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ENT Flashcards

1
Q

What kind of receptor are taste/smell receptors?

A

Chemoreceptors

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2
Q

Where are taste receptors located?

A

Tongue, palate, epiglottis and pharynx

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3
Q

What is the lifespan of a receptor cell?

A

approx. 10 days

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4
Q

What are the four types of papilla on the tongue?

A

Filiform, fungiform, vallate and foliate

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5
Q

Which type of papilla does not contain tastebuds?

A

Filiform

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6
Q

What are “tastants”?

A

Taste provoking chemicals

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7
Q

What happens when tastants bind to taste buds?

A

Ionic channels change to produce a depolarising receptor potential which initiates APs in afferent nerves
Signals conveyed to brainstem and thalamus then to cortical gustatory areas in the frontal lobe

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8
Q

What nerve gives supply to the epiglottis and pharynx?

A

CNX, vagus

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9
Q

What are the five primary tastes?

A

Salty, sour, sweet, bitter, umami

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10
Q

What stimulates salty taste receptors?

A

Chemical salts, especially NaCl

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11
Q

What stimulates sour taste receptors?

A

Acids with free H+ ions

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12
Q

What stimulates sweet taste receptors?

A

Glucose

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13
Q

What stimulates bitter taste buds?

A

Alkaloids, poison and toxic plant derivatives

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14
Q

What stimulates umami taste buds?

A

Amino acids, especially glutamate

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15
Q

What is ageusia?

A

Loss of taste

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16
Q

What is hypoguesia?

A

Reduced taste function

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17
Q

What is dysguesia?

A

Distortion of taste

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18
Q

What can cause aguesia?

A

Nerve damage, inflammation, endocrine disorders

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19
Q

What can cause hypogeusia?

A

Medication or chemo

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20
Q

What can cause dysguesia? (9)

A

Glossitis, gum infection, tooth decay, reflux, URTIs, medication, cancer, zinc, chemo

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21
Q

Which cell types does olfactory mucosa contain?

A

Olfactory mucosa, supporting cells and basal cells

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22
Q

Describe the structure of an olfactory receptor.

A

Thick short dendrite with a wide end called an olfactory bulb from which there is cilia projections

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23
Q

What is the lifespan of an olfactory receptor?

A

2 months

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24
Q

Describe the path of a signal from the olfactory nerve to the brain.

A

Olfactory receptors which then form afferent fibres of the olfactory nerve which pierces the cribiform plate to enter olfactory bulbs in the inferior surface of the brain then along the olfactory tract to reach the temporal lobe and olfactory areas.

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25
Q

How do odorants reach receptors in quiet breathing?

A

Diffusion

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26
Q

What must a substance be in order to be smelled?

A

Volatile to be inspired with air

Soluble in water to dissolve in the mucous

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27
Q

What is anosmia?

A

Inability to smell

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28
Q

What can cause anosmia?

A

Viral infection, allergy, nasal polyps, head injury

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29
Q

What is hyposmia?

A

Reduced ability to smell

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30
Q

What is dysosmia?

A

Altered sense of smell

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31
Q

At which frequencies do humans perceive sound?

A

20-20,000Hz

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32
Q

Summarise the main role of the outer ear

A

Sound collector

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33
Q

Summarise the main role of the middle ear

A

Mechanical force amplifier

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34
Q

Summarise the main role of the inner ear

A

Sound transducer

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35
Q

What is the TM to OW ratio?

A

18:1

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36
Q

Where are sound waves transmitted to after the OW?

A

Cochlea, organ of Corti on basilar membrane

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37
Q

Which nerve is stimulated on depolarisation of the Organ of Corti?

A

CN VII, vestibulocochlear (then to central pathways)

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38
Q

In the rest state is the Eustachian tube opened or closed?

A

Closed

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39
Q

Which muscles can open the Eustachian tube?

A

Tensor veli palatine and levator palatine

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40
Q

Why does the Eustachian tube open?

A

To equalise pressure in the ear

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41
Q

What is the scala media?

A

Cavity inside cochlea, between the tympanic duct and the vestibular duct, separated by the basilar membrane and Reissner’s membrane

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42
Q

What does the scala media contain?

A

Endolymph and Organ of Corti

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43
Q

What do the scala tympani and the scala vestibule contain?

A

Perilymph

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44
Q

When do the hair cells on the cochlea depolarise?

