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NBDE 2 > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

Mandibular Fractures from least common to most

A 
Coronoid process 1%
Ramus 2%
Alveolar Process 3%
Body 16%
Symphysis 22%
Angle 24%
Condyle 29%
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2
Q

Impacted tooth

A

one that fails to erupt in the expected window of time

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3
Q

unerupted tooth

A

impacted teeth, and those in the process of erupting

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4
Q

Impacted third molar difficulty based on angulation impaction from easiest to most difficult

A

Mesioangular (easiest)
Horizontal
Vertical
Distoangular (hardest)

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5
Q

3rd molar impaction classifications

1, 2, 3, A, B, C

A 
1 = completely outside of the ramus
2 = less than 1/2 in the ramus
3 = more than 1/2 in ramus
A = at occlusal plane 
B = above CEJ, below occlusal plane
C = below CEJ
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6
Q

Treatment for torn flap

A

repair the tear

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7
Q

treatment for puncture wound

A

leave the puncture open

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8
Q

ORIF

A

open reduction internal fixation
lay a flap, position fracture, and screw into place
used for fractures that are mobile and teeth are repositioned

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9
Q

CR-MMF

A

closed reduction maxillo-mandibular fixation

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10
Q

Le fort 1 fracture

A

horizontal fracture of the maxilla at the level of nasal fossa

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11
Q

le fort 2 fracture

A

pyramidal fracture of the maxilla, including nasal bones and the medial orbit

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12
Q

le fort 3 fracture

A

fracture through the maxilla, zygoma, nasal bones, orbit, ethmoid, base of skull

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13
Q

what is apertognathia

A

anterior open bite

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14
Q

macrogenia

A

large chin

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15
Q

how is trigeminal neuralgia treated

A

anticonvulsant drugs and microvascular decompression

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16
Q

how is odontalgia treated

A

endo or EXT

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17
Q

how is post herpetic neuralgia treated

A

anticonvulsants and antidepressants

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18
Q

features of tension headaches

A

squeezing
non-throbbing
mild-moderate severity

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19
Q

features of cluster headaches

A

associated with agitation

episodic, localized, retro-orbital pain, ipsilateral lacrimation and ptosis

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20
Q

features of temporal arteritis

A

squeezing refractory pain, jaw caludication, visual disturbance
C-reactive proteins
high ESR (erythrocyte sedimentation rate)

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21
Q

Arterial Dissection features

A

neck pain +- cerebral ischemia

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22
Q

encephalitis/meningitis features

A

diffused generalized headache
confusion
fever
nuchal rigidity (can flex neck)

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23
Q

Cerebral hemorrhages features

A

abrubt severe headache
focal persistant neurological deficit
+- nausea and vomiting

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24
Q

Subarachnoid hemorraghes features

A

sudden explosive headache
nuchal rigidity
+- focal neurological deficit
+- nausea and vomiting

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25
Q

post herpetic neuralgia features

A

severe localized burning pain that conforms to dermatomal pattern
rash or skin discoloration

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26
Q

reversible cerebral vasoconstriction features

A

mostly in females
history of migranes, pregnancy, or vasoactive drugs
sudden onset, severe and recurrent headaches
nausea, vomiting, photophobia, confusion, visual blurring
exacerbated by valsalva

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27
Q

Inoculation phase of odontogenic infection

A

first 3 days of symptoms

soft, mildly tender, doughy swelling

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28
Q

Cellulitis phase of odontogenic infectino

A

after 3-5 days

swelling becomes hard, red, indurated, and acutely tender

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29
Q

Abscess stage of odontogenic infection

A

after 5-7 days
anaerobes dominante
liquefied abscess in the center of the swollen area

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30
Q

Resolution stage of odontogenic infection

A

abscess drains spontaneously or surgically drained though the skin or mucosa
immune system takes over, healing begins

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31
Q

Treatment principles for odontogenic infection

A
  1. determine severity of infection
  2. Evaluate the patients defense mechanism
  3. Should I refer?
  4. Surgical Treatment (drain and remove cause)
  5. support the patient medically
  6. Choose appropriate antibiotic
  7. Post operative evaluation and assessment
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32
Q

drain in the inoculation stage? cellulitis stage? abscess stage?

A

inoculation typically not
can’t usually in cellulitis stage
always in abscess stage

33
Q

Which portion of the TMJ tissues are most highly vascularized and innervated

A

retrodiscal tissues

34
Q

What types of bacteria are commonly involved in odontogenic infectinos

A

aerobic gram positive cocci
anaerobic gram positive cocci
anaerobic gram negative rods

35
Q

What is the predominant group of aerobic bacteria involved in odontogenic infections

A

Strep Viridans
S. anginosus
S. Intermedius
S. constellatus

36
Q

What is the predominant group of anaerobic gram positive cocci found in odontogenic infections (65%)

A

Streptococcus and Peptostreptococcus

37
Q

What is the predominant group of anaerobic gram negative rods found in odontogenic infections (75%)

A

Prevotella
Porphyromonas
Fusobacterium

38
Q

What is the first thing you do before you treat any infection

A

collect a sample of the specimen by inserting a large needle (18 gauge) into the infection.
(if it’s full of blood don’t continue)
place sample on aerobic and anaerobic culturettes and request a gram stain, aerobic and anaerobic cultures, and antibiotic sensitivity testing

39
Q

What are the indications for antibiotic use when treating infectinos

A
  1. swelling beyond the alveolar process and deep into fascial spaces
  2. cellulitis
  3. trismus
  4. lymphadenopathy
  5. Temperature >101
  6. Severe pericornitis
  7. Osteomyelitis
40
Q

