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Oral Surgery Flashcards

1
Q

What are the 4 different types of fracture?

A
  • Simple
  • Compound
  • Comminuted
  • Pathological
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2
Q

What is a simple fracture?

A

A closed linear fracture

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3
Q

What is a compound fracture?

A

A fracture that causes a wound of break in the skin/mucosa. They are very common in tooth bearing areas

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4
Q

What is a comminuted fracture?

A

Multiple small fractures

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5
Q

What are the 4 main causes of mandibular fractures?

A
  • trauma
  • malignancy
  • pathology
  • unerupted teeth
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6
Q

What is symphysis (with regards to mandibular fractures)?

A

When there is a mandibular fracture that passes through the midline between the lower central incisors

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7
Q

What is para-symphysis (with regards to mandibular fractures)?

A

When there is a fracture that occurs in the anterior of the mandible but that does not go through the midline

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8
Q

What are the main features you may see radiographically in cases of mandibular fractures?

A
  • Radiolucent lines
  • Radiopaque area
  • Widened PDL
  • Occlusal step
  • Steps in upper and lower border of the mandible
  • Anterior open bite
  • Shortening of the ramus
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9
Q

When does a radiopaque area occur on a radiograph of a mandibular fracture?

A

When there is displacement and the fractured ends are superimposed on each other

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10
Q

What secondary view would need to be taken in cases of mandibular fractures if a radiopaque area is seen on a DPT and why?

A

A second view at 90 degrees to see which part of the bone is more buccal or lingually positioned

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11
Q

What cases occlusal steps in cases of mandibular fractures?

A

Muscle pull causing displacement

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12
Q

What is written on a radiograph if there is a potential problem on a radiograph as a result of trauma (i.e. signs of fracture)?

A

With a red dot that is placed on the film or (in the case of digital radiographs) ‘red dot’ is written on the digital image

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13
Q

Why are post operative radiographs not usually taken?

A

Because the position of the bones can directly be assessed at surgery and the occlusion checked - especially when bone plates are used

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14
Q
A
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15
Q
A
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16
Q

How does subcutaneous emphysema form after mandibular fractures?

A

When air enters the tissue spaces as a result of trauma via one or more of the fracture sites

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17
Q

What does subcutaneous emphysema look like radiographically?

A

Radiolucent mottling that is superimposed onto the bone - extending into the regions of the soft tissues

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18
Q

What is reduction (with regards to treating fractures)?

A

When the displaced bone is put back into the correct anatomical place

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19
Q

What is fixation (with regards to treating fractures)?

A

Preventing the movement of the bone while healing occurs

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19
Q

What is load bearing fixation with mandibular fractures?

A

When 100% of the occlusal load is supported (large plates)

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20
Q

What is load sharing fixation with mandibular fractures?

A

When the occlusal load is shared/distributed between hardware and bone

21
Q

What is involved in closed fixation for fractured mandibles?

A

Bone margins are not directly visualised and no incision made. The jaws are wired together (inter-maxillary fixation)

21
Q

What is involved in the open technique for fixation?

A

When the fracture margins are visualised intra-orally or extra-orally via an incision

21
Q

What radiograph would you usually take for LeFort fractures?

A

Occipito-mental views with the parallax technique

22
Why is it good that most zygomatic complex fractures are unilateral?
You have a the other side to compare the anatomy
23
What does it mean when "erect" is written on a radiograph and why is it important?
The patient was standing up when the radiograph was taken. It is important as it affects fluid flow in the sinus (gravity)
24
What type of mid-face fracture does this depict and why?
An orbital floor (blow out) fracture because of the tear drop appearance
25
What may cause radiolucency on a CT for bony fractures?
anatomy (airways); artefact; pathological (emphysema shows fracture is likely)
26
What cranial nerves are injured with superior orbital fissure syndrome?
Cranial nerves III, IV, V (opthalmic branch) and VI
27
What is a retrobulbar haemorrhage with orbital compartment syndrome?
A rare complication of zygomatic fractures when a haemorrhage leads to increased orbital pressure, which can then lead to ischemia (reduced blood flow/oxygen) which can lead to vision loss
28
How is a retrobulbar haemorrhage with orbital compartment syndrome managed?
Deplete the fluid (relieves pressure) and prescribe steroids or acetazolamide
29
What is the main goal of treatment for a zygomatic fracture?
Restoration of facial symmetry and restoration of orbital volume/globe position
30
What is meant by a low energy zygomatic fracture?
Minimal/no comminution
31
What is meant by a high energy zygomatic fracture?
Comminution at segment and fracture lines
32
What is the best landmark when reducing a zygomatic fracture?
Zygomaticosphenoid suture (where the zygoma and sphenoid bone meet)
33
What is the best method for treating zygomatic fractures?
Open reduction, internal fixation
34
What is the non-surgical management option for zygomatic fractures when there is no displacement (confirmed by a CT)?
Observation and a soft diet
35
What are the advantages of ORIF when managing zygomatic fractures?
It improves the alignment and fixation of the zygomatico-maxillary buttress provides vertical support. It also allows you to examine the fracture site and orbital rim.
36
What are the different options for reduction when managing zygomatic fractures? (4)
- Stab and hook - Screw and pull - Intraoral approach - Gillies temporal approach
37
What instrument is used for the screw and pull reduction technique for managing zygomatic fractures?
Carroll-Girard T-bar Screw
38
What is the process of the Gillies Temporal Approach for reduction of zygomatic fractures?
Incise at the temporal region, cut through skin and temporalis fascia, introduce instrument under fractured bone and elevate to reduce
39
What are the different instuments you can use for Gillies temporal approach when reducing zygomatic fractures?
Bristow/Rowe
40
What are the points of fixation for two point fixation for zygomatic fractures?
Zygomatico-maxillary buttress fixation and a frontozygomatic suture
41
What are the points of fixation for three point fixation for zygomatic fractures?
Zygomatico-maxillary buttress fixation, infraorbital region fixation and a frontozygomatic suture
42
When is two point fixation for zygomatic fractures indicated?
Minimally displaced fractures where there are minimal changes on the orbital volume and globe displacement is not evident on a CT
43
When would you do three point fixation when managing zygomatic fractures?
When there is instability and exploration of the orbital floor is required or comminution and severe displacement
44
When is orbital floor exploration indicated for zygomatic fractures?(3)
For orbital floor defects greater than 5mm on a CT; when there is soft tissue entrapment that limits upwards gaze or a herniation of orbital floor contents into the maxillary sinus
45
When would you reconstruct the orbital floor for zygomatic fractures? (3)
If the orbital floor defect is 5-10mm; enophthalmos (sunken eyes); or defects posterior to the axis of the globe
46
What are the points of fixation for four point fixation for zygomatic fractures?
Infraorbital region; zygomatico-maxillary fixation, frontozygomatic suture and a plate along the sphenozygomatic suture
47
How do you get access to the zygomatic bone for four point fixation?
Do a coronal flap which is an incision that goes along the line where a hairband would sit
48
What material is used for fixation?
Titanium plates and screws (either large plates or mini plates)

BDS (7 decks)

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