Surgery3 Flashcards
dead space in a wound is ?
any area that remains devoid of tissue after closure of the wound, usually fills in with blood, which creates a hematoma with a high potential for infection
Which of the following are ways of eliminating dead space? Select all that apply.
• close the wound in layers to minimize the postoperative void
• apply pressure dressings
• use drains to remove any bleeding that accumulates
• allow the void to fill with blood so that a blood clot will form
- close the wound in layers to minimize the postoperative void
- apply pressure dressings
- use drains to remove any bleeding that accumulates
whenever a muco-periosteal flap is elevated for a surgical extraction, there is a possibility for a sub-periosteal abscess. Thus, all surgical flaps should be ? prior to closing with sutures
irrigated liberally
Which of the following is the primary direction of luxation for extracting maxillary deciduous molars? • buccal • palatal • mesial • distal
palatal (As opposed to the buccal direction in adults. This is because the deciduous molars are more palatally positioned and the palatal root is strong and less prone to fracture)
Do not use the “cowhorn” forceps for extraction of lower primary molars because ?
the sharp beaks of these forceps could cause damage to the unerupted permanent premolar teeth
During extraction of a maxillary third molar, you realize the tuberosity has also been extracted. What is the proper treatment in this case?
• remove the tuberosity from the tooth and reimplant the tuberosity
• smooth the sharp edges of the remaining bone and suture the remaining soft tissue
• no special treatment is necessary
• none of the above
smooth the sharp edges of the remaining bone and suture the remaining soft tissue
During extraction of a maxillary third molar, if the tuberosity is fractured but intact, What is the proper treatment ?
it should be manually repositioned and stabilized with sutures
“Beware of the lone molar”— it is often ?
ankylosed to the bone. Remember: The ankylosed tooth emits an atypical, sharp sound on percussion
if tuberosity fractures occur, when should it be treated ?
at the time of surgery. If the operator is unable to do this, he/she must arrange an immediate referral
for denture construction, at the correct vertical dimension, the distance from the crest of the tuberosity to the retromolar pad should equal at least ?
1 cm
Which of the following can be safely excised in preparing the edentulous mandible for dentures? Select all that apply. • labial frenum • lingual frenum • mylohyoid ridge • genial tubercles • exostosis
• labial frenum • lingual frenum • mylohyoid ridge • exostosis (If the genial tubercles were removed, the tongue would be flaccid)
when removing a mandibular exostosis (mandibular torus), it is recommended that ? flap design, which has no vertical components, be used
an envelope
The ideal time to remove impacted third molars is:
• when the root is fully formed
• when the root is approximately two-thirds formed
• makes no difference how much of the root is formed
• when the root is approximately one-third formed
when the root is approximately two-thirds formed (at this time, age 17-21, the bone is more flexible and the roots are not formed well enough to have developed curves and rarely fracture during extraction)
When would you place a suture over a single extraction socket?
• routinely
• never
• if the patient requests it
• when there is severe bleeding from the gingiva or if the gingival cuff is torn or loose
when there is severe bleeding from the gingiva or if the gingival cuff is torn or loose
If bleeding persists for some time following an extraction, it may be helpful to instruct the patient to ?
bite on a tea bag. The tannic acid in the tea bag will help promote hemostasis
The most common cause of postextraction bleeding is ?
the failure of the patient to follow postextraction instructions
The most commonly impacted teeth are the mandibular third molars, maxillary third molars, and the: • maxillary canines • maxillary lateral incisors • mandibular first molars • mandibular premolars
maxillary canines
For impacted mandibular third molars, place the following in their correct order from the least difficult to most difficult to remove. • vertical • horizontal • distoangular • mesioangular
• mesioangular - 43% of mandibular impactions
• horizontal - 3% of mandibular impactions
• vertical - 38% of mandibular impactions
• distoangular - 6% of mandibular impactions
(Important: This is the exact opposite of impacted maxillary third molars)
All of the following are cardinal signs of a localized osteitis (dry socket) EXCEPT one. Which one is the EXCEPTION? • throbbing pain (often radiating) • bilateral lymphadenopathy • fetid odor • bad taste • poorly healed extraction site
bilateral lymphadenopathy
dry socket is most common following extraction of ?
