OMFS Flashcards
S/s of advanced osteoarthritis of the temporomandibular joint (TMJ)
- Tendency toward prognathism
- Flattening of articular surface
- Crepitus
- Antegonial notching
** crepitus, flattening of the articular surface of the condyle, limited jaw movement, and pain on mouth opening.**
** TMJ arthritis CLD NOT cause apertognathia, which is the dental malocclusion where the posterior teeth occlude prematurely, resulting in an anterior open bite.***
Dry socket aka
(localized alveolar osteitis)
____________ is a painful condition that occurs two to three days following tooth extraction and is self-limiting in nature.
Dry socket aka (localized alveolar osteitis)
_______is the preferred method for visualizing the TMJ, followed by _______.
Magnetic resonance imaging (MRI)
cone-beam computed tomography.
T/F. No obvious TMJ pathology evident on their pantomograph ( PANO) is characteristic of TMJ
TRUE.
PANs are not useful when diagnosing TMJ pain/dysfunction disorders because only hard tissues are visible, so the relation of the condylar head to the mandibular fossa and articular tubercle are also often distorted.
Best flap for mesiodens removal
Full thickness flaps
within the palatal area allow for adequate visualization of the bone surrounding the mesiodens.
also provide better blood supply
T/F. Oxygen is not stored in its liquid state for use in dental practices, so the pressure gauge is accurate for the oxygen tank.
TRUE
most common result of habituated abuse of nitrous oxide?
Peripheral neuropathy
Long-term exposure can cause vitamin B12 deficiency, numbness, and reproductive side effects (in pregnant females).
only joint structure that exerts posterior traction on the articular disc?
Superior retrodiscal lamina
Superior retrodiscal lamina functions by pulling the articular discs posteriorly against the lateral pterygoid that pulls it forward.
connects the articular disc to the tympanic plate.
The ________ muscle inserts into the lower posterior portion of the mandibular ramus as well as the angle of the mandible and serves to help close the jaw.
medial pterygoid
During an unfavorable mandibular fracture, the medial pterygoid that inserts at the mandibular angle pulls in the same direction as the vector of displacement.
Elevators are single-blade instruments that are used to do ?
Engage the tooth apical to the cementoenamel junction
_____________ are related to muscular or motor reflexive functions including peristalsis, breathing, and heartbeat and are not involved in pain perception.
Autonomic nerves
nerve innervation of the temporomandibular joint (TMJ)
The masseteric nerve,
auriculotemporal nerve,
deep temporal nerve, and
mandibular division of trigeminal nerve have branches that innervate the TMJ.
Verrill sign
Ptosis of eyelid
Verrel sign can be used to eval level of sedation
Nitrous is :
- It is heavier than air.
- It alters cardiac output minimally.
- It is not significantly metabolized.
Nitrous oxide gas is used to provide anesthesia, anxiolysis, and vasodilation (for IV placement). It is stable and combustible but does not explode.
Nitrous oxide sedation is very safe and effective. Its effects in the body are immediately removed once the nitrous oxide gas is completely expired by the patient, making anesthetic recovery time faster.
**Beware of Diffusion Hypoxia _ dont just take NO2 and O2 off. Leave O2 on
Best incision to make when removing palatal tori
Double Y incision
______________nerves are both sensory and motor nerves that transmit nociceptive stimuli from the face.
The fifth and ninth cranial nerves
clinical signs commonly associated with acute suppurative osteomyelitis
Paresthesia or anesthesia of the inferior alveolar nerve
High or intermittent fever
Intense pain
affects children and is usually correlated with a Staphylococcus aureus infection.
A guerin fx is =
a lefort 1 fx = horizontal seperation of the maxilla form the nasal and zygomatic bones AND pterygoid plates.
A ____ fx is the most commonly seenin ER/OR?
Zygomatic - blow/fist to face
Dislocation of the mandible is best managed with:
restriction of mandibular movement for a period of 2 to 4 weeks. Opening should be limited and time for healing given
The jaw area with the LOWEST incidence of fractures is?
The coronoid process with an incidence rate of 1.3%. The regions most likely to be involved in fractures are
the condylar process [29.1%], angle [ 24.5% ] symphysis [ 22% ] body [ 16% ] alveolar [ 3.1%]
CASBA
For maxillary right quadrant extractions, the patient should turn their head substantially towards_____ and the occlusal plane of the maxilla should be at _______ to the floor.
the operator
60 degrees
For extraction of maxillary teeth, the practitioner should stand and raise the patient so that the height of the patient’s mouth approximates the height of the operator’s elbow.
