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Oral Surgery > Revision Questions > Flashcards

Revision Questions Flashcards

1
Q

What are the indication for XLA?

A 
Gross caries
Advacned perio disease
Tooth/root fracture
Servere tooth surface loss
Pulpal necrosis
Apical infection

Traumatic position
Ortho indication
Syptomatic PE teeth
Interfernce with construction of dentures

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2
Q

What forces are applied to a single rooted tooth?

A

Apical pressure
Rotational movement (unscrewing)
Buccal and lingual expansion

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3
Q

What forces are applied to a molar tooth?

A

Apical pressure
Figure of 8 rotation
Buccal expansion

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4
Q

What are upper instruments?

A 
Straight - anterior teeth
Univerisal - canines and premolars
Molars - left and right
Roots - broken down roots/retained roots
Bayonettes - wisdom teeth or 7's positioned distally 
Root Bayonettes - for roots
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5
Q

What are lower instruments?

A

Universal - lower 5-5
Molars - molar teeth
Roots - broken down roots/retained roots
Cowhorns - broken down molar teeth, apically gauages in furcation

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6
Q

What are the mechanical principles for tooth elevation?

A

Wheel and Axele
Lever
Wedge

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7
Q

What are the uses of elevators?

A 
Removal of retained roots
XLA without forceps
Removal of root apices
Removal of root stumps
Loosen tooth prior to forceps
Provide point of applicaiton for forceps
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8
Q

What are the types of elevators

A

Couplands chisel - elevates and loosens the tooth off, rotational movement
Cryers - Elevates and looses the tooth off, for molar roots
Warwick james - removes roots, placed perpendicular to long axis of tooth
Luxator - Seperates perio ligament and widening of tooth socket, parallel to long axis of tooth and pushes down to seperate perio ligament

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9
Q

What are the soft tissue retractors?

A

Howarth’s periosteal elevator

Bowdler Henry Retractor (rake)

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10
Q

What are some heamostatic agents?

A

Adrenaline containing LA
Oxidised regenerated cellulose - surgicel - framework for clot formation (careful in lower 8 region as acidic and can damage IDN)
Gelatin sponge - absorbable/meshwork for clot formation
Thrombin liquid and powder
Fibrin foam

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11
Q

What are some systemic haemostatic aids?

A

Vit K
Anti-fibrinolytics - tranexamic acid - prevents clot breakdown
Missing blood clotting factors
Plasma or whole blood

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12
Q

How is haemostasis achieved

A

Peri op - LA with vasoconstrictor, artery forceps, diathermy, bonee wax
Post op - pressure, LA, diathermy, WHVP, Surgicel, Sutures

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13
Q

What are post op instructions for an XLA

A

Tell them they will be sore over the next few days as LA wears off
Use analgesia when required
Do not exercise that day and avoid anything that increases blood pressure which may result in bleeding
Avoid hard/hot foods
Avoid alcohol for that day
Do not rinse for about 24hours then start warm salty rinses
If bleeding occurs bite on damp gauze for 20-30 mins
Avoid smoking due to delayed healing and dry socket
Any concerns contact the practice

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14
Q

What are peri op complications

A 
Difficult of access and vision
Abnnormal resistance
Fracture
Involvement of maxillary antrum 
Loss of tooth
damage to nerves
Damage to vessels
Haemorrhage
Dislocation of TMJ
Damage to adjacent teeth
Broken instruments
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15
Q

What is anaesthesia?

A

Numbness/total loss of sensation

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16
Q

Paraesthesia?

A

Tingling

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17
Q

Dysaesthesia

A

impleasant sensation/pain

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18
Q

Hypoaesthesia

A

reduced sensation

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19
Q

Hyperaesthesia

A

increased/heightend sensation

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20
Q

Neuropraxia

A

Contusion of nerve/ continuity of epineural sheath and axons maintained

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21
Q

Axonotmesis

A

Continuity of axons but not epineural sheath disrupted

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22
Q

Neurotmesis

A

Complete loss of nerve continuity/nerve transected

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23
Q

What is the management of a oro antral fistuala/communication

A

Inform patient
Small sinus intact - ecourage clot, suture margins, antibiotics, post op instructions
Large lining torn - close with buccal advacnement flap, antibiotics and nose blowing instructions

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24
Q

What are the causes of a fracture tuberosity?

A

Single standing molar
Unknown unerupted molar wisdom
XLA gone wrong
Not enough alveolar support

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25
Q

What is the diagnosis of a fractured maxillary tuberosity?

A

Noise
Tear on palate
More than one tooth moving
movement

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26
Q

How do you manage a fractured maxiallry tuberosity

A

Dissect out and close wound/ reduce and stabilise
Fixation - remove/treat pulp, ensure occulsion free, antiobiotics and antiseptics, post op instructions, remove tooth 8 weeks later after splint by surgical removal

27
Q

What are the post op complications?

A 
Pain
Swelling
Ecchymosis (bruising)
Trismus
Haemorrhage
Prolonged effects of nerve damage
Dry socket
Sequestrum 
Infected socket
Chronic OAF
Osteomyelitis
Osteroradionecrosis
MRONJ
Actinmycosis
28
Q

Immediate haemorrahge (reactionary/rebound)

A

Occurs within 48hrs of XLA
Vessels open up/vasoconstrcition efftcs of LA wear off
sutures loose or lost
Patient traumatised area with tongue/finger/food

29
Q

Secondary bleeding

A

Often due to infection
Commonly 3-7days after XLA
Uusually mild ooze but can be major bleedin

30
Q

Symptoms of dry socket?

A 
Dull aching pain
bad taste
Bad/characterstic smell
Exposed bone sens and source of pain
Throbs and can radiate to pts ear 
Keeps them awake at night
31
Q

What are some predisposing factors for a dry socket?

