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BDS4 EXAM PREP > Oral surgery > Flashcards

Oral surgery Flashcards

1
Q

basic functions of LA

2

A

prevent pain
reduce bleeding

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2
Q

how does LA work

A

blocks voltage gates Na channels
LA binds to site in Na channnels and blocks it
* preventing Na influx

this blocks action potential generation and propagation

blocks presist as sufficient number of channels are blocked

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3
Q

LA affects which type of axons

A

smaller diamter axons have fewer Na channels and are more suceptible to LA block
* e.g. A delta, C, A beta then A alpha

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4
Q

where are the sodium channels on a nerve

A

concentrated of nodes of Ranvier in myelinated axons

LA needs to act on several aong the axon

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5
Q

ester type LA

A

benzocaine
procain
cocaine

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6
Q

amide type LA

A

lidocaine
articane
prilocaine
bupivicaine
mepivicaine

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7
Q

vascocontrictors
purpose

A

acts locally to constrict Blood vessesl
reduce bleeding and blood flow to help increase duration LA works by holding LA in tissue (prevent wash out)

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8
Q

types of vasoconstricors in LA

2

A

adrenaline
felypressin

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9
Q

types of topical LA (2)
function

A

2% lidocaine gel
20% benzocaine

superficial soft tissue manipulation and surface anaesthesia

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10
Q

infiltration of LA

A

LA deposited beside nerve branches

inject distal to apex of tooth into mucogingival fold

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11
Q

nerve block

A

LA deposited beside nerve trunk
abolishing sensation distal to site

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12
Q

IDB technique

A

landmarks - pteygomandibular raphe, buccal fat pad, thumb on coronoid notch, fingers on external posterior border of mandible

needle advance from contralateral premolars, inject in 1cm above occlusal plane, advance till contact bone, withdraw slightly aspirate and deposite 2/3, 1ml/30secs
withdraw and deposit last 1/3 to get lingual nerve

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13
Q

how to check for numbness

A

ask pt - rubberly, tingle, numb, swollen, fat

IDB - to midline lip, inc tongue, buccal gingiva

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14
Q

complications of LA

A

failure
prolonged (temporary/permanent)
pain during/after
trismus
hametoma
intra-vascular
blanching
facial palsy - into parotid - CNVII
broken needle
interaction with other drugs
toxicity
soft tissue damage

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15
Q

how to manage facial palsy

A

test if brow can be raised/close eyes and raise arms - assess if stroke

reassure pt not stroke
cover eye with patch - no blink reflex

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16
Q

other LA techniques

not infiltration or block

A

palatal anaesthesia - chasing
intraligamentary
intraosseous
intrapulpal
Gow gates
akinosi

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17
Q

lidocaine max dose

A

4.4mg/kg

2.2% 1:80,000

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18
Q

articaine max dose

A

5mg/kg

4% 1:80,000

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19
Q

prilocaine

A

5.0mg/kg

4% - plaiin; 3% - octapressin

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20
Q

contraindication for felypression/octrapressin

A

pregnancy

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21
Q

functions of paracetamol

A

analgeisa
antipyretic

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22
Q

max dose of paracetamol

A

4g/day

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23
Q

cautions for paracetamol

A

hepatic/renal impairment
alcohol dependent

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24
Q

how does aspirin work

A

non selective cox inhibitor that reduces production of PGs by inhibiting COX-1 and COX-2

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25
Q

functions of asipirn

2

A

antiplatlet
anti-inflammatory

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26
Q

contrindications for aspirin

7

A

Peptic ulcer disease
<16yrs (reye’s)
asthamtics
other NSAIDs
bleeding problmes
pregnant
steroids

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27
Q

functions of ibuprofen

A

analgesic
anti pyretic
anti-inflammatory

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28
Q

max dose ibuprofen

A

2.4g/day

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29
Q

contraindications for ibuprofen

5

A

peptic ulcers
pregnant
other NSAIDs
long term steroids
renal/cardiac/hepatic impairment

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30
Q

diclofenac

A

prescription only NSAID
more potent

max dose - 150mg/day

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31
Q

codeine

A

codeine and paracetaom

2mg tablets up to 15mg

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32
Q

key surgical stages

10

A

consent
anaethesiat
access
bone removal
tooth division
tooth removal/procedure
debridement
suture
haemostasis
POI and post op meds

