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FINALS!!! > Oral Surgery Revision Notes > Flashcards

Oral Surgery Revision Notes Flashcards

1
Q

Peri op complications

A

Wrong tooth
broken instruements
difficult access or vision
abnormal resistance
bleeding
maxiallry fracture
root in antrum
OAC
TMJ dislocation
damage to vessels
damage to nerves
Loss of tooth

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2
Q

How to tx bleeding

A

apply pressure with damp gauze
diathermy
sutures
WHVP
LA with vasoconstrictor
surgicel

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3
Q

Why do people bleed

A

due to meds - anticougulants
liver disease
bleeding disorder
alcoholism
trauamtised area with finger
blood clot dislodge
Vasoconstrictor of LA worn off
sutures became loose

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4
Q

Damage to nerves why

A

crushing on removal of tooth
cutting or shredding due to LA or flap design
Due to LA
Nerve damage during surgery

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5
Q

How to confirm root in antrum and tx

A

confirm radiographically
Raise a flap, suction, irrigation, curette, suture flap
(remove root either with cutreetes, ribbon gauze, endoscopically or Caldwell Luc approach)

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6
Q

Maxiallary tuberosity why they occur

A

lone standing molars
poor support of aveloar bone on removal of tooth
incorrect sequence of removal
concerscene
pathological gemination

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7
Q

tx of maxiallry tuberoisity

A

dissection out and closing
reducing and stabilising
tooth removed 8 weeks later

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8
Q

signs of maxiallry tuboosity

A

tear in palate
noise
vision
mobility seen

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9
Q

What is an OAC

A

a whole which is found betweeen the tooth socket and maxiallry sinus
OAF when it is left and starts to epithelialise

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10
Q

tx for OAc

A

if small then encourage clot to form and suture
larger require closure by buccal advancement flap, socket cleaned and sutures

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11
Q

Post op for OAC

A

nonoe blowing
no smoking
no drinking through straw
enourage steam inhalations
no wind insutrments
CHX rinse
nasal drops

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12
Q

Signs of OAC

A

bubbling at tooth socket
change in suction noise (echo)
blunt probe
direct vision
salty unilateral discahrge
draininage from nose
difficluty drinking trhougth straw

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13
Q

Why does OAc occur

A

previous hx of OAC
bulbous roots
closeness to maxiallry sinus
tuberoisty fracture
sturgical xla
osteoradionecroris
PA infection of molars
recurrent sinusitis
lasat standing molar

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14
Q

Post op complications

A

pain
bleeding
swelling
brusing
osteomyleitisis
osteoradionecrosis
actimycosis
permmanant/temp numbness
sequestrum
dry socket
infective endocariditis
trismus
Chronic OAF

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15
Q

Dry socket symptoms

A

pain radiating to ear
dull aching pain
hallitosis
kept awake at night with pain
snestivity of bone area

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16
Q

Factors for ary socket

A

female
mandible
molars
smoker
previous hx
truama to clot
OCP

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17
Q

Tx for dry socket

A

reassurance and anlagesics
La block
irrigate socket with saline and warm water
debridement of area
alveogyl placed
post op - warm salkty mows
review pt

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18
Q

Osteradionecrosis

A

bone death due to radiotherapy

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19
Q

Symptoms of osteoradioneccrosis

A

ulcers on gum
exposed bone
pain
swelling
trimus
numbness

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20
Q

Casues of osteoradionecrosis

A

radioathion therapy >60grays

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21
Q

Risks of osterioeadionecrosis

A

poor oh
perio
caries
xertosomia

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22
Q

Tx for osteoradionecrosis

A

hyperbaric oxygen
surgical debridgment
antibiotcis and CHX after XLA
Free flap reconstruction surgery

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23
Q

Actimycosis

A

rare bacterial infection casuing thick pus
incise and drain pus and high dose iv antibiotics

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24
Q

Osteomyeleitis

A

bone infection in mandible - streptococci or anaerobic cocci
refer for oral or iv antibiotncs and surgery

