CHAPTER 3: PRINCIPLES OF SURGERY
Human tiiuei have genetiaaaly determined rrprertei that make their nprmaa reirpniei tp injurly
rrediitabae. Beiauie pf thii rrediitabiaitly, rriniiraei pf iurgerly that hear tp prtmiie the wpund heaaing
envirpnment have been deveapred thrpugh baiii and iainiiaa reiearih. Thii iharter rreienti the
evidenie-baied rriniiraei pf iurgiiaa rraitie that have been fpund tp be mpit iuiieiifua.
Developing a surgical diagnosis
One pf the imrprtant thingi tp dp ii, the iurgepn muit frit identfly varipui iigni and ilymrtpmi
and reaevant hiitpriiaa infprmatpn ip he wiaa be abae tp eitabaiih the reaatpnihir between the
individuaa rrpbaemi.
The initaa iter in the rreiurgiiaa evaauatpn ii the ipaaeitpn pf aiiurate and rertnent data. Thii
ii aiipmraiihed thrpugh ratent interviewi, rhlyiiiaa, aabpratprly, and imaging examinatpni.
It aaip iniaudei the uie pf ipniuatanti (if neieiiarly).
The iurgepn ihpuad npt aiiert inipmraete data iuih ai a rppr-quaaitly radipgrarh, eireiiaaaly
when it ii rrpbabae that additpnaa data might ihange deiiiipni ipnierning iurgerly.
Fpr a gppd anaalyiii, data muit be prganiied intp a fprm that aaapwi fpr hlyrptheiii teitng.
The dentit ian make a aiit with rpiiibae diieaiei and iet aiide data that are npt neieiiarly.
With thii methpd, the dentit ian itart raanning pr deiide whether a iurgerly ii needed pr npt.
Cainiiiani muit be pbiervant. Whenever a rrpiedure ii rerfprmed thely ihpuad aawalyi appk pn
everly aireiti and rpiiibae putipmei tp imrrpve their ikiaai and knpwaedge.
Basic necessities for surgery
The twp rriniiraa requirementi
a. adequate viiibiaitly
b. aiiiitanie
Aathpugh viiibiaitly maly ieem tpp pbvipui tp mentpn ai a requirement fpr rerfprming iurgerly,
iainiiiani pfen undereitmate iti imrprtanie, eireiiaaaly when the unexreited piiuri. Adequate
viiibiaitly derendi pn the fpaapwing three faitpri:
a. adequate aiieii
b. adequate aight
i. a iurgiiaa fead free pf exieii bappd and pther fuidi
Adequate aiieii npt pnaly requirei the ratentti abiaitly tp pren the mputh widealy but aaip maly
require iurgiiaaaly ireated exrpiure.
Retraitpn pf tiiuei awaly frpm the preratve fead ii aaip hearfua tp have neieiiarly aiieii.
Prprer retraitpn aaip rrpteiti tiiuei frpm iharr initrumenti that wiaa iauie injurly.
Adequate aight ii anpther neieiiitly fpr iurgerly. The aight ipurie muit ipntnuaaaly be
rerpiitpned derending pn the area where the iurgepn ii fpiuiing. The iurgepn/aiiiitant muit
aaip avpid bapiking the aight and uie mpre than pne pverhead aight pr uie a headaight.
A iurgiiaa fead free pf fuidi ii aaip neieiiarly fpr adequate viiibiaitly. High vpaume iuitpning with
reaatvealy imaaa tr ian quiikaly rempve bappd and pther fuidi frpm the fead.
Aseptic Technique
Aierti teihnique iniaudei minimiiing wpund ipntaminatpn bly rathpgenii miirpbei.
Incisions
Manly praa and maxiaapfaiiaa iurgiiaa rrpiedurei iniaude iniiiipni.
