Oral Surgery Flashcards
What are these all types of?
ASPIRIN, CLOPIDOGREL, DIPYRIDAMOLE, PRASUGREL, TICAGRELOR
Antiplatelets
What is sialometaplasia?
A benign, self-limiting inflammatory reaction of salivary gland tissue
What type of impaction is this?
Horizontal
What INR is safe for doing bleeding causing treatments on patients on vitamin K antagonists?
If INR is <4: Treat without interrupting medication
If INR is 4 or above: Delay invasive treatment, or refer if it is urgent
What is alveolar osetitis?
Dry socket - inflammation of the alveolar bone that occurs as a complication post tooth extraction. It occurs due to the bone being exposed due to failure of a blood clot to form
What is involved in the open technique for fixation?
When the fracture margins are visualised intra-orally or extra-orally via an incision
What is paraesthesia?
an abnormal sensation, whether spontaneous or evoked
What duct does the submandibular gland drain through?
Wharton’s duct
What are these symptoms of?
● Sharp pain at the time of fracture or completely asymptomatic
● Reflux of fluids from the mouth to nose
● Sinus stiffness
● Present with symptoms of sinusitis
Fractured tuberosity
What type of impaction is this?
Mesio-angular
What is pericoronitis?
The inflammation of the gum around an erupting or partially erupted tooth
What is the management for chronic sinusitis?
● Phenoxymethylpencillin
Doxycycline for penicillin alergy
What is primary intention/healing when managing cysts?
Leaving the bony cavity to heal itself after enucleation
When is two point fixation for zygomatic fractures indicated?
Minimally displaced fractures where there are minimal changes on the orbital volume and globe displacement is not evident on a CT
What is a cyst?
a pathological cavity having fluid or semi-fluid contents, which has not been created by the accumulation of pus
Name this instrument
Needle holders
What do you do when doing a procedure that is likely to cause bleeding on a patient on:
- clopidogrel
- dipyridamole
- prasugrel
- ticagrelor
- dual therapy (in combination with aspirin)
Treat without interrupting medication but expect prolonged bleeding
What is the main goal of treatment for a zygomatic fracture?
Restoration of facial symmetry and restoration of orbital volume/globe position
What do you need to check before doing a procedure that is likely to cause bleeding on a patient taking vitamin K antagnoists?
Check INR (international normalised ratio)
What instrument is used for the screw and pull reduction technique for managing zygomatic fractures?
Carroll-Girard T-bar Screw
What are the 4 different types of fracture?
- Simple
- Compound
- Comminuted
- Pathological
What secondary view would need to be taken in cases of mandibular fractures if a radiopaque area is seen on a DPT and why?
A second view at 90 degrees to see which part of the bone is more buccal or lingually positioned
What are the points of fixation for four point fixation for zygomatic fractures?
Infraorbital region; zygomatico-maxillary fixation, frontozygomatic suture and a plate along the sphenozygomatic suture
What is this condition based on its clinical presentation?
● Pain
● Tenderness across area
● Worsens on bending over
● No swelling
● Posterior teeth TTP
● Post nasal drip
● Mucopurulent discharge
● Poor response to nasal decongestants
● History of coloured discharge
● Present less than 12 weeks at a time
Acute infective sinusitis
What does subcutaneous emphysema look like radiographically?
Radiolucent mottling that is superimposed onto the bone - extending into the regions of the soft tissues
When would you do three point fixation when managing zygomatic fractures?
When there is instability and exploration of the orbital floor is required or comminution and severe displacement
What is another word for sialithiasis?
Salivary gland stones
What type of impaction is this?
Disto-angular
What is anaesthesia?
absence of all sensory modalities
Name this instrument
Scalpel - left is 15 and right is 11
What type of saliva is in the sublingual glands?
Mucous only
What percentage of extractions result in alveolar osteitis?
1-3 % and 38% in third molars
What material is used for fixation?
Titanium plates and screws (either large plates or mini plates)
What is a comminuted fracture?
Multiple small fractures
What are the 4 main causes of mandibular fractures?
- trauma
- malignancy
- pathology
- unerupted teeth
Name this salivary lesion
Sialometaplasia
What is missing in this management of sepsis?
● Take Bloods
● Monitor Urine output
● Give Fluid challenge
● Give IV Antibiotics
● Give Oxygen
Measure lactate
What is chronic sinusitis?
An inflammation of the sinus or nasal passages occurring for more than 12 weeks at a time
What type of flap is this?
An envelope flap for lower third molar surgical removal
What is the management of osteoradionecrosis?