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25
Q

Types of biopsies

A

excisonal biopsy
incisional biopsy
punch biopsy

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26
Q

Excisonal biopsy

A

for mucoelses and fibrous polyps
lesion usually benign

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27
Q

Incisoinal biopsy

A

SCC, lichen planus
maglinant lesions poteintal
removes not all abnormal tissues

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28
Q

Punch nbiopsy

A

incisional biopsy - 4,6,8,mm punch

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29
Q

What not to biopsy

A

tip of tongue
things close to nerve
salivary gland duct orifice
large blood vessles

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30
Q

What to send in sample

A

10% formalin
suture to orietate
no gauze just filter paper

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31
Q

Asipration samples

A

blood sample
fine needle aspiration
aspiration from lesion

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32
Q

Aspiration from lesion

A

cysts and abscess

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33
Q

fine needle aspiration

A

from solid lesions

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34
Q

resorable sutures

A

mono - moncryl
poly - vicryl rapide

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35
Q

Non resorable sutures

A

mono - proliene
Poly - mersilk

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36
Q

Anaesthetsia

A

numbness/total loss of sensation

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37
Q

Paraesthesia

A

tingling sensation

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38
Q

dysathesia

A

unpleasant sensation

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39
Q

hypoaesthesia

A

reduced sensation

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40
Q

hyperaestehsia

A

increased sensation

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41
Q

Aims of suturing

A

achieve haemostasis
heal my primary intention
prevent wound breakdown
cover bone
repositon tissues

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42
Q

Handpiece for surgery

A

straight handpiece witha saline cooled bur
round or fissue tungsten carbide bur

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43
Q

Types of debridment

A

physical - mitchells trimmer, bone file
irrigation
suction

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44
Q

Causes of retained roots

A

Coronectomy
Trauma
caries
attemped XLA that failed

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45
Q

why do teeth fracture

A

thick dense cortical bone
caries, perio
Previous RCT
ankylosis
root shape
root number
root alignment

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46
Q

Radiographic report for 3rd molars

A

type of impaction
root morophoology and number
crown size
alveolar bone levels
perio health
surrounding anatomial structures
asscoaited path
follicular width

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47
Q

Depth of impactions

A

superficial - crown of 8 realted to crown of 7
moderate - crown of 8 related to crown/root of 7
deep - crown of 8 related to root of 7

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48
Q

Signs of closeness to idc

A

dark/bifid roots
diflection of roots
narrowing of roots
narrowing of IDC
darkening of IDC
diflection of IDC
juxta apical area
interuption of white lines

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49
Q

Agensis

A

organ failed to develop

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50
Q

Nerves at risk during xla of 3rd molar

A

lingual nerve
inferioer alveolar nerve
mylhyoid nerve
buccal nerve

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51
Q

Indications for xla of 3rd molar

A

infection
cysts
caries
medical conditions
high risk of disease
external resoprtion of 7/8

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52
Q

Periocrontitis

A

inflammation of surround soft tissue of a 3rd molar

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53
Q

Symptoms of periocronitis

A

hallitosis
pyrexia
trismus
pain
swelling
bad taste
regional lyphadenopathy
pus discharge
maliase

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54
Q

tissue spaces 3rd molar infection spreads to

A

submandibular space
sublingual space
buccal space
submassteric space
pterygomandibular space
paraphayngeal space

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55
Q

Submandibular draininage

A

extra oral - just 2cm below lower border of mandible toa void damage to the mandibular branch of the facial nerve

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56
Q

Sublingual draininge

A

intra oral draininge at FOM

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57
Q

Classification of fractures

A

site of fracture
no. og fracture lines - single, double, multi
size of fracture - uni/bi
displacement of fracture
involvment of surround tissues - simple, compound, commuication
special features to note
direction of fracture line

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58
Q

Factors for likelhod of displacement fractures

A

type of injury that occured
magnitue of forces
opposing occlusion
intact soft tissues
direction of fracture line

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59
Q

Tx for mandibular fractures

A

closed reduction
open reduction with internal fixation

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60
Q

Special invesitgations for mandibualr fractures

A

CBCT
OPT and PA
Occlsual
towns view
lateral oblique

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61
Q

signs and symptoms of mandibular fractures

A

pain, bruisng, swelling, bleeding
trismus
AOB
Mandible deviates to opposite side
mobile teeth
Asymmtery
occlsual derrangement
numbness of lower lip
step deformity

