Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Module 7 > Oral Surgery > Flashcards

Oral Surgery Flashcards

Topics covered: management of mandibular fractures, zygoma fractures, mid-face fractures, oral cancer, salivary gland disease. and referral to oral med and biopsy

1
Q

Which nerve exits the mental foramen and provides sensory innervation to the lower lip?

A

The mandibular division of the trigeminal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name the 4 main pairs of muscles that are attached to the mandible?

A
  1. Lateral Pterygoid
  2. Medial Pterygoid
  3. Masseter
  4. Temporalis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Other than the 4 main pairs of muscles, list some other muscles that are attached to the mandible:

A
  • Mylohyoid
  • Genioglossus
  • Geniohyoid
  • Anterior belly of the digastric
  • Mentalis
  • Buccinator
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What % of mandibular fractures account for all facial fractures?

A

36-70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List 4 potential causes of mandibular fracture:

A
  1. Assault
  2. Sports Injury
  3. RTAs
  4. Pathological - cyst, tumours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List the 5 different types of mandibular fractures?

A
  1. Simple - undisplaced, overlying periosteum is intact
  2. Compound - overlying periosteum and often overlying skin perforated, can involve tooth socket, higher potential for wound infection if wound exposed to oral cavity
  3. Comminuted - multiple fracture lines, high impact fractures (RTAs), more challenging to manage
  4. Greenstick - uncommon in mandible, associated w fractures in children, flexing of bone where the outer cortex fractures but inner cortex remains undisplaced
  5. Pathological
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are fractures classified by?

A

Their anatomical position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 8 different classifications of mandibular fractures?

A
  1. Dentoalveolar
  2. Condylar (common)
  3. Coronoid
  4. Ramus
  5. Angle of the mandible (common)
  6. Body
  7. Parasymphysis (common)
  8. Symphysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why are condylar fractures common?

A

As the condylar neck is a point of weakness (“crumple zone”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is often seen with coronoid fractures and why?

A

Often see displacement of the fracture superiorly into the infratemporal space - this is because the coronoid is attached to the temporalis muscle.

This can be difficult to manage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why are fractures of the angle of the mandible common?

A

As mandibular third molars are a point of weakness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why are parasmyphysis fractures common?

A

Due to the long root of the mandibular canine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What 4 factors influence the degree of fracture displacement?

A
  1. Pattern of fracture
  2. Degree of comminution
  3. Teeth in fracture line
  4. Muscle pull
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where will the lateral pterygoid displace a fractured condyle?

A

Anteriorly and medially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where will the temporalis, masseter and medial pterygoid displace a fractured proximal segment of the mandible?

A

Superiorly and medially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where will the digastric, geniohyoid, genioglossus, and mylohyoid displace a fractured anterior segment of the mandible?

A

Inferiorly and posteriorly

  • Known as a “bucket handle fracture” seen in edentulous mandibles.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a Guardman’s fracture?

A

Where the chin absorbs the force of the impact causing:
1. Fracture through the midline of the mandible
2. Bilateral transmission of force to condylar neck, causing condylar fracture
3. Medial displacement of the coronoid process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What extra-oral clinical features might you see in a patient with a mandibular fracture?

A
  1. Pain
  2. Swelling
  3. Bruising
  4. Trismus
  5. Concurrent soft tissue injury - cut lip, dirt, tooth fragment
  6. Otorrhea - bleeding from ear, CSF
  7. Anaesthesia/paraesthesia of the lip
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If otorrhea is observed as a clinical finding in a patient with a mandibular fracture, what must you consider?

A

Whether there has been a fracture to the base of the skull

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What intra-oral clinical features might you see in a patient with a mandibular fracture?

A
  1. Haematoma in the FOM (Coleman’s Sign) and buccal mucosa
  2. Malocclusion
  3. Tongue - stable position, swelling
  4. Step deformity in occlusion
  5. Gingival laceration
  6. Mobility, loss of teeth, or fractured teeth - inhaled, swallowed, or in soft tissue.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which 2 radiographic views would you ideally take in primary care to allow 3D visualisation of a mandibular fracture?

A
  1. DPT
  2. PA mandible/facial
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What additional radiographic views can be used in secondary care to allow 3D visualisation of a mandibular fracture?

A
  1. Reverse Towne’s
  2. CBCT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Where would you refer a patient with a mandibular fracture for radiographs, management and follow-up?

A

Refer to the nearest maxillofacial surgery department

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What complications might a delay in presentation/treatment of a fracture cause?

A
  1. Wound dehiscence
  2. Infection
  3. Exposure of hardware
  4. Non-union
  5. Fibrous union
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What 2 different treatment methods are available when managing mandibular fractures?

Which method is the preferred treatment method?

A
  1. Open technique - preferred
  2. Closed technique
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

In which fracture cases can you use open reduction?

A
  1. Displaced fractures (including edentulous displaced fractures)
  2. Multiple fractures
  3. Bilateral displaced condylar fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Is open reduction carried out intra-orally or extra-orally?

A

It can be carried out both intra-orally and extra-orally - however it is most commonly carried out intra-orally.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the purpose of open reduction and internal fixation in the management of mandibular fractures?

A

Open reduction - used to align the bone ends anatomically and recreate normal anatomy

Internal fixation - used to prevent movement of the bone margins whilst healing occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Approximately how long does it take for an adults fractured mandible to heal post-surgery?

A

~4-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Fixation can be load bearing (i.e. 2 large plates) or load sharing (i.e. one upper border plate and arch bars).

Which is the most ideal out of the 2 options?

A

Load bearing is most preferred as 100% of the functional load is supported by the fixation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What aids may be used when carrying out internal fixation?

A
  1. Titanium mini-plates - most commonly used
  2. Reconstruction plates - used in edentulous mandibles
  3. Compression plates - not commonly used
  4. Lag screws - not commonly used
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Why is titanium a useful material to use for miniplates in internal fixation?