Just refer
● Resection
● Hyperbaric Oxygen Treatment (HBOT)
● Pentoxyphyline/Tocopherol
What radiograph would you usually take for LeFort fractures?
Occipito-mental views with the parallax technique
When is a coronectomy of third molar indicated?
When there is radiographic evidence of a high risk relationship between the third molar and the IDC and there is no caries or pathology associated with the 3rd molar
This patient has recurrent infections, severe pain, suppuration, halitosis and a pathological fracture. What is this?
Osteoradionecrosis
In what salivary gland are salivary gland stones (sialithiasis) most common?
Submandibular (80%)
What are the main features you may see radiographically in cases of mandibular fractures?
- Radiolucent lines
- Radiopaque area
- Widened PDL
- Occlusal step
- Steps in upper and lower border of the mandible
- Anterior open bite
- Shortening of the ramus
What does this mean on a radiograph?
When a patient with a history of trauma has a radiograph taken, the radiographers would place a red dot near the site of possible fracture on conventional film
How long does it take for vicryl rapide sutures to dissolve?
7-10 days
What are the different options for reduction when managing zygomatic fractures? (4)
- Stab and hook
- Screw and pull
- Intraoral approach
- Gillies temporal approach
According to the SDCEP, what bleeding risk are these procedures?
● Simple extractions (1-3 teeth with restricted wound size)
● Incision and drainage of intra-oral swellings
● 6PPC
● RSD
● Direct or indirect restorations with subgingival margins
Low risk
What is a temporary alternative to a buccal advancement flap in OAC management?
Plate/modified denture
What is the process of the Gillies Temporal Approach for reduction of zygomatic fractures?
Incise at the temporal region, cut through skin and temporalis fascia, introduce instrument under fractured bone and elevate to reduce
What salivary gland is most commonly affected by sialadenitis?
Submandibular
What duct does the parotid gland drain through?
Stenson’s duct
What is hypoaesthesia?
diminished sensitivity to stimulation, excluding special senses
What are the most common indications for the surgical removal of impacted teeth? (5)
● Pericoronitis
● Caries
● Periodontal disease
● The presence of a cyst (most commonly a dentigerous cyst)
● External root resorption
When would you reconstruct the orbital floor for zygomatic fractures? (3)
If the orbital floor defect is 5-10mm; enophthalmos (sunken eyes); or defects posterior to the axis of the globe
What type of saliva is in the submandibular gland?
Mixed - mucous and serrous
What cases occlusal steps in cases of mandibular fractures?
Muscle pull causing displacement
What is load sharing fixation with mandibular fractures?
When the occlusal load is shared/distributed between hardware and bone
What are these all types of?
DALTEPARIN, ENOXAPARIN, TINZAPARIN
Injectable anticoagulants
How long does it take for most symptoms (e.g. bleeding bruising and swelling) to ease after an oral surgery procedure?
1-2 weeks
What is missing in this management of sepsis?
● Monitor Urine output
● Give Fluid challenge
● Give IV Antibiotics
● Measure Lactate
● Give Oxygen
Take bloods
Why are mesial relieving incisions preferred and when is the exception?
They allow better visual access. The exception to this is when operating around the mental foramen
What pathology makes tuberosity fracture more likely?(5)
● Sinus disease
● Odontogenic cysts
● Periapical infection
● Osteoporosis
● Very dense bone
Why is it good that most zygomatic complex fractures are unilateral?
You have a the other side to compare the anatomy
Which patients do you not interrupt anticoagulant or antiplatelet therapy for?
● Prosthetic metal heart valves or coronary stents
● Pulmonary embolism in the last three months
● Deep vein thrombosis in the last three months
● Anticoagulant therapy for cardioversion
What is this?
Alveolar osteitis (dry socket)
How is a retrobulbar haemorrhage with orbital compartment syndrome managed?
Deplete the fluid (relieves pressure) and prescribe steroids or acetazolamide
What is a retrobulbar haemorrhage with orbital compartment syndrome?
A rare complication of zygomatic fractures when a haemorrhage leads to increased orbital pressure, which can then lead to ischemia (reduced blood flow/oxygen) which can lead to vision loss
Name 5 antiplatelets
ASPIRIN, CLOPIDOGREL, DIPYRIDAMOLE, PRASUGREL, TICAGRELOR
Why are post operative radiographs not usually taken?
Because the position of the bones can directly be assessed at surgery and the occlusion checked - especially when bone plates are used
What duct does the sublingual gland drain through?
Multiple small ducts called Rivini’s ducts or a common duct with the submandibular gland called Bartholin’s duct
What does it mean when “erect” is written on a radiograph and why is it important?
