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Surgical Site Marking For Oral Surgical Procedures:Clinical Application And Patient Perspectives



Surgical site marking system for oral surgery to improve the WHO guidelines.
Surgical Site Marking For Oral
Surgical Procedures:Clinical
Application And Patient Perspectives
G. J. Knepil¹, C.T.Harvey¹, M. Thomas¹
¹Oral and Maxillo-facial Surgery Department,
Gloucestershire Royal Hospital, Gloucester, England.
To develop a system for surgical site
marking for intra-oral procedures which:
– is clinically effective
– delivers high levels of patient satisfaction.
Material and Methods
Two different systems for surgical site
marking with a surgical marker pen, for the
surgical removal of teeth were proposed.
Patients views on which parts of the body
they would find acceptable to be used for
marking were investigated.
The most acceptable system was then
Material and Methods
Patients were offered three choices of
facial marking:
1. The forehead
2. The cheek
3. Refuse marking
Total number of patients : 50
– Total Male: 26/50 Total Female: 24/50
– Children: 16/50 M:6/16 F:10/16
Number choosing cheek marking: 48
Number choosing forehead marking: 1
Number of refusals: 1
The one patient that refused marking was a
male aged 45 years because he felt it was
unnecessary and did not want his face
The one patient that chose forehead marking
was a male aged 55 years.
– He chose the forehead because he thought the
area might be more visible.
Surgeons comments:
– Of the 50 patients, there were no problems
marking 49 of the patients.
– It was recorded that the marking was slightly
smudged on one patient, who was on the end of
the list.
This was amended by re-marking the patient on
arrival pre-operatively.
Between 1/12/08 and 26/01/10 the National Reporting and
Learning System of the National Patient Safety Agency,
received 17 reports of the wrong tooth being extracted in
hospitals across the UK. It is clear from root cause analysis
that some of these events could have been avoided if a
robust marking system had been in operation.
The WHO has identified the need to introduce surgical site
marking for situations where there are multiple organs and
where organs arise on both sides of the body.
Surgical procedures on teeth meet this criteria however
WHO does not specify a satisfactory system which can be
applied to teeth.
We have found that patients are in favour of
facial marking for safety reasons.
The majority have chosen cheek marking.
Refusal was rare.
The system that we use is quick and simple
to introduce to the WHO safety check list,
and is easy for the surgeon to identify at the
time of surgery.
Marking for intra-oral procedures presents the
problem of choosing an anatomical site which is
visible at the time of surgery, which also preserves
the dignity of the patient.
We have developed a clinically effective system
which has demonstrated high levels of patient
We recommend that marking the patients cheek
should be introduced to the WHO surgical safety
checklist to reduce the number of wrong teeth
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