Oral diseases and RAD Flashcards

Question

Principle of mandibular fracture surgical management

Answer 1

ORIF: open reduction internal fixation. Use Titanium miniplates for Fixation -supports bone in position to allow healing. Plates adapted to the curve of bone

Answer 2

Removing: -Tooth luxated and/or interfering with reduction -Tooth that is fractured or infected -gross caries, advanced perio -Mobility which would not contribute to establishment of stable occlusion. -Existing pathology e.g. cyst, pericoronitis Leave if: -vital/ firm -Does not interfere with reduction and fixation of fracture -Requires removal of excessive bone, which may compromise plate/screw fixation -Assists in establishing occlusion and reducing the fracture

Answer 3

-Maxillomandibular fixation or elastics may be used to help maintain occlusion and impacted post op swelling -Post op radiographs and Review -Encourage good OH -CHX mouthwash prescribed -Soft diet for 6 weeks -Sometimes physiotherapy used to improve mouth opening (condylar fractures) -Post op antibiotics and analgesics

Answer 4

-Inflammation and bleeding from fracture ends -Soft callus – fibrous tissue replaces haematoma. Subperiosteal bone formation begins -Hard callus – calcification of soft callus -Remodelling– once got a solid union get replacement by lamellar bone

Answer 5

-Malunion/non-union (due to fracture instability or inaccurate reduction) -Fixation failure (Due to Insufficient amount of fixation, plate fracture, screw loosening, devitalisation of bone causing loosening -Infection (Due to Non-vital tissues, fracture instability, microorganisms in fracture site -Ankylosis (If < 3 years, or prolonged MMF, or condylar head fracture) -Necrosis (due to Compromised Blood supply)

Answer 6

-Re-expose fracture site to debride wound +/- sequestrectomy -MMF/ temporary fixation -Recon plate that is load bearing to aid healing -Same stage grafting -Removal of plate if no longer functioning

Answer 7

-Diagnosed clinically, as only treated if aesthetic issue - closed reduction (manipulation under anaesthetic. No flap raised) -May require packing & splinting or septal repositioning -May need – septoplasty, rhinoplasty or septo-rhinoplasty

Answer 8

-areas of strength in mid face. designed to resist trauma and protect brain -eg. Canine and zygomatic butresses -they direct the forces up the face

Answer 9

-Zygomatic arch: restricted opening & lateral excursions, step deformities, facial flattening -Zygoma: black eye -Periorbital ecchymosis/oedema), subconjunctival haemorrhage, step deformities, paraesthesia, diplopia

Answer 10

transverse fractures involving the obital, zygomatic & nasal bones 1. Fracture of dentoalveolar complex. Runs horizontally between tooth roots and floor of the nose and & antrum. Separates the palate and alveolus from the midface 2. Pyramidal fracture of nasomaxillary complex. Runs from frontonasal junction along the infraorbital rim then along the anterior maxillary sinus wall below the zygomatic buttress. Joins across the bridge of the nose 3. Complete separation of maxillary complex (midface) from rest of cranium (skull). with breaks at the frontonasal sutures, the zygomatic-frontal sutures, the zygomatic arches, and the pterygoid plates. Causes Facial flattening

Answer 11

-Facial flattening/elongation -Bilateral facial and periorbital oedema -Epistaxis (nosebleed) -Anterior or lateral open bite (malocclusion) -Ecchymosis in the maxillary vestibule -Paraesthesia of the midface -Step deformities -Hisotory of high velocity trauma

Answer 12

-Le Fort I- movement of the entire maxilla -Le Fort II- maxilla and nasal complex -Le Fort III- entire facial complex, including zygomatic buttresses

Answer 13

- keeping exposure to ionising radiations as low as reasonably practicable. - IR(ME)R- protects patients from unintended, excessive, incorrect medical exposure, ensures the benefits outweigh the risks -IRR 17: protects employees and the public working with ionising radiation

Answer 14

-All employers must register “work with a radiation generator” with the Health and Safety Executive (HSE) -Radiation protection adviser (RPA) and their roles -ALARP- exposure are as low as reasonably practicable -Have a controlled area -Radiation protection superviser (supervises to ensure local rules and regulations are adhered to) -Safe working procedures

Answer 15

-As low as reasonably practicable -Justification, maximise distance, shielding, minimise exposure time, limitation of radiation dose, written guidelines for exposure setting, high-speed film, collimator, minimal skin to focus distance (20cm from film to focal point of generator),

Answer 16

-Appointed by the employer to comply with IRR -Radiation protection adviser -assess installation plans -Acceptance into service of engineering controls, design features, safety and warning devices in relation to new or modified radiation sources -risk assessment, local rules and contingency plans -Room design -Working arrangements for pregnant employees 6 -equipment checks -PPE -Training programmes -Prevention, investigation and analysis of accidents -Quality assurance -Periodic testing of engineering controls, design features, safety and warning devices and regular checking of systems of work

Answer 17

1. Referrer- dentist, hygienist, therapist who can refer to a practitioner. Supply adequate info to enable justification by practitioner 2. Practitioner -dentist, hygienist, therapist who takes responsibility and justifies the exposure 3. Operator- patient identification, setting it up, pressing button, processing. Nurses can also do this (extra training required for setting it up) [4. Clinical evaluation- only dentist, hygienist or therapist can do this]

