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Finals Summer 2019 > OMFS 2 Sweep 1 > Flashcards

OMFS 2 Sweep 1 Flashcards

1
Q

A —– is imperative prior to definitive treatment

A

histological diagnosis

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2
Q

A true cyst contains an

A

epithelial lining

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3
Q

Inflammatory

A

Periapical Cyst

Residual Cysts

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4
Q

Developmental

A 
Dentigerous Cyst
Odontogenic Keratocyst 
Lateral Periodontal Cyst
Glandular Odontogenic Cyst
Calcifying Odontogenic Cysts (Gorlin’s Cyst
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5
Q

MANAGEMENT OF CYSTS

A

Enucleation
Enucleation & curettage (E&C)
Marsupialization
Staged marsupialization & enucleation (decompression technique)

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6
Q

Enucleation
Treatment of choice for —–
Removal of the entire cystic lesion without —–
——– allows a cleavage plane between lesion and bony cavity

A

cystic lesions

rupture

Fibrous connective tissue (CT) wall

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7
Q 
Enucleation
Indications
------
Common examples
------
A

Any cyst that can be removed in entirety & safely without harming adjacent structures

Dentigerous cyst
Periapical cyst

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8
Q

Enucleation
Advantages
—– examination of the entire cystic wall
——- is curative in certain situations

A

Histopathologic

Initial biopsy/treatment

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9
Q

Enucleation

Disadvantages

A

Possible pathological fracture
Devitalization of teeth
Injury to nerve

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10
Q

Enucleation

Technique

A

Gain access to cyst
Aspirate
Use largest curette that defect will allow: Cleavage plane
Concave surface toward bone

Visualize bony cavity for soft tissue remnants
Smooth bony margins and obtain water tight primary closure

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11
Q 
Enucleation
Post-operative course
Diet/activity modification
Meticulous oral hygiene
May require close follow-up with periodic panoramic radiograph (every ------)
-----months for bony fill
Expanded bone will recontour over time
A

6 months

6-12

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12
Q

Enucleation & Curettage (E&C)
——- first
Mechanical (burs) curettage is performed to remove —— of bone at the entire periphery of the bony cavity
Can use the curette aggressively to accomplish, but outcome is better with mechanical

A

Cyst is enucleated

1-2mm

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13
Q

Enucleation & curettage
Indications
When removing a known ——-
Second surgery after ——

A

aggressive cyst such as an OKC (high recurrence)

recurrence when 1st surgery (enucleation) was deemed curative

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14
Q

Enucleation & curettage
Advantage
——-

A

Destroys any suspected epithelial remnants, decreasing chance of recurrence

Damage to neurovascular bundle
Dental pulps stripped

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15
Q

Marsupialization
Open a cystic lesion and maintain —– to an adjacent cavity
(Oral cavity, maxillary sinus, or nasal cavity)
Decreases —– pressure
Cyst shrinkage
Bony fill
Sole treatment (rarely) or as a preliminary step before ——–

A

patency

intracystic

definitive enucleation of the smaller cyst

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16
Q 
Marsupialization
Indications
---- at risk with enucleation
Difficult ----- to all portions of cyst
Increases ---- rate
Medical compromise
A

Adjacent vital structures

surgical access

recurrence

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17
Q 
Marsupialization
Advantages
--- to perform
Can spare -----
Either ------ or makes it -----
A

Simple

vital structures

completely resolves lesion

much smaller and easier to treat and reconstruct

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18
Q 
Marsupialization
Disadvantages
Cannot -----
Areas left behind may be -----
Patient inconvenience with ------
Occasional secondary infections
A

histologically examine the entire cystic wall

more aggressive than piece removed

home care

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19
Q

Marsupialization

Technique

A

Aspirate
Create 1cm or large elliptical incision in soft tissue
Create bony window
Piece of cystic lining removed and submitted for