A

When hairs are deflected towards the longest hair

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45
Q

What are the five vestibular end organs?

A

Ampullae of lateral, posterior and superior semi-circular canals
Maculae of utricle and saccule

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46
Q

What process does the brain perceive as movement?

A

Weight of the gelatinous matrix changing

This is where the stereocilia/hairs of the utricle and sacuule project

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47
Q

What are otoconia?

A

Calcium carbonate crystals

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48
Q

Where at otoconia found?

A

Utricle and saccule

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49
Q

What do otoconia do?

A

Sense linear movement and gravitational movement

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50
Q

What happens to otoconia on movement?

A

They exert a shearing force on the hair they are coupled to

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51
Q

How are signals transmitted from the utricle and saccule?

A

Utricle - superior division of vestibular nerve

Saccule - inferior division of the vestibular nerve

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52
Q

Why are throat swabs not routinely carried out?

A

Due to commensals which are not the causative organism

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53
Q

When would you considering referring sore throat?

A

If neck mass present or if lasts longer than 3-4 weeks

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54
Q

When would you considering referring dysphagia or odynophagia?

A

If progressive or lasting >3 weeks

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55
Q

What supportive advice would you give a sore throat?

A

Avoid hot drinks, good fluid intake, warm salty water washes

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56
Q

What are the points on the Centor criteria?

A

Tonsillar exudate; cervical lymphadenopathy; fever; no cough

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57
Q

Who can’t the Centor criteria be used for?

A

Children under 3

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58
Q

What is the most common bacterial cause of sore throat?

A

Strep pyogenes

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59
Q

What is strep pyogenes?

A

Gram positive cocci, beta haemolytic

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60
Q

Which conditions may occur following a sore throat?

A

Rhuematic fever 3 weeks post sore throat

Glomerulonephritis 1-3 weeks post sore throat

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61
Q

How does diphtheria present?

A

Severe sore throat with a white membrane across the pharynx

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62
Q

Which bacteria causes diphtheria?

A

Corynebacterium diptheriae

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63
Q

When is the toxoid vaccine for diphtheria given?

A

2, 3 and 4 months

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64
Q

How is diphtheria treated?

A

Anti-toxin, penicillin/erythromycin and supportive treatment

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65
Q

What causes oral thrush?

A

Candida albicans

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66
Q

How does oral thrush present?

A

Patches of red raw mucous membranes in the throat and mouth

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67
Q

How is oral thrush treated?

A

Nystatin

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68
Q

Which group most commonly gets acute otitis media?

A

Children and infants

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69
Q

How does acute otitis media present?

A

Discharge, hearing loss, fever, lethargy

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70
Q

Which bacteria commonly cause acute otitis media?

A

H influenzae

Strep pyogenes

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71
Q

When do you take a swab in acute otitis media?

A

If the TM perforates, but not unless that happens

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72
Q

How should acute otitis media be treated?

A

Most resolve within 4 days without abx
If not, give amoxicillin or erythromycin
If immunocompromised, systemic illness or bilateral AND under two, give abx immediately

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73
Q

How does acute sinusitis present if there is secondary bacterial infection?

A

Severe pain and tenderness with purulent nasal discharge

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74
Q

What usually predisposes acute sinusitis?

A

URTI

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75
Q

How is acute sinusitis treated?

A

If severe/deteriorating for >10 days, penicillin or doxycycline
Most are self limiting over 2.5 weeks

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76
Q

What is otitis externa?

A

Infection of the outer ear canal

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77
Q

How does otitis externa present?

A

Swelling and redness of the ear canal, itch, pain, discharge

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78
Q

What are bacterial causes of otitis externa?

A

Staph aureus, pseudomonas aeruginosa

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79
Q

What are fungal causes of otitis externa?

A

Aspergillus niger, candida albicans

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80
Q

How is bacterial otitis externa treated?

A

Topical aural toilet

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81
Q

How is fungal otitis externa treated?

A

Topical clotrimazole (canesten) or gentamicin 0.3% drops

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82
Q

What is malignant otitis externa?

A

Extension of otitis externa into the surrounding ear canal

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83
Q

Which bones does malignant otitis externa commonly affect?

A

Mastoid and temporal

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84
Q

How does malignant otitis externa present?

A

Disproportionately severe pain and headache; exposed bone in ear canal and facial nerve palsy

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85
Q

How is malignant otitis externa investigated?

