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Module 7 > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

Where in the mouth do you not have minor salivary glands?

A

Gingivae
anterior hard palate

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2
Q

What is the most common pathology within minor salivary glands?

A

mucous extravasation cyst

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3
Q

How would you treat a mucous extravasation cyst?

A

excision with overlying mucosa and underlying granular tissue

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4
Q

How would you treat a benign/malignant tumour of a minor salivary gland?

A

excision with a margin or normal tissue

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5
Q

What duct opens at U7’s from parotid gland?

A

Parotid/Stenson’s duct

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6
Q

What kind of gland is the parotid?

A

Seromucous (predominantly serous)

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7
Q

What duct does the submandibular gland drain through?

A

Wharton’s duct

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8
Q

What kind of gland is the submandibular?

A

Mixed - seromucous

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9
Q

What % of salivary gland tumours are in minor salivary glands?

A

15-20%

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10
Q

What % of major salivary gland tumours are in the parotid?

A

90%

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11
Q

What % of parotid gland tumours are benign?

A

80%

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12
Q

What ducts does the sublingual gland drain through?

A

Rivini’s ducts / Bartholin’s duct

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13
Q

What kind of gland is the sublingual gland?

A

Mucous

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14
Q

What is the most common causes of pathology in major salivary glands? (4)

A

inflammatory disorders
obstructions / trauma
neoplasms
autoimmune / degenerative

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15
Q

What % of submandibular tumours are benign?

A

50%

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16
Q

What % of sublingual tumours are benign?

A

25%

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17
Q

What would you look for when diagnosing a salivary gland tumour?

A

swelling - intermittent/persistent, uni/bilateral
pain - prandial
salivary flow - xerostomia/sialorrhea
palpation - size, consistency, stones

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18
Q

What investigations would you carry out for salivary gland tumours?

A

radiographs/sialography
FNA
CT/MRI
ultrasound
labial gland biopsy
scintigraphy
blood tests, microbiology, sialochemistry

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19
Q

What are the indications for surgery of salivary glands?

A

chronic pain / symptoms (refractory)
repeated acute/chronic sialadenitis
benign/malignant tumours

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20
Q

What would you advise pt to expect post submandibular gland removal?

A

pain, bruising, swelling
scar
numbness of tongue
weakness of lower lip
weakness of tongue movement

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21
Q

What are the 4 kinds of parotid surgery?

A

extracapsular dissection
lobar resection
superficial parotidectomy
total parotidectomy

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22
Q

what are the post-op complications of parotid surgery?

A

pain, bruising, swelling, infection
facial nerve injury
gustatory sweating
numbness around ear lobe
salivary fistula
recurrence

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23
Q

What virus causes sialadenitis?

A

Paramyxovirus (mumps)
cytomegolovirus
HIV

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24
Q

How do you treat a viral infection?

A

self-limiting;
analgesics and hydration

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25
Q

what is the most common cause of bacterial sialadenitis?

A

stasis - gland not being used (starvation/obstruction)

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26
Q

How would you manage acute bacterial sialadenitis?

A

antibiotics
fluids
siologogues
analgesics

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27
Q

When would you drain sialadenitis?

A

only if abscess has formed

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28
Q

Which gland is more affected by sialadenitis?

A

submandibular

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29
Q

What is the most common cause of obstruction of a salivary gland?

A

sialolithiasis (stone)

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30
Q

what age group is most commonly affected by sialolithiasis?

A

> 20 years

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31
Q

what else can cause a blockage of ducts (apart from stones)?

A

mucous plug
duct structure (trauma)

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32
Q

what are prandial symptoms?

A

symptoms associated with eating/meal times

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33
Q

what are the clinical signs of bacterial sialadenitis?

A

oral discharge of pus from salivary ducts

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34
Q

why is the submandibular gland more affected by sialolith?

A

long duct
more alkaline pH (causes calcification)

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35
Q

what are the tx options for sialolithiasis caused by obstruction?

A

sialogogues
surgical removal
removal of gland
eliminate trauma
basket retrieval of stones

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36
Q

how does lithotrypsy work?