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33
Q

ways to minimise op site contamination

A

hand hygiene/scrubbing
PPE - sterile gloves, gown, mask
no touch techique
operative site prep

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34
Q

principles of sugical access

5

A
  • maximal access with minimal trauma
  • preserve and protect soft tissues
  • healing by primary intention (minimise scarring)
  • tension-free wound closure
  • flap margins on sound bone
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35
Q

ideal flap properties

8

A
  • wide based crevicular incision using scalpel in 1 firm continous motion
  • full thickness incision to bone (through mucoperiosteum)
  • no sharp angles
  • adequate size
  • flap reflextion cleanly to bone
  • minimise trauma to papillae
  • no crushing of soft tissues
  • keep tissues moist
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36
Q

purpose of soft tissue retraction

2

A

improve access to fiel
protect soft tissues from trauma

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37
Q

soft tissue retractors

4

A

Howarths
Wards
Minnestoa
rake retractor

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38
Q

instrument and methods of bone remoavl

A

electric straigh surgical handpiece with saline cooled tungsten carbide bur (round or fissure)
air driven can cause surgical emphysema

deep narrow gutter with mesial and distal extension
allows for correct application of elevators

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39
Q

why irrigate when accessing surgical site

A

prevents heat necrosis of bone
damage to soft tissue
clogging of bur
allows field to be kept clean of debris

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40
Q

why to we perform post surgical debridement

A

to remove dead, damaged or infected tissue to improve healing potential of remaining healthy tissue

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41
Q

methods of surgical debridement

A

surgical

mechanical - bone file, handpick, mitchells trimmer, victoria currette
chemical - saline
suction

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42
Q

purpose of sutures

A

approximate/reposition tissues
compress blood vessles
achieve haemostasis
cover bone
prevent wound breakdown
encougar heaillng by primary intention

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43
Q

principles of suture technique

3

A

tension free wound closure
evert wound edges in apopsition
knot not over would -on sound bone

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44
Q

biopsy
function
types

A

surgical dx method

incisional - FNA, punch
excisional - removal whole lesion (small, obvs benign)

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45
Q

indications for cryosurgery

A

vascular malformations
mucoceles
atypical facial pain
viral warts
superfical basal cell carcinoma
post enucleation of odontgenic keratocyst

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46
Q

nerves at risk in 3rd molar surgery

4

A

inferior alveolar nerve
lingual nerve
nerve to mylohyoid
long buccal

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47
Q

unerupted tooth

A

tooth lying within jaws, entirely covered by soft tissue
and completely covered by bone

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48
Q

partially erupted

A

tooth failed to erupt fully into normal position
may not be seen but a communication with oral cavity exists

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49
Q

impacted tooth

A

tooth prevented from completely erupting into normal functional position

due to lack of space, obstruction, abnormal eruption path

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50
Q

reasons to remove 8

A

strong
* recurrent pericoronitis
* abscess
* periapical pathology
* unrestorable
* caries in 7 whcih cannot be adequately treated
* cyst/pathology formationn
* 8 causing resorption of 7

  • active/previous infection
  • medical history - (removal>retention)
  • limited access to dental care - astronaut, mariner
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51
Q

contraindications to XLA 8

A

medical history preculdes extractions - bleeding
risk of surgical complications high - IDN
likely to have successful eruption and functional tooth in future if left
deeply impacted asymp tooth

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52
Q

possible reasons for prophylatic XLA of 8

A
  • GA required for another reasons - so prevent future GA, if continual food trapping
  • medical history - starting bisphophonates, before radiothearpy, cardiac surgery
  • possible interference with implants or dentrues
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53
Q

angulation of impaction
measured against

types

A

occlusal curve of spee - angulation of 7

can be vertical, mesial, distal, horizontal, transvere, aberrant

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54
Q

depth of impaction
how it is measured

classes

A

from alveolar crest to max depth of crown

superficial - 8 crown related to 7 crown
moderate - 8 crown related to 7 crown and root
deep - 8 crown related to 7 root

