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Oral Surgery > Exam 2 sweep 1 > Flashcards

Exam 2 sweep 1 Flashcards

1
Q

Most important priority in odontogenic infections

A

remove source of infection

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2
Q

Aerobic in —% of odontogenic infections

A

25

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3
Q

2 stage progression for

A

odontogenic infections

  • initiation by aerobic bacteria
  • second stage by anaerobic bacteria
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4
Q

In —– stage, abscess becomes walled off

A

second

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5
Q

Odontogenic infection - natural course

A

Cellulitis, abscess, fistula

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6
Q

Abscess is

A

primarily anaerobes, pus filled cavity

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7
Q

Bone thickness, muscle attachment, root angulation are all determinants of

A

spread

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8
Q

Max infection spread -

A

thin labial bone, thick palatal bone, roots of anterior teeth generally below muscles, roots of posterior teeth above muscles

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9
Q

Mand infection spread determined by

A

thin labial bone, thin lingual bone, mylohyoid attachment

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10
Q

Ludwig’s angina linked to

A

bilateral submandibular, sublingual, submental cellulitis

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11
Q

Trismus in pterygomandibular space - Direct spread from

A

submandibular or sublingual infection

Needle track infection

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12
Q

Lateral pharyngeal space

A

Vascular necrosis and hemorrhage
Erosion into oral cavity with aspiration of pus
Direct airway impingement
Spread to superior mediastinum
Spread into Danger Space with access to inferior mediastinum

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13
Q

With invasion into —– or ——, admission is needed

A

secondary space or neck space

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14
Q

Trismus under —– consider referral/admission

Trismus under —– admit

A

15 mm,

10mm

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15
Q

Temperature

—– indicates systemic involvement
Oral temperature not accurate

A

> 101

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16
Q

Malaise —-

A

how is the patient coping with infection

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17
Q

—– not a good measure of severity of odontogenic infection

A

WBC

-Elevated early and remains high throughout treatment

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18
Q

Criteria for Referral/Admission

A

Rapid onset not responsive to appropriate treatment
Poor compliance
Severe indurated swelling Secondary space involvement Trismus <15mm
Temperature >101
Airway concerns Compromised host defense

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19
Q

Principles of Incision and Drainage

A

Aspirate through sterile prep skin Incise dependant area
Incise healthy tissue
Explore entire space
Explore adjacent spaces Drain all spaces

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20
Q

PCN severe allergy - use

A

Clindamycin, 300mg q8h x 7 days

Clarithromycin, 500mg q12h x 7days

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21
Q

PCN mild allergy - use

A

Cephalexin, 500mg q6h x 7 days

Cephadroxil, 500mg q12h x 7 days May also add Metronidazole to these

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22
Q

Moderate infection - use

A

PCN VK, 500mg q6h plus Metronidazole, 500 mg q 8h

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23
Q

Mild infection - use

A

PCN VK, 500mg q6h x 7 days

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24
Q

SBE -

A

Extraction produces bacteremia
Agglutinating antibodies bind bacteria
Clumped AB/bacteria complex circulates
Infect sterile thrombus on diseased tissue or prosthetic material Infection

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25
Q

Who now requires prophylaxis w/antibiotics

A

Prosthetic cardiac valve
Previous infective endocarditis
Cardiac transplant patients with valve defects Specific At Risk Congenital Heart Disease

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26
Q

13% of all SBE due to

A

dental work

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27
Q

Endocarditis

A

Bacteremia 15 minutes or less Few species cause
May occur even with prophylaxis No human trials
High dose of cidal drug is needed

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28
Q

Standard prophy

A

Amoxicillin 2gm (50mg/kg) po 1 hour pre

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29
Q

Parenteral

A 
Ampicillin 1gm (50mg/kg) IV or IM 30 minutes
pre-op
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30
Q

With non-coronary vascular grafts Prophylaxis for

A

6 months

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31
Q

Forgot prophylaxis

Give within

A

2 hours

32
Q

TJR Prophylaxis Regimen

A

Amoxicillin or Cephalexin 2 gm

Ampicillin 2 gm or Cefazolin 1 gm IV or IM Clindamycin 600mg PO or IV

33
Q

Time antibiotic correctly
First dose —–
Repeat dose at—–

A

before surgery

1⁄2 therapeutic interval

34
Q

Correct prophy does at

A

4x MIC, 2x therapeutic dose

35
Q

Indications for Prophylaxis for Dentoalveolar Surgery

A

Poorly controlled metabolic disease Immunosuppressed
Surgery longer than 3 hours Contaminated wound
Insertion of major foreign body
Surgery adjacent to sinus such as implant placement or graft
Bony impactions
Same regimen as SBE prophylaxis

