Oral Surgery (doc micks) Flashcards
(183 cards)
1
Q
Horizontal incision along the crest of the ridge or gingival sulcus
Without incision
A
Envelope flap/ Crestal flap/ Sulcular/ Horizontal
2
Q
with 1 VI
A
Triangular Flap
3
Q
with 2 VI
A
Trapezoidal flap - best access
4
Q
for small apical lesion but with normal bone support
convex area is directed towards the occlusal
A
Semilunar Flap
5
Q
submarginal incision flap ( Luebke -Ochsenbein)
A
Modified Trapezoidal Semilunar Flap
6
Q
ORo - antral communication (Max. sinus perforation)
Traumatic extraction or aggressive infection
Most commonly displaced root- Palatal root of Max. 1st Molar
A
Pedicle Flap
7
Q
1-2mm - Oro antral comminication
A
No tx
8
Q
2-6mm
A
Figure of 8 to retain clot
9
Q
6mm or larger
A
Watertight closure with
- Buccal advancement flap (Berger’s technique)
- Palatal pedicle flap
- Pedicled Buccal fat pad
10
Q
to remove infected tissue , mucosa, or foreign objects from max. sinus
At the maxillary premolar area above the roots
A
Caldwell- Luc Technique
11
Q
BE. ‼️📌 Where can you find stratified squamous epithelium in the max. sinus
A
In cases of Oro- antral fistula
12
Q
Mechanical Principles of Extractiom
A
- ,Expansion of Bony socket
- Lever
- Wedge
- Wheel & Axle
13
Q
extraction forces
A
Apical- Buccal - Lingual - Rotation- Traction
14
Q
Order of Extractiom
A
Max. first before Mandibular
Posterior first before Anterior
15
Q
BE‼️📌 weakest portion of the needle
A
HUB
16
Q
Where to grip the needle holder
A
2/3 from the tip of the needle
17
Q
Closest of ideal suture
A
Goretex
Polyetrafluoroethylene
18
Q
BE‼️📌 Goretex can also be used as a barrier membrane material for
A
GTR
19
Q
single sutures with separate knots
best securing the papilla
A
Interrupted
20
Q
long span multiple extraction cases
A
Continuous
21
Q
used to close open socket & to prevent clot displacement
A
Figure of 8
22
Q
everted wound edges (ex. maxillary torus removal)
for suturing two adjacent papillae with one suture
A
Horizontal Mattress
23
Q
controlling bleeding deep soft tissue incision
A
Vertical Mattress
24
Q
Tooth Displacement
A
- Maxillary Sinus
- Infratemporal space/ Fossa
- Buccal space
- Submandibular Space
25
is thin bone & may fracture
Max. Tuberosity
26
remove suture tightly
If more than 2/3
27
If less than 2/3
detached to periosteum - reposition fractured segment suture tightly
28
If tooth is infected
remove tooth them fractured tuberosity & suture tightly, irrigate well
29
impacted max. 3rd molar is pushed through the periosteum
Infratemporal fossa/ space
30
Dry socket
Alveolar Osteitis / Fibrinolytic Alveolitis
31
suspected malignancy
Do not Exo
because of the risk of tumor seeding
Lateral spread of malignant cells along a wound/ needle tract
32
When is pain felt in cases of dry socket
2-4 days
33
can be rub off
Candidiasis
34
Stretch
Leukoedema
35
can't rub off /stretch
Leukoplakia
36
Wound Healing 3 Phases
Inflammatory
Proliferative
Remodeling
37
Initial Lag phase, Immediate 2-5 days
* Hemostasis
- Vasoconstriction- spontaneous reaction
- Platelet aggregation
- Thromboplastin makes clot
* Inflammation
- Vasodilation
- Phagocytosis
Inflammatory Phase
38
Fibroblastic Phase : 2 days - 3 wks
* Granulation - main purpose : fill defect , facilitate further healing granulation tissue formation
- Fibroblast lay bed of collagen - reticular type III
- fill defects and produces new capillaries
* Contraction
- wound edges pull together to reduce defect
* Re-epithelialization
Proliferative Phase (;Fibroblastic Phase 2days - 3wks)
39
new collagen forms which increases tensile strength of wounds
Scar tissue is only 80% strong as original tissue
Remodeling Phase (3 wks - 2 yrs)
40
stabilized essentially same anatomic position prior to injury
- Wound repair then occurs with minimal scar tissue
Primary Intention
41
gap left is betweem woumd edges after repair (tooth socket)
| it implies that tissue loss has occurred in the wound & requires granulation tissue
Secondary Intention
42
occurs when a wpund is initially left open for a period of observation before closure
Associated with tissue grafts & implants
Tertiary Intention (Delayed Primary Closure)
43
What intention is dental implants
Tertiary Intention
44
Local measures to control hemorrhage
1. Local pressure
2. :Gelfoam
3. Extraction socket packing materials
4. Electrocautery or Electrosurgery
5. Ice or cold compress
6. Tannic Acid / Tannins (Tea bag)
7. Sutures
45
3 types of Hemorrhage
1. Primary
2. Secondary
3. Reactionary
46
during surgery hemorrhage
Primary
47
occurs up to 2 wks post. op (infection)
Secondary
48
hours after surgery disruption of wound
Reactionary
49
‼️📌BE.