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55
Q

pericoronitis

A

inflammation of soft tissues around crown of tooth
requires communication between tooth and mouth
food trapped under operculum

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56
Q

operculum

A

flap of gingivae overlying tooth

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57
Q

signs/symptoms pericoronitis

A

pain (throbbing)
swelling (red tender operculum)
pus
bad taste
ulceration
bad smell
trismus
dysphagia
lymphadenopathy
pyrexia
malaise
fever

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58
Q

management of pericoronitis

A

OHI and irrigation under operculum
ABX if systemic 200mg Metronidazole for 3 days

XLA or coronectomy of 8
or U8 if traumtising

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59
Q

possible spaces for spread of infection from lower 8

A

buccal
submasseteric
sublingual
submandibular
parapharyngeal

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60
Q

% loss of sensation after XLA 8

parathesia

A

10- 20% temprorary
<1% permanent

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61
Q

coronectomy
what
why

A

removal of crown of tooth with deliberate retention of roots

if roots appear closely involved/related to IDC on OPT or CBCT

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62
Q

risks re coronectomy

A

infection
pain
root may migrate and erupt - need another procedure
if roots mobilised need to remove whole tooth

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63
Q

contraindication to coronectomy

4

A
  • mobile tooth/root
  • non vital tooth (grossly carious)
  • where sectioning puts nerve at risk (horizontal/disto angular impaction)
  • immunocompromised pt
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64
Q

rood and shehab signs of IDC and 8s from OPT

1990

A
  • diversion of IDC
  • Diversion of roots of 8
  • interuption of tramlines of IDC
  • narrowing of IDC
  • narrowing of roots
  • juxta apical area
  • darkening of roots where cross canal
  • bifid, dark roots
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65
Q

type of epithelium in mamxillary sinus

A

pseudostratified ciliated coloumnar with globlet cells

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66
Q

function of sinus

A

voice resonance
reserve chamber for warming air
reduce weight of skull

3

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67
Q

cilia function

A

mobilise trapped particulate matter and foreign material within the sinus and move this towards teh ostia for elimiation into the nasal cavity

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68
Q

maxillary sinus opening

A

hiatus semilunaris
4mm
superior mesial border
can become blocked in infection

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69
Q

posterior wall of maxillary sinus contains

A

posterior superior alevolar nereves and vessels

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70
Q

OAC

A

an opening is created between the sinus and oral cavity

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71
Q

dx of OAC

A

direct vision
bubbling of blood
change in sound of suction
nose blowing test

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72
Q

management of OAC

A

small - <2mm encourage clost and suture
large - close with buccal advancment flap (buccal fat pad)

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73
Q

Pt POIG for OAC

A

dont dislodge clot
avoid using straws/playing wind instruments and nose blowing
WSMW from next day
decongestants/steam inhaltion

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74
Q

OAF

A

formation/creation of a pathological epithelial
chronic and occurs secondary to OAC

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75
Q

signs/symptoms of OAC

A

liquid reflux into nose
nasal speech
problems playing wind instruments
bad taste
sinusisitis like pain
minor nose bleeds

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76
Q

management of OAF

A

exision of sinus tract
closure - primary or with buccal advancement flap (with fat pad)

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77
Q

how to dx root in sinus

A

radiogrpah - OPT/occlusal

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78
Q

how to manage root in sinus

A
  • through socket - ribbon gauze, narrow bore suction
  • OAF type apprach - flap
  • caldwell luc approach
  • endoscopic retrieval

refer

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79
Q

how to manage root in sinus

A
  • leave to monitor
  • through socket - ribbon gauze, narrow bore suction
  • OAF type apprach - flap
  • caldwell luc approach
  • endoscopic retrieval

refer

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80
Q

sinusitis

A

paranasal inflammation and infection

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81
Q

symptoms of sinusistis

A

pain/pressure or altered sensation over cheeks (infraorbital region)
nasal discharge/congestion
nasal obstruction
hyposmia
heaedache
fever
fatigue
pain worsens when moving head

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82
Q

dental pain that can mimick sinusitis

need to exclude

A

TMJD
deep caries
PA abscess
perio infection
atypical facial pain
reccent extraction socket

