Atlas Flashcards Flashcards by evan d

most common form sinusitis

maxillary

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paranasal facial pain, maxillary dental pain, retroocular pain, conjunctivitis

maxillary sinusitis

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type of sinusitis causing vertex headache and retroocular pain

sphenoid sinusitis

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severe headache above eyes, worse with leaning forward; upper lid edema, rhinorrhea

frontal sinusitis

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boggy, tender swelling above the eye

Pott puffy tumor (osteomyelitis of cranium from direct extension of FRONTAL SINUSITIS)

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loosening of tooth in socket

tooth subluxation

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Treatment of subluxation of permanent tooth

gauze packing/figure-eight suture around neighboring tooth/Coe-Pak dressing; refer dental f/u

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tooth forced deeper into alveolar socket

tooth impaction/intrusive luxation

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nosebleed with missing front tooth after car accidnet

impacted incisor driver through alveolar bone into floor of nares

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total displacement of tooth from its socket

tooth avulsion

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Transport media for avulsed teeth

Hanks balanced salt solution/Save-a-tooth>low-fat or skim milk>saline>salive. NOT WATER

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Treatment of avulsed tooth

If permanent tooth, place in socket, see oral surgeon; if primary tooth, no treatment; GIVE TETANUS SHOT, ABX (clina or PCN)

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Tooth fracture classification system

ellis
Ellis I: enamel only
Ellis II: enamel plus dentin; temp sens
Ellis III: into pulp; pink or bloody discoloration

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Bleeding at gingival crevice with associated tooth tenderness on percussion

think about tooth fracture below cementoenamel junction; get a xray

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Teeth fracture treatment

Ellis I: f/u in 24h if sharp edges
Ellis II: If<12, risk for pulp infxn (less dentin), do CaOH dressing, cover with gauze/Al foil, dentist w/in 24hr; adults see in 24-48
Ellis III: dental emergency, dental consult in 24-48hr; risk abscess formation
Root fracture: spolint; 24-48hr dentist

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What other injury to consider in pts with facial trauma?

cervical spine injury

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Tooth missing, must consider?

consider aspiration or total impaction (intrusive luxation)

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alveolar bone fracture treatment

put saline soaked gauze, tetanus, abx, oral surgeon now

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Patient presents with inability to close mouth, talk, swallow; swelling at TMJ

TMJ dislocation

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most common type of TMJ dislocation

forward

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Posterior jaw dislocations offen assoicated with what other injury?

basilar skull fx

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Unilateral jaw dislocation causes deviation towards ______ side

unaffected

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what two things can mimic TMJ dislocation

TMJ hemarthrosis, dystonic rxns (rx benadryl, benztropine)

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TMJ dislocation reduction technique

grab angles mandible both hands, thumbs on teeth, push DOWNWARD and BACKWARD
Get pre (if concern for fx) and post reduction panorex

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TMJ post-reduction instructions

avoid wide mouth opening, yawning (for a a few weeks), warm compresess, soft diet 1 week; NSAIDs

Which tongue lacs require repair?

at tip: avoid forked tongue; if >1cm that gape widely, actively bleeding, or lateral margin; use a few rapidly absorbable; always give abx, tetanus, consider admission if airway compromise a concern from bleeding

How to block tongue for repair?

inferior alveolar nerve block (blocks lingual nerve ipsilateral side); can also do local

How to numb lip for repair?

mental nerve or infraorbital nerve block (prevent tissue edema and anatomic distortion by local infiltration which makes repair difficult)

Common types dental abscesses

Gingival abscess Periodontal (gingival abscess+deeper periodontal structures) Periapical Pericoronal

Periapical vs. Periodontal

periapical deep, not obvious on inspection; tooth is tender to percuss; may have a parulis "gumboil" (simulates gingival abscess) but is a surface manifestation of periapical abscess; periapical assocaited w/carious or nonviable teeth

pericoronal abscess location

usually involves gingiva overlying partially erupted 3rd molar (especially mandibular)