A

ultrasonic waves to break up stone so it can be shed naturally

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37
Q

What is a ranula?

A

a large mucous retention cyst in the floor of mouth

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38
Q

What is the tx for a ranula?

A

marsupialisation
if high recurrence, removal of sublingual gland

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39
Q

what salivary glands have higher proportion of carcinomas?

A

minor

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40
Q

what is pleomorphic adenoma?

A

most common neoplasm of salivary gland

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41
Q

what is sialometaplasia?

A

benign, ulcerative lesion usually on hard palate

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42
Q

when would you refer to oral medicine?

A

red/white patches
erosions/ulcers
vesiculobullous lesions
burning mouth syndrome
facial pain
xerostomia

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43
Q

what are the different types of biopsy?

A

excisional and incisional

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44
Q

what are the different incisional biopsy techniques?

A

exfoliative cytology
aspirational (FNAC)
labial gland biopsy

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45
Q

when would you use excisional biopsy?

A

small, benign lesions

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46
Q

what is the advantage of excisional biopsy?

A

biopsy = treatment

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47
Q

what problems can arise with biopsies?

A

inappropriate specimen
specimen too small or macerated
can’t orientate specimen
tissues distorted by diathermy or LA
lab not informs need for frozen section

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48
Q

what is the advantages of frozen sections?

A

allow rapid diagnosis of malignancy
exclude carcinoma at time of surgery
results within 1 hour

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49
Q

what is exfoliative cytology?

A

removal of surface cells by scraping with a spatula or cytobrush

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50
Q

how is Sjogrens syndrome diagnosed?

A

labial gland biopsy

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51
Q

what is toluidine blue used for?

A

detecting oral epithelial dysplasia
selectively binds in vivo to acidic tissue components of DNA and RNA

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52
Q

what is the vizilite system used for?

A

used to detect the mucosal tissues undergoing metabolic or structural changes

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53
Q

what are the muscles involved in displacement of mandibular fractures?

A

medial pterygoid
lateral pterygoid
temporalis
masseter

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54
Q

what action will medial and lateral pterygoid muscles have on mandibular fractures?

A

pull inwards and upwards

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55
Q

what action will the temporalis have on a mandibular fracture?

A

pull upwards and backwards

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56
Q

what will likely happen if a large piece of tooth ends up in the antrum?

A

heavily bacterially infected
chronic sinusitis

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57
Q

what should be done if a large piece of tooth ends up in the antrum?

A

preventative medication
review
refer if communication persists

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58
Q

how would a large piece of tooth be removed from the antrum in secondary care?

A

cauldwell luc

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59
Q

what 2 reasons make edentulous fractures more complicated?

A

lack of anatomical landmarks
more atrophic = less vascularised, poorer healing

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60
Q

what is prescribed post-op of mandibular fracture?

A

antibiotics - IV then oral
steroids to minimise swelling
iv fluids

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61
Q

name 8 complications of tx of mandibular fractures

A

mon/mal union
altered occluson
tmj problems
scars from trauma/tx
infection
bone necrosis
numb lip
exposed plate

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62
Q

what should be done if there is doubt that a mandible can withstand forces of XLA?

A

refer

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63
Q

what specific extraction is fracture of a maxillary tuberosity associated with?

A

upper 8’s

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64
Q

what factors may make tuberosity fracture more likely?

A

thin bone at tuberosity
ankylosis of 8’s
divergent roots

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65
Q

what 2 signs may indicate a fractured tuberosity?

A

dull thud + crunching sound
tooth moves not independent of underlying bone

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66
Q

how does a displacement fracture happen?

A

root is shifted from within its anatomical position in the socket

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67
Q

name 7 places a tooth may be displaced?

A

infratemporal fossa
subperiosteal
lingual tissues
inferior alveolar canal
maxillary antrum
osophagus
lung/airways

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68
Q

what is the management of alveolus fracture during xla?

A

remove small fragments, leave large ones
record in notes in case large fragments become non-vital

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69
Q

how common is fractures mandible during xla?

