OMSITE Flashcards
Type of shock in child, hypotension but no tachycardia
○ Distributive
○ Undeveloped sympathetic ns
○ Cardiogenic
○ Distributive
Excessive hypotension with induction dose of propofol
○ Beta blocker
○ Ccb
○ ACE inhibitor
○ ACE inhibitor
Risk of not turning an emergency cricothyroidotomy into a tracheostomy
○ Subglottic stenosis
○ Recurrent laryngeal nerve injury
○ Subglottic stenosis
Most important determinant of stability of BSSO
○ # screws
○ Pattern and orientation of screws
○ Length of plate
○ Depth of screws
○ # screws
Endoscopic brow lift incisions
1 midline, 2 paramedian 2 temporal
Clark level
Clark’s level is a staging system, which describes the level of anatomical invasion of the melanoma in the skin.
Braselows
Depth-n medicine, Breslow’s depth was used as a prognostic factor in melanoma of the skin. It is a description of how deeply tumor cells have invaded.
Dedo classification
Cervical neck for facelight
Flaps
○ Blood supply
○ Indications
○ Complications
Intramembranous?
○ Ramus
○ Rib
○ Iliac crest
Ramus
What is microgap
○ implant/abutment
○ Implant/bone
○ implant/abutment
Excessive torque on implant placement
○ Necrotic bone
○ Long term success
Necrotic bone
Most important determinant of failure at one year for immediate implant placement
Loading
Implant w/o symptoms but 6 threads showing
1
○ Occlusal trauma
○ Tooth brushing
○ Occlusal trauma
Difference between peri implantitis and peri mucositis
○ Bone loss
Absolute contraindication to using bmp2
○ 76M with lung cancer
○ 23F with hiv
○ 25M for alveolar cleft grafting
76M with lung cancer
What causes rise in paCO2
○ Opioid hypoventilation
○ Machine leak
○ Opioid hypoventilation
Most common pediatric airway emergency
○ Airway obs
○ Laryngospasm
○ Bronchospasm
○ Airway obs
● 3 neuron pain system
○ Pain from tooth roots goes to cell bodies in gasserian ganglion
○ Afferent signal goes to nucleus caudalis modified before interpreted by cortex
○ Pain from tooth roots goes to cell bodies in gasserian ganglion
Indications for plavix
PVD
Difference between a hemangioma and a vascular malformation
○ Vascular malformation: Present at birth, doesn’t involute
○ Hemangioma: Not present at birth (⅔), involute
Mandibular branch Facial nerve
○ Rarely below mandible anterior to the facial vessels
○ 1.5cm below angle of mandible
Dry socket
Coagulative phase of healing
Mobility at mandible fx site
○ Disrupts blood vessel formation
○ Increases fgf
○ Disrupts blood vessel formation
10cm continuity defect after mandibular resection
○ Posterior Iliac crest
○ anterior Iliac crest
○ Calvarium
○ Rib
○ Posterior Iliac crest
Medial approach to tibia
○ Avoid vital structures
Mucicarmine stain
Stains mucin red , differentiate mucin producing tumors from those that do not produce
mucin, mucoepidermoid carcinoma vs scca
■ Also found in microorganisms with polysaccharide (mucopolysaccharide) in cell
wall (some fungi)
Lady with tumor s100 stain +, spindle cells, two different kinds of something (antoni A, antoni
B)
○ Schwannoma
○ Neurofibroma
Schwannoma
How to treat IAN after injury
2
○ Segmental resection of proximal and distal ends
Nasal tip support
Lateral (alar) cartilage
Approach to mediastinum to I&D neck fasc
Transcerivcal
Approach to mediastinum to I&D neck fasc after transcervical doesn’t work
Thoracotomy
If there is any suspicion of mediastinal extension, cardiothoracic surgery should
be considered for transcervical mediastinal debridement or, if the infection
extends below the 4th thoracic vertebra, possible thoracotomy
Soap bubble radiolucency mandible of 20 something male, painless expansion
○ Ameloblastic carcinoma?
