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Module 6 Exam > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

Radiograph views for maxillary sinus

A

occipitomental (Water’s view), DPT, periapicals

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2
Q

Drainage of maxillary sinus

A

Middle meatus through ostium located 2/3rd up the medial wall of the sinus

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3
Q

Typical history causing an acute bacterial sinusitis

A

Viral infection (of throat by Strep. pneumonia, H.influenza etc) that then causes inflammation of the respiratory epithelium than lines the sinus, this then is predisposed to getting infected by bacteria.

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4
Q

How big is the ostium of the maxillary sinus?

A

2.4mm

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5
Q

Why might nasal decongestants not work for a patient with sinusitis?

A

Mucosa overlying the ostium is inflamed and so the opening is very small, decongestants cannot enter the sinus.

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6
Q
A
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7
Q

OAF vs OAC

A

Oroantral fistula is an epithelialised Oroantral communication

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8
Q

What size of OAC will not spontaneously close?

A

anything >5mm

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9
Q

Function of maxillary sinus?

A

It’s physiological role is not well understood

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10
Q

Menthol inhalations as a way of opening the ostium for a patient with sinusitis is an example of…

A

mucolytics

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11
Q

After the sinus drains into the nasal cavity, where does it then go?

A

Through the eustachian tube and then down the pharynx

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12
Q

Chronic sinusitis?

A

Something obstructing the ostium, ongoing low-grade symptoms.

Drainage?

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13
Q

What forceps can be used to extract difficult accessing 8s?

A

Bayonets

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14
Q

Which teeth are the easiest to XLA?

A

Periodontally diseased teeth

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15
Q

When would you refer a badly broken down tooth to secondary care for XLA?

A

If tooth is fractured below the alevolus = surgical required.

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16
Q

Resorption that can aid XLA vs that can hinder it?

A

Internal - harder as tooth fractures
External - easier as tooth is less held in the bone

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17
Q

Key risk with extracting lone standing last maxillary molar?

A

Due to experiencing heavy occlusal forces there is a high risk of fracturing tuberosity

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18
Q

Traumatic vs aphthous stomatitis

A
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19
Q

How would you treat oral candidasis?

A

Systemic antifungals

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20
Q

How would you treat cold sores from herpes virus?

A

topical antivirals

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21
Q

Lichenoid reaction causes

A

Metal
Medications (NSAIDS, antihypertensives, hypoglycaemics)

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22
Q

What is an epulis?

A

growth on the gum

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23
Q

What metabolic condition may cause oral pigmentation?

A

Addisons

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24
Q

Lichen planus?

A

Autoimmune inflammatory condition

BIOPSY !