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20
Q 
Marsupialization;
histopatholgic exam
----- evacuated
Keep ------ patent
Thick cystic lining: suture to ----
Thin/friable cystic lining: ------
A

Cystic contents

window into cyst

oral mucosa

pack cavity for 10-14 days to prevent oral mucosa from healing over window

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21
Q

Marsupialization
Post-operative course
—- is responsible for irrigating the cystic cavity
Cavity may become secondarily infected
Routine follow-up with —– to assess progress

**How long do you leave the cavity open?
Until —— have been met

A

Patientradiographic evaluation

goals for choosing marsupialization

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22
Q

Staged marsupialization & enucleation

Known as “——” technique

A

decompression

Opening cyst to oral cavity (marsupialization) and surgical plan is to make the cyst smaller (decompression) for final E&C at a later date
This is more commonly performed vs. marsupialization alone

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23
Q

Staged marsupialization & enucleation
Lesion marsupialized and allowed time for:
——

Routine follow-up with radiographic assessment until bone fill stalls and/or goals met

Enucleate remaining cyst
—– around opening of cyst
Remove all —–

A

Bone cover of vital structures
Increased strengthening of jaw

Elliptical incision

cystic lining

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24
Q

Staged marsupialization & enucleation
Indications
Concern for ——-
Size of lesion
Marsupialization alone does not resolve lesion
Need to examine entire lesion histopathologically

A

injury to adjacent anatomical structures

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25
Q 
Staged marsupialization & enucleation
Advantages
Develops a ---- cystic lining
Reduces ------ complete healing
Same as for marsupialization
Simple to perform
Can save vital structures
Completely resolves lesion or makes it smaller and easier to treat and reconstruct
A

thickened

morbidity and accelerates

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26
Q

Staged marsupialization & enucleation
Disadvantages
—– marsupialization
Patient inconvenience
Occasional secondary infection
Cannot histologically examine the entire cystic wall
However, —— can remedy this concern

A

Same as for

secondary enucleation

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27
Q

Periapical
Remove ——
—- +/- curettage
—— if necessary

A

underlying process – RCT or extraction

Enucleate

Antibiotics

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28
Q

Residual

A

E&C

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29
Q

If larger – consider ——–

A

Extraction of affected tooth + E&C

staged marsupialization and E&C

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30
Q

Odontogenic Keratocyst (OKC)
—- with potential —–
If larger – consider —–

A

E&C

extraction

staged marsupialization and E&C

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31
Q

Lateral periodontal cyst

—- with preservation of —-

A

Enucleation

tooth

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32
Q

Glandular odontogenic cyst
—– and —–
Some advocate —–

A

Enucleation

curettage

more aggressive treatment (resection

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33
Q

Calcifying odontogenic cyst (Gorlin’s)

—– and ——

A

Enucleation

curettage

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34
Q

Epithelial tumors

A

Ameloblastoma
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor (Pindborg)
Squamous odontogenic tumor

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35
Q

Mixed epithelial & ectomesenchymal tumors

A

Ameloblastic fibroma
Ameloblastic fibro-odontoma
Odontoma

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36
Q

Ectomesenchymal tumors

A

Odontogenic fibroma
Odontogenic myxoma
Cementoblastoma

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37
Q

Tumors: Poorer prognosis in —– due to undetected growth

A

maxilla

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38
Q 
Enucleation & Curettage of Jaw Tumors
Indications
------ tumors
Most ------ tumors
Medically compromised
A

Slow-growing, non-aggressive

odontogenic

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39
Q

Enucleation & Curettage of Jaw Tumors

Tumor Types

A 
Odontoma
Ameloblastic fibroma/fibro-odontoma
AOT
Cementoblastoma
Odontogenic fibroma
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40
Q

Enucleation & Curettage Tumor Surgical Technique

A

Local removal of the tumor by instrumentation or direct contact with the lesion
Technique same as for cysts
May have to section lesional tissue