83
Q

3 indicators sinusistis and not dental pain

A

tenderness over cheeks
diffuse maxillary tooth pain
pain that worsens with head movements

83
Q

3 indicators sinusistis and not dental pain

A

tenderness over cheeks
diffuse maxillary tooth pain
pain that worsens with head movements

84
Q

traumatic/iatrogenic causes of sinusists

A

orbital wall #
RCT apical perforation
sinus lifts/implant placements
deep perio tx
nasal packing
NG tube
mechanical ventilation
foreign object in sinus

85
Q

acute sinusitis cause

A

post Upper resp tract infection bacterial superinfection on cilia
foreign bodies

86
Q

chronic sinuisitis cause

A

foreign bodies
poor drainiage

87
Q

TMJD

A

pain associated with the TMJ and MoM

88
Q

types of TMJD

A

myofascial pain
anterior disc displacement +/- reduction
degenerative disease - osteoarthritis, rheumatoid arthritis
chronic recurrent dislocation
ankyloisis
dysplasia of joint

89
Q

causes of TMJD

A

chronic recurrent dislocation
ankyloisis
hyperplasia
neoplasia
infection
stress
psychogenic
direct/indirect trauma
parafunctional habits - bruxism

90
Q

symptoms of TMJD

A

intermittent pain
muscle/joint/ear pain particularly on waking
trismus/jaw locking
clicking/popping noises
headaches
crepitus

91
Q

differential dx for TMJD

A
  • dental pain - esp lower 8s
  • sinusitis
  • ear infection
  • salivary gland disease
  • referred pain - angina
  • headaches
  • atypical facial pain
  • trigeminal neuralgia
  • condylar fracture
  • temporal arteritis
92
Q

conservative/supportive TMJD management

A

no chewing gum
replace missing posterior teeth - balanced occlusion
supported yawning
soft diet
hot and cold compresses
massage
stress managementb - relaxation
reducing opening

phsyiotherapy - jaw exercises
hypnnotherapy
medications - analgesia, botox, steroids, anxiety
splints

93
Q

surgical TMJD options

A

arthrocentesis
arthroscopy
condlytomy
TMJ replacement

94
Q

how to image TMJD

A

OPT
US

95
Q

origin
insertion
function
temporalis

A

Origin - temporal fossa and deep temporal fascia
Insertion - Coronoid process and anterior border of ramus
Function - elevation and retrusion

96
Q

origin
insertion
function
masseter

A

Origin - temporal process of zygomatic bone and zygomatic arch
Insertion - angle and ramus
Function - elevation and protrusion

97
Q

origin
insertion
function
medial ptergoid

A

Origin - maxillary tuberosity and medial surface of lateral pterygoid plate
Insertion - medial surface of ramus and angle
Function - elevation and protrusion

98
Q

origin
insertion
function
lateral pterygoid

A

Origin - infra temporal surface of greater wing of sphenoid and lateral surface of lateral pterygoid plate
Insertion - neck of mandible (fovea) and capsule/intracapsular disc
Function - depression and protrusion

99
Q

concious sedation

A

technique which the use of a drug(s) produces a state of depression on teh CNS enabling Tx to be carried out but during which verbal contact with the pt is maintained through the period of sedation

the medications used for dental concious sedation should carry a margin of safety wide enough to render unintended loss of conciousness unlikely

pt must remain concious, retain protective reflexes and is able to understand and respond to verbal commands

100
Q

methods of concious sedation

A

IV
IS
Oral
transmucosal

101
Q

indications for concious sedation

A

ASA I or II
mild/moderate learning difficulty
moderate/severe anxiety
medical conditions aggravated by stress (epilepsy, asthama)
medical conditions that make operating difficult (parkinsons, ceral palsy)
traumatic/unpleasant procedures (SR 8)
excessive gag reflex

102
Q

contraindications to concious sedation

A

severe/uncontrolled systemic disease
severe mental disabilty
severe psychogenic problems
unaccompanied
unwilling/uncooperative
narcolepsy
hypothyroidism

103
Q

ASA classes

A

I - normally healthy
II - mild systemic disease
III - moderate systemic disease (limits activity but not incapacitating)
IV - severe systemic disease that is a constant threat to life
V - moribund patient who is not expected to survive >24hrs
VI - Declared brain-dead patient whose organs are being removed for donor purposes

