Oral Sugery p323 Flashcards

Question

#mandible/maxilla causes

Answer 1

* impacted wisdom tooth * large cyst/atrophic mandible * radiographs essential * forceful application

Answer 2

* size of tooth * radiographic position of roots in relation to antrum * bone at trifurcation of roots * bubbling of blood * nose holding test (careful as can create an OAF) * direct visison * good lighting and suction - echo * blunt probe 9take care not to create an OAF)

Answer 3

* encourage clot * suture margins * antibiotic * post-op instructions

Answer 4

* where? * STOP * suction * radiograph

Answer 5

* crush injuries * cutting/shredding injuries * transection * damage from surgery or damage from LA may not know at the time

Answer 6

contusion of nerve continuity of epineural sheath and axons maintained

Answer 7

continuity of axons but not epineural sheath (disrupted)

Answer 8

complete loss of nerve

Answer 9

unpleasant sensation/pain

Answer 10

reduced sensation

Answer 11

increased/heightened sensation

Answer 12

* veins (+++) * arteries - spurts/haemorrhage (+++) * arterioles -spurts/pulsating (+++) * vessels in muscle * vessels in bone

Answer 13

relocate immediately (analgesia and advice on supported yawning) if unable to relocate try local anaesthetic into masseter intraorally if still unable to relocate - immediate referral

Answer 14

hit opposing teeth with forceps crack/fracture/move adjacent teeth with elevators crac/fracture/remove restorations/crowns/bridges adj teeth

Answer 15

e.g. when removing deciduous molar extraction or damage too developing permanent premolars

Answer 16

stop radiograph retrieve

Answer 17

* pain/swelling/ecchymosis * trismus * hamorrhage * prolonged effects to nerve damage * dry socket * sequestrum * infected socket * chronic OAF/root in antrum

Answer 18

a piece of dead bone tissue formed within a diseases or injured bone

Answer 19

intraoperative immediate post op (within 48hrs after vasoconstrictor wears off) secondary bleeding 3-7 days later due to infection

Answer 20

* often starts 3-4 days after extraction * takes 7-14 days to resolve * localised osteitis -inflammation affecting lamina dura * some say clot does not form others say clot breaks down * smoking/female/contraceptives/LA vasconstrictor can all predispose * hamaetagenous bacteria in socket, excessive rinsing

Answer 21

* warm saline * analgesia * alvogel (LA and antiseptic mix)

Answer 22

* dull aching pain - moderate to severe * ususally throbs/can radiate to patient's ear/often awake at night * exposed bone is senstive and is the source of the pain * characterist bad smell and taste

Answer 23

* osteomyelitis * osteoradionecrosis * MRONJ * actinomycosis * infective endocarditis

Answer 24

caused by rheumatic fever, heart valve replacment and anthing dental - but very rare was hypothesised that post extraction microorgamisms would form vegetations on the heart valve leading to IE NICE guidelines "AB prophylaxis for IE is not recommended routinely" - Risk assess pt

Answer 25

rare bacterial infection *(Actinomyces israelli/A.naeslundii/A.viscosus)* * the bacteria have low virulence and must be inoculated into an area of injur or susceptibility * e.g. recent extraction/severely carious teeeth/bone fracture/ minor oral trauma * it erodes through tissues rather than follow typical fascial planes and spaces pattern of progression

Answer 26

fairly chronic * multiple skin sinuses and swelling * thick tenacious pus * bacterial colonies look like sulphur granulus on histology responds to antibiotic therapy but returns when therapy stopped * have to remain on antibiotics for a long time - penicillins, doxycycline or clindamycin **refer**

Answer 27

invasion of bacteria into cancellous bone causes soft tissue inflammation and oedema in the closed bony marrow spaces

Answer 28

* oedema in an enclosed space leads to increased tissue hydrostatic pressure * higher than blood pressure feeding arterial vessels * compromised blood supply results in soft tissue necrosis * involved area becomes ischaemic and necrotic * bateria proliferate because normal blood borne defences do not reach the tissue osteomyelitis spreads until arrested by antibiotic and surgical therapy

Answer 29

mandible * only main vessle is the inferior alveolar artery which also has deep overlying cortical bone which limits penetration of periosteal blood vessels = poorer blood supple and more likely to be infected

