Oral surgery Flashcards
basic functions of LA
2
prevent pain
reduce bleeding
how does LA work
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
LA affects which type of axons
smaller diamter axons have fewer Na channels and are more suceptible to LA block
* e.g. A delta, C, A beta then A alpha
where are the sodium channels on a nerve
concentrated of nodes of Ranvier in myelinated axons
LA needs to act on several aong the axon
ester type LA
benzocaine
procain
cocaine
amide type LA
lidocaine
articane
prilocaine
bupivicaine
mepivicaine
vascocontrictors
purpose
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)
types of vasoconstricors in LA
2
adrenaline
felypressin
types of topical LA (2)
function
2% lidocaine gel
20% benzocaine
superficial soft tissue manipulation and surface anaesthesia
infiltration of LA
LA deposited beside nerve branches
inject distal to apex of tooth into mucogingival fold
nerve block
LA deposited beside nerve trunk
abolishing sensation distal to site
IDB technique
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
how to check for numbness
ask pt - rubberly, tingle, numb, swollen, fat
IDB - to midline lip, inc tongue, buccal gingiva
complications of LA
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
how to manage facial palsy
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
other LA techniques
not infiltration or block
palatal anaesthesia - chasing
intraligamentary
intraosseous
intrapulpal
Gow gates
akinosi
lidocaine max dose
4.4mg/kg
2.2% 1:80,000
articaine max dose
5mg/kg
4% 1:80,000
prilocaine
5.0mg/kg
4% - plaiin; 3% - octapressin
contraindication for felypression/octrapressin
pregnancy
functions of paracetamol
analgeisa
antipyretic
max dose of paracetamol
4g/day
cautions for paracetamol
hepatic/renal impairment
alcohol dependent
how does aspirin work
non selective cox inhibitor that reduces production of PGs by inhibiting COX-1 and COX-2
functions of asipirn
2
antiplatlet
anti-inflammatory
contrindications for aspirin
7
Peptic ulcer disease
<16yrs (reye’s)
asthamtics
other NSAIDs
bleeding problmes
pregnant
steroids
functions of ibuprofen
analgesic
anti pyretic
anti-inflammatory
max dose ibuprofen
2.4g/day
contraindications for ibuprofen
5
peptic ulcers
pregnant
other NSAIDs
long term steroids
renal/cardiac/hepatic impairment
diclofenac
prescription only NSAID
more potent
max dose - 150mg/day
codeine
codeine and paracetaom
2mg tablets up to 15mg
key surgical stages
10
consent
anaethesiat
access
bone removal
tooth division
tooth removal/procedure
debridement
suture
haemostasis
POI and post op meds
ways to minimise op site contamination
hand hygiene/scrubbing
PPE - sterile gloves, gown, mask
no touch techique
operative site prep
principles of sugical access
5
- 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
ideal flap properties
8
- 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
purpose of soft tissue retraction
2
improve access to fiel
protect soft tissues from trauma
soft tissue retractors
4
Howarths
Wards
Minnestoa
rake retractor
instrument and methods of bone remoavl
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
why irrigate when accessing surgical site
prevents heat necrosis of bone
damage to soft tissue
clogging of bur
allows field to be kept clean of debris
why to we perform post surgical debridement
to remove dead, damaged or infected tissue to improve healing potential of remaining healthy tissue
methods of surgical debridement
surgical
mechanical - bone file, handpick, mitchells trimmer, victoria currette
chemical - saline
suction
purpose of sutures
approximate/reposition tissues
compress blood vessles
achieve haemostasis
cover bone
prevent wound breakdown
encougar heaillng by primary intention
principles of suture technique
3
tension free wound closure
evert wound edges in apopsition
knot not over would -on sound bone
biopsy
function
types
surgical dx method
incisional - FNA, punch
excisional - removal whole lesion (small, obvs benign)
indications for cryosurgery
vascular malformations
mucoceles
atypical facial pain
viral warts
superfical basal cell carcinoma
post enucleation of odontgenic keratocyst
nerves at risk in 3rd molar surgery
4
inferior alveolar nerve
lingual nerve
nerve to mylohyoid
long buccal
unerupted tooth
tooth lying within jaws, entirely covered by soft tissue
and completely covered by bone
partially erupted