○ Odontogenic myxoma
Odontogenic myxoma
Gait disturbance after AICBG
Tensor fascia lata
Primary resistance to transverse widening in SARPE
○ Palatal symphysis/suture
○ Zygomaticomaxillary buttress
○ Pterygoids
Palatal symphysis/suture
Most important place to put plate for stability of ZMC repair
○ Zygomaticomaxillary
○ Zygomaticotemportal
○ zygomaticofrontal
○ Inferior oribtal rim
○ Zygomaticomaxillary
2 condylar fractures and a symphysis fractures
○
Widening of the lower face
High mandibular plane angle
○ Long condyles?–>
No. Would be opposite.
Most important for long BSSO
○ Curve of Spee
○ Curve of Wilson
○ Posterior crossbite
○ Curve of Spee
Diagnosis of transverse maxillary discrepancy
○ Casts in CR
○ Casts in CO
○ Casts in class I canine occlusion
○ Casts in normal pt’s occlusion
○ Casts in class I canine occlusion
Relative vs absolute transverse discrepancy
Best way to assess maxillary occlusal can’t
-Medial canthal line to canines
-Posterior apertognathia
Medial canthal line to canines
Pt in ER with FOM swelling after tori removal
Hematoma from lingual artery
Which of the following poses the greatest airway risk
Plunging ranula
Most dangerous complication of arthrocentesis
Fluid accumulation in lateral pharyngeal space
Tmj disc is composed of
○ i/II collagen
○ i/iv collagen
○ ii/iii collagen
i/II collagen
Tmj disc is
Avascular, alymphatic, virtually acellular
Planning esthetic crown lengthing, how much residual gingival tissue
Needs at least 2mm residual keratinized tissue
Advantage of sarpe
Bigger movements
Direction of osteotomy of pterygoid plates
Anterior inferior medial
Lf1 skeletal malocclusion
Anterior open bite
Young female with anterior open bite after using tmj splint. What kind of tmj splint can cause
this
○ Flat plane
○ Posterior bite splint
○ Anterior bite splint
○ Soft one
Anterior bite splint
Idiopathic juvenile arthritis in tmj
Unilateral
Von Willebrands Classificaiton
Von willebrand classifications, which is true (asks you type of deficiency, what size multimer is
missing or deficient)
○ Class i
○ Class iia
○ Class iib
○ Class iii
○ Von Willebrand Disease
■ Type I: Partial quantitative vWF deficiency, 25%
■ Type II: Qualitative vWF deficiency, 66%
● IIa: Decreased large/medium multimers, normal platelet count
● IIb: Decreased large multimers, decreased platelet count
■ Type III: Total vWF deficiency, 8%. Very little or no detectable plasma or
platelet vWF.
Plavix
Plts
Benzos
Rem sleep
Rem sleep
25%
Methohexital
Seizures
Propofol infusion syndrome in kids
A recently identified adverse effect associated with the drug has been labeled “propofol
infusion syndrome.” It tends to occur with propofol infusions longer than 48 hours, but
has also been reported after short-term infusions using large doses. The syndrome is
characterized by the combination of metabolic acidosis, acute bradycardia and/ or
asystole, and rhabdomyolysis, and it can be fatal (see Figure 16-16). Although the
mechanism is not entirely understood, it is thought to result from direct effects on
mitochondria.
Propofol Infusion Syndrome
A, Propofol produces many clinical side effects including myocardial depression. B, The
electrocardiogram (ECG) shows sudden nodal bradyarrhythmia seen in propofol
6
infusion syndrome. Also shown is the coved-type ST-segment elevation in the right
precordial leads (arrows).
Work up to confirm sjogrens
○ Ana, salivary gland biopsy, schirmer test
Phenytoin
○ Cbc
Carbemazepine
CBC
Starting 3 months ago developed allodynia, trigeminal nerve numbness…
Mri
Onion skin condyle in older lady
Osteosarcoma*
■ More likely osteomyelitis/peripheral periostitis in older pt…
Pt with factor v leiden, how would you significantly increase circulating vWf
DDAVP-Desmopressin (DDAVP®) is used to help stop bleeding in patients with von Willebrand’s disease or mild hemophilia A. DDAVP causes the release of von Willebrand’s antigen from the platelets and the cells that line the blood vessels where it is stored.
Respiratory acidosis (pH 7.26, paco2 50, hco3 26)
○ Hyperkalemia
○ Hypercalcemia
○ Decreased urine output
Hypercalcemia
Nutritional status
○ Prealbumin
Shown a picture like this. kimmelstiel wilson nodules in a diabetic. What’s the nodules?