Answer 30

bone takes on a patchy/moth eaten appearance when seen radiographically

Answer 31

* streptococci * anaerobic cocci - Peprostreptococcus * anaerobic gram -ve rodes - Fusobacterium and Prevotella

Answer 32

early osteomyelitis * difficult to distinguish from dry socket/localised infection acute suppurative osteomyelitis * little to no radiographic change chronic osteomyelitis * pus/no pus, with bony destruction in area of infection

Answer 33

seen in patients who have received radiotherapy of the head and neck to treat cancer bone within radiation beam becomes virtually non-vital * endarteritis = reduced blood supply * turnover of any remaining viable bone is slow * self-repair ineffective * worse with time mandible most commonly affected (poor blood supply)

Answer 34

differing opinions on whether careful routine extraction ir surgical is best Antibiotics, CHX and review provide hyperbaric oxygen to increase local tissue ocygenation before and after surgery

Answer 35

class of drugs used to treat osteoporisis, Paget's disease and malignant bone metastases inhibit osteoclast activity and so inhibit bone resorption and therefore bone renewal can remain in body for years

Answer 36

* occurs post extraction * trauma/spontaneous * exclusive to jaws * both mandible and maxilla * risk higher in patients receiving IV bisphosphonates but still occurs in patients on oral bisphosphonates * ranges from small asymptomatic areas of exposed bone to extensive bone exposure/dehiscence/pus/pain * drug dose/diabetes/steroids/chemo/smoking are risk factors

Answer 37

avoid extraction if at all possible if a must -\> refer

Answer 38

* bisphosphonates * RANKL inhibitor + monoclonal antibody - Denosumab * antiangiogenic drugs - Bevacuzimab (block growth factor) and Sunitinib nad Sorafenib (bind to tyrosine kinase receptor)

Answer 39

**Molar teeth roots below the mylohyoid line** Signs and symptoms of a submandibular space infection: * trismus (difficulty opening the mouth), * inability to palpate the inferior border of the mandible * swelling of the face over the submandibular region. If the space contains pus, the usual treatment is by incision and drainage * The site of the incision is extra-oral, and usually made 2-3cm below, and parallel to, the inferior border of the mandible

Answer 40

**located between mylohyoid line superiorly and the platysma inferiorly** This space may be created by pathology, such as the spread of pus in an infection * Odontogenic infection of the mandibular anterior teeth may erode through the lingual cortical plate of the mandible. If the level at which the infection breaks out of the mandible is below the attachment of the mylohyoid, then it will spread into the submental space * *However, it is more usual for odontogenic infections to spread into the submental space via first involving the submandibular space.* Cutaneous infections or symphyseal/parasymphyseal mandibular fractures may also give rise to a submental space infection. Signs and symptoms of a severe submental abscess include * a firm swelling below the chin * dysphagia (difficulty swallowing). Treatment is by surgical incision and drainage, with the incision running transversely in a skin crease behind the chin.

Answer 41

fascial space of the head and neck It is a potential space **located below the mouth and above the mylohyoid muscle, and is part of the suprahyoid group of fascial spaces.** * This space may be created by pathology, such as the spread of pus in an infection, e.g. odontogenic infections. A periapical abscess may spread into the sublingual space if the apex of the tooth is above the level of attachment of mylohyoid, and the infection erodes through the lingual cortical plate of the mandible. Signs and symptoms of a sublingual space infection might * a firm, painful swelling in the anterior part of the floor of the mouth. * A sublingual abscess may elevate the tongue and cause drooling or dysphagia (difficulty swallowing). * usually little swelling visible on the face outside the mouth. Comes with a risk ➡ Ranula can form if sublingual plica incised ➡ wharton’s duct and sublingual vasculature is located here

Answer 42

Comes with a risk ➡ Ranula can form if sublingual plica incised ➡ wharton’s duct and sublingual vasculature is located here

Answer 43

A periapical abscess may spread into the sublingual space if the apex of the tooth is above the level of attachment of mylohyoid, and the infection erodes through the lingual cortical plate of the mandible. Signs and symptoms of a sublingual space infection might * a firm, painful swelling in the anterior part of the floor of the mouth. * A sublingual abscess may elevate the tongue and cause drooling or dysphagia (difficulty swallowing). * usually little swelling visible on the face outside the mouth.

