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Tim's Cards > Oral Surgery III - The Whole Enchilada > Flashcards

Oral Surgery III - The Whole Enchilada Flashcards

1
Q

Fluid in or under the epithelium; a large blister

A

Bulla

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2
Q

Dried or clotted serum protein on surface of skin or mucosa

A

Crust

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3
Q

a superficial ulcer or excoriation

A

Erosion

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4
Q

A circumscribed area of color change without elevation

A

Macule

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5
Q

A large palpable mass, elevated above the epithelial surface

A

Nodule

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6
Q

A small palpable mass, elevated above the epithelial surface

A

Papule

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7
Q

A flat but elevated lesion

A

Plaque

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8
Q

A cloudy or white vesicle filled with pus

A

Pustule

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9
Q

A macroscopic accumulation of keratin

A

Scale

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10
Q

A loss of epithelium

A

Ulcer

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11
Q

A small loculation of fluid in or under the epithelium; a small blister

A

Vesicle

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12
Q

Any lesion that persists for _____ weeks with no apparent etiologic basis is a _________

A

2 weeks

Indication for biopsy

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13
Q

Any inflammatory lesion that does not respond to local Tx with _____ days is basis for a Biopsy

A

10-14 days

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14
Q

Persistent ______ changes in superficial tissue is an indication for Biopsy

A

hyperkeratotic

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15
Q

Any persistent _________ is an indication for Biopsy

A

tumescence (swelling)

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16
Q

________ Inflammatory changes of _______ is an indication for Biopsy

A

Persistent

unknown cause

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17
Q

Lesions that interfere with _________ is an indication for Biopsy

A

local function

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18
Q

Any lesion that has characteristics of ________ is an indication for Biopsy

A

Malignancy

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19
Q

7 Indications for Biopsy:

A

2 week lesion w/out etiologic basis

10-14 day non-responsive inflammatory lesion

Persistent superficial hyperkeratosis

Persistent tumescence

Inflammatory changes of unknown causes that persist

Lesions interfering with Local Function

Looks like Malignancy

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20
Q

7 things that may indicate Malignancy:

A

Erythroplasia (red/speckled red/white)

Ulceration

Duration longer than 2 weeks

Rapid growth

Bleeding

Induration - (loss of pliability)

Fixation - feels attached to adjacent structures

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21
Q

4 types of Biopsy:

A

Cytology

Aspiration

Incisional

Excisional

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22
Q

Cytology was first used as a _______

Some studies find high _______

Must be examined by ________

A

pap smear

false negatives

pathologist

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23
Q

What is the prime indication for Cytology biopsy?

A

Large areas of mucosal change monitored for Dysplasia

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24
Q

An Aspiration Biopsy must be done on what prior to surgical intervention?

A

Any Radiolucency

*could by high flow vascular lesion

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25
Q

A Fine Needle Aspiration Biopsy is indicated in the Tx of solitary ______ masses suspected to represent a tumor

___ gauge or smaller needle is used

A

Parotid

21

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26
Q

An Incisional Biopsy samples what part of a lesion?

A

Representative

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27
Q

3 Reasons to do an Incisional Biopsy:

A

over 1 cm/close proximity to vital anatomic structures

Difficult to excise

Suspicion of Malignancy

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28
Q

Shape of an Incisional Biopsy:

Include:

Do what for the pathologist?

A

Wedge

normal tissue at edges

orient

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29
Q

T/F

Incisional Biopsy should by broad and shallow

A

False

**narrow and deep enough to go all the way through the structure

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30
Q

An Excisional Biopsy should be done only in what cases?

Good for what size lesions?

A

Malignancy NOT expected

1 cm or less

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31
Q

Biopsy Technique should use regional _____ and use _____ incisions

A

field blocks

sharp

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32
Q

A Biopsy sample is placed directly into ________

A

10% Formalin

33
Q

MRONJ =

A

Medication Related Osteonecrosis of the Jaws

34
Q

T/F

Osteoradionecrosis of the jaws is pretty much the same as MRONJ in treatment and response

A

False

*NOT the same, in any way

35
Q

MRONJ is defined as _______ bone that can be probed (intra/extra oral fistula) in the MF region persisting for ________

A

exposed

8 weeks

36
Q

MRONJ does NOT refer to _______, but its causes are what 2 types of drugs?

A

radiation therapy

antiresorptive, antiangiogenic

37
Q

T/F

MRONJ is a fairly new disease and huge numbers of people are on meds that put people at risk

A

True

38
Q

T/F

Normal course of debriding bone and moving flaps, successful for other Tx, does not tend to work for MRONJ

A

True

39
Q 
T/F
Hyperbaric Oxygen (HBO) works well for MRONJ
A

False

*osteoradionecrosis, etc.

40
Q

With MRONJ, wounds tend to ______ with surgical intervention

A

enlarge

41
Q

T/F

There is no definitive Tx for MRONJ

A

True

42
Q

T/F

MRONJ pts may have to be on continuous or episodic antibiotics for the rest of their lives

A

True

43
Q

T/F

Oral bisphosphonates, RANK-L inhibitors, monoclonal antibodies, and anti-angiogenesis drugs can all cause MRONJ

A

True

44
Q

How many cases of MRONJ have been reported in the literature?