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41
Q

Resection of Jaw Tumors

Indications
—– lesions either by histopath or clinical behavior
Tumors need a margin of —– to decrease chance of recurrence
Tumors that would be difficult to remove in entirety by —–

A

Aggressive

uninvolved tissue (hard or soft)

enucleation/curettage alone

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42
Q

Resection of jaw: tumor types

A 
Tumor Types
Ameloblastoma
Myxoma
CEOT
Squamous odontogenic tumor
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43
Q 
Resection Technique - tumors:
Lesion is removed with a ---- margin of uninvolved tissue
Marginal – maintains continuity at -----
Segmental – ------- portion removed
Total – remove -----
A

1cm

inferior border

full-thickness

entire jaw

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44
Q

Osteoinduction

 New bone formation from differentiation of —- cells, derived from ——- cells, into ——.

A

osteoprogenitor

mesenchymal

osteoblasts

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45
Q

Osteoinduction

 Differentiation is influenced by —— from the bone —–.

A

bone inductive proteins

matrix

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46
Q

Osteoinduction

 Host cells must be stimulated to differentiate into the osteoblasts by ——.

A

transplanted growth factors and cytokines

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47
Q

 BMP (Bone Morphogenic Protein)
 Initiates ——-.
 Member of the —– family of growth factors

A

osteoinduction

cytokine

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48
Q

 BMP (Bone Morphogenic Protein)

 Acts on —- cells to induce differentiation into
——.

A

progenitor

osteoblasts

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49
Q

 BMP (Bone Morphogenic Protein)

 Higher in — bone vs. —–.

A

cortical

cancellous

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50
Q

Osteoconduction

 Formation of new bone from either —— along a biologic framework.

A

host-derived or transplanted osteoprogenitor cells

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51
Q

Osteoconduction

 Provide only ——

A

passive framework or “scaffolding.”

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52
Q

Osteoconduction

 Does not ——- – conducts ——- from host into/around the scaffolding.

A

actually produce bone

bone forming cells

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53
Q

Osteogenesis
 Formation of new bone from —– cells.
 Have ——- and —— properties.
 Only ——- grafts possess all these criteria.

A

osteoprogenitor

osteoinductive, conductive

autogenic

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54
Q

Two-Phase Theory of Osteogenesis  PHASE I
 Transplanted cellular bone produces new —–. The amount of bone regeneration depends of the amount of ————.
 Considerable amount of cell death occurs during grafting procedures, and this phase may not lead to an impressive amount of regeneration.
 Determines —— of bone that the graft will form.
 Most active within—— weeks.

A

osteoid

transplanted bone cells that survive

quantity

4

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55
Q

Two-Phase Theory of Osteogenesis  PHASE II

——- from the graft bed begin after grafting, and —— from host connective tissue soon begins.
 Initial ——- is resorbed and replaced by —— bone. As the initial graft is resorbed, —— proteins are released from the matrix.
 Determines ——.
 Begins at —— and peaks around ——-.
 Remodeling process continues indefinitely.

A

Angiogenesis and fibroblastic proliferation

osteogenesis

woven bone, lamellar, bone morphogenic

quality

2 weeks, 6 weeks

56
Q

Autografts: possible —– properties

A

osteogenic

57
Q 
 Allografts/Homografts
 ------
 Cadaver bone
 Carries ------ in some cases
 Replaced by patient’s own bone
 No donor site morbidity
 Readily available
 Disadvantages include no ------ for phase I osteogenesis, longer ------ period, encapsulation, disease transmission, graft/host reaction and patient acceptance.
A

Osteoconductive

inductive proteins

viable cells, consolidation

58
Q 
Xenograft
 Grafts transplanted between individuals of different
species (i.e. bovine bone/Bio-Oss)
 No donor site morbidity
 -------
 Carrier for ------ proteins (possible)
 Limitless quantity
 Disadvantages include expense and longer ----- period, disease transmission and patient acceptance
A