Answer 44

Odontogenic infection of the mandibular anterior teeth may erode through the lingual cortical plate of the mandible. If the level at which the infection breaks out of the mandible is below the attachment of the mylohyoid, then it will spread into the submental space * *However, it is more usual for odontogenic infections to spread into the submental space via first involving the submandibular space.* Cutaneous infections or symphyseal/parasymphyseal mandibular fractures may also give rise to a submental space infection. Signs and symptoms of a severe submental abscess include * a firm swelling below the chin * dysphagia (difficulty swallowing).

Answer 45

Signs and symptoms of a submandibular space infection: * trismus (difficulty opening the mouth), * inability to palpate the inferior border of the mandible * swelling of the face over the submandibular region.

Answer 46

a fascial space of the head and neck It is a potential space, **bilaterally located in the chin, between the mentalis muscle superiorly and the platysma muscle inferiorly.** Commonly the origin of the infection is an anterior mandibular tooth with associated periapical abscess which erodes through the buccal cortical plate of the mandibular at a level below the attachment of the mentalis muscle

Answer 47

Commonly the origin of the infection is an anterior mandibular tooth with associated periapical abscess which erodes through the buccal cortical plate of the mandibular at a level below the attachment of the mentalis muscle

Answer 48

**lies between the Buccinator muscle and overlying skin and superficial fascia** Commonly the origin of the infection is an anterior mandibular tooth with associated periapical abscess which erodes through the buccal cortical plate of the mandibular at a level below the attachment of the mentalis muscle. * A hematoma may create the buccal space, e.g. due to hemorrhage following wisdom teeth surgery. Buccal space abscesses typically cause a facial swelling over the cheek that may extend from the zygomatic arch above to the inferior border of the mandible below, and from the anterior border the masseter muscle posteriorly to the angle of the mouth anteriorly. Long standing buccal abscesses tend to spontaneously drain via a cutaneous sinus at the inferior of the space, near the inferior border of the mandible and the angle of the mouth. An untreated cutaneous sinus can cause disfiguring soft tissue fibrosis, and the tract can become epithelial lined.

Answer 49

typically cause a facial swelling over the cheek that may extend from the zygomatic arch above to the inferior border of the mandible below, and from the anterior border the masseter muscle posteriorly to the angle of the mouth anteriorly.

Answer 50

Long standing buccal abscesses tend to spontaneously drain via a cutaneous sinus at the inferior of the space, near the inferior border of the mandible and the angle of the mouth. ## Footnote **An untreated cutaneous sinus can cause disfiguring soft tissue fibrosis, and the tract can become epithelial lined**

Answer 51

It is located between the levator anguli oris muscle inferiorly and the levator labii superioris muscle superiorly. Canine space infections may occur by spread of infection from the buccal space Signs and symptoms of a caninen space abscess include * swelling that obliterates the nasolabial fold. If left untreated, infections of this space will eventually spontaneously drain via the medial or lateral canthus of the eye, as this is the path of least resistance. Treatment is usually by surgical incision and drainage, and the incision is placed inside the mouth to avoid a facial scar. Odontogenic infections may spread to involve the canine space. * most likely causative tooth is the maxillary canine or maxillary first premolar. This occurs when pus (e.g. from a periapical abscess), perforates the buccal cortical plate of the maxilla above the level of attachment of the levator anguli oris muscle. * more likely if the tooth root is long (the maxillary canine has the longest root of all the teeth), and its apex lies at a level above the muscle attachment.

Answer 52

Odontogenic infections may spread to involve the canine space. * most likely causative tooth is the maxillary canine or maxillary first premolar. This occurs when pus (e.g. from a periapical abscess), perforates the buccal cortical plate of the maxilla above the level of attachment of the levator anguli oris muscle. * more likely if the tooth root is long (the maxillary canine has the longest root of all the teeth), and its apex lies at a level above the muscle attachment. OR by spread of infection from the buccal space

Answer 53

swelling that obliterates the nasolabial fold

Answer 54

Treatment is usually by surgical incision and drainage, and the incision is placed inside the mouth to avoid a facial scar if left untreated, infections of this space will eventually spontaneously drain via the medial or lateral canthus of the eye, as this is the path of least resistance.