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%
2
Q
Impacted tooth
A
one that fails to erupt in the expected window of time
3
Q
unerupted tooth
A
impacted teeth, and those in the process of erupting
4
Q
Impacted third molar difficulty based on angulation impaction from easiest to most difficult
A
Mesioangular (easiest)
Horizontal
Vertical
Distoangular (hardest)
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
6
Q
Treatment for torn flap
A
repair the tear
7
Q
treatment for puncture wound
A
leave the puncture open
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
9
Q
CR-MMF
A
closed reduction maxillo-mandibular fixation
10
Q
Le fort 1 fracture
A
horizontal fracture of the maxilla at the level of nasal fossa
11
Q
le fort 2 fracture
A
pyramidal fracture of the maxilla, including nasal bones and the medial orbit
12
Q
le fort 3 fracture
A
fracture through the maxilla, zygoma, nasal bones, orbit, ethmoid, base of skull
13
Q
what is apertognathia
A
anterior open bite
14
Q
macrogenia
A
large chin
15
Q
how is trigeminal neuralgia treated
A
anticonvulsant drugs and microvascular decompression
16
Q
how is odontalgia treated
A
endo or EXT
17
Q
how is post herpetic neuralgia treated
A
anticonvulsants and antidepressants
18
Q
features of tension headaches
A
squeezing
non-throbbing
mild-moderate severity
19
Q
features of cluster headaches
A
associated with agitation
episodic, localized, retro-orbital pain, ipsilateral lacrimation and ptosis
20
Q
features of temporal arteritis
A
squeezing refractory pain, jaw caludication, visual disturbance
C-reactive proteins
high ESR (erythrocyte sedimentation rate)
21
Q
Arterial Dissection features
A
neck pain +- cerebral ischemia
22
Q
encephalitis/meningitis features
A
diffused generalized headache
confusion
fever
nuchal rigidity (can flex neck)
23
Q
Cerebral hemorrhages features
A
abrubt severe headache
focal persistant neurological deficit
+- nausea and vomiting
24
Q
Subarachnoid hemorraghes features
A
sudden explosive headache
nuchal rigidity
+- focal neurological deficit
+- nausea and vomiting
25
post herpetic neuralgia features
severe localized burning pain that conforms to dermatomal pattern
rash or skin discoloration
26
reversible cerebral vasoconstriction features
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
27
Inoculation phase of odontogenic infection
first 3 days of symptoms
| soft, mildly tender, doughy swelling
28
Cellulitis phase of odontogenic infectino
after 3-5 days
| swelling becomes hard, red, indurated, and acutely tender
29
Abscess stage of odontogenic infection
after 5-7 days
anaerobes dominante
liquefied abscess in the center of the swollen area
30
Resolution stage of odontogenic infection
abscess drains spontaneously or surgically drained though the skin or mucosa
immune system takes over, healing begins
31
Treatment principles for odontogenic infection
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
32
drain in the inoculation stage? cellulitis stage? abscess stage?
