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Need To Recall > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

When removing epulis, what is the ideal tissue forceps to be used?

A

Allis tissue forceps

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2
Q

principles of oral surgery

A

asepsis
atraumatic surgery
maintain patient airway
good anes/pain control
control of infection

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3
Q

CD4 serial extraction is proposed by

A

Bunon & Dewel

D4C - Tweed (siya din yung tweed’s triangle na IMPA, FMA, FMAI)

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4
Q

best time for exo for patients with ESRD End-stage renal disease

A

1-2 days after dialysis

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5
Q

universal sign of ischemic chest pain

A

Levine’s sign

Angina (stable, unstable, variant or prinzmetal)

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6
Q

management of pericoronitis

A

abx
irrigation
consider removing upper 3rds (trauma to operculum)

EXO of 3rd

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7
Q

mucosal defects if not resting on solid bone

A

dehiscence, fenestration

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8
Q

sizes of blades and indication

A

No. 11 - incision and draining procedures (precise or sharply angled incision)
No. 12 - sickle-shaped - maxillary tuberosity area and impacted teeth
No. 15 - intra-oral No. 15 C - thin blade for implants (smaller #10)
No. 10 - skin incisions (extraoral)

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9
Q

blade handle

A

bard-parker handle no. 3

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10
Q

flap that provides best access

A

trapezoidal flap (2 vertical incisions)

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11
Q

convex area of semilunar flap is directed towards ____

A

occlusal

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12
Q

submarginal incsion flap or modified trapezoidal semilunar flap aka

A

Luebke-Ochsenbein

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13
Q

tx and flap options for oro-antral communication

A

1-2mm - no tx
2-6mm - figure of 8 suture
>6mm - water tight closure with flap:
Pedicle flap
Berger flap (buccal advancement flap)
pedicled buccal fat pad

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14
Q

most commonly displaced root into the maxillary sinus

A

palatal root of 1st molar

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15
Q

used to remove infected tissue, mucosa, foreign objects from maxillary sinus

A

caldwell-luc technique

*at the maxi premolar area above the roots (other sources: sa canine ata)

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16
Q

best suture needle for OS

A

material: carbon steel > stainless steel
shape: 1/2 > 1/4, 3/8
configuration: reverse cutting > round, conventional cutting
attachment: swaged > eye

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17
Q

best part of suture needle to grasp

A

2/3 or 3/4 from the tip

Most fragile part: swaged end/eye of needle

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18
Q

most common absorbable suture material

A

chromic gut (7-10days) with chromium salts to prolong absorption

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19
Q

absorbable suture materials

A

I. Natural: gut (sheep/cow; 4-5days), chromium gut (7-10days), collagen (bone grafting)
II. Synthetic: absorbs after 2-3 weeks; Polyglycolic acid (Dexon), Polyglactin (Vicryl)

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20
Q

non absorbable suture material

A

silk (Dacron polyester) - most popular, cheapest, easiest to use
Nylon - has memory

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21
Q

ideal size for intraoral suture material

A

3-0 & 4-0

5-0 or 6-0 = cosmetic procedure
7-0 to 10-0 = microsurgery

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22
Q

principle of suturing: needle passage

A

from free to fixed
from thinner to thicker
from deeper towards the elevated side

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23
Q

suture should be ___ away from the margin and ___ from the next suture

A

2-3mm from the margin and 3-4mm from next suture

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24
Q

suture technique for everted wound edges (maxillary torus removal)

A

horizontal mattress - for suturing two adjacent papillae with one suture

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25
Q

suture technique good for controlling bleeding because of tight closure at the deeper part

A

vertical mattress

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26
Q

suture technique used to close open sockets and prevent clot displacement

A

figure of 8 - used din sa 2-6mm oro antral communication

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27
Q

if maxillary tuberosity fracture during exo, you should ___

A

if more thatn 2/3 - remove suture slightly
if less than 2/3 and attached to periosteum - reposition, suture lightly
if small and detached - remove and suture tightly

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28
Q

barrier membrane material used for guided tissue regeneration

A

gore-tex / PTFE (polytetrafluoroethylene)
durable, excellent knot tying characteristics, flexible

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29
Q

common space/fossa for maxillary third molar to be displaced into

A

infratemporal space/fossa

tx: retrieve after 2 weeks to allow fibrosis to take place, make it more stable and para di ma-push further

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30
Q
  1. if too lateral incision, tooth may be displaced into what space
  2. if lingual plate is fractured, tooth may be displaced into..
A
  1. buccal space
  2. submandibular space
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31
Q

non healing or delayed healing extraction socket with radiating pain (2-4 days)
foul odor and foul taste in mouth