A

As it osseointegrates well.

This means that the miniplates can successfully remain throughout life.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the advantages and disadvantages of open reduction and internal fixation?

A

Advantages:
- Improved alignment and occlusion
- Fracture immobilisation
- Avoids IMF (closed technique)
- Low rate of malunion
- Lower rate of infection

Disadvantages:
- Morbidity of surgical procedure - as requires GA
- Expensive hardware
- Need for GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

For open reduction and internal fixation, what set of principles determine the number of plates needed and the position of the plates?

A

Champy’s principles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How do the Champy’s principles work?

A

They work by assessing where the stress intention lines are in the mandible and then maximising the position of miniplate osteosynthesis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

In accordance with Champy’s principles, where should the miniplate be placed and why?

A

Along the ideal line of osteosynthesis - to counteract distraction forces that occur along the fracture line.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

In accordance with Champy’s principles, in the mandibular angle region, where should the plate be placed?

A

Either along or just below the oblique line of the mandible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

In accordance with Champy’s principles, in the mental foramina region, where should the plates be placed?

A

2 plates below the apices of the teeth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What can be used in conjunction with open reduction and internal fixation to improve the occlusion and reduce the fracture?

A

Pre-operative IMF (closed technique)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What does the closed technique involve?

A

Intermaxillary fixation (IMF) - wiring the jaws together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What aids can be used to facilitate IMF?

A

Arch bars
Eyelet wires
Leonard buttons
Cast cap splints
Gunning splints - for edentulous cases
IMF screws

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the indications for using a closed reduction technique?

A
  1. Non-displaced favourable fractures
  2. Grossly comminuted fractures
  3. Significant loss of overlying soft tissue
  4. Edentulous mandibular fractures
  5. Fractures in children
  6. Coronoid process fractures
  7. Undisplaced condylar fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the advantages and disadvantages of closed reduction?

A

Advantages:
- Inexpensive
- Simple - can be done under LA
- No foreign body (reduced risk of infection)

Disadvantages:
- Not absolutely stable (still movement at bone margins)
- Prolonged period of IMF up to 6 weeks ( impact on patient’s life)
- Possible TMJ sequelae
- Decreased oral intake
- Possible pulmonary consideration (esp if pt has reflux/vomiting issues)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Why are edentulous fractures more challenging?

A
  • Atrophy
  • Poorly vascularised (poor healing capacity)
  • Lack of anatomical landmarks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What classification system is used to classify mandibular atrophy in edentulous mandibles?

A

The Luhr Mandibular Atrophy Classification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How should edentulous fractures be managed?

A

With the placement of large reconstruction load-bearing plates (extraorally)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Condylar fractures can be extra-capsular or intra-capsular.

Which one is difficult to treat, and which one is most common?

A

Difficult to treat - Intra-capsular
Most common - Extra-capsular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the suggested management for condylar fractures?

A

Often can be managed conservatively - soft diet, analgesics, NSAIDs

However, if there is displacement or dislocation of the condylar head then active treatment is required:

Intra-capsular: closed reduction using Leonard buttons and elastic traction.

Extra-capsular: open reduction and internal fixation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How do you manage a greenstick (no displacement) fracture?

A

Manage conservatively using splints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How would you manage the patient postoperatively following surgical management of a mandibular fracture?

A

Managed on Ward/ITU
Depends on treatment method (open v closed)
Wire cutters or scissors can be used to remove IMF
There is no specific guidance on prescribing antibiotics
Pt may require short-term steroids/fluids
Post op xrays are not taken routinely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What complications may arise following surgery for a mandibular fracture?

A
  1. Inadequate fixation - resulting in mobility/non-union/fibrous union/malunion
  2. Altered occlusion
  3. Distracted TMJ
  4. Scars - trauma and iatrogenic
  5. Infection - 0.4-32%
  6. Bone necrosis, osteonecrosis
  7. Numb lip - due to damage of IAN or mental nerve
  8. Exposed plate - can be removed under LA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are the aims when treating a fracture of the zygoma?

A
  1. Restore facial projection/symmetry
  2. Restore orbital region - volume, globe, position, shape of palpebral fissure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What 4 factors does the delivery of treatment for a facial fracture depend on?

A
  1. Timing
  2. Type of fracture
  3. Mechanism
  4. Presentation - degree of comminution, stability of fracture, presence of other features
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Why is the management of zygoma fractures not normally carried out immediately?

A

To allow time for facial swelling, oedema, and conjunctival chemosis to reduce - this also helps to improve surgical access.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are the 4 different types of zygoma fractures?

A
  1. Non-displaced fracture
  2. Displaced, minimally comminuted fracture
  3. Complex and comminuted fracture
  4. Isolated zygomatic arch fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Why is open reduction and internal fixation a good treatment option for fractures of the zygoma?

A

As it provides:
- Improved alignment
- Vertical support to the zygoma
- Inspection of fracture sites prior to closure
- Inspection of the orbital rim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Which 5 findings in a zygoma fracture would indicate the need for inspection of the orbital floor?

A

If there is:
1. >5mm defects on CT Scan
2. Severe displacement
3. Comminution of the bones
4. Soft tissue entrapment with limited upward gaze of the eye
5. Orbital contents herniation into maxillary sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are the 5 different options available for reduction of a zygoma fracture?

A
  1. ZMC hook - stab incision, hooks under the bone to provide traction
  2. Oral ZMC hook - IO approach, vestibular incision, hooks under bone to provide traction
  3. Screw reduction - screw insertion to provide traction
  4. Carroll-Girard T-Bar - provides traction similar to screw reduction
  5. Surgical approach - oral or temporal (Gilles) - Gilles temporal approach is ideal for isolated arch fractures (W type fractures)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How would you carry out the surgical Gilles Temporal technique for reduction of a zygoma fracture?

