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.
2
Q
What cells do radicular cysts arise from?
A
Cells of Malassez
3
Q
What cells form dentigerous cysts?
A
Remnants for the CEJ in the follicular tissues.
4
Q
At cellular level, what initiates a cyst to form?
A
- Epithelial remnants triggers an inflammatory response causing proliferaiton of these cells.
- Ball of growth forms and the central cells within this ball undergoes apoptosis therefore the peripheral cells continue to proliferate.
- 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.
5
Q
Can a cyst erode the overlying cortical bone due to hydrostatic pressure?
A
Yes
6
Q
Name some signs and symptoms of cysts.
A
- Asymptomatic - chance finding of radiographs
- Bony exapansion (egg shell crackling)
- Fluctuant swelling
- Missing teeth
- Carious, discoloured, fractured teeth
- Tilted/displaced teeth
- Discharge sinus
- Loose teeth
- Mental hypoesthesia
- Hollow percussion note
- Pain and swelling if secondarily infected
- Pathological fracture.
7
Q
What are some investigations you would carry out if suspected a cyst?
A
- Vitality test
- Radiology
- Aspiration of cyst contents
- Biopsy
8
Q
What are 3 management aims for cysts?
A
- To eradicate the pathology
- To minimise surgical damage
- To restore function quickly
9
Q
Name 6 treatment options of cysts?
A
- Enucleation - first line
- Marsupialisation
- Enucleation and marsupialisation
- Enucleation and curretage/excision
- En bloc resection jaw- continuity maintained
- partial resection- continuity lost.
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.
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.
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
13
Q
Name examples of how you could eliminate dead space clinically?
A
- Drain placement
- Procedure to collapse bony walls e.g make cavity slightly more saucer shape
- Use of biological and other materials to fill the space
- Use layered soft tissue closure e,g suturing muscles
14
Q
Name some advantages of enucleation
A
- Complete removal of pathology for histopathology
- Cavity heals without complication
15
Q
Name some disadvantages of enucleation.
A
- Infection
- Incomplete removal of lining
- Damages to adjacent teeth or antrum
- Weakening of bone
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
17
Q
When would you consider marsupialisation for cysts rather than enucleation?
A
- When the cyst is very large involving many teeth
- Complex medical history or old/frail patients
- Cyst involves an unerupted tooth
18
Q
What is the difference in surgical technique between enucleation and marsupialisation?
A
Marsupialisation you cut flap over the osteotomy site.
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.
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
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
22
Q
List the most common to least common 5 odontogenic cysts?
A
- Radicular cyst (60-75%)
- Dentigerous cysts (10-15%)
- Odontogenic keratocyst (5-10%)
- Paradental cyst (3-5%)
- Lateral periodontal cyst/gingival cyst (<1%)
23
Q
Name the most common non-odontogenic cyst?
A
- Nasopalatine cyst (5-10%)
24
Q
What % of radicular cysts remain after the tooth has been xla e.g to form a residual cyst?
A
20%
25
What is the treatment for a radicular cyst?
Enucleation of cyst and endodontic surgery.
26
What is the treatment for a residual cyst?
Marsupialise if cyst is very large then enucleate.
27
What would you see radiographically in a paradental cyst?
Usually distal to lower 8's - doughnut shaped which is attached to the CEJ. Treatment would be xla and enucleate.
28
What are lateral periodontal cyst and gingival cyst associated with in which radicular cysts are not?
Vital teeth
29
What is the treatment for a dentigerous cyst?
- Enucleation with removal of associated tooth
- marsupialisation if unerupted is potentially functional and can be aligned orthodontically.
30
What does an odontogenic keratocyst arise from and where is the most common area?
- Remnants from the dental lamina
- Posterior mandible
31
Why is an odontogenic keratocysts difficult when treating with enucleation?
- Lining is very fragile
- Grows in an antero-posterior direction
- Has finger-like projections
- Have daughter/satellite cysts
32
What are the treatment options for odontogenic keratocysts?
- Enucleation
- Curettage of cavities with cryotherapy?
- en bloc resection an option previously??
33
If radiograph showed root resorption of other teeth then what would this suggest?
More likely to be a malignancy rather than a cyst - this would need to be biopsied to confirm.
34
What is Gorlin-Goltz syndrome?
Genetic autosomal dominant condition
- Mutations of PTCH gene found on chromosome 9.
35
What is clinical features of Gorlin-Goltz syndrome/multiple basal cell naevoid syndrome?
- Multiple odontogenic keratocysts
- Skeletal abnormalities
- Frontal bossing - supra-orbital ridging
- Wide space between eyes
- Multiple basal cell carcinomas.
36
What is the treatment for lateral periodontal/gingival cyst?
