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BDS4 ORAL SURGERY > BDS4 Oral Surgery PPs > Flashcards

BDS4 Oral Surgery PPs Flashcards

1
Q

What foramen does the ophthalmic branch of CNV pass through?

A

Superior orbital fissure

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2
Q

What foramen does the maxillary branch of CNV pass through?

A

Foramen rotundum

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3
Q

What foramen does the mandibular branch of CNV pass through?

A

Foramen ovale

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4
Q

What is the origin, insertion, innervation & function of the masseter?

A

Origin = zygomatic process of maxilla (superficial head) & zygomatic arch (deep head)

Insertion = ramus + angle of mandible

Innervation = masseteric nerve of CNV3

Function = Elevation of mandible

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5
Q

What is the origin, insertion, innervation & function of the Temporalis?

A

Origin = floor of temporal fossa

Insertion = coronoid process & ramus of mandible

Innervation = deep temporal nerves of CNV3

Function = Elevation of mandible, retraction of mandible

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6
Q

What is the origin, insertion, innervation & function of the Medial Pterygoid?

A

Origin = medial surface of lateral pterygoid plate & maxillary tuberosity

Insertion = medial surface of angle of mandible

Innervation = medial pterygoid nerve of CNV3

Function = Elevation of mandible, protrusion of mandible, side to side movements

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7
Q

What is the origin, insertion, innervation & function of the Lateral Pterygoid?

A

Origin = greater wing of sphenoid bone (superficial head) & lateral pterygoid plate (deep head)

Insertion = articular disc of TMJ & neck of mandibular condyle

Innervation = lateral pterygoid nerve of CNV3

Function = protrusion, lateral movement, stabilisation of TMJ

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8
Q

What is the histopathology of a squamous cell carcinoma?

A
  • Increased mitotic activity
  • Cellular atypia
  • Abnormal keratinisation
  • Pleomorphism
  • Basal cell hyperplasia
  • Disturbed polarity of cells
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9
Q

Patient attends with a right body mandibular fracture.

Other than pain, bruising & swelling, list 6 other signs and symptoms of mandibular fractures:

A
  • Step deformity
  • Facial asymmetry
  • Occlusal derangement
  • Sublingual haematoma/bleeding
  • Numbness of lower lip
  • AOB
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10
Q

Patient attends with a right body mandibular fracture.

What factors cause displacement of mandibular fractures?

A
  • Direction of fracture line
  • Opposing occlusion
  • Magnitude of force applied
  • Mechanism of injury
  • Soft tissue status (intact or not)
  • Other associated fractures
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11
Q

Patient attends with a right body mandibular fracture.

What does displacement of fragments depend on?

A
  • Pull of attached muscles
  • Angulation and direction of fracture line
  • Integrity of periosteum
  • Extent of communication
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12
Q

What anaesthetic is not recommended for pregnant patients?

A

Citanest [contains Felypressin which can induce labour]

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13
Q

What type of joint is the TMJ?

A

synovial, hinge type joint

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14
Q

What artery supplies the TMJ?

A

Branches of the external carotid:
- superficial temporal artery
- deep auricular artery
- ascending pharyngeal
- maxillary artery

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15
Q

What nerves supply the TMJ?

A

Innervated by:
- Auriculotemporal branch of CNV
- Masseteric branch of CNV

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16
Q

Disc displacement with reduction:

In terms of disc and condylar movement, describe how disc displacement with reduction occurs.

A
  • Articular disc is displaced from normal position and moved anterior to the condyle
  • When the jaw opens, the displaced disc “reduces” or snaps back into its normal position between condyle and fossa
  • Associated with clicking or popping sound
  • As jaw closes the disc can again displace anteriorly causing another click/pop
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17
Q

What is the risk of not treating disc displacement with reduction?

A
  • May progress to a closed lock state
  • Wear on the disc
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18
Q

Give 5 signs of Zygomatico-Orbital fracture:

A
  • facial asymmetry
  • periorbital ecchymosis
  • subconjunctival haemorrhage
  • numbness in infraorbital area
  • step deformity of zygomatic arch
  • flattened appearance
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19
Q

How would you clinically assess for a zygomatico-orbital fracture?

A
  • visual inspection
  • palpation of zygomatic arch/infraorbital rim/maxilla
  • assessment of jaw movement & trismus
  • test for sensory deficits in the infraorbital distribution
  • check for visual diplopia
    , restricted eye movement, displacement of eye
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20
Q

What radiographic views may be taken for a zygomatic-orbital fracture?

A
  • CT scan
  • OM radiograph 10 and 40 degrees
21
Q

What INITIAL management should you consider for a zygomaticoorbital fracture?

A
  • Analgesia and anti-inflammatories to control pain and swelling
  • Consider antibiotics to eliminate infection
  • Asses for additional injuries
  • Ice to reduce swelling
22
Q

What DEFINITIVE management should you consider for a zygomaticoorbital fracture?

A

If fracture is stable & non-displaced:
- Observation and conservative care

If displaced:
- Surgery via open reduction and internal fixation with pins and plates

23
Q

What are the 5 radiographic signs of fractures?

A
  • Sharply-defined radiolucent line/lines contained within the boundary of a bone
  • Radiopaque line/area contained within the boundary of a bone (caused by overlap of bone
  • Change in normal anatomical outline/shape of a bone or soft tissue [asymmetry]
  • Opacification (i.e. ↑ radiopacity of contents) of paranasal sinuses
  • Surgical emphysema (i.e. air within the soft tissues resulting in radiolucent areas)
24
Q

What is a tripod fracture?