A

PV, CRP, imaging, biopsy and culture

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86
Q

What is a culture in malignant otitis externa most likely to show?

A

Pseudomonas aerginuosa

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87
Q

Which patients are at risk of malignant otitis externa?

A

Immunocompromised and radiation to head and neck

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88
Q

Which virus causes infectious mononucelosis?

A

EBV

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89
Q

How does infectious mononucleosis present?

A

Fever, lymphadenopathy, sore throat, pharyngitis, tonsillitis, malaise, lethargy, jaundice, rash, atypical lymphocytes

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90
Q

How is infectious mononucleosis treated?

A

Usually self-limiting over 4 weeks, paracetamol

Corticosteroids if it is a complicated case

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91
Q

What advice should be given to infectious mononucleosis patients?

A

Avoid sport for 6 weeks (to avoid splenic rupture); get bed rest; avoid alcohol

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92
Q

How is infectious mononucleosis investigated?

A

EBV IgM; Paul Bunnell test; FBC; LFT; monospot film

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93
Q

When is HSV Type 1 most likely to be acquired?

A

In childhood, through saliva contact

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94
Q

What are the symptoms of HSV type 1?

A

May be asymptomatic OR systemic upset, fever, inflammation, vesicles on lips, buccal mucosa and hard palate

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95
Q

How is HSV type 1 treated?

A

Acyclovir 3 weeks

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96
Q

Which type of HSV tends to reactivate more?

A

HSV Type 2

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97
Q

Which virus causes genital herpes?

A

HSV Type 1 or 2

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98
Q

What is a herpetic whitlow?

A

Paiful lesion on finger or thumb caused by HSV

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99
Q

How is HSV confirmed?

A

Swab of whitlow lesion and PCR

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100
Q

What causes herpangina?

A

Coxsackie virus (enterovirus)

101
Q

How does herpangina present?

A

Vesicles or ulcers on soft palate

102
Q

How is herpangina diagnosed?

A

PCR test of swab in medium

103
Q

What are apthous ulcers?

A

Recurring painful oval ulcers around the mouth which have inflammatory halos

104
Q

How are apthous ulcers treated?

A

Self-limiting over 3 weeks

105
Q

Which bacterium can cause syphilis?

A

Bacterium treponema pallidum

106
Q

How is syphilis investigated?

A

IgG and IgM antibodies

107
Q

How is syphilis treated?

A

IM Penicillin

108
Q

What are important facts to find out on nasal trauma?

A

Blood/discharge, airway restriction, LOC

109
Q

What is a septal haematoma?

A

“boggy” swelling in the nasal apertures

110
Q

How is septal haematoma treated?

A

Incised and drained under LA

111
Q

What is a complication of stagnant blood in the nose?

A

Infection, leading to abscess

112
Q

From what does the cartilage of the nasal septum receive its blood supply?

A

Perichondrium

113
Q

How are nasal fractures managed?

A

Diagnosed clinically, reviewed in 5-7 days when swelling goes down, can be straightened under LA within 2 weeks

114
Q

Which arteries supply the nose?

A

Sphenopalatine, ethmoid and greater palatine

115
Q

What can be given in epistaxis if bleeding does not cease within 10 mins?

A

Lignocaine and adrenaline, cauterisation with silver nitrate

116
Q

What may fracture to cause a CSF leak?

A

Cribiform plate of the ethmoid bone

117
Q

What is otherwise known as cauliflower ear?

A

Pinna haematoma

118
Q

How is a pinna haematoma treated?

A

Drained and sutured together, pressure dressing applied

119
Q

How is a laceration on the outer ear treated?

A

Sutured in the anatomical position (may need to remove some cartilage)

120
Q

What shouldn’t be used in the ear for risk of necrosis?

A

Adrenaline

121
Q

What are “racoon eyes” or bruising posterior to the ear indicative of?

A

Temporal bone fracture

122
Q

What should be done in a temporal bone fracture?

A

Test hearing for TM function, CNVII testing

123
Q

What is haemotympanum?

A

Blood behind the TM

124
Q

What can cause haemotympanum or ossicular chain disruption?

A

Temporal fractures

125
Q

What can haemotympanum or ossiculr chain disruption cause?

A

Conductive deafness

126
Q

In how many patients does facial palsy accompany temporal fractures?