Enucleation.
37
Name 2 non-odontogenic cysts.
1. Nasopalatine duct cyst
2. Nasolabial cyst.
38
What do non-odontogenic cysts form from?
Epithelium from the embryonic arches
39
What is the common clinical and radiographic presentation of a nasopalatine cyst?
- salty discharge
- slow painless swelling
- positive vitality on teeth
- heart shaped radiolucency in incisive canal.
40
What is the treatment for a nasopalatine cyst?
- confirm vitality of teeth
- Enucleation via envelope flat palatally.
41
What is Staphnes idiopathic bone cyst?
- Development anomaly
- Ectopic salivary tissue in concavity in the medial aspect of the mandible *below the IAN*
- No active treatment required
42
What are the 2 types of bone cysts?
1. Solitary bone cyst
2. Aneurysmal bone cysts
43
What is the treatment for aneurysmal bone cyst?
- 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.
44
What would you find in the histology of an aneurysmal bone cysts?
Consists of a mass blood-filled space with scattered giant cells.
45
What are solitary bone cysts?
- Large radiolucency arching up between roots of teeth
- Tend to resolve spontaneously.
46
What is an ameloblastoma?
- 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
47
What would your differential diagnoses be if there was a large radiolucency in the posterior mandible and what would you do?
- Odontogenic keratocyst
- Aneurysmal or solitary bone cyst
- Ameloblastoma??
Need to take biopsy here to confirm diagnosis.
48
What does the management of an ameloblastoma involve?
En bloc resection
49
How do you differentiate between at radicular cyst and a periapical granuloma?
Periapical granuloma <6mm
>6mm can then be defined as a cyst.
50
Give examples of conditions in which you would carry out an excisional biopsy to send for histopathology.
1. Mucocoele
2. Denture induced hyperplasia
3. Epulis e.g pyogenic granuloma
4. Fibroepithelial poylp
51
What is mapping biopsys?
Multiple biopsies in different areas
52
When carrying out an incisional biopsy what part of a white lesion would you want to biopsy?
The worst looking part.
53
What are some problems that can occur when taking a biopsy?
- 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
54
When are frozen sections used and what is the disadvantges of this?
- 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.
55
What is exfoliative cytology?
- 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.
56
What is fine needle aspiration FNAC?
- 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
57
What kind of biopsy would you carry out to diagnose with Sjogrens syndrome?
Labial gland biopsys.
58
What is toluidine blue?
A dye that binds to abnormal tissues to help aid in biopsys. Not frequently used as requires high sensitivity/specificity.
59
If a lesions is >2cm has a greater potential of being a malignant lesion. True or false?
True.
60
Where are the 2 places in the mouth where you dont have salivary glands.
1. Gingivae
2. Hard palate
61
When do the major saliva glands only produce saliva.
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.
62
Where anatomically is the parotid gland, what is the parotid duct called and what type of saliva does it produce?
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.
63
What are the different parts/lobes of the parotid gland?
- 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.
64
What important structures run through the parotid gland?
- Facial nerve
- Terminal branches of external carotid artery
- superficial temporal artery
- Maxillary artery
- Greater auricular nerve?
65
Where is the submandibular gland located anatomically, what is the duct called and what type of saliva does it produce?
- 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.
66
Where is the sublingual gland located anatomically, what is the duct called and what type of saliva does it produce?
- 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
67
What are some common pathology/disorders associated with major salivary glands?
-Viral e.g mumps, Coxsackie, CMV, HIB
- Bacterial infection
- TB, sarcoid
- radiation induced
- Obstruction/trauma
- Neoplasm
- autoimmune/destructive e.g Sjogrens
68
What virus is mumps caused by?
Paramyxovirus
69
Who are CMV viruses most commonly seen in?
Neonates and immunocompromised.
70
What can be some causes of bacterial sialadenitis?
- Caused by stasis of gland e.g fasting, dehydration
- Can be due to systemic causes such as immunosuppressed/medication/irradiation
71
What is the management of bacterial sialadenitis?
- Antibiotics
- Fluids
- Sialogogues
- Analgesics
72
What is it called when there is pain at meal times in the salivary glands?
Prandial symptoms
73
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?
Risk of retrograde spread and cause cavernous sinus thrombosis, refer to max fax for IV AB's
74
What is the most common reason for obstruction of salivary glands?
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
What is the clinical presentation of obstructive sialadenitis.
- 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
What are some signs of acute sialadenitis secondary to obstruction?
Stasis allows secondary infection
Increasing, painful swelling 24-72 hours duration
Oral discharge of pus
Systemic manifestations
77
Why is the submandibular gland more likely to get sialoliths?
