ناصر سالم محمد نوح

311 MDS COURSE

Course File;  311 MDS

رقم المقرر و رمزه: 311 راس.

اسم المقرر: جراحة الفم و الوجه و الفكين و الممارسة العامة.

عدد الساعات 4 ساعات: ساعتان محاضرة و ساعتان عيادات.

المتطلب السابق: التخدير الموضعي و خلع الأسنان 211.

هذا المقرر يعطى الطالب معلومات أساسية عن التعامل لخلع الأسنان. يقوم الطالب بعمل خلع الأسنان السهلة مثال الأسنان المتخلخلة أو الأسنان الأمامية. كذلك يتعلم الطالب كيف يعطى المخدر الموضعي، كما يتعلم الطالب المواد و الأدوات المستخدمة في خلع الأسنان. بالإضافة إلى ذلك سوف يتم تدرىب الطلاب على المعالجة السريرية بالمستشفى و يشمل ذلك إجراءات تنويم المرضى و الإجراءات المتبعة فى غرف العمليات.

A.                Course description

The 311 course in oral and maxillofacial surgery is designed, based on its objectives, to expose students to the specialty and help them develop the knowledge, skills and values to become competent in performing minor oral surgery. An introduction of minor oral surgery is diagnosis and treatment planning for oral surgical procedures which are essential for the general practitioner.  The main course objective is practical application of local anaesthesia and the performance of simple extractions. 

The educational program rests on two central elements: a rigorous didactic program that combines lectures with small-group learning, and a clinical program that imparts proficiency in the basics of oral surgical practice. The students are being able with a good understanding of the evaluation, diagnosis and management of the surgical patient.

This course theoretically covers mainly management of medically compromised patients, exodontia including simple and complicated extraction; management of severe oral infection including osteomyelitis and osteo-radionecrosis; the principles of diagnosing and treating facial trauma which includes fractures of the mandible and the middle third of the facial skeleton; the dental implications of the maxillary sinus; surgical aids to pathology with special reference to biopsy, and introduction of tumors including benign and malignant, diagnosis and principles of management. The students will be oriented with the hospital evidence-based surgery. We believe that our curriculum provides students with a solid foundation that they will use for the rest of their professional lives, whether or not surgery is a career goal.

B.                 Course objectives

The student should be able to:

1.                  Apply what he had been instructed in the previous course [211 MDS].

2.                  Assess the patient whether normal or medically compromised, draw out a treatment plan and execute it by the help of his instructor.

3.                  Know local anaesthesia and application of techniques: inferior dental block and infiltration anaesthesia.

4.                  Perform simple extractions.

5.                  Identify the forceps and elevators used in extraction, how to hold and apply them in practice.

6.                  Should know the different types of emergency and how to manage it.

7.                  Assess impacted and unerupted teeth and how to treat it.  How to design a muco-periosteal flap and to remove bone.

8.                  Understand and treat dental infections e.g. periocoronitis, periapical abscess and periodontal abscess.

9.                  Recognize and assess the different types of cysts.  How to differentiate and the outline of treatment.

10.              Know antibiotics: Types, dose, mode of action, antibiotics use in oral surgery.

11.              Know haemorrhage: Types, aetiology and outline of management

12.              Apply the knowledge gained in the previous courses.

13.              Diagnose and treat infections in and around the oral cavity including incision and drainage of dental abscesses.

14.              Diagnose and have the knowledge of how to treat facial fractures including first aid procedures.

15.              Understand the conservative and surgical management of maxillary antrum complication of odontogenic origin including recent and long-standing oro-antral fistulae.

16.              Assist in the early diagnosis of oral malignancy by performing a biopsy from suspected oral lesions.  The student should also be able to liaise with the oral pathologist to reach the correct diagnosis.

17.              Student orientation with the hospital based surgical procedures and protocols of pt admission and preparation which reflect the theoretical dictated part. Also operating room protocol will be explained.