A
  1. Identify incision site
  2. Skin incision and dissect to temporalis fascia
  3. Incise temporalis fascia
  4. Introduce instrument and navigate beneath zygomatic arch
  5. Introduce elevator (Bristow/Rowe) to reduce
  6. Close wound with sutures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What aids can be used for the fixation of a zygoma fracture?

How many points of fixation is considered ideal?

A

Miniplates and screws.

2/3 point fixation is considered ideal - however 4 point fixation may be used in comminuted high energy injuries.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

List 3 common fixation points in the management of a zygoma fracture:

A
  1. Frontozygomatic suture
  2. Zygomaticomaxillary buttress
  3. Infraorbital region
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

List some other features that may present when dealing with a zygoma fracture:

A
  1. Orbital content/volume derangement
  2. Facial asymmetry
  3. Infra-orbital nerve issues
  4. Functional issues - jaw opening, masticatory
  5. Associated fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How would a non-displaced zygomaticomaxillary complex (ZMC) fracture be treated?

A
  1. Confirm by CT scan
  2. Non-surgical management - antibiotic, nasal decongestant (if any maxillary sinus involvement), analgesia
  3. Frequent observation - monitor for asymmetry or functional deficit (if these occur patient may need ORIF)
  4. Soft diet - to avoid any fracture displacement by the masseter muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

How would a displaced minimally comminuted ZMC fracture be treated?

A

Can attempted to treat with reduction alone (reducing the fracture back to its initial position - however there is a risk of fracture displacement

OR

Treat with ORIF (1-4 point fixation) with titanium mini-plates and screws:
- Reduction by direct visualisation to restore facial symmetry, globe volume, position and function
- Fixation at the frontozygomatic suture, zygomaticomaxillary buttress and inferior orbital areas (2-3 point - ideal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What are the indications for a 2-point fixation method in the treatment of ZMC fracture?

A
  1. Minimally displaced fractures
  2. Stable ZMC fracture after initial reduction with no palpable step deformity at the infra-orbital rim
  3. No evident changes to orbital volume and globe displacement on CT scan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What are the indications for a 3-point fixation method in the treatment of ZMC fracture?

A
  1. Instability of the fragment
  2. Exploration of orbital floor required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How would a complex and comminuted ZMC fracture be treated?

A

Major reconstruction
Larger flaps for exposure
Reconstruction of facial buttresses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What would indicate the need for reconstruction when managing a ZMC fracture?

A
  1. Enophthalamos - sunken globe due to loss of supporting structures
  2. Larger defects (5-10mm)
  3. Defects posterior to the axis of the globe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are the complications associated with ZMC fractures?

A
  1. Pain
  2. Facial asymmetry
  3. Scarring
  4. Bleeding (epistaxis)
  5. Hardware failure (exposure palpability)
  6. Infraorbital nerve paraesthesia
  7. Temperature sensitivity
  8. Facial paresis or paralysis
  9. Poor cosmetic result
  10. Trismus
  11. Ophthalmological complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What should be performed by the oral and maxillofacial team prior to surgery for a ZMC fracture?

A

An ophthalmology exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What post-op ophthalmological complications can occur following ZMC fracture surgery?

A
  1. Decreased visual acuity
  2. Ectropion - eyelid turned outwards, excessive eye dryness/watering
  3. Entropion - inverted eyelid, redness, irritation, excessive eye watering
  4. Corneal exposure/abrasion
  5. Ptosis - upper eyelid drooped
  6. Epiphora - watery eye
  7. Enophthalamos - sunken eye
  8. Orbital dystopia - eyes not level
  9. Diplopia
  10. Blindness - caused by superior orbital fissure syndrome or retrobulbar haemorrhage with compartment syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What does superior orbital fissure syndrome (SOFS) cause?

A
  1. Ophthalmoplegia - eye movement problems
  2. Ptosis - upper eyelid droop
  3. Proptosis - bulging eyes
  4. Mydriasis - fixed dilated pupils
  5. Loss of accommodation
  6. Anaesthesia to forehead/upper eyelid
  7. Anaesthesia to cornea/bridge of nose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

How do you manage superior orbital fissure syndrome?

A

Conservative management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What does retrobulbar haemorrhage with compartment syndrome (RBH+OCS) cause?

A
  1. Arterial bleed
  2. Closed non-expansile space
  3. Increased intra-orbital pressure
  4. Orbital compartment syndrome
  5. Reduced perfusion
  6. Ischaemia of optic nerve and retina
  7. Permanent vision loss
  8. Proptosis
  9. Conjunctival chemosis
  10. Subconjunctival haemorrhage
  11. Tense globe to palpation
  12. Reduced visual activity
  13. Sluggish pupil response
  14. Relative afferent pupillary defect
  15. Intense globe pain
  16. Diplopia - double vision
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is the management for retrobulbar haemorrhage with compartment syndrome (RBH+OCS)?

A
  1. Non-surgical - fluid deplete, mannitol, acetazolamide, steroids
  2. Surgical - lateral canthotomy - surgical decompression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is the most likely cause of a mid-face fracture?

A

High energy/high impact forces from:
- RTAs
- Severe assault weapons
- Falls from height
- Industrial - large machinery
- Agriculture - large animals
- War injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are the borders of the midface?

A
  1. Superior borders:
    - zygomatic, frontonasal, frontomaxillary
  2. Inferior borders:
    - occlusal plane (upper teeth)
    - alveolar ridge
  3. Posterior borders:
    - pterygoid plates of the sphenoid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Where does the middle third facial skeleton gain its stability from?

A

Paired buttressing system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What anatomical feature of the mid-face can help to manage masticatory forces?

A

Struts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What can the midface do to protect the brain, skull, and cranium from trauma?

A

It can collapse and absorb forces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What 3 parts make up the buttressing system of the mid third facial skeleton?