Osteoconductive

inductive

consolidation

59
Q

 BMP-2=Infuse® has been approved for —– and grafting of —– defects

A

sinus floor augmentation

mandibular

60
Q

Recombinate grafts not approved for

A

Not approved in children/skeletally immature patients

61
Q

Diseases associated with bone healing problems

A

Drug (Medication) Related Osteonecrosis (MRONJ) of the Jaws
Osteo-Radio-Necrosis (ORN)
Osteomyelitis

62
Q

Drugs associated with MRONJ

A
  • Bisphosphonates
    2- Anti-Resorptive agents (e.g: Denosumab )
    3- Anti-Angiogenic medications (e.g: Tyrosine kinase inhibitors and monoclonal antibodies targeting VEGF)
63
Q

What are Bisphosphonates (BP)?

A

Synthetic analogs of inorganic pyrophosphate

64
Q

How do Bisphosphonates work?

A

How do they work?
High affinity for Ca2+
Inhibition of osteoclasts
May inhibit capillary neo-angiogenesis

65
Q

BP indications:

Oral

A

Osteoporosis and Osteopenia
Paget’s disease
Osteogenesis- Imperfecta

66
Q

IV

A

Bone metastases associated with solid tumors
Hypercalcemia of malignancy
Multiple myeloma

67
Q

Diagnosis of MRONJ

Current or previous treatment with a —-
Exposed bone in the —— that has persisted for more than —- weeks
No history of —– to the jaws

A

bisphosphonate

maxillofacial region

Eight

radiation therapy

68
Q

Fosamax (alendronate)

Actonel (risedronate)

A

Oral BP

69
Q

Aredia (pamidronate)
Zometa (zolendronate)
Reclast (zolendronate)

A

IV BP

70
Q

Boniva (inandronate)

A

IV and Oral BP

71
Q

Anti-angiogenic agents: e.g:

A

Sunitinib

72
Q

Why in the jaws ? MRONJ

A

Increased bone turnover in the jaws (Remodeling rate is 10 times more than long bones )

Thin overlying oral mucosa due to jaw anatomy.

73
Q 
Asymptomatic patient taking oral BP
Sound recommendations are still lacking 
<4 years : -----
<4 years +risk factor (Steroid/anti-Angiogenic meds.) :-------
>4 years: --------
A

proceed with planned treatment

Stop BP therapy 2 months prior to treatment

Drug holiday for 2 months

74
Q

Clinical Stage 1 MRONJ

A

Exposed/necrotic bone
Asymptomatic
No infection

Treatment
Oral antimicrobial rinses (e.g. Peridex)

75
Q

Clinical Stage 2 MRONJ

A

Exposed/necrotic bone
Pain
Infection

Treatment
Oral antimicrobial rinses
Antibiotic therapy

76
Q

Clinical Stage 3 MRONJ

A 
Findings
Exposed/necrotic bone
Pain
Infection
One or more of the following:
Fracture, extra-oral fistula, oro-nasal communication. osteolysis

Treatment
Surgical debridement or resection
Antibiotic therapy

77
Q

Osteo-Radio-Necrosis (ORN)

A

A condition in which Irradiated bone becomes exposed through a wound in the overlying skin and/or mucosa and persist without healing for 3 to 6 months

78
Q

ORN Three Hs theory

A

Hypoxia
Hypovascularity
Hypocellularity

79
Q

ORN Stage 1

A

Superficial involvement, only Cortical bone exposed

Treated with Conservative : Chlorhexidine MW

80
Q

ORN Stage 2

A

Localized involvement with involvement of cortical and medullary bone

Treatment:
Conservative : Local debridement w,w/o HBO
Chlorhexidine MW

81
Q

ORN Stage 3

A

Diffuse involvement including inferior border. Usually associated with pathologic fracture and possible osteo-cutaneous fistula

Treatment:
Surgical resection and reconstruction

82
Q

Hyperbaric Oxygen Treatment may

A

Stimulates:
collagen synthesis
Angiogenesis
Epithelialization

83
Q

Osteomyelitis

A

An inflammatory process of the bone marrow that involves cancellous and cortical bone with a tendency of progression.

