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BDS5 > Oral surgery > Flashcards

Oral surgery Flashcards

1
Q

What are the nerves that innervate maxillary aspects?

A
  • Trigeminal nerve (maxillary)
  • Superior alveolar nerve
  • Greater palatine nerve
  • Lesser palatine nerve
  • Nasopalatine nerve
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2
Q

What are the mandibular nerves?

A
  • Trigeminal nerve (mandibular)
  • Inferior alveolar nerve
  • Mental nerve
  • Lingual nerve
  • Long buccal nerve
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3
Q

What LA contains no adrenaline?

A

Prilocaine
- Contraindicated 3rd trimester of pregnancy

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4
Q

What considerations would you have treating a patient with heart conditions?

A

Angina, ischaemic heart disease
o GA risk

Congenital heart disease
o Infective endocarditis

Heart failure patients
o Orthopnoea – needs to be sitting up

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5
Q

What to do if patient has asthma?

A
  • Salbutamol
  • Give them their pump
  • Avoid if severe asthma
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6
Q

When would you avoid giving NSAIDs

A
  • severe Asthmatic
  • Warfarin/ bleeding risks (NOAC)
  • Peptic stomach ulcers
  • Pregnant
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7
Q

What are NSAIDs?

A
  • Non Steroidal anti inflammatory drugs
  • inhibit Cox-1/2
  • diclofenac/ aspirin/ ibuprofen
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8
Q

What does oedema mean?

A
  • Swelling due to fluid build up
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9
Q

What do you need for consent to be valid

A
  • voluntary
  • Informed
  • Capacity
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10
Q

Why is LA less effective in infected areas?

A
  • Lower pH
  • More vascularity
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11
Q

Problems that can be caused when injecting LA

A

Haematoma
o Laceration of vein causing swelling
o Reassure if happens

Intravascular injection
o Aspirate
o Tachycardia, temp blindness

Trismus
o Intramuscular injection
o Vascular bleed

Facial paralysis
o Into parotid gland
o Eye dropping

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12
Q

What things would indicate high risk of OAC?

A
  • Close to the anatomical floor
  • Lone standing molar
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13
Q

What to do if fractured tuberosity?

A
  • Leave in situ
  • Splint the tooth and bone
  • Re-attempt a surgical in 6-8 weeks
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14
Q

What is dry socket and incidence

A
  • Otherwise known as alveolar osteitis
  • Post extraction pain 3% incidence 20% incidence surgically extracted
  • Localised pain 2-3day after
  • Blood clot isn’t maintained.
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15
Q

What are pre-disposing factors of dry socket?

A
  • Poor OHI
  • Extraction trauma
  • Smoking
  • Site – more common in the mandible
  • Systemic – oral contraceptive use
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16
Q

How would you manage dry socket

A
  • Reassure
  • Irrigate with saline/chlorhexidine
  • Dress socket with Alvogyl
  • Enforce ohi
  • Analgesics
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17
Q

Aims of raising a flap

A
  • Gain access
  • Maintain blood supply
  • Avoid gingival scaring
  • Avoid nerves
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18
Q

Types of flaps?

A
  • Envelope flap
  • 2 sided flap
  • 3 sided flap
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19
Q

Intra oral suturing types

A
  • Single interrupted suture
  • Simple continuous suture
  • Vertical mattress suture
  • Horizontal mattress suture
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20
Q

What are the suture material types?

A
  • Absorbable vs Non-absorbable
  • Braided vs monofilament
  • Vicryl or vicryl rapide is braided
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21
Q

What should you consider when giving paracetamol

A
  • May use with NSAID due to anti-inflammatory
  • Cautious with liver disease patients
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22
Q

What adverse effects of NSAIDs

A
  • Cardiovascular patients, asthmatics
  • history of GI bleed/ ulceration Avoided of inflammatory bowel disease
  • Gastrointestinal bleeds (overcome by selective cox-2 nsaids)
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23
Q

What is the analgesic ladder?

A
  • Weak opoids such as codeine
  • Strong opoids such as morphine
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24
Q

What are side effects of opioids?