The patient was standing up when the radiograph was taken. It is important as it affects fluid flow in the sinus (gravity)
What do subcutaneous emphysemas look like on a radiograph?
Radiolucent mottling that is superimposed onto the bone - extending into the regions of the soft tissues
According to the SDCEP, what bleeding risk are these procedures?
● LA
● BPE
● Supragingival PMPR
● Direct or indirect restorations with supragingival margins
● Endodontics
● Impressions
● Fitting/adjusting orthodontic appliances
Unlikely to cause bleeding
What % of odontogenic cysts are radicular?
60%
What is the flap design used to manage OAC?
Buccal advancement flap
What should you do when doing high bleeding risk treatment for patients taking apixaban and dabigatran?
Advise patient to miss morning dose
What is the treatment for acute infective sinusitis?
● Do nothing
● Menthol inhalation
● Mucolytics - for 2 weeks
● 0.5% epinephrine nasal drops TDS for 1 week
What type of impaction is this?
Vertical
When does a radiopaque area occur on a radiograph of a mandibular fracture?
When there is displacement and the fractured ends are superimposed on each other
How long does it take for an OAC to epithelialise into an OAF?
Around 7-8 days
What do you do when doing a procedure that is likely to cause bleeding on a patient on a anticoagulant/antiplatelet combination?
Consult with the patient’s prescribing clinician in order to assess the likely impact of the particular drug combination and the patient’s bleeding risk
What are the different instuments you can use for Gillies temporal approach when reducing zygomatic fractures?
Bristow/Rowe
What do you do as a GDP for pericoronitis? (5)
- Irrigate with saline or chlorhexidine
- Eliminate trauma (e.g. grinding cusps or XLA of opposing tooth)
- Advise analgesics
- Assess with DPT
- Refer
What do you do when doing a procedure that is likely to cause bleeding on a patient on a low dose of injectable anticoagulants?
Treat without interrupting medication
What is missing in this management of sepsis?
● Take Bloods
● Monitor Urine output
● Give IV Antibiotics
● Measure Lactate
● Give Oxygen
Give fluid challange
Name this instrument
MacIndoe’s Scissors
What is allodynia?
pain due to a stimulus that does not normally provoke pain
Name this instrument
Kilner’s cheek retractor
When would you use marsupialisation when managings cysts?
- large lesions with multiple healthy adjacent teeth
- Old/frail patients
- Cysts with teeth that can erupt through
What is the management for a small tuberosity fracture without sinus perforation?
● Dissect segment from gingivae and periosteum
● Suture
What are the most common epithelial remnants that cause cysts?
The root sheath of Hertwig’s epithelial cell rests of Malassez (which go on to form the root of the tooth) and the reduced enamel epithelium (which form a lining over the crown of the tooth and follicular tissue)
Name this instrument
Mitchell’s trimmer
What should you do when doing low bleeding risk treatment for patients taking direct oral anticoagulants?
Treat without interrupting medication
What is missing in this management of sepsis?
● Take Bloods
● Monitor Urine output
● Give Fluid challenge
● Measure Lactate
● Give Oxygen
IV antibiotics
What do you do when doing a procedure that is likely to cause bleeding on a patient on a high dose of injectable anticoagulants?
Consult with the prescribing clinician
What is the best method for treating zygomatic fractures?
Open reduction, internal fixation
Name 3 Vitamin K antagonists?
WARFARIN, ACENOCOUMAROL, PHENINDIONE
What is reduction (with regards to treating fractures)?
When the displaced bone is put back into the correct anatomical place
What is missing in this management of sepsis?
● Take Bloods
● Give Fluid challenge
● Give IV Antibiotics
● Measure Lactate
● Give Oxygen
Monitor urine output
What is sialadenitis?
A salivary gland bacterial infection that causes swelling of the gland
In what size OAC is spontaneous closure likely?
Less than 5mm
What is written on a radiograph if there is a potential problem on a radiograph as a result of trauma (i.e. signs of fracture)?
With a red dot that is placed on the film or (in the case of digital radiographs) ‘red dot’ is written on the digital image
What are all of these a type of?
● Bavacizumab
● Sunitinib
● Aflibercept
Anti-angiogenic drugs (cancer)
What % of surgical removal of mandibular third molars result in permanent nerve damage/altered sensation?
less than 1%
Name this
Palatal rotation flap
How long does dry socket take to heal if you do nothing to treat it?
up to 6-8 weeks
What is missing in this management of sepsis?
● Take Bloods
● Monitor Urine output
● Give Fluid challenge
● Give IV Antibiotics
● Measure Lactate
Give oxygen
What type of flap is this?