the mandibular molars
Before removing a palatal torus: • an intraoral picture should be taken • a mandibular torus, if present, should be removed • a stent should be fabricated • a biopsy should be taken
a stent should be fabricated
? is the most common complication seen after the surgical removal of a mandibular molar
dry socket
The maxillary torus should not be excised en masse to prevent ?
entry into the nose (the palatine bone will come out with torus)
Which two major forces are used for routine tooth extractions? • rotation • pulling • pushing • luxation
- rotation
* luxation
A Class ? lever is used during tooth extractions
II (fulcrum is close to the apex)
The root of which tooth is most often dislodged into the maxillary sinus during an extraction procedure?
• palatal root of the maxillary first premolar
• palatal root of the maxillary first molar
• palatal root of the maxillary second molar
• palatal root of the maxillary third molar
palatal root of the maxillary first molar
The Caldwell-Luc procedure eliminates blind procedures and facilitates the recovery of large root tips or entire teeth that have been displaced into the maxillary sinus. When performing this procedure, an opening is made into the facial wall of the antrum above the: • maxillary tuberosity • maxillary lateral incisor • maxillary premolar roots • maxillary third molar
maxillary premolar roots
in which situation a root tip can be left in maxillary sinus ?
- root tip is small (2 or 3 mm),
- noninfected,
- cannot be removed through the small opening in the socket apex
If a root tip of a mandibular third molar disappears from site while trying to retrieve it, its most likely location is ?
the submandibular space
Which suture grading below is the thickest? • 2/0 • 3/0 • 4/0 • 5/0
2/0 (intraoral suturing require the use of 3/0- or 4/0, but on extraoral skin surfaces finer gauge is preferred such as 6/0 or even finer. This helps reduce scar visibility)
Because suture material is foreign to the human body, ? should be used
the smallest-diameter suture sufficient to keep the wound closed properly
Which of the following events are correctly paired with the stages of wound healing? Select all that apply.
• fibroblasts lay a bed of collagen / proliferative phase
• platelet aggregation / inflammatory phase
• contraction of the wound / remodeling phase
• thromboplastin makes a dot / inflammatory phase
- inflammatory 2. proliferative 3. remodeling phases
• fibroblasts lay a bed of collagen / proliferative phase
• platelet aggregation / inflammatory phase
• thromboplastin makes a dot / inflammatory phase
contraction of the wound occurs during the proliferative phase
? is the agent of choice for the debridement of intraoral wounds
3% hydrogen peroxide
Sutures placed intraorally are normally removed: • 1-2 days postoperatively • 5-7 days postoperatively • 9-11 days postoperatively • 13-15 days postoperatively
5-7 days postoperatively
Regardless of the flap design used, certain principles should be followed while incising and reflecting the gingiva. With this in mind, the termination of a vertical incision at the gingival crest must be:
• midbuccal of the tooth
• at the line angle of the tooth
• midlingual of the tooth
• beyond the depth of the mucobuccal fold
at the line angle of the tooth
types of incisions used in oral surgery and their indications?
- Linear: for apicoectomies.
- Releasing: for extractions, augmentations, etc.
- Semilunar: for apicoectomies
While attempting to remove a grossly decayed mandibular molar, the crown fractures. What is the recommended next step to facilitate the removal of this tooth?
• use a larger forcep and luxate remaining portion of tooth to the lingual
• separate the roots
• irrigate the area and proceed to remove the rest of the tooth
• place a sedative filling and reschedule patient
separate the roots
When luxating a tooth with forceps, the movements should be firm and deliberate, primarily to ? with secondary movements to ?
