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Module 9 > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

Give a definition of a cyst.

A

A cyst is a pathological cavity having fluid or semi-fluid contents, which has not been created by the accumulation of pus. These occur more only in the jaws than elsewhere are and often more epithelial lined.

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2
Q

What cells do radicular cysts arise from?

A

Cells of Malassez

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3
Q

What cells form dentigerous cysts?

A

Remnants for the CEJ in the follicular tissues.

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4
Q

At cellular level, what initiates a cyst to form?

A
  1. Epithelial remnants triggers an inflammatory response causing proliferaiton of these cells.
  2. Ball of growth forms and the central cells within this ball undergoes apoptosis therefore the peripheral cells continue to proliferate.
  3. This forms a fluid filled sac which slowly grows causing hydrostatic pressure on the bone which then results in osteoclasts being activated resulting in resorption.
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5
Q

Can a cyst erode the overlying cortical bone due to hydrostatic pressure?

A

Yes

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6
Q

Name some signs and symptoms of cysts.

A
  1. Asymptomatic - chance finding of radiographs
  2. Bony exapansion (egg shell crackling)
  3. Fluctuant swelling
  4. Missing teeth
  5. Carious, discoloured, fractured teeth
  6. Tilted/displaced teeth
  7. Discharge sinus
  8. Loose teeth
  9. Mental hypoesthesia
  10. Hollow percussion note
  11. Pain and swelling if secondarily infected
  12. Pathological fracture.
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7
Q

What are some investigations you would carry out if suspected a cyst?

A
  1. Vitality test
  2. Radiology
  3. Aspiration of cyst contents
  4. Biopsy
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8
Q

What are 3 management aims for cysts?

A
  1. To eradicate the pathology
  2. To minimise surgical damage
  3. To restore function quickly
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9
Q

Name 6 treatment options of cysts?

A
  1. Enucleation - first line
  2. Marsupialisation
  3. Enucleation and marsupialisation
  4. Enucleation and curretage/excision
  5. En bloc resection jaw- continuity maintained
  6. partial resection- continuity lost.
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10
Q

What is enucleation?

A
  • This is the complete removal of the cyst lining
  • Following enucleation closure can be primarily or secondarily by packing defect
  • This maybe contraindicated if the cyst is large, involving a number of vital teeth, in a difficult anatomical site or involving a potentially useful unerupted tooth.
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11
Q

What would you need to consider when planning your flap for enucletion?

A
  • Doesn’t directly rest of the osteotomy site e.g crestal incision, well away from the tissues caused the by the cyst.
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12
Q

Name 2 reasons why you would want to eliminate a dead space after removal of cyst?

A
  • To reduce reactionary haemorrhage
  • To reduce post op infection
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13
Q

Name examples of how you could eliminate dead space clinically?

A
  1. Drain placement
  2. Procedure to collapse bony walls e.g make cavity slightly more saucer shape
  3. Use of biological and other materials to fill the space
  4. Use layered soft tissue closure e,g suturing muscles
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14
Q

Name some advantages of enucleation

A
  1. Complete removal of pathology for histopathology
  2. Cavity heals without complication
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15
Q

Name some disadvantages of enucleation.

A
  1. Infection
  2. Incomplete removal of lining
  3. Damages to adjacent teeth or antrum
  4. Weakening of bone
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16
Q

What is marsupialisation?

A

This involves creating a window or pouch in the cyst lining, suturing the flap to the remaining lining to allow shrinkage of the lesion which may become self cleansing or be subsequently removed

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17
Q

When would you consider marsupialisation for cysts rather than enucleation?

A
  1. When the cyst is very large involving many teeth
  2. Complex medical history or old/frail patients
  3. Cyst involves an unerupted tooth
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18
Q

What is the difference in surgical technique between enucleation and marsupialisation?

A

Marsupialisation you cut flap over the osteotomy site.

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19
Q

Why do you make an acrylic bung in marsupialisation

A

Not easily self cleansable therefore food and debris can get stuck in wound- acrylic bung acts as a stopper preventing large debris from entering.

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20
Q

What are some advantages of marsupialisation?

A
  • Avoids pathological fracture
  • Treatment for medically compromised patients
  • Avoids damage to adjacent structures
  • Allows potentially useful teeth to erupt
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21
Q

Name some disadvantages of enucleation?