A
  1. Vertical Buttress
    - includes nasomaxillary, zygomaticomaxillary, pterygomaxillary buttresses.
  2. Horizontal Buttress
    - includes frontal, zygomatic, and maxillary buttresses.
  3. Sagittal Buttress
    - includes zygomatic arches, palate, floor of orbit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What are the characteristics of the middle third of the facial skeleton?

A
  1. Fragile
  2. Fracture usually affects multiple bones
  3. Low tolerance to impact forces
  4. Protective - can collapse in response to trauma
  5. Posterior displacement of the maxilla in response to fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Which bones of the midface are most likely to fracture in response to traumatic forces?

A

Nasal bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What might you expect to see when an edentulous patient presents with a midface fracture?

A

A posteriorly displaced maxilla - however as the patient is edentulous you can expect to see:

  • Anterior open bite
  • Facial lengthening
  • Limited airway
  • Nares blood clot
  • Coincident head injury
  • Dish face deformity (in severe cases)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What classification system is used to classify mid-face fractures?

A

The Le Fort Classification System

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is a Le Fort I fracture?

A

A fracture that results from a force directed above dentoalveolar segment.

Separates the teeth and whole alveolar complex.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is a Le Fort II fracture?

A

A fracture that results from a force directed at the nasal bones.

A pyramidal fracture - maxillary teeth at the base of the pyramid, with the nasofrontal suture at the apex of the pyramid.

Separates the whole maxilla with part of the nasal bones and the lower part of the pterygoid plates.

89
Q

What is a Le Fort III fracture?

A

Results from a force directed level to the orbits

Separates the ZMC, nasal bones, palatal bones, and most of the pterygoid plate from the rest of the cranium

90
Q

If a patient displays a combination of Le Fort fractures, what would you classify the fracture as?

A

Panfacial

91
Q

What complications can occur as a result of a midface fracture?

A
  1. Airway complications
  2. Haemorrhage
  3. Head injury
  4. Orbital/eye injury
  5. Other trauma
92
Q

What are the 4 initial management steps when managing a midface fracture?

A
  1. Airway management
  2. Control haemorrhage
  3. Head injury assessment/GCS
  4. Secondary survey - facial fracture assessment
93
Q

What might be the cause of airway obstruction following a midface fracture?

A

Physical anatomical changes - displaced maxilla and LFH
Swelling (local oedema)
Bleeding
Foreign body
Loss of consciousness - compensatory mechanisms lost
Head injury and respiratory depression

94
Q

What 3 things are assessed in the Glasgow Coma Scale?

What score is the most concerning?

A
  1. Eye opening
  2. Verbal response
  3. Motor response

Score of 1 is most concerning - means no response.

95
Q

What is assessed in the secondary survey when managing a midface fracture?

A

Head and neck assessment:

(a) Extra-oral assessment
- asymmetry
- laceration
- ecchymosis
- discharge from nose/ears
- systematic bilateral palpation
- frontal bones
- supraorbital rims
- frontonasal suture
- lateral orbital rims
- zygoma
- zygomatic arch

(b) Intra-oral assessment
- maximal inter-incisal opening
- maxillary vestibule
- zygomaticomaxillary buttress
- palate
- occlusal steps
- malocclusions
- mobility of maxilla

(c) Eye/Orbit

96
Q

How does a Le Fort I fracture commonly present?

A

Mobility of tooth bearing segment of the upper jaw
Crepitus in buccal sulcus
“Cracked pot” percussion note from upper teeth
Intra-oral haematoma in buccal sulcus
Palatal haematoma
Fractured teeth cusps
Bruising of upper lip and lower midface
Occlusal discrepancy
Anterior open bite
Dentures not fitting

97
Q

How does a Le Fort II/III fracture commonly present?

A

Bi-lateral peri-orbital bruising (panda eyes)
Subconjunctival haemorrhage
Lengthening of face
Malocclusion - anterior open bite
Gross oedema of the face
Nasal deformity
CSF rhinorrhoea
Diplopia and other visual problems
Mobility of upper jaw - Le Fort III would mobilise slightly higher up
Palatal haematoma
Mandibular fractures
Nasal septal haematoma - must be decompressed when found as can block the airway
Palatal split

98
Q

How are midface fractures assessed?

A

By CT scan

99
Q

What finding is used to confirm diagnosis of all Le Fort fractures?

A

A fracture line extending through the pterygoid plates

100
Q

How would a Le Fort I fracture be diagnosed?

A

Evidence on CT scan of a fracture line:
- Through the pterygoid plates
- And within the piriform aperture

101
Q

How would a Le Fort II fracture be diagnosed?

A

Evidence on CT scan of a fracture line:
- Through the pterygoid plates
- And through the inferior orbital rim and zygomatic buttress

102
Q

How would a Le Fort III fracture be diagnosed?

A

Evidence on CT scan of a fracture line:
- Through the pterygoid plates
- And through the lateral orbital wall and zygomatic arch

103
Q

How would you manage a midface fracture?

A
  1. After pt stable aim to restore normal function
    - ocular
    - nasal
    - oral
    - dental
  2. Aesthetics:
    - symmetry
  3. ORIF with mini plates and screws
    - fixate at buttress areas
  4. Reduction may require disimpaction with Rowes disimpaction forceps
  5. Mid-face access:
    - bi-coronal flap - not common
    - intra-oral vestibular
    - zygomatic/orbit
    - direct - lacerations
104
Q

What are the reconstruction principles of pan facial trauma?