A
  • Constiapation
  • Tolerance
  • Physical dependence
  • Nausea and vomiting
  • Respiratory depression
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25
Q

What is the ASA classification

A
  • Asa 1 – healthy
  • Asa 2 – mild systemic disease
  • Asa 3 – severe systemic disease
  • Asa 4 – severe systemic disease where there is a constant threat to life
  • Asa 5 – patient that is going to die without operation
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26
Q

What is conscious sedation

A
  • Drug that produces a state of depression
  • Patient is in verbal contact
  • Can protect themselves
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27
Q

What is the problem of patient taking recreational drugs for sedation

A
  • Adverse reaction and unpredictable
  • Anxious and aggressive
  • 72hours before must stop
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28
Q

Contraindications for IVS

A
  • Allergy to benzodiazepines
  • Poor venous access
  • Co-morbidities
  • Pregnancy
  • Impaired liver or kidney
  • High bmi
  • Respiratory disease
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29
Q

What drugs used in IVS

A
  • Midazolam
  • Flumazenil – reversal agent
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30
Q

Indications for GA

A
  • Extensive procedure – over 40 mins ish
  • Very anxious patient
  • Uncooperative patient
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31
Q

Contraindications for GA

A
  • High bmi (over 30)
  • Significant comorbidities
  • Allergies to the drug
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32
Q

Definition of general anaesthesia

A
  • State of controlled unconsciousness
  • Patient feels nothing.
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33
Q

What are common side effects of GA

A
  • Nausea, sore throat, fainting, memory loss
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34
Q

Categories of bleeding disorders

A
  • Vascular disorders – changes in capillaries
  • Thrombocytic disorders – decreased platelet, changes in the function of platelets
  • Disorders of coagulation – deficiency of certain coagulation factors (haemophilia A&B)
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35
Q

What is thrombocytopenia?

A
  • Concentration of platelets are abnormally low (below 50x10^9)
  • Reasons can be:
    o Bone marrow doesn’t produce enough
    o Platelets are trapped in an enlarged spleen
    o Increased destruction of platelets
    o Increased use of platelets
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36
Q

What is Von Willebrand disease

A
  • Congenital bleeding disorder
  • vWF protein stabilises factor 8
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37
Q

what is haemophilia

A
  • type A Is defficiency of factor 8
  • type B is deficiency of factor 9
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38
Q

what is tranexamic acid

A
  • prevents fibrin clot lysis
  • way of managing bleeding
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39
Q

local measures to control bleeding

A
  • local pressure with gauze
  • Suture
  • Haemostatic agent (oxide cellulose – surgical)
  • Local anaesthetic with adrenaline
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40
Q

What is MRONJ

A
  • Medication related osteonecrosis of the jaw
  • Bisphosphates and denosumab (RANKL inhibitor)
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41
Q

Risk factors for MRONJ

A
  • Duration of prescription: Oral BP over 3/4 years
  • Procedure that exposes bone
  • Mandible > Maxilla
  • Poor OH
  • SDCEP Guidelines
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42
Q

What are the stages of MRONJ

A
  • Stage 0 – non specific clinical findings, radiographic changes
  • Stage 1 – exposed and necrotic bone, but asymptomatic
  • Stage 2 – exposed bone with infection
  • Stage 3 – exposed bone and infection with another issue
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43
Q

Who are low risk of MRONJ

A
  • Medication for less than 4 years
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44
Q

Who are high risk of MRONJ

A
  • Long term medication user
  • Previous diagnosis of MRONJ
  • Conditions affect the bone
  • Systemic corticosteroid/ immunosuppressed
  • SDCEP guidelines
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45
Q

Management of MRONJ patient

A
  • Prevention advice
  • Check with their GDP
  • Avoid traumatic extraction and 8 week follow up appointment
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46
Q

What are the paranasal sinus

A
  • Frontal sinus
  • Ethmoidal cells
  • Sphenoidal cells
  • Maxillary sinus
47
Q

What are the functions of the sinus

A
  • Moisten the air
  • Warms air
  • Lighten skull
  • Resonance
  • Immunological for upper respiratory tract
48
Q

What is the definition of OAC

A
  • Communication between mouth and sinus
  • Higher incidence in males, 3-4th decade
49
Q

Pre-disposing factors of OAC

A
  • Relationship of tooth to antrum
  • Submerged teeth
  • Large antrum
  • Lone standing tooth
  • Increasing Age
  • Hypercementosis
  • Loss of bone
  • Excessive force
50
Q

OAC clinical diagnosis

A
  • Hollow sound with sucker
  • Bubbling bleeding
  • Air entry into mouth holding nose (not recommended)
  • Bone/antral lining on the roots when extracting
  • Radiograph shows a defect in antral floor
51
Q

Treatment of OAC

A
  • Prevention better
  • Treat before infection from mouth gets into
    antrum
  • Treatment depends on size
    o Small: suture
    o Large: buccal advancement flap, palatal rotational flap
  • Can place acrylic plate.
  • Antral regime
52
Q

What not to do as part of the antral regime

A
  • Smoke for 72 hours
  • Blow your nose forcefully, ( don’t hold sneeze)
  • Don’t use straws or whistle or blow balloons, percussion instruments
  • Go flying for next 4-6 weeks
53
Q

What do you do as part of antral regime?