A
  • Orifice closes and cyst reforms
  • Repeat visits
  • Manual dexterity and compliance
  • Complete lining not available for histology
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22
Q

List the most common to least common 5 odontogenic cysts?

A
  1. Radicular cyst (60-75%)
  2. Dentigerous cysts (10-15%)
  3. Odontogenic keratocyst (5-10%)
  4. Paradental cyst (3-5%)
  5. Lateral periodontal cyst/gingival cyst (<1%)
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23
Q

Name the most common non-odontogenic cyst?

A
  1. Nasopalatine cyst (5-10%)
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24
Q

What % of radicular cysts remain after the tooth has been xla e.g to form a residual cyst?

A

20%

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25
Q

What is the treatment for a radicular cyst?

A

Enucleation of cyst and endodontic surgery.

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26
Q

What is the treatment for a residual cyst?

A

Marsupialise if cyst is very large then enucleate.

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27
Q

What would you see radiographically in a paradental cyst?

A

Usually distal to lower 8’s - doughnut shaped which is attached to the CEJ. Treatment would be xla and enucleate.

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28
Q

What are lateral periodontal cyst and gingival cyst associated with in which radicular cysts are not?

A

Vital teeth

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29
Q

What is the treatment for a dentigerous cyst?

A
  • Enucleation with removal of associated tooth
  • marsupialisation if unerupted is potentially functional and can be aligned orthodontically.
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30
Q

What does an odontogenic keratocyst arise from and where is the most common area?

A
  • Remnants from the dental lamina
  • Posterior mandible
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31
Q

Why is an odontogenic keratocysts difficult when treating with enucleation?

A
  • Lining is very fragile
  • Grows in an antero-posterior direction
  • Has finger-like projections
  • Have daughter/satellite cysts
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32
Q

What are the treatment options for odontogenic keratocysts?

A
  • Enucleation
  • Curettage of cavities with cryotherapy?
  • en bloc resection an option previously??
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33
Q

If radiograph showed root resorption of other teeth then what would this suggest?

A

More likely to be a malignancy rather than a cyst - this would need to be biopsied to confirm.

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34
Q

What is Gorlin-Goltz syndrome?

A

Genetic autosomal dominant condition
- Mutations of PTCH gene found on chromosome 9.

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35
Q

What is clinical features of Gorlin-Goltz syndrome/multiple basal cell naevoid syndrome?

A
  • Multiple odontogenic keratocysts
  • Skeletal abnormalities
  • Frontal bossing - supra-orbital ridging
  • Wide space between eyes
  • Multiple basal cell carcinomas.
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36
Q

What is the treatment for lateral periodontal/gingival cyst?

A

Enucleation.

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37
Q

Name 2 non-odontogenic cysts.

A
  1. Nasopalatine duct cyst
  2. Nasolabial cyst.
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38
Q

What do non-odontogenic cysts form from?

A

Epithelium from the embryonic arches

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39
Q

What is the common clinical and radiographic presentation of a nasopalatine cyst?

A
  • salty discharge
  • slow painless swelling
  • positive vitality on teeth
  • heart shaped radiolucency in incisive canal.
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40
Q

What is the treatment for a nasopalatine cyst?

A
  • confirm vitality of teeth
  • Enucleation via envelope flat palatally.
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41
Q

What is Staphnes idiopathic bone cyst?

A
  • Development anomaly
  • Ectopic salivary tissue in concavity in the medial aspect of the mandible below the IAN
  • No active treatment required
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42
Q

What are the 2 types of bone cysts?

A
  1. Solitary bone cyst
  2. Aneurysmal bone cysts
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43
Q

What is the treatment for aneurysmal bone cyst?

A
  • Raise a flap, removal of bone to access cyst, curettage of cyst to send for histopathology
  • Often curettage for biopsy triggers healing, therefore usually find this resolves post biopsy.
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44
Q

What would you find in the histology of an aneurysmal bone cysts?

A

Consists of a mass blood-filled space with scattered giant cells.

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45
Q

What are solitary bone cysts?

A
  • Large radiolucency arching up between roots of teeth
  • Tend to resolve spontaneously.
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46
Q

What is an ameloblastoma?