Sclerosis
Most widely accepted classification system for hair loss
Norwood
● Nevoid basal cell carcinoma
Multiple supernumerary teeth
○ X linked recessive
○ Autosomal dominant, multiple basal cell carcinomas of the skin, odontogenic
keratocysts, intracranial calcification, and rib and vertebral anomalies
Principal presentation of orofacial granulomatosis
Labial swelling
8
■ Orofacial granulomatosis (OFG) is a condition characterized by persistent
enlargement of the soft tissues of the mouth, lips and the area around the mouth
on the face.
20 something male pt, painless expansile mass of mandible, soap bubble appearance
○ Ameloblastoma
○ Ameloblastic carcinoma
Ameloblastoma
Calcifying odontogenic cyst treatment
Enucleation and curretage
Calcifying epithelial odontogenic tumor (CEOT) treatment
Excision/resection
Hemifacial microsomia
Migration?
Microstomia after avulsive gsw
○ FTSG
○ Local rotational flap
■ RFFF is also acceptable but don’t remember choices
Local rotational flap
■ RFFF is also acceptable but don’t remember choices
Most common anaerobic bacteria found in chronic maxillary sinusitis
Peptostreptococcus
Treacher collins facial features
Anti mongoloid…x….y…..z…
Tmj inflammation
TNF a
Large high pressure avm what would you expect to in blood
○ Fibrin split products
○ Fibrinogen
Fibrin split products
Wernicke encephalopathy vs wernicke korsakoff syndrome
○ Confabulatory psychosis
Concentration of compound A
Amount of gas diffusing over the absorbent (inverse proportion, low flow causes inc
concentration of compound A)
Which pt would you not use sevo for in a 4-6 hour surgery
Obese woman creatine 2.4
Serotonin syndrome
Mydriasis
Junctional epithelium of implants analogous to what in natural tooth
Sharpey’s fibers
Propofol causes
Bronchodilation
Keep maximum number of fat cells alive during graft harvest
Large bore cannula
○ Avoid centrifuging
○ Brown fat has greatest regenerative potential
Large bore cannula
Minimum pedicle width for nasolabial flap
1-1.5
Holaway ratio demonstrates relationship of central incisor to
Chin
How to avoid nasal defects from LF1
Alar cinch
Suture associated with Crouzon
Coronal
Trauma pt can’t see when laying down, can when he gets up
Hyphema
Location/anatomic boundaries of the lacrimal gland/ sac (?)
superior/inferior limb of the lateral/ medial canthal tendon (???)
■ The two limbs of the medial canthal tendon cover the lacrimal sac; the two limbs
of the lateral canthal tendon cover Eisler’s fat pad. peterson’s
Most common type of hair loss
Androgenic alopecia
Large mandibular discontinuity defect after tumor resection. Biggest negative impact on
postoperative quality of life (QOL) grafted with nonvasculairzed bone graft
○ Condyle
○ angle
○ Body (no implants in avascular bone)
○ Symphysis
Body (no implants in avascular bone)
PICBG nerve injury
The superior cluneal nerve (L1, L2, L3), skin over the posterior buttocks.
Blood supply of temporalis muscle flap being used for TMJ disc
Primary: Anterior and posterior deep temporal arteries (Imax)
○ Secondary: Middle temporal artery (superficial temporal artery)
Post operative gait disturbance AICBG
Tensor fascia lata
What cosmetic defect warn pt about to get temporalis flap about?
Temporal hollowing
Adverse outcome of flumazenil
○ Seizure
○ Resedation
Resedation
Most common complication of silastic malar implant
○ Permanent hypoesthesia
In end stage renal disease which inhalatory meds not to given?
Sevofluroane
When the 70kg pt didn’t drink from 10pm and showed up for 8am appointment what is his fluid
imbalance?
1,100mL
Propofol is a
Bronchodilator
Minimal strut of septal cartilage to maintain tip support
1cm caudal and dorsal strip
Bacteria in healthy sulcus next to implant?
G+ anaerobic cocci and rods
In B/L maxillary cleft maxillary growth is restricted in which direction? Transverse? A/P?
Vertical?
