A Time Out was performed verifying patient procedure and laterality. Vitals, associated labs and imaging reviewed. *** carpules (1.7 ml each) of 2% lidocaine 1:100,000 epinephrine was used to anesthetized ***. Anesthesia was verified. Archbars were measured and cut to fit patient’s maxillary and mandibular arches. 24 gauge wires were used to secure archbars to the teeth. Once archbars secured, the patient was placed in maxillary-mandibular fixation using 24 gauge fish loops. Bilateral occlusion achieved.
The patient tolerated procedure well.

Extraction General
Procedure and Technique:
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 #*** and any necessary teeth were answered. Patient amendable to treatment.
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.*** 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. Injections were reinforced with 0.5% marcaine 1:200,000 epinephrine, a total of *** cc.
Attention was first made to the ***. A 15 blade was used to make a sulcular incision. A full thickness mucoperiosteal flap was reflected.A n elevator was used to luxate the tooth and it was extracted with a forceps. Curettage and bone filing of the socket was performed. Copious normal saline irrigation of the flap and socket was performed. Positive hemostasis was achieved.
Attention was made to the ***. A 15 blade was used to make a sulcular incision. A full thickness mucoperiosteal flap was reflected.A n elevator was used to luxate the tooth and it was extracted with a forceps. Curettage and bone filing of the socket was performed. Copious normal saline irrigation of the flap and socket was performed. Positive hemostasis was achieved.
Attention was made to the ***. A 15 blade was used to make a sulcular incision. A full thickness mucoperiosteal flap was reflected.A n elevator was used to luxate the tooth and it was extracted with a forceps. Curettage and bone filing of the socket was performed. Copious normal saline irrigation of the flap and socket was performed. Positive hemostasis was achieved.
Attention was made to the ***. A 15 blade was used to make a sulcular incision. A full thickness mucoperiosteal flap was reflected.A n elevator was used to luxate the tooth and it was extracted with a forceps. Curettage and bone filing of the socket was performed. Copious normal saline irrigation of the flap and socket was performed. Positive hemostasis was achieved.
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