A
  • Odontogenic tumour (most common) - arising from tooth forming structures
  • Essentially benign but can be locally aggressive and invasive
  • Uni or multilocular, defined or diffuse edged, usually displaces adjacent structures.
  • 40-50 years 80% mandible
  • Need to biopsy
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47
Q

What would your differential diagnoses be if there was a large radiolucency in the posterior mandible and what would you do?

A
  • Odontogenic keratocyst
  • Aneurysmal or solitary bone cyst
  • Ameloblastoma??

Need to take biopsy here to confirm diagnosis.

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48
Q

What does the management of an ameloblastoma involve?

A

En bloc resection

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49
Q

How do you differentiate between at radicular cyst and a periapical granuloma?

A

Periapical granuloma <6mm
>6mm can then be defined as a cyst.

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50
Q

Give examples of conditions in which you would carry out an excisional biopsy to send for histopathology.

A
  1. Mucocoele
  2. Denture induced hyperplasia
  3. Epulis e.g pyogenic granuloma
  4. Fibroepithelial poylp
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51
Q

What is mapping biopsys?

A

Multiple biopsies in different areas

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52
Q

When carrying out an incisional biopsy what part of a white lesion would you want to biopsy?

A

The worst looking part.

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53
Q

What are some problems that can occur when taking a biopsy?

A
  • inappropriate specimen
  • specimen too small or macerated
  • cant orientate specimen
  • tissues distorted by diathermy or LA
  • Lab not informed of need for frozen section
  • Lack of clinical detail on form
  • Specimen gone up aspirator
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54
Q

When are frozen sections used and what is the disadvantges of this?

A
  • mostly used in hospital setting for intra-operative to determine if got clear margins for cancer
  • can be used to diagnose immunobullous disorders
  • disadvantage is cannot be used to determine degree of dysplasia.
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55
Q

What is exfoliative cytology?

A
  • removal of surface cells by scraping with a spatula or cytobrush
  • widely used in cervical cancer screening
  • research continues in its application in diagnosis in oral carcinoma.
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56
Q

What is fine needle aspiration FNAC?

A
  • Determines whether lesion is solid or cystic/fluid filled
  • simple to perform - just insert needle into area/swelling
  • interpretation difficult but experienced cytopathologist have high success rate
  • cyst contents can undergo further test e.g microbiology or protein electrophoresis
  • Very useful with lumps in the parotid glands and neck lumps to determine whether the lump is a tumour
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57
Q

What kind of biopsy would you carry out to diagnose with Sjogrens syndrome?

A

Labial gland biopsys.

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58
Q

What is toluidine blue?

A

A dye that binds to abnormal tissues to help aid in biopsys. Not frequently used as requires high sensitivity/specificity.

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59
Q

If a lesions is >2cm has a greater potential of being a malignant lesion. True or false?

A

True.

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60
Q

Where are the 2 places in the mouth where you dont have salivary glands.

A
  1. Gingivae
  2. Hard palate
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61
Q

When do the major saliva glands only produce saliva.

A

When you eat. The rest of the time when fasting they do not produce saliva which can sometimes cause bacteria from the mouth to enter the duct and cause an infection.

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62
Q

Where anatomically is the parotid gland, what is the parotid duct called and what type of saliva does it produce?

A

Parotid gland is located anterior to the ear, behind the ramus of the mandible
- Stensons duct which opens opposite the second maxillary molar tooth.
- Produces predominantly serrous saliva.

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63
Q

What are the different parts/lobes of the parotid gland?

A
  • superficial parotid sits above the facial nerve accounts for 4/5 of the parotid
  • deep lobe sits below the facial nerve
  • Tail of the parotid sits behind the angle of the mandible
  • Accessory lobe individual gland that sits above the gland.
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64
Q

What important structures run through the parotid gland?

A
  • Facial nerve
  • Terminal branches of external carotid artery
  • superficial temporal artery
  • Maxillary artery
  • Greater auricular nerve?
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65
Q

Where is the submandibular gland located anatomically, what is the duct called and what type of saliva does it produce?

A
  • paired glands located in the submandibular triangles. Encapsulated and covered by cervical fascia and stylohyoid ligament.
  • Whartons duct drains into the floor of the mouth
  • Mixed seromucous glands.
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66
Q

Where is the sublingual gland located anatomically, what is the duct called and what type of saliva does it produce?