| What do you call bleeding in an extraction socket after a few days due to wound sepsis-
Secondary
50
‼️📌BE
Primary Lesions
FLAT= MAPA
Flat non- palpable lesions- skin discoloration
(ex. freckles, flat moles, port- wine stain)
ex.
Macule
Papule
51
<10mm - small
Macules
52
>10 mm - large
Papule
53
‼️📌BE
| Elevated Lesions - PA-PLA- Nod
Papule
Plaques
Nodule
54
ex. of Elevated Lesion
Nevi, warts , lichen planus, insect bites
55
<10 mm small
Papules
56
>10 mm - large
Plaques
57
firm lesions that extend into the dermis or subcutaneous tissue
Nodules
58
ex. of nodules
Cysts
Lipoma
Fibroma
59
Clear- fluid filler blister VBP
Vesicles
Bullae
Pustules
60
clear fluid filler blister - <10mm- small
Vesicles
61
clear fluild filler blister
| >10mm large
Bullae
62
vesicles contain pus
Pustules
63
‼️📌BE
| What primary lesioj appears loculated
Vesicles
64
Secondary Lesion
1. Erosions
2. ,Ulcers
3. Fissure
4. Atrophy
5. Excoriation
6. Crusts (scabs)
7. :Scale
8. Scar
9. ,Eschar
65
shallow, superficial opening that shows loss of part or all of the epidermis
Erosions
66
crater-like lesions with loss of the epidermis & at least part of the dermis
Ulcers
67
linear often painful deep breaks within skin surface
| result of excessive xerosis (dryness of skin)
Fissure
68
localized shrinking of the skin which result in paper thin, wrinkled skin with easily visible vessels
results from loss of epidermis, dermis or both
Atrophy
69
linear erosion caused by scratching , rubbing or picking
Excoriation
70
consist of dried serum, blood or pus over damaged layers of skin
Occurs in inflammatory or infectious skin diseases (eg. impetigo)
Crusts (scabs)
71
thin, compressed superficial accumulation of horny epthelium
Scale
72
permanent fibrotic skin changes that develop as consequences of tissue injury
Scar
73
necrotic tissue discarded from the surface of the skin following injury or disease
Burn px or gangrene
Eschar
74
elevated lesions caused by localized edema
Urticaria (wheals or hives)
75
non-blamchable, small foci of hemorrhage.
| Causes include platelet abnormalities
Petechiae <3 mm
76
3-10 mm larger area of hemorrhage that may be palpable
| may indicate a coagulopathy
Purpurs
77
>10mm flat , discoloration from bleeding underneath the epithelium
Ecchymosis
78
extravasation & pooling of blood into a space within tissues
Hematoma - tumor like
79
portion of axon distal to the site of injury degenerate
| within 78 hrs phagocytosis by adjacent schwann cell & by macrophages
Wallerian degeneration
80
schwann cell outgrowths from portion of axon distal to site of injury attempt to connect the proximal & distal nerve stumps
Bungner's Band
81
axonal outgrowths randomly aligning with fibrin clot
Neuroma
82
proximal to the site of injury
Retrograde/ Primary Nerve
83
Which classification always requires bone & tooth reduction
Horizontal
84
Winter's Line
occlusal plane help assess the axial inclination of the impacted tooth
White line
85
alveolar crest shows amount of overlying bone
Amber
86
vertical line from amber line to CEJ on mesial side; measures depth of impaction
if 5mm longer, is indicative that the tooth should be removed under GA
Red line
87
Preparing for wound closure
1. Curette- remove the follicular sac attached to distal 2nd molar
2. Bone file
3. Irrigate w/ NSS- Isotonic solution
88
bone is broken
skin or mucosa is not broken
no communication between fracture & external environment
Simple Fracture / close fracture
89
both bone & skin are broken
seen in oral cavity even if no mucosal lacerations
PDL space provides communication with external environment
Compound fracture / open fracture
90
1 bone more than 1 fracture line
Complicated fracture / Complex fracture
91
bone is broken into several pieces because fracture line did not travel in a linear pattern
can be simple (crush wounds)
Compound (gun shot wound)
Comminuted Fracture
92
one side fracture other side is bent
| more common in younger patients because bone is more resilient (high organic content)