A

very rare

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70
Q

name 3 wats how mandible fracture may happen during xla

A

excessive force
thin mandible due to pathology, age or congenital condition
wrong instrument used

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71
Q

where does the zygomatic bone join the mandible?

A

coronoid process

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72
Q

what is a type 1 zygomatic fracture?

A

no significant displacement

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73
Q

what is a type 2 zygomatic fracture?

A

fracture of zygomatic arch

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74
Q

what 2 bones does fracture of the zygomatic arch involve?

A

zygomatic
temporal

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75
Q

what is a type 3 zygomatic fracture?

A

rotation around the vertical axis

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76
Q

what are the 2 types of rotation around the vertical axis on a type 3 zygomatic fracture?

A

internal
external

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77
Q

what is a type 4 zygomatic fracture?

A

rotation around longitudinal axis

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78
Q

what is a type 5 zygomatic fracture?

A

displacement en bloc

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79
Q

what are the 3 types of displacement en bloc?

A

medially
inferiorly
laterally

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80
Q

what is specific about a lateral displacement en bloc fracture?

A

rare - high force impact fracture

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81
Q

what is a type 6 zygomatic fracture?

A

displacement of the orbital-antral part

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82
Q

what is a type 7 zygomatic fracture?

A

displacement of orbital rim segments

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83
Q

what is a type 8 zygomatic fracture?

A

complex comminuted fractures

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84
Q

what is specific about a complex comminuted zygomatic fracture?

A

high force impacts

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85
Q

what are the 2 most common causes of zygomatic fracture?

A

road traffic accident
interpersonal violence

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86
Q

what symptom of zygomatic fracture may be difficult to see because of swelling?

A

depression over malar prominence

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87
Q

how clinically would a depression over malar process be confirmed?

A

palpate

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88
Q

where should the zygoma be palpated for deformation during suspected fracture?

A

zygomatic arch
malar prominence
infra-orbital margins
maxillary buttress

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89
Q

what name describes when there is no posterior limit of iris due to bleeding?

A

subconjunctival haemorrhage

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90
Q

which 2 nerves may be damaged in a zygomatic fracture as a consequence of the extension to the orbit?

A

infraorbital
maxillary trigeminal CNV2

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91
Q

how likely is it for the orbital floor/wall to be damaged during a zygoma fracture?

A

very - almost always

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92
Q

what may a pt experience if the zygomatic joint to the mandible is fractured?

A

restricted opening
trisumus

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93
Q

what advantage does ORIF have?

A

improved alignment

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94
Q

what type of support does fixation of zygomaticomaxillary buttress provide?

A

vertical

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95
Q

what does orbital rim exposure allow for during ORIF?

A

inspection of orbital floor

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96
Q

what radiographs should be taken for Le Fort fractures?

A

CT scan

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97
Q

what fractures are needed to be a le fort 1?

A

pterygoid plates
lateral poriform aperture

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98
Q

what fractures are needed to be a le fort 2?

A

pterygoid plates
inferior orbital rim
zygomatic buttress

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99
Q

what fractures are needed to be a le fort 3?

A

pterygoid plates
lateral orbital wall
zygomatic arch

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100
Q

where does force apply for a le fort 1 fracture?

A

above dentoalveolar segment

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101
Q

what is a le fort 1 fracture less commonly known as?

A

guerin fracture

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102
Q

where does force apply for a le fort 2 fracture?

A

nasal bones

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103
Q

what shape is a le fort 2 fracture?

A

pyramidal

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104
Q

what are 2 indications for 3-point fixation?

A

instability of fragments with 2 point fixation
exploration of orbital floor required

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105
Q

when might there be indication for 4 point fixation?

A

zygomatic arch has major traumatic event

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106
Q

what is the aim of fixation?

A

rigid immobility of fractured segment to correct anatomical position

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107
Q

what is different about management of complex comminuted zygomatic fractures?

A

major reconstruction
larger flap exposure
reconstruction of buttress

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108
Q

how is a non displaced zygomatic fracture diagnosed/confirmed?