A
  • smallest, lies on the floor of mouth covered only by oral mucosa.
  • Drains via tiny ducts (Rivinis duct) on the plica sublingualaris or a common duct which joins the submandibular duct (Bartholins duct)
  • Mucous gland
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67
Q

What are some common pathology/disorders associated with major salivary glands?

A

-Viral e.g mumps, Coxsackie, CMV, HIB
- Bacterial infection
- TB, sarcoid
- radiation induced
- Obstruction/trauma
- Neoplasm
- autoimmune/destructive e.g Sjogrens

68
Q

What virus is mumps caused by?

A

Paramyxovirus

69
Q

Who are CMV viruses most commonly seen in?

A

Neonates and immunocompromised.

70
Q

What can be some causes of bacterial sialadenitis?

A
  • Caused by stasis of gland e.g fasting, dehydration
  • Can be due to systemic causes such as immunosuppressed/medication/irradiation
71
Q

What is the management of bacterial sialadenitis?

A
  • Antibiotics
  • Fluids
  • Sialogogues
  • Analgesics
72
Q

What is it called when there is pain at meal times in the salivary glands?

A

Prandial symptoms

73
Q

What is the concern if a patient presents with acute swelling from bacterial sialadenitis with the swelling extending into the eye region? What should you do?

A

Risk of retrograde spread and cause cavernous sinus thrombosis, refer to max fax for IV AB’s

74
Q

What is the most common reason for obstruction of salivary glands?

A

Sialolithiasis (saliva stones) forming from stasis of the gland causing a build up of calcium and phosphate ions. Bacteria infection can these arise from this.

75
Q

What is the clinical presentation of obstructive sialadenitis.

A
  • Recurrent episodes of transient prandial swelling in salivary glands,
  • No symptoms between attacks as saliva escapes from the glands.
  • The bigger the stone the more severe the symptoms.
  • Complete obstruction causes stasis of the saliva and allows commensals from the oral cavity to enter the gland.
76
Q

What are some signs of acute sialadenitis secondary to obstruction?

A

Stasis allows secondary infection
Increasing, painful swelling 24-72 hours duration
Oral discharge of pus
Systemic manifestations

77
Q

Why is the submandibular gland more likely to get sialoliths?

A
  • They have a longer duct
  • More alkaline pH making calcium and phosphates ions likely to come out of solution and be deposited.
78
Q

What are the treatments for obstructive disorders of salivary glands?

A
  • sialogogues to stimulate stone passing
  • surgical removal of intraductal stone
  • surgical removal of gland if intraglandular and severe symptoms
  • eliminate trauma
79
Q

What are some techniques used for removing sialoliths (saliva stones)?

A
  • Basket retrieval (only small stones)
  • Lithotrypsy.
80
Q

What is a ranula and what is the treatment for this?

A

A large mucous retention cyst in the floor of the mouth
- Marsupialisation - high recurrence
- Can enucleate however depends on site and size as lingual vein and artery runs through here.

81
Q

What is sialometaplasia?

A

Traumatic inflammatory lesions- trauma caused damage to the ducts in the salivary gland of the hard palate. This causes necrosis of the palate. Often painful- should resolve within 2-3 weeks - if not then biopsy as may be SCC.

82
Q

Do tumours of saliva gland occur mostly in the major or minor salivary glands?

A

Tumours occur mainly in the major salivary glands.

83
Q

Where are the 2 most common places for tumours to occur in minor salivary glands?

A

55% in soft palate
20% in upper lip

84
Q

What has a high proportion of carcinomas, major or minor salivary glands?

A

Minor salivary glands.

85
Q

What is the most common benign salivary gland tumour?

A

Pleomorphic adenoma

86
Q

What is the name of a benign salivary gland tumour that is bilateral?

A

Warthins tumour.

87
Q

What are indications for a parotidectomy and what are the different types?

A
  • Painful Sjogrens syndrome
  • Benign or malignant tumours
  • Extracapsular dissection
  • Lobar resection
  • Superficial parotidectomy
  • Total parotidectomy
88
Q

What is Freys syndrome?

A

Gustatory sweating

89
Q

What is the closed technique in fractures of the mandible?

A

The fracture margins are not directly visualised - no incision. Intermaxillary fixation occurs (wiring the jaws together)
There is often mobility at the fracture site than can have a detrimental effect on healing.

90
Q

What is an open technique in fractures of the mandible?