36
Q

Surgery

A

Inflammatory papillary hyperplasia Inflammatory fibrous hyperplasia Frenal attachments

37
Q

Preserve the ——. Especially important for ——-

A

buccal plate

maxillary molars and canine eminences

38
Q

Types of alveoloplasty

A

Digital compression
Intraseptal
Surgical - reflection of facial mucoperiosteal flap and removal of undercuts and irregularities

39
Q

Intraseptal Alveoloplasty

Indications :

A

Ridge with regular contour
Adequate height
Undercut to the depth of the labial vestibule

40
Q

Surgical alveoloplasty with

A

full thickness flap

41
Q 
Buccal Exostosis
Less common than ---------- torus
Usually in ------------
 Indications for reduction
---------
A

maxillary or mandibular

maxillary molar areas

Interfere with stability or retention of denture Chronic traumatic ulceration

42
Q

After max tuberosity surgery, at least

A

2-3mm sulcus height distal to tuberosity needed

43
Q

Inflammatory Papillary Hyperplasia

 Treatment

A

Non surgical
-Proper denture adjustment, Antifungals e.g.: Nystatin

Surgical excision
Abrasion of the superficial layer of palatal mucosa

44
Q

Inflammatory Fibrous Hyperplasia

A

Denture rim flap of tissue*

Reline denture after tx.

45
Q

If lesion persists for —— or more with no known etiology, biopsy

A

2 weeks

46
Q

Biopsy Any inflammatory lesion that does not
respond to local therapy
within

A

two weeks

47
Q

Biopsy Persistent changes in

A

epithelial tissue

48
Q

BIopsy Lesions that interfere with

A

function

49
Q

Biopsy Bone lesions that are not

A

identifiable by

clinical and radiological findings

50
Q

Bulla

A

Loculated fluid in or under the epithelium of skin or mucosa

51
Q

Erosion

A

Superficial ulcer (excoriation)

52
Q

Macule

A

Circumscribed area of color change without elevation

53
Q

Papule

A

Small palpable mass, elevated above the epithelial surface

54
Q

Nodule

A

Large palpable mass, elevated above the epithelial surface

55
Q

Plaque

A

Flat elevated lesion, the confluence of papules

56
Q

Pustules

A

Cloudy or white vesicle (PMN leukocytes)

57
Q

Scale

A

Macroscopic accumulation of keratin

58
Q

Ulcer

A

Loss of epithelium

59
Q

Color

A

Red more ominous than white

60
Q

Biopsy if Persistent —– changes
Any ——- under normal tissue
Inflammatory changes of unknown cause
persistent for long periods

A

hyperkeratotic

tumescence

61
Q

Biopsy types

A

Oral Cytology

Aspirational
Incisional
Excisional

62
Q

Cytology indications

A

Large areas of mucosal change

Need for monitoring dysplastic changes

63
Q

Cytology technique

A

Moistened tongue depressor or cement spatula
Lesion scraped
Smear and fixate over glass slide

64
Q

Aspiration indications

A

Lesions suspected to contain fluid

Intraosseous lesions

65
Q

Aspiration technique

A

18 G needle, 5 or 10 ml syringe Needle inserted during aspiration Repeated repositioning
Cortical perforation if needed

66
Q

Incisional indications

A 
Extensive lesion (>1 cm) Hazardous location
High suspicion of malignancy Closure
67
Q

Incisional technique

A 
Representative area
Wedge fashion (deep and narrow) Include normal tissue
68
Q

Excisional indications

A

Small lesion (<1 cm) Benign appearance Closure

69
Q

Excisional tech

A

Entire lesion
Margin of normal tissue (2
-
3mm)

70
Q

When doing soft tissue biopsy and administering local, Wait —- for hemostasis

A

10 minutes

71
Q

Soft tissue biopsy - borders:

A

2-3 mm border for benign, 5 mm for malignant

72
Q

Use traction sutures whenever possible for

A

soft tissue biopsy

73
Q

Specimen care

A

10% formalin solution (4% formaldehyde)
20 times the volume of the specimen
Totally immersed in solution

74
Q

Following soft tissue biopsy for closure,

A

Undermine mucosa Primary closure Surgical dressing

75
Q

Aspirate - ——– lesions

A

Radiolucent

76
Q

For intraosseous bone biopsy - —–mm bone around lesion

A

4-5

Osseous window
Burs Round
Trephine Rongeurs
Avoid anatomic structures Submit osseous window with specimen

Oral Surgery (6 decks)

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