A

CT scan

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109
Q

what is the tx for displaced and minimally comminuted zygomatic fracture?

A

reduction alone

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110
Q

what is the name for when force is applied directly to the eye, causing the floor of one orbit to be disrupted and resulting in contents being herniated into maxillary sinus?

A

orbital blowout

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111
Q

which fracture complication causes bleeding from behind the eye and risks blindness?

A

retrobulbar haemorrhage

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112
Q

what is the management of retrobulbar haemorrhage?

A

immediate surgical management

113
Q

what are 5 indications for orbital floor exploration post zygomatic fracture?

A

defects >5mm on ct scam
severe displacement
comminution
soft tissue entrapment with limited upward gaze
orbital contents herniation into maxillary sinus

114
Q

what are 3 indications for reconstruction of orbital floor?

A

enopthalmos
larger defects 5-10mm
defects posterior to the axis of the globe

115
Q

what may make airway management worse in a midface fracture?

A

loss of conciousness

116
Q

which vessel may cause haemorrhage on a midface fracture?

A

maxillary artery

117
Q

what scale should be used to assess a head injury?

A

glasgow coma scale

118
Q

what is the name for when one eye appears at a different level to the other and how does this happen?

A

orbital dystopia
severe injury where suspensory ligaments are disrupted

119
Q

what is enopthalmos? and how does this happen?

A

globe appears sunken in
change in volume of the orbit

120
Q

what is the name for when the globe appears extruded and how does this happen?

A

exothalmus
decrease in orbital volume - bones pushed together

121
Q

how would an exothalmus be identified clinically?

A

stand behind patient and look downwards to see if difference between eyes

122
Q

what is the first step of ‘outside-in’ approach of treating a panfacial fracture?

A

reconstruct outer face and struts first

123
Q

what determines where reconstruction will start on panfacial fractures?

A

most reliable reference structures with least comminution

124
Q

what is the closed technique for management of mandibular fractures?

A

no incision
just IMF

125
Q

what are the 2 types of fixation?

A

load bearing
load sharing

126
Q

what is the direct technique of placing mini plates for fixation of mandibular fracture?

A

transoral approach

127
Q

what is the indirect technique of placing mini plates for fixation of mandibular fracture?

A

transbuccal approach

128
Q

what type of fracture is one which involves a tooth socket?

A

compound

129
Q

why is a fracture involving a tooth socket predisposed to infection?

A

fracture line runs through PDL to oral cavity, exposing it to oral microbiota

130
Q

what is a greenstick fracture?

A

bone flexes, outer cortices will fracture but inner cortices will flex so there is no displacement

131
Q

who are greenstick fractures associated with?

A

children

132
Q

what are the 3 most common types of mandibular fracture?

A

condylar
angle
parasymphysis

133
Q

how does a condylar fracture happen?

A

condyle is a point of weakness
when mandible is presented with force it is pushed into the base of the skull and condyle will crack

134
Q

how might an angle fracture of the mandible happen?

A

unerupted/partially erupted 8’s will present a point of weakness

135
Q

why is parasymphisis fracture common?

A

long rooted canine

136
Q

if there is a coronoid fracture, why is there often displacement?

A

due to insertion of temporalis

137
Q

describe a guardsman’s fracture of the mandible

A

one midline symphisis fracture and bilateral condylar fractures

138
Q

why do the condyles break in a guardsman’s fracture of the mandible?

A

force travels back to the point of weakness (condyles) from the chin

139
Q

what action will the masseter have on a mandibular fracture?

A

pull upwards and inwards

140
Q

what % do mandibular fractures make up of all facial fractures?

A

36-70

141
Q

what is the most common cause of mandibular fractures?

A

interpersonal violence

142
Q

what are the 5 different types of fractures?

A

simple
compound
comminuted
greenstick
pathological

143
Q

what does the amount of fixation depend on?

A

severity of injury

144
Q

what is the requirement for proper reduction?

A

direct visualisation

145
Q

where are the 3 points of reduction for a zygomatic fracture?

