Pathology and Reconstruction Flashcards by OMFS Resident

Antoni A, Antoni B and Verocay bodies

Neurilemomma (aka schwannoma)

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Why unlimited growth potential of Myxoma?

Anti-apoptotic proteins present -Specifically BCL-2

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Myxoma – what decreases recurrence

Liquid nitrogen is the most efficient type of freezing spray available for bone cryosurgery.The
most commonly observed complications associated with cryotherapy are pathologic fractures
and bone sequestra.

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HIV and asthma with firm nodule in vestibule

Hodgkins Lymphoma –not common in oral cvity, non-hodgkin lymphoma in an immunocompromised pt much
more common (large B cell lymhoma most common type)

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Trecher Collins picture – what is it?

Mandibulofacial dysostosis

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What is a common tx for all stages of rhabdomyosarcoma

chemotherapy

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Most common SCCa chemo regimen

Cisplatin (this not on test)
Most common chemotherapeutics for OSCCA include Cetuximabd as primary therapy or docetaxel, cisplatin, flurouracail, as well as bleomycin, and cetuximab (Erbitux),

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Recurrent cutaneous melanoma – what Ab infusion has been shown to decrease recurrence

vegF

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Patient with Acinic Cell Carcinoma, where is it most likely?

Stems from ductal elements or cells*** (Acinar cells)

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When resecting mandible for neoplasm and replacing condyle with Rib graft, what is most concerning?

Heterotopic bone formation

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Why do you put a piece of fat after superficial parotidectomy?

Prevent freys syndrome

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If after facial injury the stenson’s duct was disrupted and severely masserated and you cannot find the two ends, what do you do?

Ligate proximal end

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How can you tell difference between fibrous dysplasia and ossifying fibroma?

Must be combinaton of clinical, radiographic histo only supports diagnosis it is not diagnostic

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Neurofibromitosis I follow what nerves?

peripheral

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American vs African Burkits lymphoma

African more likely in posterior mandible

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Neck dissection, where do you have to be careful to avoid shoulder injury

2b*** CN 11 separates 2a and 2b

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OKCs growth past bone

If they grow through the bone, they do not grow into the soft tissue

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The three FAS facial features are:

A smooth philtrum: The divot or groove between the nose and upper lip flattens with increased prenatal alcohol exposure.
Thin vermilion: The upper lip thins with increased prenatal alcohol exposure.
Small palpebral fissures: Eye width decreases with increased prenatal alcohol exposure.

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Möbius syndrome

Most people with Möbius syndrome are born with complete facial paralysis and cannot close their eyes or form facial expressions.

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Pt with hyperdontia and which condition are they likely to have…

Cleidocranial dysplasia has the most teeth (from Neville 2ed p538)
Cleidocranial dysplasia: retained primary teeth and unerupted permanent teeth…numerous unerupted permanent and supernumerary teeth…number of supernumerary can be impressive…reports up to 60 teeth - formerly known as cleidocranial dysostosis

Gardner’s syndrome: increased presence of odontomas, supernumerary and impacted teeth. Although up to 20% of affected patients demonstate supernumerary teeth, the frequency is not nearly as high as cleidocranial dysplasia

Ectodermal dysplasia: hypodontia, can have anodontia

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McCune Albright Syndrome triad

polyostotic fibrous dysplasia, precocious puberty, unilateral café au lait spots

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nests and cords of cuboidal cells arise from the region of the epidermal basal cells. The neoplastic cells around the periphery of the invading nests and strands are usually palisaded and often columnar.

basal cell carcinom

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a core of keratin surrounded by a concentric collar of raised skin or mucosa and is associated with a rapid onset.

keratocanthoma

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patient has a lip lesion that has a 1.5cm diameter, with 2- 3 month history. Has lymphadenopathy & a cheesy center?

keratocanthoma

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difference between breslow and clarks

Breslows IS DEPTH OF INVASION IN MM Clarks level is which layer of tissue involved

Rushton Bodies are found in:

radicular cyst

Treatment for oral and esophogeal candidiases, no systemic signs mentioned

nystatin Nystatin or clotrimazole lozenges is the first line treatment, followed by Ketoconazole due to the fact that ketoconazole cannot be used for more than 2 weeks without liver function test being needed due to potential for liver toxicity

Vascular supply of anterior and posterior temporalis

anterior 3rd of temporalis muscle is based off the frontal branch (anterior branch) of superficial temporal artery posterior 2/3rds is based off the parietal branch (posterior branch) of the superficial temporal artery.

Cerebellopontine angle tumor causing symptoms of trigeminal neuralgia. What kind of tumor most likely?

The most common cerebellopontine angle (CPA) tumor to cause TN-like symptoms is a benign tumor called an acoustic neuroma.