A

dry socket
alveolar osteitis
fibrinolytic alveolitis

tx: gentle curettage, copious irrigation, eugenol dressing in the socket for obtundent effect

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32
Q

Wound healing first phase

A

Inflammatory phase / initial lag phase (immediate 2-5 days)
Hemostatiss - vasoconstriction, platelet aggregation, thromboplastin for clot
inflammation - vasodilation, phagocytosis

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33
Q

second phase of wound healing

A

proliferative phase (fibroblastic phase 2 days to 3 weeks)
Granulation - fibroblasts lay bed of collagen (Reticular first type III - allows for angiogenesis)
fills defect and produces new capillaries
Reepithelialization - epithelial healing

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34
Q

3rd phase of wound healing (when??)

A

remodeling phase (maturation phase: 3 weeks to 2 years)
new collagen type I forms
scar tissue

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35
Q

wound healing by primary intention vs secondary vs tertiary

A

primary - stabilized in essentially the same anatomic position prior to injury, minimal scar tissue (suturing??)
secondary - gap is left bet wound edges after repair (tooth socket), requires granulation tissue
tertiary /delayed closure - would is initially left open for a period of observation before closure, tissue grafts and implants, burn patients

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36
Q

type of hemorrhage seen in bleeding due to wound sepsis a few days after exo

A

secondary hemorrhage

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37
Q

types of hemorrhage

A

primary - during surgery
secondary - post op bleeding up to 14 days due to infection/sepsos
tertiary - post op bleeding 2-3 hours after surgery due to movement or disruption of surgical site or anes wears off

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38
Q

healing response characterized by restitution of new tissue, structurally and functionally indistinguishable from old tissue is:

A

regeneration

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39
Q

what makes bone healing “privileged”?

A

regeneration

40
Q

cause of necrotizing sialometaplasia

A

death of minor salivary gland in the palate after infiltration

41
Q

gelfoam / gelatin-based sponge used to control hemorrhage is absorbed in ___ (how long?)

A

4-6 weeks

42
Q

collacone and surgicell are __

A

extraction socket packing materials

43
Q

how does electrocautery or electrosurgery control hemorrhage

A

coagulation tip will precipitate the protein and stop bleeding by closing blood vessel opening

44
Q

local measures to control hemorrhage

A

ice or old compress
tannic acid/tannins (tea bag)
suture
local pressure
gel foam
extraction socket packing material
electrocautery or electrosurgery
hydrogen peroxide (diluted)
tranexamic solution

45
Q

primary lesions

A

flat, non palpable lesions
macules (<10mm)
patch (>10mm)
elevated leions
papules (<10mm)
plaques (>10mm)
nodules - firm lesions that extend to dermis or subq
clear, fluid filled blisters
vesicles (<10mm)
bullae (>10mm)
pustules - vesiccles that contain pus

46
Q

erosion vs ulcer

A

erosion - shallow, superficial opening that shows loss of part or all of the epidermis
ulcer - crater like lesion with loss of epidermis and part of dermis

47
Q

linear, often painful deep breaks within the skin surface

A

fissure - result of excessive xerosis (Dryness of skin)

48
Q

linear erosion caused by scratching, rubbing, or picking

A

excoriation

49
Q

consists of dried serum, blood, or pus over damaged layers of skin

A

crusts (scabs)
occurs in inflammatory or infectious skin diseases (eg impetigo)

50
Q

thin, compressed superficial accumulation of horny epithelium

A

scale

51
Q

permanent fibrotic skin changes that develop as a consequence of tissue injury

A

scar

52
Q

necrotic tissue discarded from the surface of the skin following injury or disease

A

eschar (seen in burn patients or gangrene)

53
Q

rate of nerve regeneration

A

1 - 1.5mm / day

54
Q

recovery of neuropraxia

A

spontaneous and complete within 3 to 4 weeks

55
Q

primary vs secondary primary degeneration

A

primary - immediately proximal to injury
secondary or wallerian degeneration - distal to the site of injury degenerate (within 78 hours, phagocytosis by adjacent schwann cells and by macrophage)

56
Q

schwann cell outgrowths from portion of axon distal to site of injury in an attempt to connect the proximal and distal nerve stumps

A

Bungner’s band - if hindi continous can cause axonal outgrowths or Neuroma

57
Q

axonal outgrowths randomly aligning with fibrin clot

A

neuroma

58
Q

based on root development, when is it ideal to remove a lower 3rd molar

A

2/3 of root developed

1/3 - difficult to luxate and crown will roll around socket

59
Q

classification of impacted lower 3rd molar depending on the inclination of 3rd molar to 2nd molar

