Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

1- viva sem 2 > 1-Oral surg > Flashcards

1-Oral surg Flashcards

1
Q

Surgical plan (10 steps)

A
  1. draw image
  2. mhx
  3. flap type + content
  4. Flap elev + instru (molt #9 periosteal elevator)
  5. bone removal + bur [(tungsten carbide) round]
  6. sectioning of tooth + bur (fissure bur)
  7. delivery path + instru (luxator + elevator)
  8. would closure + suture type (abs/non-abs & mono/braided)
  9. Medications to prescribe + reasons (NSAIDs + paracetamol + oxy)
  10. post-op followup
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Flap design (4 things) WAAM

A
  1. wider base
  2. access
  3. avoid (vital struct)
  4. Margins over sound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

flap margins to avoid

A
  1. over bony
  2. over non-sound bone
  3. over papilla
  4. mid-buccal of crown
  5. releasing incisions on 1)lingual 2)palatal 3)at mental foramen (i.e. 2nd premol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
  1. Flap types
A
  1. Envelope (least access)
  2. 3-corner (most common)
  3. 4 corner (most access + apical access)
  4. semilunar (apicectomy)
  5. pedicle (OAC)
  6. y-incision (palatal torus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Bone guttering + bur? 2 advantages?

A
  1. gutter along buccal in M-D (Round or Fissure bur)

2. Adv = 1)aplication point/easier to disp 2)improved visi for sectioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

2 indications for tooth sectioning + bur? 2 adv?

A
  1. i) resists elevation even after bone removal ii)divergents roots - i.e. no common path of removal
  2. i)less force & dec risk for damage ii)less bone needs to be removed - less damage/increased
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Purpose of suturing

A
  1. Reducing chance of infection
  2. Assists haemostasis and healing
  3. healing by primary intention so reduces scarring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Disadv of Abs/Non-abs & Braided/mono-fil (adv are pretty much the inverse of their counterpart)

A

Abs - can dissolve early
non-abs - need removal
Braided - can tear tissue/bacteria adhere
monofilament - weak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

5 mandatory steps before exodontia can be done

A
  1. clinical exam
  2. med hx
  3. radiograph
  4. dx
  5. consent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

3 types of bleeding and causes

A

**ITS NOT PRIM, SEC, TERT. REACTIONARY IS THE SECOND ONE!!!
primary = immediately after trauma, before clot forms
reactionary = 8-12 hours after surgery when vasoconstrictive effects of LA wear off
secondary = 7-10days due to infection produced enzymes dissolving clot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Incisional biopsy

A

1) uncertain dx OR malignancy OR >1cm
2) Narrow/deep WEDGE >4mm/>6mm + NORMAL TISSUE
3) non-representative - multiple sites required to FULLY MAP LESION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Excisional biopsy

A

1) dx certain + <1cm

2) Ellipsoid Length 2x width, 2-3mm margin of normal tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Other 5 types of biopsies

A

Note: Excision, incision, punch, exfoliative - superficial lesions ——-fine needle cytology, fine needle core biopsy, trephine for deep

1) Punch biopsy - not used in mouth, rot can distort
2) exfoliative cytology - least representative/invasive
3) fine needle asp/non-asp cytology - no architecture
4) fine needle core biopsy - some architecture
5) trephines - architecture, but high risk bleed/damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Biopsy Transport

A
  1. 10% formalin (i.e. 4% formaldehyde)
  2. michel’s solution
  3. saline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

8 Intra-op complications of extraction

A
  1. iatrogenic lacerations
  2. fracture of maxillary tuberosity
  3. fracture of mandible
  4. excessive primary bleeding
  5. root tip fracture
  6. dislodgement of tooth/bone fracture into tissue space
  7. Max sinus involvement
  8. IAN involvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

solution to iatrogenic laceration (intra-op comp1/8)

A
  1. achieve hemostasis 2. suture 3. inform patient of incident
17
Q

Solution to fracture of maxillary tuberosity (intra-op comp 2/8)

A

1) stop immediately 2) take opg 3) refer to oral surgeon

18
Q

Solution to fracture of mandible (intra-op comp 3/8)

A

1) stop immediately 2) take opg 3) refer to oral surgeon

19
Q

7 Solution to excessive primary bleeding (intra-op comp 4/8)

A
  1. pressure
  2. clot stabilizing agent (surgicel/gelfoam)
  3. tranexamic acid
  4. sutures
  5. adrenaline
  6. bone wax
  7. electro-cautery
20
Q

2 possible solutions to root tip fracture (intra-op comp 5/8)

A

2 possibilities

1) <4mm, no infection/apical radiolucency, below lvl of bone–> Tx = leave
2) otherwise: Tx1 = nonsurg- rootpick Tx2 = surgical - conventional technique or Open window technique

21
Q

4 possibilities when it comes to tooth/bone fracture dislodged into soft tissue space (intra-op comp 6/8)

(max sinus value of root is <3mm, don’t confuse with root tip fracture which is <4mm)