tooth failed to erupt fully into normal position
may not be seen but a communication with oral cavity exists
impacted tooth
tooth prevented from completely erupting into normal functional position
due to lack of space, obstruction, abnormal eruption path
reasons to remove 8
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
contraindications to XLA 8
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
possible reasons for prophylatic XLA of 8
- 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
angulation of impaction
measured against
types
occlusal curve of spee - angulation of 7
can be vertical, mesial, distal, horizontal, transvere, aberrant
depth of impaction
how it is measured
classes
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
pericoronitis
inflammation of soft tissues around crown of tooth
requires communication between tooth and mouth
food trapped under operculum
operculum
flap of gingivae overlying tooth
signs/symptoms pericoronitis
pain (throbbing)
swelling (red tender operculum)
pus
bad taste
ulceration
bad smell
trismus
dysphagia
lymphadenopathy
pyrexia
malaise
fever
management of pericoronitis
OHI and irrigation under operculum
ABX if systemic 200mg Metronidazole for 3 days
XLA or coronectomy of 8
or U8 if traumtising
possible spaces for spread of infection from lower 8
buccal
submasseteric
sublingual
submandibular
parapharyngeal
% loss of sensation after XLA 8
parathesia
10- 20% temprorary
<1% permanent
coronectomy
what
why
removal of crown of tooth with deliberate retention of roots
if roots appear closely involved/related to IDC on OPT or CBCT
risks re coronectomy
infection
pain
root may migrate and erupt - need another procedure
if roots mobilised need to remove whole tooth
contraindication to coronectomy
4
- mobile tooth/root
- non vital tooth (grossly carious)
- where sectioning puts nerve at risk (horizontal/disto angular impaction)
- immunocompromised pt
rood and shehab signs of IDC and 8s from OPT
1990
- 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
type of epithelium in mamxillary sinus
pseudostratified ciliated coloumnar with globlet cells
function of sinus
voice resonance
reserve chamber for warming air
reduce weight of skull
3
cilia function
mobilise trapped particulate matter and foreign material within the sinus and move this towards teh ostia for elimiation into the nasal cavity
maxillary sinus opening
hiatus semilunaris
4mm
superior mesial border
can become blocked in infection
posterior wall of maxillary sinus contains
posterior superior alevolar nereves and vessels
OAC
an opening is created between the sinus and oral cavity
dx of OAC
direct vision
bubbling of blood
change in sound of suction
nose blowing test
management of OAC
small - <2mm encourage clost and suture
large - close with buccal advancment flap (buccal fat pad)
Pt POIG for OAC
dont dislodge clot
avoid using straws/playing wind instruments and nose blowing
WSMW from next day
decongestants/steam inhaltion
OAF
formation/creation of a pathological epithelial
chronic and occurs secondary to OAC
signs/symptoms of OAC
liquid reflux into nose
nasal speech
problems playing wind instruments
bad taste
sinusisitis like pain
minor nose bleeds
management of OAF
exision of sinus tract
closure - primary or with buccal advancement flap (with fat pad)
how to dx root in sinus
radiogrpah - OPT/occlusal
how to manage root in sinus
- through socket - ribbon gauze, narrow bore suction
- OAF type apprach - flap
- caldwell luc approach
- endoscopic retrieval
refer
how to manage root in sinus
- leave to monitor
- through socket - ribbon gauze, narrow bore suction
- OAF type apprach - flap
- caldwell luc approach
- endoscopic retrieval
refer
sinusitis
paranasal inflammation and infection
symptoms of sinusistis
pain/pressure or altered sensation over cheeks (infraorbital region)
nasal discharge/congestion
nasal obstruction
hyposmia
heaedache
fever
fatigue
pain worsens when moving head
dental pain that can mimick sinusitis
need to exclude
TMJD
deep caries
PA abscess
perio infection
atypical facial pain
reccent extraction socket
3 indicators sinusistis and not dental pain
tenderness over cheeks
diffuse maxillary tooth pain
pain that worsens with head movements
3 indicators sinusistis and not dental pain
tenderness over cheeks
diffuse maxillary tooth pain
pain that worsens with head movements
