ORAL SURGERY - SBA examples

Question 1

what are signs of mandibular fractures?

Answer 1

• bruising on the FOM
• step in the occlusion
• anterior open bite
• palpable step in the lower border of the mandible

Question 2

what are symptoms of mandibular fractures?

Answer 2

• pain on swallowing
• pain, swelling, redness, increased heat in the jaw/ear area
• difficulty speaking, chewing and breathing
• numbness/ bruising on face and neck
• trismus

Question 3

what is used for pre-operative inter maxillary fixation for a displaced dentate fractured mandible?

Answer 3

eyelet wires

Question 4

what are the classifications of mandibular fractures?

Answer 4

simple (closed linear)
compound (open to mouth/ skin)
pathological (weakened area by pathology)
comminuted

Question 5

what are condylar neck # usually found alongside?

Answer 5

of the angle or canine region of the opposite side of the mandible

Question 6

what is a guardsman # of the mandible?

Answer 6

bilateral condylar + symphyseal

caused by a fall on the point of the chin

Question 7

what differs with rx for a condylar neck #?

Answer 7

may be fixed several days later - usually within 2 weeks

Question 8

what radiographs are essential in order to diagnose and assess mandibular fractures?

Answer 8

DPT + PA mandible

Question 9

what radiographs are used to assess condylar # prior to fixation?

Answer 9

CT scan

Question 10

what type of mandibular # needs abx?

Answer 10

compound (perforates through periosteum and skin, so through tooth socket into oral cavity)

Question 11

what symptom is associated with a parasymphyseal #?

Answer 11

unilateral numbness of lower lip and anterior teeth - due to the mental foramen and incisive nerve

Question 12

what symptom is associated with a mandibular body #?

Answer 12

bilateral numbness of lower lip and anterior teeth

Question 13

when should teeth be removed in regards to a facial #?

Answer 13

wisdom teeth, grossly broken down, perio infected teeth in the # line

Question 14

how are teeth involved in facial # preserved?

Answer 14

provisional abx
adequate reduction and immobilisation
endo

Question 15

what is the most appropriate rx for a displaced # of the parasymphysis?

Answer 15

open reduction with 2 mini-plates for fixation

Question 16

where would plates be placed for a mandibular angle#?

Answer 16

1 plate along or just below the oblique line of the mandible

Question 17

what technique is used to treat # of edentulous mandibles?

Answer 17

thick reconstruction bone plates (load bearing)

Question 18

how are condylar # managed?

Answer 18

pt <12 years old: analgesia, soft diet, intermaxillary elastic guidance (if needed)
pt > 12 years old: elastic traction for occlusion, reassessment 7 days later, if spontaneous occlusion not possible - ORIF

Question 19

what is the most common method of treating mid face#?

Answer 19

internal fixation with intraosseous plating

Question 20

what is the general appearance of lichenoid lesions?

Answer 20

reticular
uniform
homogenous
bilateral (if medication related)

Question 21

what kind of biopsy is used for homogenous lesions?

Answer 21

incisional biopsy of most concerning area

Question 22

why do you avoid biopsying ulcers?

Answer 22

it may not give the best tissue to show invasive cancer as an ulcer generally has lost epithelium and has lots of necrotic material

Question 23

how is a suspected vesiculobullous lesion investigated?

Answer 23

an incisional biopsy of blistered area sent on ice - for immunofluorescence using antibodies to determine where the split in the epithelium occurs

the tissue is sent on ice and not fixed by transporting it in a solution of saline with formalin

Question 24

when would you do FNA to investigate pathology?

Answer 24

a lump within a major gland

Question 25

what investigations are carried out for sjogrens?

Answer 25

labial gland biopsy - cut through mucosa of lower lip to identify between 5 and 8 lobules of minor salivary glands (as changes in the these are mirrored with major glands)

Question 26

what flap is used for surgical removal of a mesioangularly impacted lower 3rd molar?

Answer 26

triangular flap

Question 27

where is the triangular flap cut for a mesioangularly impacted 3rd molar?

Answer 27

distal relieving incision - up ascending ramus

coronal incision - down the alveolar crest fibres of tooth including papilla of 7 and 8

mesial relieving incision - from the 7 into the sulcus

Question 28

what is the general rule for units of flaps?

Answer 28

one unit infront one behind

Question 29

what suture material is best for anterior of the mouth?

Answer 29

a fine suture material - 4/0 or 5/0

Question 30

how is the diagnosis for acute atrophic candidiasis made?

Answer 30

on clinical grounds:
a history of sore mouth following abx
mouth/ tongue hard and soft palate appear red and sore

Question 31

when would aspiration cytology be used?

Answer 31

fluid containing lesions i.e., cysts

Question 32

what lesions would you find PAS positive hyphae?

Answer 32

candidal leukoplakias

Question 33

when would you want an MRI for suspected salivary gland path?

Answer 33

tumours that involve the deep lobe of the parotid gland

Question 34

what investigation would be chosen for localised salivary gland lumps?

Answer 34

ultra-sound guided fine needle aspiration cytology

Question 35

what is a marked difference between pleomorphic adenoma and warthins tumour?

Answer 35

warthins tumour can be bilateral