An envelope flap for surgical removal of impacted canines
What is involved in closed fixation for fractured mandibles?
Bone margins are not directly visualised and no incision made. The jaws are wired together (inter-maxillary fixation)
When is orbital floor exploration indicated for zygomatic fractures?(3)
For orbital floor defects greater than 5mm on a CT; when there is soft tissue entrapment that limits upwards gaze or a herniation of orbital floor contents into the maxillary sinus
What type of saliva is in the minor salivary glands?
Mucous only
What is the missing presentation of sepsis?
● Slurred speech
● Extreme shivering
● Severe breathlessness
● Illness so bad they feel like they’re dying
● Skin mottled/discoloured/ashen
Passed no urine
What type of mid-face fracture does this depict and why?
An orbital floor (blow out) fracture because of the tear drop appearance
Name this instrument
Spencer Well’s artery forceps
What is sepsis?
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection
What is load bearing fixation with mandibular fractures?
When 100% of the occlusal load is supported (large plates)
What are radicular cysts associated with?
The apices of a non-vital tooth
How does enucleation work?
Enucleation is the complete removal of the cyst lining. Once you remove the cyst lining, you are left with a large bony cavity which then fills with blood clot which then forms granulation tissue before being ultimately replaced (in part) by bone
When should you review a patient at risk of MRONJ after an extraction?
8 weeks
What is the management for a small tuberosity fracture with sinus perforation?
● Dissect segment and close socket primarily
What is para-symphysis (with regards to mandibular fractures)?
When there is a fracture that occurs in the anterior of the mandible but that does not go through the midline
How do subcutaneous emphysemas occur?
When air enters the tissue spaces as a result of the trauma via one or more of the fracture sites
What should you do when doing high bleeding risk treatment for patients taking rivaroxaban or edoxaban in the morning?
Delay dose until 4 hours after haemostasis has been achieved
What are the 4 nerves in the vicinity of third molars that you need to consider?
- IAN
- Long buccal nerve
- Lingual nerve
- Mylohyoid nerve
How do you get access to the zygomatic bone for four point fixation?
Do a coronal flap which is an incision that goes along the line where a hairband would sit
Name this complication from oral surgery
Oro-antral fistula
Name this instrument
Howarth’s Periosteal elevator
Name this instrument
Bone file
What is meant by a low energy zygomatic fracture?
Minimal/no comminution
What is the missing presentation of sepsis?
● Extreme shivering
● Passed no urine
● Severe breathlessness
● Illness so bad they feel like they’re dying
● Skin mottled/discoloured/ashen
Slurred speech
What are the points of fixation for three point fixation for zygomatic fractures?
Zygomatico-maxillary buttress fixation, infraorbital region fixation and a frontozygomatic suture
What type of saliva is in the parotid gland?
Mixed - mucous and serous but mainly serous (watery thin consitution)
How long after an extraction does alveolar osteitis present?
2-3 days after
What are the advantages of ORIF when managing zygomatic fractures?
It improves the alignment and fixation of the zygomatico-maxillary buttress provides vertical support. It also allows you to examine the fracture site and orbital rim.
What is the non-surgical management option for zygomatic fractures when there is no displacement (confirmed by a CT)?
Observation and a soft diet
What are these all signs of?
● Crunch or loud crack
● Sudden loosening of tooth and bone together
● Bone comes away with tooth during extraction
● Observable opening into maxillary sinus
Fractured tuberosity
Name this instrument
Tooth tissue forceps
What can you prescribe for an OAC?
● Antibiotics (Penicillin V)
● 0.5% epinephrine drops
● Mucolytic inhalations
What is an oro-antral communication?
A pathological opening between the maxillary sinus and the oral cavity
How does subcutaneous emphysema form after mandibular fractures?
When air enters the tissue spaces as a result of trauma via one or more of the fracture sites
Name this instrument
Minnesota retractor (retract buccal flap)
What is the most common pathology of minor salivary glands?
Mucous extravasation cyst
What is the missing presentation of sepsis?
● Slurred speech
● Extreme shivering
● Passed no urine
● Illness so bad they feel like they’re dying
● Skin mottled/discoloured/ashen
Severe breathlessness
What is a pulmonary embolism?
When one of the pulmonary arteries in the lungs get blocked
What is the missing presentation of sepsis?
● Slurred speech
● Extreme shivering
● Passed no urine
● Severe breathlessness
● Illness so bad they feel like they’re dying
Skin mottled/discoloured/ashen
What are the points of fixation for two point fixation for zygomatic fractures?
Zygomatico-maxillary buttress fixation and a frontozygomatic suture
What is osteoradionecrosis?