A/P
First line of treatment of DVT? Unfract heparin?
Heparin (LMWH>UFH)
Treatment of Cdiff
Metronidazole
Soap bubbles
Desmoplastic ameloblastoma**
■ Does not have typical radiographic features of ameloblastoma, but was one of
the only answer choices that made sense at the time
Complication of not converting crich to trach
Stenosis
Between which fat pads is the inferior oblique located
medial/nasal, central
Long term intubated patient what is the risk?
Tracheal stenosis
Indication for ablation?
Afib
Extravasation of irrigation fluid
(excessive perforation of capsule during needle or trocar
insertion)
Stain for odontogenic myxoma
Mucicarmine
What is the normal thickness of the retropharyngeal soft tissues at vertebral level C2?
6mm but ≤ 7mm
ABG with acidosis, patient what can you expect on BMP?
Hyperkalemia
Patient Hyperkalemic at 6.5 and ESRD. How do you treat it?
Hemodialysis Definitive treatment
Bacteria with Pericoronitis
Fusobacterium, Strep Milleri, Peptostreptococcus
Implant flora with healthy sulcus:
Anaerobic (facultative) gram + cocci
Articaine metabolism
95% is metabolized by plasma esterases, 5-10% by CYP
Cone-in-a-cone implant
Morse taper
Photo of palate with description of encapsulated growth, S100 staining, and description of
either Verocay bodies or Antoni A/B
Schwannoma
Histology with Liesegang ring calcification
Calcifying Epithelial Odontogenic Tumor (Pindborg tumor)
Histo of follicular ameloblastoma
Islands of odontogenic epithelium, cystic degeneration in central zones
11
Histology of Plexiform Ameloblastoma
Anastomosing cords of odontogenic epithelium. The islands “open up”
Description of 12 y.o. w/ radiolucency in post mandible w/ histo photomicrograph
Ameloblastic fibroma
How is pediatric patient`s airway different from adult:
Larynx is higher (or more cephalad) and more anterior.
The tongue is also larger in proportion and higher, the pharynx is smaller,
epiglottis is larger and floppier, attachment of vocal cords is more caudal, and the
narrowest area is at the cricoid cartilage; airway funnel shaped)
Axial CT of patient with restricted opening to 5 mm and looked like a benign condylar growth
Bony ankylosis
Condylar hyperplasia: how do you determine if the growth has arrested?
○ Models
○ Scintigraphy
○ Scintigraphy
Patient with AVNRT (AV-nodal reentrant tachycardia) during sedation and try vagal maneuvers
(carotid massage) that don’t work what medication do you give first:
Adenosine
EKG shown with SVT and patient is clinically stable, what med do you give?
Adenosine
What would you give ablation tx for?
AtrioVentricular Nodal Reentry-Tach (AVNRT)
■ (ALSO: Atrial Fibrillation, Atrial Flutter, Ventricular Tachycardia, Accessory
pathways/WPW)
Patient given Atropine for bradycardia and gets agitated. What do you give for treatment?
Physostigmine
Extra-pyramidal effects
Benadryl
Which of the following has fastest onset?
Lidocaine
Meralgia Paresthetica (Bernhardt-Roth):
Lateral cutaneous nerve of thigh (syn: Lateral Femoral Cutaneous- LFCN)
Most neurosensory damage from bone graft taken from mandible:
Symphysis Graft
Patient with bilateral subcondylar fractures and mid symphysis and palatal fx, what is the most
common issue?
Widening of lower face
Patient given D2 Antagonist (Metoclopramide, Prochlorperazine, Chlorpromazine) for PONV,
gets EPS (agitation and perioral spasms), treatment :
Benadryl
Patient taking Levodopa for Parkinson’s, which medication to avoid:
Reglan (metoclopramide)
Consequence of prolonged intubation:
Tracheal stenosis
What opioid is metabolized by plasma esterases?
Remifentanil
What opioid receptor causes the most respiratory depression?
Mu2
Which nerve is most commonly damaged in Face Lift Modified Rhytidectomy incision?
Great Auricular Nerve
What complication do you get from aggressive excavation for harvest near Tibial Plateau?
Interarticular Hematoma
How do you treat persistent seroma following tibial bone harvest?
