Oral and Maxillofacial Surgery Course Didactic Outline

Introduction & Organization of Course:

Students are introduced to the definition & scope of the specialty, and informed of the organization, grading system, quizzes, tests, CE, Oral/Written presentations, and reading requirements of the course.

Perioperative Management

Classification of diabetes; effects of diabetes on systemic function, medication used in treatment of diabetes-modes of action, peak, duration, complications; differential diagnosis: diabetic coma vs. insulin shock; the gravid patient-hormonal and cardiovascular changes; factors in guiding treatment schedule; drug effects on fetus. Physical and laboratory evaluation of medically compromised patients with liver, adrenal or thyroid disease; effects of steroids on systemic function; patient management.

Definition of hypertension and review of etiologies, laboratory test for evaluation; review of drug therapy used in management; considerations in treatment of cardiac patients-angina pectoris. Clinical evaluation and management of patient with arrhythmias; interpretation of EKGs and pulses associated with arrhythmias; antiarrhythmic drugs.

Obstructive and restrictive pulmonary diseases and treatment considerations; Rheumatic fever?etiology, criteria for diagnosis, pathology, treatment; prevention of bacterial endocarditis-prophylaxis regimens; dental management of patients on anticoagulation therapy-heparin vs. Coumadin; laboratory evaluation; drug interactions.

Wound Classifications and Sterile Techniques:

Wound Classifications, concern of infections, and sterile techniques used in surgery.

Surgical Instruments and Suture materials:

Instruments used in outpatient oral and maxillofacial surgery practice; suture materials-absorbable vs. non-absorbable; consideration for selection.

Flap Design in Oral Surgery:

Principles of flap design and types of flaps; anatomical considerations; indications for flap procedures.

Exodontia Techniques:

Review of fundamental techniques used in exodontia practice; cardinal forces, hand and chair position, use of elevators, surgical extractions.

Surgical Removal of Impacted Teeth:

Classification of impacted teeth -mandibular vs. maxillary; theories in regard to etiology and frequency of occurrence; indications for removal of impacted teeth and review of factors indicating non-removal. Case presentations of surgical removal of impacted teeth-Interpretation of radiographs, surgical approaches; management of pericoronitis prior to surgery.

Complications Following Odontectomies & Exodontia:

Management of complications associated with exodontia-including hemorrhage swelling and pain; review of routine postoperative care and instructions. Management of complications following odontectomies-swelling, infection, delayed healing (dry socket), trismus, altered sensation, displacement of teeth into spaces, sinus or canal fractures.

Management of Infection & Antibiotics in Infection:

Case presentations?management of facial infection involving major facial spaces; Ludwig’s angina and cavernous sinus thrombosis; signs and symptoms, pathways of infection spread, treatment. Review of antibiotics used in the management of facial infections; antibiotic classification, dosage, spectrum, mode of action, side effects; culture and staining techniques; bacterial identification and sensitivities.

Facial Space Infections-Criteria for Hospitalization of Infections:

Review of anatomy of fascial spaces, involvement by odontogenic infections, and criteria for specialist referral and hospitalization.

Care of the Hospitalized Patient:

Justifications for admission to hospital; types of admissions, hospital notes and orders, consultations-coordination of specialty services in the management of a traumatized, compromised patient. . Review of analgesics-prescription writing, classification, side effects, narcotics and NSAIDs.

Maxillary Sinus:

Anatomy, bacteriology and histology of maxillary sinus, clinical and radiographic evaluation of sinusitis; removal of pathology from sinus; patient management and drug therapy; closure of oroantral fistula.

Endodontic Surgery & Management of Cystic Lesions:

Indications for apicoectomies and retrograde amalgams; surgical techniques; postoperative management; case presentations.

Pre-prosthetic Surgery:

Clinical evaluation of edentulous ridges-reasons for alveoplasty; instrumentation and surgical techniques; types -interradicular, simple, radical; case presentation. Clinical evaluation of patients for preprosthetic surgery; surgical techniques in performing tuberosity and tori reductions; anatomical considerations. Indications for vestibuloplasty; surgical principles in performing vestibuloplasty-maxillary vs. mandibular; grafting procedures; postoperative management; case presentation.

Implant Surgery-Anatomic Considerations:

Review of residual ridge classifications, bone densities, implant and bone grafting options relating to the residual ridge orders.

Bone Grafting Considerations Related to Implant Dentistry:

Bone grafting biology; Bone graft materials: Autogenous, Allogeneic, Alloplastic; and Bone grafting procedures: sinus lifts and ridge augmentation techniques.

Radiographic considerations in Implant & Reconstructive Surgery:

Anatomical limitation in implant surgery, evaluation of bony anatomy using radiographic studies with emphasis on computed tomographic examinations and interactive CT treatment planning.

Care of the Traumatized Patient:

Considerations in initial treatment of the traumatized patient with multiple facial injuries-airway management, monitoring, vital signs, laboratory test, fluid replacement, radiographs, physical examination; case presentation.

Facial Fractures I:

Principles in management of facial fractures -dentoalveolar and mandibular fractures; diagnosis, classifications, methods of stabilization-unfavorable vs. favorable, edentulous vs. dentulous; case presentations.

Facial Fractures II:

Maxillary, Le Fort, Zygomaticomaxillary complex, nasal, frontal, NOE fractures and management techniques.

Surgical Correction of Dento-Facial Deformities I – Diagnosis and Treatment Planning:

Diagnosis and treatment planning in determination of specific skeletal deficiencies for surgical correction of facial deformities-interpretation of cephalometric x-ray and model surgery.

Surgical Correction of Dento-Facial Deformities II – Mandibular/Maxillary Considerations:

Mandibular considerations in surgical correction of facial deformities; case presentation of surgical techniques-vertical oblique, sagittal and horizontal osteotomies. Maxillary considerations in surgical correction of facial deformities-case presentation of surgical techniques-Le Fort procedures, midfacial augmentation.

Facial Neuralgia and Paralysis:

Signs, symptoms and therapy of facial neuralgias-tic douloureux, glossopharyngeal, sphenopalatine and atypical neuralgias; Bell’s palsy-etiology, signs, symptoms, management.

Temporomandibular Joint Surgical Aspects:

Anatomy of temporomandibular joint-review of muscles of mastication; evaluation of function-radiographic techniques and interpretation -tomography, CT scan, conservative therapy. Temporomandibular joint pathology -ankylosis, internal derangement, arthritis-degenerative joint disease-surgical management of TMJ disorders; case presentation.

Salivary Gland Diseases:

Review of salivary gland diseases with emphasis of those that require surgical management.

Emergency Management

Management of emergency cases in the office, with emphasis in advanced techniques in the oral surgery office.