Key physical exam finding differentiating sinus tract extension of periapical abscess from periodontal abscess

tenderness with tooth percussion (seen in periapical)

Usual nidus of infection for buccal space abscess

maxillary 2nd and 3rd molars; rarely 3rd mandibular molar

Key physical exam finding differentiating buccal space abscess from canine space abscess

buccal space abscess swelling spares nasolabial fold

buccal space

between skin/fascia and buccinator muscle

canine space

btwn maxilla and levator labii superiororis muscle of face

canine space abscess nidus of infection

almost always MAXILLARY CANINE TOOTH

Treatment of buccal space and canine space abscesses

parenteral abx; dental/oral surgery consult for I&D; involved teeth usually have to come out

Ludwig Angina

bilateral cellulitis of submandibular and sublingual space with tongue elevation

usual nidus of infection in Ludwig angina

posterior mandibular molars

symptoms of Ludwigs

brawny submandibular induration, tongue elevation, trismus, fever, dysphonia, odynophagia

complications of Ludwigs

spread to deep cervical layers to medastinum; airway compromise; acute laryngospasm (may be precipitated by attempts at oral/nasotracheal intubation)

Ludwig treatment

parental abx (PCN+clinda or metro), airway setup, oral surgey consult for drainage of abscess, ICU admission for airway surveillance

Parapharyngeal Space Abscess presentation

fever, dysphagia, odynophagia, drooling, ipsilateral otalgia, unilteral neck and jaw angle swelling with rigidity and limited neck motion

complications of parapharyngeal space abscess

cranial neuropathies, jugular vein septic thrombophlebitis, erosion into carotid artery

origin of parapharyngeal abscess

bacterial pharyngitis, sinuses, dental, or lymphatic spread

name the abscess: oropharngeal abscess with crnail nerves IX through XI involvement

parapharyngeal space abscess

edematous interdental papillae with graying psueodmembrane and punched out ulcer, foul breath, strong metallic taste, fever

acute necrotizing ulcerative gingitivitis (Trench mouth)

cause of trench mouth

anaerobes, especially fusobacterium

complications of trench mouth

peripapical abscess, alveolar bone destruction; so needs dental followup

treatment trench mouth

abx, warm saline irrigation, systemic analgesics, topical anesthetics, oral rinses

consider this disease in someone with trench mouth

HIV

associations with trench mouth

steroid use, HIV, DM

parotid enlargement, enamel erosion

bulimia

side of teeth usually eroded with repeated vomiting

lingual

side of teeth usually eroded by lemon sucking or dipping snuff

buccal (and labial too)

How to distinguish thrush from hairy leukoplakia

leukoplakia can't be removed by tongue depressor

prodrome of fever, malaise, cervical adenopathy then lesion on lip

herpes

aphthous ulcers tend to occur on what kind of oral mucosa

movable (rarely seen on hard palate and gingiva); herpes more likely on gingiva, hard palate, and vermilion border

treatment oral herpes

if primary infxn and adult, use antivirals; viscous lidocaine; secondary infxn with oral PCN or clinda; steroids CONTRAINDICATED

Causes of aphthous ulcers

stress, B12/folate def, local trauma, immunocompromised

oral ulcers, genital ulcers, uveitis

Behcet syndrome

herpangina

posterior pharyngx

GI disease associated with aphthous ulcers

Crohns

complication of overuse of topical anesthetics orally

methemoglobinemia

strawberry tongue major causes

scarlet fever, Kawasaki, toxic shock syndrome

in scarlet fever, before strawberry tongue, how does tongue look?

white coating

predisposing factors to black hairy tongue

smoking, GERD, poor oral hygiene, chemo, abx; papillae stained or have chromogenic orgs

geographic tongue

lacks hyperplastic papillae seen in black hairy tongue?