Oral

Question 1

Median Rhomboid glossitis
- what is it
- what causes it
- Symptoms?

Answer 1

Median Rhomboid glossitis
* - Rare anomaly
* - Results from failure of lateral halves of tongue to fuse properly leaving tuberculum impar in midline
* - Smooth red usually symptom free area persists

Question 2

Causes of gingival hyperplasia:
(5)

Bonus for sub causes of the categories

Answer 2

*Inflamed enlargement – mouth breathers, poor oral hygiene

*Drug induced – anticonvulsants (phenytoin, sodium valproate) Ca channel blockers, cyclosporin

*Enlargement assoc with systemic diseases or conditions – hormonal, leukaemia, GOA

*Neoplastic enlarge

*Falsely enlarged

Question 3

Causes of black hairy tongue (3)

Answer 3

*Fungal – Aspergillus niger & related to prolonged Abx
*Freq incidental finding with no pathology except hypertrophy of filiform papillae
*Tobacco can cause it

Question 4

Oroantral fistula
Aetiology (4)

Answer 4

• Dental extraction
• Trauma e.g. maxilla fracture
• Neoplasia (e.g. in antrum)
• Caldwell-Luc operation - incision line fails to heal

Question 5

Oroantral fistula

Symptoms

Answer 5

Purulent discharge
Foul smell / taste
General sinonasal symptoms

Question 6

Oroantral fistula

Investigations

And what will one of them show

Answer 6

Orthopantomogram
CT will show - interruption of cortical floor of sinus overlying extraction socket.
Biopsy if suspect neoplasia
MC&S of any pus if infected

Question 7

Oroantral fistula

Management

Answer 7

Must determine how long it’s been there
And if cocommittant infection

• If immediate, can try and close
• If infected, must Rx infection first
• > > Abx, Decongestants, Pus swab, Endoscopic or Caldwell Luc procedure to clear out maxillary sinus
• Then fix fistualr once infection resolved

Fixing the fistula:
* Conservative e.g. small defect (<3mm)
* Medical - treat any infection: antibiotics
* If noticed immediately at tooth extraction - immediate suture repair
* Surgical repair : A surgical flap is required if >5mm & present for >3 weeks

Question 8

Oroantral fistula with cocommittant infection - management:

Answer 8

Must determine how long it’s been there
And if cocommittant infection

• Abx
• Decongestants
• Pus swab
• FESS / Endoscopic or Caldwell Luc procedure to clear out maxillary sinus
• THEN fix fistula once infection resolved