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62
Q

Signs and symptoms of maxiallry fracture

A

pain, bleeding,swelling, brusing
asymmetery
AOB
paraesthesia of infraorbital nerve
step deformity
nose bleeds
blurry vision (diplopia
flattened face
trismus

63
Q

Imaging for maxiallry fractures

A

CBCT
opt, pa, SMV OM

64
Q

Zygomatic factures radiographs

A

need 2 views - use occipitomental view - 2 angles 10 and 30/40 degrees

65
Q

Signs and symptoms of zygomatic fracture

A

pain, brusing, swelling, bleeding
blurry vision
flattend face
pain on eye movement
altered sensation
paraesthedsia of inraorbital nerve
lots of tears

66
Q

Causes of TMD

A

Bruxists
nail biting
chewing gum
Clenching/grinding teeth
ankylosis
hyperplasia
lack of posterior support
degenerative

67
Q

Features of TMD

A

F>M
18-30 years
clicking/popping sound
headaches
trismus
crepitus
linea alba
tongue scalloping
masseteric hypertropy
NCTSL

68
Q

Investigations forTMD

A

Ultrasound
CBCT or MRI
Arthography
Nuclear imaging
Transcrainal view

69
Q

Management of TMD

A

reassurance
anglesics
reduce stresses
cut food into small pieces
support jaw when yawning
avoid chewing gum/nail biting
avoid wide opeing

70
Q

Physical magnement of TMD

A

acuupuncture
TENS
Ultrasound
physio
massage/heat
relaxation

71
Q

Meds for TMD

A

botox
anti- depressants
NSAIDS
diazepam
steriods

72
Q

Blood supply to tmd

A

deep auricular arterty

73
Q

Nerve supply to tmd

A

auricotemproal nerve

74
Q

How the TMJ works

A

opens intially as a rotation movement
translates forwards and slides down the articular tubercle from the mandibular fossa

75
Q

What muscle does the TMJ attach to

A

the lateral pterygoid muscle

76
Q

Anterior displacement with reduction

A

there is a clicking sound
antericular disc anteriolry placed, posterior band further forwards adn streches bilaminar zone of disc

77
Q

Anterior displacement without reduction

A

grating sound, disc infront of condyle
loss of elasticity of bilaminar zone

78
Q

Functions of splints

A

protection of TMJ
Help with function of MOM
prevent grinding of teeth
stabilise occlusion
preven jaw head from rotating to far posterior on glenoid fossa

79
Q

Clincial issues with maxillary sinus

A

root in antrum
OAC/OAF
sinusitits
bengin and malgninat lesions

80
Q

Opening of maxillary sinus

A

hitaus semilunaris (below middle concha)

81
Q

Causes of sinusitis

A

viral infection
fungal infection
XLA
forgein object
bening or malginant lesions

82
Q

signs and symptoms of sinusitis

A

sneezing
nasal congestion and discharge
facial pain
pressure
pain in maxiallry teeth
cough
ear pain
pain onpalpation of infraorbital region

83
Q

tx for sinusitits

A

nasal decongestions
humidiifed air
steam inhlations
bacterial - Pen V 250mg

84
Q

Epitheliunm for sinuses

A

psedustratified ciliated columnar epithelium with gobelt cells

85
Q

cilated

A

mobilies trapped matter and foregin material
and moves material to ostia for elimination

86
Q

5 cardinal signs of inflmmation

A

redness
heat
swelling
loss of function
inflammation

87
Q

Potential for prescribing antibiotics

A

immunocomporomsided
cellulitis
severe percoronitis
osteomyeletis
spread of infection past alveolar bone
lymphadenopathy
trismus
temp >30degress

88
Q

SIRS

A

sysyemic inflammatory response system

89
Q

SIRS cretieria

A

WBC <4x10^9 > 12 x10^9
resp >20/min
hr >90/min
temp <36/>38

90
Q

Pulpal pain fibres

A

c fibres

91
Q

perio ligamnet fibres

A

a delta fibres

92
Q

Upper anterior spread

A

lip
nasiolabial region
infra orbital region

93
Q

Upeer posterior spread

A

maxiallary antrum
palate
intra temporal region
cheek

94
Q

Abscess spreading buccally above mylohoyoid vs below

A

above = sublingual space
below = submandibular space

95
Q

What is Ludwig’s angina

A

i is rare type of cellulitis that occurs due to an abscess of a tooth left untreated that can spread
it is casued by a bacterial infection that spreads into the submandibular and sublingual spaces

