oral surgery Flashcards
pericornitis
infection of the tissue surrounding the crown of a tooth
lower 3rd molars most commonly
signs and symptoms of pericornitis
mild - swelling of soft tissue around the crown of the tooth, bad taste, pain
moderate - lymphadenopathy, trismus, extraoral swelling
severe - fever, malaise, spreading infectino and abscess formation
tx pericoritis
depends on severity of infection
management of mild infections
- OHI such as cleaning around the tooth and operculum with CHX or hot salty waterreleif of trauma from opposing tooth - grind cusps or XLA
- analgesics
- antibiotics (metronidazole)
severe infection may need XLA lower third molar and incision and drainage
NICE stands for
national institute of health and clinical excellence
NICE guidelines for extraction of wisdom teeth
surgical removal of impacted third molars should be limited to pt with evidence of pathology such as
- caries
- non treatable pulpal and/or periapical pathology
- cellulitis
- absscess and osteomyelitis
- internal and external resorption of the tooth and adjacent tooth
- fracture of tooth
- tooth/teeth impeding surgery or reconstructive jaw surgery
- tooth is within the field of tumour resection
what features on a radiograph would suggest that a wisdom tooth is associated with the inferior dental nerve
loss, deviation or narrowing of the ‘tramlines’ of the inferior dental canal and a radiolucent badn across the root of the tooth
what specific information must be given to a pt prior to removal of an impacted lower wisdom tooth (wouldn’t give if removing upper wisdoom tooth)
numbness/tingling of the lower lip, chin and tongue - may be temporary or permanent
possibility of damage to inferior alveolar nerve and lingual nerve
features of an ulcer that would be suspicious of malignancy
indurated
rolled edges
present on the lateral border of tongue
people most likely to have oral malignancy
older adults
males
risk factors for oral malignancy
smoking
alcohol consumption
intraoral use of tobacco products
betel nut/pan chewing
most common oral malignancy
squamous cell carcinoma
tx for squamous cell carcinoma in the mouth
surgery
- excision and primary closure
- excision and reconstruction
surgery and radiotherpy and/or chemotherapy (combined)
internal derangement of the TMJ
localised mechanical fault in the joint which interferes with its smooth action
pt may complain of
if have internal derangement of TMJ
clickling of joint
- displacement of the disc prevents the condyle from moving smoothly and if the disc and condyle ‘jump’ over each other this is felt by the pt as a click or pop
locking of the joint
- disc may be displaced and prevent the condyle from moving normally within the fossa
pain in the joint
- may be due to joint itself, and alteration in synovial fluid, can be associated muscle spasm
if TMJ derangement is unilateral
what side would TMJ move to on opening
side with derangement
first movement is hinge - normal
after 1cm, then go onto translation - unable to on side with derangement but other side is fine so midline will move towards static condyle
imaging of TMJ
ideal
magnetic resonance imaging MRI
branch of trigmenial nerve most commonly affected by trigeminal neuralgia
mandibular > maxillary > optalmic
trigeminal neuralgia most commonly in
females
mid to old age
differential diagnosis for trigeminal neuralgia
concern if pt doesnt fit normal demographic
multiple sclerosis
central lesion
features of pain from trigeminal neuralgia
- paroxysmal
- trigger area
- does not disturb sleep
- excruciating pain
- shooting
- sharp, electric shock, burning character
- short acting
medication that is effective for trigeminal neuralgia
- carbamazepine
- phenytoin
- gabapentin
- lamotrigine
- oxcarbazepine
- baclofen
dry socket
localised osteitis that occurs in a socket follwing removal of a tooth
predisposing factors for dry socket
smoking
oral contraceptives
difficult extractions
mandibular extractions
posterior extractions
single extractions
immunosuppression
bony pathology
when does pain from dry socket ususally start
2-3 days after extraction
management of dry socket
- reassurance and explanation
- give analgesics
- debride the socket with CHX or warm salty water
- gentle pack the socket with a dressing e.g.Alvogyl
- review
common signs and symptoms for
undisplaced unitlateral fractured mandibular condyle
pain on mandibular movement but no occlusal alteration
common signs and symptoms for
orbital blow out fracture