A

Longitudinal - 20% of cases

Transverse - 80% of cases

127
Q

How do temporal fractures come about?

A

Transverse - frontal blows

Longitudinal - lateral blows

128
Q

Which kind of temporal fracture is more common?

A

Longitudinal

129
Q

Where are transverse temporal fractures seen?

A

Perpendicular to the long axis of the petrous pyramid

130
Q

What is conductive hearing loss?

A

When sound isn’t properly conducted through the ear canal

131
Q

What can cause conductive hearing loss?

A

Fluid in the ear canal, TM perforation, ossicular disruption, stapes fixation (osteosclerosis?)

132
Q

What can cause sensorineural hearing loss?

A

CNVIII palsy, cochlea pathology

133
Q

What is sensorineural hearing loss?

A

Problems which changing sound waves into electrical impulses (transduction)

134
Q

How is facial paralysis managed?

A

Never decompression and EMG studies

135
Q

In which group(s) is neck trauma more common?

A

Men (fight), adolescents (dumb)

136
Q

What does Zone 1 of the neck include?

A

Trachea, oesophagus, thoracic duct, thyroid, vessels and spinal cord

137
Q

What are the borders of zone 1 of the neck?

A

Clavicles to cricoid cartilage

138
Q

What are the borders of zone 2 of the neck?

A

Cricoid cartilage to angle of mandible

139
Q

What does Zone 2 of the neck include?

A

larynx, hypopharynx, CNX, XI, XII, carotids, internal jugular, spinal cord

140
Q

What does Zone 3 of the neck include?

A

Pharynx, caortids, IJV, spinal cord

141
Q

What are the borders of Zone 3 of the neck?

A

Angle of mandible to base of skull

142
Q

What is a complete penetrating neck injury?

A

One which completely goes through the platysma

143
Q

How should a neck injury be investigated?

A

Endoscopy, FBC, CXR, CT angiogram

144
Q

When should urgent exploration be done in the neck?

A

If suspicion of expanding haematoma, hypovolaemic shock, airway obstruction of blood in aerodigestive tract.

145
Q

What urgent investigation should be done?

A

Bronchoscopy, phayngoscopy, oesophagoscopy

146
Q

What is the weakest point of the orbital rim?

A

Infraorbital groove

147
Q

Where do most fractures of the bony oribt occur?

A

Posterior medial section (as is the thinnest)

148
Q

What is a “tear drop sign” on CT?

A

Shows infraorbital contents coming into the sinus (due to a blow out fracture)

149
Q

How are bony orbit fractures managed?

A

Conservatively

Surgical repair if there is entrapment, large defects or significant exophthalmos

150
Q

Where is a Le Fort I fracture?

A

Across the apices of the theeth

151
Q

Where is a Le Fort II fracture?

A

Through frontal maxilla, through lacrimal bone and inferior orbital floor

152
Q

Which cartilage determines the diameter of the larynx?

A

Cricoid

153
Q

What is the karina?

A

When the trachea splits into the left and right bronchus

154
Q

What does Poiseuille’s equation show?

A

Larger radius of trachea = less resistance (therefore less work of breathing)

155
Q

What are sternal or subcostal recession signs og?

A

Airway obstruction

156
Q

How is epiglottitis treated?

A

Give antibiotics and fluids, get ENT consultant

157
Q

How are foreign bodies investigated?

A

Bronchoscopy

158
Q

What causes recurrent respiratory papillomatosis?

A

HPV 6, 11, 16, 18

159
Q

How is a sub-glottis stenosis treated?

A

Cut in 4 places and inflate balloon to set size, then inject steroids

160
Q

What can causes subglottic stenosis?

A

Vasculitis

161
Q

What should be assessed in suspected airway obstruction?

A

Work of breathing, skin circulaions

162
Q

When should tracheostomy be performed?

A

As a last resort

163
Q

What simple test can be done first to check hearing?

A

Tuning fork test

164
Q

What does a tympanogram show?

A

How the TM moves/how mobile it is

165
Q

What may reduce a tympanogram?

A

Fluid or something else behind the TM

166
Q

What are the 4 types of deafness?

A

Conductive, sensorineural, mixed, central

167
Q

Where may referred pain in the ear be coming from?

A

Back of the throat (CN IX), always look in throat

168
Q

How can a CSF leak present?

A

Clear discharge from the ear

169
Q

What does dizziness suggest?

