxiliary staff education in emergency recognition and management 3. Establishment and periodic testing of a system to access medical assistance readily when an emergency occurs 4.
Ambu- lances carrying emergency medical technicians are useful to the Continuing Education dentist facing an emergency situation. An important feature of continuing education is to be kept readily available. These conditions are more likely to turn into an emergency when the patient is physiologically or emotionally The dentist must ensure that all office personnel are trained to assist stressed. Dentists who deliver parenteral sedatives other than nitrous oxide are wise to obtain certification in advanced cardiac life medical history and present problems should be performed.
Not all emergencies. Although any patient could have a medical emergency at any time. Pulling mandible forward by pulling on anterior mandible 4. Some recom- mend that continuing education in medical emergency management be obtained annually.
ACLS available. Easily identified lists can be placed on each maintain certification in basic life support BLS. Oral-maxillofacial surgeons are a good resource. Resuscitation bag ventilation 1. Pushing mandible forward by pressure on the mandibular angles 3.
Personal continuing education in emergency recognition and Circulation Provided by External Cardiac management Compressions 2. The most common conditions affected or precipitated by in the recognition and management of emergencies. The office most problems from occurring by modifying the manner in which staff should be preassigned specific responsibilities so that in the oral surgical care is delivered.
This position is useful for on the floor. If dentists have Emergency Supplies and Equipment made arrangements for help from nearby professionals. In addi. If the operatory is too small to allow the patient to be placed legs are raised above the level of the trunk. The numbers should be called periodically needles. The drugs and any equipment in the kit must appropriate emergency drugs. Resuscitation air mask bag unit airways.
Operatories should be large enough to allow a oxygen. Equipment for respiratory assistance includes oral and nasal out of the mouth and pharynx. Emergency kits containing a variety of drugs are commercially available Figure Dental chair placing patient in position such that the care. A list of drugs that should be in a dental tion. Labeling should should facilitate placing the patient in the supine position or.
Many dentists use oxygen supplied in a portable tank.. Useful drug administration equipment includes syringes and automatic-dial telephone. For fast and effective augmentation of venous return. The patient to be placed on the floor for BLS performance and should dentist should be properly trained or assisted by a properly trained One basic piece of equipment is the dental chair that ensure that no drugs have passed the expiration date.
Tonsil-type administration of injectable drugs is needed during office emergen- large suction tip is useful for rapidly clearing large volumes of fluids cies. Oral and nasal airways. The involvement of small positive pressure to the patient.
As with all allergies. Office emergency response systems are available to help guide the dentist and staff during emergencies and drills.
Hypersensitivity Reactions hydrocortisone Solu-Cortef Several of the drugs administered to patients undergoing oral surgery Narcotic antagonist Naloxone Narcan can act as antigenic stimuli. Of the four basic types of hypersensitivity reactions. Nitrolingual tologic. Skin or mucosal reactions include localized areas of pruritus. Virginia Beach.
Allergic reactions affecting the respiratory tract are more serious individual and should ensure a means of delivering the oxygen under and require more aggressive intervention. Establishing a system to check peri. Dentists who use a central oxygen system also need to The patient will complain of dyspnea and may eventually become have available oxygen that is portable for use outside of the operatory.
Example of commercially available emergency kit of appropriate size and complexity for dental office. Skin lesions usually take anywhere from minutes to hours to appear. Corticosteroid Methylprednisone Solu-Medrol. Re-exposure to the antigen triggers a cascade of Antihistamine Diphenhydramine Benadryl. Although skin and mucosal reactions are not in them- bitartrate Medihaler-Epi selves dangerous.
Table details the manifestations of type I Antihypoglycemic Candy containing sugar. The section has been organized into a com- chlorpheniramine Chlor-Trimeton bination of specific problems such as hypersensitivity reactions. Involvement of the larger airways usually first occurs at the A obstruction. Angioedema of the vocal cords causes partial or total airway delayed onset occurs after oral or topical drug administration. The patient is usually unable to speak and produces variety of signs and symptoms of anaphylaxis exist.
As the edema worsens. Benadryl 50 mg or Chlor-Trimeton 10 mg. Pain result- administration. The patient should be asked to describe the exact location signs and symptoms. IV or intramuscular IM antihistamine should be adminis. Disordered cardiovascular function initially bypass the laryngeal obstruction.
Accompanied by dyspnea. Symptoms of respiratory compromise soon epinephrine 0. If a patient claims to have an allergy to a particular drug. Part I Principles of Surgery and trunk. For patients who are unable to does have a drug allergy. If an allergy is truly left shoulder and arm.
Patients with documented heart disease who possible. Prevention and Management Extraction Complications Preprosthetic Surgery Implant Treatment: Basic Concepts and Techniques Principles of Management and Prevention of Odontogenic Infections Complex Odontogenic Infections Principles of Endodontic Surgery Management of the Patient Undergoing Radiotherapy or Chemotherapy Odontogenic Diseases of the Maxillary Sinus Principles of Differential Diagnosis and Biopsy Correction of Dentofacial Deformities Facial Cosmetic Surgery Management of Patients with Orofacial Clefts Facial Neuropathology Examples of Useful Prescriptions V: Consent for Extractions and Anesthesia VI: Just as important, Chapter 2 also provides information about measures to lower the probability of emergencies.
Contemporary surgery is guided by a set of guiding principles, most of which apply no matter where in the body they are put into practice. Chapter 3 covers the most important principles for those practitioners who perform surgery of the oral cavity and maxillofacial regions. Surgery always leaves a wound, whether one was initially present or not.
Although obvious, this fact is often forgotten by the inexperienced surgeon, who may act as if the surgical procedure is complete once the final suture has been tied and the patient leaves.
Chapter 4 presents basic wound healing concepts, particularly as they relate to oral surgery.