104
Q

advantages inhalation sedation

A

flexible duration
rapid onset
rapid recovery
no injection required
few side effects
can be used in <12

105
Q

disadv of inhalation sedation

A

pt need to be able to nose breath with open mouth
expesive
space needed for equipement
difficulty determining actual dose administered - porblems with nose hood staying place

106
Q

indications for inhalation sedation

A

mild/mod anxiety
ASA I or II
enhanced gag reflex
trauamatic procedure
medical condisiotn aggrevated by stress
unaccompanied adult needed sedation

107
Q

contrindications to sedation

A

blocked nose/tonsilitis - unable to nose breathe
severe COPD or asthma (ASA III or more)
neuromuscular disease (MS)
pregnancy
no trained staff available

108
Q

equipment used in IHS

A

gas cyclinders - labelled and colour coded
pressure reducing valve
flow control meters
reservoid bag
gas delivery hoses
nasal hood
waste scavenging system

109
Q

procedure for IHS

A

Machine on,
mix to 100% O2, flow 5-6l/min.
Nasal hood on, patient breathe through nose,
check reservoir bag movements,
O2 reduced by 10% first min and 5% every other min until patient feels different.

Tx finished then O2 increased by 10-20% every min.
2-3mins of 100% O2 to prevent diffusion hypoxia,
nasal hood removed,
machine off

110
Q

complications of IHS

A

Over-sedation - nausea, headache, vomiting, unresponsive
Panic -

reduce sedation, reassure patient

111
Q

signs of adequate sedation

nitrous oxide

A

Relaxation, warmth, giddiness, lethargy, lessened pain awareness, slowed response to commands (but still responsive)
happy to proceed with tx

112
Q

safety feature of IHS

A

Air entrapment valve,
oxygen flush button,
oxygen monitor,
colour coding,
reservoir bag,
scavenging system,
pressure dials,
pressure reducing valve

113
Q

advantages of IV sedation

A

Good sedation and muscle relaxation,
lessened pain awareness,
easy to control/titrate,
few side effects if done properly

114
Q

disadvantages of IV sedation

A

IV cannula,
behaviour during recovery,
swallowing efficacy,
escort for 24hrs,
doesn’t address anxiety

115
Q

indications for IV sedation

A

ASA I or II,
>12yrs old,
mild/moderate anxiety,
traumatic procedure,
medical conditions aggravated by stress - e.g. tremors in cerebral palsy, Parkinson’s

116
Q

contrindications to IV

A

ASA III or IV, COPD,
<12yrs old,
pregnancy,
NM diseases (myasthenia gravis),
hepatic insufficiency, intracranial pathology

117
Q

drug and concentration for IV sedation

A

Midazolam. 1mg/ml.
1-2ml bolus then 0.5-1ml increments every 2 mins

118
Q

mech of action for midazolam

A

GABA is affected which is an Inhibitory neurotransmitter

benzodiazepines act on CNS receptors to enhance the effect of GABA, reducing neuronal excitability and prolonging time for receptor repolarisation

119
Q

side effects of midazolam sedation

3

A

Resp depression,
hypotension,
tachycardia

120
Q

things to monitor during sedation

A

heart rate (pulse)
o2 saturation
blood pressure

121
Q

reversal agent for midazolam

A

Flumazenil. 100mcg/ml.

Injected in the same volume as midazolam, but can be given in larger boluses if medical emergency

shorter half life than midazolam so may wear off and pt re-sedates

122
Q

complications of IV sedation

10

A

Venospasm,
intra-arterial infection,
extravascular injection,
haematoma,
fainting,
hyper-response,
hypo-response,
paradoxical reaction,
allergic reaction,
over-sedation,
sexual fantasy

123
Q

signs of adequate IV sedation

A

Slurring/slowing of speech,
delayed response to commands,
relaxed,
Verrill’s sign (halfway eyelid ptosis),
Eve’s sign (can’t touch nose)

124
Q

signs for IV cannulation

A

Dorsum of hand, antecubital fossa

125
Q

indications for TMJ surgery

7

A

neoplasia/other pathology (severe osteoarthritis)
ankylosis,
recurrent chronic dislocation,
developmental disorders,
trauma
internal derangement,
chronic severe limited mouth opening

