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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
Q

Idiopathic lesions? and an example of one

A

Unknown aetiology

Lipomas (mini fat balls)

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26
Q

How many mandibular 8s are impacted %?

A

72%

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27
Q

Ratio of mandibular 8s that fail to develop?

A

1 in 4 adults

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28
Q

Current guidance on removal of third molars

A

SIGN (scottish specific guidance) was revoked in 2015

So now refer to NICE guidance (2000)

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29
Q

Key indications for removal of third molars

A

Pericoronitis 8-59%
unrestorable caries
cellulitis/osteomyelitis
periodontal disease
orthodontic reasons

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30
Q

Management of pericoronitis

A
  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

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31
Q

What are the four different types of impaction?

A
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32
Q

What radiographic features indicate a close relationship with the IDC?

A

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 !!

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33
Q

What is the most common to least common type of molar impaction?

A

Mesial (40%)
Vertical (30-38%)
Distal (6-15%)
Horizontal (3-15%)

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34
Q

What can you warn patients about in terms of their risk of transient/permanent numbness after XLA?

A

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…

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35
Q

Coronectomy conditions

A

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 !

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36
Q

What risks do you need to warn patients of for XLA?

A

o Pain
o Swelling
o Bruising
o Possible hypoaesthesia of lip/tongue
o Trismus
o Infection
o Bleeding
o Surgical (stitches?)

  • OAC
  • MT fracture
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37
Q

Paraesthesia

A

Tingling

38
Q

Hypoaesthesia

A

weakness of sensation (as though LA hasn’t really worn off)

39
Q

Dysesthesia

A

pain

40
Q

Incidence rate for something to be necessary to warn a patient of?

A

> 5%

41
Q

CBCT and impacted molars?

A

Won’t change management so not warranted.

Only in very specific instances

42
Q

5 points for surgical planning

A

o Please ask oliver before flying
 Path of withdrawal
 Application point
 Obstacles (extrinsic/intrinsic)
 Bone removal
 Flap design

43
Q

Describe the flap you would raise for a impacted lower 8

A

“triangular flap”

44
Q

What is the first bone you’d remove when surgically extracting a lower 8 and how?

A

Round bur to create a narrow gutter mesiobuccally avoiding adjacent roots (cutting posterior to anterior)

45
Q
A

Convergent roots

46
Q
A

divergent roots

47
Q

Which incision of flap is most important?

A

2nd incison (papillae one)

48
Q

Maxillary 8s surgical extraction

A

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
Q

Second most commonly impacted tooth?

A

maxillary canines (1.7% incidence)

50
Q

Why do ectopic maxillary canines appear palatally usually?

A

Tooth germ sits palatally during development

51
Q

Path of eruption for maxillary canine?

A

LONG 22mm

52
Q

How common can ectopic maxillary canines cause resorption of incisor roots?

A

12.5%

53
Q

Impacted canines treatment: conservative

A

 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
Q

Impacted canines treatment: interceptive

A

EXTRACT primary canine but early (10-13 years)

78% of cases will have normal eruption of the permanent successor following this.

55
Q

Impacted canines treatment: exposure and alignment

A

• 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
Q

Impacted canines treatment: surgical removal

A

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
Q

Impacted canines treatment: Transplantation

A

o Rarely done (good with open apex)
o >10 mins
o High failure rate (30% over 9 years)

technique sensitive

58
Q

What genetic conditions are associated with ectopic canines?

A

Cleft lip and palate, cleidocranial dysplasia

59
Q

Most common causes for delayed incisor eruption?

A

Trauma (causing dilacerated roots)
Supernumerary teeth

60
Q

4th most commonly displaced tooth

A

mandibular premolars

61
Q

Where are supernumeraries most commonly found?

A

Palatal in maxilla or premolar/third molar

62
Q

Mesiodens

A

conical supernumeraries between central incisor

63
Q

What should you be careful of when surgically removing mandibular premolars?

A

Avoid mental foramen during flap design

64
Q

What are odontomes?

A

causes; trauma or genetic mutation

tumours of tooth tissue (account for 22% of all tooth tumours)

65
Q
A

Complex odontomes (can’t make much out)

66
Q
A

Compound odontomes (can make out individual teeth)

67
Q
A

Towel clips - Used to secure surgical drapes in place during procedures.

68
Q
A

McKessons Mouth Prop - Keeps the patient’s mouth open by providing support between the teeth.

69
Q
A

Molt No.9 Periosteal Elevator - Used to detach and lift the periosteum (gum tissue) from the bone.

70
Q
A

Mitchell’s Trimmer - A double-ended instrument for trimming and contouring soft tissue or bone.

71
Q
A

Howarth’s Nasal Rasp/Periosteal elevator - Elevates the periosteum and smoothens bone surfaces.

72
Q
A

Minnesota retractor - Holds back the cheek and tongue to provide better visibility and access.

73
Q
A

Bowdler-Henry Rake Retractor - Used to retract soft tissues during oral surgery.

74
Q
A

Warwick James - elevators Elevates teeth or roots during extraction procedures.

75
Q
A

Ficklings Forceps Used to grasp and manipulate tissues or small objects.

76
Q
A

Spencer Wells Clamps blood vessels to control bleeding during surgery.

77
Q
A

Rongeurs/Bone Nibbler Trims and removes small pieces of bone.

78
Q
A

Kilners Cheek Retractor - Retracts the cheek to improve access to the surgical site.

79
Q
A

Toothed tissue forceps - Used to hold and manipulate tissues and teeth.

80
Q
A

Scissors

McIndoe (top)
Iris (bottom)

81
Q
A

needle holders - Holds suturing needles securely while stitching tissue.

82
Q

Features of a well designed flap

A
  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
Q

Incision for upper 8s

A

“slash style”

84
Q

Sequestrum

A

Necrotic fragments of bone left behind - treat as dry socket

85
Q

DOACs examples and advice for XLA

A

Apixaban, dabigatran, rivaroxaban…

Miss morning does and treat early

86
Q

Vitamin K antagonists examples and advice for XLA

A

Warfarin (coumarins)

Check INR before treatment (no more than 24 hours before) make sure below 4.

87
Q

Antiplatelet drugs examples and advice for XLA

A

Aspirin, clipidogrel, dipyridamole…

Treat as normal

88
Q

Diagnosis for sepsis

A

INFECTION
and
TWO OR MORE:
 Temp >38 or <36
 HR >90
 RR > 20
 WCC >12 or <4
 BP systolic <100

89
Q

Features of a patient with sepsis

A

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
Q

Treatment of sepsis

A

• 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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