A 
Molars
Mandible
Smoking 
Females
OCP
LA - vasoconstrictor
32
Q

Management of dry socket

A

Supportive - reassurance/systemic analgesia
LA block
Irrigate socket with saline
Curettage/debridement - encourage bleeding, new clot formation
Antiseptic pack (alvogyl)
Advise pt analgesia and hot salty mw’s
Review pt and change pack and dressings

33
Q

What is osteomyeltisi?

A

Inflammation of the bone marrow - usually mandible due to poor blood supply
Infection of the bone
Pt often systemically unwell/ raised temp
Site of XLA tender

34
Q

What are predisposing facotrs of osteomyelitits?

A

Odontogenic infections

Fractures of mandible

35
Q

What is acute supparative osteomyelitis

A

Little or no radiograph change

At least 10-12 days required for lost bone to be detected radiographically

36
Q

Chronic osteomyelitis

A

+/- pus - bony destruction in the area of infection

37
Q

Treatment for osteomyeltis

A

Medical and surgical
Antibiotics - clindymacin/pencillin (longer course than normal)
Serve acute osteomyelitis may require hosiptal admission and IV antibiotics
Surgical - drain pus, remove any non vital teeth in area of infection, remove any loose peices of bone, removal of bony cortex, perofration of bony cortex, exicsion of necrotic bone

38
Q

How can you prevent osteoradionecrosis?

A

Scaling/CHX Mw up to XLA
Careful XLA technique
Antibiotics, CHX mw and review
Hyperbaric oxygen - in increase local tissue oxyenation and vascualr in growth to hypoxic areas

39
Q

What is treatment for osteoradionecorsis

A

Irrigation of necrotic debris
Antibiotics not helpful unless secondary infection
Loose Sequestra removed
Small wounds, heal over course of weeks/months

40
Q

Factors for MRONJ

A

Deugs
Length of time patient is on drugs
Diabetes/ steriods/anti cancer chemo/smoking

41
Q

What is the management for MRONJ?

A

Remove sharp edges of bone
CHX Mw
Antibiotics if suppration

42
Q

What is actinomycosis?

A

Rare bacterial infection
It crodes through tissues rather than follow typical fascial planes and spaces
Thick lumpy pus

43
Q

What is the treament for Actinomycosis?

A

I&D of pus accumulation
Excision of chronic sinus tracts
Excision of necrotic bone and foreign bodies
High dose antibiotics for intial control
Long term antibiotics to prevent reccurrence

44
Q

What is infective endocariditis?

A

Inflammation of endocardium affecting heart valves or CMP caused by bacteria

45
Q

What are the stages of surgery

A 
Consent
Safety checklist
LA
Access
Bone removal 
tooth removal
Debridement/wound management 
Suture
Achieve haemostasis
Post op instructions
Follow up
46
Q

Points for surgical access

A

Wide based incison - circulation and perufsion
Use scalpel in one form/firm stroke
No sharp angles and good sized flap
Minimise truama to dental papillae
No crushing and keep tissues moist
Make sure wounds are not closed under tension
Aim for healing by primary intentions to minimise scarring

47
Q

Types of debridement

A

Physical - bone file or handpiece to remove sharp bony edges/ mitchell’s trimmer to remove soft tissue debirs
Irrigation - sterile saline into socket
Suction - Aspirate under flap, check oscket for reainted apices

48
Q

What handpieces are used for surgery?

A

Straight handpiece with saline cooled bur

Round or fissue tungsten carbide bur

49
Q

Why do you not use an air tubrine handpiece for surgery?

A

Can cause surgical emphysema

50
Q

Aims of suturing

A 
Achieve haemostasis
Cover bone
Healing by primary intention
Reposition Tissues
Prevent wound breakdown
51
Q

What are the suture types

A

Resorable - mono - moncryl
- Poly - vicrly rapide

Non resorable - mono - proliene
- Poly - mersilk (black silk)

52
Q

Monofilament sutures?

A

Single stranded and resistant to bacterial colonisation

Less filaments reduces the number of sources of possible infection

53
Q

Polyfilament sutures

A

Several filaments twisted together
Easier to handle
Prone to wicking - more filaments increases the number of sources of possible infection, fluid and bacteria may accumulate

54
Q

Resorable Sutures

A

Suture material absorbed by the tissues and patient does not need to come back
Used where suture removable is difficult

55
Q

Non - resorable sutures

A

Tensile strength does not reduce and not absorbed by the tissues and patient must return for suture removable
Used in areas where suture is required for longer duration

56
Q

Aims of retracting flap

A

Better access and vision
Retraction of soft tissues
Closure of OAF

57
Q

4 things that influence flap design

A 
Personal perfernces
Access needed
Procedure
Surrounding nerves
Ability to suture it back
Area in mouth
58
Q

Causes of neuro-sensory deficity?

A

Damage due to LA
Damage to nerve in surgery
Crushing on removal of tooth
Cutting/shredding due to LA or flap design

59
Q

4 nerves damaged by XLA 3rd molar

A

Lingual nerve
Inferior alveolar nerve
Buccal nerve
Mylohyoid nerve

60
Q

2 nerves that are blocked when injected into the pterygomandibular space

A

Lingual nerve

Inferior alveolar nerve

61
Q

History of sharp pain that is not relieved by analgesia

A

Trigeminal Neuralgia

62
Q

Stenson’s Duct opens opposite (parotid duct)

A

Upper 2nd molar

63
Q

Incidience of sialolitheis (salivary gland stones)

A

Submandibular gland

64
Q

Complication of PSANB

A

Heamatoma

Oral Surgery (6 decks)

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