What antibiotics are useful for odontogenic infectinos

A 
penicillin
amoxicillin
clindamycin
azithromycin
metronidazole
41
Q

what is different about metronidazole than the other antibiotics typically used in treating odontogenic infections

A

metronidazole is only for abligate anaerobes

42
Q

what is the typical amount of time between treatment of an odontogenic infection and follow up appointments

A

2-3 days

43
Q

Define the sublingual space vs. submandibular space

A

sublingual space is superior to the mylohyoid muscle and inferior to the epithelium of the floor of the mouth
submandibular space is inferior to the mylohyoid muscle and superior to the platysma

44
Q

What is osteomyelitis

A

inflammation of the medullary part of the bone

45
Q

is osteomyelitis more common in the mandible than the maxilla

A

yes, due to relative differences in blood supply

46
Q

how is osteomyelitis treated

A

antibiotics or surgery (debridement or resection)

47
Q

What are bisphosphonates used to treat

A 
IV: 
multiple myeloma
pagets disease 
and metastatic diseases
Oral: used to treat osteoporosis
48
Q

how do bisphosphonates work

A

they inhibit osteoclastic activity = decreased bone resorption

49
Q

how is MRONJ diagnosed

A

non-healing bony exposure in jaws for at least 8 weeks with current or former bisphosphonate use
without history of radiation to the jaw

50
Q

before beginning bisphosphonate use, what should a dentist tdo for their patients

A

plan any procedures involving bone prior to them beginning therapy
EXT, tori removal, alveoplasty

51
Q

What is stage 1 MRONJ and how is it treated

A

exposed and necrotic bone or fistula that probes to bone. no evidence of infection
antibacterial mouth rinse, 3 month follow up, pt education

52
Q

what is stage 2 MRONJ and how is it treated

A

exposed and necrotic bone or fistula that probes to bone. with signs of infection (pain, redness, pus)
Systemic treatment with oral antibiotics, antibacterial mouth rinse, pain control, debridement

53
Q

What is stage 3 MRONJ and how is it treated

A

exposed and necrotic bone or fistula that probes to bone. with signs of infection (pain, redness, pus) with one of the following: exposed bone beyond alveolus, pathologic fracture, extra-oral fistula, oral/antral/nasal communication
antibiotic therapy, pain control, antibiotic mouth rinse, surgical debridement/ressection

54
Q

What is a cytology biospy and how is it done

A

a cytology brush is rotated on the lesion 5-10 times to obtain cells from all 3 epithelial layers. the cells are transferred to a slide and fixed.
results are negative/positive/atypical
more biopsy for positive/atypical

55
Q

When are incisional biospies performed

A 
lesions:
 > than 1 cm
polymorphic
suspicous for malignancy
anatomical area with high morbitiy
56
Q

when are excisional biopsies performed

A 
lesions:
< 1 cm
vascular lesions
pigmented lesions
remove lesions and uninvolved tissues
57
Q

hard tissue biopsy steps

A
  1. aspirate (vascular consider arteriogram)
  2. FTMPF over sound bone
  3. avoid neurovascular structures
  4. 1mm of osseous tissue around lesion curetted
58
Q

fissural cyst vs. odontogenic cyst

A

fissural - derived from epithelial remnants trapped along fusion lines
odontogenic cysts - form from tooth development tissues

59
Q

Cyst treatment options

A

enucleation - removal of the mass, or structure
marsupialization - opening the cyst and suturing it open
Enucleation and currettage - enucleate and curette the wall of the cavity

60
Q

What are the most common malignancies in the mouth

A

epidermoid carcinomas (squamous cell)

61
Q

What is critical length in local anesthesia

A

three nodes of ranvier need to be blocked to achieve complete anesthesia

62
Q

What is the order in which sensations dissapear and reappear with local anesthesia

A

pain
temperature
touch
pressure

63
Q

what does increased blood supply to an area do to local anesthetic

A

decreases the duration of action

64
Q

why does marcaine (bupivicaine) have a long duration of action

A

it has high protein binding characteristics

65
Q

what affects an anesthetics duration of action

A

lipid solubility, protein binding

66
Q

what is the effect of pKa on local anesthetics

A

lower pKa (closes to physiologic ph 7.4) means faster onset

67
Q

what are the signs of mild to moderate toxicity to LA

A

talkative
apprehension
excitability

slurred speech
dizziness
disorientation

68
Q

what are the signs of severe LA toxicity

A

seizures
coma
respiratory depression
death

69
Q

before 1985 what were most allergies to LA from

A

methylparaben (preservative)

70
Q

what is the metabisulfite in LA for

A

antioxidant present with vasoconstrictors

71
Q

what anesthetic is likely to cause methemoglobemia

A

prilocaine >600 mg for 70 kg adult

second is septocaine

72
Q

what is the most potent local anesthetic

A

bupivicaine (marcaine)

73
Q

what are the least potent local anesthetics

A

Prilocaine and Septocaine

74
Q

Septocaine 4% (articaine)

A

ester and amide combo
Metabolized in blood and liver
pKa = 7.7
MRD = 7 mg/kg

75
Q

Bupivicaine .5% marcaine

A

amide
metabolized in the liver
pka = 8.1
MRD = 90 total

76
Q

Lidocaine 2% (Xylocaine)

A

amide
metabolized by liver
pka = 7.7
MRD = 7mg/kg and 500 total

77
Q

Mepivicaine 3% carbocaine

A

amide
metabolized by liver
pka = 7.6
MRD = 6.6 mg/kg and 400 total

78
Q

Prilocaine 4%

A

amide
metabolized by the liver
pka = 7.8
MRD = 8mg/kg and 600 total

79
Q

what percentage of broken needles are 30 guage

A

97%

NBDE 2 (6 decks)

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