96
Q

What bacteria can causesludwigs anging

A

streptoccoal and staphylococcla bacteria

97
Q

How does the spread of ludwigs anginga happen

A

epiglottis to parapharngeal spcaes to airbway obstruction
death can occur if sepsis, spread into the necka and mediasteunum

98
Q

Intraoral signs of ludwigs angina

A

drooling
raised tongue
swelling, diffuclty breathing and swallowing

99
Q

extra oral signs of ldwigs anginga

A

redness and swelling in the submandibular region
fever or chills
general maliase

100
Q

What is cellulitis

A

a bcaterial infeciton that spreads into the deep layers of the skin

101
Q

Paracetamol max does

A

4grams
500mg 1-2tabs every 4-6hrs

102
Q

Carbamzepines

A

for trigeminal neuralgia
100/200mg tabs

103
Q

contraindicaitons of carmazepine

A

pregnant or breast feeding
renal or hepatic impairment
cardiac impairment
skin reaction
porphyria
gluacoma
hx of bone marrow depression

104
Q

Avoid parcetamol

A

alcohol dependenace
renal or hepatic impairment
cytotixs
lipid regualting drugs

105
Q

Ibuprofen max dose

A

2-4g per day

106
Q

avoid ibuprofen

A

peptic ulcerations
asthma
cardial renal or hepttic impairment
preg
elederly orther NSIADs
steriods

107
Q

Ibuprofen and drug interactions

A

antibiotics
ACE inhibitors
beta blockers
anticogulants
antidepressants
diruetics
lithium
calcium channel blockers

108
Q

Aspirin avoid

A

elederly
ashmatics
peptic ulceration
renal or hepatic impairment

109
Q

Max does of aspirin

A

300mg x12 in 24hrs

110
Q

Mechanism of aspirin

A

reduces produciton of prostaglnaidns
inhibits cox 1 and cox 2 which reduces platelet aggreation

111
Q

COX 1

A

responsible for the reduction of prostaglandins assoicated withplatelet aggeration

112
Q

COX 2

A

the enzyme reposnsible for most inflammatory prstaglandins

113
Q

ASA classification

A

Amercian soceity of anaestesiilogist of medical status

114
Q

ASA 1 and 2

A

can be trested by sedaiton dentists

115
Q

ASA 3,4,5

A

hospital setting only sedation

116
Q

ASA I

A

normal healthy person, non smoker and min alcholol, BMI <30

117
Q

ASA II

A

mild systemic disease - smoker, BMI<35, controlled diabetes, mild asthma, epilpspy, preg pts, BP 140-159/90-94

118
Q

ASA III

A

moderate systemic disease - type 1 diabetes, >3months since MI or CVA, BP 160-199/95-114, BMI<35, stable angina, COP

119
Q

ASA IV

A

severe systemic disease - BP 200/115, unstable anginga, uncontrolled angina, <3months MI or CVA

120
Q

ASA V

A

moribud - severe threat to life, not expected to survive

121
Q

ASA VI

A

brain dead - organs for donation

122
Q

Vital signs to monitor in sedation

A

BP
HR
Oxygen levels with pulse oximeter

123
Q

BMI

A

weight/height^2
<18.5 = underweight
18.5-25 = normal
25-30 = overweight
>35= obese

124
Q

Indications for sedation

A

phobic pts
gagging pts
parkinson’s disease - prevents resting tremor occur
cerebral palsy
learning difficulties
pt who is not coperative

125
Q

Contraindications for sedation

A

pregnant patients
COPD
Spreading infection compromising airway
severe uncontrolled systemic disease
pyhsichatric diseases
Hypothyrodism

126
Q

Hypothyroidism and sedation

A

contraindicated as drug metabolism slowed downa and can also lead to resp failure

