2. Introduction to oral maxillofacial surgery .pptx

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1. Introduction to Oral & Maxillo f acial Surgery. Mr.Rami Wisa BDS,MFD RCSI ,MD in OMFS

2. Clinical examination

3. Remember the four basic techniques 1-Inspection 2-Palpation 3-Percussion 4-Auscultation

4. General examination :- why ???? This is very important because many systemic diseases as well as many skin diseases present with skin lesions and ulcers. Examine the whole patient with care, looking especially at their hands and facies , which can supply important clues to the diagnosis.

5. General inspection General look. Pallor. ( in anemic patient) Cyanosis. Jaundice. Others

6. Cyanosis:- If the concentration of reduced hemoglobin in blood rises above 5 gm %, a bluish tinge is seen in the skin and mucous membrane Sites to look for cyanosis are :- 1- Nails 2- Tip of the nose 3- Ear lobule 4-Inner surface of the lip 5- Tongue 2 types of cyanosis :- 1- peripheral cyanosis . 2- central cyanosis .

7. 1- peripheral cyanosis:- if only nails ,nose and ear lobules are cyanosed while the color of the lips and tongue is normal it is due to either : A- Reduced blood supply or B- Defective venous drainage ( the hands is usually cold in these condition ) Causes :- A- Exposure to cold . B- Severe hypotension . C- Raynauds phenomenon . D- Venous obstruction .

8. Central cyanosis :- if tongue and lips are cynosed . It may be due to inability of the lungs to oxygenate the blood with arterial blood in the heart or oustside , patient is usually dyspenic . - Causes:- 1- Respiratory failure . 2-Cyanotic heart disease .

9. Vital signs Blood pressure. Pulse rate. Respiratory rate. Temperature.

10. How to measure blood pressure Stop smoking at least 30min before. Use a machine that has been validated, well maintained and properly calibrated. Measure sitting BP routinely, with additional standing BP in elderly and diabetic patients and those with possible postural hypotension Rest the patient for at least 2 minutes before reading. Remove tight clothing from the arm. Support the arm at the level of the heart. Use a cuff of appropriate size.

11. Palpate the brachial pulse at the anticubital fossa and place the stethoscope. The pressure in the cuff is slowly raised to 200 mmHg. Lower the pressure slowly (2 mmHg per second). Read the BP to the nearest 2 mmHg. The systolic is recorded when the first sound is heard through the stethocope ( Korotkoff sound). The diastolic is recorded when the sound heard through the stethocope disappear.

12. If the reading is high repeat after 5 min. Take two measurements at each visit.

13. Extra oral examination Facial a symmetry. Eyes. Nose. Lips. Ears. Neck. TMJ. Lymph nodes.

14. Eyes Look for any asymmetry of the position, size or colour of the eyes and especially any abnormality in the width of the palpebral fissures. This can be caused by ptosis (droopy eyelids) or proptosis ( exophthalmos ) when the eyeball is pushed forwards, pushing the lids apart (see Chapter 11, pages 292–4). The size and equality of the two pupils should be recorded (dilated, constricted or unequal).

15. Eyes :- Look for any asymmetry of the position, size or colour of the eyes and especially any abnormality in the width of the palpebral fissures. This can be caused by ptosis (droopy eyelids) or proptosis ( exophthalmos ) when the eyeball is pushed forwards, pushing the lids apart . The size and equality of the two pupils should be recorded (dilated, constricted or unequal).

16. Patients should be asked if they experience any double vision ( diplopia ) in any particular position.While the eye movements are being tested, the presence of any strabismus (squint) can usually be easily seen conjunctiva:- pale mean patient is anemic sclera:- yellow discoloration -jaundice

17. Nails :- 1- cyanosis 2- koiloncyhia – iron deficency anemia 3-pallor – anemic 4-clubbing :- causes of clubbing A- resipratory diseases B- cardio vascular disease eg cyanotic heart disease C- GIT

18. Tempro mandibular joint Inspection: Swelling /Depression. Scars. laceration / abrasion. Palpation: Tenderness. Clicking. Crepitation.

19. Auscultation .

20. Mouth opening Range/ limitation. Deviation.

21. Lymph nodes examination If palpable check for: Size. Tenderness. Mobility. Shape. Number.

22. Intra oral examination Teeth. Oral mucosa. Tongue. Cheek. Hard and soft palate. Floor of the mouth.

23. Cranial nerve examination

24. Investigations

25. Vitality test

26. Blood tests Complete blood count (CBC). Random blood glucose (RBG). (Other tests for blood glucose level?!) Bleeding profile (PT, APTT and INR). Renal function test (serum potassium, serum sodium, creatinine and urea levels). Liver function tests (liver enzymes).

27. Urine tests Urine analysis (for pH, protein, glucose, ketones, blood / hemoglobin). Pregnancy test .

28. Imaging Periapical X-ray. Dental Pan Tomography (DPT) or Ortho Pan Tomography (OPG). Occlual views. Chest X-ray. Others.

29. Any questions?!!