Oral Surgery Flashcards
what is an oral antral communication
an acute communication between the sinus and the oral cavity
what is an oro-antral fistula
a chronic communication between sinus and oral cavity
what are mucoceles
damaged minor salivary glands
where saliva gets trapped in the minor gland
what is a ranula
an enlarged mucocele in the floor of the mouth which results from damage to sublingual salivary gland
what are cysts
epithelial lined fluid filled cavities in bone or soft tissue
what is enucleation of the cyst
removal of the entire cyst
what is marsupialisation of a cyst
removal of part of the cyst lining and leaving it open ‘de-roofing’
what are the straight upper anterior forceps used for
upper 3-3
what are upper universal forceps used for
upper 5-5
where does the beak part of the upper molar forceps engage the tooth
the buccal aspect
what are the lower universal forceps used for
lower 5-5
can the lower molar forceps be used on both sides
yes
what are lower cowhorn forceps used for
lower molars with separate roots
squeeze in the furcation to pull the tooth out
where should a right handed operator stand when taking out lower right molars
behind patient
what are upper bayonet forceps used for
upper 8 removal
where should a right handed operator stand when taking out upper teeth
in front of patient
where should a right handed operator stand when taking out lower left molars
in front of patient
what is the advantage of using elevators
less likely to fracture tooth when removing with forceps
widen PDL space and elevate the tooth
what are cryers elevators used for
removal of remaining roots if fractured
name three examples of soft tissue surgery
frenectomy
excisional papillary hyperplasia
excision of flabby ridges
name five examples of hard tissue surgery
removal of retained roots
mandibular tori removal
palatine tori removal
maxillary tuberosity
implants
what is a vestibuloplasty
extended ridges by deepening the sulcus
when are NHS able to provide implants
if patient has hypoplasia, been in an accident or have (had) oral cancer
what is the blood supply to TMJ
deep auricular artery (branch of maxillary artery)
what are the three nerve supplies to TMJ
auriculotemporal
masseteric
posterior deep temporal
what other related structure does the auriculotemporal nerve supply
external auditory meatus
what is the origin and insertion of the masseter
origin - zygomatic buttress
insertion - angle of mandible
what is the origin and insertion of the temporalis
origin - temporal fossa
insertion - coronoid process of mandible
what is the origin and insertion of the medial pterygoid
origin - medial surface of lateral pterygoid plate
insertion - medial side of angle of mandible
what is the origin and insertion of the lateral pterygoid
origin - bas of skull and lateral border of pterygoid plate
insertion - pterygoid fovea beneath mandibular condyle
what are the four suprahyoid muscles
digastric
mylohyoid
geniohyoid
stylohyoid
what are the four infrahyoid muscles
thyrohyoid
sternohyoid
sternothyroid
omohyoid
what causes pain in the TMJ
since anterior band of articular disc is not innervated
when the joint slips forward it compresses the bilaminar zone which causes pain
name difference causes of TMD
degenerative disease
myofascial pain
disc displacement
chronic recurrent dislocation
ankylosis
hyperplasia
neoplasia
what are examples of degenerative disease that can cause TMD
osteoarthritis
rheumatoid arthritis
how does myofascial pain occur in TMD
inflammation of MOM or TMJ secondary to parafunctional habits
trauma
stress
how should the TMJ be assessed extra-orally
MOM
joint clicks
jaw movements
facial (a)symmetry
how should the TMJ be assessed intra-orally
signs of parafunctional habits (linea alba, scalloped tongue, NCTSL occlusally)
MOM palpation
how can the TMJ be viewed radiographically
OPT to exclude a dental cause
CBCT
MRI
what are the clinical features of TMD
intermittent pain of several months
muscle, joint, ear pain especially in the morning
trismus or locking
clicking/ popping joint noises
headaches
what are reversible treatments for TMD
counselling patient
jaw exercises
NSAIDs
muscle relaxants
tricyclic antidepressants
Botox
what is involved in the counselling of TMD
reassurance
soft diet
masticate bilaterally
no wide opening
no chewing gum
stop parafunctional habits
what are splints used for in TMD
bite raising appliances
must wear for a few weeks before improvement is felt
what are two examples of irreversible treatment for TMD
occlusal adjustment
TMJ surgery (arthroscopy/ disc repositioning)
how may patients with internal derangement of the TMJ present
with painful clicking
due to lack of coordinated movement between condyle and articular disc
what is the most common cause of TMJ clicking
anterior disc displacement with reduction
what is anterior disc displacement with reduction
disc is initially displaced anteriorly by condyle during opening until the disc reduction occurs
name three events that could cause trismus from trauma
after IDB
after prolonged dental treatment
infection
what can be used to aid in limited mouth opening
jaw screw
what are the consequences dentally of an AOB
chronic gingivitis
dry mouth
increased caries risk
who makes up the MDT in orthognathic surgery
clinical psychologist
orthodontic specialist
