This ebook is uploaded by dentalebooks.com CHURCHILL LIVINGSTONE An imprint of Elsevier Limited © Harcourt Publishers Limited 2001 © Elsevier Science Limited 2003 © 2007, Elsevier Limited. All rights reserved. The right of Jonathan Pedlar and John Frame to be identifi ed as authors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988 No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Cop- yright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. Permis- sions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, USA: phone: (+1) 215 239 3804, fax: (+1) 215 239 3805, e-mail: [email protected]. You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting ‘Customer Support’ and then ‘Obtaining Permissions’. First published 2001 Reprinted 2003 Second edition 2007 ISBN13 9780443100734 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Note Knowledge and best practice in this fi eld are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manu- facturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Authors assumes any liability for any injury and/or damage to persons or property arising out or related to any use of the material contained in this book. The Publisher Printed in China This ebook is uploaded by dentalebooks.com Prelims-F10073.indd iv 5/22/07 8:25:08 PM This page intentionally left blank This ebook is uploaded by dentalebooks.com This page intentionally left blank This ebook is uploaded by dentalebooks.com Preface to the First Edition This book is directed at dentists in training. It should In addition, we would like specifi cally to thank provide a basic theory background, to assist the Professor Ken-Ichiro Murakami for access to the development of skills in diagnosis, treatment planning, photographs of the arthroscopic views of the TMJ and active surgical care and postoperative management. to Mr P N Hirchmann for the two radiographs for We hope it will also aid personal development, by Chapter 16. There are those also, who have made pointing toward further reading and stimulating the signifi cant input to the text itself, even though their desire to read more deeply. We have endeavoured names do not appear formally as authors: Dr A to bring together a variety of authors all of whom Aiken for Chapter 4 and Mr J D Fenwick, consultant have extensive experience in undergraduate and Otorhinolaryngologist, who kindly reviewed Chapter postgraduate education in Oral and Maxillofacial 16 and made many helpful suggestions. Surgery to form a team, which represents a mainstream We also thank the departments of medical and view in UK dental schools. dental illustration and of radiology around the United We are very grateful to all the authors for the time Kingdom who have made a major contribution to and effort they have contributed, over and above their illustration of this text and Mr Ian Ramsden who normal work in their departments, for their responses has expertly redrawn and polished the artwork. to our requests for amendments and for their tolerance The department of medical and dental illustration of our editorial interference. Undoubtedly, their at Leeds University has taken a particularly heavy families, as well as ours, will have taken back seats burden and has consistently, cheerfully and speedily for prolonged periods during this work. To them produced high-quality photographic illustrations we apologise and hope they will forgive us on the for us. We are indebted also to the universities and grounds that the book, in the end, is worth it. Our hospital trusts of the authors’ host institutions for secretaries too have given their efforts unstintingly. permission to use their material. Ms Janice Urquhart at Harcourt Brace has been, throughout, patient, supportive and optimistic; there J. P., J. W. F. 2001 must have been times that she thought this book would never materialise. This ebook is uploaded by dentalebooks.com vii Prelims-F10073.indd vii 5/22/07 8:25:09 PM Preface to the Second Edition We are delighted to produce this second edition Readers will also fi nd new succinct sections on following the success of the fi rst and the warm osteonecrosis of the jaws, associated with bisphos- tributes and reviews which it received. This allows phonate medication, and on infection with methicillin- us to take into account the inevitable advances in resistant Staphylococcus aureus, the former because knowledge, technique and terminology that occur it has recently become recognized as a serious over a period of just a few years, but even from shortly complication of tooth removal and the latter because after publication of the fi rst edition we were aware of it has become more important in the minds of issues where improvements were necessary. politicians and the public since the fi rst edition was Thanks to advances in printing it has become produced. much easier to use colour illustrations and we have We remain indebted to our authors and those who thus, where possible, replaced black and white have made contributions in the form of illustration, clinical photographs with colour ones. The chapters secretarial support, advice or permissions and to covering pathological conditions of the oral mucosa colleagues at Elsevier who, as