A

frontozygomatic suture
zygomatico maxillary buttress
inferior orbital areas

146
Q

what is a possible tx plan for an early non-comminuted with minimal displacement zygomatic fracture?

A

reduction alone

147
Q

what is a possible tx plan for older minimally comminuted minimally displaced zygomatic fracture?

A

ORIF

148
Q

what is the most reliable indicator of proper reduction for a zygomatic fracture?

A

zygomaticosphenoidal suture

149
Q

alignment of which suture along with reduction will likely to restore symmetry and orbital volume after a zygomatic fracture?

A

zygomaticosphenoidal suture

150
Q

what does orif stand for?

A

open reduction internal fixation

151
Q

what does internal fixation mean?

A

screws and plates

152
Q

what does external fixation mean?

A

headgear + immobilisation

153
Q

what approach is used for extra-oral open reduction?

A

submandibular approach - incision in neck

154
Q

when is the extra-oral open reduction indicatied?

A

displaced fractures involving lower border of mandible
edentulous pts

155
Q

why is extra-oral open reduction advised for edentulous fractures of mandible?

A

avoids stripping periosteum of the mandible to minimise effect on the vascularity of the bone

156
Q

what is a pathological fracture?

A

where the pathology predisposes the bone to fracture

157
Q

name 8 types of mandibular fracture

A

dento-alveolar
condylar
coronoid
ramus
angle
body
parasymphisis
symphisis

158
Q

how long might jaws be wired together if closed technique used?

A

up to 6 weeks

159
Q

what are 5 advantages of open reduction?

A

improved alignment + occlusion
fracture immobilised
avoid need for IMF
low rate of malunion
lower rate of infection

160
Q

name 3 disadvantages of open reduction

A

morbidity of surgical procedure
expensive
need for GA

161
Q

what is the difference between intraoral and extraoral reduction?

A

intraoral - stripping of periosteum
extraoral - minimise stripping of periosteum

162
Q

what are the number and placement of screws dictated by?

A

champy’s principles

163
Q

where are miniplates placed?

A

line of osteosynthesis to counteract distraction forces along fracture line

164
Q

describe for anterior, body + angle of mandible where plates would be placed to maximise load bearing capacity?

A

anterior - 2 low down
body - under mental foramen
angle - at external oblique ridge

165
Q

who is most likely to have mid-face fractures?

A

young/old males

166
Q

what are the 4 major parts of the zygomatic bone?

A

frontal
medial
maxillary
temporal

167
Q

what structure does the zygomatic bone primarily protect?

A

maxillary sinus

168
Q

what is the name of the area which when fractures can be felt intraorally in the buccal sulcus?

A

zygomaticomaxillary complex

169
Q

which zygomatic fracture complication happens when the fracture extends posteriorly to the eye into the superior orbital fissure and which cranial nerves are at risk as a result?

A

superior orbital fissure syndrome
CN3,4,5,6

170
Q

what is diplopia?

A

double vision

171
Q

how is a zygomatic fracture investigated?

A

occipitomental radiographs
ct scan if suspected orbital floor
opthalmology review

172
Q

why is closed technique used in mandibular fractures in children?

A

tx cannot inhibit growth i.e plates

173
Q

what are 3 advantages of closed technique?

A

cheap
simple - can be done under LA
no foreign body - decreased risk of infection

174
Q

what are 5 disadvantages of closed technique?

A

not absolutely stable
prolonged period of fixation
possible TMJ sequelae
decreased oral intake
pulmonary considerations if reflux

175
Q

when would reconstruction plates be used in open reduction of a mandibular fracture?

A

edentulous mandible

176
Q

what are 7 indications for closed reduction of a mandibular fracture?

A

non-displaced favourable fractures
grossly comminuted fractures
significant loss of overlying tissue
edentulous mandibular fractures
fractures in children
coronoid process fractures
undisplaced or minimally condylar fractures

177
Q

what are the requirements for a fracture to be classified as simple?

A

undisplaced
overlying periosteum is intact

178
Q

what are the requirements for a fracture to be classified as compound?