inoculation typically not
can't usually in cellulitis stage
always in abscess stage
33
Which portion of the TMJ tissues are most highly vascularized and innervated
retrodiscal tissues
34
What types of bacteria are commonly involved in odontogenic infectinos
aerobic gram positive cocci
anaerobic gram positive cocci
anaerobic gram negative rods
35
What is the predominant group of aerobic bacteria involved in odontogenic infections
Strep Viridans
S. anginosus
S. Intermedius
S. constellatus
36
What is the predominant group of anaerobic gram positive cocci found in odontogenic infections (65%)
Streptococcus and Peptostreptococcus
37
What is the predominant group of anaerobic gram negative rods found in odontogenic infections (75%)
Prevotella
Porphyromonas
Fusobacterium
38
What is the first thing you do before you treat any infection
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
What are the indications for antibiotic use when treating infectinos
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
What antibiotics are useful for odontogenic infectinos
```
penicillin
amoxicillin
clindamycin
azithromycin
metronidazole
```
41
what is different about metronidazole than the other antibiotics typically used in treating odontogenic infections
metronidazole is only for abligate anaerobes
42
what is the typical amount of time between treatment of an odontogenic infection and follow up appointments
2-3 days
43
Define the sublingual space vs. submandibular space
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
What is osteomyelitis
inflammation of the medullary part of the bone
45
is osteomyelitis more common in the mandible than the maxilla
yes, due to relative differences in blood supply
46
how is osteomyelitis treated
antibiotics or surgery (debridement or resection)
47
What are bisphosphonates used to treat
```
IV:
multiple myeloma
pagets disease
and metastatic diseases
Oral: used to treat osteoporosis
```
48
how do bisphosphonates work
they inhibit osteoclastic activity = decreased bone resorption
49
how is MRONJ diagnosed
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
before beginning bisphosphonate use, what should a dentist tdo for their patients
plan any procedures involving bone prior to them beginning therapy
EXT, tori removal, alveoplasty
51
What is stage 1 MRONJ and how is it treated
exposed and necrotic bone or fistula that probes to bone. no evidence of infection
antibacterial mouth rinse, 3 month follow up, pt education
52
what is stage 2 MRONJ and how is it treated
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
What is stage 3 MRONJ and how is it treated
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
What is a cytology biospy and how is it done
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
When are incisional biospies performed
```
lesions:
> than 1 cm
polymorphic
suspicous for malignancy
anatomical area with high morbitiy
```
56
when are excisional biopsies performed
```
lesions:
< 1 cm
vascular lesions
pigmented lesions
remove lesions and uninvolved tissues
```
57
hard tissue biopsy steps
1. aspirate (vascular consider arteriogram)
2. FTMPF over sound bone
3. avoid neurovascular structures
4. 1mm of osseous tissue around lesion curetted
58
fissural cyst vs. odontogenic cyst
fissural - derived from epithelial remnants trapped along fusion lines
odontogenic cysts - form from tooth development tissues
59
Cyst treatment options
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
What are the most common malignancies in the mouth
epidermoid carcinomas (squamous cell)
61
What is critical length in local anesthesia
three nodes of ranvier need to be blocked to achieve complete anesthesia
62
What is the order in which sensations dissapear and reappear with local anesthesia
pain
temperature
touch
pressure
63
what does increased blood supply to an area do to local anesthetic
decreases the duration of action
64
why does marcaine (bupivicaine) have a long duration of action
it has high protein binding characteristics
65
what affects an anesthetics duration of action
lipid solubility, protein binding
66
what is the effect of pKa on local anesthetics
lower pKa (closes to physiologic ph 7.4) means faster onset
67
what are the signs of mild to moderate toxicity to LA
talkative
apprehension
excitability
slurred speech
dizziness
disorientation
68
what are the signs of severe LA toxicity
seizures
coma
respiratory depression
death
69
before 1985 what were most allergies to LA from
methylparaben (preservative)
70
what is the metabisulfite in LA for
antioxidant present with vasoconstrictors
71
what anesthetic is likely to cause methemoglobemia
prilocaine >600 mg for 70 kg adult
| second is septocaine
72
what is the most potent local anesthetic
bupivicaine (marcaine)
73
what are the least potent local anesthetics
Prilocaine and Septocaine
74
Septocaine 4% (articaine)
ester and amide combo
Metabolized in blood and liver
pKa = 7.7
MRD = 7 mg/kg
75
Bupivicaine .5% marcaine
amide
metabolized in the liver
pka = 8.1
MRD = 90 total
76
Lidocaine 2% (Xylocaine)
amide
metabolized by liver
pka = 7.7
MRD = 7mg/kg and 500 total
77
Mepivicaine 3% carbocaine
amide
metabolized by liver
pka = 7.6
MRD = 6.6 mg/kg and 400 total
78
Prilocaine 4%
amide
metabolized by the liver
pka = 7.8
MRD = 8mg/kg and 600 total
79
what percentage of broken needles are 30 guage
97%