A

The fracture margins are visualised intra-orally or extra-orally via an incision
This is generally the preffered option as the fracture is immobilised to allow a period of healing.

91
Q

What is reduction?

A

Aligns the bone ends anatomically
Recreates the normal anatomy

92
Q

What is fixation?

A

Prevents movement of the bone margins whilst healing occurs
Can be load bearing so that 100% of the functional load is supported by the fixation e.g 2 large plates
Can be load sharing such that the load is distributed between the hardware and the bone margins e.g one upper boarder plate and arch bars

93
Q

What are different methods of open fixation?

A
  • Mini plates
  • Reconstruction plates
  • Compression plates
  • Lag screws
94
Q

What are different methods of closed fixation? E.h intermaxillary fixation?

A
  • Arch bars
  • Eyelet wires
  • Leonard buttons
  • Cast cap splints
  • Gunning splints
95
Q

What are indications for close reduction IMF?

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 or minimally condylar fractues
96
Q

Name 3 advantages of closed reduction?

A
  1. Inexpensive
  2. Simple procedure
  3. No foreign body so reduced risk of infection
97
Q

Name 5 disadvantages of closed reduction?

A
  1. Not absolutely stable
  2. Prolonged period of IMF up to 6 weeks
  3. Possible TMJ sequelae
  4. Decreased oral intake
  5. Possible pulmonary considerations
98
Q

What are indications of open technique?

A
  1. Displaced unfavourable fractures
  2. Multiple fractures
  3. Edentulous displaced fractures
  4. Bilateral displaced condylar fractures
99
Q

What are 5 advantages for open reduction?

A
  1. Improved alignment and occlusion
  2. Fracture immobilised
  3. Avoid IMF
  4. Low rate of malunion or non-union
  5. Lower rate of infection
100
Q

What are 3 disadvantages of open reduction?

A
  1. Morbidity of surgical procedure
  2. Expensive hardware
  3. Need for GA
101
Q

What is Champys principle?

A

Mini-plate osteosynthesis = placement of a plate along the so called ideal line of osteosynthesis, thereby counteracting distraction forces that occur along the fracture line.
- In the mandibular angle region, this line indicates that a plate may be placed either along or just below the oblique line of the mandible
-Between the mental foramina 2 plates are recommended below the apices of the teeth

102
Q

What is the difficulty in open reduction in edentulous patients?

A
  • Mandible is atrophic so there may not be enough room to place plates
  • Lack of anatomical landmarks
  • Poorly vascularised so poor healing
  • The less bone height the greater the complication rate
103
Q

What post-operative care is required with both open and closed techniques?

A
  • instructions and how to release IMF to nurses
  • IV antibiotics (no guidance)
  • Steroids
  • Fluids IV
  • Post op xrays - not now routinely taken
104
Q

What are some complications of both open and closed reduction?

A
  • Non-union, fibrous union, mal-union
  • Altered occlusion
  • Distracted TMJ
  • Scars, trauma and iatrogenic
  • Infection
  • Necrosis
  • Numb lip
  • Exposed plate
105
Q

What are some considerations in primary care in managing mandibular fractures?

A
  • Teeth in fracture line are rendered non-vital
  • Presence of plates in areas of planned extractions
  • Altered sensation in the lower lip
106
Q

What are types of condylar fractures?

A
  • Extracapsular
  • Intracapsular
  • TMJ effusion –> trauma within the joint caspsule, no breakages
107
Q

What does a condylar fracture do to the occlusion?

A

The occlusion on the side of the fracture becomes shorter and can create an lateral open bite on the opposing arch.

108
Q

What is the treatment for a condylar fracture?

A

Conservative: soft diet, analgesics
Open reduction and internal fixation
Closed - leonard buttons and elastic traction

109
Q

How are paediatric mandibular fractures mostly treated with?

A

Conservative management e.g splints. Internal fixation in most cases not possible as tooth germs and condylar growth is present.

110
Q

What are some clinical extra-oral features of a mandibular fracture?

A
  • pain
  • swelling
  • trismus
  • concurrent soft tissue injury
  • otorrhoea
  • Anaesthesia/paraesthesia of lip
111
Q

What are some intra-oral clinical features of a mandibular fracture?

A
  • Haematoma in the floor of the mouth
  • Malocclusion
  • Tongue swelling
  • Step deformity
  • Gingival laceration
  • Mobility or loss of teeth, # teeth
112
Q

What 2 radiographs are recommended for a mandibular fracture?