A

fracture has perforated through overlying periosteum

179
Q

what are the requirements for a fracture to be classified as comminuted?

A

fracture pattern has multiple fracture lines
bone broken into multiple small fragments

180
Q

what will attachment of the lateral pterygoid muscle mean in a guardsman’s fracture of the mandible?

A

attaches to the condyle, contracts to drag the condylar head inwards causing medial displacement of coronoid process

181
Q

If a condylar fracture with displacement is not treated, what will happen?

A

Shortening height of mandible
Shorter on one side
Open bite on opposite side

182
Q

What could complete immobilisation of mandible in an intracapsular condylar fracture cause?

A

Ankylosis of joint - trismus

183
Q

How is a paediatric green stick fracture of mandible managed?

A

Splints

184
Q

Why is surgery in paediatric condylar fractures avoided?

A

Risk to condylar growth plate

185
Q

What is the ideal management of le fort fractures?

A

ORIF

186
Q

What is often seen (dentally) on a panfacial fracture?

A

Loss of occlusal relationship

187
Q

What is the first step of ‘inside-out’ approach when treating a panfacial fracture?

A

Reconstruct maxillary mandibular unit

188
Q

What clinical indications (3) might there be that there is maxillary sinus involvement on a zygomatic fracture?

A

Epistaxis - nose bleed
Subcutaneous emphysema
Buccal sulcus ecchymosis

189
Q

What causes subconjunctival haemorrhage?

A

Bleeding from the conjunctival or episcleral blood vessels into the subconjuctival space

190
Q

What is opthalmoplegia and how would this be recognised clinically?

A

Entrapment of muscles in the eye
Trouble looking in one specific direction

191
Q

What will attachment of the lateral pterygoid muscle mean in a guardsman’s fracture of mandible?

A

Attaches to the condyle, contracts to drag the condylar head upwards and inwards causing medial displacement of coronoid process

192
Q

What does the anatomy of the mandible cause 1/3rd of all fractures to have?

A

2 breaks

193
Q

When is a bucket handle fracture of the mandible common?

A

Edentulous mandible

194
Q

When might we see intramural bleeding on a zygomatic fracture?

A

If fracture extends to maxillary buttress

195
Q

How can we tell if a zygomatic fracture has extended to the maxillary buttress?

A

Palpate intraorally

196
Q

During a zygomatic fracture, if the pt blows their nose and there is a rapid and painful swelling of one cheek, what might this indicate?

A

Maxillary sinus disruption

197
Q

What can be used to reconstruct mandibular fractures, especially when there are multiple present?

A

CBCT

198
Q

What 4 factors will determine the amount of displacement in a mandibular fracture?

A

Pattern of fracture
Degree of comminution
Teeth in fracture line
Muscle pull

199
Q

What effect can teeth in a fracture line sometimes have?

A

Keep the fracture together

200
Q

Where is the incision made for oral approach during reduction of zygoma?

A

Intraoral vestibular incision

201
Q

Where is incision made for the Gillies Temporal approach?

A

2cm in hairline

202
Q

Which artery do we have to be careful not to touch during the Gillies temporal approach?

A

Superficial temporal

203
Q

Which 2 instruments are used in the gillies temporal approach?

A

Bristow
Rowe

204
Q

Where are the 3 main points of fixation in a zygomatic fracture?

A

Frontozygomatic suture
Zygomaticomaxillary buttress
Infraorbital region

205
Q

What are most complications of zygomatic fracture management linked with?

A

Injuries with eye

206
Q

What is the incidence of superior orbital fissure syndrome?

A

0.3-0.8%

207
Q

What does the inferior orbital fissure contain?

A

Oculomotor nerve
Abductees nerve
Nasocillary nerve
Inferior orbital vein

208
Q

What nerve damage results in opthalmoplegia?

A

Occulomotor
Trochear
Abductees

209
Q

What nerve damage results in ptosis?

A

Superior branch of oclulomotor

210
Q

What is ptosis?