Evacuation and closed drain
Why must you locate Gerdy’s tubercle when doing tibial harvest?
Avoid patellar tendon*
What is the most common complication from Radial Forearm Flap (RFFF)?
Flap necrosis over tendons
What is the difference between ALT (Anterior Lateral Thigh) and RFFF (Radial Forearm Free
Flap)?
Donor site morbidity
● GCS (Glascow Coma Scale). Description of how the pt presents, with an image.
This one here is decerebrate * because no internal rotation of feet.
■ …it’s obviously decorticate…
Patient with Kimmelstiel-Wilson disease and DM and picture of glomerulus. What can happen
to kidneys?
○ nodular sclerosis
Patient with trauma and high serum Osm and low urine Osm.
Central (Neurogenic) Diabetes Insipidus
Dedo classification?
pattern of neck changes with aging
MOA (mode of action) of DM Drugs.
○ Thiazolidinediones
■ PPAR activator, sensitize adipocytes insulin
MOA (mode of action) of DM Drugs.
○ Biguanides
Decrease gluconeogenesis, increase insulin sensitivity, decrease glucose
absorption
Sulfonylurea M of A
Increase insulin release
Artery/Veins anastomosed in Free Fibula Flap (Blood supply to Fibula Flap)
Peroneal Artery and Vena Comitans (w/ Facial A/V)
Which part of hand could be affected with RFFF without prior Allen’s Test?
Thumb (and Forefinger)
Give Dopamine for whom? Patient with
Euvolemic Hypotension
At what tooth position is the IAN closest buccally?
1st molar
Who is most likely to get Angioedema from ACE inhibitor?
Black ppl
Pt w/ primary HTN, what class of drugs has a negative impact on Lipid and Glucose
metabolism?
Beta Blockers
How do you avoid bat wing deformity following facelift?
Platysmal plication
Role of papaverine in microvascular surgery?
Antispasmodic, vasodilator
ATLS is designed to manage patients in:
second peak of death
Mechanism of Botox:
○ Impedes Ach release from presynaptic neuron at neuromuscular plate
REM Sleep:
REM is 25% of total sleep.
Benzodiazepines affecting sleep:
Decrease REM
What reason would you perform early 2ndary alveolar cleft grafting?
If ectopic eruption is occuring
Patient w/ immature tooth (open apex) that is avulsed. Tx?
Reimplant and observe
What is the advantage of vomer flap for cleft palate repair?
Prevents anterior fistula
Patient with Crouzon , What suture is affected?
Coronal
What is Hinderer’s point? Why is it not clinically important?
Malar eminence
■ Because soft tissue can compensate for underlying skeletal asymmetries?
Zygomatic implant ideal position from lateral canthus?
1 cm lateral and 1.5-2 cm inferior
Which of the following statements regarding esthetic evaluation of the midface is true?
The zygomatic prominence should be located 2 cm inferior and 1.5 to 2 cm lateral to the
lateral canthus of the eye.
Synovial cell types A and B have what function?
Synovial A cells are mAcrophAge-like cells. B cells are fiBroBlasts.
Type of collagen for TMJ disk?
Type 1 - (disk is fibro-connective tissue, articular surface is fibro-cartilage)
■ It is the only type of cartilage that contains type I collagen in addition to the
normal type II. Fibrocartilage is found in the soft tissue-to-bone attachments,
pubic symphysis, the anulus fibrosus of intervertebral discs, menisci, the
triangular fibrocartilage and the TMJ.
Structure arising from Meckels’ Cartilage ?
Sphenomandibular ligament
Propofol causes:
Bronchodilation
■ (it’s also anti-emetic , neuroprotector/anticonvulsant , decreases arterial
pressure/profound vasodilation , decreases pre- and afterload)
What happens in chronic TMJ inflammation?
increased collagen type 3 crosslinking
■ Type III collagen, which is found in fibrous repair tissue, was also found in sites
of repair of mandibular condylar cartilage, including RA and osteomyelitis.
● Type II and type III collagen in mandibular condylar cartilage of patients
with temporomandibular joint pathology. JOMS
● Picture of arthroscopy and picking the corresponding MRI image (one showing reducing disk,
one showing non-reducing disk, one showing effusion and asking to correlate them)
Patient gets Arthroscopy. What prevents the access to the joint w/ endoscope?