84
Q

Osteomyelitis occurs more in

A

mandible than maxilla

85
Q

Osteomyelitis Predisposing factors

A

Immune-compromised patients:
DM
Alcoholism (malnutrition)
Myeloproliferative disease : leukemia, sickle cell
Chemotherapy
Fractures and Odontogenic infections in immune-compromised patients
Osteopetrosis (AlbersSchonberg disease

86
Q

Radiogrpahic“Moth-eaten” appearance

Radio-opacities Sequestra (islands of necrotic non-resorbed bone)

A

Osteomyelitis

87
Q

Clindamycin is the Antibiotic of choice for

A

osteomyelitis

88
Q

Osteomyelitis:
Hospitalization may be required for —-
Mild cases : —–
Severe cases : up to —–

A

IV Abx

4 weeks

6 months

89
Q

Osteomyelitis: Surgical:

A

Debridement/Marginal resection/Segmental re section (depend on involvement to remove dead bone

90
Q

Buccal plate

A

1mm

91
Q

Lingual plate

A

1mm

92
Q

Sinus

A

1mm

93
Q

IAN

A

2mm superior

94
Q

Mental foramen

A

5mm from anteiror/bony foramen

95
Q

Inferior border

A

1mm

96
Q

Adjacent tooth

A

2mm

97
Q

Implant to implant distance

A

3mm

98
Q

Block graft

Augment horizontal dimension of alveolus
Harvested graft traditionally shaped like a block
—– bone
Block maintains space under soft tissue while remodeling
Site ready for implant placement — months

A

Cortical +/- cancellous

4-6

99
Q

Intraoral Donor Sites

chin & Ramus

A

Limited quantity
Isolated defects of 1-2cm in size
No cancellous needed
Small but real risk of paresthesia

100
Q

Extraoral Donor Site

Iliac crest

A

Large quantity of bone
Two surgeon “team” allows for harvest and site preparation simultaneously
Requires sterile field and anesthetic/surgical support that may limit venue and increase cost
Extraoral scar and site distant from oral cavity may not be well accepted by the patient

101
Q

For bone grafting w/prosthetic:

A

Temporary prosthesis
Non-load bearing
Limit wear

102
Q

Difficult to obtain vertical augmentation due to —-

A

pressure from Soft tissue envelope or a prosthesis

103
Q

Vertical graft concerns:
Increased risk of ——
Inadequate ——- to recipient bed
—— rates greater than with horizontal augmentation

A

graft/membrane exposure

adaptation and/or fixation of the bone graft

Resorption

104
Q

Latency phase of distraction O

A

Revascularization
Osteoprogenitor cells accumulate

4-7 days

105
Q

Distraction phase of distraction O

A

1mm per day

osteoblast induction
Woven bone formation

106
Q

Consolidation phase of distraction O

A

2-3 months

active distraction complete
Bony regenerate remodels into mature bone

107
Q

Autograft ready in —- vs. allograft (——-)

BMP quick but cost prohibitive

A

4 months, 6-8 months

108
Q

Indirect sinus lift Augmentation yield ~

A

4mm of bone

109
Q

– Closed lock:

A

like a catch, but stays that way for minutes, hours, days, etc.

110
Q

– Catching:

A

opens easily part way but gets caught at 1-2 finger-widths of opening, then opens the rest of the way

111
Q

Stiffness:

A

can stretch more (with pain) vs. moves ok then hits a brick wall

112
Q

Palpate posterior maxillary vestibule
• Lateral/posterior – ——
• Posterior on ascending ramus – ——–

A

masseter origin

temporalis insertion

113
Q

– “—-” MR units are not suitable for TMJ imaging

A

Open

114
Q

– —-maximizes contrast, resolution

A

T1

115
Q

– —- demonstrates fluid, higher S/N ratio

A

T2

116
Q

Rotational movement: — mm
• Translational movement: —– mm
• Lateral excursions move contralateral joint——

A

20

40-50

: 7-10 mm

117
Q

• Why might one skip arthrocentesis?