For maxillary extractions, the occlusal plane should always be at 60 degrees to the floor.
when ext anterior teeth, the patient should ___ ____.
face forward
When ext teeth in the left upper quadrant, the patient should _________.
only turn slightly towards the operator.
_______ are used specifically for the removal of tooth roots.
Pick type elevators
It may be necessary to drill a hole in the root and use the buccal plate as a fulcrum.
Seldin retractors retract ________. They do not have a ____2_____, should not be used to ____3____, and they are designed similarly to Henahan retractors.
- oral soft tissues
- sharp leading edge
- retract mucoperiosteum
What nerve supplies the efferent muscles of the tongue?
Hypoglossal
The hypoglossal (CN XII) exits the skull through the hypoglossal canal of the occipital bone and supplies the afferent sensations of the muscles of the tongue, as well as efferent motor control to the intrinsic muscles of the tongue, the genioglussus, the hyoglossus, and the styloglossus muscles.
Most commonly impacted teeth
Mand 3rds, Max 3rds, Max Canines
primarily d/t inadequate arch length
__1___ requires brush placed over lesion 5-10 xs so that ___2__ is obtained.
- Cytology biopsy
2. cells from all three epithelial layers
Exam shows a suspicious 3cm lesion in ventrolateral tongue, what is next tx?
Incisional biopsy
- used when lesion is large > 1cm, polymorphic, poss malig, or in area of low morbid
WHen to use an Excisional biopsy
Used when lesion is small < 1cm polymorphic, poss malig, or in area of low morbid
The chorda tympani is a small ____1_____ branch of the ___2____ that innervates the ___3___ and ___4___.
- parasympathetic
- facial nerve (CN VII)
- submandibular
- sublingual salivary glands
The chorda tympani also supplies the taste sensation for the body of the tongue.
most common malignant tumor in oral cavity
SCC - epidermoid carcinoma
Cancers of the ____________ met to the head and neck
Breast Prostate lung kidney thyroid hematopoetic system colon
Most commonly congenitally missing teeth
3rd molars, Maxillary Laterals, Mand 2ms
priamrily d/t failure to form
Pharmacodynamics of LA
Block Na2+ channels
How will increased blood flow affect LA?
Inc bld flow = shorter duration of action
1
1
1
1
The lingual nerve is a branch of the trigeminal (CN V) that supplies the _____, ______, and ______. 1
- body of the tongue,
- the floor of the mouth
- the lingual gingiva of the mandibular teeth
It exits the skull through the foramen ovale on the sphenoid bone.
How will increased protein binding affect LA?
Inc protein binding = inc lipid sol = INC DUration of action
Which LA has two different concentrations
Mepivicaine = 2% or 3%
Bupivicaine ( 0.5%)
How will pKa affect LA?
Lower pKa = inc non-ionized form of LA = Faster onset
The majority of injectable LA used today are
Tertiary Amines
The _________ nerve is both _____. It supplies the base of the tongue and the pharyngeal muscle.
- glossopharyngeal (CN IX)
- afferent and efferent
the efferent innervation = the swallowing mechanism. The afferent component = the taste sensation for the posterior one-third of the tongue.
which LA injection has the highest degree of failure
IAN
Sensory and taste of Posterior 1/3 of tongue
Sensory and Taste of Anterior 2/3 of tongue
SEN AND TASTE Post 1/3 = Glossopharyngeal n.
SEN ant 2/3 = lingual n of CN V3
Taste ant 2/3 = Chorida Tympani ( CN7)
Pregnancy class C LAs
BAME ;
Bupivicaine, Articaine, Mepivicane, Epinepherine
Class B = lido/prilocaine
An infraorbital nerve block will anesthatize what nerves?
ASA, MSA
Lateral Nasal
Superior Labial
Inferior palpebral
________ is a procedure that divides the ramus of the mandible by a horizontal cut on the medial aspect and a vertical cut on the lateral aspect of the ramus. This procedure allows the mandible to either be advanced or setback in order to remedy excess or deficit of the mandible.
A bilateral sagittal split osteotomy
S/s of dyspnea, orthopnea, pedal edema?
CHF
tx: ACE inhibtor ; DIgoxin*
Most common reason of cardiac arrest /heart failure in children?