C.                Course Outline:

i.   Lectures topics

1.      Medically compromised patients  I

2.      Medically compromised patients  II

3.      Emergency in oral surgery I

4.      Emergency in oral surgery II

5.      Dental infection I

6.      Dental infection II

7.      Diagnosis and management of oro-facial infection I

8.      Diagnosis and management of oro-facial infection II

9.      Impacted and unerupted teeth I

10.  Impacted and unerupted teeth II

11.  Cysts of the jaws I

12.  Cyst of the jaws II

13.  Antibiotics and prescription

14.  Haemorrhage in oral surgery

15.  Periapical surgery

16.  Maxillofacial injuries: Introduction

17.  Fracture of the mandible

18.  Fracture of the maxilla

19.  Principles in the management of mandible fractures

20.  Principles in the management of midface fractures

21.  Complications in fracture management

22.  Diagnosis and management of Cysts I

23.  Diagnosis and management of Cysts I

24.  Tumors of the jaws I

25.  Tumors of the jaws II

26.  Maxillary sinus in dentoalveolar surgery

27.  Maxillary sinus in dentoalveolar surgery

28.  Revision I

29.  Revision I

30.  Continuous assessment

ii.         Clinical sessions:

            Preclinical training for maximum student orientation before pt treatment during the first 4 weeks will be employed. Skull models and phantom labs will be used for that purpose. No booking of pts for the first 4 sessions. During this period, the students should have a good background of all basic clinical skills and theoretical (anatomical) revisions required for conducting the clinical objectives aimed during the year. All the necessary steps in dealing with the pts should be fully practiced and understood before managing any patient.

            The clinical part includes the management of patients:  assessment of complaint, relevant medical history, relevant dental history and clinical examination to reach diagnosis.  The students have to perform different techniques of local anaesthesia, do simple extractions by the use of forceps and elevators. Students have to know about hospital and operating room protocols.  

Lecture topics in details [contents]:

1-2.      Medically compromised patients I & II          (See reference book)

Introduction – medical conditions usually involved and how to evaluate in history and management

3-4       Emergencies in oral surgery: I & II    

·         Introduction: relevant medical history – emergency kit, fainting [syncope, vaso-vagal shock], hypoglycaemic coma and epilepsy.

·         Cardio-vascular emergencies: acute heart failure – myocardial

infarction, circulatory collapse, cardiac arrest, tracheostomy,

                                       and neurotic fit.

5-6.      Dental infections I, & II         -           Minor Oral Surgery pp 232-249

·         Acute and chronic alveolar abscess: definition, aetiology, pathology & bacteriology, signs and symptoms, cellulitis, radiography, management, abscess incision and drainage.

·         Acute and chronic periodontal abscess: definition, aetiology,

pathology, signs and symptoms, radiograph, management including

subgingival curettage and periodontal surgery.–MinorOralSurg pp372-374

·         Pericoronitis: definition, age-incidence, aetiology, clinical

     classification [acute, subacute and chronic pericoronitis], signs and 

     symptoms for each category, radiography, management including

     history, clinical examination and treatment [general measures and local

     measures], others [e.g.] fluctuation, incision & drainage, pus swab and

     culture and sensitivity test and blood examination.

7-8.      Impacted and unerupted teeth: I, & II  - Minor Oral Sugery pp109-143

·         Definition, aetiology, local factors and general factors, indication and contra-indication for removal, pre-operative assessment of impacted lower third molar, upper canine, pre-molars and any other impacted teeth.

·         Radiographic interpretation, George Winter lines, access, position

and depth, root pattern, investing bone texture, inferior dental

canal relation.

·         Surgical removal [mucoperiosteal flap] by different techniques:

split-bone technique, surgical burs and tooth division, delivery of tooth, wound toilet and post-surgical instructions.

9-10.    Cyst of the jaws: I & II          -           Minor Oral Surgery pp 184-205

·         Definition, signs and symptoms, radiographic appearance, odontogenic

cysts and non-odontogenic cyst, the treatment of cysts by enucleation or marsupialization [techniques, indications and contra-indications for each].

·         Odontogenic cysts: cyst of eruption, dentigerous cyst, lateral

periodontal cyst, primordial cyst, keratocyst and radicular cyst.

non-odontogenic cyst: incisive canal cyst, globulo-maxillary cyst, median  cyst and ameloblastoma

11-12.  Antibiotics in oral surgery and prescription –

Minor Oral Surgery pp 249-258

Definition, bactericidal, bacteriostatic, indications [preventive and

      therapeutic], general management of antibiotics, choice of AB, route

      of administration, dose, duration and side effects [toxicity,

      hypersensitivity  reaction and its signs and symptoms, development of

      resistant strains,  disturbance of bacterial flora of the gastro-intestinal

      tract and oral flora]. Antibiotic drugs: penicillin group, other antibiotics especially if patient is allergic to penicillin, anti-fungal antibiotics. Prescription for adults and children

13.       Haemorrhage in oral surgery: [see reference textbook]

a.         Haemorrhage in the normal patient; during the operation [incision planning, haemostats to secure bleeding, pressure, haemostatic agents, hypotensive anaesthesia and vaso-constrictors] and post-operative haemorrhage [failure to control haemorrhage, factors restarting haemorrhage and infection at the wound site]. Bleeding from the socket [causes and how to treat] and haematoma formation.

b.         Haemorrhagic disease:

Defect in coagulation [haemophilia, Christmas disease, hypoprothrombinaemia] and its management, thrombocytopenia [idiopathic] and treatment, abnormalities of the capillaries: purpura, Von Willebrand’s disease, hereditary haemorrhagic telangiectasia and management, acute leukemia, anticoagulant and surgery [heparin, warfarin, and dicoumarol], different tests and management.