A
  • Long duration of symptoms
  • History of failed steroid injection/arthrocentesis
  • Long history of late, hard, painful pop
  • Unable to obtain MRI
  • Certain implants, severe claustrophobia, morbid obesity
  • Anticipated difficulty with arthrocentesis • Obesity; anxious but has anesthetic risks
118
Q

Arthrocentesis

• Indications

A
  • Acute closed lock
  • Acute trauma (hemarthrosis)
  • Capsulitis/synovitis
119
Q

Arthrocentesis

Advantages

A
  • Minimally invasive
  • Fast, simple procedure – usually done in office
  • Does not require general anesthetic
  • Highly effective at increasing joint mobility, reducing pain
120
Q

Arthrocentesis

• Disadvantages

A

• Indications not well established except for acute closed
lock
• May not adequately release adhesions, etc.
• Limited success for chronic or more severe conditions

121
Q

Indications for Arthroscopy

A
  • Pain and dysfunction with the following conditions: • Decreased condylar translation due to disk hypomobility
  • Anteriorly displaced disk with or without reduction • Closed lock
  • Traumatic injury
122
Q

Advantages of Arthroscopy

A
  • Minimally invasive
  • Outpatient procedure
  • Rapid recovery
  • Excellent success (80-95%)
  • Low morbidity
  • Allows examination under anesthesia
123
Q

Disadvantages of Arthroscopy

A
  • Advanced disease may not improve
  • Disk unlikely to reposition
  • Failure usually requires open surgery
  • Requires aggressive postoperative physical therapy and patient compliance
  • Morbidity includes nerve or middle ear injury (both extremely rare)
124
Q

Adhesion types •

A

Light, filmy

• Fibrous bands • Pseudowall

125
Q

Disk pathology

A
  • Neovascularization • Fibrillation

* Perforation

126
Q

Adhesion lysis

A
  • Light adhesions – in course of inspection
  • Heavier bands, walls –
  • Use blunt trocar
  • Sweeping motion lateral-medial
  • Light contact with articular surface
  • Reassess with arthroscope
127
Q

Lavage

• Quantity rarely a concern, typically —– or more • Lactated Ringer’s vs. Normal Saline?

A

2-300ml

128
Q

• Arthrotomy:

A

Incision into the joint

129
Q

• Arthroplasty:

A

Repair, revision, and/or

reconstruction of joint tissues (hard and soft)

130
Q

• Meniscectomy=

A

Discectomy: Removal of the disk

131
Q

Disk Repair/Repositioning Procedures

• Indications

A
  • Minimal disk displacement

* Otherwise generally healthy joint tissues • Near-normal disk morphology

132
Q

Disk Repair/Repositioning Procedures

Disadvantages:

A

• Often do not change disk position • Pop or click may recur

133
Q

Meniscectomy (Discectomy) with/without Interpositional Graft

• Graft Materials (if used):

A
  • Dermis
  • Temporal fascia
  • Auricular cartilage
134
Q

Meniscectomy (Discectomy) with/without Interpositional Graft

Indications

A
  • Severe degenerative changes in disk
  • Disk beyond repair
  • Severe interference with normal function (for example, patient with late, hard, painful pop on mouth opening due to disk reduction)
135
Q

Meniscectomy (Discectomy)

Disadvantages

A

Disadvantages
• Malocclusion or failure uncommon but possible
• Replacement requires graft harvest
• Replacement may offer little benefit over meniscectomy without graft
• Alloplastic materials (artificial disks) not available

Finals Summer 2019 (1 decks)

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