orthognathic surgeon
restorative dentist
speech and language therapy
how much gingival margin should show upon smiling
1-2mm
name three advantages of surgery first approach
reduction of duration of treatment time
faster orthodontic tooth movement
immediate improvement in facial appearance
cost effective
name the sinuses in the head
frontal sinus
sphenoid sinus
ethmoid air cells
maxillary sinus
when do the sinuses form during embryological development
3rd and 4th months
what are the three functions of the paranasal sinuses
resonance to the voice
reserve chambers for warming inspired air
reduce weight of the skull
what is the opening to the maxillary sinus
middle meatus (hiatus semilunaris)
can become narrow or blocked during episodes of inflammation/ disease
what is found on the posterior wall of the maxillary sinus cavity
alveolar canals that transport the posterior superior alveolar vessels and nerves to maxillary posterior teeth
what epithelium is found in the paranasal sinuses
pseudostratified ciliated columnar
what is the function of cilia in sinus epithelium
mobilise trapped particles and foreign material
move the material down the ostia for elimination into the nasal cavity
what are the clinical significances of maxillary sinuses
OAC
OAF
root in the antrum
sinusitis
benign or malignant lesions
how would a possible OAC/F be diagnosed
size of tooth
radiographic position of roots related to the antrum
bubbling of blood
nose holding test
how are OACs managed
inform patient
encourage clot
suture margins
possible abxs
minimise pressure formation within sinus and mouth
how do small OACs (less than 2mm) usually heal
with normal blood clot formation and routine mucosal healing
what may patients complain about in OAFs
problems with fluid consumption (runny nose)
problems with speech
problems with playing wind instruments
problems with smoking
bad taste/ odour/ halitosis
pain/ sinusitis like symptoms
what are the common aetiological factors associated with fracture of maxillary tuberosity
single standing molar
inadequate alveolar support
unknown unerupted molar or wisdom tooth
what is the management of a fractured tuberosity
reduce and stabilise
orthodontic buccal arch wire with composite
splint
dissect out and close wound primarily
what should you remember to do if you are splinting teeth after maxillary tuberosity fracture
remove or treat pulp
ensure out of occlusion
consider abx
post-op instructions
what is the aetiology of sinusitis
viral infection - inflammation and oedema, trapping of debris within the cavity
why may mucociliary clearance patterns be altered
allergens
inflammation
anatomic abnormalities
what dental factors have to be ruled out when investigating sinusitis
periapical abscess
periodontal infection
deep caries
recent extraction socket
TMD
what is the treatment for sinusitis
ephedrine nasal drops 0.5% one drop each nostril up to TID for 7 days
humidified air
what is the antibiotic regime for sinusitis when symptomatic treatment is not effective
amoxicillin 500mg TID for 7 days
doxycycline 100mg once daily for 7 days
what is the advantage of an aspiration biopsy
prevents contamination by oral commensals
protects anaerobic species
what is a fine needle aspiration biopsy
aspiration of cells from solid lesions
(neck swellings, salivary gland lesions)
what is an excision surgical biopsy
removal of all clinically abnormal tissue
used for benign lesions
what is an incision surgical biopsy
representative tissue sample for larger lesions
of an uncertain diagnosis
what is a punch biopsy
type of incisional biopsy
hollow trephine removes core of tissue
minimal damage
how is the area biopsied chosen
must be large enough
must be representative
include perilesional tissue
how should a sample be sent to the pathology lab
should be placed immediately in 10% formalin
include relevant clinical information
why is gauze not used for biopsy transfer
distorts the samples
what is used in biopsy transfer to prevent distortion
filter paper
what should be filled out on the lab card for a biopsy
date of birth of patient
sex
who has requested the sample
address of dentist
contact number
whether it is for histopathology or cytopathology
date and time collected
nature of specimen
what is a fibrous epulis
swelling arising from gingivae
response to irritation
smooth surface rounded swelling that is pink
use excisional biopsy
what is a fibroepithelial polyp
frictional irritation or trauma
pink
smooth surface
most common on buccal mucosa and inner surface of lip
surgical excision
what is a giant cell epulis
peripheral giant cell granuloma
found in anterior regions of mouth
deep red or purple colour with broad base
requires x-ray to ensure not originating centrally
surgical excision required
what is a haemangioma
collection of blood vessels causing a lump under the mucosa
developmental overgrowths
blue in colour
surgical removal required
what is a lipoma
benign neoplasm of fat
soft swelling
pale yellow
excision required
what is a neoplasm
abnormal mass of tissue that forms when cells grow and divide more than they should or do not die when they should
what is a pregnancy epulis
related to calculus and often bleed easily
hormonal changes enhance response to tissue irritation
larger lesions should be excised
what is a pyogenic granuloma