A

Decreased tension of the extraocular muscles

211
Q

What is my mydriasis?

A

Fixed dilated pupil

212
Q

what nerve damage causes anaesthesia of the forehead/upper eyelid

A

Lacrimal + frontal branches of trigeminal V1 - ophthalmic

213
Q

If a mandibular fracture is undisplaced, what might be one of the only clinical signs?

A

Small gingival laceration or tear

214
Q

What is a tx possibility if a mandibular fracture is undisplaced with no mobility?

A

Heal without further management

215
Q

What does it mean if there is any mobility of a mandibular fracture?

A

Margins are constantly moving and not given any other time to heal
Needs further management

216
Q

What is the most common material used for fixation now?

A

Titanium plates + screws

217
Q

What is another more expensive option for fixation?

A

Resorbable plates + screws

218
Q

What is the name for drilling holes distant from fracture site and then threading wires across to bind them together?

A

Wire osteosynthesis

219
Q

What causes mal/non union of a mandibular fracture?

A

Mobility of fracture

220
Q

What is the incidence of infection post mandibular fracture?

A

0.4-32%

221
Q

What might cause a numb lip after mandibular fracture?

A

Damage to IAN or mental though tx or injury

222
Q

What happens if a plate becomes exposed?

A

Have to remove

223
Q

What would be done if a mandibular fracture involves an 8?

A

XLA 8

224
Q

What would be done if mandibular fracture involves a 2?

A

RCT

225
Q

What are the 2 types of condylar fracture?

A

Intracapsular
Extracapsular

226
Q

Why is intracapsular condylar fracture difficult to treat?

A

Small fragements

227
Q

Which 3 mid-face bones have low tolerance to impact?

A

Nasal
Zygomatic
Maxillae

228
Q

What is the purpose of crumple zones?

A

Protect from brain injuries

229
Q

What is a dental outcome of a mid-face fracture?

A

Anterior open bite

230
Q

What are mid-face fractures usually consistent with?

A

Le fort pattern

231
Q

When would management of zygomatic fracture ideally be stared?

A

A week or so

232
Q

Why is management of zygomatic fracture not started after 1 month?

A

Bony healing may occur in unfavourable/unaesthetic positions so bones would have to be cut and repositioned

233
Q

Why is management of zygomatic fractures may started immediately?

A

To allow reduction of swelling and better understanding of anatomy

234
Q

What is likely in a high energy impact zygomatic fracture?

A

Comminution

235
Q

Where is force applied for a le fort 3 fracture?

A

Level of orbits

236
Q

What are the 3 forms of initial management of midface fractures?

A

Airway management
Haemorrhage control
Head injury assessment

237
Q

Which bone is usually displaced, and where, to cause obstruction of the airway in a midface fracture?

A

Maxilla
Brings soft palate down onto dorsum of tongue to cause obstruction

238
Q

What is the dental presentation clinically, of a le fort 1 fracture?

A

Mobility of tooth - bearing segment

239
Q

Where will a haematology appear intraorally in a le fort 1 fracture?

A

Buccal sulcus

240
Q

What is the clinical presentation of eyes in a le fort 2/3 fracture?

A

Subconjunctival haemorrhage

241
Q

Which 2 places generally have 2-point fixation after zygomatic fracture?

A

Frontozygomatic
Zygomaticomaxillary buttress

242
Q

What are 3 indications for 2-point fixation of zygomatic fracture?

A

Minimal displacement
Zygomaticomaxillary buttress remains stable after reduction
Minimal changes to orbital volume and no globe displacement on ct scan

243
Q

What radiographic assessment is usually used for mandibular fractures?

A

DPT
PA mandible - 2 views

244
Q

What might happen if a mandible fracture is not managed?

A

Permanent malocclusion

245
Q

How long after mandibular fracture should a pt receive tx?

A

72 hours

246
Q

Why is fracture of the mandible commonly prone to infection?

A

Often involves tooth or socket, exposing fracture to the commensals in the mouth

247
Q

What is significant about teeth involved in mandibular fracture and what tx do the require?