126
Q

internal derangement in TMD

A

painful clicking
lack of coordinated movement between condyle and articular disc
condyle has to overcome mechanical obstruction before full point movement can be acheived

127
Q

disc displacment
difference between with adn without reduction

A

with reduction - disc displaced anteriorly during opening until disc reduction occurs, disc retrun to normal on closing (click), short

without reductin - condyle cannot translate as normal, disc stuck in displaced position, needs disc reloaction (jaw locked)

128
Q

arthrocentesis

A

lavage of upper joint space (endoscopic) using hyaluronic acid to break down adhesions and remove inflammatory exudate, allowing disc to reposition

129
Q

arthroscopy

A

endoscopic lavage of joint space, adhesion removal, removal of damaged tissue, plication to reposition disc

130
Q

arthrotomy/discectomy

A

open joint surgery, lavage of space and removal of disc

131
Q

condylotomy

A

high condylar shave. Condyle repositioned anteriorly and inferiorly beneath disc, improving function

132
Q

temoral joint replacement

A

TJR - where gross destruction of joint architecture and marked reduced function. Condylar head and glenoid fossa replaced

133
Q

purpose of orthognathic surgery

A

correct conditions of jaw and face caused by underlying skeletal disharmonies

134
Q

indications for orthognathic surgery

6

A
  • gross jaw deficiencies - maxillary or mandibular hypoplasia, Class III malocclusion
  • airway defects
  • TMJ pathology
  • acromegaly
  • after trauma
  • severe soft tissue discrepancies
135
Q

types of orthognathic surgery

6

A
  • LFI - disarticulate maxilla from BoS and reposition
  • LFII - midface advancement
  • LFIII - move entire mid face and zygoma complex
  • Split Sagittal Osteotomy - separation of ramus from body (BSSO)
  • Vertical subsigmoid osteotomy - mandible posterior movement
  • Bimax - LFI and SSO
136
Q

indications for implants

A

restore aesthetics and function
* congentiallty missing teeth or after trauma or cancer tx

denture rentetion

136
Q

indications for implants

A

restore aesthetics and function
* congentiallty missing teeth or after trauma or cancer tx

denture rentetion

137
Q

contraindications for implants

A

pathology present - caries; periodotnal
poor OH
uncontrolled diabetes
medications - long term bisphophonates, bleeding disorders
poor bone quality or quantity

lack of space
poor bone quality or quantity

138
Q

osseointegration

A

direct abutment to implant surface such that osteoblasts can be seen to be growing on implant

139
Q

types of bone graft

A

autograft - own tissue
allograft - donor human tissue
xenograft - animal tissue
alloplast - synthetic bone substitute

140
Q

mandible #
features

10

A
  • pain swelling bleeding bruising
  • limited opening/trimus
  • occlusal derrangement
  • lower lip/chin numbness
  • loose/mobile teeth
  • anterior open bite
  • asymmetry
  • deviation of mandible on opening to opposite side
  • step deformity
  • sublingal haematoma
141
Q

views to dx mandible #

A

OPT
PA mandible
CBCT

142
Q

management of mandible #

A

control pain and infection

options
* KUO
* open reduction internal fixation
* intermaxillary fixation

143
Q

factors influecning displacement

A

direction of # line
opposing occlusion
magnitude of force
mech of injury

144
Q

classification of fractures

A

site
number
site
type (involvement of surrounding tissue)
displacement
direct # line
specific types

145
Q

maxillary #
signs

A

pain swelling bleeding bruising
mobile teeth
disclusion
trismus
occlusal step deformity
infraoribital numbness
asymmetry/flat cheek
nose bleed/epitaxis

146
Q

imaging needed for maxillary #

A

CBCT
OPT

147
Q

tx for maxillary fracture

A

undisplaced - KUO
ORIF
intermaxillary fixation

148
Q

symptoms of zygomatico oribital fracture

A

pain swelling ecchymoisis
subconjuctival haemorrhade
infraoribital numbness
trismus
lacerations
facial flatness
orbital rim step deformity
proptosis
diplopia
tethering
enophthalmos
reduced visual acuity