A

That the inner ear is damaged

170
Q

If dizziness but no hearing loss, what could this be?

A

BPPV or vestibular neuronitis

171
Q

What is tinnitus?

A

Constant extra sounds

172
Q

Which age group typically gets AOM?

A

Children

173
Q

How does AOM present?

A

Red, swollen, angry ear, tender

Bacterial infections will cause yellow/smelly discarhge

174
Q

What is “glue ear”?

A

Otitis media with effusion.

Presence of fluid blocks Eustachian tube

175
Q

How is “glue ear” treated?

A

Nothing for three months if unilateral

If >3 months or bilateral then offer heaing aid or grommet insertion

176
Q

What is a cholesteatoma?

A

Skin in the wrong place (middle of ear) causing flaky discharge

177
Q

What is vertigo?

A

The sensation of the room spinning

178
Q

What do the lateral semi-circular canals do?

A

Sense rotational movement

179
Q

What do the superior semi-circular canals do?

A

Sense vertical movement

180
Q

What does the utricle sense?

A

The downward force of gravity

181
Q

What is the vestibulo-ocular reflex?

A

When the head is turned to one side, there is increase firing in the semi-circ canals on that side, and reducedon the other

182
Q

How do you determine if the cause is vestibular or not?

A

Videonystagmogrpahy

183
Q

What can failure of the vestibule-ocular reflex cause?

A

Nystagmus

184
Q

How should “dizziness” be investigated?

A

Otoscopy, neurologically, BP, balance, audiometry

185
Q

How does BPPV present?

A

Vertigo on leaning forward or back or turning over in bed for 30s to 1min.

186
Q

What causes BPPV?

A

Calcium carbonate on hair cells break free, float up in fluid and sit in the posterior semi-circular canal

187
Q

What test should be done for BPPV? Describe it.

A

Hallpike’s test.
Position the patient sitting but so when the lie back their head will be over extended. Turn the head to one side and lie back in one quick motion. Nystagmus present on BPPV.

188
Q

Which manoeuvre is done to attempt to move the otoliths back to the utricle in BPPV?

A

Epley manoeuvre

Sit, head to left, head to right, recovery position, sit.

189
Q

How often should the Epley manoeuvre or Brandt-Daroff exercises be performed?

A

5 times in a set
3 sets per day
2 weeks

190
Q

What is vestibular neuronitis?

A

Vertigo for up to 3 days

191
Q

What may precede vestibular neuronitis?

A

Viral symptoms

192
Q

How does labrynthitis present?

A

Sudden onset vertigo which improves over a few days with hearing loss or tinnitus

193
Q

How is labyrinthitis treated?

A

Vestibular sedatives or prochloperazine/buccastem (dopamine receptor antagonist), but normally self-limiting

194
Q

How is Meniere’s diagnosed?

A

Diagnosis of exclusion

195
Q

What happens during an attack in Meniere’s?

A

Vertigo so violent it makes people sick and they are too dizzy to do anything during the attack

196
Q

What may precede an attack in Meniere’s?

A

Worsening tinnitus and hearing loss

197
Q

What dietary factors may help Meniere’s?

A

Salt restriction

198
Q

What happens to the endolymphatic space in a Meniere’s attack?

A

There is a break which allows the two fluids to mix and damage organs

199
Q

What should be done if hearing is completely lost?

A

Give gentamicin to destroy the balance function in the ear

can’t get an attack on ur balance if u don’t have balance

200
Q

Which kinds of tissue does MRI visualise best?

A

Soft tissue

201
Q

What is the common separate primary tumour for a head and neck cancer?

A

Lung

202
Q

What is the most common type of tumour in the head and neck?

A

SCC

203
Q

Which side of the vocal cords is more likely to be paralysed?

A

The left, due to its longer course

204
Q

What may a high resp rate indicate with regards to a head and neck cancer?

A

Upper airway mass/narrowing

205
Q

What is the 5 year survival rate of head and neck cancer?

A

25%

206
Q

Why might plastic surgery be under taken?

A

Aesthetics, reconstruction, functional

207
Q

What is the botulinum toxin and how does it work?

A

Botox

Paralyses small parts of the muscle for 3-6 months

208
Q

What two naturally occurring options can be used as a filler?

A

Fat or hyaluronic acid

209
Q

What must be done before wound closers?

A

Clean, debridement, checked for foreign bodies

210
Q

What is primary wound closure?