limited eye movements esp when trying to look up
common signs and symptoms for
bilateral displaced fractured condyles
anterior open bite
common signs and symptoms for
le Fort III fracture
CSF leak from nose
common signs and symptoms for
fractured zygomatic arch
trismus
common signs and symptoms for
fractured zygoma
anaesthesia/paraesthesia of the infraorbital nerve
common signs and symptoms for
fractured angle of the mandible
anaesthesia/paraesthesia of the inferior dental nerve
common signs and symptoms for
dislocated mandible
limited mandibular movement possible but inability to occlude or open wide
pt appears to have class III malocclusion
most appropriate medicine
Bell’s palsy
prednisolone 0.5mg/kg/12 hours for 5 days
most appropriate medicine
atypical facial pain
notriptyline 10mg continuing prescription
most appropriate medicine
acture pericornitis
metronsidazole 200mg three times daily for 5 days
most appropriate medicine
post surgical pain relief
ibuprofen 400mg three time daily for 5 days
most appropriate medicine
angular cheilitis
miconazole gel
most appropriate medicine
anitbiotic cover for extraction for pt with prosthetic heart valve
amoxicillin 3g
most appropriate medicine
prevention of post-surgical bleeding
tranexamix acid mouthwash three times daily for 5 days
most appropriate medicine
trigeminal neuralgia
cabamazepine 100-200mg twice daily
local haemastatic measures
- apply preesure
- administer local anaesthetic with vascoconstrictor
- pack with haemostatic dressing e.g. Surgicel
- suture
- bone wax
- biting on a swab soacked with tranexamic acid or tranexamic acid mouthwash
- acrylick suck down splint
aim of management of fractured mandible
restoration of function and aeshtetics
stages of tx of fractured mandible
- reduction
- fixation
- immobilisation
- rehabilitation
complications of fractured mandible
- non union
- malunion
- infection
- malocclusion
- nerve damage
signs/symptoms of oroantral communication after XLA upper first molar
- visible defect or antral mucosa visible on careful examination of socket
- hollow sound when suction used in socket
- bones with smooth concave upper surface (with or without antral mucosa on it) between the roots
management of oroantral communication
- surgical closure of the defect by: approximating the palatal and buccal mucosa, but there is usually inadequate soft tissue - buccal advancement flap or buccal fat pad or palatal rotation flap
- advise the pt not to blow nose for 10 days
- some surgeons prescrivbe broad-spectrum antibiotics, inhalatioon and nasal decongestants
Bell’s palsy is the paralysis of X nerve which results in a facial palsy
it may be caused by a X infection, particularly X
tx involves a X course of X, as well as X
Bell’s palsy is the paralysis of facial nerve which results in a facial palsy
it may be caused by a viral infection, particularly herpes simplex virus
tx involves a short course of prednisolone, as well as aciclovir
how to test the function of the nerve involved in Bell’s palsy?
- ask pt to close their eyes
- ask the pt to smile
- ask the pt to purse their lips
- ask teh pt to wrinkle their forehead
why is it important to recognise Bell’s palsy early
early tx can prevent permanent disability and disfugurement
boundaries of submandibular space
laterally: mandible below mylohyoid line
medially: mylohyoid muscle
inferiorly: deep cervical fascia and overlying platysma and skin
principles of dental infection management
identification and removal of cause of infection
- establish drainage of the abscess (intraoral/extraoral)
- commence appropriate antimicrobial treatment
- assess if there is any predisposing factors for infection e.g. immunosuppression, diabetes, steroid therapy
- supportive measures, analgesics, fluids, soft diets etc
TMN classification
classification system for tumours and stands for
T - tumour
N - nodes
M - metastases
used to stage tumors
pt with intraoral tumour stages as T2 N1 M0
pt had a tumour 2-4cm in size, with a single ipsilateral lymph node less than 3cm in diameter and no metastases
pt has stage III disease
Mx means
distant metastases cannot be assessed
graft Vs flap
graft is a piece of tissue that is tranferred by complete separation nad gains a new blood supply by ingrowth of new blood vessels
flap has its own blood supply. They can be ‘pedicled’ i.e. their original blood supply is used or ‘free’ i.e. they have to be ‘replumbed’ into the blood supply at the recipient site