A

WINTER’S
Mesioangular - easiest, most common
distoangular - hardest
vertical
horizontal - 2nd easiest
buccoverted - you can see cusp tips
linguoverted - cannot see cusp tips

60
Q

different winter’s lines

A

white line - occlusal plane, helps assess the axial inclination of the impacted tooth
amber line - alveolar crest, shows amount of overlying bone
red - vertical line from amber line to CEJ on mesial side; measures depth of impaction - if 5mm or longer, is indicative that the tooth should be removed under GA

61
Q

classification of impacted lower 3rd m according to anterior border of the ramus

A

PELL & GREGORY
Class 1 - there is sufficient space for the widest part of the tooth
Class 2 - insufficient space
class 3 - there is no space

62
Q

classification of impacted lower 3rd m according to depth of impaction

A

PELL & GREGORY
Position A - Higher than the occlusal of 2nd molar
Position B - between occlusal and cervical of 2nd molar
Position C - below CEJ of 2nd molar

63
Q

hardest impacted 3rd molar to exo based on winter’s classification

A

Mandi:
mesioangular - easiest
distoangular - hardest

Maxi:
mesioangular - hardest
distoangular - easiest

64
Q

classification of impacted canines

A

ARCHER’S
Class 1 - palatal (vertical, horizontal, semivertical)
class 2 - labial (v, h, sv)
class 3 - crown is labial and the root is palatal
class 4 - at the alveolar bone above the apices of the teeth, neither labial or palatal
class 5 - inside palate of edentulous maxilla

65
Q

bur used for odontectomy

A

round bur (#6, #8)
tapering fissure bur (#557 and #703)

66
Q

types of fracture

A

simple fracture - bone is broken, skin or mucosa is not broken
compound fracture - both bone and skin are broken (PDL space provides communication with external environment)
complicated fracture - 1 bone, more than 1 fracture line
comminuted fracture - shattered/several pieces (can be simple or compound)
greenstick fracture - one sided fracture/ di umabot sa buong bone

67
Q

maxillary fractures (other names) and pathognomonic signs

A

Le Fort I / Horizontal / Guerin’s / Low maxillary / transmaxillary - floating jaw
Le Fort II / Pyramidal Fracture - Battle’s sign or Post-auricular ecchymosis or mastoid ecchymosis and Raccoon eye (Base: dentition, apex: nasofrontal suture)
Le Fort III /Transverse Fracture / Cranio Dysjunction - Dish face, Cerebrospinal rhinorrhea due to basilar fracture usually cribriform plate of ethmoid bone

68
Q

most common part of mandible involved in a fracture

A

condyle, angle, symphysis

least common: coronoid

69
Q

Mandibular fracture

A

Guardsman fracture - bilateral condyle + symphysis
Bucket-Handle fracture - bilateral mandibular body fracture in edentulous patients, proximal segment is pulled anteriorly and superiorly (masseter), anterior segment is pulled inferiorly (genioglossus, geniohyoid)
inferiorly and posteriorly?? - digastric and mylohyoid??

70
Q

aka as tripod fracture, nerve usually involved in paresthesia

A

zygomaticomaxillary complex fracture; paresthesia is common: infraorbital nerve
muscle imblances (ocular m. and masseter)
maxillary sinus hematoma

71
Q

articulations of zygoma

A

superiorly - zygomaticofrontal
anteriorly - zygomaticomaxillary
posteriorly - zygomatico-temporal
contributes to orbit
medially borders the mandible

72
Q

radiographs used

A

panoramic radiograph (OPG) - both arches
water’s view - maxi sinus, frontal, ethmoid sinus
reverse towne view (tingin sa baba?) - condylar neck fractures; like posteror anterior view
submentoverter view (SMV) (from baba) or Jug-Handle - zygomatic arch, sphenoid sinus

73
Q

treatment of fractures

A
  1. debridement
  2. reduction (open or closed)
  3. fixation (interdental wiring technique, interosseous wiring technique, circumferential wiring (edentulous mandible), titanium plates with screws, intermaxillary fixation (ERICH ARCH BAR)
  4. immobilization (3-6 weeks) and functional rehabilitation
74
Q

best treament for greenstick fracture of mandible

A

interdental wiring to restore normal occlusion

75
Q

condylar neck fracture displaces the condyle due to?