- the facial
* the lingual
it is recommended to use ? when removing mandibular teeth to diminish pressure on the contralateral TMJ
a bite block
While extracting a mandibular third molar, you notice that the distal root tip is missing. Where is it most likely to be found? • in the infratemporal fossa • in the submandibular space • in the mandibular canal • in the pterygopalatine fossa
in the submandibular space
Ludwig angina is the most commonly encountered neck space infection, involves ?
the sublingual, submandibular, and submental spaces
Arrange the following five phases of healing of an extraction site in their correct order.
• replacement of the connective tissue by fibrillar bone
• hemorrhage and clot formation
• replacement of granulation tissue by connective tissue and epithelialization of the site
• recontouring of the alveolar bone and bone maturation
• organization of the clot by granulation tissue
Five phases of healing of an extraction site:
- hemorrhage and clot formation
- organization of the clot by granulation tissue
- replacement of granulation tissue by connective tissue and epithelialization of the site
- replacement of the connective tissue by fibrillar bone
- recontouring of the alveolar bone and bone maturation
? have been shown to have the greatest effect on granulation tissue, they retard healing
Glucocorticoids
The same stages that occur in normal wound healing of soft tissue injuries also occur in the repair of injured bone. However, ? are also involved in repairing damaged bone tissue
osteoblasts and osteoclasts
which muscles will displace the mandible both
• anteriorly and medially?
• superiorly and medially ?
- lateral pterygoid muscle (The patient will deviate to the side of the fracture on opening)
- temporalis, masseter, and medial pterygoid
? are second only to nasal fractures in frequency of involvement. • le fort I • le fort II • le fort III • zygomatic fractures
zygomatic fractures
The most common mechanism producing facial fractures is ?
auto accidents (about 70% of auto accidents produce some type of facial injury)
Specific terminology, used to describe the different types of fractures that occur?
- Simple fractures are closed
* compound fractures are open and exposed through a wound
displacement of facial fractures can cause ?
obstruction of the airway resulting in respiratory arrest
what is vital to any treatment of a patient with facial fractures?
Control of the airway
the highest incidence of fractures occurs in ?, These fractures are usually the result of ?
- young males between the ages of 15 and 20
* trauma
The most frequent complication associated with mandibular fracture management is: • hematoma • wound dehiscence • facial or trigeminal nerve injury • infection
infection (is an important cause of nonunion)
The most common cause of postoperative infection is ?
movement at the fracture site due to mobile hardware
what is most often a sequela of fractures?
a fat embolism
What determines whether muscles will displace fractured segments from their original position? • attachment of the muscle • type of fracture • direction of muscle fibers • line of fracture
line of fracture
A favorable fracture is one that ?
is not displaced by masticatory muscle pull
In general, mandibular fractures are less common in children than in adults. When mandibular fractures occur in children, ? fractures of the mandible, particularly in the condylar region, are relatively common. • simple • greenstick • compound • comminuted
greenstick
- Comminuted fractures :
* Greenstick fractures :
- multiple fractures of a single bone. They may be simple or compound
- extends only through the cortical portion of the bone without complete fracture of the bone, closed fractures involving incomplete fractures with flexible bone.
the most common complication of an open fracture is ?
infection
any jaw fracture extending through tooth-bearing bone is considered ? fracture due to potential tears in the PDL and exposure of the fracture to the oral flora
an open
Computed tomography (CT) scan is the gold standard for evaluation of which of the following? Select all that apply. • mandibular fractures at the angle • fractures of the mandibular condyle • le fort I fractures • zygomatic fractures
- mandibular fractures at the angle
- fractures of the mandibular condyle
- le fort I fractures
- zygomatic fractures
Dysfunction of ? is common in a patient with a zygomatico-maxillary complex (ZMC) fracture
the infraorbital nerve
Treatment options of mandibular fractures can be divided into ?
- rigid fixation,
- semirigid fixation,
- nonrigid or closed reduction
- Methods considered rigid fixation are ?
- types of semirigid fixation ?
- nonrigid fixation ?