A
  • Antrum should be clean (antibiotics look at FGDP antibiotic prescribing not recommended)
  • Use nasal decongestants – reduce degree of swelling of nasal lining and reduces risk of sneezing
    o Beware of rebound congestion (after 7-10 days of decongestant use)
  • Use steam inhalation (olbas oil)
  • Chlorhexidine mouthwash to reduce oral bacterial load.
54
Q

When to use immediate or delayed closure?

A
  • Size of defect
    o Larger defects – ideal to close at time to stop sinus contamination and nasal regurgitation
  • Experience level
  • Will it heal spontaneously?
  • Quality of tissues – inflamed then delay.
55
Q

How to do surgical closure

A
  • Incision around the fistula and excise
  • Incision of the buccal mucosa to create 3 sided flap
  • Subperiosteal release to allow flap to advance over the hole
  • Use of Vicryl suture
  • Or palatal rotational flap
    o Dressing the palate (Coe pak on dressing plate)
56
Q

What is oral-antral fistulae (OAF)

A
  • OAC that has epithelialized
  • Not present immediately after extraction
57
Q

What are the signs and symptoms of OAF

A
  • Regurgitation of fluids/food into the nose
  • Nose bleed
  • Chronic sinusitis
  • Antral mucosa prolapse into the mouth
  • Fluid in sinus shown on the radiograph
58
Q

What increases risk of fracture of tuberosity?

A
  • Lone standing molar
  • Hypercementosis
  • Bulbous roots
  • Splayed roots
  • Large antrum
  • Excessive force
59
Q

What to do on fractured tuberosity management

A
  • Small
    o Raise a flap
    o Dissect fractured bone
    o Close previous OAC
    o Antral regime
  • Large
    o Leave and allow to heal for 8 weeks
    o Splint
60
Q

What to do when displaced roots

A
  • Prevention is key
  • Attempt to remove with suction first
  • 2 radiographs to parallax where they are
  • GA for removal (Caldwell Luc procedure)
  • Placed on an antral regime
61
Q

What is acute sinusitis

A
  • Decreased drainage and increased infection
  • Pre-disposing factors
    o Poor drainage
    o Deviated septum
62
Q

What are the signs of sinusitis?

A
  • Nagging pain over mid face
  • Pyrexia, tenderness
  • Mucopurulent discharge
  • Facial swelling, cheek oedema
  • Teeth TTP but vital
  • Radiographic opacity
63
Q

Acute sinusitis treatment?

A
  • Bed rest and antibiotics
  • Nasal decongestants and inhalations
  • Surgical
    o Antral washouts for antrum
64
Q

What is the complication of acute sinusitis

A
  • Spread to other sinuses
  • Laryngitis
  • Chronic recurrence
65
Q

What symptoms chronic sinusitis

A
  • Mucopurulent discharge
  • Thickened antral mucosa
  • Nasal obstruction
  • Opacity on the radiograph
  • Treatment same as acute
66
Q

What other conditions affect sinus

A
  • Atypical facial pain
  • Myofascial pain
  • Dental pain
67
Q

What is indications of extractionof 8s

A
  • Unrestorable caries/ causing caries in the 7
  • Pulpal/periapical pathology
  • Cellulitis, abcess
  • Resorbtion of tooth or adjacent tooth
  • Pericoronitis
68
Q

What is Pericoronitis

A
  • Soft tissue inflammation related to the crown of partially erupted tooth
  • Streptococci and anaerobic bacteria present
69
Q

What is the incidence of pericoronitis?

A
  • 70% of partially erupted third molar
  • Stress and immunocompromised patient will get more
70
Q

What is acute pericoronitis diagnosis?

A
  • localised Pain and swelling
  • Radiation of pain
  • Severe cases: trismus and facial swelling
  • Lymphadenopathy
  • Swollen operculum
71
Q

What is chronic pericoronitis

A
  • Pus exuding beneath operculum
  • Radiographic signs of enlargement of the pericoronal space
72
Q

What is the management of pericoronitis

A
  • Irrigate the operculum
  • Chlorhexidine mw
  • Ohi and single tuft brush
  • Grind the opposing third molar / extract
  • Antibiotic if systemic
    o Temp and unwell
    o Difficulty swallowing
    o Fgdp guidelines
    o 1st line metronidazole 400mg Tds 5 days
    o 2nd line amoxicillin 500mg tds 5 days
  • Extract if one severe or multiple episodes (NICE guidelines)
  • Remove operculum?
73
Q

How to tell issues with IDN nerve in the radiographic

A
  • Diversion of the canal
  • Darkening of the root (banding)
  • Interruption of the white tram line
74
Q

What’s the radiation dose of a CBCT compared to OPT

A
  • 10x more radiation
75
Q

What are the indications for CBCT?

A
  • Third molar surgery and decision for corenectomy cant be made from the original x ray
76
Q

What is Coronectomy

A
  • Removal of the crown
  • High risk of id nerve damage
  • Infection and caries are contra-indications
  • No enamel to be left in situ
  • If roots mobilised proceed to removal
77
Q

What is the incidence of permanent damage

A
  • 0.2% tongue
  • 0.5% lip and chin
78
Q

What are the characteristics of benign lesions

A
  • Excessive accumulation of cells
  • Do not invade surrounding tissues
  • Does not metastasize
79
Q

What are the indication of removal of benign cyst

A
  • Pain
  • Function
  • Aesthetics
  • Continual growth
  • Pressure on adjacent structures
  • Damage to adjacenet structures including roots
  • Infection
80
Q

What are the surgical methods of removing cyst

A
  • Excisions
  • Curettage
  • Enucleation
  • Marsupialisation
81
Q

What is a cyst of the jaw?

A
  • Closed ‘sac like’ pocket of tissue
  • May be filled with fluid, air, pus or other material
  • Usually benign
  • Expand via osmotic tension
82
Q

What’s the classification of cysts

A
  • Odontogenic vs non-odontogenic
  • Odontogenic
    o Developmental
    o Inflammatory
    o Neoplastic
  • Non-odontogenic
    o Developmental
    o No epithelial lining
83
Q

What is the management of cysts of the jaw

A
  • Enucleation – surgically remove intact from surrounding capsule
  • Curettage – scrapping
  • Marsupialisation
84
Q

What is enucleation

A
  • Removal of the lesion with the lining
  • Complete healing of cyst and healing
  • Complete lining available for histopathology
  • Disadvantages
    o Clot can become infected
    o Incomplete removal
    o Damage of structures
85
Q

What is marsupialisation

A
  • Decompression of the cyst by creating a surgical window
  • Relieves intracystic pressure
  • Needs to be kept clean
  • Less damage to structures compared to enucleation
  • Disadvantages
    o Pateient needs to keep area clean
    o Whole lining not available
    o Several visits
    o Bony infil may not occur
86
Q

What are the advantages and disadvantages of using laser

A
  • Advantages
    o Dry surgical field
    o Reduction in blood loss
  • Disadvantages
    o Cost
    o No pathology sample
87
Q

What are the advantages and disadvantages of cryotherapy

A
  • Advantages
    o No cutting involved
    o Tissue intact at the end so no bleeding
  • Disadvantage
    o No pathology specimen
    o Cost of equipment
    o Ulceration post op
88
Q

What is leukaemia?

A
  • Blood cancer
  • Patients may be anaemic, hepatitis B or C or HIV
  • Dental treatment should be postponed
  • Infections should be treated aggressively
  • NSAIDs should be avoided
89
Q

What is lymphoma

A
  • Hodgkin’s and non-Hodgkin’s lymphomas present as enlarged cervical lymph nodes
  • Management similar as leukaemia
90
Q

What does haemostasis consist of

A
  • Vessel constriction
  • Platelet plug formation
  • Coagulation cascade
91
Q

Should bleeding disorder patient have a local anaesthetic block?

