ContemporaryOralAndMaxillofacialSurgery-Chapter1 PDF

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PONTILLAS, KYLA MAE D. CHAPTER I: operative Health Status Evaluation Biographic Data First information obtained from a patient Name, age, home address, gender, occupation, name of primary care physician, intelligence and personality assess reliability The patient is the Chief Complaint Preferably ve...

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PONTILLAS, KYLA MAE D. [DMD 5Y1-1]

CHAPTER I: Pre- operative Health Status Evaluation Biographic Data -

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First information obtained from a patient Name, age, home address, gender, occupation, name of primary care physician, intelligence and personality – assess patient’s reliability The patient is the “historian”

Chief Complaint -

Preferably verbatim Establish priorities during history taking and treatment planning Clarify “why” the patients desire treatment May reveal “true” reason why patient is asking care

History of Chief Complaint -

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“History of present illness” First appearance, any changes since first appearance, influence on or by other factors Pain= date of onset, duration, location, radiation, factors that worsen or mitigate the pain Constitutional symptoms= fever, chills, lethargy, anorexia, malaise, weakness More detailed history of chief complaint

Medical History -

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Can indicate certain allergies to medications Should include a statement that assures patient of confidentiality and consent to individuals who will have access to the dental records. Inquire about specifically common medical problems:

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Brief Family History- relevant inherited diseases (eg. Hemophilia)

Review of Systems -

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Sequential, comprehensive method of eliciting patient symptoms on an organorgan basis. May reveal undiagnosed medical symptoms Can disclose previously undiagnosed problems that may jeopardize successful sedation

• Neck: Carotid bruits Physical Examination -

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Focus on the oral cavity and on the entire maxillo-facial region Should be written in a naccurate description than a history of suspected medical diagnoses Should begin with measurement of vital signs Inspection, palpation, percussion, and auscultation Inspection Options if patient is not ASA I or ASA II

• Head and face: General shape, symmetry, hair distribution • Ear: Normal reaction to sounds (otoscopic examination if indicated) • Eye: Symmetry, size, reactivity of pupil, color of sclera and conjunctiva, movement, test of vision • Nose: Septum, mucosa, patency • Mouth: Teeth, mucosa, pharynx, lips, tonsils • Neck: Size of thyroid gland, jugular venous distention -

Palpation

• Temporomandibular joint: Crepitus, tenderness • Paranasal: Pain over sinuses • Mouth: Salivary glands, floor of mouth, lips, muscles of mastication • Neck: Thyroid gland size, lymph nodes -

Percussion

• Paranasal: Resonance over sinuses (difficult to assess) • Mouth: Teeth -

Auscultation

• Temporomandibular joint: Clicks, crepitus

1. Modifying routine treatment plans by axietyreduction measures, pharmacologic anxiety control techniques, more careful monitoring of the patient during treatment, or a combination of these methods. 2. Obtaining medical consultations for guidance in preparing patients to undergo ambulatory and oral surgery. 3. Refusing to treat the patient with congestive heart failure. 4. Referring patient to an oro-maxillofacial surgeon.

MANAGEMENT OF PATIENTS WITH COMPROMISING MEDICAL CONDITIONS

Myocardial Infarction -

Cardiovascular Problems (Ischemic Heart Disease) Angina Pectoris -

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Progressive narrowing/spasm of one or more coronary arteries that leads to mismatch between myocardial oxygen demand and ability of coronary arteries to supply oxygen-carrying blood. Myocardial blood supply cannot be increased to meet the increased oxygen requirements that result from coronary artery disease. Men over 40, post-menopausal women Heavy pressure or squeezing in the substernal region radiating to the left shoulder or arm. IMPORTANT: Ask about patient’s angina history Ask what precipitates the angina (Frequency, duration and severity of pain) Ask about the patient’s response to medication SAFE: Occurs only during moderately vigorous exertion Responds to rest Responds to oral nitroglycerin No recent activity “Anxiety Reduction Protocol” – usually uses profound local anesthesia LOCAL ANESTHESIA Less than 4 ml 0.04 mg Epinephrine: 1:100,000 30 minute period

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Occurs when ischemia causes myocardial cellular dysfunction and death When an area of the coronary artery narrowing has a clot for that blocks blood flow Infected area – non-functional, necrotic 6 month window period

Cerebrovascular Accident (Stroke) -

Patient would be further susceptible to neurovascular accidents Patients are taking anti-coagulants and blood pressure lowering agents

Dysrhythmias -

Usually have a history of ischemic heart disease

Congestive Heart Failure (Hypertrophic Cardiomyopathy) -

When a diseased myocardia us unable to deliver the cardiac output demand by the body. - May lead to pulmonary edema = less efficient pump of myocardia - Lower cardiac output = Generalized weakness, impaired renal clearance of excess fluid = vascular overload - Symptoms: Orthopnea – shortness of breath when supine Paroxysmal Nocturnal Dyspnea – respiratory difficulty 1 or 2 hours after lying down Ankle edema – increase in interstitial fluid Weight gain

Pulmonary Problems

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Asthma -

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“True asthma” – episodic narrowing of inflamed small airways which produce wheezing and dyspnea. Patient should be questioned about “aspirin allergy” Severe asthma – xanthine-derived bronchodilators such as theophylline and corticosteroids Acute attacks – Cromolyn, epinephrine, metaproterenol in aerosol Nitrous oxide is safe to administer – if triggered by anxiety Emergency Kit : injectable epinephrine and theophylline Avoid: NSAIDs

Chronic Obstructive Pulmonary Disease -

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Caused by long term exposure to pulmonary irritants such as tobacco smoke that causes metaplasia of pulmonary airway tissue. Airways are inflamed, disrupted and lose their elasticity Clinical manifestations: Mucosal edema Excessive secretions Bronchospasm Bronchodilators: theophylline Avoid: Sedatives, hypnotics, narcotics = depress respiration Patient may need to be in an upright sitting position

Renal Problems Renal failure -

Require periodic renal dialysis Avoid NSAIDs

Renal Transplantation and transplantation of any organ -

May need supplemental corticosteroids In the perioperative period

Cyclosporine A – gingival hyperplasia (immunosuppressive drug administered after organ transplantation)

Hypertension -

Chronically elevated blood pressure Mild or moderate =...