14.       Apicectomy and periapical curettage: - Minor Oral Surgery pp 315-327

Definition, factor governing the retention of a pulpless tooth, indications and contra-indications to surgical endodontics, pre-operative assessment, technique of apicectomy and periapical curettage, surgical flap credentials, post-operative progress and focal sepsis.

15-18.  Maxillofacial injuries: I, II, III & IV    [All # of the mandible]

                                                            [All # of the middle third of facial skeleton]

·         Introduction, incidence, surgical anatomy

       Fracture of the mandible: classification, clinical examination [general

      and local] signs and symptoms according to the sites of fracture,

      radiography.

·         Management: first aid, soft tissue laceration, food and fluid, sedation

and transportation.  Definitive treatment to the different sites of the

mandible fracture including, temporary immobilization, and the

different methods for reduction and immobilization [dental wiring,

transosseous wiring, arch bar, cap splint, gunning-type splint, extra-

oral pin fixation, transfixation and bone plates]

post-operative care including immediate, intermediate and late care

fracture of the mandible in children

·         Fracture of the middle third of the facial skeleton: classification [Le

Fort I, II, III], clinical signs and symptoms in the various types of

fracture [dento-alveolar fractures, zygomatic complex, isolated orbital

floor, fracture, nasal complex, Le Fort I, II & III].

·         Management, cerebrospinal fluid and rhinorrhea, radiography post-

operation care [immediate, intermediate and late post-operation care.

·         Complications in fracture management [anaesthesia, scars, derangement of the occlusion, non-union, TMJ derangement, deformity of the mandible and infection], mal-union, gunshot-type fracture management.

19-20.  Oro-facial infection: I, & II    [see reference textbook]

·         The spread of infection factors, different facial spaces and their surgical anatomy.

·         Spaces and potential spaces around the jaws:  lower jaw [submental, submandibular, sublingual, buccal, submasseteric, parotid, pterygomandibular and lateral pharyngeal]  

·         Upper jaw [palatal, canine fossa and infratemporal]

signs and symptoms in each space infection and management, peritonsillar abscess [quinsy], Ludwig’s angina, surgical drainage, the use of heat in soft tissue abscess, sinus formation and cavernous sinus thrombosis

21-22.  Maxillary sinus in disease, trauma and dentoalveolar surgery: I & II – Minor Oral Surgery pp 207-221

·         Maxillary sinus anatomy, teeth relation, involvement during tooth extraction, oro-antral communication [O.A.F.] newly created or chronic O.A.F. and its management.

·         Radiography, root or tooth in the antrum removal, the use of nasal drops and inhalations, surgical closure of O.A.F. [different techniques and their indications], fracture of the maxillary tuborosity, involvement of maxillary sinus in trauma and intra nasal antrostomy.

23-24.  Tumors of the jaws: I & II – [see reference textbook]

·         Benign and malignant [osteoma, osteoblastoma, central hemangioma, chondroma, chondro-sarcoma, fibro sarcoma, osteogenic sarcoma, Ewing’s tumor and metastatic tumors]

·         Rare bone tumors: traumatic neuroma, neurolemmoma [Schwannoma], neuro-fibroma and pigmented neuroectodermal tumor of infancy, Complications and management of tumors, Biopsy, types and indications

D.            Methodology

                Didactic + clinical

E.         Evaluation and Grades

            Test No.                                  Type of evaluation                Grades

            1^st C.A.T.                                       Written                             15 %

2^nd C.A.T.                                       Written                             15 %

Student Activities        Clinical assignment & Log book       10 %

Clinical assessment                    Clinical/Oral                         20 %

Final examination                           Written                             40 %

F.         Required textbook

1. Oral and Maxillofacial Surgery: An Objective-Based Textbook By Jonathan Pedlar and  John W. Frame. (2001)
2. Fractures of the Facial Skeleton By Peter Banks and Andrew Brown. (2001)

G.        Reference textbook

Contemporary Oral and Maxillofacial Surgery By Peterson, Ellis, Hupp, Tucker. 4 edition (2003)

H.        Date of file approved by the Department: ______