traumatic/iatrogenic causes of sinusists
orbital wall #
RCT apical perforation
sinus lifts/implant placements
deep perio tx
nasal packing
NG tube
mechanical ventilation
foreign object in sinus
acute sinusitis cause
post Upper resp tract infection bacterial superinfection on cilia
foreign bodies
chronic sinuisitis cause
foreign bodies
poor drainiage
TMJD
pain associated with the TMJ and MoM
types of TMJD
myofascial pain
anterior disc displacement +/- reduction
degenerative disease - osteoarthritis, rheumatoid arthritis
chronic recurrent dislocation
ankyloisis
dysplasia of joint
causes of TMJD
chronic recurrent dislocation
ankyloisis
hyperplasia
neoplasia
infection
stress
psychogenic
direct/indirect trauma
parafunctional habits - bruxism
symptoms of TMJD
intermittent pain
muscle/joint/ear pain particularly on waking
trismus/jaw locking
clicking/popping noises
headaches
crepitus
differential dx for TMJD
- dental pain - esp lower 8s
- sinusitis
- ear infection
- salivary gland disease
- referred pain - angina
- headaches
- atypical facial pain
- trigeminal neuralgia
- condylar fracture
- temporal arteritis
conservative/supportive TMJD management
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
surgical TMJD options
arthrocentesis
arthroscopy
condlytomy
TMJ replacement
how to image TMJD
OPT
US
origin
insertion
function
temporalis
Origin - temporal fossa and deep temporal fascia
Insertion - Coronoid process and anterior border of ramus
Function - elevation and retrusion
origin
insertion
function
masseter
Origin - temporal process of zygomatic bone and zygomatic arch
Insertion - angle and ramus
Function - elevation and protrusion
origin
insertion
function
medial ptergoid
Origin - maxillary tuberosity and medial surface of lateral pterygoid plate
Insertion - medial surface of ramus and angle
Function - elevation and protrusion
origin
insertion
function
lateral pterygoid
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
concious sedation
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
methods of concious sedation
IV
IS
Oral
transmucosal
indications for concious sedation
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
contraindications to concious sedation
severe/uncontrolled systemic disease
severe mental disabilty
severe psychogenic problems
unaccompanied
unwilling/uncooperative
narcolepsy
hypothyroidism
ASA classes
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
advantages inhalation sedation
flexible duration
rapid onset
rapid recovery
no injection required
few side effects
can be used in <12
disadv of inhalation sedation
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
indications for inhalation sedation
mild/mod anxiety
ASA I or II
enhanced gag reflex
trauamatic procedure
medical condisiotn aggrevated by stress
unaccompanied adult needed sedation
contrindications to sedation
blocked nose/tonsilitis - unable to nose breathe
severe COPD or asthma (ASA III or more)
neuromuscular disease (MS)
pregnancy
no trained staff available
equipment used in IHS
gas cyclinders - labelled and colour coded
pressure reducing valve
flow control meters
reservoid bag
gas delivery hoses
nasal hood
waste scavenging system
procedure for IHS
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
complications of IHS
Over-sedation - nausea, headache, vomiting, unresponsive
Panic -
reduce sedation, reassure patient
signs of adequate sedation
nitrous oxide
Relaxation, warmth, giddiness, lethargy, lessened pain awareness, slowed response to commands (but still responsive)
happy to proceed with tx
safety feature of IHS
Air entrapment valve,
oxygen flush button,
oxygen monitor,
colour coding,
reservoir bag,
scavenging system,
pressure dials,
pressure reducing valve
advantages of IV sedation
Good sedation and muscle relaxation,
lessened pain awareness,
easy to control/titrate,
few side effects if done properly
disadvantages of IV sedation
IV cannula,
behaviour during recovery,
swallowing efficacy,
escort for 24hrs,
doesn’t address anxiety
indications for IV sedation
ASA I or II,
>12yrs old,
mild/moderate anxiety,
traumatic procedure,
medical conditions aggravated by stress - e.g. tremors in cerebral palsy, Parkinson’s
contrindications to IV
ASA III or IV, COPD,
<12yrs old,
pregnancy,
NM diseases (myasthenia gravis),
hepatic insufficiency, intracranial pathology
drug and concentration for IV sedation
Midazolam. 1mg/ml.