149
Q

views for oribital zygomatic #

A

occipitomental 15 and 30
CBCT

150
Q

management of zygimatic oribital fracture

A

if undisplaced KUO
closed reduction (IMF)
ORIF

151
Q

possible reasons for skull bone fractures

A

assaults
RTA
industrial
iatrogenic
falls
war

152
Q

2 key microbes in dentoalevoalr infection

A

s,angiosus
p.intermedia

153
Q

5 cardinal signs of inflammation

A

heat
redness
swelling
pain
loss of function

154
Q

standard tx of denoalevolar infection

A

incision and drainage
remove sourde - XLA common
post op analgesia and possible antibiotic

155
Q

signs fo OMFS referral due to dentoalveolar infection

A

airway compromise
swallowing difficulties
rapid spreading facial infection - over midline, eye closing
sepsis risk - SIRS

e.g. swollen FOM, unable to palpate lower border mandible

156
Q

lower anterior
fascial spaces for spread of infection

A

submental
sublingual (roots above mylohyoid attachement)

157
Q

lower posteriors
fascial spaces for spread of infection

A

sublingual (roots above mylohyoid)
submandibular (roots below mylohyoid)
buccal (roots below buccinator attachment)
submasseterc
parapharyngeal
retrophayrngeal
pterygomandibular

158
Q

upper anteriors
fascial spaces for spread of infection

A

infraoribital
palate

159
Q

upper posterior
spread of infection

A

buccal - rots above buccinator attachment
superficial temporal
deep temporal
infratemporal
palate

160
Q

upper posterior
spread of infection

A

buccal - rots above buccinator attachment
superficial temporal
deep temporal
infratemporal
palate

161
Q

indications for antibiotics due to dentoalevolar infection

A

immunocompromised
extremes of age
associated systemic symtoms - fever, malaise

162
Q

ludwig angina

A

bilateral cellulits of submandibular and sublingual
raised FoM - hard to breath
systemic symptoms
skin hot to touch

163
Q

cyst
defintion

A

pathological cavity filled with fluid or semi-fluid or gaseous conent
not created by pus accumulation

164
Q

cysts arise from

A

odontogenic - cell rests of Mallassez, glands of serres, REE

or non odontogenic

165
Q

signs/sym cysts

A

asymp mainly
unless infected
tooth mobilty
tooth displacement
tooth discloration
ectopic eruption
delyaed eruption
swelling
dicomfort
altered sensation
bast taste
sinus tract
bone perforation

166
Q

investigations for cysts

A

radiograph
FNA

167
Q

tx of cysts

2

A

enucleation - removal of entire cystic lesion inc lining

marsuialisation - de root and gradual deflation

168
Q

enculeation

A

removal of entire cystic lesion
gold standard unless v large or high risk fo recurrentce

169
Q

marsupilisation

A

de roof and gradual deflate
surgical window in cyst wall, removal of intracystic contents and suture open
encourage cyst to decrease in size and then followed by enucleation at diff appt

when enucleation contraindicated - risk of damage to imp structure, risk jaw #, difficult access

170
Q

examples odontogenic cyst

A

raidcular
residual
odontogenic

171
Q

examples non odontogenic cyst

A

nasopalatine
simple bone
aneurysmal

stafne cavity

172
Q

radicular cyst

%
aetiology
tx
histology
other forms

A

60-70%
tooth pulpitis, leading to necrosis, periapical granuloma (apical bone inflammation), stimulation of rests f Malasez, epithelial proliferation and radicualr cyst formation and growth

RCTx or XLA

thin oftne incomplete epithelial lining, fibrous connective tissue wall/capsule with inflammation present

residual or inflammation lateral perio

173
Q

inflammatory paradental cyst
appearance

A

usually adj to crown but doesnt surround it , related to erupted or PE tooth
pouch lined by non k epithelium
commpnly 8s with reccurent pericorontitis

174
Q

dentingeorus cyst

A

developmental cyst forms around crown of unerupted tooth
wall attached to ACJ and entire crown sits in cystic cavity
thin non-k epithelium, layer of fibrous connective tissue between REE and oral mucosal epithelial