- They have a longer duct
- More alkaline pH making calcium and phosphates ions likely to come out of solution and be deposited.
78
What are the treatments for obstructive disorders of salivary glands?
- sialogogues to stimulate stone passing
- surgical removal of intraductal stone
- surgical removal of gland if intraglandular and severe symptoms
- eliminate trauma
79
What are some techniques used for removing sialoliths (saliva stones)?
- Basket retrieval (only small stones)
- Lithotrypsy.
80
What is a ranula and what is the treatment for this?
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
What is sialometaplasia?
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
Do tumours of saliva gland occur mostly in the major or minor salivary glands?
Tumours occur mainly in the major salivary glands.
83
Where are the 2 most common places for tumours to occur in minor salivary glands?
55% in soft palate
20% in upper lip
84
What has a high proportion of carcinomas, major or minor salivary glands?
Minor salivary glands.
85
What is the most common benign salivary gland tumour?
Pleomorphic adenoma
86
What is the name of a benign salivary gland tumour that is bilateral?
Warthins tumour.
87
What are indications for a parotidectomy and what are the different types?
- Painful Sjogrens syndrome
- Benign or malignant tumours
- Extracapsular dissection
- Lobar resection
- Superficial parotidectomy
- Total parotidectomy
88
What is Freys syndrome?
Gustatory sweating
89
What is the closed technique in fractures of the mandible?
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
What is an open technique in fractures of the mandible?
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
What is reduction?
Aligns the bone ends anatomically
Recreates the normal anatomy
92
What is fixation?
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
What are different methods of open fixation?
- Mini plates
- Reconstruction plates
- Compression plates
- Lag screws
94
What are different methods of closed fixation? E.h intermaxillary fixation?
- Arch bars
- Eyelet wires
- Leonard buttons
- Cast cap splints
- Gunning splints
95
What are indications for close reduction IMF?
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
Name 3 advantages of closed reduction?
1. Inexpensive
2. Simple procedure
3. No foreign body so reduced risk of infection
97
Name 5 disadvantages of closed reduction?
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
What are indications of open technique?
1. Displaced unfavourable fractures
2. Multiple fractures
3. Edentulous displaced fractures
4. Bilateral displaced condylar fractures
99
What are 5 advantages for open reduction?
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
What are 3 disadvantages of open reduction?
1. Morbidity of surgical procedure
2. Expensive hardware
3. Need for GA
101
What is Champys principle?
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
What is the difficulty in open reduction in edentulous patients?
- 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
What post-operative care is required with both open and closed techniques?
- instructions and how to release IMF to nurses
- IV antibiotics (no guidance)
- Steroids
- Fluids IV
- Post op xrays - not now routinely taken
104
What are some complications of both open and closed reduction?
- Non-union, fibrous union, mal-union
- Altered occlusion
- Distracted TMJ
- Scars, trauma and iatrogenic
- Infection
- Necrosis
- Numb lip
- Exposed plate
105
What are some considerations in primary care in managing mandibular fractures?
- Teeth in fracture line are rendered non-vital
- Presence of plates in areas of planned extractions
- Altered sensation in the lower lip
106
What are types of condylar fractures?
- Extracapsular
- Intracapsular
- TMJ effusion --> trauma within the joint caspsule, no breakages
107
What does a condylar fracture do to the occlusion?
The occlusion on the side of the fracture becomes shorter and can create an lateral open bite on the opposing arch.
108
What is the treatment for a condylar fracture?
Conservative: soft diet, analgesics
Open reduction and internal fixation
Closed - leonard buttons and elastic traction
109
How are paediatric mandibular fractures mostly treated with?
Conservative management e.g splints. Internal fixation in most cases not possible as tooth germs and condylar growth is present.
110
What are some clinical extra-oral features of a mandibular fracture?
- pain
- swelling
- trismus
- concurrent soft tissue injury
- otorrhoea
- Anaesthesia/paraesthesia of lip
111
What are some intra-oral clinical features of a mandibular fracture?
- Haematoma in the floor of the mouth
- Malocclusion
- Tongue swelling
- Step deformity
- Gingival laceration
- Mobility or loss of teeth, # teeth
112
What 2 radiographs are recommended for a mandibular fracture?
DPT and PA mandible
113
What is a Guardsmann fracture?
A fracture at the symphisis of the mandible and 2 separate condylar fractures.
114
What is a bucket handle fracture?
Bilateral body fractures
115
What is subconjuctival haemorrhage?
Disruptions of the orbital wall cause bleeding in the eye
116
What is opthalmoplegia?
can't look in a certain direction due to entrapment of orbital muscles
117
What is orbital dystopia?
One orbit appears at a different level then the other - damage to ligaments.
