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Flashcards in disjbaiofg midterm Deck (29)
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1

Radiographic Markers on Pano

Horizontal inclination is the most dangerous

2

what is Microneurosurgery ?

o Can help repair damaged nerves (from trauma or iatrogenic
injury)
o Ideally performed 6-12 months following trauma
o >12 months cant really help them

3

timeline of Microneurosurgery?

o If nerve shows no signs of improving - refer to specialist
within early stages (~3 mo)
o If no sharp sensation at 3 weeks – start worrying

4

Microneurosurgery procedures?

o Use sharp 15 blade to cut nerve in half and approximate back
together
o Use cadaver nerves
o Fair success rates if between 3-6 months (the earlier the
better)

5

Nerve Injury Classifications

1) Sunderland Grade (1-5)
2) Seddon Grade (Neurapraxia, Axonotmesis, Neurotmesis)
3) Tissue Damage (Myelin, Axon, Endoneurieum, Perineurium,
Epineurium)

6

Sunderland Grade (1-5)

1 = better
5= worst

7

Seddon Grade (Neurapraxia, Axonotmesis, Neurotmesis)

Neurapraxia = better
Nerotmesis = worst

8

Tissue Damage (Myelin, Axon, Endoneurieum, Perineurium,
Epineurium)

If through all layers = No recovery

9

Dry Socket AKA

fibrinolytic alveolitis or alveolitis sicca dolorosa

10

Dry Socket definition

o Increases in severity between day 1 and 3
o Accompanied by partial or total disintegration of the clot
o Can be with or without halitosis
o Looks like exposed bone (or a bony head?)

11

Dry Socket Etiology

o *Trauma, esp to the bone (crushed with elevators, not cooled)***
o Bacteria – systemic not as efficacious
o Smoking
o Fibrinolytic diathesis (birth control, high estrogen, genetics)
o PDL injections?

12

Dry Socket Incidence

o *More common in females esp if on birth control with high estrogen*
o 3-4% following routine extractions
o *45% on mandibular 3rds*

13

Dry Socket Prevention

o Antiseptic rinse – pre-op
o Atraumatic surgery – keep bone cool and don’t crush
o Intra-socket Ab – tetracycline, clindamycin
o Operate during low estrogen phase?
o No smoking
o Don’t operate during acute infection
o Copious irrigation

14

Dry Socket Longevity

Usually gets better within about 7-10 days

15

Dry Socket Treatment

o Systemic Ab NOT indicated
o Saline irrigation of socket (have pt do the same 2x daily for 7 days)
- Diluted CHX, gently brush area
o Analgesics + NSAIDS + narcotics
- NSAIDS are best
- Be careful when prescribing narcotics
o Packing, eugenol with radiopaque strip
- Topical analgesic that numbs exposed bone
- Will delay healing

16

MX 3rd Molar Treasure Hunt

May slip into the infratemporal fossa; Send to the hospital

17

Long Standing 3rd Molar in Function = RED FLAG

1) Bone is harder and more dense
2) Inflammation may cause condensing osteitis
3) Upon extraction may fracture MX tuberosity

18

Third Molar Extraction

• Take out when 1/3 to 7/8 root formation
• Epithelium hides on the distal of the 3rd molar, need to remove
• Important to remove follicle – contains pluripotent stem cells

19

Primary intention wound healing

Minimal scar and Wound sutured without complications

20

secondary intention wound healing

Infection, ischemia, tension or tissue loss and Generates excess scar tissue

21

Wound Healing

Proper surgical technique promotes primary intention healing
**applies to bone and soft tissue (scaring can occur between bone and implant upon heat formation = all bad)

22

Primary Bone Healing

• Minimal fibrous callus formation
• Achieved by using bone plates or compression screws
• Allows short duration of MXMD fixation (wiring jaw shut)
• Critical to success of dental implants

23

sutures

• All are foreign bodies, remove as soon as possible (5-7 days in
mouth)
• Resorbable sutures produce some inflammation, therefore some
scarring
o Some resorb really quickly and the wound may open up faster
• Goal: obtain hemostasis and promore primary healing

24

Suture Types **Know adv and disadv of each**

• Monofilament, Resorbable
• Monofilament, Nonresorbable
o Esthetics bc wont cause scarring
• Braided, Resorbable
o + Last longer, stronger
o - Can cause inflammation, hurts, can be a source of infection
• Braided, Non-Resorbable
o Strength

25

Monofilament suture

Adv = traps less bacteria

Disadv = knot has an easier tendancy to come unraveled

26

Braided suture

Adv = stronger, know will hold longer due to friction

Diadv = braided traps more bacteria

27

resorbable

If we have the notion that the patient will not come back

28

suture suage

Suture has been crimped and threaded (needle and suture have
already been bound together)

29

NEedle types

1) Cutting Needle- Goes through tissue fast and easy
2) Non-cutting- If suturing together intestines and nerves
3) X-1 - Identifies the size and shape of the needle; 3.0 = bigger, 4.0 = smaller

***Ideal: Smallest needle, smallest suture