- screw technique, compression plating, reconstruction plates, and external pin fixation
- Miniplate fixation and wire fixation
- Maxillomandibular fixation ((MMF) with ivy loops, arch bars, or transalveolar screw), gunning splints, and lingual splints
Closed reduction is best used in the treatment of:
• favorable, nondisplaced fractures
• displaced and unstable fractures, with associated midface fractures, and when MMF is contraindicated
• either of the above
• none of the above
favorable, nondisplaced fractures
The process of fracture healing can occur in:
• one way: by direct or primary bone healing which occurs without callus formation
• one way: by indirect or secondary bone healing which occurs with a callus precursor stage
• two ways: by direct or primary bone healing, which occurs without callus formation, and indirect or secondary bone healing, which occurs with a callus precursor stage
two ways: by direct or primary bone healing, which occurs without callus formation, and indirect or secondary bone healing, which occurs with a callus precursor stage
The most common pathognomonic sign of a mandibular fracture is:
• nasal bleeding
• exophthalmos
• malocclusion
• numbness in the infraorbital nerve distribution
malocclusion
(other signs also:
• Lower lip numbness
• Mobility, pain, or bleeding at the fracture site)
Le Fort I ?
the fracture line traverses the maxilla through the piriform aperture above the alveolar ridge, above the floor of the maxillary sinus, and extends posteriorly to involve the pterygoid plates. This fracture allows the maxillae and hard palate to move separately from the upper face as a single detached block. Le Fort I fracture is often referred to as a transmaxillary fracture
Le Fort II ?
superiorly, this fracture traverses the nasal bones at the frontonasal sutures. It extends laterally through the lacrimal bones, crossing the floor of the orbit, fracturing the medial and inferior orbital rims, and fracturing the pterygoid plates posteriorly. In this fracture, the attachment of the zygomatic bones to the skull at the lateral orbital rims and at the zygomatic arches is preserved. As a result of this fracture, the maxillary and nasal regions are movable relative to the rest of the midface and skull. Because of its triangular pattern, this fracture is often referred to as a pyramidal fracture
Le Fort III ?
this fracture line involves fracture of all the buttress bones linking the maxilla to the skull. This fracture allows the entire upper face (nasal, maxillary, and zygomatic regions) to move relative to the skull. In this fracture, there is a craniofacial disjunction with a separation a the frontozygomatic suture, nasofrontal junction, orbital floor, and zygomatic arch laterally
Which type of Le Fort fracture is often referred to as a pyramidal fracture?
• le fort I
• le fort II
• le fort III
le fort II
Which type of Le Fort fracture is often referred to as a transmaxillary fracture?
• le fort I
• le fort II
• le fort III
le fort I
The least common site for a mandibular fracture to occur is the: • body • angle • symphysis • coronoid process
coronoid process
Patients with hypocalcemia have an ionized calcium level below 2.0 or serum calcium concentration lower than 9 mg/dL. Some of the most common causes are: • hyperparathyroidism and cancer • diabetes and hypothyroidism • renal failure and hypoalbuminemia • graves disease and hypopituitarism
renal failure and hypoalbuminemia
usually the first sign of hypokalemia (less potassium) is ?
skeletal muscle weakness or cramping
- the major extracellular cation is ?
* the major intracellular cation is ?
- sodium
* potassium
Whether a bone cyst or other cysts are completely enucleated or treated by marsupialization depends on the: • duration • origin • color • size and location to vital structures
size and location to vital structures (marsupialization, decompression, and the Partsch operation all refer to creating a surgical window in the wall of the cyst. The cyst is uncovered or “deroofed” and the cytic lining made continuous with the oral cavity or surrounding structures. The cyst so is opened and emptied)
cysts and cyst-like lesions can be classified as fissural or odontogenic. ? have a higher rate of recurrence than do fissural and cyst of odontogenic inflammatory origin.
Keratocystic odontogenic tumors (Enucleation with curettage is done)
At what point should the EMS be activated with adult victims?