failure of normal healing and overgrowth of granulation tissue
red in colour
requires surgical excision
what is a squamous cell papilloma
benign neoplasm
white surface and cauliflower appearance
excision at base required
what causes denture hyperplasia
poorly fitting dentures
what is a leaf fibroma
chronic irritation from denture
would be round if not covered by denture but because it is it becomes flattened
excision required
what is a mucocele
mucous extravasation cyst
most common minor salivary gland problem
due to damage of minor salivary gland and leakage into duct
what is a ranula
mucocele on floor of mouth
what is the classic description of SCC
ulcer
rolled margin
induration
lump of red or white colour and non-healing
what biopsy should be taken for suspected SCC
incisional
what causes microtrauma to TMJ
chronic joint overloading secondary to stress related bruxism
what occlusal and anatomical factors can cause TMD
occlusal - deep bite, occlusal disharmony, lack of teeth
anatomy - class II
what does articular cartilage consist of
chondrocytes
collagen fibres in proteoglycan matrix (inflammatory disease produces proteases that degrade proteoglycans)
which parts of TMJ are innervated
capsule
synovial tissue
subchondral bone
what are the functions of a bite appliance
eliminates occlusal interference
prevents joint head from rotating so far posteriorly in glenoid fossa
reduces loading on TMJ
name four indications for TMJ reconstruction
joint destruction (trauma/ infection)
ankylosis
developmental deformity
tumours
what tumours are related to TMJ
giant cell lesions
fibro-osseous lesions
myxomas
what is the ankylosis classification of TMJ
type 1 - flattening of condyle
type 2 - bony fusion at outer edge of articular surface
type 3 - marked fusion between upper part of ramus and zygomatic arch
type 4 entire joint replaced by mass of bone
name four causes of bone loss
congenital
traumatic
pathology
natural
what is arthrocentesis of TMJ
flushing saline into joint cavity to flush away inflammatory exudate
what are three types of bone graft
onlay
interpositional
sinus lift
name four indications for zygomatic implants
severe maxillary atrophy
sinus pneumatisation
avoid harvesting of bone graft
hemimaxillectomy
how can airway emergencies present in facial trauma
primary - direct trauma to airway
secondary - loss of support to soft tissue leading to obstruction
define three aspects of a difficult airway
uncleared neck
poor mouth opening
intoxicated/ abnormal GCS
what adjuncts to stop bleeding can be used in OMFS
tranexamic acid
medication impregnated gauze/ packing
what is considered in secondary survey of the patient brought to OMFS
dental injury
- avulsed teeth
- tetanus
soft tissue
- on top of cranial fractures
- tissue loss
what would you do if a patient with a mandibular fracture presented to the practice
tell patient to FAST and go straight to OMFS centre
phone Maxfax and tell them patient is coming
have all relevant patient details ready
if not happy with conversation with DCT phone the consultant
what are clinical signs and symptoms of mandibular fractures
pain/ swelling/ limited function
occlusal derangement
numbness of lower lip
loose or mobile teeth
bleeding
facial asymmetry
what are the four classifications of maxillo-facial fractures
naso ethmoidal fractures
lateral middle third fractures (zygoma)
central middle third
mandibular fractures
what are the five types of central middle third fractures
nasal bone
unilateral maxillary fractures
le fort 1
le fort 2
le fort 3
what are malar fractures
zygoma displaced downwards
periorbital bruising and swelling
diplopia
what is the initial care for malar fractures
exclude ocular injury
prophylactic abxs
avoid blowing nose
what is definitive management for malar fractures
review once swelling subsides
more radiographs and CT scans
closed reduction and fixation
open reduction and internal fixation
how are mandibular fractures classified
involvement of surrounding tissue (simple/ compound/ comminuted)
number of fractures (single, double/ multiple)
side of fracture (unilateral/ bilateral)
site of fracture
direction of fracture line
displacement of fracture
how should radiographs be taken for mandibular fractures
2 radiographs at 90 degrees to one another (eg OPT and PA mandible)
what is the treatment for undisplaced fractures
no treatment
what is the treatment for displaced fractures
closed reduction and fixation
open reduction and internal fixation
what are common features of mandibular fractures
2 point vertical mobility of mandible
sublingual haematoma
contralateral numbness to side of impact
ipsilateral numbness if impact was distant to mental nerve
what are signs of orbital fractures
infra-orbital paraesthesia
diplopia
subconjunctive bleed
what are signs of zygomatic fracture
unilateral epistaxis (nosebleeding) when nose is not injured
paraesthesia
buttress tender, arch tender
what are signs of midface fractures
mobility of maxilla when skull is stabilised
numbness
nose bleeding common
what are signs of naso-orbital-ethmoidal fractures
repositioned nose
buttress not tender
nose bleeding
numb
what are signs of naso-maxillary fractures
buttress intact
numb
unilateral nose bleeding without blow to nose
how long should mandibular surgery ideally be undertaken after injury
24-48 hours
