Oral diseases and RAD Flashcards
What is a cyst. General symptoms and signs. Further investigations. What is the most common
-pathological cavity filled with fluid or semi-fluid contents. Lined by epithelium. Not created by pus
-asymptomatic, incidental finding, investigating unerupted tooth, slow growing. If large enough causes bony expansion, mobility, root resorption, pathological fracture or altered nerve sensation. Well-defined radiolucency
-radiograph, vitality test, aspiration, incisional biopsy
-radicular cysts most common (65%)- odontogenic inflammatory cyst
What is an odontome. How they look radiographically
-benign tumours linked to tooth development. Hard tissue growing abnormally. Limited growth potential (stop growing when mature) Made of calcified tissue (so radiopaque). Commonly cause displaced teeth rather than mobile
-tx: removal if interfering with eruption. Otherwise leave if asymtpomatic and monitor for cystic change or root resorption
What is an ameloblastoma. cells involved. characteristics. tx
-Benign odontogenic tumours- epithelial without mesenchyme
-asymptomatic, incidental finding of missing tooth, common in angle of mandible, tooth displacement,
-radiolucent, well defined and corticated, very aggressive locally and high recurrence so resected with 1cm clear margins
What Benign odontogenic tumour (epithelial with mesenchyme) has soap bubble appearance
Odontogenic myxoma
4 methods of surgical management of cysts. Which is most common
1.Enucleation: +/- peripheral ostectomy, chemical fixation or cryotherapy
2.Marsupialisation
3.Decompression
4.Resection
-enucleation most common
What is marsupialisation and its pros and cons
-Not removing cysts all in one go
-Open it up and hold open using a pack (BIPP/ gauze) so pressure is relieved which gradually decreases size of cavity and promotes bone healing
-Lining will undergo metaplasia and become normal keratinised epithelium
-Pros:
*less invasive, preserves vital structures
*Short procedure
*GA not needed. Done under LA
-Disadvantages
*Can be difficult to suture friable lining to oral mucosa
*Lining remains
*High rate of Recurrence for keratocysts (as lining not removed)
*Changing pack and having a pack = difficult for patient
*Can Close over quite easily
What is decompression surgical management for cysts. Pros and cons
-Open cyst and drain the fluid using a tube to allow shrinkage and reduce pressure
-Pros:
*Allows shrinkage
*Useful for Larger cysts where enucleation may threaten vital structures
*Relatively easily achieved vs marsupialisation / enucleation
-Cons
*Further surgery
*Drain may be lost and cavity close back up
*Doesn’t remove cyst lining, relying on it metaplasing or need surgery after to remove
How does enucleation work for treatment of cysts. Pros and cons
-Muco-periosteal flap raised, Remove ALL cyst lining, Close flap over cavity, Pack if necessary
-Advantage:
*Complete removal of cyst lining so less risk of recurrence
*Definitive treatment for most cysts. Low recurrence as removing lining
-Disadvantage
*Leaves dead space- Infection risk (Can pack / place bone graft if large)
*Damage to adjacent structures- Loss of vitality, IAN damage
*Risk of Jaw fracture (less bone support if drilling through bone to access cyst)
*Antral / nasal involvement causing communication
*Invasive
*May need GA
Adjuvants to enucleation to prevent recurrence of odontogenic keratocysts (high recurrence rate)
-carnoy’s solution (alcohol, chloroform, ferric chloride, glacial acetic acid)- removes any remaining viable lining
-cryotherapy (liquid nitrogen to freeze everything)- causes cell death
-Peripheral ostectomy -bur to remove margin around cyst
-5% 5-fluorouracil (chemotherapeutic agent)
What cyst has high recurrence rate. What syndrome is this cyst associated with. Tx options
-odontogenic keratocyst
-parakeratonised
-Found in Golin-Goltz syndrome (skeletal abnormalities and basal cell naevi -> BCCs)
-Tx: Enucleation with adjuvant of carnoy’s solution or 5% 5-fluorouracil
What is ATLS and what it involves
-advanced trauma life support
-Initial management for life-threatening trauma.
-it improves chance of survival as more in depth than BLS
1-Primary survey= ABDCE and cervical spine immobilisation (neck brace) Stabilising life-threatening injuries
2-Secondary survey: E/O and I/O assessment. Investigations
3-Soft tissue and hard tissue management
Causes of airway obstruction and its management
-Blood clots from perfuse bleeding
-Foreign bodies e.g. dentures, tooth
-Tongue
-Posterior displacement of maxilla
-Bilateral parasymphyseal mandibular fracture-loss of support for tongue muscles so it falls back and obstructs the airway
-swelling
-Management=head tilt chin lift or jaw thrust to open airway
Initial management of bleeding and blood loss. Complication
- DO NOT remove foreign body
-Control haemorrhage: use pressure, haemostat clips (arterial forceps) diathermy for small vessels, ties for large vessels, fracture reduction
-check vital signs
-risk of hypovolemic shock (signs = cyanosed, decreased BP, sweating & tachycardic)
-raise legs to increase circulation to head
-fluids, basic bloods (O rhesus –ve) then specific blood (matched)
Explain AVPU for assessing disability
-assessing neurological status and head injury
-alert? verbally responsive? Painful stimuli? Unresponsive?
Explain GCS for assessing disability
-assessing neurological status and head injury
-Eye opening, motor responses, verbal responses.
-Out of 15, lower is worse. 3 is lowest
-8 or less = coma state
Vital signs and their normal values
-Temperature: 35.5 – 37.5
-Respiratory rate: 15-20/ min
-Blood pressure: 120/80
-Pulse rate: 60-100/ min
Does increased intracranial pressure cause pupil dilation or constriction
dilation
Secondary survey involves extra and intra oral assessment once injuries are stabilised. List what needs to be assessed
-E/O:
-Inspect: lacerations, ecchymosis (brusing), oedema, facial deformity & CSF leaks (straw-like at nostril or ear)
-Assess for head injury, retro-bulbar haemorrhage & eye observations
-Palpate for tenderness, step deformities, crepitus of jaw & paraesthesia
-CN 5 & 7 tests
-I/O:
-Inspect for missing teeth, broken teeth/dentures, lacerations, ecchymosis & step deformities in the occlusal plane
-Palpate tenderness, step deformities, mobility of teeth/bone & paraesthesia
-Assess occlusion, mandibular movements
Radiographs: 2 planes at right angles
What is retrobulbar haemorrhage. symptoms
-site threatening, an emergency as a sign of increased intracranial pressure.
- bleed behind eye. Increased ocular pressure can compress on optic nerve and other nerves
-Causes pain, paralysis, proptosis (protruded), poor vision. Pressure needs to be released to treat
How to manage wounds once bleeding is controlled
-LA or GA
-decontamination and debridement (saline, iodine, scrub)
-Primary closure: Tension-free. Use sutures/ steristrips if superficial/ staples (useful in hairline)/ Dermabond glue.
-For Deep layer closure: dissolvable and undyed vicryl. Close in anatomical layers (eg. muscle to muscle, fat to fat) to remove dead spaces as a site for infection and to avoid scarring
-may need ointments or dressing during closure
-skin grafts needed if tissue loss through epidermis and full/ partial dermis
-local or regional flaps for aesthetics
-Consider antibiotic prophylaxis for dirty wounds