A
  • Maxillomandibular unit
  • Establish occlusion
  • Restore bony pillars
  • Re-establish relationship, occlusal structures with skull base
105
Q

List 6 causes of oral cancer:

A
  1. Tobacco
  2. Alcohol
  3. Genetic predisposition
  4. HPV (likely oropharyngeal cancer rather than oral cavity cancer)
  5. EBV (nasopharyngeal cancer)
  6. HHV 8 (Kaposi’s not OSCC)
106
Q

List 4 types of oral pre-malignant disorders:

A
  1. Leukoplakia
  2. Erythroleukoplakia
  3. Proliferative Verrucous Leukoplakia (PVL)
  4. Submucous fibrosis

*oral lichen planus and chronic hyperplastic candidosis (controversial)

107
Q

What % of Leukoplakia’s undergo malignant transformation?

A

8-22%

108
Q

How would you describe a Leukoplakia?

A

A white plaque that is attributable to no other cause
Can be homogenous or non-homogenous
Can be focal or multifocal
40-46% demonstrate dysplasia/CIS/SCC

109
Q

How would you manage a Leukoplakia?

A

Refer to Oral Medicine department for surgical excision, serial biopsies/reviews with photography

110
Q

How would you describe an Erythroleukoplakia?

A

Non-homogenous Leukoplakia
Red, pebbly granular plaque
90% demonstrate dysplasia/CIS/invasive disease on biopsy (high risk)

111
Q

What are the main characteristics of submucous fibrosis?

A

Juxta-epithelial inflammation
Fibrosis of oral mucosa with progressive trismus
Mucosal burning, ulceration, dryness
More commonly seen in India/Bangladesh/Pakistan

112
Q

What is the most common cause of submucous fibrosis?

A

Areca nut (e.g. from betel quid) + genetics?

113
Q

How does fibrosis occur in submucous fibrosis?

A

Aetiological factors (e.g. areca nut - betel quid) induce the activity of TGF-beta.

This produces collagen and inhibits collagen degradation, resulting in fibrosis.

114
Q

What % of submucous fibrosis undergoes malignant transformation?

A

7-30%

115
Q

How would you manage a patient with submucous fibrosis?

A

By medical/physical/surgical management

116
Q

How would you describe PVL?

A

Proliferative, multi-focal, exophytic, persistent

117
Q

What are the risk factors for PVL?

A

There are no risk factors.

*more common in elderly women and oral microbiome dysbiosis may be a contributory factor

118
Q

What % of PVL undergoes malignant transformation?

A

70-100%

119
Q

On average, how long does it take for PVL to become malignant from diagnosis?

A

~23 months

120
Q

What is the main treatment provided for the management of PVL?

A

Surgical treatment

121
Q

List 7 red flags that may make you suspicious of malignancy?

A
  1. Ulcer persisting >2 weeks despite removal of obvious causation
  2. Rolled margins, central necrosis
  3. Speckled (Erythroleukoplakia appearance)
  4. Cervical lymphadenopathy - enlarged (>1cm), firm, fixed, tethered, non-tender
  5. Worsening pain (neuropathic, dysesthesia, paraesthesia)
  6. Referred pain - ear, throat, mandible
  7. Weight loss (local/systemic)
122
Q

What staging method is used when staging cancer?

A

The TNM staging method

123
Q

Who is involved in the management of a patient that has oral cancer?

A

The multidisciplinary team (MDT) - this may involve:

  1. The patient themselves
  2. CNS
  3. Oncologists
  4. Radiologists
  5. Surgeons
  6. Dieticians
  7. Speech therapists
  8. MDT liaison
  9. Pathologists
  10. Restorative dentists
124
Q

What oral cancer management methods are available?

A
  1. Surgery
  2. Radiotherapy
  3. Chemo-radiotherapy
  4. Dual and triple modality
  5. Immunotherapy
125
Q

When planning surgical management for the removal of oral cancer, what planning decisions must be considered prior to surgery?

A
  1. Planning the resection
  2. Planning neck management
  3. Planning reconstruction - with CT
  4. Planning oral rehabilitation
126
Q

List 12 clinical situations that would indicate a necessary referral to the local Oral and Maxillofacial Surgery Department:

A
  1. Persistent pain following extraction
    - all odontogenic causes have been excluded
  2. Non-healing socket following extraction
  3. Dry socket - pain persisting for >10 days
  4. Cervicofacial infections
    - immediate referral necessary when signs of spreading infection, where drainage of abscesses not possible in primary care, immunocompromised and paediatric patients
    - suspicion of sepsis requires immediate referral to emergency dept.
  5. Persistent haemorrhage from extraction socket/biopsy site:
    - refer if bleeding fails to resolve after direct pressure and placement of a haemostatic agent and suturing
    - refer if patient has lost a considerable volume of blood
  6. OAC and root displacement of teeth/roots/implants into maxillary sinus:
    - refer when communication cannot be closed in primary care or if the roots/implants have been displaced to an extent where they cannot be retrieved
  7. Dento-alveolar trauma:
    - refer if there are facial or intra-oral lacerations which appear soiled, if extent of injury or compliance of patient renders tx under LA unsuitable, if there is suspicion of an inhaled or imbedded tooth fragment
  8. Nerve injury:
    - refer if there is persistent altered sensation in a nerve division
  9. Fracture of maxillary tuberosity:
    - immediate referral if there is persistent haemorrhage following tuberosity fracture
    - abandoned extractions which have been splinted/sutured back into position will require elective surgical removal
  10. Dislocated mandible:
    - immediate referral if there is failure to relocate jaw in primary care (sedatives or GA may be required)
  11. Hypochlorite extrusion:
    - immediate referral if there is swelling and erythema extending towards the neck or eye, or if there is breathing/swallowing issues
  12. Fractured mandible:
    - immediate referral required
127
Q

List 6 clinical presentations that would indicate a necessary referral to the local Oral Medicine department?

A
  1. Red/white patches - potential malignancy
  2. Erosions/ulcers
  3. Vesiculobullous lesions
  4. Burning mouth syndrome
  5. Facial pain
  6. Xerostomia
128
Q

What does a biopsy involve?