○ Not enough injection of fluid to distend the joint space
Wernicke vs. Korsakoff difference?
Confabulatory Psychosis
Z-plasty with 60 degree angle gives what rotation?
○ 90 Degrees
Why use Desflurane ?
Fast return of cognitive fxn (Faster Emergence)
Desflurane is quick on/off, why?
Low blood gas partition coefficient
What is the mechanism by which sevo causes HEPATIC damage.
Causes antigenic response
● EPTFE is non degradable, why?
The body has no enzyme to break down C-F bond
Patient with crown restored onto implant 5 months prior. Develops recession and pain (maybe
minor exudate) with exposed threads. Xray looked with bone loss. What to do?
remove implant then wait then regraft (bone and soft tissue)
When placing Alloderm what is the orientation? (Smooth surface BM likes the blood, rough
surface BM likes blood, smooth surface dermal likes blood, rough surface dermal likes blood)
Basement membrane (BM) side is dull, rough, repels blood and goes against
non-vascular tissue (up); dermal/CT side is smooth and likes blood and goes against
the wound or most vascular tissue (down)
What is the point of putting soft tissue graft at time of implant sx?
Add buccal gingival thickness
Flapless implant placement causes what?
Apical fenestration increases
Difference between TADs (Temporary Anchorage Devices) and Implants?
Time of loading (healing time) (faster) and amount of loading (Less)
What BMP is bad?
BMP 3
When using BMP with collagen carrier, the most important step is?
Soak for 15 mins
With immediate loading of implants in edentulous mandible what do you need to be
successful?
use acrylic prosthesis to splint implants
Patient image with FOM lesion?
Dermoid cyst
What is the definitive way to differentiate ossifying fibroma from fibrous density?
some shit about fibroblasts/osteoblast lineage
Impacted tooth with radiolucent/radiopaque lesion, 13F?
AOT Adenomatoid odontogenic tumor
Intraoral flap with least amount of shrinkage.
Vascularized Flap
Difference between FTSG and PTSG
Full thickness graft has MORE primary contracture, LESS secondary contracture, poorer graft
“take”, easier post-op wound care compared to STSG.
Percentage of patients over 40 years that have radiographic evidence of OA.
40
CT recon with L subcondylar fx with all wrong options.
L V3 paresthesia , L open bite, reduced L excursion, deviation to R on opening
Rhabdomyosarcoma in head and neck are of what origin?
Embryonal (Most Common)
Most common Osteosarcoma cell of origin (type of Osteosarcoma)?
○ Chondroblast
Most common Salivary Gland tumor with multifocal origin?
Canalicular Adenoma
Most common Salivary Gland tumor with perineural invasion ?
Adenoid cystic carcinoma
Histology of mucoepidermoid carcinoma
Varying amounts of mucous, epidermoid, and glandular cells that may be arranged in
solid/cystic pattern
Low-grade mucoepidermoid carcinoma showing cystic spaces lined with epidermoid
and mucous cells.
Patient has redundant maxillary mucosal tissue length. What vestibuloplasty technique do you
u
○ Submucosal Vestibuloplasty
What is the physiologic basis for platform switching?
Narrower abutment platform to reduce crestal bone loss
Patient with T2N0M0 FOM SCC w/ 3 mm depth. Which of the following is true
Use of radiation to treat initially, precludes its use later as adjunctive therapy
Melanoma is staging:
Breslow criteria is thickness
Which protein is affected in Pemphigus Vulgaris :
Desmoglein III
Lower eyelid Blepharoplasty. Patient with pain, proptosis, etc. What is happening?
Retrobulbar Hematoma
A patient with Mucous Membrane Pemphigoid (Cicatricial) is likely to get which of the
following?
Symblepharon
What causes Boxy nose/Bulbous tip of nose?
Lateral Crura hyperplasia – Lower Lateral Cartilage
Why must you preserve Webster’s triangle?
To preserve nasal airway patency
What Antibiotics get to CSF/cross BBB?
Ciprofloxacin
Wegener’s Granulomatosis treatment to INDUCE remission?
Induction of Remission in Severe: Cyclophosphamide, Rituximab, Glucocorticoids
Internal Nasal Valve Angle
10-15°
How do you evaluate the Internal Nasal Valve patency?