A

Rendered non-vital
Endo in primary care

248
Q

Where should a fracture of the mandible be referred?

A

Max fax

249
Q

Why would close reduction be used for non-displaced favourable fractures and minimally dispalvced condylar fractures if not severe?

A

Only short period of IMF
Used in condylar only if bilateral

250
Q

Why can we not use open technique for grossly comminuted mandibular fractures?

A

Too many pieces of bone to fit back together

251
Q

Why is closed technique used for significant loss of overlying tissues?

A

No soft tissue to cover plates

252
Q

What type of zygomatic fracture causes a subconjunctival haemorrhage?

A

Periorbital / intracranial

253
Q

When might there be altered sensation of eye during zygomatic fracture?

A

If fracture involves infraorbital margin + nerve

254
Q

when might there be numb teeth, upper lip or cheek in a zygomatic fracture?

A

If fracture involves CNV2

255
Q

Describe a bucket handle fracture of the mandible

A

Bilateral parasymphiseal fractures

256
Q

Which muscles pull the anterior segment downwards and backwards in a bucket handle fracture?

A

Mylohyoid
Genioglossus
Digastric

257
Q

What is a clear clinical sign of displacement in fracture of mandible?

A

Malocclusion

258
Q

Why might there be otorrhoea of external auditory meatus in a mandibular fracture?

A

Condylar head sits immediately in front of it and may have been driven into middle cranial fossa

259
Q

What is ‘Coleman’s sign’ in a mandibular fracture?

A

Haematoma in FOM

260
Q

Why does Coleman’s sign happen?

A

Periosteum overlying the bone has torn and haemorrhaged into tissues

261
Q

What nerve damage causes anaesthesia of cornea/bridge of nose?

A

Sensory nasocillary nerve

262
Q

What is the treatment for superior orbital fissure syndrome?

A

Conservative observation
Surgical management

263
Q

What risk comes with surgical mangement of SOFS?

A

Risk of further damage

264
Q

What is the incidence of retrobulbar haemorrhage with compartment syndrome post-zygomatic fracture?

A

1%

265
Q

What are 2 symptoms of RBA + OCS?

A

Intense globe pain
Diplopia

266
Q

What is a severe consequence of RBA + OCS?

A

Permanent loss of vision

267
Q

Describe 8 signs of retrobulbar haemorrhage with compartment syndrome?

A

Ptosis
Conjunctival haemorrhage
Subconjunctival haemorrhage
Tense globe to palpation
Reduced visual acuity
Sluggish pupil response
Relative afferent pupillary defect
Opthalmoplegia

268
Q

What are 4 non-surgical management options for retrobulbar haemorrhage with compartment syndrome?

A

Fluid deplete
Niannitol - decreases pressure
Acetazolamide - decreases pressure
Steroids

269
Q

What is the surgical management option for RBA + OCS?

A

Lateral craniotomy - surgical decompression

270
Q

What is the name for drilling one hole into solid bone with another hole in the mobile fragment and then screw engages both to pull them together?

A

Lag screw fixation

271
Q

What is the aim of reduction?

A

Reapproximare the bone to original position

272
Q

What are the 3 methods of reduction?

A

Percutaneous bone hook
Bone hook
Screw insertion to provide traction

273
Q

How does reduction using subcutaneous bone hook work?

A

Stab incision and introduction of instrument to provide traction

274
Q

How does reduction using a bone hook work?

A

Intrraoral vestibular incision and introduction of instrument to provide traction

275
Q

What are the 2 sites of approach for reduction of zygomatic fracture?

A

Oral
Gillies temporal

276
Q

What us conservative management of condylar fractures?

A

Soft diet
NSAIDs

277
Q

What would be the tx if trauma caused disruption to capsule with no breakage but inflammation of joint?

A

2 weeks of NSAIDs

278
Q

What is the name for trauma causing disruption to the capsule with no breakage but inflammation of the joint?

A

TMJ joint diffusion

279
Q

What is the tx for a displaced condylar fracture?

A

ORIF

Module 7 (8 decks)

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