Greenstick
| Tx. Interdental wiring
93
📌‼️BE
| What type of fracture implies damage to adjacent vital structures
Complex fracture- free fragment can impinge on the adjacent structures
94
Floating Jaw
| Surgical principle in orthognathic surgery
Le Fort I (Horizontal/ Guerin's / Low Maxillary/ Transmaxillary Fracture)
Le Fort I Osteotomy
95
Base:
Apex:
Battle's sign or Post - Auricular Ecchymosis
Hemorrhage of pterygoid plexus- connection of veins
Raccoon Eye- bilateral hemorrhages of the eye
Dentition
Nasofrontal suture
Le Fort II / Pyramidal Fracture
96
Tx. Le Fort II
Upper Eyelid Incision
97
discontinuity between the cranial bone & facial bones
Dish face (big concavity)
CSF rhinorrhea
Le Fort III/ Transverse Fracture/ Craniofacial Dysjunction/ Basilar Fracture
98
3 common sites of Fracture
Condyle
Angle
Symphysis
99
📌‼️BE
| bilateral condyle + symphysis
Guardsman Fracture
100
bilateral mand. body fracture (edentulous px)
Bucket Handle Fracture
101
Ellis Classification
102
Tripod Fracture
Zygomaticomaxillary Complex Fracture
103
📌‼️BE
| Which is not a sign w/ Tripod Fracture
Anosmia
104
sinuses
Water's View
105
view of both arches (Orthopantograph)
Panoramic Radiograph
106
condylar neck fractures
| similar to postero-anterior view
Reverse- Towne's View
107
zygomatic arch
Submentovertex View / Jug handle
108
ORIF
Open reduction & Internal Fixation
109
Dental wiring for wiring technique jaw fracture
External fixation
110
tooth tied to the tooth using stainless steel wire
Interdental Wiring Technique
111
bone tied to the bone using stainless steel wire
Interosseous Wiring Technique
112
used edentulous mandible
Circumferential wiring
113
📌‼️‼️‼️BQ.
1. Best tx for Greenstick fracture of Mandible
2. Condylar Neck Fracture displaces the condyle due to
3. Radiographs useful in confirming Mandibular Fracture
4. Basic Principles in tx Mandibular Fracture
5. Fracture at Mand. condyle (subcondylar region) jaw deviates where?
1. INTERDENTAL Wiring
2. Lateral Pterygoid Muscle
3. Panoramic Best: CBCT
4. 1. Reduction & Fixation 2. Restoration of Occlusion
5. Forward medially
114
Subcondylar fracture of mandible
same side jaw deviation
115
Muscles determines the infection Intraoral & Extraoral swelling
Masseter
Buccinator
Mylohyoid
116
Above mylohyoid
Intraoral swelling
117
Below mylohyoid
Extraoral swelling
118
For Mand. Teeth
More posterior:
More anterior:
Below mylohyoid
| Above mylohyoid
119
guide to occlusion
Splint
120
‼️📌BE
| What muscle does the needle pass through conventional IAN block
Buccinator Muscle
121
Cellulitis ( Phlegmon)
```
Acute
Severe/ Generalized
Large
Diffused borders
Doughy to indurated
No pus
Greater seriousness
Aerobic / Mixed
```
122
Abscess
```
Chronic
Localized
Small
Well- circumscribed
Fluctuant
Yes pus
Less seriousness
Anaerobic
```
123
‼️📌BQ
1. Most serious complication from Facial Abscess secondary to infected maxillary canine
2. Needle aspiration of central bone lesion
3. 3rd molar imfection DIRECTLY spreads to
4. Infection in the pterygomandibular space
1. CST
2. We need to see if vascular lesion (Hemangioma)
3. Submandibular, Pterygomandibular, Parapharyngeal spaces
4. Intraoral drainage perforates the buccinator muscles
124
Px. experiences difficulty breathing & speaking
Submandibular
Sublingual
Submental spaces
Ludwig's angina
125
Tx. Ludwigs Angina
IV antibiotics
Emergency department first
Prevent further airway obstruction first
126
infection of the marrow spaces/ cancellous bone
Osteomyelitis
127
necrotic bone separated from healthy bone
Sequestrum
128
sclerotic bone that shields healthy bone away from necrotic bone
Radiopaque & is not removed
Involucrum
129
exit of pus preventing further spread of infection
Cloaca
130
surgical removal of sequestra to prevent the spread of infection & minimize tooth mobility & bone loss
131
allow you to visualizs the entire infected area
| eliminatin of healthy bone until you expose the undercut
Saucerization
132