Cottle Test
Normal Nasolabial angle?
Women 95-110°
○ Men 90-95°
Shape of the papilla is most dictated by?
3-5 mm contact of adjacent teeth
Patient with long term edentulism when you get most bone loss?
Within first year …
Why do you take pulp out after necrotic tooth after trauma?
To prevent inflammatory resorption
What is the cause of root resorption after trauma
Osteoclasts eating root surface
What is true about orthodontic extrusion prior to implant placement?
overcompensate 2-3 mm of soft tissue
Intrusion in pediatric tooth what to do?
Observe for 4-8 weeks then extract
STSG gets regeneration from what?
Adnexa
13 mm implant has 7mm bone loss around it after 6 months with no purulence, mobility etc.
What do you do?
Detoxify the implant
Contraindication for Z-Plasty?
Keloid
Inferior mediastinal extension of nec fasc below level of carina or posteriorly to level T4. How
do you approach?
Posterolateral thoracotomy
Guideline of surgical management based on diffusion of descending necrotizing
mediastinitis, Endo 1999
Most common route of extension to mediastinum from?
Retropharyngeal space
How to treat Mediastinal infection arising from cervically drained prior infection?
Transcervical
Bone formation from distraction of the ramus?
Intramembranous
What factor allows for incorporation and healing of non-vasc autogenous bone graft?
Cortical to cancellous ratio
Calvarial bone use because?
Embryologic
What is the most accurate way to tx plan distraction for OSA.
CT
Studies have shown that which type of fixation is more stable for BSSO advancement?
3x superior border bicortical screws
Most common problem with Genioplasty after 1 year?
Notching
What is true when comparing BSSO and IVRO for long term stability?
Pogonium is equally stable
■ Pogonium = Pogonion
Tibia graft
15 cc obtainable
Best test to check Malnutrition
mediterranean
Picture of dude with deep temporal lac. What clinical deficit does he have?
ipisilateral orbicularis oculi issue (temporal)
○ ipisilateral frontalis weakness (temporalis)
○ forehead paresthesia
○ ear paresthesia
ear paresthesia
● Platysma flap. What blood supply?
Submental
Position of supraorbital nerve from a vertical tangent to what structure?
medial iris
Radial forearm
A: Radial
V: Vanae comitantes or cephalic vein
Ulnar Forearm
A: Ulnar
V:Vanae comitantes or cephalic vein
Lateral Arm
A: Posterior radial collateral
V: Posterior radial collateral
Lateral Thigh
A: Deep Femoral
V:Vanae Comitantes
Anteriolateral Thigh
A: Descending branch, lateral circumflex femoral
V: Vanae comitantes
Scapular/Parascapular
A: Subscapular
V:Subscapular
Rectus abdominis:
A: Deep inferior epigastric
V: Deep inferior epigastric
Latissimus:
A: Thoracodorsal: branch of sub scapular
V: Subscapular
Fibula:
A: Peroneal
V: Vanae Comitantes
Radius:
A; RAdial
V: Vanae comitantes or cephalic vein
Scapula:
A: Subscapular
V: Subscapular
Iliac Crest:
A: Deep circumflex iliac
V: Deep circumflex Iliac
Jejunum
A: Sup Mesenteric
V: Sup mesenteric
Momentum:
AGastroepiploic
V: Gastroepiploic
Temporal-Parietal
A: Superficial Temporal
V: Superficial Temporal
SCM
Correct-Superior based: occipital
Inferior based: transverse cervical
Deltopectoral Flap:
internal mammary, off of subclavian
Modified Condylotomy Osteotomy should be parallel to the posterior border of the ramus for:
Better control of the proximal segment
Patient has brisk bleed at anterior condylar neck with sx. What is the source?
○ masseteric a
○ deep temporal a
○ retromandibular v
○ IMAX
○ masseteric a
What do you need for autogenous fat graft as a filler?
○ must centrifuge
○ need tumescent injection prior to fat injection
○ need large bore syringe for fat transfer
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○ washing it with colloid
○ need large bore syringe for fat transfer
How do you know if Tonic-Clonic was due to Seizure or from Neurocardiogenic syncope?