A

Zygomatic complex fracture that involves:
- zygomatic arch
- infraorbital rim
- lateral orbital rim

25
Q

Give 3 methods for abscess drainage post incision:

A
  • Irrigation and debridement
  • Place a drain
  • Open drainage
26
Q

Give two common bacteria found in dentoalveolar infections. For each bacteria give the antibiotic effective against it:

A

Streptococcus Anginosus = penicillin (cell wall), clindamycin (protein synthesis)

Prevotella Intermedia = penicillin (cell wall), metronidazole (DNA synthesis)

27
Q

How would you describe the key features of a swelling case to theConsultant over the telephone?

A
  • Prior to phoning, ensure that you have all the patients details to hand.
  • Ensure location for conversation is in a location that does not compromise patient confidentiality.
  • Situation – patient, age, diagnosis(a severe spreading submandibular odontogenic infection)
  • Background- Summarise the significant points in the patients history eg when/if extraction carried out, signs and symptoms since.
  • Assessment- what have you found today? Any relevant E/O and I/O findings as well as results of observations. Be specific when giving a description of the pathology ie which anatomical location (landmarks), structures involved, size of lesion (avoid non-specific terms such as small/large).
  • Recommendation- what you think should happen eg “I think this patient needs to be seen urgently as I’m concerned about their airway”
28
Q

Despite effective antimicrobial activity against oral anaerobes, clindamycin is not routinely used instead of metronidazole. Why not?

A
  • Risk of C. Difficile infection
  • Metronidazole more targeted spectrum of activity against anaerobic bacteria
29
Q

What 2 drugs are found in Co-Amoxiclav?

A
  • Amoxicillin
  • Clavulanic acid

EFFECTIVE AGAINST BETA LACTAMASE that is RESISTANT TO AMOXICILLIN

30
Q

Co-amoxiclav may be used as a second choice antibiotic.

ii. When should it be given to patients instead of the standard second choice antibiotic?

A

Severe spreading infection with spreading cellulitis and where the infection is not responding to first line antimicrobials

31
Q

State 3 red flags signs of sepsis:

A
  1. Systolic BP </= 90mmHg
  2. HR >/= 130bpm
  3. Respiratory rate >/= 25/min
32
Q

You assess a patient and they have one sepsis red flag present. What must be done next?

A
  • Dial 999 and state pt has red flag sepsis
  • Start pt on oxygen to maintain saturation >94%
  • Arrange blue light transfer to hospital
33
Q

List the therapeutic indications for XLA of mandibular 3rd molars:

A
  • Infection
  • Caries in 3rd molar or adjacent teeth
  • Periapical abscess
  • Periodontal disease
  • Cyst formation
  • Tumour formation
34
Q

What is the goal of marsupialisation of a cyst?

A

Creates a permanent opening in the cyst allowing continuous drainage and pressure release
- aim for cyst shrinkage

35
Q

Give 5 reasons for failure of endodontic treatment:

A
  • incomplete root canal filling
  • missed canals [eg accessory canals]
  • coronal leakage
  • fractured instruments
  • root fractures
36
Q

Give 2 aims of periradicular surgery:

A
  • Remove pathology and infection need root apex
  • Create a sealed apical barrier to prevent ingress of microbes
37
Q

What flap designs are used in periradicular surgery?

A
  • Semilunar flap
  • Mucoperiosteal full thickness 3 sided flap
38
Q

Name 2 instruments used in root-end preparation of periradicular surgery:

A
  • Ultrasonic tips
  • Specialised endodontic handpieces
39
Q

Name 3 retrograde root filling materials:

A
  • MTA
  • GI cement
  • Amalgam
  • Ethoxybenzoic Acid Cement
40
Q

Give five reasons for failure of periradicular surgery:

A
  • Inadequate root end seal
  • Persistent aggressive infection or pathology
  • Root fracture
  • Inadequate surgical technique
  • Patient has poor OH or fails to adhere to post op care
41
Q

Give 3 reasons why a root may fracture during extraction:

A
  • Extensive decay of tooth
  • Poor extraction technique with excessive force
  • Complex anatomy of root
42
Q

Give 3 indications for leaving a root in situ:

A
  • Close proximity to anatomical structures
  • Risk of excessive trauma required to extract
  • Pt cannot tolerate surgery
43
Q

What is an OAC vs OAF?

A

OAC = acute open passage or communication between oral cavity and sinus

OAF = chronic opening that has become lined with epithelium, forms when OAC does not heal properly

44
Q

Give 5 risk factors for development of OAC:

A
  • XLA of posterior maxillary teeth
  • Root in close proximity to sinus on radiograph
  • Pre-existing sinus pathology
  • Severe dental/maxillary trauma
  • Poor XLA technique with excessive force
45
Q

List three peri-operative signs of an OAC:

A
  • Visible communication/hole
  • Air bubbling/blood bubbling
  • Whistling sound when pt breathes
46
Q

List three post-operative signs of an OAC afte extractions:

A
  • Nasal discharge when drinking
  • Recurrent sinus infections
  • Altered voice/nasal resonance tone to voice
47
Q

Discuss three types of OAF closure methods:

A
  • Buccal advancement flap [create buccal mucoperiosteal flap, advanced to cover hole]
  • Palatal flap
  • Buccal fat pad flap
48
Q

Aside from surgery, what other management option exists for OAC pts?

A

Obturator

BDS4 ORAL SURGERY (16 decks)

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