removal of undermined & infected cortical plates of bone
Decortication
133
retrograde progression of infection against the flow of veins from the source of infection towards the cavernous sinus
CST / CS Thrombophlebitis
134
Types of Biopsy
1. Excisional
2. Incisional
3. Exfoliative Cytology
4. Fine Needle Aspiratiom Biopsy
135
not the most accurate
Exfoliative Cytology
136
used in radical neck dissection
Malignant lymph nodes of the necks are removed , frozen & immediately examined until 2 consecutive nodes are determined to be benign
Frozen-Section Biopsy
137
Specimen handlinfg
10% Formalin solution
138
total removal of a cystic lesion
Enucleation
139
surgical opening a cystic cavity
| to decrease intracystic pressure & prevent further expansion of cyst
Marsupialization// Decompression// Partsch Operation
140
with removal 1-2mm of bone around the entire periphery of the cystic cavity
this is reserved for more aggressive pathologic lesions
prevent recurrence
Enucleation with Curettage
141
cauterizing & fixating agent that penetrates cancellous spaces in the bone at 1.5-2mm
Carnoy's solution
142
carnoys solution
anti mitotic
used for SCC & BCC
5- FLUOROURACIL ointment
143
Dimension for choosing an Implant
Length- vital structures
| Width - adjacent teeth implants
144
Greater surface area
Greater osseointegration
145
Between implant & vital structure & Between implant & natural tooth
1.5mm
146
Implant - Implant
3mm
147
What to do if implant approximates vital structure on post-op radiograph
Withdraw implant
148
Why titanium
Biocompatible
149
Why is constant irrigation necessary
Necrosis 47*C
150
What is the direct connection between lining bone & a load bearing endosseous implant at the light microscopic level
Osseointegration
151
Types of Implants
1. Endosseous
2. Subperiosteal
3. Transosseous
152
surgically inserted into the jaw bone
| Most commonly used type
Endosseous
153
custom made to fit on supporting areas in the jaws
| type of implant that RIDES on bone underneath the mucoperiosteum
Subperiosteal
154
penetrate the entire jaw
Transosseous
155
Bone Repair
1. Osteogenesis
2. Osteoconduction
3. Osteoinduction
156
formation of new bone from osteoprogenitor cells
Osteogenesis
157
passive framework or scaffold to guide formation of a new bone
Osteoconduction
158
illicit bone formation
Osteoinduction
159
Classification of Grafts
1. Autogenous (autografts)
2. Allogenic ( allograft)
3. Isogenic (Isografts)
4. :Xenogenic
5. Alloplast
160
same individual
best
iliac crest, lateral ramus , ant. mandible
Autogenous (Autografts)
161
cadaver
Allogenic (allografts)
162
high rate of dieases transmission, infection
Fresh- Frozen
163
osteoconductive , used together with autografts
Freeze- Dried
164
exposes BMP which are osteoinductive
| osteoconductive but lacks mechanical strength
Demineralized Freeze Dried
165
same species & related
Isogenic (Isografts)
166
another species usually bovine , porcine
Xenogenic
167
synthetic graft material
Alloplast
168
Mostly cortical bone mass
Ant. Mandible
High implant stability but low blood supply
D1
169
Thick cortical bone with coarse trabecular bone underneath
Ant.& Posterior Mandible
High implant stability with excellent blood supply
D2
170
Porous cortical bone with fine trabecular bone underneath
Posterior Mandible, Ant. Posterior Maxilla
Low implant stability
D3
171
Mostly fine trabecular bone
Posterior Maxilla
Most challenging
D4 - soft
172
What characteristic of Chlorhexidine makes it valuable antiseptic mouth rinse?
long term effect stay add antimicrobials
Substantivity
173
long narrow beak with parallel striations
Hemostat
174
Can autoclave
Fraser Aspiration
175
Disposable syringe
16-18G, 10-20cc
176
worst place perforate the lower molar
Bifurcation
177
No radiograph evidence
| + percussion
Symptomatic Apical Periodontitis
178
151 mandibular
44 - rf
16
17
179
Maxillary
150
69
180
Mental foramen implant
5mm
181
IAN implant
2mm
182
Buccal & Lingual implant
1-2mm
183
Max. Sinus implant
1mm