○ Visual changes
○ Loss of continence (wiki says that loss of continence doesn’t happen with psychogenic
seizure, also w/ psychogenic seizure the patient will resist forceful eye opening if their
eyes are closed during the seizure).
○ Weakness afterward
○ Tachycardia
Weakness afterward
What happens with Marfan’s patients?
○ AR and Atrial Dilatation
○ Coarctation of the Aorta with Dilation
○ Mitral prolapse and Aortic root Dilation
Mitral prolapse and Aortic root Dilation
Mitral stenosis causes?
○ Pulmonary HTN
PEEP used for?
○ Atelectasis
○ Barotrauma
○ Atelectasis
Pt develops Laryngospasm post-op and is broken with positive pressure. In PACU pt SpO2
drops to 84% with 4 LPM of O2 (baseline: 98% on RA) CXR is taken what do you do
meanwhile:
○ Antibiotics and Steroid
○ Observation
○ Broncho lavage
○ Diuretic and Intubate
Diuretic and Intubate
ARDS happens from?
Endogenous cytokines
Patient gets maxillary lefort. What pre-op condition causes most unacceptable esthetic
concerns?
○ narrow alar base
○ obtuse nasolabial angle (increases w/ this procedure)
○ 1mm tooth show at rest
○ having dorsal hump
obtuse nasolabial angle (increases w/ this procedure)
NOE classification of Manson and Markowitz considers what structures?
MCT (Medial Canthal Tendon) and Lacrimal Bone
Most common reason for skin graft failure?
○ local inflammatory factors
○ granulation tissue presence
○ recipient site defects
recipient site defects
What produces TGF B in fracture healing?
○ Platelets
○ Fibroblasts
○ osteoblasts
○ Platelets
Lacrimal Sac is between:
○ Anterior and Deep Medial Canthal Ligament
Patient comes back with anterior open bite after maxillary osteotomy w/ midpalatal osteotomy
for transverse discrepancy. Why?
○
Transverse relapse
How does Lefort 1 present?
○ Anterior Open Bite
○ Posterior Open Bite
Anterior Open Bite
Facial Nerve innervates muscles from:
○ Deep aspect
■ Except levator angularis superioris, buccinators, mentalis (basically muscles
anterior to commissure) which
Deep aspect
● IVRO with sigmoid notch bleed? How to tx?
○ Embolize masseteric artery
○ External Carotid ligation
○ Cauterize Internal Maxillary
Embolize masseteric artery
With Lefort 1, how to prevent arterial bleed?
○ Hypotensive anesthesia
○ Limit Lateral Nasal Osteotomy to 30 mm (to avoid descending palatine artery)
○ Nasal septum protective chisel
Limit Lateral Nasal Osteotomy to 30 mm (to avoid descending palatine artery)
TMJ disc is:
○ Avascular
○ Aneural
○ Alymphatic
○ Virtually acellular
Which inflammatory mediator is reduced after arthrocentesis?
TNF-alpha
Which of the following is an acceptable way to manage a non-healing/infected angle fx?
○ Champy
○ I+D plus recon plate
○ Ex Fix w/ 1 pin on each side
○ I+D plus recon plate
Which of the following has the highest rate of cell survival following graft?
○ cancellous milled graft
○ unmilled cancellous graft
○ slurry
○ unmilled cancellous graft
Temporalis Flap for Oronasal Communication:
○ Can easily be brought across midline to distant sites
○ Off of anterior posterior Deep Temporal Arteries
○ Can get CNVII damage
Off of anterior posterior Deep Temporal Arteries
What is the most reliable way to check vitality of free flap?
○ external Doppler
○ serial clinical exams
○ needle pricks
serial clinical exams
Wilkes classification: Question asks which class if patient experiences constant pain and
crepitus.
Wilkes stage 5
Ketamine mechanism/class:
NMDA Receptor ANTAGONIST!!! (dissociative agent)
BRONJ staging where patients has pain, pus, etc limited to alveolar bone
Stage 2
Patient has fracture with mobility at the site. What is seen?
○ increased insulin growth factor
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○ increased fibroblast growth factor
○ increased/disrupted capillary growth
○ electric coupling
increased fibroblast growth factor
During Posterior Iliac Bone harvest Superior Clunial Nerve injury means:
○ L1, L2, L3 involvement and paresthesia of superior ½ of buttocks