10-15%

174
Q

dentingeorus cyst

A

developmental cyst forms around crown of unerupted tooth
wall attached to ACJ and entire crown sits in cystic cavity
thin non-k epithelium, layer of fibrous connective tissue between REE and oral mucosal epithelial

10-15%

175
Q

dentingerous cyst in kids

A

eruption cyst
blue swelling

176
Q

dentingerous cyst Vs enlarged follicle

A

<2.5mm follicle
5-10 probable cyst?
>10mm cyst

177
Q

unique features of odongenic keratocysts

A

aggressive growth (bone infiltration)
high rate of recurrent - daughter cells

178
Q

radiographic appearance of OKC

A

multilocular
scalloped
grows in AP direction usually in mandible ramgus/angle

5-10%

179
Q

radiographic appearance of OKC

A

multilocular
scalloped
grows in AP direction usually in mandible ramgus/angle

5-10%

180
Q

differential dx for OKC

A

ameloblastoma
giant cell lesion
odontogenic myoxoma
cherubism
aneurysmal bone cyst
OKC

181
Q

hisotlogical features of OKC

A

thin epithelium
parakeratosis
pallasading basal layer
thin capsule
dughter cysts

182
Q

key FNA features for OKC

A

keratin cheese like semi solid fluid

low soluble proten contect <4g/dl

normal is clear

183
Q

syndrom assoc with many OKC

A

golin goltz

allso superficial BCCs

184
Q

radicular cysts and PDL

A

teeth non vital so PDL space continuous with cyst and not tooth

185
Q

simple bone cysts
difference

A

often empty cavitities devoid of lining
resolve spontaneously or after trauma (debridement/eploration)

186
Q

examples of non odontogenic tumours

A

squamous cell papilloma
fibroma
lipoma
osteoma
osteoblastoma
ossifying fibroma

187
Q

examples of odontogenic tumours

A

ameloblastoma
adenomatoid odontogenic tumour
calcifying epithelial odotongenic tumour
myxoma
ameloblastic fibroma
odontome

188
Q

papilloma clinical appearance

A

white/pink
cauliflower

189
Q

features of osteomas
syndrome assoc

A

soft hard benign neoplasms of bone
unilateral covered by normal muocsa
gardner syndrome

190
Q

clinical features of ossifying fibromas

A

slow growing
well demarcated
painless
expansive growth

191
Q

radiographic features of ossifiying fibromas

hisotlogical features

A

well defined radiolucency
well corticated

cellular fiborus tisssue, immature bone, acellular calcification

192
Q

3 types of ameloblastoma

A

unicystic
polycystic
peripheral

193
Q

clinical features of ameloblastomas

A

slow growing
expansive growth
locally destructive
rarely metastasise

194
Q

histology of ameloblastoma

A

islands of follicles
peripheral cells resemble ameloblasts
centre resembles stellate reticulum which may show changes

195
Q

histology of ameloblastoma

A

islands of follicles
peripheral cells resemble ameloblasts
centre resembles stellate reticulum which may show changes

196
Q

adenomatoid odontogenic tumorus
radiographica
low recurrence - why

A

pathcy calcifications
complete capsule

197
Q

calcifying epithelial odontogenic tumour
radiographic

A

radiolucency with scattered radiopacities

198
Q

odotogenic myoxmas
radiographic appearancde
histology features
recurrence rate

A

mulitlocular soap bubble appearance

very loose connective tissue, sparse cells, high quantity of glycans

high recurrence rate - soft gelatinous tissue which can tear easily

199
Q

odontome
types

A

compound - multple small teeth (denticles), tissue formed in correct order
complex - irregular mix of dentla hard tissues

200
Q

Le fort classification

A

1 - horizontal (tooth bearing area detatched)
2 - pyrimidal - involves nasal and IO rims
3 - transverse - whole maxilla detatched from base of skull, involves frotozygomaticostures

201
Q

classfication of mandibular fracture

A

simple - not through tissue
compound - through tissue or involves teeth
comminuted - multiple fractures in 1 bone

number for fractures
side of fractures
site of fractures
displaced/undisplaced
favourable/unfavourable

BDS4 EXAM PREP (25 decks)

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