Answer 18

-legally responsible person for radiological installation -identify those able to be referrer, practitioner and operator -ensure regulations are enforced and good practice is followed -follows referral guidelines -provide patients with info about benefits and risks of exposure -setting and reviewing diagnostic reference levels -appoints the RPA and RPS -risk assessment -define the controlled areas -produce local rules -clinical audits -investigate incidents -usually the practice owner

Answer 19

-dose quantity established for each standard diagnostic examination for a standard patient cohort -reviewed at least every 3 years or when changes are made to the equipment -investigation needed if patient doses regularly excess the DRL

Answer 20

-Intra-oral (mandibular molar)- 1.2mGy -DPT- 81mGy.cm2 CBCT- 265mGy.cm2

Answer 21

-CBCT- entire room -I/O and DPT: direction of the primary beam and 1.5m radius of the beam entry point

Answer 22

-IRR- reportable incidents are rare. eg. contingency plan triggered, an individual relieves an overexposure -IRMER- more common. eg. wrong patient, wrong body part, wrong image

Answer 23

-referrer gives insufficient or unclear info -no clinical indication -recent images and findings available -radiation risk not outweighed by benefits

Answer 24

-from 20 week scan to 20 years old. -2D ultrasound. Then 3D scan to know the extent. Diagnosis may not be confirmed until birth -Primary surgery when a baby (3 months for lip, 1year ish for palate) -Alveolar bone grafting of palate at 8-10 years old, just before upper 1s are about to erupt. Ortho appliance to hold in place for 6 months -rhinoplasty, speech surgery if necessary -restorative work -ortho to expand collapsed arch (before 13 years old when suture fuses) close gaps, align teeth -+/- orthognathic surgery -Lifelong care monitoring speech, hearing, feeding, psychology, appearance, dental health

Answer 25

1. Unilateral cleft lip (+/- palate)- one side of lip. Muscle of lip attached to nose. Can be part of lip or goes all the way through lip, gum, nose and palate 2. Bilateral cleft lip (+/- palate)- both sides of lip. Can extend up into gum, nose and palate 3. Cleft palate – midline of palate 4. Bilateral Cleft of palate- gap in hard and/or soft palate. 5. Submucous cleft palate – Roof of mouth is formed but muscles in wrong place. Eg. Uvula can be doubled

Answer 26

-when don’t fuse properly during development. Happens very early in pregnancy. -Normal palate formation-palatal shelves grow out from side of jaw. Grow down then lift up and grow towards each other to form middle of palate. If don’t join then creates a gap in the palate Palate fuses from the front backwards. So more severe cases extend towards the incisive fossa -Can be linked to environmental factors such as substance abuse and medications, but often no explanation. Can be genetic. -22q11 deletion associated with DiGeorge syndrome.

Answer 27

-Routine family dental care: acclimatisation, prevention -Routine interventions- restorations, extractions -Liaison with MDT team -Reinforce good OH as essential for these patients- Usually increased risk of caries. But cleft does not equal caries. It is down to oral hygiene, diet, motivation. Cleft may make OH harder -help manage potential hypoplasia, hypodontia, delayed eruption, supernumerary teeth

Answer 28

1.MRI- 3D, good for soft tissues (eg. For saliva gland tumours), no radiation, must remove magnetic metal, switch off pace-makers, noisy, claustrophobic, must tolerate lying flat and still, expensive 2.CT- 3D, high radiation, good for soft and hard tissues (not as good as MRI for soft) Cheaper than MRI, must tolerate lying flat and still, claustrophobic (but machine wider than MRI), anything metal (eg. Amalgam) can cause scatter 3.CBCT- 3D, less ionising than CT, radiation similar to DPT, good for hard tissues (eg. TMJ, ID canal, implant assessment, cysts, odontomes, fractures etc), takes seconds. Cheap, Metal causes artefacts 4.PET (either MRI or CT)- 3D, radioactive glucose to view sites with increased metabolic demand (eg. Inflammation, cancer). Expensive, long time to sit still 5.Ultrasound- 3D, no radiation, well tolerated, cheap, non-invasive, good for soft tissues, bad for hard tissues, more difficult to interpret, only good for superficial structures, can guide FNA 6.X-ray- 2D, good for hard tissues, cheap, less radiation, quick to take

Answer 29

-dental panoramic tomography -produces images of a slice of an object - 2D -focal trough= the slice that is in focus -assessing 8s, mandible fractures, periodontal bone loss, ortho assessment, bony lesions, implant planning, TMJ disorders

Answer 30

-Absorbed= energy per kg. Grays -equivalent= calculated for different organs. mSv. In dentistry it is the same to absorbed dose -Effective dose= takes into account radiosenstitivity of tissues. mSv

Answer 31

-more comfortable for patient, quick. Useful when a patient's anatomy prevents the proper placement of the film, eg. shallow palate, difficulty opening their mouth wide, gag reflex -placing the film as close to the tooth as possible and directing the X-ray beam at a line that bisects the angle between the tooth and the film -BUT image distortion, less reproducible, risk coning off of the image

Answer 32

-Tinnest point of tooth- between ADJ and bone. So high penetration of beam so looks dark

Oral diseases and RAD Flashcards

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