A

lateral pterygoid muscle to medially and forward

76
Q

radiographs useful in confirming mandibular fracture

A

lateral oblique / PA ceph -coronoid? Tmj??
panoramic radio -entire md
intraoral radio
towne’s projection

77
Q

basic principles in treating mandibular fractures

A

reduction of fracture
fixation of fracture
restoration of occlusion

78
Q

fracture at md condyle jaw deviates where

A

towards same side (ipsilateral)

79
Q

most serious complication from facial abscess secondary to infected maxillary canine

A

cavernous sinus thrombosis / thrombophlebitis - PHOTOPHOBIA, headache, nausea, fever

80
Q

needle aspiration of central bone lesion rationale

A

to rule out if vascular lesion –> bleeding if incised kasi

81
Q

3rd molar infection directly spreads to

A

submandibular, pterygomandibular, parapharyngeal

82
Q

intraoral drainage for infection in pterygomandibular space is through ___

A

buccinator muscle

83
Q

sequestrum vs involucrum

A

sequestrum - necrotic bone separated from healthy bone
involucrum - sclerotic bone that shields healthy bone from necrotic bone – radiopaque and not removed

84
Q

gap in the cortex of a bone affected by chronic osteomyelitis that allows the drainage of pus or other material from the bone into the adjacent tissues

A

CLOACA

85
Q

surgical removal of necrotic bone to prevent the spread of infection and minimize tooth mobility and bone loss

A

sequestrectomy
- better to delay until involucrum is fully formed
- light curettage
- SAUCERIZATION - removal of overlying bone to access
- DECORTICATION - removal of undermined and infected cortical plates of bone

86
Q

needle used in fine needle aspiration biopsy

A

18G needle

87
Q

biopsy used in radical neck dissection

A

frozen-section biopsy - malignant lymph nodes of the neck are removed, frozen and immediately examined until 2 consecutive nodes are determined to be benign

88
Q

Carnoy’s solution is…

A
  • it is a cauterizing and fixating agent that penetrates cancellous spaces in the bone at 1.5 - 2mm –> prevents recurrence after excision etc
  • 1 g ferric chloride + 10 mL solution (60% absolute alcohol, 30% chloroform, 10% glacial acetic acid)
    3-5mins is sufficient because more than can possibly damage vital structures
89
Q

types of resection

A
  1. marginal resection - without disruption of the continuity of bone
  2. partial resection - partial removal of a full-thickness segment of the bone thereby disrupting continuity
  3. total resection - complete removal of the entire bone
  4. composite resection - resection of a tumor with bone, adjacent soft tissues, and contiguous lymph node channels
90
Q

types of implants

A
  1. endosseous (root form or blade form)
  2. subperiosteal - rides on bone, underneath the mucoperiosteum
  3. transosseous - penetrate the entire jaw
91
Q

bone repair

A

osteogenesis - formation of new bone (spontaneous vs transplanted)
osteoconduction - passive framework or scaffold to guide formation of new bone
osteoinduction - illicit bone formation by bone morphogenic proteins (BMP)

92
Q

classification of grafts

A
  1. autogenous / autograft - same individual, best (ostegenic, osteoconductive, osteoinductive)
  2. allogenic / allograft - same species, NOT related (
    a. Fresh frozen (high rate of infection), b. freeze dried (osteoconductive), c. demineralized freeze dried (exposes BMPs which are osteoinductive, also osteoconductive but lower mech strength)
  3. Isogenic / isograft - same species, RELATED
  4. Xenogenic / xenograft / heterograft - another species
  5. alloplast - synthetic graft, intert
93
Q

heating bone above 47 degree C can lead to bone necrosis. how to avoid?

A

use copious irrigation

94
Q

implant distance minimum

A

bet implant and natural tooth or vital structure - min 1.5mm
bet 2 implants - min. 3mm

95
Q

effect of bone density to implant stability? best bone density type?

A

more cortical bone, higher implant stability but lower blood supply

BEST would be D2 bone type = thich cortical bone with coarse trabecular bone underneath - anterior and post mandible - high implant stability with EXCELLENT blood supply

d1 - anterior mandible
d2 - anterior and post mandible
d3 - posterior mandible, anterior and posterior maxilla (porous - low implant stability)
d4 - posterior maxilaa (MOSTLY fine trabecular, most challenging)

96
Q

three methods to reflect tissue

A

prying or twisting - pointed end to elevate soft tissue
push stroke - broad end separates mucoperiosteum
pull/ scrap stroke - tends to shred periosteum if not careful

Need To Recall (19 decks)

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