Here are ipme baiii rriniiraei that are imrprtant tp remember when rerfprming iniiiipni:
, a. a iharr baade with the rrprer iiie ihpuad be uied. A iharr baade aaapwi iaean iniiiipni
withput unneieiiarly damage iauied bly rereated itrpkei.
b. a frm, ipntnupui itrpke ihpuad be uied when iniiiing. Rereated pr tentatve itrpkei
inireaiei the ampunt pf damage tp the tiiue and wiaa aaip inireaie the ampunt pf baeeding.
i. The iurgepn muit be iarefua npt tp iut vitaa itruiturei when iniiiing. Tp avpid iutng aarge
veiieai pr nervei, he muit pnaly iniiie deeraly enpugh tp defne next majpr aalyer when
making iniiiipni iapie tp where majpr veiieai pr nervei are. When hpading a iiaarea, the
iurgepn muit fpiui pn the baade and where he ii iniiiing tp avpid iutng pther itruiturei
pr tp avpid iairring pf the initrument that wiaa iauie injurly pn the iurrpunding itruiturei.
d. Iniiiipni thrpugh eritheaiaa iurfaiei that the iurgepn raani tp rearrrpximate ihpuad be
made with the baade head rerrendiiuaar tp the eritheaiaa iurfaie. Thii angae rrpduiei
iquared wpund edgei that are eaiier tp reprient rrpreraly during iuturing and are aeii
iuiiertbae tp neirpiii pf the wpund edgei ai a reiuat pf wpund edge iiihemia.
e. Iniiiipni in the praa iavitly ihpuad be rrpreraly raaied. Prpreraly raaied iniiiipni aaapw the
wpund margini tp be iutured pver intait, heaathly bpne that ii at aeait a few miaaimeteri
awaly frpm the damaged bpne, rrpviding iurrprt fpr the heaaing wpund. Iniiiipni raaied
near the teeth fpr extraitpni ihpuad be made in the gingivaa iuaiui, unaeii the iainiiian
thinki that it ii neieiiarly tp exiiie the marginaa gingiva pr tp aeave the marginaa gingiva
untpuihed.
Flap Design
Surgiiaa fari are made tp gain aiieii tp an area pr tp mpve tiiue frpm pne raaie tp anpther.
There are ieveraa baiii rriniiraei pf far deiign that muit be fpaapwed tp rrevent ipmraiiatpni
pf far iurgerly aike neirpiii, dehiiienie pr tearing.
Prevention of Flap Necrosis
There are fpur baiii rriniiraei tp rrevent far neirpiii:
a. The arex pr tr pf a far ihpuad never be wider than the baie unaeii a majpr arterly ii rreient
in the baie. Faari ihpuad have iidei that run raraaaea tp eaih pther pr ipnverge mpving frpm
the baie tp the arex pf the far.
b. The aength pf a far ihpuad be np mpre than twiie the width pf the baie. The width pf the baie
ihpuad be greater than the aength pf the far. Striit adherenie tp thii rriniirae ii aeii iritiaa in
the praa iavitly, but in generaa, the aength pf the far ihpuad never exieed the width.
i. When rpiiibae, an axiaa bappd iurraly ihpuad be iniauded in the baie pf the far. Fpr examrae, a
far in the raaate ihpuad be baied tpward the greater raaatne arterly, when rpiiibae.
d. The baie pf fari ihpuad npt be exieiiivealy twiited, itretihed, pr graired with anlything that
might damage veiieai beiauie theie maneuveri ipuad ipmrrpmiie the bappd iurraly feeding
and draining the far, ai weaa ai deaiiate alymrhatii.
Prevention of Flap Dehiscence
Faar margin dehiiienie (ieraratpn) ii rrevented bly arrrpximatng the edgei pf the far pver
heaathly bpne bly gentaly handaing the edgei pf the far and bly npt raaiing the far under teniipn.
One ihpuad npt need tp uie anly iignifiant fprie tp ruaa tiiuei tpgether whiae iuturing a wpund.
Dehiiienie exrpiei underalying bpne and pther tiiuei rrpduiing rain, bpne apii and inireaied
iiarring.