A

When the wound edges are pulled together

211
Q

What is rhinitis?

A

An infection or non-infective inflammation of the mucosal membrane of the nose

212
Q

What can infective rhinitis progress to?

A

Rhinosinusitis

213
Q

What can cause non-infective rhinosinusitis?

A

Allergy, vasomotor issues or polyps

214
Q

What is intermittent allergic rhinitis set off by pollen better known as?

A

Hayfever

215
Q

What may cause persistent rhinitis?

A

House dust mite allergy, pet saliva allergy

216
Q

What can medication can be given for rhinitis?

A

Anti-histamines for immediate relief
Min dose topical steroids for background defence
Immunotherapy for IgE mediated reactions

217
Q

How can polyps in the nose be treated?

A

Steroids, but more commonly surgically excisesd

218
Q

How is infective rhinosinusitis treated?

A

Not treated unless worsening over 5 days or leads to orbital cellulitis

219
Q

How does rhinosinusitis present?

A

Pain, discharge and blockage

220
Q

Why does orbital cellulitis need treated in rhinosinusitis?

A

Risk of blindness and potential spread to brain

221
Q

What tests should be performed in non-infective allergic rhinitis?

A

Skin prick testing, RAST for specific IgE

222
Q

What might a painful, boggy swollen nose be indicative of?

A

Septal haematoma

223
Q

What complication may occur in septal haematoma?

A

Cartilage necrosis and collapse

224
Q

What to the palatine tonsils develop from?

A

Dorsal wing of the 1st pharyngeal pouch, ventral wing of second pouch

225
Q

When do adenoid tonsils developed?

A

16 weeks gestation

226
Q

What is the tonsillar fossa formed by?

A

Muscular tonsillar pillars - palatoglossus and palatopharyngeus

227
Q

What are “crypts” on the tonsils?

A

Stratified squamous epithelium deeply invaginates the tonsil to form crypts

228
Q

What is the epithelium in the adenoid tissue made of?

A

Ciliated pseudostratified columnar

229
Q

What causes acute viral tonsillitis?

A

EBV, rhinovirus, parainfluenza, enterovirus and adenovirus

230
Q

What causes acute bacterial tonsillitis?

A

GABHS - Strep pyogenes/pneumo, SA, H influenzae

231
Q

How does viral acute tonsillitis present?

A

Malaise sore throat, fever, lymphadenopathy

232
Q

How does bacterial acute tonsillitis present?

A

Odynophagia, halitosis, unable to do normal activity

233
Q

What treatment is given with a Centor criteria score of 0-1?

A

No antibiotics

234
Q

What treatment is given with a Centor criteria score of 2-3?

A

Delayed abx, chance of infection

235
Q

What treatment is given with a Centor criteria score of >4?

A

Treated empirically with abx, probably bacterial infection

236
Q

Which antibiotic is given in tonsillitis?

A

Penicillin 500mg QDS for 10 days

Clarithromycin if allergic

237
Q

When is a tonsillectomy considered?

A

If >5 cases per year for 2 years
or
>7 prescriptions for one year
>3 per year for 3 years

238
Q

How does a peritonsillar abscess form?

A

When bacterial escapes the capsule of the tonsil and produces pus

239
Q

How does a peritonsillar abscess present?

A

Odynophagia and sore throat following tonsillitis, displacement of the uvula

240
Q

How is a peritonsillar abscess treated?

A

Aspirin and abx, drain if they don’t “pop” themselves

241
Q

What virus commonly causes glandular fever?

A

EBV

242
Q

How does glandular fever present?

A

Membranous exudate, lymphadenopathy, petechial haemorrhages, hepatosplenomegaly

243
Q

How is glandular fever investigated?

A

EBV IgM, monospot and Paul Bunnell tests

244
Q

How is glandular fever treated?

A

Antibiotics and steroids for 6 weeks

245
Q

How is obstructive hyperplasia in kids treated?

A

Usually isn’t as there is a good chance they will regress as child grows

246
Q

What are risk factors for “glue ear”?

A

Kids, daycare, smokers in household, recurrent UTRI, immunodeficiency, bottle feeding, preterm

247
Q

What will tuning fork tests show in glue ear?

A

Conductive hearing loss

248
Q

What are complications of grommets?

A

Infection risk, early extrusion, perforation

ENT (2 decks)

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