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SAQs for dentistry > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

Once you have done injections for a lower first molar how will you test each nerve has been anaesthetised?

A

Probing in the buccal gingival sulcus of the lower first permanent molar to be extracted will test whether the buccal nerve has been anaesthetised
Probing in the lingual gingival sulcus will test whether the lingual nerve has been anaesthetised
As the buccal mucosa anterior to the mental foramen will be anaesthetised in a successful IDB this area can be probed to determine where the inferior dental/alveolar nerve has been successfully anaesthetised. However, care must be taken not to do this too close to the midline because there is crossover supply from fibres on the contralateral side and a false negative result may occur

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2
Q

What alternative techniques could you try if an IDB doesn’t work? (2)

A
  • intraligamentous

- intraosseous injection

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3
Q

Name 2 vital structures you should avoid when carrying out surgical tooth removal in the maxilla and mandible?

A

Maxilla- greater palatine artery, nasopalatine nerves and arteries
Mandible- lingual nerve and mental nerve

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4
Q

What are the principles you should adhere to when designing a mucoperiosteal flap for surgical tooth extraction?

A
  • provide adequate access to surgical site
  • retain a good blood supply to the mucoperiosteal flap, so the base must be broader than the apex, unless the flap includes a decent sized artery within the flap
  • avoid vital structures such as local nerves and blood vessels
  • have their margins placed on sound bone and not over the area where you are removing bone
  • be able to be extended if necessary
  • be able to be closed appropriately at the end of the operation
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5
Q

What functions do sutures perform?

A
  • approximate and hold the wound margins in the appropriate place to enable them to heal. The smaller the space between the 2 margins the quicker the wound will heal.
  • Sutures will help in holding the mucoperiosteal flap over bone, which will reduce the risk of it becoming non vital
  • help haemostasis
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6
Q

Name 2 different sutures that could be used to suture an intraoral wound and an advantage of each

A

Non resorbable:

  • braided- black silk- soft and easy to knot
  • monofilament- prolene- hygienic

Resorbable:

  • braided, polyglactin (vicryl) or polysorb, which is glycoside/lactide co polymer- soft easy to knot, resorbs so patient does not need to have sutures removed
  • monofilament, polyglecaprone 25 (monocryl)- hygienic, reservable but slow resorption
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7
Q

What are bisphosphonates?

A

Bisphosphonates are pyrophosphate analogous that inhibit resorption of bone. Their proposed mechanism of action includes:

  • reduction of bone turnover
  • inhibition of osteoclast activity
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8
Q

In which conditions might a patient be prescribed bisphosphonate medication?

A
  • osteoporosis
  • prevention of skeletal fractures in susceptible individuals
  • pagets disease
  • osteogenesis imperfecta
  • metastatic bone disease
  • multiple myeloma
  • renal cell carcinoma and gastric tumours
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9
Q

Name some local risk factors for MRONJ

A
  • mandibular extractions
  • all dentoalveolar surgery
  • periodontitis, presence of oral abscesses or infection
  • poor OH
  • denture related trauma
  • thin mucosal coverage
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10
Q

If there was a mandibular fracture which radiological views would demonstrate it?

A
  • a dental panoramic radiograph and another view at another angle usually a posterior anterior view of the mandible
  • an alternative would be oblique lateral views of the mandible and PA mandible but the oblique lateral views are often inferior to a panoramic radiograph
  • cone beam computed tomography or standard CT would also provide good information regarding the fracture but is not indicated in simple fractures due to the higher radiation dose relative to dental panoramic radiograph and PA mandible
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11
Q

What is the difference between an alveolar and dento alveolar fracture?

A

A fracture of the alveolar process may or may not involve the alveolar socket
A dento alveolar fracture would involve fracture of the alveolar process and the socket

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12
Q

What features would lead you to suspect that the child has sustained a dento alveolar fracture? (3)

A
  • teeth related to the fractured dento alveolar segment are typically all mobile and move as a unit
  • an occlusal change will often be present due to the displacement of the entire segment
  • the teeth of the affected segment are often tender to percussion
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13
Q

How would you manage a dento alveolar fracture in a child?

A
  1. administer LA
  2. reposition the displaced segment with digital pressure applied both labially and palatally or with forceps if necessary
  3. stabilise the fractured segment for 4 weeks with flexible splinting such as: an acid etch splint with composite with or without wire
    orthodontic brackets on the teeth and splinting with a flexible sectional arch wire
    performed trauma arch wires
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14
Q

What are the signs and symptoms of pericoronitis?