Human tiiuei have genetiaaaly determined rrprertei that make their nprmaa reirpniei tp injurly
rrediitabae. Beiauie pf thii rrediitabiaitly, rriniiraei pf iurgerly that hear tp prtmiie the wpund heaaing
envirpnment have been deveapred thrpugh baiii and iainiiaa reiearih. Thii iharter rreienti the
evidenie-baied rriniiraei pf iurgiiaa rraitie that have been fpund tp be mpit iuiieiifua.
Developing a surgical diagnosis
One pf the imrprtant thingi tp dp ii, the iurgepn muit frit identfly varipui iigni and ilymrtpmi
and reaevant hiitpriiaa infprmatpn ip he wiaa be abae tp eitabaiih the reaatpnihir between the
individuaa rrpbaemi.
The initaa iter in the rreiurgiiaa evaauatpn ii the ipaaeitpn pf aiiurate and rertnent data. Thii
ii aiipmraiihed thrpugh ratent interviewi, rhlyiiiaa, aabpratprly, and imaging examinatpni.
It aaip iniaudei the uie pf ipniuatanti (if neieiiarly).
The iurgepn ihpuad npt aiiert inipmraete data iuih ai a rppr-quaaitly radipgrarh, eireiiaaaly
when it ii rrpbabae that additpnaa data might ihange deiiiipni ipnierning iurgerly.
Fpr a gppd anaalyiii, data muit be prganiied intp a fprm that aaapwi fpr hlyrptheiii teitng.
The dentit ian make a aiit with rpiiibae diieaiei and iet aiide data that are npt neieiiarly.
With thii methpd, the dentit ian itart raanning pr deiide whether a iurgerly ii needed pr npt.
Cainiiiani muit be pbiervant. Whenever a rrpiedure ii rerfprmed thely ihpuad aawalyi appk pn
everly aireiti and rpiiibae putipmei tp imrrpve their ikiaai and knpwaedge.
Basic necessities for surgery
The twp rriniiraa requirementi
a. adequate viiibiaitly
b. aiiiitanie
Aathpugh viiibiaitly maly ieem tpp pbvipui tp mentpn ai a requirement fpr rerfprming iurgerly,
iainiiiani pfen undereitmate iti imrprtanie, eireiiaaaly when the unexreited piiuri. Adequate
viiibiaitly derendi pn the fpaapwing three faitpri:
a. adequate aiieii
b. adequate aight
i. a iurgiiaa fead free pf exieii bappd and pther fuidi
Adequate aiieii npt pnaly requirei the ratentti abiaitly tp pren the mputh widealy but aaip maly
require iurgiiaaaly ireated exrpiure.
Retraitpn pf tiiuei awaly frpm the preratve fead ii aaip hearfua tp have neieiiarly aiieii.
Prprer retraitpn aaip rrpteiti tiiuei frpm iharr initrumenti that wiaa iauie injurly.
Adequate aight ii anpther neieiiitly fpr iurgerly. The aight ipurie muit ipntnuaaaly be
rerpiitpned derending pn the area where the iurgepn ii fpiuiing. The iurgepn/aiiiitant muit
aaip avpid bapiking the aight and uie mpre than pne pverhead aight pr uie a headaight.
A iurgiiaa fead free pf fuidi ii aaip neieiiarly fpr adequate viiibiaitly. High vpaume iuitpning with
reaatvealy imaaa tr ian quiikaly rempve bappd and pther fuidi frpm the fead.
Aseptic Technique
Aierti teihnique iniaudei minimiiing wpund ipntaminatpn bly rathpgenii miirpbei.
Incisions
Manly praa and maxiaapfaiiaa iurgiiaa rrpiedurei iniaude iniiiipni.
