Surgeon's Log 1

Today is Oral Maxillofacial Surgery day for my group as we spent the whole day at OMFS Dept for both morning & afternoon clinical sessions.

Morning

Had extraction clinics. Did extraction on a osteoporotic & hypertensive old lady with history of cardiac enlargement & angina pectoris.

Extracted her retained 13 root & 36 bony spicule (it felt like tooth fragment to me though...).

Retained 23 root was also indicated for extraction but it showed periapical radiopacity (denser than surrounding bone) surrounded by a faint zone of raiolucency. The surgeon in-charge told me that it's sequestrum (radiopaque) surrounded by a zone of inflammatory front, which is the host reaction to contain the sequestrum.

I was very grateful to have come across an article which explained that bis-phosphonate (a drug used to treat osteoporosis) could cause osteochemonecrosis, when i was searching for journals for my Social Behavioural Science project literature review.

My patient took 1 pill of Forsamec once a week, which explained the condition.

During the attempt to extract her badly carious tooth 44, the crown & half of the root was broken, leaving a conical root fragment which was slightly mobile but too stubborn to be elevated out from the socket.

A full thickness mucoperiosteal flap was raised and several unsuccessful attempts were initiated to elevate that stubborn fragment out of the socket. That root was then suspected to be either ankylosed/ hypercementosed.

My patient was ushered into the minor operating theatre and a minor oral surgery was then performed by the surgeon to remove that hypercementosed root fragment.

Did my 1st ever suture on a human being today, thanks to my dedicated supervising surgeon =) I learned a lot today!

Lunch hour

Attended a rescheduled Orthodontics revision session. The orthodontist in-charge was very kind to have brought tidbits & peanuts for us considering it's lunch time.

Afternoon

Had Minor Oral Surgery clinical session.

I'm very grateful to have my clinical partner to be my assistant for the surgery as we've already built up a very good rapport =)

Luckily my hand didn't tremble too much when i was cutting on the mucoperiosteum. First-timers are always nervous & it's always best if the supervisor is an encouraging teacher as we are handling scalpels here which cut! That's the purpose of we going to the dental school, to learn =)

Raising a mucoperiosteal flap is like deboning a chicken, stripping its flesh from the bones. It sounds disgusting, but the feeling when doing it is good =D

Drilling the alveolar bone was the most surprising part to me as never did i know that bone was so much softer than dental enamel! I guess that explained the higher radiodensity of dental enamel =)

Sectioning the tooth was the only time when a dental surgeon can forget about avoiding the pulp when drilling into a tooth! Just drill into it for that tooth is deemed to be extracted :)

I think i need to practise more on suturing :)