Surgery4 Flashcards
Which of the following factors would have the greatest negative influence on a dental implant's success? • hypertension • patient over 70 years of age • smoking • alcohol • post-by pass surgical patient
smoking
the minimum space required for a 4.0-mm diameter implant is ?
7.0 mm — 1.5 mm on each side of the implant plus the diameter of the implant
the maximum amount of taper to allow for proper draw on an overdenture attachment, such as an “O” ring, is ?
15 degrees
Currently, the most popular used implants are: • blade form implants • subperiosteal implants • transosseous implants • root form implants
root form implants
To prevent infective endocarditis in patients at risk for such infections, the American Heart Association (AHA) frequently issues guidelines for prophylactic antibiotic coverage during dental procedures. In accordance with the most recently revised AHA guidelines, which of the following are acceptable antibiotic options for the prevention of infective endocarditis? Select all that apply. • cephalexin • amoxicillin • clarithromycin • erythromycin • azithromycin • clindamycin
cephalexin amoxicillin clarithromycin azithromycin clindamycin (Amoxicillin: 2.0 grams, if allergic Clindamycin: 600 mg)
The mandibular left second molar of a 14-year-old boy is unerupted. Radiographs show a small dentigerous cyst surrounding the crown. What is the treatment of choice?
• surgically extract the unerupted second molar
• uncover the crown and keep it exposed
• prescribe an antiinflammatory medication and schedule a follow-up appointment in 6 months
• no treatment is necessary at this time
uncover the crown and keep it exposed (Dentigerous cysts are those associated with the crowns of unerupted teeth. Some literature refers to these cysts as “follicular” or “primordial” cysts.
dentigerous cysts are probably the result of ?
degenerative changes in the reduced enamel epithelium)
if dentigerous cysts form when a tooth is erupting, they are called ?
eruption cysts (simple incision or “deroofing” is all that is needed!)
Which of the following are considered primary fascial spaces? Select all that apply. • buccal • canine • submaxillary • masticator • vestibular
- buccal
- canine
- submaxillary
- vestibular
The spaces directly adjacent to the origin of the odontogenic infections are ?
the primary fascial spaces
Fascial spaces that become involved following spread of infection to the primary spaces are ?
the secondary fascial spaces
? infections can result in cavernous sinus thrombosis via the ophthalmic veins
- canine space infections
* deep temporal space infections
the submandibular space is continuous with ?. The mylohyoid muscle divides this space and serves as the inferior border of the sublingual space and the superior boader of ?
- the lateral pharyngeal space
* the submaxillary space
Body temperature can be measured in several different ways, which one is the most accurate? • orally • axillary • rectally • aurally
rectally (axillary is the least accurate)
For every 1°C rise in body temperature, there is a corresponding ? beats/min increase in the patient’s heart rate
9-10
Osteomyelitis usually begins in the medullary space involving the ? • periosteum • soft tissues • cortical bone • cancellous bone
cancellous bone (medullary space) (two types: Suppurative and Nonsuppurative)
Acute osteomyelitis occurs more frequently in which jaw?
the mandible (Important point: a reduced blood supply will predispose bone to osteomyelitis)
Which conditions would require preoperative antibiotic prophylaxis for the prevention of bacterial endocarditis?
Select all that apply.
• prosthetic heart valve
• complex cyanotic congenital heart disease
• prior coronary artery bypass graft
• surgically constructed systemic pulmonary shunts or conduits
• mitral valve prolapse with regurgitation and/or thickened leaflets
- prosthetic heart valve
- complex cyanotic congenital heart disease
- surgically constructed systemic pulmonary shunts or conduits
- mitral valve prolapse with regurgitation and/or thickened leaflets
Why is a conventional handpiece that expels forced air contraindicated when performing dentoalveolar surgery?