1-2ml bolus then 0.5-1ml increments every 2 mins
mech of action for midazolam
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
side effects of midazolam sedation
3
Resp depression,
hypotension,
tachycardia
things to monitor during sedation
heart rate (pulse)
o2 saturation
blood pressure
reversal agent for midazolam
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
complications of IV sedation
10
Venospasm,
intra-arterial infection,
extravascular injection,
haematoma,
fainting,
hyper-response,
hypo-response,
paradoxical reaction,
allergic reaction,
over-sedation,
sexual fantasy
signs of adequate IV sedation
Slurring/slowing of speech,
delayed response to commands,
relaxed,
Verrill’s sign (halfway eyelid ptosis),
Eve’s sign (can’t touch nose)
signs for IV cannulation
Dorsum of hand, antecubital fossa
indications for TMJ surgery
7
neoplasia/other pathology (severe osteoarthritis)
ankylosis,
recurrent chronic dislocation,
developmental disorders,
trauma
internal derangement,
chronic severe limited mouth opening
internal derangement in TMD
painful clicking
lack of coordinated movement between condyle and articular disc
condyle has to overcome mechanical obstruction before full point movement can be acheived
disc displacment
difference between with adn without reduction
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)
arthrocentesis
lavage of upper joint space (endoscopic) using hyaluronic acid to break down adhesions and remove inflammatory exudate, allowing disc to reposition
arthroscopy
endoscopic lavage of joint space, adhesion removal, removal of damaged tissue, plication to reposition disc
arthrotomy/discectomy
open joint surgery, lavage of space and removal of disc
condylotomy
high condylar shave. Condyle repositioned anteriorly and inferiorly beneath disc, improving function
temoral joint replacement
TJR - where gross destruction of joint architecture and marked reduced function. Condylar head and glenoid fossa replaced
purpose of orthognathic surgery
correct conditions of jaw and face caused by underlying skeletal disharmonies
indications for orthognathic surgery
6
- gross jaw deficiencies - maxillary or mandibular hypoplasia, Class III malocclusion
- airway defects
- TMJ pathology
- acromegaly
- after trauma
- severe soft tissue discrepancies
types of orthognathic surgery
6
- 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
indications for implants
restore aesthetics and function
* congentiallty missing teeth or after trauma or cancer tx
denture rentetion
indications for implants
restore aesthetics and function
* congentiallty missing teeth or after trauma or cancer tx
denture rentetion
contraindications for implants
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
osseointegration
direct abutment to implant surface such that osteoblasts can be seen to be growing on implant
types of bone graft
autograft - own tissue
allograft - donor human tissue
xenograft - animal tissue
alloplast - synthetic bone substitute
mandible #
features
10
- 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
views to dx mandible #
OPT
PA mandible
CBCT
management of mandible #
control pain and infection
options
* KUO
* open reduction internal fixation
* intermaxillary fixation
factors influecning displacement
direction of # line
opposing occlusion
magnitude of force
mech of injury
classification of fractures
site
number
site
type (involvement of surrounding tissue)
displacement
direct # line
specific types
maxillary #
signs
pain swelling bleeding bruising
mobile teeth
disclusion
trismus
occlusal step deformity
infraoribital numbness
asymmetry/flat cheek
nose bleed/epitaxis
imaging needed for maxillary #
CBCT
OPT
tx for maxillary fracture
undisplaced - KUO
ORIF
intermaxillary fixation
symptoms of zygomatico oribital fracture
pain swelling ecchymoisis
subconjuctival haemorrhade
infraoribital numbness
trismus
lacerations
facial flatness
orbital rim step deformity
proptosis
diplopia
tethering
enophthalmos
reduced visual acuity
views for oribital zygomatic #
occipitomental 15 and 30
CBCT
management of zygimatic oribital fracture
if undisplaced KUO
closed reduction (IMF)
ORIF
possible reasons for skull bone fractures
assaults
RTA
industrial
iatrogenic
falls
war
2 key microbes in dentoalevoalr infection
s,angiosus
p.intermedia
5 cardinal signs of inflammation
heat
redness
swelling
pain
loss of function
standard tx of denoalevolar infection
incision and drainage
remove sourde - XLA common
post op analgesia and possible antibiotic
signs fo OMFS referral due to dentoalveolar infection
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
lower anterior
fascial spaces for spread of infection
submental
sublingual (roots above mylohyoid attachement)
lower posteriors
fascial spaces for spread of infection
sublingual (roots above mylohyoid)
submandibular (roots below mylohyoid)
buccal (roots below buccinator attachment)
submasseterc
parapharyngeal
retrophayrngeal
pterygomandibular
upper anteriors