A

DPT and PA mandible

113
Q

What is a Guardsmann fracture?

A

A fracture at the symphisis of the mandible and 2 separate condylar fractures.

114
Q

What is a bucket handle fracture?

A

Bilateral body fractures

115
Q

What is subconjuctival haemorrhage?

A

Disruptions of the orbital wall cause bleeding in the eye

116
Q

What is opthalmoplegia?

A

can’t look in a certain direction due to entrapment of orbital muscles

117
Q

What is orbital dystopia?

A

One orbit appears at a different level then the other - damage to ligaments.

118
Q

What is enopthalmos?

A

Intruded eye

119
Q

What is orbital blowout?

A

Inferior border of the orbit has significant damage where contents of eye drop into sinus.

120
Q

What is retrobulbar haemorrhage

A

A bleed behind the eye - can cause an increase in volume putting pressure on optic nerve, risk of blindness.

121
Q

What is orbital fissure syndrome?

A

Rare - fracture extend to superior orbital fissure can result in cranial nerve damage (3,4,5,6)

122
Q

What is diplopia?

A

Double vision

123
Q

What radiographs are normally taken for zygomatic fractures?

A
  • occipitomental view
  • DPT
124
Q

What is the horizontal buttresses in mid face fractures?

A
  1. Frontal
    2, Zygomatic
  2. Maxillary
125
Q

What is the vertical buttresses in mid face fractures?

A
  1. Nasomaxillary
  2. Zygomaticomaxillary
  3. Pterygomaxillary
126
Q

What is the sagital buttresses in mid face fractures?

A
  1. Zygomatic arches
  2. Palate
  3. Floor of orbit
127
Q

What 3 bones have the lowest tolerance to impact?

A

Nasal bones least resistant
Zygomatic arch directly
Maxillae

128
Q

What are some clinical findings of a mid face fracture?

A
  • Anterior open bite*
  • Facial lengthening
  • Extreme- soft palate obstruct airway
  • Nares blood clot
  • Coincident head injury
  • Dish face deformity if severe
129
Q

What is Le Fort I?

A

The fracture extends around both maxillary antra,through the nasal septum and the pterygoid plates. This causes palate-facial separation.

130
Q

What is a le fort fracture II?

A

These fractures extend superiorly in the mid face to include the nasal bridge, maxilla, lacrimal bones, orbital floor and rim. They are pyramidal fractures with teeth at the base and nasal bone at the apex.

131
Q

What is a Le Fort III fracture?

A

Cranial-facial separation. The fracture line in this injury passes from the nasofrontal area across the medial, posterior, and lateral orbital walls, the zygomatic arch and through the upper portion of the pterygoid plates.

132
Q

What 3 things does glasgow coma scale take into account?

A

eye, verbal, motor

133
Q

What are some initial/immediate management for facial fractures?

A
  • check airway
    -haemorrhage
    -head injury
134
Q

What are come clinical findings of Le Fort 1?

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 mid-face

Occlusal discrepancy

Anterior open bite tendency

Dentures not fitting

135
Q

What are clinical presentations of Le Fort III?

A

Bilateral peri-orbital bruising (“panda eyes”)​

Subconjunctival haemorrhage​

Lengthening of face​

Malocclusion - AOB​

Gross oedema of face​

Nasal deformity​

CSF rhinorrhoea​

Diplopia and other visual problems​

Mobility of the upper jaw​

Palatal haematoma

Mandibular fractures​

Nasal Septal Haematoma​

Palatal split

136
Q

What radiograph would you take for a mid face fracture?

A

CT scan

137
Q

What is the mandatory fracture lines in Le Fort I?

A
  • pterygoid plates
  • lateral piriform aperture
138
Q

What is the mandatory fracture lines in Le Fort II?

A
  • pterygoid plates
    -Inferior orbital rim
  • Zygomatic buttress
139
Q

What is the mandatory fracture lines in Le Fort III?

A

-pterygoid plates
-lateral orbital wall
-Zygomatic arch

140
Q

What is the instrument used to disimpact in mid face fractures?

A

Rowes

141
Q

What are the places of fixation for Le Fort I fracture?

A

Buttresses:
- nasomaxillary
-zygomaticomaxillary

142
Q

What are the places of fixation for Le Fort II fracture?