previously, have remained and bone, along with biopsy as an investigative tool, patient and supportive. have been completely reshaped. We have introduced a brief overview of cleft lip and palate. We have also J. P., J. W. F. 2007 extended the self-assessment questions into the chapters on diagnosis and medically compromised patients and rationalized the introductory chapters. This ebook is uploaded by dentalebooks.com viii Prelims-F10073.indd viii 5/22/07 8:25:09 PM Contributors C. Gerry Cowan BDS FDSRCS FFDRCSI Jonathan Pedlar BDS PhD FDSRCS (Eng) Head of Division of Oral Surgery, Oral Medicine, Senior Lecturer in Oral Surgery, Leeds Dental Institute, Leeds, UK Oral Pathology and Consultant in Oral and Maxillofacial Surgery, School of Dentistry, Queen’s University, Belfast, UK J. Philip Rood MDS MSc MB BS FDSRCS FRCS Professor and Consultant in Oral and Maxillofacial Surgery, John W. Frame PHD MSc BDS FDSRCS (Eng & Ed) Guy’s, King’s and St Thomas’ School of Dentistry, London, UK Professor of Oral Surgery, University of Birmingham, School of Dentistry, Birmingham, UK Jonathan P. Shepherd DDSc PhD BDS MSc FDSRCS (Eng) FDSRCS (Edin) C. Michael Hill MDSc FDSRCS (Ed) BDS FDSRCS (Eng) MSc Head of Department and Professor of Oral and Maxillofacial Consultant in Oral and Maxillofacial Surgery, University of Surgery, University of Wales College of Medicine, Department Wales College of Medicine, Department of Oral Surgery, of Oral Surgery, Medicine and Pathology, Dental School, Medicine and Pathology, Dental School, Cardiff, UK Cardiff, UK John D. Langdon MB BS MDS FDSRCS FRCS FMedSci Kathryn H. Taylor BSc BDS FDSRCS Professor of Oral and Maxillofacial Surgery, Guy’s, King’s and Lecturer in Oral and Maxillofacial Surgery, Leeds Dental St Thomas’ School of Dentistry, London, UK Institute, Leeds, UK John J. Marley BSc BDS PhD FDSRCS(OS) (Eng) FFDRCSI David W. Thomas PhD MScD FDSRCS Senior Lecturer and Consultant in Oral and Maxillofacial Professor and Consultant in Oral and Maxillofacial Surgery, Surgery, School of Dentistry, Queen’s University, Belfast, UK University of Wales College of Medicine, Department of Oral Surgery, Medicine and Pathology, Dental Ian R. Matthew PhD MDentSc BDS FDSRCS (Eng & Ed) School, Cardiff, UK Assistant Professor of Oral Surgery, University of British Columbia, Faculty of Dentistry, Vancouver, Canada Graham R. Ogden BDS MDSc PhD FDS RCPS Professor of Oral and Maxillofacial Surgery, University of Dundee, Dental School, Dundee, UK This ebook is uploaded by dentalebooks.com iixx Prelims-F10073.indd ix 5/22/07 8:25:09 PM This page intentionally left blank This ebook is uploaded by dentalebooks.com 1 Why and how you should read this book J. Pedlar Surgery is a very practical subject and requires ‘hands- exams in oral surgery; yes, we hope it will help on’ experience to develop the skills required to you pass your finals; yes, we hope it will help if practise it successfully. However, it also requires you are preparing for postgraduate exams. But no, extensive theoretical knowledge to back up the manual these are not the reasons we have written the book. skills. This makes it possible for surgeons to: It has been produced with the intent of developing particular abilities which will make you a more ● reach a reliable diagnosis competent dentist. If you are looking for a magical ● select cases for treatment key that you can use to unlock the hardened hearts ● determine the urgency of treatment of your examiners without having to develop an ● determine who has the skill to perform the understanding of your subject, this book is probably treatment not for you. ● identify the best environment for treatment Because the book is firmly directed at developing ● advise the patient on options, success rates, skills, chapters start with lists of objectives that complications, etc. we attempt to address within the chapter. Each of ● perform treatments within their skill level and these objectives has direct relevance to the work a know how to extend their limits young practitioner may be expected to undertake. ● evaluate their own surgical performance We have not stipulated a precise career level at which ● recognize when treatment has not gone this book would become important, nor when it would according to plan and take appropriate cease to be of value, partly because undergraduate action. courses will continue to vary in the timing of various This book is directed at dentists in training. It components and partly because the skills required should provide you with a basic theory background to practise in either a primary care or a hospital setting to assist you in developing your skills, point you vary from practice to practice and over a period towards further reading and stimulate your desire to of time. read more deeply. It is not expected that you will It should be clear exactly what skills are being merely ‘cram’ your way through it, regard yourself as addressed in each part of the book. Think hard about trained and launch immediately into major surgery. skills objectives before reading each chapter. You may have certain expectations of a textbook. Should you read the chapters in the order they Does this text give answers to exam questions? Yes, are