118
What is enopthalmos?
Intruded eye
119
What is orbital blowout?
Inferior border of the orbit has significant damage where contents of eye drop into sinus.
120
What is retrobulbar haemorrhage
A bleed behind the eye - can cause an increase in volume putting pressure on optic nerve, risk of blindness.
121
What is orbital fissure syndrome?
Rare - fracture extend to superior orbital fissure can result in cranial nerve damage (3,4,5,6)
122
What is diplopia?
Double vision
123
What radiographs are normally taken for zygomatic fractures?
- occipitomental view
- DPT
124
What is the horizontal buttresses in mid face fractures?
1. Frontal
2, Zygomatic
3. Maxillary
125
What is the vertical buttresses in mid face fractures?
1. Nasomaxillary
2. Zygomaticomaxillary
3. Pterygomaxillary
126
What is the sagital buttresses in mid face fractures?
1. Zygomatic arches
2. Palate
3. Floor of orbit
127
What 3 bones have the lowest tolerance to impact?
Nasal bones least resistant
Zygomatic arch directly
Maxillae
128
What are some clinical findings of a mid face fracture?
- Anterior open bite*
- Facial lengthening
- Extreme- soft palate obstruct airway
- Nares blood clot
- Coincident head injury
- Dish face deformity if severe
129
What is Le Fort I?
The fracture extends around both maxillary antra,through the nasal septum and the pterygoid plates. This causes palate-facial separation.
130
What is a le fort fracture II?
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
What is a Le Fort III fracture?
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
What 3 things does glasgow coma scale take into account?
eye, verbal, motor
133
What are some initial/immediate management for facial fractures?
- check airway
-haemorrhage
-head injury
134
What are come clinical findings of Le Fort 1?
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
What are clinical presentations of Le Fort III?
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
What radiograph would you take for a mid face fracture?
CT scan
137
What is the mandatory fracture lines in Le Fort I?
- pterygoid plates
- lateral piriform aperture
138
What is the mandatory fracture lines in Le Fort II?
- pterygoid plates
-Inferior orbital rim
- Zygomatic buttress
139
What is the mandatory fracture lines in Le Fort III?
-pterygoid plates
-lateral orbital wall
-Zygomatic arch
140
What is the instrument used to disimpact in mid face fractures?
Rowes
141
What are the places of fixation for Le Fort I fracture?
Buttresses:
- nasomaxillary
-zygomaticomaxillary
142
What are the places of fixation for Le Fort II fracture?
-Infra-orbital
-Naso-frontal
-Zygomaticomaxillary
143
What are the places of fixation for Le Fort III fracture?
Frontozygomatic
Naso-frontal
Zygomatic arches
144
Name all paranasal sinuses
- maxillary
- ethmoid
- sphenoid
- frontal
145
What is the volume of the maxillary sinus?
15-30mls
146
Where does the maxillary sinus drain?
Middle meatus
147
What is acute infective sinusitis
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
How is acute infective sinusitis managed?
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
What flap is raised in treating an oro-antral fistula?
Buccal advancement flap.
150
What are 3 complications of sinusitis?
- brain abscess
- orbital cellulitis
- cavernous sinus thrombosis
151
What are some symptoms of oro-antral communication?
Passage of fluid down nose, passage of air into mouth, alteration of voice, unilateral epistaxis, nasal obstruction.
152
How many mm if greater than, an oro-antral communication is unlikely to close spontaneously?
5mm.
153
What is an ectopic tooth?
malpositioned due to congenital factors
154
What is a displaced tooth?
malpositioned due to presence of pathology.
155
What are the most common impacted teeth in order?
- Mandibular 3rd molars
- Maxillary canines
- Mandibular premolars/canines
- Maxillary incisors
- Maxillary third molars.
156
What are the guidelines you follow when considering extractions of lower third molar teeth?
NICE
157
What are relative contra-indications for removal of lower third molars?
-asymptomatic teeth
- non-compliant patients
- overt nerve involvement
way up all variables
158
Give a definition of pericoronitis.
Inflammation of the tissues around the crown of any partially erupted tooth.
159
What are symptoms/features of pericoronitis?
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
What is the treatment for pericoronitis?
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
Name 6 radiographic signs of a close relationship between the lower third molar and the IDC?
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
What is the % of risks involved with extractions of teeth to the lingual and ID nerve.
Lower lip:
Short term- 5%
Long term- <1%
Tongue:
Short term - 10%
Long term- <1%
163
What are the 5 points planned from radiograph (DPT)?
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
What type of flap would you raise for a lower wisdom tooth removal?
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
What sutures would you use after removing a lower third wisdom tooth?
3-0 vicryl rapide.
166