• after 1 minute of CPR
• after 2 minutes of CPR
• after 3 minutes of CPR
• immediately when an adult is found to be unresponsive
immediately when an adult is found to be unresponsive (For a victim less than 8 years of age, the EMS should be activated after 1 minute or 5 cycles of CPR. This is because, in younger patients, the most likely cause of arrest is respiratory)
The normal value for blood urea nitrogen (BUN) is: • 2-5 mg/dL • 7-18 mg/dL • 23-30 mg/dL • 33-50 mg/dL
7-18 mg/dL (increased in oral decease and dehydration; decreased in liver damage and malnutrion)
Which of the following are stages of hemostasis? Select all that apply: • vascular • leukocytic • platelet • coagulation
- vascular
- platelet
- coagulation
When a child less than 8 years of age has a pulse but is breathless, what is the recommended rate of rescue breathing? • once every 3 seconds • once every 5 seconds • once every 8 seconds • once every 10 seconds
once every 3 seconds (20 breaths/min) (When an adult has a pulse but is breathless, the recommended rate of rescue breathing is once every 5-6 seconds (10-12 breaths/minute))
A victim whose heart and breathing have stopped has the best chance for survival if emergency medical services are activated and CPR is begun within ?
four minutes
classification to a patient: Class 1 Class 2 Class 3 Class 4 Class 5
Class 1 — Healthy patient, no medical problems
Class 2 — Mild systemic disease
Class 3 — Severe systemic disease, but not incapacitating
Class 4 —Severe systemic disease that is a constant threat to life
Class 5 — Moribund, not expected to live 24 hours regardless of operation
The American Society of Anesthesiologists would give what classification to a patient with a severe systemic disease that is a constant threat to life? • class 1 • class 2 • class 3 • class 4 • class 5
class 4
What is the most frequent cause of airway obstruction in an unconscious person? • chewing gum • cigarette • tongue • hard candy
tongue
if too much pressure is incorrectly applied during CPR directly over the xyphoid process, ?may be injured
the liver
Perhaps the single most important consideration in ruling out hemorrhagi disorder is ?
history
Which of the following is the most common error in blood pressure measurement?
• applying the blood pressure cuff too tightly
• applying the blood pressure cuff too loosely
• overinflating the blood pressure cuff
• underinflating the blood pressure cuff
• the use of too large or too small cuffs
the use of too large or too small cuffs
Which of the following is the gold standard for bone regenerative grafting materials for several reasons, including the capability to support osteogenesis and having osteoinductive and osteoconductive properties? • xenogenic bone • allogeneic bone • autogenous bone • alloplastic bone
autogenous bone
the bone marrow for grafting defects in the mandible and maxilla is generally obtained from ?. Also used for ridge augmentation
the iliac crest (anterior and posterior)
A eostochondral rib graft may be employed with the cartilaginous portion simulating the TMJ and condyle. When used for ridge augmentation, there is a great deg of ?
shrinkage
The most commonly used allogeneic bone is:
• freeze-dried
• demineralized freeze-dried bone
• fresh frozen
freeze-dried (Allogeneic bone is nonvital, osseous tissue harvested from one individual and transferred to another of the same species)
Which of the following refers to a horizontal osteotomy of the anterior mandible? • blepharopfasty • genioplasty • cervicofacial rhytidectomy • rhinoplasty
genioplasty
the two currently accepted methods of chin augmentation?
- alloplastic implants
* sliding genioplasty
The term alloplastic is synonymous with: • original • natural • synthetic • genuine
synthetic such as hydroxyapatite (contains no animal or human components)
advantages of restructuring an atrophic ridge with hydroxyapatite granules
- simple surgical technique
- no donor site is required
- hydroxyapatite is totally biocompatible and nonresorbable
disadvantages of restructuring an atrophic ridge with hydroxyapatite granules
- migration of the hydroxyapatite granules
- abnormal color under the mucosa
- mental nerve neuropathy- usually occurs from excessive augmentation
Which of the following is found between the bone and implant of an endosseous dental implant? • periodontal ligament • peri-implant ligament • epithelial ligament • a bone-implant interface
a bone-implant interface (osseointegration)
you need a minimum of ? mm of bone height to place an endosseous (root form, dental implant)
10 mm