A

? I think it should be avoided

92
Q

What is anticoagulant therapy used for and warfarin MOA

A
  • Prevention of venous thrombosis in heart disease patient
  • Stroke prophylaxis
  • Warfarin: inhibits vitamin K dependent synthesis
  • Measured in prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT)
  • INR is also looked at: 1 is normal and patients taking anticoagulants usually in the range 2-4
  • INR should be measured within 24 hours of surgery
  • Local haemostatic measures necessary
  • Medical emergency in hospital is slow vitamin K drip or fresh frozen plasma
  • Contraindications
    o Metronidazole interacts with warfarin (erythromycin instead)
    o Amoxycillin interferes less with warfarin
    o Aspirin and other NSAID (lesser extent) should be avoided
    o Warfarin not usually effected by paracetamol
93
Q

Name a NOAC which is a Factor Xa inhibitor

A
  • Rivaroxaban
    o 1 daily, rapid onset
  • Apixaban
    o 2 daily, rapid onset
  • Edoxaban
94
Q

Name a NOAC which is a direct thrombin (factor IIa) inhibitor

A
  • Dabigatran
  • 2 times a day, rapid onset
95
Q

What is the procedure for NOACs in OS

A
  • Low risk of bleeding
    o Continue medication as normal
  • High risk of Bleeding
    o Miss (apixaban, dabigatran)
    o Delay rivoroxaban
  • Appointment early in the week and day
  • Heamostatic measures
    o Oxidised cellulose mesh and suture
96
Q

Name some antiplatelet mediations

A
  • Aspirin
  • Clopidogrel
  • Dipyridamole
97
Q

What is the management of patients on antiplatelet medication

A
  • Max of three extraction
  • Haemostatic measures
  • Aspirin + clopidogrel taker should be referred
  • platelets have a long half life (1 week)
98
Q

What are the issues with patients with hepatic disease

A
  • Clotting problems
  • Drug metabolism impairment
99
Q

What is reactive haemorrhage?

A
  • After effects of LA
  • Several hours later
  • Not very common
100
Q

What is secondary haemorrhage

A
  • Caused by secondary infection of clot
  • Occurs several days later
  • Relatively rare
101
Q

What are the salivary glands?

A
  • Parotid gland
  • Submandibular glands
  • Sublingual gland
  • Minor salivary glands (600-1000)
102
Q

What is the MRONJ Diagnostic criteria

A
  • Current or previous treatment with anti-resorptive or anti-angiogenic medication
  • Exposed bone that can be probed through an intra-oral/extra-oral fistula that last more than 8 weeks
  • No history of radiotherapy
  • No obvious metastatic disease of the jaw
103
Q

Name some drugs cause MRONJ

A
  • Bisphospanates (anti-resorptive)
  • Zoledronate
  • Denosumab (RANKL)
  • Sunitinib
104
Q

What are bisphosphonates and how they work

A
  • Inhibit resorption of the bone
    o Osteoclastic apoptosis
  • High affinity for bone
  • Long half life
  • Alendronic acid
105
Q

What can you tell about Denosumab

A
  • RANKL inhibitor
  • Osteoclast function stopped
  • Does not bind to bone
  • Effects diminished after 6 months
106
Q

What are anti-angiogenic drugs

A
  • Interfere with formation of new blood vessels
  • Treat cancers
  • Bevacizumab
107
Q

Whats good to do pre anti-resporptive/angiongenesis drugs

A
  • Extract poor prognosis teeth
  • Good OHI
  • Smoking cessation
  • Fix dentition
108
Q

How would you treat MRONJ

A
  • Pain management
  • Antibacterial mouthwash (secondary infection)
  • Potential debridement
109
Q

What are factors that affect socket healing

A
  • Local
    o Inflammation
    o Foreign bodies
    o Radiation exposure
  • Systemic
    o Medications
    o Diabetes
    o Smoking
    o Deit/nutrition
110
Q

What is osteomyelitis

A
  • Inflammation of the bone cortex
  • Usually as a result of spread of infection
  • Management
    o Pus sample/swab
    o Radiograph, CT
  • Chronic osteomyelitis
    o AB bead treatment
111
Q

What is osteoradionecrosis?

A
  • Defined as non-healing region of devitalised bone in radiated field, persists for over 3 months
  • 3 stages
    o 1 is confined to the alveolar bone
    o 2 is alveolar bone and mandible above the mandibular canal
    o 3 under the level of the mandibular canal with pathological fracture or skin fistula
  • Treatment
    o Prophylactic extraction
    o Dietary change and fluoride advice
  • antibiotics: tacpherol, pentoxifylin
  • hyperbaric oxygen therapy
112
Q

Where can an alveolar abscess originate from?

A
  • Periapical periodontitis
  • Pericoronitis
  • Periodontal disease (periodontal abscess)
113
Q

What is an operculectomy

A
  • Surgical excision
  • May regrow or damage lingual nerve
114
Q

What are contra-indications of a Coronectomy

A
  • Carious tooth
  • Apical pathology
  • Mobile tooth
  • Medical history and risk of infection, IE

BDS5 (10 decks)

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