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25
Idiopathic lesions? and an example of one
Unknown aetiology Lipomas (mini fat balls)
26
How many mandibular 8s are impacted %?
72%
27
Ratio of mandibular 8s that fail to develop?
1 in 4 adults
28
Current guidance on removal of third molars
SIGN (scottish specific guidance) was revoked in 2015 So now refer to NICE guidance (2000)
29
Key indications for removal of third molars
Pericoronitis 8-59% unrestorable caries cellulitis/osteomyelitis periodontal disease orthodontic reasons
30
Management of pericoronitis
1. Irrigate with saline and give OHI 2. XLA or grind down opposing tooth cusps 3. antibiotics if pt is systemically unwell 2 or more incidences to warrant XLA typically
31
What are the four different types of impaction?
32
What radiographic features indicate a close relationship with the IDC?
o Diversion or deviation o Darkening of the root – indicate the canal sitting in a groove o Loss of laminate dura o Narrowing Juxta apical area —> highest risk for nerve crushing !!
33
What is the most common to least common type of molar impaction?
Mesial (40%) Vertical (30-38%) Distal (6-15%) Horizontal (3-15%)
34
What can you warn patients about in terms of their risk of transient/permanent numbness after XLA?
Specifically lip (as this will be determined by the individuals radiographic presentation) - short term (5%), long term (1%) Non-specifically tongue (as this cannot be radiographic ally assessed) - short term (10%), long term (1%) Tongue more maybe due to retraction of soft tissues in this area…
35
Coronectomy conditions
o Remove crown and leave the roots o If you mobilise the roots, you MUST remove them. o Not always a great alternative as the roots migrate and can cause patients more problems long term o Technique sensitive (cannot leave any enamel) o ANECDOTAL EVIDENCE !
36
What risks do you need to warn patients of for XLA?
o Pain o Swelling o Bruising o Possible hypoaesthesia of lip/tongue o Trismus o Infection o Bleeding o Surgical (stitches?) - OAC - MT fracture
37
Paraesthesia
Tingling
38
Hypoaesthesia
weakness of sensation (as though LA hasn’t really worn off)
39
Dysesthesia
pain
40
Incidence rate for something to be necessary to warn a patient of?
>5%
41
CBCT and impacted molars?
Won’t change management so not warranted. Only in very specific instances
42
5 points for surgical planning
o Please ask oliver before flying  Path of withdrawal  Application point  Obstacles (extrinsic/intrinsic)  Bone removal  Flap design
43
Describe the flap you would raise for a impacted lower 8
“triangular flap”
44
What is the first bone you’d remove when surgically extracting a lower 8 and how?
Round bur to create a narrow gutter mesiobuccally avoiding adjacent roots (cutting posterior to anterior)
45
Convergent roots
46
divergent roots
47
Which incision of flap is most important?
2nd incison (papillae one)
48
Maxillary 8s surgical extraction
o Thin cortical bone = less complicated o Remove if going for a GA for lower 8s o Don’t always need to use a handpiece as bone is so thin (may just need coupland 2)
49
Second most commonly impacted tooth?
maxillary canines (1.7% incidence)
50
Why do ectopic maxillary canines appear palatally usually?
Tooth germ sits palatally during development
51
Path of eruption for maxillary canine?
LONG 22mm
52
How common can ectopic maxillary canines cause resorption of incisor roots?
12.5%
53
Impacted canines treatment: conservative
 LEAVE  Happy with their situation  No pathology  However having decious teeth aren’t good long term, may aesthetically be disadvantageous in older age  Tooth is very high up radiogrpahically and so wont cause any issues.
54
Impacted canines treatment: interceptive
EXTRACT primary canine but early (10-13 years) 78% of cases will have normal eruption of the permanent successor following this.
55
Impacted canines treatment: exposure and alignment
• open technique o raise a flap, suture the gingivae higher up – not good for aesthetics o Make an acrylic plate “dressing plate” helps with post-op pain with co packs dressing sedative • closed technique o immediately attach a bracket onto the tooth o gold chain then stitch gingave over bracket
56
Impacted canines treatment: surgical removal
large palatal flap The only time NVB is fine to cut through, greater palatine nerves overtime take over = no numbness good for complex morphology canines causing problems (i.e. resorption of incisor roots)
57
Impacted canines treatment: Transplantation
o Rarely done (good with open apex) o >10 mins o High failure rate (30% over 9 years) technique sensitive
58
What genetic conditions are associated with ectopic canines?
Cleft lip and palate, cleidocranial dysplasia
59
Most common causes for delayed incisor eruption?
Trauma (causing dilacerated roots) Supernumerary teeth
60
4th most commonly displaced tooth
mandibular premolars
61
Where are supernumeraries most commonly found?
Palatal in maxilla or premolar/third molar
62
Mesiodens
conical supernumeraries between central incisor
63
What should you be careful of when surgically removing mandibular premolars?
Avoid mental foramen during flap design
64
What are odontomes?
causes; trauma or genetic mutation tumours of tooth tissue (account for 22% of all tooth tumours)
65
Complex odontomes (can’t make much out)
66
Compound odontomes (can make out individual teeth)
67
Towel clips - Used to secure surgical drapes in place during procedures.
68
McKessons Mouth Prop - Keeps the patient's mouth open by providing support between the teeth.
69
Molt No.9 Periosteal Elevator - Used to detach and lift the periosteum (gum tissue) from the bone.
70
Mitchell’s Trimmer - A double-ended instrument for trimming and contouring soft tissue or bone.
71
Howarth’s Nasal Rasp/Periosteal elevator - Elevates the periosteum and smoothens bone surfaces.
72
Minnesota retractor - Holds back the cheek and tongue to provide better visibility and access.
73
Bowdler-Henry Rake Retractor - Used to retract soft tissues during oral surgery.
74
Warwick James - elevators Elevates teeth or roots during extraction procedures.
75
Ficklings Forceps Used to grasp and manipulate tissues or small objects.
76
Spencer Wells Clamps blood vessels to control bleeding during surgery.
77
Rongeurs/Bone Nibbler Trims and removes small pieces of bone.
78
Kilners Cheek Retractor - Retracts the cheek to improve access to the surgical site.
79
Toothed tissue forceps - Used to hold and manipulate tissues and teeth.
80
Scissors McIndoe (top) Iris (bottom)
81
needle holders - Holds suturing needles securely while stitching tissue.
82
Features of a well designed flap
1. Broad base to ensure blood supply 2. Avoid nerves (or include them in the flap) 3. avoid creating small avasular areas 4. Extend 1 unit either side 5. Incision margins supported 6. Include papillae 7.
83
Incision for upper 8s
“slash style”
84
Sequestrum
Necrotic fragments of bone left behind - treat as dry socket
85
DOACs examples and advice for XLA
Apixaban, dabigatran, rivaroxaban… Miss morning does and treat early
86
Vitamin K antagonists examples and advice for XLA
Warfarin (coumarins) Check INR before treatment (no more than 24 hours before) make sure below 4.
87
Antiplatelet drugs examples and advice for XLA
Aspirin, clipidogrel, dipyridamole… Treat as normal
88
Diagnosis for sepsis
INFECTION and TWO OR MORE:  Temp >38 or <36  HR >90  RR > 20  WCC >12 or <4  BP systolic <100
89
Features of a patient with sepsis
o S – slurred speech o E – extreme shivering o P – passing no urine o S – severe breathlessness o I – I feel like I might die o S – skin mottled, ashen, blue or very pale
90
Treatment of sepsis
• The sepsis 6- BUFALO o Oxygen o Blood cultures o IV antivbiotics o Fluid challenge o Measure lactate o Measure urine output

Module 6 Exam (10 decks)

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