4/7/06

-Make sure suture board checked off in comp! (horizontal mattress, vertical mattress,
square knot, figure of eight)
-3 important things on history: social, medical,
-Some lesions look alike, only differentiated based on clinical picture of patient
-Quantify! (social drinking means what??, smoking)
-If medical history negative say that.. (bleed, pain, numbness?)
-Draw foro patholigst where take lesion MULTIPLE INCISIONAL BIOPSY (
-EXCISE LESION + NORMAL TISSUE
-Follow muscle pull; cut following muscle pull or else DESHISCE)
-ex: farmer out in sun all the time, 3 biopsy on lip, crack, bleed, change muscle pull so
prevent from happening again
-Zplasty?
-Worry when in glandular layer
-Make z, transpose & 2 to change muscle pull of chronically irritated area where patient
doesnt want to coporate, take wedge out of lesion make cuts on either side, lesion out,
transpose flap, suture everything in place, change muscle pull, 1 week post op; SOLAR
CHEILITIS
-WHEN DO CONSULT IN CLINIC: anytime work in mucosal layer intraoral, talk to
patient about potential creation of mucocele; if not mucocele to begin with (excise into
area to cut out lesion, cut into salivary ducts
-if dont inform patient beforehand and come in week later with more; so
INFORM PATIENT THAT ITS RISK
-MUCOCELE: hx (go UP AND DOWN); only thin gin lip area that goes up and
down is mucocele; something happens to salivary gland; falls on ground and hits lip on
duct; body walls off with CT, chomp on it, saliva go down
-be careful of pumping in too much local!
-Local Anesthetic in very carefully
-Get traction, lift lesion and filet out of bed; tension, elliptical incision
-STRAWBERRY PIT: once have lesion out, look inside of surgical bed and take out with
ATSON TISSUE PICKUP so prevent mucocele, then close
-MUCOCELE (CT surroudningn saliva)
-ex: Verrucous Carcinoma on lip
-Mucocele (too big, then cant take out MARSUPIALIZATION (open up inside to
outside and let granulate and destroy on own)
-Underside of tongue (verrucous carcinoma
-Palpate to see how deep it is
-Follow muscle pull (eseciall yin tongue; ONLY PLACE IN MOUTH WHERE PUT
EXTRA KNOTS CUZ MUSCULUARITY OF TONGUE)
-Ellipitcal incision around lesion excise TISSUE PICKUPS TO TAKE LESION
OUT muscular bed sutures in to close
-only anatom (vein, nerve in posterior)

-EPULIS FISSURATUM: patients reaction to ill fitting denture; as bone change with
reapreating wear and bone resorbs, more give, more space, body tries to fill to mamke
denture more stable, problem with granulation tissue is it is movable
-Anything take out, biopsy cuz 1% chance something could be more than it seems
-By suturing and extending old denture falge act as barrier o can reepitheliaze and nice
long flange for new denture, sitting on suture to prevent relapse
-GRANULUATION TISSUE: when lose bone, try to fill in space
-Next Module: MEDICATION: OLD!!, but best one can find; when talk about SBE
prophylaxis incorrect!, RESPONSIBLE FOR HOW TO WRITE PRESCRIPTION AND
WHAT DIFFERENT PARTS OF PRESCRIPTION MEAN AND DIFFERENT
CLASSES OF DRUGS, HOW TO USE PDR, DRUGS USED IN CLINIC (VICODIN,
TYLENOL, ASPIRIN, TYLENOL #3,4,1,2-WHATS IN IT, DRUGS USE DIN IV
(VERSED, VALIUM, DEMEROL), QUESTIONS RIGHT OUT OF BOOK!
-NARCOTICS:
-RX:what you are going to give patient (ex: VicodiN-500 mg syn..500 mg; less
probs than with tylenol 3 like vommitting, diarrhea; this has synthetic codeine), cottage
cheese or something to coat stomach very FEW problems with vicodin
-DISP: How many give patient (signel tooth extraction 12 -15 enough); when
go to highland write out number (spell it!!)
-Sig: what pharmacist translates into English for patient; pain pills dose at 1 tab
q3-4h prn pain (q3-4 genreally recommended for pain), dose every 3-4 then patient stay
about threshold and comfortable
-ex: Synalgos DC (synthetic narcotic; only fiference is vicodin is Tylenol based and
syngaos DC be careful with patients on coumadin or have bleeding ulcers wehrwas
vicodin can give to anybody, has little bit of caffeine in it; DC=dihydrocodeine (synthetic
narcotic); same equivalents
-class 3 drugs can be called in over phone
-class 2 drugs CANNOT (PERCODIN, PERCOCET, TYLOX: more potent; in old days
called triplicate, now with special forms in CA dont need
-Assign thingsn to different class based on addiction potential
-Vicodin most abused drug in country
-Tylenol with codeine (know whats in each one BOARDS
-know Percodin tylox & whats in them
-Synalogs DC (Caffeine, Fluorinol)
-patient allergic and is drug addict, what do you give? NSAID (like motrin; motrin 800prescription-can o nly take 1 tabl q6h prn pain; equivalent to Tylenol #3)
-Story: Absolute perfect acadmy award on phone, give narcotics, never seen in practice;
give no one nartcotic, only nonsteroidal unless know for sure; can take 4 OTC motrin
(each 200 mg; will be fine until can see them in morning)
-Class 2
-Difficult aextraction -> VICODIN