A

Mild- swelling of soft tissue around the crown of the tooth, bad taste, pain
Moderate- lymphadenopathy, trismus, extraoral swelling
Severe- fever, malaise, spreading infection and abscess formation

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15
Q

What does the acronym NICE stand for?

A

National institute for heath and care excellence

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16
Q

What gland does a duct obstruction normally affect?

A

It most commonly affects the submandibular salivary gland because the saliva produced by this gland is a thick mucous type and the duct is long and has an upward course with a bend at the hilium

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17
Q

What investigations would you do for an affected salivary gland? (5)

A
  • bimanual palpitation
  • plain radiography (usually an occlusal view)
  • sialography
  • ultrasound
  • scintiscanning
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18
Q

What features of an ulcer would make you suspect it was malignant? (3)

A
  • indurated
  • rolled edges
  • present on the lateral border of the tongue
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19
Q

Which groups of people are more likely to have oral malignancies? (2)

A

Older adults

Males

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20
Q

What is the most common malignancy of the oral cavity?

A

Squamous cell carcinoma

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21
Q

What treatment is available for squamous cell carcinoma?

A

Surgery:

  • excision and primary closure
  • excision and reconstruction

Radiotherapy:

  • surgery and radiotherapy (and/or chemotherapy) combined
  • photodynamic therapy
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22
Q

What does the term internal derangement of the temporomandibular joint mean?

A

A localised mechanical fault in the joint, which interferes with its smooth action

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23
Q

What might a patient with an internal derangement of the TMJ complain of? (3)

A
  • clicking of the joint
  • locking of the joint
  • pain in the joint
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24
Q

If the internal derangement was unilateral, to which side would the mandible deviate on opening and why?

A

The mandible would deviate towards the side of the internal derangement. This is because the mandible is able to carry out the hinge movement normally, hence the mouth opens (usually about 1cm). Further movement i s usually due to translation of the condyle. If there is an obstruction on one side that condyle will not translate and move forward. The other condyle continues to move in a normal manner and the midline moves towards the static condyle, i.e. that side with internal derangement

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25
Q

If imaging of the TMJ were required, which type would be ideal?

A

Magnetic resonance imaging

26
Q

Which branch of the trigeminal nerve is most frequently affected in trigeminal neuralgia?

A

Mandibular> maxillary> ophthalmic

27
Q

In which sex and what age does trigeminal neuralgia occur most commonly?

A

Female> male

Mid to old age

28
Q

If you had a patient with symptoms of trigeminal neuralgia who did not fit into the common demographic group what other conditions might they have? (2)

A
  • multiple sclerosis

- a central lesion

29
Q

Give 5 features of the pain of trigeminal neuralgia

A
  • paroxysmal
  • trigger area
  • does not disturb sleep
  • excruciating pain
  • shooting
  • sharp, electric shock, burning character
  • short acting
30
Q

Name 2 types of medicine that are effective in trigeminal neuralgia?

A
  • carbamazepine
  • phenytoin
  • gabapentin
  • lamotrigine
  • oxcarbazepine
  • baclofen
31
Q

Trigeminal neuralgia affecting the ID nerve of the mandibular branch of the trigeminal nerve may be treated surgically. What procedures do you know that can be used on the distal aspect of the nerve? (3)

A
  • cryotherapy
  • alcohol injection
  • nerve sectioning
    All the above procedures are done at the point where the nerve enters the mandible at the lingual
32
Q

Less commonly neuralgia may affect another cranial nerve and patients may present with pain to their dentist. Which nerve is involved?

A

Glossopharyngeal nerve

33
Q

What do you understand by the term dry socket?

A

It is the localised osteitis that occurs in the socket following removal of the tooth

34
Q

Give 5 factors that would predispose a patient to getting a dry socket?

A
  • smoking
  • oral contraceptives
  • difficult extractions
  • mandibular extractions
  • posterior extractions
  • single extractions
  • immunosuppression
  • bony pathology
35
Q

How soon after extraction does the pain from a dry socket usually start?

A

2-3 days after extraction

36
Q

What are the steps in the management of a dry socket? (5)

A
  • reassurance and explanation
  • give analgesics
  • debride the socket with chlorohexidine or warm salty water
  • gentle pack the socket with dressing e.g alvogyl
  • review if necessary
37
Q

What are the common signs and symptoms of undisplayed unilateral fractured mandibular condyle?

A

Pain on mandibular movements but no occlusal alteration

38
Q

What are the common signs and symptoms of an orbital blow out fracture?

A

Limited eye movements especially when trying to look upwards

39
Q

What are the common signs and symptoms of bilateral displaced fractured condyles?

A

Anterior open bite

40
Q

What are the common signs and symptoms from a le fort III fracture?

A

CSF leak from the nose

41
Q

What are the common signs and symptoms for a fractured zygomatic arch?

A

Trismus

42
Q

What are the common signs and symptoms for a fractured zygoma?

A

Anaesthesia/ paraesthesia of the infraorbital nerve

43
Q

What are the common signs and symptoms of a fracture of the angle of the mandible?

A

Anaesthesia/ paraesthesia of the inferior dental nerve

44
Q

What are the common signs and symptoms of a dislocated mandible?

A

Limited mandibular movement possible, but inability to occlude or open wide. The patient appears to have a class III malocclusion with hollowing of the TMJ area

45
Q

What do you understand by the term orbital blow out? Which part of the orbit is most likely to fracture and why?

A

Orbital blow out means that the rim of the orbit is intact but some part of the bony orbital wall has been fractured. Usually the floor of the medial wall fractures as the bone is thinnest in these regions

46
Q

What medication do you give for prevention of post surgical bleeding?

A

Tranexamic acid mouthwash three times daily for 5 days

47
Q

Name 4 local measures that can be used to control post surgical bleeding

A
  • apply pressure
  • administer local anaesthetic with vasoconstrictor
  • pack with haemostatic dressing e.g. surgical
  • suture
  • bone wax
  • biting on a swab with tranexamic acid, tranexamic acid mouthwashes
  • acrylic suck down splint
48
Q

What are the stages of managing a fractured mandible that needs active treatment? (4)

A
  • reduction
  • fixation
  • immobilisation
  • rehabilitation
49
Q

The most common mode of treatment of fractures of the mandible nowadays involves the use of mini bone plates across the fracture site. Why it inter maxillary fixation often done along with this?

A

Inter maxillary fixation is done to recreate the patients original occlusion whilst the fractured bone ends are fixed together. The IMF also allows extra traction applied after the operation is needed

50
Q

Give 3 complications of fractures of the mandible

A
  • non union
  • malunion
  • infection
  • malocclusion
  • nerve damage
51
Q

What term is used to describe a fracture that involves both condyles and the symphyseal region, and what is the characteristic mechanism of injury?

A

Guardsman fracture- it is thought to occur when a patient falls on their chin or suffers a blow to the chin

52
Q

What signs and symptoms would make you suspect that you created an oroantral communication following the extraction of an upper first permanent molar? (3)

A
  • a visible defect or antral mucosa visible on careful examination of socket
  • hollow sound when suction used in socket
  • bone with smooth concave upper surface between the roots of the extracted tooth
53
Q

If a root has been pushed into the antrum how can a surgeon gain access to remove the root once the socket has healed?

A

By raising a flap in the buccal sulcus in the region of the upper canine/ premolars and removing bone- known as caldwell luc procedure

54
Q

What is bells palsy and what is treatment for it?

A

Bells palsy is paralysis of facial nerve which results in a facial palsy. It may be caused by a viral infection particularly herpes simplex. Treatment involves a short course of prednisolone as well as acyclovir

55
Q

How would you test the function of the nerve involved in bells palsy? (4)

A
  • ask the patient to close the eyes
  • ask the patient to smile
  • ask the patient to purse the lips
  • ask the patient to wrinkle the forehead
56
Q

For a mandibular third molar what sites/spaces does infection normally spread? (5)

A
  • sublingual
  • submandibular
  • submasserteric
  • lateral pharyngeal
  • retropharyngeal
57
Q

What are the boundaries of the submandibular space?(3)

A

Laterally- mandible below the mylohyoid line
Medially- mylohyoid muscle
Inferiorly- deep cervical fascia and overlying platysma and skin

58
Q

If a patient with an intramural tumour is staged as T2 N1 MO what does this mean?

A

The patient has a tumour 2-4cm in size, with a single ipsilateral lymph node less than 3cm in diameter and no metastases. This patient has stage 3 disease

59
Q

What does Mx mean?

A

Distant metastasise cannot be assessed

60
Q

Lesions may be treated by using a graft or a flap- what do you understand by these terms?

A

A graft is a piece of tissue that is transferred by complete separation and gains a new blood supply by ingrowth of new blood vessels. A flap has its own blood supply. They can be “pedicled” i.e. there original blood supply used or “free” i.e. they have to be replumbed into the blood supply at the recipient site

SAQs for dentistry (4 decks)

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