A

The removal of tissues for histopathological examination:
- Mucosa
- Bone
- Curettage of cyst lining or contents

129
Q

Name 2 different types of biopsy:

A
  1. Incisional biopsy
  2. Excisional biopsy
130
Q

What does an incisional biopsy involve?

A

The removal of a representative reasonably sized portion of the lesion to establish definitive diagnosis before treating.

Multiple specimens may be necessary (mapping biopsies).

131
Q

What are the 3 different types of incisional biopsy?

A

Exfoliative cytology
Aspirational (FNAC)
Labial gland biopsy

132
Q

What does exfoliative cytology involve?

A

The removal of surface cells by scraping with a spatula or cytobrush

133
Q

What does fine needle aspirational cytology (FNAC) involve?

A

Involves the insertion of a fine needle into a particular area/swelling and removal of some of the contents for analysis.

134
Q

What is FNAC useful for?

A

Helps to determine whether a lesion is solid or cystic, fluid-filled or vascular

Useful for investigating lumps in the parotid gland

135
Q

What type of scan can help to improve the accuracy of FNAC?

A

US scan

136
Q

What does a labial gland biopsy involve?

A

This involves harvesting a small amount of salivary tissue from minor glands in the lower lip

137
Q

Which type of incisional biopsy is used in the diagnosis of Sjogren’s Syndrome?

A

Labial Gland Biopsy

138
Q

What does an excisional biopsy involve?

A

Removal of entire lesion including a base of normal tissue to ensure the full lesion has been removed

Can be carried out using a scalpel/suturing or cutting diathermy.

139
Q

Out of scalpel/suturing or cutting diathermy, which method of excisional biopsy is the most preferred method and why?

A

Cutting diathermy is the most desired excisional biopsy method as it avoids post-op bleeding and the need for suturing.

140
Q

Why are pyogenic granulomas commonly seen in pregnant women?

A

Pyogenic granulomas (i.e. pregnancy epulis) are frequently seen in pregnant woman due to increased hormones and inflammation

141
Q

How would you manage a patient that has denture hyperplasia + candidiasis?

A

Excisional biopsy
Systemic antifungals to clear candida infection
Improved denture hygiene
Soft lining placement in denture and tissue conditioner
Allow healing period
Construct new denture

142
Q

How would you treat a mucocele?

A

Excise mucocele and salivary gland to prevent reoccurrence
Close with suture

143
Q

How would manage a lesion that looks suspicious of a SCC?

A

Investigate the lesion by carrying out an incisional biopsy (large piece of worse looking site of lesion)

144
Q

What are the main characteristics of a SCC?

A
  1. Exophytic (grows outwards)
  2. Highly keratinised
  3. Heaped
  4. Indurated soft tissue lesion
  5. Significant size in high risk site
145
Q

What is Speckled Leukoplakia?

A

Leukoplakia (white patches) and Erythroplakia (red patches that wont wipe off, and aren’t attributed to by other causes).

146
Q

What is the difference between Erythroplakia and Erythroleukoplakia?

A

Erythroplakia is a red lesion

Erythroleukoplakia is a Leukoplakia with a red component

147
Q

When carrying out complete removal of a lesion, how much clinically normal tissue should you remove around the margin?

A

1cm in all dimensions

148
Q

What instruments are required for biopsy?

A

LA
Soft tissue tray
Scalpel/sutures
Diathermy
Punch biopsy
CO2 laser
Cryotherapy

149
Q

When can you use cutting diathermy in biopsy?

A

When removing large lesions by excisional biopsy

150
Q

When should you use a punch biopsy?

A

For small biopsies ~6mm

151
Q

When can you use CO2 lasers in biopsy?

A

In the management of vascular lesions

152
Q

When can you use cryotherapy in biopsy?

A

Limited to the management of vascular lesions

153
Q

What happens to the sampled lesion following punch biopsy?

A
  1. Sample fixed in formal saline - sample will become deproteinised and shrink in size
  2. Transferred to pathology department where it will be embedded in wax and sectioned into 4 micrometre sections
  3. Sections stained with H&E stain and assessed down the microscope
  4. A report is then written
154
Q

How does a CO2 laser work as a method of biopsy?

A

It works by vaporising the tissue in order to cut it

155
Q

What safety precautions must you make when carrying out a biopsy using CO2 laser?

A

Significant training is required

Protect the patients eyes as the laser can reflect off metal

Metal instruments must be covered or plastic instruments must be used in order to protect the patient and the operator and the patients soft tissues from laser reflection

156
Q

What should the patient be warned of prior to biopsy using CO2 laser?

A

They are likely to experience significant post-op pain although healing tends to be good.

157
Q

What does the biopsy technique involve?

A

Choose most appropriate site - worst looking part of lesion, appropriate/tolerable for pt.

Infiltration of LA for anaesthesia and haemostasis.

Reasonable size sample and one that can be easily orientated - can use coloured sutures/pins on cardboard to demonstrate orientation of lesion.

Ensure the sample includes overlying and underlying soft tissue.

Atraumatic technique - don’t compress the tissue too much.

Haemostasis - may require diathermy.

Primary closure where possible.

158
Q

What problems can occur during biopsy?

A
  1. Inappropriate specimen
  2. Specimen too small/macerated
  3. Can’t orientate specimen
  4. Tissue distorted by diathermy, laser, or LA
  5. Lab not informed of need for frozen section - need to inform in advance
  6. Lack of clinical detail on form - HPC, size, colour, texture, site, ulcerated, indurated, sign, contact details, risk factors (smoking, alcohol)
  7. Specimen gone up aspirator
159
Q

When are frozen sections used in biopsy?

A

Used peri-operatively when cancers are being managed - when you want to biopsy base/periphery of site to make sure you’ve removed all of the cancer - allows for rapid diagnosis (can receive results in 1hour)

Required for direct immunofluorescence

*for oncology reasons you would only use frozen sections biopsy for already proven cancers - difficult to assess dysplasia so wouldn’t be suitable for diagnosing cancer.