A

-Infra-orbital
-Naso-frontal
-Zygomaticomaxillary

143
Q

What are the places of fixation for Le Fort III fracture?

A

Frontozygomatic
Naso-frontal
Zygomatic arches

144
Q

Name all paranasal sinuses

A
  • maxillary
  • ethmoid
  • sphenoid
  • frontal
145
Q

What is the volume of the maxillary sinus?

A

15-30mls

146
Q

Where does the maxillary sinus drain?

A

Middle meatus

147
Q

What is acute infective sinusitis

A

bacterial infection which follows a viral infection, commonly caused by Strep. Pneumoniae, H. influenzae but Moraxella catarrhalis, Staph. Aureus and alpha haemolytic strept also found​

​

diagnosis on clinical grounds no need for radiograph (opaque sinus or fluid level)

148
Q

How is acute infective sinusitis managed?

A

Mucolytics, inhalations for 2 weeks​

antimicrobials only in severe cases or immunocompromise- need to be effective against penicillinase producing bacteria therefore augmentin (375mg tds), doxycycline (50-100mg OD), clarithromycin (250mg qds)

SDCEP:
Inhalations​

Epinephrine nasal drops 0.5% tds for 1 week​

Amoxicillin 500 mg tds for 7 days​

Doxycycline 100 mg – for 1 week - 200mg on the first day

149
Q

What flap is raised in treating an oro-antral fistula?

A

Buccal advancement flap.

150
Q

What are 3 complications of sinusitis?

A
  • brain abscess
  • orbital cellulitis
  • cavernous sinus thrombosis
151
Q

What are some symptoms of oro-antral communication?

A

Passage of fluid down nose, passage of air into mouth, alteration of voice, unilateral epistaxis, nasal obstruction.

152
Q

How many mm if greater than, an oro-antral communication is unlikely to close spontaneously?

A

5mm.

153
Q

What is an ectopic tooth?

A

malpositioned due to congenital factors

154
Q

What is a displaced tooth?

A

malpositioned due to presence of pathology.

155
Q

What are the most common impacted teeth in order?

A
  • Mandibular 3rd molars
  • Maxillary canines
  • Mandibular premolars/canines
  • Maxillary incisors
  • Maxillary third molars.
156
Q

What are the guidelines you follow when considering extractions of lower third molar teeth?

A

NICE

157
Q

What are relative contra-indications for removal of lower third molars?

A

-asymptomatic teeth
- non-compliant patients
- overt nerve involvement

way up all variables

158
Q

Give a definition of pericoronitis.

A

Inflammation of the tissues around the crown of any partially erupted tooth.

159
Q

What are symptoms/features of pericoronitis?

A

trismus, pain, dysphagia, malaise, bad taste,
Signs of inflammation and pus
Cheek biting and cuspal indentations
Halitosis, food packing
Can progress with systemic symptoms and spread to adjacent tissue spaces

160
Q

What is the treatment for pericoronitis?

A

Local measures: irrigation with saline, oral hygiene measures, remove trauma i.e upper third molar or grind down cusps

General measures: analgesics, antibiotics if systemically unwell or immunocompromised.

Admission in severe airway threatening cases.

161
Q

Name 6 radiographic signs of a close relationship between the lower third molar and the IDC?

A
  1. Diversion of IDC
  2. Darkening of root as it is crossed by the IDC
  3. Loss of lamina dura of IDC
  4. Narrowing of IDC
  5. Deflection of roots of lower third molar as they approach the IDC
  6. Juxta apical area
162
Q

What is the % of risks involved with extractions of teeth to the lingual and ID nerve.

A

Lower lip:
Short term- 5%
Long term- <1%

Tongue:
Short term - 10%
Long term- <1%

163
Q

What are the 5 points planned from radiograph (DPT)?

A
  1. What would be the path of eruption
  2. Extrinsic/intrinsic obstacles to remove
  3. Required bone removal
  4. Point of application
  5. Flap design
164
Q

What type of flap would you raise for a lower wisdom tooth removal?

A

distal relieving incision up the ascending ramus, around the crown of the 3M, include the papilla between the 3M and 2M and mesial relieving incision.

165
Q

What sutures would you use after removing a lower third wisdom tooth?

A

3-0 vicryl rapide.

166
Q
A

Module 9 (20 decks)

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