Oral Surgery

STANDARD OPERATING PROCEDURES IN ORAL & MAXILLOFACIAL SURGERY

OPERATION THEATRE PROTOCOL

  • Cleanliness of hospital environment
  • Ensure infection control for the patient who undergo surgical procedure
  • Critical instruments are sterile by autoclave, Semi-Critical instruments are sterile by using Glutaraldehyde solution & more than 2 % strength alkaline solution; Non-Critical instruments are cleaned by washing with detergent
  • Allow the patient to become dry before draping
  • Sterile area should be separated from other by draping
  • Team members should not talk except when essential
  • The doors from the corridors into operating room should be kept close
  • For hand scrubbing the area should be wide enough
  • Operator should gloved properly
  • Temperature of the operation theatre should be in between 24-270C
  • Relative humidity should be 45 – 600C
  • The room should be well ventilated

PATIENT PREPARATION

  • Hospitalization 2 – 3 days prior to surgery
  • Intake patient’s medical history
  • Outside clothing should be discarded & the patient should be provided with clean hospital clothing
  • Patient should not be shifted in operating room with full bladder
  • The oral cavity should be thoroughly inspected, loose teeth should be extracted as the may come in the way of intubation
  • Application of preoperative skin antiseptic
  • Scrubbing of the operative site, starts at the Centre& goes to periphery
  • Then the area should be painted with 5% povidine iodine solution & remain on skin for atleast 2 minute
  • Adhering drape is applied
  • For isolation of mouth clear plastic drape with an adhesive side can be used

INFECTION CONTROL

  • Appreciation of basic microbiology & modes of disease transmission
  • Implementation of work practices which prevent transmission of infection
  • Conscientious hygiene, including handwashing & regular cleaning of work areas
  • Adoption of nationally recommended procedures for sterilization & disinfection
  • Single-used or sterilisable equipment used routinely where this is practical
  • Appropriate use of antibiotics
  • Vaccination against infections which are potential risk in health care setting
  • Ongoing quality management & improvement
  • Risk minimization technique
  • Precaution require the assumption that all blood & body substances are potential sources for infection
  • Standard precaution include good hygiene practice

STERILISATION

  • Steam sterilization is the preferred method of sterilization of re-usable dental instruments
  • Instrument surface must be in direct contact with dry saturated steam at the required temperature, for the requisite time, in the absence of air
  • The machine must be periodically tasted to ensure that the parameters established at installation are still valid
  • Two type of sterilizer is commonly used in dental surgeries, these are Type N & Type B
  • Type N sterilizers also known as bowl & instrument, unwrapped instruments & utensile sterilizers, or natural displacement sterilizers
  • Type B sterilizers also known as vacuum bench top sterilizers
  • Majority of surgical instruments are sterilized by type N sterilizer
  • In general for autoclaving temperature should be 1210C, pressure 15 lbs, time 15 minute
  • Metal instruments should kept 4 minute at 1340C in autoclave
  • Wraped metal instruments should kept 9 minute at 1340C in autoclave
  • Textile articles should kept 12 – 16 minute at 1340C in autoclave
  • Note the chamber pressure guage till it comes to zero
  • After drying is completed valve is turned off the autoclave

WASTE MANAGEMENT

  • Spent X-ray fixer used in dental clinics to develop X-rays is a hazardous material that should not be simply rinse down the drain
  • Undeveloped X-ray films contain a high level of silver & must be treated as hazardous waste & needs to disposing in a recommended container for for recycling
  • The lead foil inside X-ray packet & lead aprons contain leachable toxin which can contaminate soil & ground water. This should only be handed over to CWC.
  • Blood-soaked/dripping gauze should be enclosed in a yellow biomedical waste bag covered with a double bag, a CWC should be contacted for disposal
  • All sharp waste (needle, scalpels, glass carpules, burs, files, blades etc.) should collect in a red or yellow puncture resistance container with a lead that cannot be removed, with biohazards symbol & once full, the CWC should be contacted for disposal
  • Nonchlorinated plastic container should be preferred to minimize environmental impacts & placed in a solid waste stream for management of chemicals, disinfectants & sterilizing agents
  • Nonhazardous wastes should be collected in a PVC plastic container & recycle them wher the service exists.

MEDICAL EMERGENCY MANAGEMENT

  • Ensuring that oxygenated blood is being delivered to critical organs, this is consistent with basic cardiopulmonary resuscitation
  • In severe emergency give CPR to the patient
  • Oxygen pressure should not be exceed 35 liters per minute which provide some additional time to induced emergency drug to the patient
  • Epinephrine is the drug of choice for the emergency treatment of anaphylaxis & asthama. This is also indicate for cardiac arrest
  • Nitroglycerin is indicated for acute angina or myocardial infraction.
  • Injectable Antihistamine is indicated for the management of allergic reactions. Whereas mild non-0life threatening allergic reaction may be managed by oral administration
  • Salbutamol is a selective beta-2 agonist is the firstchoice for management of bronchospasm
  • Aspirin is one of the more newly recognized life-saving drugs as it acts on acute myocardial infraction
  • Oral carbohydrate source should be provided to the patient
  • Glucagon allows intramascular management of hypoglycemia in an unconscious patients
  • Atropine an anti-muscarinic, anti-cholinergic drug is indicated for management of hypotension, which is accompanied by bradycardia
  • Administration of a corticosteroid such as hydrocortisone may be indicated for prevention of recurrent anaphylaxis
  • Morphine is indicated for the management of severe pain which occurs with myocardial infraction
  • Injectable Benzodiazepine is indicated for management of seizures which are prolonged or recurrent