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BDS3 exam prep > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

management of acute OAC

A

inform patient
if small or sinus intact:
- encourage clot
- suture margins
- antibiotics?
- post-op instructions

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2
Q

management of chronic OAF

A

excise sinus tract
buccal advancement flap
OR
palatal flap
bone graft/collagen membrane

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3
Q

what are some peri-operative complications

A

haemorrhage
nerve/vessel damage
fractured root/tooth
abnormal resistance
dislocation of TMJ

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4
Q

Aims when retracting a flap

A

achieve maximal access w/ minimal trauma
protect soft tissues
no sharp angles
healing by primary intention to minimise scarring
wide based incision

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5
Q

factors influencing flap design

A
  • base wider than flap
  • trauma to interdental papilla should be minimal
  • flap margins and sutures should lie on sound bone
  • tissues should be kept moist
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6
Q

what instruments do you use to remove bone?

A

electrical straight handpiece w/ saline cooled bur (round or fissure/ tungsten carbibe)

motor driven - if turbine may lead to surgical emphysema

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7
Q

how to debride prior to a suture

A
  1. Physical
    - bone file/handpiece to remove sharp bony edges
    - mitchells/victoria currette to remove soft tissues
  2. Irrigation
    - sterile saline into socket and underflap
  3. Suction
    - aspirate under flap to remove debris
    - check socket for retained apices
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8
Q

what much retained root can be safely left in aveolar bone?

A

3mm

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9
Q

what are predisposing factors to alveolar osteitis (dry socket)

A

lower extraction (molar)
smoker
female
oral contraceptive
LA w/ vasoconstrictor

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10
Q

what are the presenting signs and symptoms of dry socket

A

severe pain radiating to ear
c/o bad taste in mouth (+odour)
pt may think you’ve left tooth in

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11
Q

management of dry socket

A
  • reassure pt & manage w/ pain relief
  • give LA to help w/ pain relief & to allow you to carry out irrigation
    -irrigate socket w/ warm saline (or sterile water) to wash out food/debris
  • encourage clot
  • pack w/ antiseptic pack (BIP) OR alvogyl
  • advise pt, salty mouthwashes
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12
Q

what are 3 nerve deficits

A

paraesthesia - tingly
dysaesthesia - unpleasnt/pain
hypo/hyperaesthesia

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13
Q

what are causes of nerve damage

A
  • crushing injuries - from forceps
  • cutting/shredding injuries - needle may hit nerve during LA
  • transection injuries - nerve lacerated during incisions
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14
Q

flap design for a surgical extraction of 45

A
  • distal relieving incision at 5 extending into attached gingivae
  • cervicular incision extending form mesial of 4 to distal of 5
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15
Q

list haemostatic control

A
  • use LA w/ vasoconstrictor
  • pressure w/ finger OR damp gauze
  • diathermy
  • suture
  • artery forceps
  • bone wax
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16
Q

what can cause prolonged bleeding post XLA

A
  • vasoconstricting effects of LA worn off
  • sutures are loose
  • Pt has traumatised area w/ tongue/finger/food
  • Pt has bleeding disorder
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17
Q

what is surgicel?

A

a haemostatic agent.
it is an oxidised cellulose. it acts as a framework for clot formation

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18
Q

how would you management a maxillary tuberosity fracture?

A

If SMALL
- could potentially LEAVE IT
- remove fragement(s)
- reduce and stabilise
- close wound
- treat with ab

If LARGE
- stabilise mobile part(s) of bone w/ rigid fixation techniques e.g. splinting, arch bars for 4-6 weeks
- remove/treat pulp
- treat w/ ab
- remove tooth 8 weeks later

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19
Q

indications for extractions

A

gross caries
advanced perio
tooth/root fracture
severe tooth surface loss
pulpal necrosis
apical infection
symptomatic partially erupted
traumatic position
orthodontic purposes
interference with denture construction

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20
Q

what are the mechanical principles for tooth elevation. the 3 basic modes of action

A

wheel and axle
lever
wedge

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21
Q

what can cause difficult access during a XLA

A
  • trismus
  • reduced aperture of mouth (congenital/syndromes - microstomia; scarring)
  • crowded/malpositioned teeth
22
Q

what can cause abnormal resistance during XLA

A
  • thick cortical bone
  • shape/form of roots
  • number of roots
  • hypercementosis
  • ankylosis
23
Q

what are the most common places you can fracture of the alveolar bone

A

buccal plate
canine
molars

24
Q

steps to follow, following a jaw fracture

A

inform pt
post-op radiograph
refer?
ensure analgesia
stabilise
if delay, antibiotic