160
Q

What is the most reliable diagnostic aid in the diagnosis of oral lesions?

A

Histopathological examination - most reliable indicator of malignancy

161
Q

If you see a suspicious oral lesion on clinical examination what should you do?

A

Initiate urgent 2-week referral to oral med for investigation of mouth cancer - incisional biopsies would be carried out

Advise pt:
- Reason for referral
- Smoking cessation advice, and reduce alcohol consumption to 14 units/week
- If potentially malignant the lesion will be incised
- if malignant the lesion will be surgically removed

162
Q

Name a high risk area for oral cancer:

A

FOM

163
Q

What are the 2 worst risk factors for oral cancer?

A
  1. Smoking
  2. Alcohol
164
Q

What size would an oral lesion be to be classified as higher risk of becoming malignant?

A

> 2cm

165
Q

What is the purpose of minor salivary glands?

A

To produce constant background moisture

166
Q

What is the most common minor salivary gland pathology?

A

A mucus extravasating cyst

167
Q

How is a mucus extravasating cyst treated?

A

By excision with overlying mucosa and underlying glandular tissue

168
Q

What is the purpose of the major salivary glands?

A

Produce saliva when you think about food/start to eat food.
- these glands don’t produce saliva during fasting periods.

169
Q

What are the 3 different types of major salivary gland?

A
  1. Parotid glands
  2. Submandibular glands
  3. Sublingual glands
170
Q

Out of the 3 pairs of major salivary glands, which pair of glands is the largest?

A

Parotid glands

171
Q

Where is the parotid gland located?

A

It is located anterior to the ear behind the ramus of the mandible and overlaps the masseter muscle.

172
Q

What is the name of the duct associated with the parotid gland?

Where can this duct be found?

A

The Stensen’s duct

Located just opposite from the second maxillary molar tooth.

173
Q

What type of gland is the parotid gland?

A

The parotid gland is a mixed seromucous gland - however predominantly serous.

174
Q

What does the parotid gland consist of?

A
  1. Superficial parotid:
    - sits above facial nerve, accounts for 4/5 of the parotid
  2. Deep lobe of the parotid:
    - sits deep to facial nerve, accounts for 1/5 of the parotid
  3. Accessory lobe of the parotid:
    - sits above duct as duct goes forwards
175
Q

What important structures within/near the parotid gland should be considered prior to surgery?

A
  1. Facial nerve and it’s branches
  2. Terminal branches of the external carotid artery, the superficial temporal artery, and the maxillary artery.
  3. Greater auricular nerve
176
Q

Where are the submandibular glands located?

A

In the submandibular triangle - outlined by the anterior and posterior heads of the digastric muscle.

Stylohyoid muscle and ligament sits posteriorly

177
Q

What is the name of the duct associated with the submandibular gland?

Where can this duct be found?

A

Wharton’s duct

Can be found in the FOM

178
Q

What type of gland is the submandibular gland?

A

Mixed seromucous gland

179
Q

What important structures near the submandibular gland should be considered prior to surgery?

A
  1. Several lymph nodes, facial artery/vein and mandibular branch of facial nerve sit superiorly to submandibular gland.
  2. Trigeminal nerve sits deep to the submandibular gland.
180
Q

Where are the sublingual glands located?

A

FOM

181
Q

What are the names of the ducts associated with the sublingual glands?

Where can these ducts be found?

A

Rivinus’ ducts - can be found at the plica sublingualis

Can also drain via the Bartholin’s duct (common duct involving several sublingual ducts joint together)

182
Q

What type of gland is the sublingual gland?

A

A mucous gland

183
Q

What important structures near the sublingual gland should be considered prior to surgery?

A
  1. Lingual nerve sits medially
  2. Submandibular duct crosses under lingual nerve, more superficial
184
Q

List the 4 most common causes of salivary gland pathology:

A
  1. Inflammatory disorders
    - viral infections
    - bacterial infections
    - TB, sarcoidosis
    - radiation induced
  2. Obstruction/trauma
  3. Neoplasms
  4. Autoimmune/degenerative - e.g. Sjogrens syndrome
185
Q

What are the causes of viral sialadenitis (gland infection)?

A
  1. Paramyxovirus (mumps virus)
  2. CMV (cytomegalovirus)
  3. HIV
186
Q

How does mumps most commonly present?

A

As a bilateral enlargement of the parotid glands
(however can be unilateral)

Most commonly affects younger patients however if affecting adults, can be quite severe.

187
Q

How does CMV most commonly present?

A

Can affect the parotid glands

Most primary infections are asymptomatic, but severe disseminated disease may be seen in neonates and immunocompromised - e.g. transplant and HIV positive patients

188
Q

Which glands may be affected by HIV?

A

Parotid glands

189
Q

What are the causes of bacterial sialadenitis (gland infection)?

A
  1. Local causes - secondary to stasis:
    - lack of gland function (e.g. fasting)
    - obstruction of gland (e.g. mucus plug/stone)
  2. Systemic causes:
    - immunosuppression
    - immune based
    - medication
    - dehydration
    - irradiation
190
Q

How would you manage acute bacterial sialadenitis?

A
  • Antibiotics
  • Fluids
  • Sialagogues (saliva stimulants) - e.g. chewing gum, lemon juice
  • Analgesics
  • No incision and drainage unless abscess formation

*If chronic symptoms (symptoms that wont resolve with ABs), further investigation is necessary (e.g. MRI scan) and surgery may be indicated.

191
Q

How would you manage a patient with acute sialadenitis in primary care?

