The patient was greeted at the bedside in the prep and hold area. I reviewed previously signed informed consent. All questions regarding extraction of teeth #1,16,17,32 were answered.

The patient was brought in the operating room and placed in a supine position on the operating room table. A time out was performed with surgical, nursing, and anesthesia staff verifying patient procedure and laterality. Anesthesia placed appropriate monitors and intubated patient without issue. The patient was draped in the usual sterile fashion.

A throat pack was moistened and placed in the oropharynx. 8 cc of 1% lidocaine 1:100,000 epinephrine was used to anesthetize bilateral inferior alveolar nerve, lingual nerve, buccal nerve, superior alveolar nerve, greater palatine nerve.
Attention was first made to the right maxilla. A 15 blade was used to make a sulcular incision with distal release. A full thickness mucoperiosteal flap was reflected. A hall drill with #8 round bur and copious normal saline irrigation was used to make a bony window exposing tooth #1. An elevator was used to luxate the tooth and it was extracted with a forceps. Copious normal saline irrigation of the flap and sockets was performed. 3-0 chromic gut sutures were placed. Positive hemostasis was achieved.
Attention was made to the right mandible. A 15 blade was used to make a sulcular incision with distal hockey stick release. A full thickness mucoperiosteal flap was reflected. A hall drill with #8 round bur and copious normal saline irrigation was used to make a bony window exposing tooth #32. A #702 bur was used to section the tooth. An elevator was used to luxate the tooth segments and they were extracted with rongeur. Copious normal saline irrigation of the flap and sockets was performed. 3-0 chromic gut sutures were placed. Positive hemostasis was achieved.
Attention was made to the left maxilla. A 15 blade was used to make a sulcular incision with distal release. A full thickness mucoperiosteal flap was reflected. A hall drill with #8 round bur and copious normal saline irrigation was used to make a bony window exposing tooth #16. An elevator was used to luxate the tooth and it was extracted with a forceps. Copious normal saline irrigation of the flap and sockets was performed. 3-0 chromic gut sutures were placed. Positive hemostasis was achieved.
Attention was made to the left mandible. A 15 blade was used to make a sulcular incision with distal hockey stick release. A full thickness mucoperiosteal flap was reflected. A hall drill with #8 round bur and copious normal saline irrigation was used to make a bony window exposing tooth #17. A #702 bur was used to section the tooth. An elevator was used to luxate the tooth segments and they were extracted with rongeur. Copious normal saline irrigation of the flap and sockets was performed. 3-0 chromic gut sutures were placed. Positive hemostasis was achieved.
Injections were reinforced with 0.5% marcaine 1:200,000 epinephrine, a total of 10 cc.
The throat pack was removed and the oral cavity suctioned. Sterile drapes were removed and the face cleansed with normal saline and dried. Patient was emerged from anesthesia and transported to the post anesthesia care unit.

All sponge counts were correct with nursing staff. No complications encountered. I was present for the entire procedure. No qualified resident was available to assist because of skills and techniques relevant to the speciality. These skills included dissection, critical portions of the procedures as well as closure.

Patient Disposition:
PACU and extubated and stable