• too much bone will be removed
• these handpieces can cause tissue emphysema or an air embolus, which can be fatal
• these handpieces are not high-powered enough to remove bone
• all of the above
these handpieces can cause tissue emphysema or an air embolus, which can be fatal
Anyone scheduled for general anesthesia should have a chest x-ray and patients over 40 years old should also have a/an: • ECG • MRI • panorex • biopsy
ECG
Incision for drainage (I&D) in an area of acute infection should only be performed after:
• a culture for antibiotic sensitivity has been performed
• localization of the infection
• a sinus tract is formed
• the patients fever has cleared up
localization of the infection
? (which are highly virulent and aerobic) initiate the infectious process, a cellulitis then occurs followed by proliferation of anaerobic organisms
streptococcus species
Which of the following techniques is best for a wide-based frenectomy?
• diamond excision
• v-y advancement
• z-plasty
v-y advancement (the other two are effective when frenum is narrow)
Care must be taken to avoid excessive infiltration directly in the frenum area while doing frenectomy since it may obscure ?
the anatomy that must be visualized at the time of excision
An orofacial infection can reach the cavernous sinus through two routes: an anterior route via the ? and ?, and a posterior route via the ? and the ?
• transverse facial vein; pterygoid plexus of veins, angular; inferior ophthalmic veins
• inferior alveolar, anterior superior alveolar arteries, descending palatine; greater palatine arteries
• supratrochlear; supraorbital veins, superficial temporal; lingual veins
• angular; inferior ophthalmic veins, transverse facial vein; pterygoid plexus of veins
aangular; inferior ophthalmic veins, transverse facial vein; pterygoid plexus of veins
which cranial nerves pass through the cavernoue sinus?
cranial nerves III, IV, V (ophthalmic division of V), and VI
A surgical procedure used to recontour the supporting bone structures in preparation of a complete or partial denture is called a/an: • closed reduction • operculectomy • alveoloplasty • gingivoplasty
alveoloplasty
a closed reduction is ?
the closing of the space between fractured bone without cutting through the soft tissue or surrounding bone
a gingivoplasty is a ?
surgical procedure to reshape the gingivae to create a normal functional form
an operculectomy is ?
the removal of the operculum, which is the flap of tissue over an unerupted or partially erupted tooth
While there are many reasons for autotransplanting teeth, tooth loss as a result of dental caries is the most common indication, especially when:
• maxillary central incisors are involved
• mandibular first molars are involved
• mandibular canines are involved
• maxillary third molars are involved
mandibular first molars are involved
The most likely cause of autotransplanting failure will be ?
a chronic, progressive external root resorption
The almost universal sequelae of an allogeneic tooth (from one individual is placed in another individual) transplant is ?
ankylosis and progressive root resorption
Which of the following are systemic contraindications to elective surgery? Select all that apply.
• blood dyscrasias (i.e., hemophilia, leukemia)
• controlled diabetes mellitus
• addison disease or any steroid deficiency
• fever of unexplained origin
• nephritis
• any debilitating disease
• cardiac disease
- blood dyscrasias (i.e., hemophilia, leukemia)
- addison disease or any steroid deficiency
- fever of unexplained origin
- nephritis
- any debilitating disease
- cardiac disease
treatment with IV bisphosphonates increases the risk of ?
osteonecrosis of the jaw
? will usually drain into the buccal space which lies between the buccinator muscle and overlying skin and superficial fascia
infected maxillary molars and mandibular molars
The most common site for oral cancer is the: • buccal mucosa • tongue and floor of the mouth • palate • attached gingiva
tongue and floor of the mouth
Squamous cell carcinoma usually affects ?
the lower lip
Lip carcinoma commonly present: ?
as an ulcer. In many cases, a keratin crust covers the ulcer. The rest of the lip vermilion may show actinic changes
From a histologic point of view, ? tumors have the highest degree of malignancy
poorly differentiated
The universal sign of laryngeal obstruction is: • mydriasis • stridor (crowing sounds) • sweating • tachycardia
stridor (crowing sounds) (Stridor is a high-pitched, noisy respiration, like the blowing of the wind)
Pericoronitis is acute inflammation of the tissue overlying and surrounding a partially erupted or erupting tooth. The most commonly involved tooth is a: • maxillary third molar • maxillary second molar • mandibular third molar • mandibular second molar
mandibular third molar
The principal etiologic factors in pericoronitis are ?