A

17,000

45
Q

3 types of Antiresorptives associated with MRONJ:

A

IV bisphosphonates

Oral bisphosphonates

RANK Ligand inhibitor (human monoclonal antibody)

46
Q

What 4 conditions are Treated with MRONJ-causing drugs ?

A

Cancers that metastasize to bone (breast, prostate, lung)

Bone lesions/multiple myeloma

Osteoporosis

Soft tissue tumors

47
Q

3 Common Oral Bisphosphonates:

*used for Osteoporosis

A

alendronate Fosamax

risendronate Actonel

ibandronate Boniva

48
Q

2 IV Bisphosphonates

*used for Bone Metastases

A

pamidronate Aredia

zoledronate Zometa

49
Q

Name of the RANK-L inhibitor

*monoclonal antibody used for Bone Metastases

A

denosumab Xgeva

50
Q

Name of RANK-L inhibitor

*monoclonal antibody used for Osteoporosis

A

denosumab Prolia

51
Q

Bisphosphonates and RANK-L both work by inhibiting what?

A

Osteoclast activity

52
Q

Osteoclasts, though they break bone down, release ______ and growth factors

A

BMP

53
Q

Antiangiogenic meds interfere with the formation of vessels/vascular supply and cause what?

A

Avascular Necrosis

54
Q

denosumab (anti RANKL antibody) is doses via _______ injection at an interval of _______

A

subQ

6 months

55
Q

More than ___ million osteoporotic fractures accor in the US every year

This places ________ people in nursing homes

A

1.5 million

180,000

56
Q

T/F

Hip fracture mortality exceeds 20%

A

True

57
Q

The annual direct care expenditure on osteoporotic fracture was ______ in 2002

*expected to double or triple by 2050

A

12 to 18 Billion dollars

58
Q

What is the systemic marker of bone turnover to assess MRONJ risk?

What are the parameters?

Is it useful in all pts?

A

CTX - collagen type I C telopeptide

100 - 150 moderate risk (less than high, greater than minimal)

no

59
Q

CTX - collagen type 1C telopeptide is NOT a useful test in what 3 pts?

A

Cancer

methotrexate (falsely low)

Steroids (falsely low)

60
Q

Is the CTX test a valid systemic test for MRONJ?

A

No

61
Q

Ideally, before IV BP therapy, you should extract nonrestorable teeth, eliminate perio, and treat caries

During therapy avoid anything invasive

Treat caries, splint, etc

A

True

62
Q

If surgery is unavoidable with a pt taking IV BP, what is the most important thing?

A

Informed Consent

63
Q

T/F

Pts should have a dental screening and preventative Tx PRIOR to initiating antiresporptive or antiangiogenic therapy

A

True

64
Q

To prevent MRONJ, pts should take a drug holiday off of oral BP or denosumab for what disease?

At what time?

A

Osteoporosis

4 years

65
Q

T/F

If MRONJ develops in a Cancer Pt, the oncologist may consider discontinuing therapy until soft tissue closure

A

True

66
Q

MRONJ must be addressed in pts taking antiresorptive therapy b/c it is likely to exceed ____ years

A

4

67
Q

T/F
Implant placement should be avoided in pts on IV bisphosphonates or antiangiogenic drugs for Cancer

***also avoid direct osseous injury

A

True

True

68
Q

For Osteoporosis pts taking BP, if there are no clinical risk factors, you don’t have to alter or delay surgery on what condition?

A

Pt taking BP LESS than 4 years

69
Q

Osteoporosis pts taking BP less than 4 years taking _____ or _______, must contact prescribing provider for a Drug Holiday for at least ____ before oral surgery and wait for osseous healing

A

corticosteroids, antiangiogenics

2 months

70
Q

Osteoporosis pts taking BP for MORE than 4 years w/ or w/out concomitant therapy, contact prescribing provider for ________ before oral surgery and wait for osseous healing

A

drug holiday for 2 Months

71
Q

If Ostoporosis pt taking drug over 4 years, how long of a drug holiday for Prolia (denosumab) prior to surgery?

Reclast (zolendronate)? before/after

A

3 months

9 months / 3 months

72
Q

What are 3 indications for jaw Resection in MRONJ?

A

won’t respond to nonsurgical Tx

Fractures

Direct sinus

73
Q

alendronate may reduce the risk of hip fx by ___%

***could prevent 100k fxs and thousands deaths

A

40

74
Q

T/F

90% of MRONJ pts can be maintained pain free

A

True

75
Q

T/F

MRONJ is rare, less severe, and reversible with discontinuation of IV

A

False

***only true for ORAL meds

76
Q

T/F

3 of the 4 diognostic criteria for MRONJ are historic data so you have to ask many questions to make a diagnosis

A

True

77
Q

What is the important time frame for the duration of dosing of Oral BP’s?

A

4 years

78
Q

IV BP’s are significantly more likely to cause MRONJ

***often given w/ chemo, so Ask About Hx!!
Zometa, Aredia, Xgeva…

A

True

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