fascial spaces for spread of infection
infraoribital
palate
upper posterior
spread of infection
buccal - rots above buccinator attachment
superficial temporal
deep temporal
infratemporal
palate
upper posterior
spread of infection
buccal - rots above buccinator attachment
superficial temporal
deep temporal
infratemporal
palate
indications for antibiotics due to dentoalevolar infection
immunocompromised
extremes of age
associated systemic symtoms - fever, malaise
ludwig angina
bilateral cellulits of submandibular and sublingual
raised FoM - hard to breath
systemic symptoms
skin hot to touch
cyst
defintion
pathological cavity filled with fluid or semi-fluid or gaseous conent
not created by pus accumulation
cysts arise from
odontogenic - cell rests of Mallassez, glands of serres, REE
or non odontogenic
signs/sym cysts
asymp mainly
unless infected
tooth mobilty
tooth displacement
tooth discloration
ectopic eruption
delyaed eruption
swelling
dicomfort
altered sensation
bast taste
sinus tract
bone perforation
investigations for cysts
radiograph
FNA
tx of cysts
2
enucleation - removal of entire cystic lesion inc lining
marsuialisation - de root and gradual deflation
enculeation
removal of entire cystic lesion
gold standard unless v large or high risk fo recurrentce
marsupilisation
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
examples odontogenic cyst
raidcular
residual
odontogenic
examples non odontogenic cyst
nasopalatine
simple bone
aneurysmal
stafne cavity
radicular cyst
%
aetiology
tx
histology
other forms
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
inflammatory paradental cyst
appearance
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
dentingeorus cyst
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%
dentingeorus cyst
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%
dentingerous cyst in kids
eruption cyst
blue swelling
dentingerous cyst Vs enlarged follicle
<2.5mm follicle
5-10 probable cyst?
>10mm cyst
unique features of odongenic keratocysts
aggressive growth (bone infiltration)
high rate of recurrent - daughter cells
radiographic appearance of OKC
multilocular
scalloped
grows in AP direction usually in mandible ramgus/angle
5-10%
radiographic appearance of OKC
multilocular
scalloped
grows in AP direction usually in mandible ramgus/angle
5-10%
differential dx for OKC
ameloblastoma
giant cell lesion
odontogenic myoxoma
cherubism
aneurysmal bone cyst
OKC
hisotlogical features of OKC
thin epithelium
parakeratosis
pallasading basal layer
thin capsule
dughter cysts
key FNA features for OKC
keratin cheese like semi solid fluid
low soluble proten contect <4g/dl
normal is clear
syndrom assoc with many OKC
golin goltz
allso superficial BCCs
radicular cysts and PDL
teeth non vital so PDL space continuous with cyst and not tooth
simple bone cysts
difference
often empty cavitities devoid of lining
resolve spontaneously or after trauma (debridement/eploration)
examples of non odontogenic tumours
squamous cell papilloma
fibroma
lipoma
osteoma
osteoblastoma
ossifying fibroma
examples of odontogenic tumours
ameloblastoma
adenomatoid odontogenic tumour
calcifying epithelial odotongenic tumour
myxoma
ameloblastic fibroma
odontome
papilloma clinical appearance
white/pink
cauliflower
features of osteomas
syndrome assoc
soft hard benign neoplasms of bone
unilateral covered by normal muocsa
gardner syndrome
clinical features of ossifying fibromas
slow growing
well demarcated
painless
expansive growth
radiographic features of ossifiying fibromas
hisotlogical features
well defined radiolucency
well corticated
cellular fiborus tisssue, immature bone, acellular calcification
3 types of ameloblastoma
unicystic
polycystic
peripheral
clinical features of ameloblastomas
slow growing
expansive growth
locally destructive
rarely metastasise
histology of ameloblastoma
islands of follicles
peripheral cells resemble ameloblasts
centre resembles stellate reticulum which may show changes
histology of ameloblastoma
islands of follicles
peripheral cells resemble ameloblasts
centre resembles stellate reticulum which may show changes
adenomatoid odontogenic tumorus
radiographica
low recurrence - why
pathcy calcifications
complete capsule
calcifying epithelial odontogenic tumour
radiographic
radiolucency with scattered radiopacities
odotogenic myoxmas
radiographic appearancde
histology features
recurrence rate
mulitlocular soap bubble appearance
very loose connective tissue, sparse cells, high quantity of glycans
high recurrence rate - soft gelatinous tissue which can tear easily
odontome
types
compound - multple small teeth (denticles), tissue formed in correct order
complex - irregular mix of dentla hard tissues
Le fort classification
1 - horizontal (tooth bearing area detatched)
2 - pyrimidal - involves nasal and IO rims
3 - transverse - whole maxilla detatched from base of skull, involves frotozygomaticostures
classfication of mandibular fracture
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