Respiratory distress
Most common heart defects in children
VSD
Bilateral mandibular fractures in the _____1_____ region will most likely lead to mandibular displacement inferiorly and ___2___.
- parasymphysis
- posteriorly
The pull of the genioglossus, geniohyoid, and digastric muscles facilitate the inferior and posterior displacement of the mandible. This may result in a compromised airway and the patient may have difficulty breathing, so it is critical to evaluate the airway of a patient with bilateral parasymphysis fractures.
Most commonly impacted teeth?
Mand 3rds, Max 3rds, Max Canines
primary reason = arc length
Most congenitally missing teeth?
3rd molars, Max laterals, Mand 2PM
d/t failure to form
Most difficult molar ext?
Fully bony impaction
*(any any impacted tooth)
WInter’s classifcation of 3rd molars
Refers of the long axis of 3rd to 2nd Vertical mesoangular = easiset Horizontal Distoangular = Difficult Buccolingual other
Classifcation of 3rds suing ABC, 123
Pell and gergory ABC = Impaction depth A = same lvl, at occlusion B = halfway down 2nd C = below Cervical line of 2nds ( most difficult)
123 = relationship to ramus 1 = crown ant to ramus 2 = half the crown in ramus 3 = whole crown in ramus ( most difficult)
What is possible whenever a mucoperiosteal flap is elevated during surgaical ext
Subperiosteal abcess
Irrigate throughly to removed fractured tooth or bone spicules bleow soft tissue
How does Dig work?
Inhibits Na/K/ATPas = inc Ca influx into cell; INC contractility of heart ( ionotropic)
Tx of OAC
Oro-antral communication
Tx:
<2mm do nothing
2-6mm (four A’s) = abx, antihistamine, analgesics afirn nsal spray (vasocont to dec sinus pressure) + Figure 8 sutures
>6 mm = Flap surgery for priamry closure
How can a pt be molar class 2 and skeletaly class 3?
ANB and Cleft palate
What sx will pt with cleft palate likely need in the furtre?
Mandibular Set back
early sx to fix lip/palate causes pt to dvlp class 3 so have setback to correct class 3
Most commonly used surgery for mand augmentation?
bilateral sagital osteotomy BSSO
Before sx when shld you stop warfin?
DONT STOP MED - risk of bldclot > risk of bleeding
INR of 2.5 needed for omfs
Etoh pt , what labs to order?
PT/INR
Apertognathic aka
anterior open bite
Canine and deep temporal space infxns can result in _____ via the opthalmic veins.
Canvernous Sinus Thrombosis
Lateral pharyngeal infxns can transverse the ____1____ and__2____ spaces and spread into the ____3___
- retropharyngeal
- prevertebral
- mediastinum
6 tx principles of odontogenic infxns ( in spaces)
- Det severity of infxn
- Eval host reponse
- Refer or no?
- Sx ( culture 2mml min anearobic 2 lab )
- Support pt medically
- Rx Abx ( typically streptococc/anaearobes ->PEN V or CLinda/clarithro
Types of biopsy:
- Cytology
- Aspiration
- incisional
- Exisional
Proper specimen care requires that the tissue be place in __________________________.
10% formalin in a vilume 20xs that of the specimen.
Biopsy Data sheet ( hx, findings, xry,pic)
Distended jugulars, pitting edema, dyspnea?
CHF
Orthostatic HPN + Headache =
SE of Nitrates
dliates bld vsl dec BP* inc HR
NOT indicated for TIA - only angia***
Which receptor is for lungs and which is for heart?
Beta 2 receptor for LUNGS ( two lungs)
Beta 1 for heart ( 1 heart)
Hyperventilation causes?
Tachycardia and tachypnea
postion of pt whose crown fell into mouth
Upright
Common early sign of syncope
Pallor
Pt unconscious , postioning?
Trensdelengburg
All forms of shock have what?
dec perfusion to tissues
most common ER in dental chair
syncope
t-burg ; amonia salts
can occur after does of LA
Carpopedal spasms can cause ?
Hyperventilation
Carpopedal spasms are frequent and involuntary muscle contractions in the hands and feet.
Hyponatrimia can induce
Sz
muscles elevating the jaw :
masseter,
temporalis,
medial pterigoid
What is the best predictor for pulpal anesthesia?
Backward pressure
When do you know that is it a non-odontogenic pain:
When pain is not relieved with LA
What tooth and what condition makes it most difficult to properly anesthetize the tooth:
Irreversible pulpitis and mandibular