presented? No, not necessarily. We have tended we hope it will help you to pass any dental school to put toward the beginning of the book those subjects This ebook is uploaded by dentalebooks.com 1 Ch01-F10073.indd 1 5/22/07 6:50:57 PM 1 / Why and how you should read this book often taught early in an oral surgery course, but being a clear scientific basis. Such subjects are very the chapters are independent of each other and likely to be addressed differently in different schools. can be read in any order. However, the beginning Examples from the oral surgery field are whether of each chapter contains a brief statement of the patients should be brought back for a follow-up assumed knowledge that you should have before appointment after minor surgery, or if steroids should reading the chapter. The ‘assumption’ is ours, but be used to reduce swelling after third molar surgery. if you do not have a command of the stated areas Where you find in this book dogmatic statements you will gain far less from that chapter. It is in your that are at odds with what is taught in your school, interest to develop your skills in a sensible and do not feel that either the book or your teachers are logical order, recognizing areas of weakness (even necessarily wrong, but ask your tutors for clarification if they have already been taught on your course), on the basis and significance of the difference of and addressing them before attempting to move on. opinion. There is room for honourable difference Should you read the whole book before starting of opinion between clinicians (particularly where oral surgery? Almost certainly, no. If your course there are few hard data) that must be respected. extends over months to years, you are probably Such differences can also often be very stimulating best served by reading small chunks regularly, pre- topics for research. ferably in parallel with lectures and small group The term ‘surgery’ is derived from the Greek chir learning, or in relation to specific patients you (meaning hand) and ergos (meaning work). So have seen. Likewise, do not leave it all till the night surgery might be almost any work done with the before finals: you may pass the examination but hands; however, usage is generally restricted to will be unlikely to retain any useful skills for more practical therapies, such as those involving cutting, than a few weeks afterward. repairing and dressing living tissues. Surgery has a Should you take the tests at the end of each long history of management of wounds and infec- chapter? Although we do not wish to be prescriptive tions, but, since the advent of sound aseptic as to how our readers should learn (and some principles, there has been a dramatic increase in students do not find this sort of exercise enjoyable), the application of surgery to improving function learning is a process that benefits from refl ection and aesthetics under a wider range of conditions. on the degree to which understanding has been The term ‘oral’ pertains to the mouth but, even in the achieved. We believe that these tests will help you 1950s and 1960s, those who particularly developed and, like the text itself, they are directed at specific oral surgery as a branch of dental surgery in the UK learning objectives. Try them, or at least some of them, did not restrict themselves solely to diseases of, or and see for yourself. operating within, the mouth. How should you use the references? To cover all There has been increasing specialization within the relevant fact and opinion related to oral surgery dentistry and the rest of medicine over many decades; would take a book the size of an encyclopaedia. the development of dentistry itself could be seen as This book must be brief to enable you to get to grips a specialization within medicine. The advantage of with the content. At times authors must simplify specialization is increased skill amongst practitioners subjects just to get them in, and in these areas your in that area of practice; the disadvantage is loss of understanding will be limited if you read only what some general and widely applicable abilities. It is is between these covers. The articles and books unavoidable that boundaries will be set to specialities referred to offer you a little more background, a little and that specialists will practise within limits, but more detail and in some places controversy. Read as there has long been a reluctance to define limits too many of them as you can and by all means add to the precisely. Attempts to set rigid limits to any speciality list with references you have found or that have been would be likely to stifl e development and enterprise, suggested to you by your tutors. Try to get a feel for and could not satisfactorily account for variation the fact and science that underly the didactic content in interest and ability amongst its practitioners. of the book: do not just accept it as ‘the truth’. So, although oral surgery could be said to be an In most areas of medicine and dentistry there are area of practice within dentistry, its limits are not issues which are taught dogmatically, without there well defined and it spreads somewhat towards 22 Ch01-F10073.indd 2 5/22/07 6:50:58 PM