Oral Surgery Flashcards
What is a bisphosphonate?
This is a classification of anti-resorptive drug that is used in patients with cancer (prostate, breast and multiple myeloma) and osteoporosis
It works by reducing bone resorption by inhibiting the enzymes essential for the function of osteoclasts (reduces bone turnover by stopping bone being broken down) - they have a high affinity for HA and persist in skeletal tissue for significant period of time
What do cancer patients usually have?
Higher dose, IV bisphosphonates therefore high risk
What is the relevance of bisphosphonates to dentistry?
Relevant as bisphosponates later bone turnover and persist in the skeletal tissue for numerous years including the jaw bone and as a result this can increase the risk of a rare side effect known as MRONJ - this is where following an extraction there is delayed healing and exposed bone that can cause pain and discomfort. This is why it is important we undertake any dental tx including extractions prior to starting this drug therapy
What is the risk of MRONJ on pts on bisphosphonates?
0.01-0.1% in non cancer pts
1% in cancer pts
What is an anti-angiogenic drug?
Drugs that target the processes by which new BVs are formed and are used in cancer tx to restrict tumour vascularisation
often used in conjunction with bisphosphonates in management of cancer and some evidence of inc MRONJ risk
Before anti-resorptive or anti-angiogenic tx what should be done?
Ideally before or as soon as possible after we want to get pt as dentally fit as feasible - prioritise preventative care to prevent future issues, carry out any extractions, and if when pt is on med they need the extractions must ensure pt understands risk and that it is very small - pt shouldn’t be discouraged from taking med
What patients are low risk for bisphosphonates?
if tx is for osteoporosis or other non malignant diseases such as pagers disease with ORAL bisphosphonates for less than 5 years and not on systemic glucocorticoids
osteoporosis tx with quarterly or yearly infusions of IV for less than 5 years and no systemic glucocorticoids
osteoporosis or non malignant disease with denosumab who are not taking systemic glucocorticoids
What pts are high risk for bishosphonates?
Pts treated for osteoporosis with oral or quarterly or yearly IV infusions for > 5 yrs
pts with osteoporosis tx with bisphosphonates or desonumab and also systemic glucocorticoids
pts being tx for cancer
pts with prev MRONJ
What are the types of facial fractures?
Zygomatico-orbital fracture
mandibular fracture (body, angle, parasymphyseal, mental, ramus, condylar head, condyle)
How can you tell a patient has a zygomatic-orbital fracture?
Radiopacity in sinus, dropping
How do you examine patient with suspected facial fracture?
Assess for any ASYMMETRY (assess infant, above and below and can gently palpate)
Observe and note and LACERATIONS
Any peri-orbital BRUISING OR SWELLING?
ANY BLEEDING IN THE EYE
SENSATION EXAM - any altered sensation in the cheek, below the eye or above the lip
Vision - any double vision - get patient to follow finger, assess response to light
What are some signs and symptoms of a zygomatic-orbital fracture?
Asymmetry
Step deformity
Altered sensation/numbness
pain
swelling
brusing
bleeding
diplopia
initial swelling in zygomatic area then flatness
visual impairment
SENSORY DEFECITY –> INFRA-ORBITAL NERVE
TRISMUS
sub-conjunctival haemorrhage
broken teeth
gingival lacerations
loose teeth
What is further investigations for zygomatic-orbital fracture?
OM 15 30
CBCT
What is the management for zygomatic-orbital fractures?
Urgent phone call to max fax/a+e and referral
CR and fixation
ORIF
avoid nose blowing, no eating as may be having surgery, prophylactic antibotics, exclusion of ocular injury