A

POSSIBILITY 1 = CAN’T FIND AFTER SEARCHING
1) take chest x-ray to rule out aspiration

POSSIBILITY 2: under mucosa/into infratemporal/into submandibular:
1) massage back into socket 2) if unsuccessful –>refer to Oral surgeon

POSSIBILITY 3: INTO MAX SINUS (<3mm & not infected/apical patho)

1) attempt to retrieve
2) if unsuccessful –> leave and treat as OAC

POSSIBILITY 4: INTO MAX SINUS (>3mm or infected)
1) must retrieve –> enlarge socket

22
Q

Maxillary sinus involvement (intra-op comp 7/8).

i don’t know what an OAF is. I know OAC, but OAF is apparently when OAC becomes epithelially lined if not closed…. and its importance is that the epithelium has to be removed if flap surgery being done, so as to close over sound bone, not tissue at margins.

A

3 scenarios possible:

1) <2mm wide –> tx = sinus precautions
2) 2-6mm –> tx = 1)sinus precautions 2)surgicel/gel foam+suture 3)AB - augmentin or doxycycline
3) >6mm –> tx= 1)sinus prec 2)buccal flap adv (1st choice) OR pedicle flap 3)AB - augmentin or doxycycline

23
Q

IAN involvement (intra-op comp 8/8).

don’t know a tx, just refer to OS. It should have never happened in the first place.

A

7 signs of of IAN involvement
A) 4 root sign: darkening (key sign), deflection, narrowing, bifid
B) 3 canal signs: displacement (key sign), interruption, narrowing

24
Q

8 post-op complications of extractions

A
  1. Reactionary bleeding
  2. swelling (e.g. trismus)
  3. bruising
  4. infection/secondary bleeding
  5. alveolar osteitis
  6. MRONJ
  7. Osteoradionecrosis
  8. nerve damage
25
Q

Reactionary bleeding (post-op comp 1/8)

A 
Cause = vasocontrictor of LA wearing off
Tx = will self-resolve
26
Q

Swelling (trismus) - more common in surgical exos (post-op comp 2/8)

A 
Cause = 1)hematoma 2) muscle damage 3)too much LA injected into closed space
Tx = cold compress and monitor, self-resolves
27
Q

Bruising - common (post-op comp 3/8)

A 
Cause = extravasated RBCs, common in elderly and patients on anticoags b/c they have trouble clotting.
Tx = will self resolve
28
Q

Secondary bleeding (post-op comp 4/8)

A 
Cause = secondary infection
Tx = AB (Amoxicillin and metronidazole?)
29
Q

Alveolar osteitis (post-op comp 5/8)

A 
Cause = clot dislodged, unknown etiology
Tx = 1)Alvogel optional (most common cause of foreign body rxn in dent) 2) analgesics

Typically resolves in a week (can take up to 2)

30
Q

MRONJ (medication related osteonecrosis of the jaw)
(post-op comp 6/8)

CAUSE IF ANTIRESROPTIVE DRUG = REMODELLING
CAUSE IF ANTIANGIOGENIC DRUG = ISCHEMIA

Pre-op risk assess
Post-op Diagnosis
Tx if Dx

Antiresorptive drugs = bisphos (alendronate, risedronate) + Rank-L inhib (denosumab aka prolia)

Antiangiogenic drug (zoledronic acid)

A

A) Pre-op risk assessment for referral- high risk if any of the following: 1)prev hx 2)>4y on Rank-L(e.g. denosamab)/bisp 3)currently on Rank-L(e.g. denosamab)/bisphos + extra risk fact

B) Post-op dx - 4criteria:

1) Current/prev tx w/ ANTIRESORPTIVES/ANTIANGIOGNEIC
2) exposed bone/bone probed through fistula
3) has persisted for >8w
4) no hx of radiotherapy or cancer (b/c its 100% more likely to be osteoradionecrosis or cancer causing resorb instead of meds)

Tx 
stage 0 (dx, but no necro) -->nothing
stage 1 (necro bone) -->CHX 
Stage 2 (necro bone + inf) --> CHX + AB + debride
Stage 3 (necro bone + maj inf) --> CHX + AB + resection
31
Q

Osteoradionecrosis (post-op comp 7/8)

A

Cause = radiation induced proliferation of endocytes narrowing BV–>ishemia –>necrosis. DOESN’T ALWAYS OCCUR, and if it occurs it could self-resolve in <3m.

Prevent by: don’t do surgery in radio field in the 2 weeks leading upto or 3 months after the radiotherapy

Dx criteria: 1)radiotherapy + no current cancer 2)persisting >3m

Tx: 1) debride bone back to bleeding margins 2)drugs to dilate BV

32
Q

Nerve damage (post-op comp 8/8)

A

Cause commonly IAN involvement or releasing cut of flap damaging lingual.

If temporary or injection related then monitor and should return back to normal

If severed or involvement–>refer to OS immediate to rejoin if possible.

1- viva sem 2 (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions