Oral Surgery

Question 1

Osteoradionecrosis has the highest incident rate within the first ___ years of radiotherapy. What is the % rate?

Answer 1

• first 3 years

- 70%

Question 2

which jaw has the higher risk of ORN? give 2 reasons why

Answer 2

mandible
less vascular
denser bone

Question 3

what are the 5 conservative Tx for ORN?

Answer 3

antiseptic MW
antibiotic 
hyperbaric oxygen therapy
ultrasonic therapy 
sequestrectomy

Question 4

what is the Marx’s classification? (3)

Answer 4

severity of ORN
has 3 stages
based on response to hyperbaric oxygen therapy

Question 5

what is the newest classification for ORN severity? (3)

Answer 5

Notani (in 2002)
has 3 stages
based on radiographic and clinical findings

Question 6

What bacteria causes actinomycosis ?

Answer 6

Actinomyce isrealii

Question 7

What antibiotic is effective against actinomycosis? (2)

Answer 7

Penicillin

Doxycycline (if penicillin allergy)

Question 8

according to NICE guidelines, what conditions constitutes an urgent referral for oral cancer? (7)

Answer 8

unexplained ____ lesion for >3 weeks

• red and white patch
• ulceration or mass
• tooth mobility
• horseness
• lump in neck
• pain in head/neck associated with otalgia (ear ache)
• persistent swelling of parotid or submandibular gland

Question 9

what are the post XLA socket healing stages? (3)

Answer 9

0-3 weeks - inflammation
3-4 weeks - proliferation
6-8 weeks - remodelling

Question 10

flap design rules (7)

Answer 10

Maximise blood supply
o broad base
o oblique/curved relieving incisions
o avoid prolonged retraction

• Avoid overtense sutures
• Avoid damage to nerves
• Support margins on bone
• Larger rather than smaller (one unit anterior and one unit posteriorly)

Question 11

what is

• Lignocaine
• Septocaine
• Scandonest
• Citanest

Answer 11

2% lidocaine
septocaine - 4% articaine

scandonest 2% mepivicaine

citanest - 2.5% prilocaine

Question 12

flap designs

- types (6)

Answer 12

• trapezoid
• triangular
• envelope
• Y-shaped (for palatal exotoses)
• semilunar (Caldwell-Luc)
• pedicle

Question 13

suture material

• types (2)
• examples (4)

Answer 13

resorbable
- collagen, vicryl

non-resorbable
- silk, nylon, prolene, titanium

Question 14

what flap is made to manage OAC?

Answer 14

pedicle flap

• buccal advacement
• palatal rotational flap

Question 15

signs of roots of 8s close to IDC? (6)

Answer 15

IDC canal

• diversion
• darkening
• narrowing
• loss of lamina dura
• Deflection of root of lower 8s as they approach IDC
• Interruption of juxta apical area

Question 16

bone grafts

- types (3)

Answer 16

• autogenous (self)
• xenograft (dif species)
• allograft (same species)

Question 17

where are autogenous grafts taken from? (4)

Answer 17

ramus
chin (symphysis)
tuberosity
hip

Question 18

histology shows __, what is the diagnosis?

• outer basal cell layer is comprised of elongated palisaded cells with reversed nuclear polarity
• towards basement membrane, overall appearance looks like piano keys
• above basal cell layer, is a zone of very loosely packed stellate cells with large spaces between them

Answer 18

ameloblastoma

elongated cells resemble pre-ameloblast
loose cells resemble stellate reticulum

Question 19

what is the Tx for ameloblastoma?

Answer 19

excision with 1cm margin of normal bone

Question 20

what is TNM? (3)

Answer 20

assessing cancer stage

TNM

• Tumour size
• Lymph node involvement
• Metastasis

Question 21

How is T in TNM graded? (4)

Answer 21

(in max diameter)
T1 - <2cm 
T2 - 2-4cm 
T3 - >4cm
T4 - extends to involve other structures (ie mandible or skin)

Question 22

how is cancer prognosis assessed? (2)

Answer 22

• stage (TNM)

- grade (histology)

Question 23

How is N in TNM graded? (5)

Answer 23

N0 - no lymph node involvement

(in single ipsilateral node ___ max diameter)
N1 - <3cm
N2a - 3-6cm

N2b - multiple ipsilateral node, not more than 6cm

N2c - bilateral or contralateral node <6cm

N3 - >6cm

Question 24

How is M in TNM graded? (2)

Answer 24

M0 - none

M1 - distant metastasis

Question 25

what constitutes stage 4 in cancer assessment? (4)

Answer 25

T4
N2, N3
M1

Question 26

what histological features indicate oral dysplasia? (5)

Answer 26

• cellular atypia (pleomorphism)
• lost of stratification of epithelial layer
• basal cell hyperplasia (“tear drop” rete ridges)
• hyperkeratosis
• acanthosis

Question 27

what are the branches of the facial nerve? (5)

Answer 27

TZBMC

• temporal
• zygomatic
• buccal
• marginal mandibular
• cervical

Question 28

facial nerve innervates? (2)

Answer 28

• muscles of facial expression (motor)

- anterior 2/3 of tongue (taste) via chorda tympani