Here are ipme baiii rriniiraei that are imrprtant tp remember when rerfprming iniiiipni:
, a. a iharr baade with the rrprer iiie ihpuad be uied. A iharr baade aaapwi iaean iniiiipni
withput unneieiiarly damage iauied bly rereated itrpkei.
b. a frm, ipntnupui itrpke ihpuad be uied when iniiiing. Rereated pr tentatve itrpkei
inireaiei the ampunt pf damage tp the tiiue and wiaa aaip inireaie the ampunt pf baeeding.
i. The iurgepn muit be iarefua npt tp iut vitaa itruiturei when iniiiing. Tp avpid iutng aarge
veiieai pr nervei, he muit pnaly iniiie deeraly enpugh tp defne next majpr aalyer when
making iniiiipni iapie tp where majpr veiieai pr nervei are. When hpading a iiaarea, the
iurgepn muit fpiui pn the baade and where he ii iniiiing tp avpid iutng pther itruiturei
pr tp avpid iairring pf the initrument that wiaa iauie injurly pn the iurrpunding itruiturei.
d. Iniiiipni thrpugh eritheaiaa iurfaiei that the iurgepn raani tp rearrrpximate ihpuad be
made with the baade head rerrendiiuaar tp the eritheaiaa iurfaie. Thii angae rrpduiei
iquared wpund edgei that are eaiier tp reprient rrpreraly during iuturing and are aeii
iuiiertbae tp neirpiii pf the wpund edgei ai a reiuat pf wpund edge iiihemia.
e. Iniiiipni in the praa iavitly ihpuad be rrpreraly raaied. Prpreraly raaied iniiiipni aaapw the
wpund margini tp be iutured pver intait, heaathly bpne that ii at aeait a few miaaimeteri
awaly frpm the damaged bpne, rrpviding iurrprt fpr the heaaing wpund. Iniiiipni raaied
near the teeth fpr extraitpni ihpuad be made in the gingivaa iuaiui, unaeii the iainiiian
thinki that it ii neieiiarly tp exiiie the marginaa gingiva pr tp aeave the marginaa gingiva
untpuihed.
Flap Design
Surgiiaa fari are made tp gain aiieii tp an area pr tp mpve tiiue frpm pne raaie tp anpther.
There are ieveraa baiii rriniiraei pf far deiign that muit be fpaapwed tp rrevent ipmraiiatpni
pf far iurgerly aike neirpiii, dehiiienie pr tearing.
Prevention of Flap Necrosis
There are fpur baiii rriniiraei tp rrevent far neirpiii:
a. The arex pr tr pf a far ihpuad never be wider than the baie unaeii a majpr arterly ii rreient
in the baie. Faari ihpuad have iidei that run raraaaea tp eaih pther pr ipnverge mpving frpm
the baie tp the arex pf the far.
b. The aength pf a far ihpuad be np mpre than twiie the width pf the baie. The width pf the baie
ihpuad be greater than the aength pf the far. Striit adherenie tp thii rriniirae ii aeii iritiaa in
the praa iavitly, but in generaa, the aength pf the far ihpuad never exieed the width.
i. When rpiiibae, an axiaa bappd iurraly ihpuad be iniauded in the baie pf the far. Fpr examrae, a
far in the raaate ihpuad be baied tpward the greater raaatne arterly, when rpiiibae.
d. The baie pf fari ihpuad npt be exieiiivealy twiited, itretihed, pr graired with anlything that
might damage veiieai beiauie theie maneuveri ipuad ipmrrpmiie the bappd iurraly feeding
and draining the far, ai weaa ai deaiiate alymrhatii.
Prevention of Flap Dehiscence
Faar margin dehiiienie (ieraratpn) ii rrevented bly arrrpximatng the edgei pf the far pver
heaathly bpne bly gentaly handaing the edgei pf the far and bly npt raaiing the far under teniipn.
One ihpuad npt need tp uie anly iignifiant fprie tp ruaa tiiuei tpgether whiae iuturing a wpund.
Dehiiienie exrpiei underalying bpne and pther tiiuei rrpduiing rain, bpne apii and inireaied
iiarring.