Most difficult mandibular defect to reconstruct:

symphysis

Most likely complication if reconstruct a mandibular defect with a plate only

Most failures of mandibular reconstruction with a plate alone were due to plate extrusion

Epulis of newborn histology

granular cells

What reconstruction of a floor of mouth defect would cause the worst pooling of saliva and food debris?

STSG

Te99 scan at ratio of 3.0 means what?

Final image quality is of diagnostic value

Ameloblastoma can histologically resemble both what?

craniopharyngeomas and basal cell carcinomas

How does bronchogenic carcinoma met to mandible:

Batson’s plexus

Why is the DCIA good for vascularized hip grafts?

Provides excellent bone stock and soft tissue bulk

Why does a skin graft placed intraorally loose its keratin later?

Mucosilisation

Significance of the thyroid ima and its rate of occurrence

Thyroid IMA artery occurs in 3-10% of the population and can cause problems in performing tracheostomy or thyroidectomy

Ewing’s sarcoma most closely related to what two things histologically?

non-hodgkin’s lymphoma and neuroblastoma

Treatment for causalgia?

physical therapy, tricyclic antidepressants, SSRI, anticonvulsants, gabapentin, steroids, opiods, local anesthetic injections, stellate ganglion block, neurostimulation, sympathectomy, low-dose IV ketamine infusion.

Numbness of ear after submental SAL (suction-assisted lipectomy). What nerve damaged?

Greater auricular

What indicates poor prognosis in maxillary SCC

Trismus or decreased tongue mobility may be an indication of invasion into deeper structures

Which subtype of osteosarcoma has the worst prognosis?

small cell

Frey’s syndrome in detail regarding the parasympathetic and sympathetic rearrangement.

The Auriculotemporal branch of the Trigeminal nerve carries sympathetic fibers to the sweat glands of the scalp and parasympathetic fibers to the parotid gland. As a result of severance and inappropriate regeneration, the fibers may switch courses, resulting in "Gustatory Sweating" or sweating in the anticipation of eating, instead of the normal salivatory response.

Freys pre/post and ganglion

post, otic

Patient has peritonsilar deviation associated with #32 infection. Pt also has horners syndrome. Which space is it?

poststyloid parapharyngeal

Lemierre's syndrome is thrombophlebitis of where?

IJV

Facial nerve paralysis lower third of face only that wasn’t surgical related.

contralateral central lesion

Rhabdomyosarcoma with histologic microscopic margins in bone. What do you do?

chemo/rad

Fungal sinusitis is most commonly which organism?

aspergillosis

Which nerve in the RFFF gives a sensate flap?

lateral antebrachial cutaneous nerve

Most common area on skin for lichen planus?

Flexor surfaces of forearms, knees, palms, soles of feet (These usually affect the flexor surfaces of the extremities)

Patient has laser removal of dysplastic hyperkeratosis. What is the highest risk potential for recurrence?

dysplasia

Treatment for solitary plasmacytoma

radiation

Picture of thumb nail lesion

acral lentiginous melanoma

Café au lait with precocious puberty is ?

McCune Albright Syndrome

Hemifacial microsomia arches?

1 and 2

40% defect of lower lip, use this flap

Kerapandzic flap

What is primary palate mostly composed of?

From lateral and medial nasal process and maxilay process

Most common bacteria associated with Parotiditis

s aureus

Osteosarcoma in palate; large lesion extending across palate; you are told that you resect the lesion, question regarding tx

wide exision with chemo

Adenoid cystic tx

resection and radiation;

Graft over what with least likely success?

cartilage

expansion of maxilla, warm to touch, increased alkaline phosphatase

pagets

1 cm SCCa on the cheek, what margins do you need?

5mm

Pt has pustules on buccal mucous and palate

crohns | pyostomastitis vegetans: unusual oral expression of IBS (ie, ulcerative colitis or crohn’s)

chondromalacia which each grade means

- Grade I: cartilage softening caused by digestion of proteoglycan collagenases; clinically: cartilage turns opaque white (not normal tannish) - Grade II: furrowing results from disruption of collagen fibrils at calificied and non-calcified cartilage attachment and hydrated swelling of proteoglycan-depleted areas along the TMJ fibrils - Grade III: fibrillation and ulceration caused by rupture of the deeper collagen fibers from their calcified and non-calcified cartilage attachment and then the disruption on the articular surface fibrils; fibrillar strands hang from articular eminence 71 - Grade IV: crater formation and subchondral bone exposure results from breakdown of deep and superficial fibrils

OKC histo

Derived from dental lamina with a corrugated parakeratinized surface, 6-8 cell layers thick with a prominent, palisaded basal cell layer often described as a picket fence or tombstone appearance with no present rete ridges

AOT adenomatoid odontogenic tumor from what?

dental lamina

most common salivary tumor in children?

What is the major disadvantage of Abbe flap?

Commisure reconstruction