theme 3 - principles of OS Flashcards
3 places bleeding likely to come from (not tooth) after extraction
- bone
- gingivae
- FOM
what is used for chemical cautery?
silver nitrate
when removing lower 8 what 2 things can be left behind?
- loose bone/root fragment
2. soft tissue pathology
how does suturing promotes healing?
minimises dead space
promotes healing
minimised scarring
4 aspects of ideal suturing
- close in layers
- ensure support
- close approximation of wound edges
- tension free
3 reasons to consider drainage
- infected site
- incision of abscess
- closure of dead space
2 types of drainage
- closed drain
2. open drain
5 ways to minimise infection after extraction
- sterile technique
- minimal damage
- debridement
- elimination of dead space
- drains where appropriate
3 life threatening complications of surgery
- airway obstruction
- haemorrhage
- infections
if tongue pushed back blocking airway how do you resolve this?
chin lift
4 factors infection depends on
- virulence of organsism
- number of organisms
- host resistance
- local anatomy
2 ways commensals change into pathogens
- change site
2. change in host resistance
what happens in days 0-3 of odontogenic infection?
inoculation + acute inflammation
soft mildly tender swelling
what happens in days 3-7 of odontogenic infection?
cellulitis
bacteria penetrating through tissue planes
hard erythematous swelling, warm, painful
what happens in days >5 of odontogenic infection?
abscess
undermines skin/mucosa
compressible + shiny + fluctuant
if you drained cellulitis what would it be?
serosanguinous fluid with flecks of pus
if abscess burst itself what does it become?
chronic abscess
decreased erythema, size + tendernes
residual firmness
microbiology behind sepsis
release of mediators - NO, bradykinin, histamine, prostaglandins due to bacteria or their endotoxins
state of vasodilation, enhanced capillary leak, myocardial depression
how does sepsis differ to infection
aberrant or dysregulated host response
presence of organ dysfunction
what happens in septic shock
end stage sepsis
low BP
serum lactate >2mmol
what is qSOFA?
quick sepsis related organ failure assessment
GCS <15 - drop in >= 1 with proven infection
RR>22
SBP<100
sepsis 6
- oxygen in
- iv broad spectrum antibiotics
- fluids in
- blood cultures (before antibiotics in)
- lactate
- fluid balance monitoring
what is crystalloid used for?
to treat high lactate +/or hypovolaemia in sepsis
what is SIRS?
systematic inflammatory response syndrome - systemic response to septicaremia
difference between bacteraemia + septicaemia
bacteraemia = bacteria in blood stream ranged by immune system
septicaemia = actively dividing bacteria’s in blood stream, leading to SIRS + hypovolemic shock
4 vital signs of infection
- pyrexia >38.3 or hypothermia <36
- tachC >90bpm
- tachyP >20RR
- WCC <4 or >12
5 signs of infection
- vital signs
- airway
- eyes - swelling
- specialist environment - FBC, lactate, U&E, CRP +/- coagulation screen
- culture + sensitivity - aspirate > swab
4 stages of treatment of surgical infection
- remove cause
- institue drainage
- prevent spread
- restore function
type of infection in teeth, periodontist, bone + TMJ
bacterial
types of infection in soft tissue
virus, bacteria + fungi
types of infection in salivary glands
primary viruses
secondary bacteria
3 methods of spread of orofacial infection
- venous
- lymphatics
- tissue/fascial planes
how does pterygoid plexus + angular veins @ medial cants of eye allow brain infection
no valves
into which superficial lymph nodes fo FOM, tip of tongue, lower lip + chin drain
submental
into which superficial lymph nodes fo face, cheek, upper lips, anterior 2/3 of tongue drain
submandibular
what are tissue spaces
not actually spaces
space between fascial planes + muscle attachments
full of connective tissue
CT destroyed by inflammation
abscess in which tooth is most likely to cause palatal swelling?
lateral incisor
how does infection spread if lower molar tooth perforated below mylohyoid?
goes below into submittal/submandibular - E/O swelling
how does infection spread if lower molar tooth perforated above mylohyoid?
into FOM - I/O swelling
what does all neck fascia lead to?
mediastinum
5 consequences of spread of infection from tooth
- airway obstruction - Ludwig’s angina
- intracranial spread
- mediastinal infection
- necrotising fasciits
- sepsis
what type of infection is hot potato voice common in
quinsy - peritonsillar abscess
what is Ludwig’s cellultis
bilateral submandibular + sublingual cellulitis
can spread down through lateral pharynx space + larynx = oedema at glottis
worrying signs + symptoms of intracranial spread of infection
- eye closure, altered movement, swelling
2. altered GCS
2 complications of intracranial spread of infection
- cavernous sinus thrombosis
2. brain abscess
rule for extra oral drainage to avoid mandibular branch of fascial nerve
2cm below inferior border of mandible
what sort of epithelium lines maxillary antrum?
respiratory epithelium - cilia to allow drainage against gravity
what connect maxillary sinus to nose?
osmium - allow drainage
best imaging for maxillary sinus?
CT
difference between OAC + OAF
OAF = epitheliased tract - takes 7-10days
2 common causes of OAC
maxillary tuberosity damage
bony disruption
instructions to patient after OAC
no nose blowing for 2/52
takes 2 weeks to epithelialize over
sneeze with mouth open - decreases sinus pressure
OHI
what nasal decongestants can be used for OAC
ephedrine 0.5% - 1-2 drops a day
if antibiotics for OAC/sinusitis
1st - amoxicillin
2nd - doxycycline
how long should a splint/denture be warn for over OAC?
2 weeks
3 surgical options of OAC
1st line = buccal advancement flap
2nd line = palatal advancement flap
3rd line = tongue flap
why is slower LA better
more conc around nerve
how long to inject IDB
1 min
reasons for LA failure
technique pharmaceutical treatment anatomical pathological psychological
anatomical reasons for LA failure
barriers to LA diffusion - dense cortical bone in mandible + zygomatic buttress upper 6s + PDL
anatomical variation
position of tooth - coring effect
accessory nerves
how to remove mandibular accessory nerves
high block
why does pathology affect LA success
alteration in pH
increased vascularity so LA removed faster
loss of LA via draining sinus
hyperalgesia
2 types of high mandibular block
akinosi-vazarnai
gow gates
which nerves for high mandibular blocks anaesthetise?
IAN, lingual, long buccal, mylohyoid, auricle temporal
not cervical - use buccal infil