When exposed irradiated bone fails to heal over a period of 3 months without any evidence of persisting or recurrent tumour
What are all of these types of?
WARFARIN, ACENOCOUMAROL, PHENINDIONE
Vitamin K antagonists
What type of flap is this?
A three sided flap for surgically exposing maxillary incisors
What is a simple fracture?
A closed linear fracture
What is cardioversion?
A medical procedure that is used to restore a normal heart rhythm in people with certain types of abnormal heartbeats, also known as arrhythmias
What number scalpels are usually used for oral surgery?
A number 15 or 11 scalpel
What is meant by a high energy zygomatic fracture?
Comminution at segment and fracture lines
What is secondary intention/healing when managing cysts?
Packing the defect and replacing subsequent packs until granulation tissue fills the base of the defect to the top after enucleation
Name this instrument
Molt no.5 (periosteal elevator)
What happens if an oro-antral communication is left?
If more than 5mm, it remains permeable and epithelialises to develop into an oro-antral fistula and can cause maxillary sinusitis
What are these all a type of?
APIXABAN, DABIGATRAN, RIVAROXABAN, EDOXABAN
Direct oral anticoagulants
What is the best landmark when reducing a zygomatic fracture?
Zygomaticosphenoid suture (where the zygoma and sphenoid bone meet)
What may cause radiolucency on a CT for bony fractures?
anatomy (airways); artefact; pathological (emphysema shows fracture is likely)
Name this instrument
Rake retractor (retract buccal tissue)
What is this condition based on its clinical features?
● Passage of fluid down the nose
● Passage of air into the mouth
● Alteration of voice
● Unilateral epistaxis
● Intra-oral antral polyp
● Cacogeusia
● Facial pain
Oro-antral communication
Where are there no minor salivary glands?
gingivae and anterior hard palate
Name 3 injectable anticoagulants
DALTEPARIN, ENOXAPARIN, TINZAPARIN
What is dysthesia?
unpleasant abnormal sensation, whether spontaneous or evoked
What is the missing presentation of sepsis?
● Slurred speech
● Extreme shivering
● Passed no urine
● Severe breathlessness
● Skin mottled/discoloured/ashen
Illness so bad they feel like their dying
What type of flap is this?
Triangular flap for lower third molar surgical removal
Name 4 direct oral anticoagulants (DOACs)
APIXABAN, DABIGATRAN, RIVAROXABAN, EDOXABAN
What is symphysis (with regards to mandibular fractures)?
When there is a mandibular fracture that passes through the midline between the lower central incisors
What is the missing presentation of sepsis?
● Slurred speech
● Passed no urine
● Severe breathlessness
● Illness so bad they feel like they’re dying
● Skin mottled/discoloured/ashen
Extreme shivering
What is fixation (with regards to treating fractures)?
Preventing the movement of the bone while healing occurs
What is deep vein thrombosis?
A blood clot in a deep vein (most common in the legs and pelvis)
What cranial nerves are injured with superior orbital fissure syndrome?
Cranial nerves III, IV, V (opthalmic branch) and VI
What are all of these a type of?
● Alendronic acid
● Risedronate sodium
● Zoledronic acid
● Ibandronic acid
● Pamidronate disodium
● Sodium clodronate
Bisphosphonates
What is this condition based on its clinical presentation?
● Pain
● Tenderness across area
● Worsens on bending over
● No swelling
● Posterior teeth TTP
● Post nasal drip
● Mucopurulent discharge
● Poor response to nasal decongestants
● History of coloured discharge
● Present more than 12 weeks at a time
Chronic sinusitis
Name this instrument
Rongeures (Bone nibblers)
What is hyperalgesia?
an increased response to stimulus that is normally painful
What % of surgical removal of mandibular third molars result in temporary nerve damage/altered sensation?
approx 5%
What does sialometaplasia look like clinically and histopathologically?
Squamous cell carcinoma or mucoepidermoid carcinoma
According to the SDCEP, what bleeding risk are these procedures?
● Complex extractions
● Adjacent extractions that will cause large wounds
● More than 3 extractions at once
● Flap raising procedures
● Gingival recontouring
● Biopsies
High risk
What do you do when doing a procedure that is likely to cause bleeding on a patient on aspirin?
Treat without interrupting medication
What is a compound fracture?
A fracture that causes a wound of break in the skin/mucosa. They are very common in tooth bearing areas
What dental anatomy makes tuberosity fractures more likely?(5)
● Long or bulbous roots
● Hypercementosis
● Multirooted teeth
● Lone standing molars
● Ankylosis
Name this flap
Buccal advancement flap