127
Q

Sedation and interaction with drugs

A

antihistamines
eryhromycin
antidepressants
alocohol
recreational drugs
antipsychiotics
opiods

128
Q

Complications of drug adminstration

A

sexual fantasy
hyporepsonders - drug abusers, alcoholics,
hypoeresponders
oversedation
allergic reaction - given adrenaline

129
Q

Contraindications of cannulation

A

fainting
heamatoma
venospasm - unable to locate veins
extramuscualr injection
intra-arterial injection - injection straight into an artery

130
Q

Indications for inhalation sedation

A

needle phobia
gaggers - reduced gag reflex
anxious pts
pts medical conditions increased by stress
people with liver probs

131
Q

Contraindications of inhalation sedation

A

common cold
severe asthma
COPD
Fear of face mask
unable to breathe through nose
1st tri of pregnancy
tonsilaaer enlargement

132
Q

Advantages of inhaltion sedation

A

quick recovery
rapid onset
no needles
no injection
no ammnesia
few side effects

133
Q

Disadvantages of inhaltion sedation

A

staff becomed addicted
not potent
expensive equipment
requires space for equipment
requires to breathe through nose

134
Q

Colour of oxygen

A

black

135
Q

colour of nitrous oxide

A

blue

136
Q

Pre op instructions before inhaltion sedation

A

light meal before
take meds as normal
wear loose clothing
accompaoined by adult
accompained with escort for home
no alcohol

137
Q

Signs of adequate sedation

A

feels comfortable and relaxed
reduced blink reflex
pt awake
reduced reaction to painful stimuli
reduced spontansoues movement
verbal contact mainted

138
Q

Recovery from inhlation sedation

A

oxygen adminstered 10-20% over a period of 2mins to prevent diffuision hypoxia

139
Q

Flow rate for inhaltion sedation

A

5-6litres

140
Q

Oversedation

A

naseua/vomtiing
loss of consciousness
sluggish responses
inchoerent speech
mouth closes repeatedly
uncontroable laughter/tears
reduced co-operation

141
Q

Equipement for inhalation sedation

A

Nasal hood
Gas cyclinders
Gas delivery hoses
Reservoir bag
Flow meter
Waste scavenging system
Pressure reading vavles

142
Q

Post op advice following sedation

A

analgesics
do not sign irreversible docs for first 24hrs
do not drive or operate machinary for 24rs
rest and recovery
do not be in charge of anyone till the next day
be careful with cooking and domestic applaiances

143
Q

Contraindications of IV sedation

A

hepatic insufficiency
porphyria
benzodazepine allergy (midazolam)
myaesthenia gravis -leads to pt being paralysed but still awake

144
Q

Flumanzeil

A

benzodiazepine anatagonist which displaced midazolam from recptor sites blocking any action potential

145
Q

Midazolam half life

A

90mins

146
Q

Midazolam

A

5mg/5ml
ph3.5 allows to be soluble when ingested
medtabolised in theliver and bowel

147
Q

Eve’s sign

A

shows motor co-ordination - t tries to touch the tip of nose with finger and theri eyes closed

148
Q

Verrill’s sign

A

drooping of eyelids

149
Q

Sites for cannulation

A

dorsum of hand
antecubital fossa

150
Q

Why is an indwelling canula placed

A

to allow for emergecny drugs to be placed (teflon cannula)

151
Q

Day of IV sedation

A

no nail varnish affect pulse oximeter
meal 1hr before procedure
wear loose clothing
no makeup so can check face colour
escort home
not to be left alone for 1st 12 hrs
not to be in charge of anyone for 1st 12 hrs
pain relief
check height, BMI, BP, MH
no alcohol
no cold (affects O2 saturation)

152
Q

How does midazolam work

A

it binds to receptors that control sodium ion movement
receptors associated with GABA - which allows chlrodie ions from extracellular fluid to enter cells are negatively charged).
midazolam increases affinity for GABA, increasing the inbitory action of GABA
Respoonsible for anticovulsant and sedative effects

Also minimic action of inhibitory neurotransmitted gylcine - muscle relaxnt action

153
Q

Potency

A

measure of affinity a drug has for its receptor
the strength it has on its recptor
length of time required to eliminator the drug

FINALS!!! (20 decks)

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