25
Q

what are risk factors of causing involvement of maxillary antrum during XLA

A
  • extraction of upper molars/premolars
  • close relationship of roots to sinus on radiograph
  • last standing molars
  • large bulbous roots
  • older patient
  • previous OAC
  • recurrent sinusitis
26
Q

what are the stages of surgery (generally)

A

anaesthesia
access
bone removal*
tooth division*
debridement
suture
achieve haemostasis
POI/POM

*as necessary

27
Q

what are the main risks and complications when carrying out XLA

A

pain
bleeding
swelling
bruising
infection
dry socket
retained roots
OAC
further procedures
damage to adjacent teeth and structures

28
Q

aims of suturing

A

position tissues cover bone
prevent wound breakdown
achieve haemostasis
encourage healing by primary intention

29
Q

types of sutures

A

non absorbable
absorbable
+
monofilament
polyfilament

30
Q

when removing the 3rd molar what are nerves that can be damaged

A

lingual*
inferior alveolar*
mylohyoid
buccal

*most common

31
Q

mechanistic action of ASPIRIN

A

inhibits cyclooxygenase - reduced production of prostaglandins
+
aspirin inhibits COX1 = inhibition reduces platelet aggregation

32
Q

what groups of people do you NOT give aspirin to

A

peptic ulcer
haemophilia
children <16
hypersensitivity

33
Q

what groups of people should you be cautious of giving ibuprofen to

A

previous active peptic ulceration
elderly
pregnancy/lactation
renal/cardiac/hepatic impairment

34
Q

mechanistic action of paracetamol

A

blocks feedback mechanism - indirectly reduced PG synthesis

35
Q

how do opiods act on the body

A

act on spinal cord - dorsal horn pathways - central regulation of pain

produced effects via specific receptors

36
Q

reasons for teeth fracturing during XLAs

A

thick cortical bone
root shape
root number
hypercementosis (wide apex)
ankylosis
caries
alignment

37
Q

define neuropraxia

A

focal segmental demyelination at the site of injury without disruption of axon continuity and its surrounding connective tissue

results in blockage of nerve conduction and transient weakness or paresthesia

38
Q

define axonotmesis

A

nerves are stretched. the axon is disrupted in its myelin sheath.

39
Q

define neurotmesis

A

complete loss of nerve continually/nerve transected

40
Q

common post extraction complications XLA

A

pain/swelling/ecchymosis
trismus
haemorrhage
nerve damage - prolonged effects
dry socket
sequestrum
infected socket
chronic OAF/root in antrum

41
Q

less common post-op complications

A

osteomyelitis
ORN
MRONJ
actinomycosis
bacteraemia/ infective endocarditis

42
Q

management of post-op bleeding

A

pressure - finger/biting on damp pack
LA with vasoconstrictor
haemostatic aids e.g. Surgicel, bone wax in socket
suture socket
ligation of vessels/diathermy if available

43
Q

what would you do if you cannot arrest haemorrhage?

A

URGENT REFERRAL
weekdays - dental hosp
weekends - A&E

44
Q

why is it important to remove any sequestrum

A

it prevents/delays healing

45
Q

what are predisposing factors to osteomyelitis

A

odontogenic infection and fractures of mandible

46
Q

what causes involucrum

A

Involucrum formation typically indicates chronic osteomyelitis. this is an inflammatory reaction

it appears radiographically as an increase in radiodensity surrounding the radiolucent area

47
Q

Treatment of Osteomyelitis

A

Antibiotics (if severe, may require hosp admission and IV Ab)

Surgical treatment:
- drain pus if possible
- remove any non vital teeth in area of infection
- in fractured mandible, remove any wires/plates/screw in the area
- corticotomy
- perforation of bony cortex
- excision of necrotic bone

48
Q

ORN prevention

A
  • scaling/chlorhexidine prior to extraction
  • careful extraction technique
  • Ab, chlorhexidine + review post op
  • Hyperbaric Oz to increased local tissue oxygenation + vascular ingrowth to hypoxic areas before and after XLA
49
Q

ORN treatment

A
  • irrigation of necrotic debris
  • Ab
  • loose sequestra removed
  • small wounds usually heal over course of weeks/months
  • severe cases - resection of exposed bone, margin of unexposed bone and soft tissue closure
  • hyperbaric oxygen
50
Q

what is actinomycosis

A

rare bacterial infection
chronic
multiple skin sinuses and

BDS3 exam prep (13 decks)

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