food debris and bacterial waste product: that have accumulated under the soft tissue flap, overlying a partially erupted tooth
Bleeding that consists of pinpoint dots of blood is called ?. Larger flat areas where blood has collected under the tissue, up to a centimeter in diameter, are called ?. A very large area is called a/an ? • purpura, petechiae, ecchymosis • petechiae, ecchymosis, purpura • ecchymosis, purpura, petechiae • petechiae, purpura, ecchymosis
petechiae, purpura, ecchymosis
petechiae less than 2mm
purpura 2-10mm
ecchymosis larger than 10mm
Postoperative ecchymosis is a result of ?, is common after extractions in ? due to the fragility of the vessel walls
- trauma to the underlying blood vessels
* elderly patients
? must be considered if surgery is to be performed of an irradiated mandible
Hyperbaric oxygen therapy
Osteoradionecrosis does not develop unless ?
the patient’s oral condition is not optimized before radiation therapy
Thrombocytopenia (low platelet count) that is less than ? is an absolute contraindication to elective surgical procedures because of the possibility of significant bleeding. • 50,000/mm3 • 75,000/mm3 • 100,000/mm3 • 125,000/mm3
50,000/mm3 (normal platelet count is 150,000 - 450,000)
Which of the following characteristics raise the suspicion of malignancy? Select all that apply. • erythroplasia • ulceration • duration • slow growth • bleeding • induration • fixation
- erythroplasia
- ulceration
- duration
- bleeding
- induration
- fixation
Local spread of oral carcinoma is achieved by ?
direct invasion and infiltration of adjacent structures
Which of the following is the most common technique used for mandibular advancement?
• the step osteotomy
• mandibular ramus sagittal split osteotomy
• the vertical ramus osteotomy
• the vertical body osteotomies
mandibular ramus sagittal split osteotomy (both Cl II & III)
- the vertical ramus osteotomy
* the vertical body osteotomies
- just cl III
* just cl III with extraction of usually mandibular bicuspids teeth bilaterally
The prototypic neuropathic facial pain is: • postherpetic neuralgia • burning mouth syndrome • trigeminal neuralgia • temporal arteritis
trigeminal neuralgia
burning mouth syndrome is most commonly seen in ?
postmenopausal females
What is the best way to palpate the posterior aspect of the mandibular
condyle?
• intraorally
• externally over the posterior surface of the condyle with the mouth open
• through the external auditory meatus
• any of the above
externally over the posterior surface of the condyle with the mouth open
most common cause of masticatory pain and compromised function in TMJ?
myofascial pain disorder
The most common direction in which the articular disc in the TMJ can be displaced is: • laterally • medially • posteriorly • anteromedially
anteromedially (Because of the anteromedial direction of the lateral pterygoid muscle)
a click sound is usually demonstrated when?
When the articular disc is displaced anteromedially to the condyle, a click sound is usually demonstrated when the mouth is opened and the condyle moves past the thick posterior band of the articular disc.
A crepitation sound is usually associated with ?
a degenerative process (osteoarthritis) of the condyle
Which surgical approach is the best to expose the TMJ?
• preauricular
• submandibular
• both are the same
preauricular
? is one standard surgical approach to the ramus of the mandible and neck of the condyle. It is not the best approach for procedures within the joint space itself
submandibuiar approach (Risdon approach)
What clinical sign is considered pathognomonic for the first stage of internal derangement of the articular disc? • ringing in the ears • reciprocal clicking • muscle inflammation • headaches
reciprocal clicking
The most common form of pain and discomfort associated with TMJ disorders is ?
masticatory myalgia or myofascial pain. This is a disorder characterized by pain and masticatory muscle spasm and limited jaw opening