A
  1. Establish origin (odontogenic vs salivary gland disease)
  2. Take a history:
    - establish whether there is prandial symptoms (pain and swelling at mealtimes that usually resolves a few hours after meals) or toothache like symptoms
    - prandial symptoms indicates partial gland obstruction
  3. Examine the patient - determine status of teeth
  4. Investigate with radiograph
  5. If odontogenic, establish management:
    - however if systemically compromised refer to the maxfac dept
    - could prescribe oral antimicrobial however referral for IV antibiotics may be more appropriate if swelling is severe and there is a risk retrograde spread
192
Q

List 6 different salivary gland pathologies caused by obstruction/trauma.

A
  1. Sialolithisis (salivary stone)
  2. Obstructive sialadenitis (gland infection)
  3. Acute sialadenitis (gland infection) secondary to obstruction
  4. Mucus retention cyst
  5. Mucus extravasation cyst
  6. Necrotising sialometaplasia
193
Q

Which gland is most commonly affected by sialolithisis and why?

A

The submandibular gland - due to its long torturous duct and alkaline pH

194
Q

What causes sialolithisis?

A

Salivary stones, mucus plug or duct stricture causes stasis of saliva which can lead to secondary gland infection (obstructive sialadenitis)

195
Q

How do you retrieve intraductal salivary stones?

A
  1. Via incision under LA
  • may need to place traction suture behind sialolith before removal so that the stone doesn’t migrate backwards
  • flush out with saline and then place open suture
196
Q

How do you retrieve intraglandular salivary stones?

A

If chronic sialadenitis will require surgical removal of the affected gland.

197
Q

Will removal of salivary glands result in dry mouth?

A

No - removal of one or 2 salivary glands will not result in dry mouth.

198
Q

What is obstructive sialadenitis?

A

Gland infection caused by salivary stones.

Presents as recurrent episodes of transient prandial salivary gland swelling - back pressure of saliva causes swelling of the gland and pain

199
Q

What happens in obstructive sialadenitis if there is complete obstruction?

A

Results in stasis of saliva and allows commensalism from the oral cavity to enter the gland - this can be persistently painful.

200
Q

In salivary gland disease, what does the production of pus indicate?

A

That there is a bacterial infection.

201
Q

How might a patient with acute sialadenitis present to you?

A

Ascending infection
Increasingly painful swelling (24-72 hours)
Oral discharge of pus
Systemic symptoms - temperature, lymphadenopathy, malaise, increased respiratory rate etc.

202
Q

How might you treat obstructive sialadenitis?

A

Sialagogues - to encourage salivary flow
Surgical removal (larger stones)
Eliminate trauma (e.g. calculus)
Basket retrieval of stones - less invasive way of removing small intraductal stones
Lithotripsy - non-invasive way of removing small intraductal stones using ultrasonic waves

203
Q

Which x-rays would you take to investigate salivary glands?

A

True mandibular occlusal - identify the presence of salivary stones
DPT to capture parotid/submandibular glands - stones may look like unerupted teeth

204
Q

What are the 2 causes of a mucocele?

A

Trauma (mucus extravasation cyst)
Obstruction in minor salivary glands (mucus retention cyst)

205
Q

How do you treat a mucocele?

A

Removal of cyst (surgical excision) and the underlying gland (to prevent recurrence)

206
Q

Which area does necrotising sialometaplasia affect?

A

Affects the minor salivary glands of the palate

207
Q

What appearance does necrotising sialometaplasia have?

A

It presents as a SCC (worrying appearance, ulcerated, indurated, keratitic periphery)

208
Q

At what point do you decide to refer a potential necrotising sialometaplasia?

A

If it hasn’t resolved within 2-3 weeks - however early referral for biopsy with this presentation would not be frowned upon

209
Q

Which type of tumour is more common in minor SG’s than major SG’s?

A

Carcinomas

210
Q

What is the difference between an inflammatory salivary gland lesion or a neoplastic salivary gland lesion?

A

Inflammatory lesion:
- diffuse swelling - obstructive or viral sialadenitis (if bilateral - sjogrens or sialodenosis)
- fluctuant

Neoplastic lesion:
- localised (if bilateral - warthins)
- asymmetrical
- nodular
- firm
- facial nerve potentially affected
- potential facial palsy
- pain affecting tongue (if lingual nerve is affected)

211
Q

If worried about bone invasion in salivary gland disease, what investigation would you carry out?

A

CT scan

212
Q

What biopsy would be carried out to investigate for sjogrens?

A

Labial gland biopsy

213
Q

What information about a lesion would you receive from an ultrasound scan when investigation salivary gland disease?

A

Size, consistency and vascularity of the lesion

214
Q

Where would you most commonly see a mucocele?

A

Lower lip

215
Q

In what cases of salivary gland disease would surgery be indicated?

A

Chronic pain/symptoms
Repeated acute or chronic sialadenitis
Benign + malignant tumours (+/-reconstruction)

216
Q

What are the risks associated with surgical removal of submandibular gland?

A

Pain
Swelling
Bruising
Scarring
Numbness of the tongue - transient or permanent
Weakness of lower lip - transient or permanent
Weakness of tongue movement - if hypoglossal nerve is damaged

217
Q

What are the indications for parotid surgery?

A
  1. Symptomatic sjogrens syndrome
    - superficial parotidectomy
  2. Tumours
    - benign: extracapsular dissection (e.g. pleomorphic adenoma)
    - malignant: lobar resection
  3. Deep lobe tumour
    - total parotidectomy
    - resection of nerve if facial nerve involvement - this will result in facial palsy
218
Q

What are the risks associated with surgical removal of parotid gland?

A

Pain
Swelling
Bruising
Facial nerve injury - weakness of muscles of FE
Gustatory sweating (Frey’s syndrome)
Numbness around ear lobe - damage to auriculotemporal nerve
Salivary fistula - saliva drains into neck and will need surgical correction
Infection
Recurrence of tumour

219
Q
A

Module 7 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions