Maxilofacial Surgery

• General Anaesthesia & Sedation in Oral & Maxillofacial Surgery
• Temporomandibular Joint Disorders
• Orthognathic Osteotomy Procedures
• Maxillofacial Trauma
• Pre-Prosthetic Surgery
• Extraction
• Cysts & Tumours of the Orofacial Region
• Salivary Gland Disorders

• Maxillary Sinus & Its Implications
• Orofacial & Neck Infections
• Facial Neuropathology
• Distraction Osteogenesis
• Clefts Lip & Palate
• Implants
• Clinical Topics
• Oral and Maxillofacial Surgery

Distraction Osteogenesis Definition

Distraction Osteogenesis: Distraction Osteogenesis is a technique by which lengthening of a bone by new bone formation occurs in between the 2 osteotomies distracted fragments

Distraction Osteogenesis Short Essays

Question 1. Distraction osteogenesis.
Answer:

Distraction Osteogenesis Of Definition:

Distraction Osteogenesis is a technique by which lengthening of a bone by new bone formation occurs in between the 2 osteotomised distracted fragments

Distraction Osteogenesis Of Advantages:

• Safer
• Decreased morbidity
• Decreased operative time
• Conservative
• Can be done in younger patients
• No bone grafting needed
• Growth of bone & soft tissue

Distraction Osteogenesis Phases

Read And Learn More: Oral and Maxillofacial Surgery Question and Answers

Distraction Osteogenesis Of Indications:

1.  Mandibular:
   • Microsomia
   • Syndromes
   • TMJ conditions
   • Trauma
   • Deficiencies
2. Maxillary:
   • Cleft lip/ palate
   • Deficiency
   • Palatal expansion
3. Craniofacial:
   • Syndromic condition

Distraction Osteogenesis Of Steps:

• Surgical fracture
• Controlled segmental movement
• The bone formation between segments
• Soft tissue remodeling

Distraction Osteogenesis Phases

Distraction Osteogenesis Of Principles:

1.  Bone C ut:
   • Done along with preserving the blood supply
2. Latency:
   • 5–7 days in older patients
   • 1–2 days in younger patients
3.  Rate:
   • It refers to the amount of separation Usually needed 1 mm per day
   • Younger patients: 1.5-2 mm per day
   • In necrosed patients: 0.5-1 mm per day
4. Rhythm:
   • Refers to frequency of application of force
   • 2 times a day
5. Consolidation Phase:
   • 4–6 weeks
6. Retention Phase:
   • Refers to the removal of appliances & stabilization of the jaw.

Orthognathic Surgery And Osteotomy Procedures Important Notes

1. Indications Of Sagittal Split Osteotomy:

• Mandibular prognathism
• Mandibular retrognathia
• Bimaxillary protrusion
• Skeletal open bite
• Mandibular excess

2. Classification Of Osteotomy Procedures:

1. Mandibular Body Osteotomies
   • Mandibular body osteotomies
     • Anterior body
     • posterior body
     • Midsymphysis
   • Segmental Subapical
     • Anterior
     •  Posterior Total
   • Genioplasties
     • Augmentation
     • Reduction
     • Straightening
     • Lengthening
2. Mandibular ramus osteotomies
   •  Sub condylar
   •  Bisagittal split
3.  Maxillary osteotomy procedures
   • Segmental
     • Single Tooth
     • Interdental
     • Anterior
     • Posterior
   •  Total
     • Superior repositioning
     • Inferior repositioning
     • Advancement of maxilla
     • Leveling of maxilla

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3. Types Of Genitoplasty:

• Augmentation genioplasty
• Reduction genioplasty
• Straightening genioplasty
• Lengthening genioplasty

4. Treatment For Mandibular Prognathism:

• Sagittal split osteotomy with mandibular setback Oblique sub condylar osteotomy

5. Bilateral Sagittal Split Osteotomy:

• First described by Trauner and Obwegesser
• Modified by Dalpont, Hunsuck, and Epker It is the most popular and versatile procedure
• Performed on mandibular ramus and body
• The osteotomy splits the ramus and the posterior body of the mandible sagitally
• This allows either setbacks or advancement

6. Various Malocclusion And Their Treatment Options;

Orthognathic Surgery And Osteotomy Procedures Long Essays

Question 1. Pre-operative planning in orthognathic surgery.
Answer:

Assessment Of Patient:

• Includes:
  • Patient’s chief complaint
  • Patient’s expectations
  • Medical status of the patient
• Patient’s Examination:
  • Hard & soft tissues examination
  • TMJ evaluation
• Measurement Of Facial Proportions:
  • Dividing facial contour in 3 horizontal planes & comparing them
  • Dividing facial contour in 3 vertical planes & comparinging them
  • Facial profile examination
• Radiographic Examination:
  • Conventional radiography: For assessing any pathology
  • Cepholometric analysis
  • Hard & soft tissue landmarks are marked & jaw & face
  • contour is analysed
  • Special radiography done
  • Facial photography: For maintaining records
  • For computer-aided analysis
  • For treatment planning
  • For comparing pre- & post-operative appearance
• Model Surgery:
  • Involves the construction of occlusal models
  • Predict any occlusal problems
  • Modify orthognathic movements
• Treatment Planning:
  • All data is collected
  • Analysis is done
  • Review all orthodontic & surgical options
  • Decision made on whether surgical or orthodontic treatment is required

Phases Of Treatment:

1.  Pre orthodontic preparatory phase
   • Treatment of periodontics & restorative problems
2. Pre-surgical orthodontics
   • Orthodontically aligning of teeth
3. Surgical phase
   • Model surgery done
   • Fabrication of splint
   • Osteosynthesis done
4. Post-surgical phase
   • 4–8 weeks after surgery
   • Closing of spaces present
   • Removal of orthodontic brackets
   • Applying retainers
5. Prosthodontics phase
   1.  Placement of implants
   2. Periodontal management
   3. Esthetic restoration

Orthognathic Surgery And Osteotomy Procedures Short Essays

Question 1. Bilateral sagittal split osteotomy.
Answer:

Bilateral Sagittal Split Osteotomy

Described by Obwegeser & Trauner

Procedure Of Bilateral Sagittal Split:

• Bite block inserted on opposite side
• Incision made on lateral ascept of anterior border of the ramus
• Extend the incision into the vestibular depth
• Soft tissue dissection done
• Soft tissues are reflected
• Medial bone cut is done through lingual cortex
• Cut extended upto second molar region bite block is removed
• Separate the segments with the help of osteotome
• Accordingly, advancement or setback is done
• Fix the fragment

Question 2. Anterior maxillary osteotomy.
Answer:

Anterior Segmental Osteotomies:

• Indications:
  • Pre-maxillary protusion
  • Deep bite
  • Anterior open bite

1. Wassmund Procedure:

• Blood supply is from palatal mucoperiosteum Vertical incision given in the premolar region
• A small vertical incision given in the midline to expose the anterior nasal spine
• Premolars are extracted
• Buccal bone cuts are made
• The palatal cortical plate is cut vertically
• · Detach the nasal septum
• Mobilize the segment
• Reposition it to the desired position
• Fix it
• Closure of wound

2. Wunderer’s Procedure:

•  Blood supply is from buccal mucoperiosteum
• Horizontal incision is given across the palate
• Vertical incisions made in buccolabial sulcus
• A small vertical incision given in the midline to expose the anterior nasal spine
• Extract the premolars
• Buccal bone cuts given
• Detach nasal septum
• Mobilize palatal bone cut
• Mobilize anterior segment
• Fix & sutured it

Question 3. Mandibular hypertrophy.
Answer:

Features Of Mandibular Hypertrophy:

1. Extraoral features:
   • Concave profile
   • Anterior facial divergent
   • Prominent chin
2. Intraoral features:
   • Class 2 malocclusion
   • Lingually tilted lower incisors
   • Anterior cross bite
   • Narrow upper arch
   • Wide lower arch
   • Posterior crossbite
   • Crowded upper teeth
   • Spacing present in lower teeth

Treatment Of Mandibular Hypertrophy:

• Chin cup therapy to restrict maxillary growth
• In nongrowers
• Surgical mandibular setback which is followed after split osteotomy

Question 4. Genioplasty.
Answer:

Genioplasty

Used as an adjunctive

Types Of Genioplasty:

1. Augmentation Genioplasty:
   • Deglove inferior border of the symphysis
   • Periosteal releasing incision given
   • Horizontal osteotomy cut given at the apices of canine
   • Segment is mobilized
   • Removal of bony interferences
   • Check for the facial contour
   • Fix the superior body
2. Reduction Genioplasty:
   • Horizontal osteotomy cuts are given
   • Setback the fragment
   • Excise the bony interference
   • Fix the fragment
3.  Straightening Genioplasty:
   • Horizontal osteotomy cut are given
   • Shift segment laterally
4.  Lengthening Genioplasty:
   • Horizontal osteotomy cut are given
   • Segment is shifted inferiorly
   • Bone graft is sandwiched between the fragments.

Question 5. Cephalometry
Answer:

1. Introduced by Broadbent in USA & Hofrath in Germany in 1931
2. Describes analysis & measurements made on the cephalometric analysis

Types Of Cephalometry:

1. Lateral cephalogram
2. Frontal cephalogram

Uses Of Cephalometry:

• For diagnosis
• To study dental & soft tissue structures
• For the classification of skeletal & dental abnormalities
• Assess facial type
• For treatment planning
• For presuming results
• For predicting growth-related changes
• For research work

Question 6. Treatment for mandibular prognathism.
Answer:

Treatment For Mandibular Prognathism

• Sagittal split osteotomy with mandibular setback
• Oblique sub condylar osteotomy
  • Described by Obwegeser & Trauner

Procedure Of Treatment For Mandibular Prognathism:

• Bite block inserted on the opposite side
• Incision made on the lateral aspect of the anterior border of the ramus
• Extend the incision into the vestibular depth
• Soft tissue dissection done
• Soft tissue reflected
• Medial bone cut done in second molar region
• The bite block is removed
• Separate the segments with the help of osteotome
• Setback is done
• Fix the fragment

Orthognathic Surgery And Osteotomy Procedures Short Question And Answers

Question 1. Shift cone technique.
Answer:

Shift Cone Technique

Shift Cone Technique is an object localization technique

Technique Of Shift Cone:

• A standard radiograph is taken
• The tube is shifted either mesially or distally
• Second radiography is taken
• If an object appears on the same side, then it is located lingually
• If the object appears on the opposite side in the radiograph, then it is located buccally
• Also called same lingual opposite buccal [Slob Technique]

Question 2. Indications of sagittal split osteotomy.
Answer:

Indications Of Sagittal Split Osteotomy

• Mandibular prognathism
• Mandibular retrognathia
• Bimaxillary protrusion
• Skeletal open bite
• Mandibular excess

Question 3. Classification of Osteotomy procedures.
Or
Mandibular orthognathic producers.
Answer:

1. Mandibular Body Osteotomies:
   • Mandibular body osteotomies:
     • Anterior body
     • posterior body
     • Midsymphysis
   • Segmental Subapical:
     • Anterior
     • Posterior
     • Total
   • Genioplasties:
     • Augmentation
     • Reduction
     • Straightening
     • Lengthening
2.  Mandibular Ramus Osteotomies:
   1. Sub condylar
   2. Bisagittal split
3. Maxillary Osteotomy Procedures:
   • Segmental:
     
     • Single Tooth
     • Interdental
     • Anterior
     • Posterior

• • Total:
    • Anterior
    • Posterior
    • Superior repositioning
    • Inferior repositioning
    • Advancement of maxilla
    • Levelling of maxilla

Question 4. Define orthographic surgery.
Answer:

Orthographic Surgery

1. Orthognathic surgery is the art and science of diagnosis treatment planning & execution of treatment by combining orthodontics & oral & maxillofacial surgery to correct musculoskeletal endosseous & soft tissue deformities of the jaws & associated structures.
2. In severe skeletal deformities, orthodontic along may compromise stability & esthetics & surgery alone may compromise function & stability.

Ortho gnathic Surgery And Osteotomy Procedures Viva Voce

1. Genitoplasty is done to correct the deformities of the chin without altering the denture-bearing part
2. Anterior maxillary osteotomy is combined with an anterior subapical mandibular osteotomy to correct bimaxillary protrusion
3. In reduction genioplasty, the symphysis part of the mandible is reduced so that chin will attain a straight profile
4. Lefort I osteotomy are commonly performed procedure for the treatment of maxillary retrognathia
5. Apertognathia is a condition in which there is open bite deformity
6. During genitoplasty there are chances of injuring mental nerve

Maxillofacial Trauma Important Notes

1. Classification Of Fracture

• Classification Of Fractures Of Maxilla: 
  1. Lefort classification
     • Lefort 1
     • Lefort 2
     • Lefort 3
  2. Erich’s classification Horizontal fracture
     • Pyramidal fracture
     • Transverse fracture
  3. Depending to the zygomatic bone
     • Sub zygomatic
     • Supra zygomatic
  4. Depending on level
     • Low level
     • Mid-level
     • High level
• Classification Of Mandibular Fractures:
  • General Classification
    1. Simple/closed
       • Doesn’t communicate with the exterior
    2. Compound
       • It communicates with exterior
    3. Comminuted
       • Bone is crushed into pieces
    4. Complex
       • Involvement of vital structures
    5. Impacted
       • One fragment driven into other
    6. Greenstick
       • Fracture of one fragment & bending of other
    7. Pathological
       • Superimposition of disease
  • Completeness
    • Complete fracture
    • Incomplete fracture
  • According To The Favourability & Direction
    • Horizontal favourable fracture
    • Horizontal unfavourable fracture
    • Vertical favourable fracture
    • Vertical unfavourable fracture

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• • Kazanjian Classification:
    • Class 1: When teeth present on both sides of the fracture line
    • Class 2: When teeth are present only on one side of the fracture line
    • Class 3: When either side of the fracture line is edentulous
  • Anatomical Classification:
    • Symphysis fracture
    • Canine region fracture
    • Body fracture
    • Fracture of angle
    • Fracture of ramus
    • Coronoid fracture
    • Condylar fracture
    • Fracture of dentoalveolar region

2. Favourable And Unfavorable Fractures:

1. Horizontally Favorable Fracture: When viewed from side, the fracture line runs from the lower border of the mandible extending upward and backward to meet the upper border
2. Horizontally Unfavorable Fracture: The Fracture line extends from the lower border in an upward and forward direction to meet the upper border
3. Vertically Favorable Fracture: When viewed from above the fracture line that runs from buccal plate obliquely backward towards the lingual plate, it will resist medial displacement of the posterior segment
4. Vertically Unfavorable Fracture: If the vertical direction of the fracture line favors the unopposed action of the medial pterygoid muscle, the posterior fragment will be pulled lingually

3. Management Of Mandibular Fractures

•  Wiring:
  • Essig’s wiring
  • Gilmer’s wiring
  • Risdon wiring
  • Eyelet wiring
  • Multiloop wiring
• Arch Bar Fixation
• Bone Plating

4. Important Features Of Different Types Of Fractures:

5. Methods Of Immobilization Of Mandibular Fractures:

• Osteosynthesis without IMF
• Intermaxillary fixation
• IMF with osteosynthesis

6. Principles Of Fracture Management:

• Reduction
• Fixation
• Immobilization

7. Line Of Fracture:

1. Lefort 1:  Fracture line extends from the nasal septum to the lateral pyriform rims, travels horizontally above the teeth apices runs below the zygomatic buttress and crosses the lower third of the pterygoid laminae
2. Lefort 2: The fracture line runs from the middle area of the nasal bone down either side crossing the frontal process of the maxilla into the medial wall of each orbit  Within each orbit the line crosses the lacrimal bone behind the lacrimal sac
3. Lefort 3: The fracture line extends from the frontonasal suture transversely backward parallel with the base of the skull and involves full depth of the ethmoid bone including the cribriform plate

8. Classification Of Condylar Fractures

• General Classification:
  • Simple fracture
  • Compound fracture
  • Comminuted fracture
• Lindhal Classification:
  1. Fracture Level
     • Condylar head fracture
     • Condylar neck fracture
     • Subcondylar fracture
  2. Relationship Of The Condyle To Ramus:
     • Undisplaced
     • Deviated
     • Displaced with medial overlap
     • Displaced with lateral overlap Anteroposterior overlap
  3. Relationship Of Condylar Head To Fossa:
     • No displacement
     • Displacement
     • Injury to meniscus
• Maclennan Classification:
  • No displacement
  • Deviated
  • Displacement
  • Dislocation

9. Complications Of Fractures:

1. Early Complications:
   • Local:
     • Haemorrhage- Internal or external
     • Damage to vital structures
     • Damage to surrounding tissues, nerves or skin
     • Haemarthrosis
   • Systemic Complications:
     • Fat embolism
     • Shock
     • Thromboembolism
     • Pneumonia
2. Late Complications
   • Local Complications:
     • Delayed union
     • Non-union
     • Malunion
     • Myositis ossificans
   • Systemic Complications:
     • Gangrene, tetanus, septicaemia
     • Osteoarthritis

Maxillofacial Trauma Long Essays

Question 1. Classify fractures of maxilla & mandible. Discuss the management of mandibular fractures. Management And types of Dental Wiring
Answer:

Classification Of Fractures Of Maxilla:

1. Lefort Classification:
   • Lefort I
   • Lefort II
   • Lefort III
2.  Erich’s Classification:
   • Horizontal fracture
   • Pyramidal fracture
   • Transverse fracture
3.  Depending To The Zygomatic Bone:
   • Sub zygomatic
   • Supra zygomatic
4.  Depending On Level:
   • Low level
   • Mid level
   • High level

Classification Of Mandibular Fractures:

1. General Classification:

• Simple/Closed: Doesn’t communicate with exterior
• Compound: It communicate with exterior
• Comminuted: Bone is crushed into pieces
• Complex: Involvement of vital structure
• Impacted: One fragment driven into other
• Greenstick: Fracture of omne fragment and bending o other
• Pathological: Superimposition of disease

2. Completeness:

• Complete fracture
• Incomplete fracture

3. According To The Favourability & Direction:

• Horizontal favorable fracture
• Horizontal unfavorable fracture
• Vertical favorable fracture
• Vertical unfavorable fracture

4. Kazanjian Classification:

• Class 1: When teeth present on both sides of the fracture line
• Class 2: When teeth are present only on one side of fracture line
• Class 3: When either side of the fracture line is edentulous

5. Anatomical Classification

• Symphysis fracture
• Canine region fracture
• Body fracture
• Fracture of angle
• Fracture of ramus
• Coronoid fracture
• Condylar fracture
• Fracture of dentoalveolar region

Clinical Features Of Fractures Of Maxilla:

• Change in the contour of the face
• Lacerations
• Ecchymosis of the floor of mouth Occlusal disturbances
• Step deformity of the mandible
• Pain & tenderness
• Trismus
• Deviated mouth opening
• Anaesthesia & paraesthesia of the lower lip & chin

Management And Types Of Dental Wiring:

1. Essig’s Wiring:

• Used to stabilize dentoalveolar structures
• Steps:
  • Move the luxated teeth back to the position
  • Adapt wire to the teeth
  • Pass the wirws one end buccly and other lingually
  • Join both the ends
  • Pass small wires Interdentally and fix it
  • Twist it cut it and adjust in

2. Gilmer’s Wiring:

• Pre stretched wire is passed around the individual tooth
• Both ends are brought together & twisted Repeat for each tooth
• Repeat for both the arches
• Final twisting mandibular & maxillary wires
• Twist cut it & adapt interdentally

3. Risdon’s Wiring:

• Pass the wire around both the 2nd molar
• Both the ends are twisted together
• Repeat for each tooth
• Both the base wires are brought to the midline
• Twisted together
• Cut it
• Adapt it to the neck of the teeth

4. Eyelet Wiring:

• Prepare loops in the center of wire
• Two tails of the wire are passed interdentally
• One end is passed around distal tooth from lin gually to buccally
• Other end is passed around mesial tooth lingually to buccally
• Twist both the ends
• Cut it short

5. Multiloop Wiring:

• Adapt solder wire around the buccal surface of the tooth
• Adapt wire buccally from last molar to midline
• Pass the other end distal to the 2nd molar over lingual side
• Pass interdentally bring it to the buccal side by passing under the wire
• Now pass it from buccal to lingual
• Round it around the tooth
• Repeat the same procedure

6. Arch Bar Fixation:

Arch Bar Fixation is a method of indirect fixation used in the management of mandibular fractures.

Structure Of Arch Bar Fixation:

• Stainless steel strip consisting of hooks
• In upper jaw hooks are located in upward direction
• In lower jaw it is located in downward direction
• Structure Of Arch Bar Fixation is adapted to the buccal surface
• Structure Of Arch Bar Fixation is fixed to each tooth with the help of stainless steel wires

Advantages Of Arch Bar Fixation:

1. Less traumatic
2. Stable appliance

Question 2.  Describe clinical features & management of Lefort 1.
Or
Classify fractures of the middle third of the facial skeleton. How would you manage Leforte Fractures?
Or
Lefort 1 fracture And Geurin fracture
Answer:

Lefort 1:

• Clinical Features Of Lefort 1:
  • Oedema of lower part of face
  • Ecchymosis in buccal vestibule
  • Bilateral epitaxis
  • Mobility of upper teeth
  • Disturbed occlusion
  • Pain
  • Upward displacement of fragment telescopic fracture
  • ‘Cracked cup’ sound on percussion of upper teeth
• Guerin sign’ecchymosis in the greater palatine region

Management Of Lefort 1:

• Principles:
  1. Reduction
  2. Fixation
  3. Immobilization

Principles Are Of Lefort 1:

1. Reduction:

• Reduction of impacted fragment with the help of disimpaction forceps ( Rowe’s & William’s forceps)
• Placement of Rowe’s forcep:
• The straight blade is placed into the nostrils
• A curved blade is placed over the palate
• Placement of William’s forceps: placed over the buccal accept
• Displaces maxilla in mesiodistal direction

2. Fixation:

• Zygomatic suspension fixation is done
• Holes are drilled over the zygomatic arch
• Pass the wire through it
• Bring it up to the arches
• Twisted over are arch bars

3. Inter Maxillary Fixation:

Question 3. Classify zygomatic fractures. Describe about its clinical features & its management.
Or
How to the management of zygomatic fracture and Gillies Temporal Approach.
Answer:

Classification Of Zygomatic Fractures:

1. Based On The Extent Of Involvement:
   • Fractures involving orbit
   • Fractures not involving the orbit
2. Zingg Classification:
   • Type 1:
     • Isolated to one component
     • Zygomatic arch
     • lateral orbital wall
     • Inferior orbital rim
   • Type 2:
     • Involving all four buttresses
   • Type 3:
     • Complex fractures
3. Based On Direction:
   • Displacement around a horizontal axis
   • Displacement around vertical axis

Clinical Features Of Zygomatic Fractures:

• Flattening of cheek
• Unilateral epistaxis
• Tearing of sinus mucosa causes blood to collect into the sinus cavity
• As the maxillary sinus drains into the middle meatus, unilateral epistaxis occurs
• Circumorbital ecchymosis
• Subconjunctival hemorrhage
• Due to the ability of oxygen to diffuse through conjunctiva to the collected blood under the conjunctiva
• Limitation of ocular movements
• Enophthalmus
• Due to herniation of orbital contents through the fractured walls
• Blurring of vision
• Anesthesia of cheek
• Edema of cheek
• Step deformity
• Limitation of mandibular movements Trismus
• Due to spasm of temporalis by impingement of zygomatic arch fragments on muscle

Management Of Zygomatic Fractures:

• Stable fractures: open reduction
• Unstable fractures open reduction & trans osseous wiring

Operative Technique:

• Gillies Temporal Approach:
  • Plugged external auditory meatus with cotton
  • Incision given over zygomatic arch as well as temporal area
  • Expose temporal fascia
  • Insert Bristow’s periosteal elevator above the temporal muscle
  • Manipulate it upward, forward & outward
  • Reduction is done
  • Closure of wound

Question 4. Classify condylar fractures. Describe its clinical features, & its management.
Or
Clinical features & management of condylar
Answer:

Classification Of Condylar Fracture:

1. General Classification:

• Simple fracture
• Compound fracture
• Comminuted fracture

2. Lindhal Classification:

• Fracture Level:
  • Condylar head fracture
  • Condylar neck fracture
  • Subcondylar fracture
• Relationship Of The Condyle To Ramus:
  • Undisplaced
  • Deviated
  • Displaced with medial overlap
  • Displaced with lateral overlap
  • Anteroposterior overlap
• Relationship Of Condylar Head To Fossa:
  • No displacement
  • Displacement
• Injury To meniscus:

Lindhal’s Classification Of Condylar Fracture:

• CH – Condylar head intracapsular fracture
• CN-  Condylar neck fracture,
• SC – Subcdylar fracture

3. Maclennan Classification:

• No displacement
• Deviated
• Displacement
• Dislocation

1. No displacement
2. Displacement
3. Deviation
4. Dislocation
5. Comminution (Multiple fragmentation)

Relation Ship Of The Condylar Fragment:

• 1 – To the Mandibular ramus stump
• 2-  To the Glenoid fossa

Clinical Features Of Condylar Fracture:

• Abrasion over the fractured area
• Difficulty in mastication
• Laceration over chin
• Facial nerve injury
• Limitation in mouth opening
• Deviation of chin
• Bleeding of external auditory meatus
• Pain
• Lack of condylar movement
• CSF leak

Intraorally Of Condylar Fracture:

• • Premature contact of molars
  • Posterior open bite
  • Crossbite
  • In bilateral cases: Anterior open bite with posterior gagging” Guardman’s Fracture”

Management Of Condylar Fracture:

1.  Non-Surgical Treatment:
   • Restrict the movements
   • Restrict the diet to semisolid
   • Application of class II elastic traction
   • Correction of malocclusion
   • IMF for 2-3 weeks
2. Surgical Treatment:
   1. Absolute Indications:
      • Dislocation in middle cranial fossa
      • Anterior dislocation
      • Bilateral condylar fracture
   2. Relative Indications:
      • subcondylar fracture with anterior openbite
      • Anterior & medial displacement of the fragment
      • Malunited fracture
      • Loss of posterior teeth
      • Interference with the functions

Question 5. Write diagnosing & management of fracture of angle of the mandible in 40 years old edentulous patient.
Answer:

Diagnosis Of Fracture :

• Making of impression of upper & lower arches
• Fabrication of cast models
• Study of occlusion through it
• Model surgery is carried out through it

Management Of Fracture :

• Use of denture for fixation & immobilization of fragment
• The denture can be used as a splint
• Splinting of the denture by circum mandibular wiring
• If dentures are not present
• Impression is taken of upper & lower arches Processing of acrylic baseplates
• Used as denture called
• Gunning Splint
• Processing of archbars into dentures
• Wiring of denture
• Prosthetic incisors are removed to create a hole for feeding purposes

Question 6. Write clinical features & management of Lefort 3
Answer:

Clinical Features Of Lefort 3:

• Balloning of face
• Panda facies
• Racoon eyes
• bilateral subconjunctival hemorrhage
• lengthening of face
• Separation of sutures
• ‘Dish face’ deformity
• Enophthalmus
• Diplopia
• Deviation of nasal bridge
• Epitaxis
• CSF rhinorrhoea

Management Of Lefort 3:

Question 7. Describe the management of unfavorable fractures.
Answer:

Management Of Unfavorable Fractures:

Question 8. Write in short principles of fracture management. Add a note on different modalities for fracture mandible involving teeth in the line of fracture.
Or
Fracture of the body of the mandible in children.
Answer:

Principles Of Fracture Management:

1.  Reduction:
   • Restoration of fractured fragments to their original position
   • Brought by
     • Closed reduction
     • Open reduction
2.  Fixation:
   • Fractured fragments are fixed
   • This prevent displacement of the fragments
     • Consists of:
       • Direct fixation
       • Indirect fixation
3. Immobilization:
   • Fixation device is retained in position till bony union is obtained
   • Immobilization depends on type of fracture & bone involve

Management Of Fracture Of Mandible Involving Teeth In The Line Of Fracture:

1. Teeth can be extracted or retained
2.  Indications for them

Maxillofacial Trauma Short Essays

Question 1. Diplopia.
Answer:

Diplopia

• It is a blurred, double vision experienced by the patient
• It can be temporary or permanent

Types Of Diplopia:

1. Monocular Diplopia:
2. Double vision through one eye
   • Indicates detached lens or traumatic injury
3.  Binocular Diplopia:
   • Blurred through both the eyes

Causes Of Diplopia:

1. Physical Interference:
   • Fibrous adhesions Haematoma
   • Herniation of periorbital fat
2. Functional Interference:
   • Disturbance to the inferior rectus & inferior oblique muscle
3. Neurological Causes:
   • Paralysis of nerve
   • Supranuclear impairment
   • Intraorbital damage
   • Infranuclear injuries

Diagnosis of Diplopia:

1. Testing Motions Of The Eye:

• Hold a pencil at an arm distance from the patient
• Ask the patient in all the 9 direction
• Observe obstruction in any direction if present

2. Forced Duction Test:

• Grasp the tendon of inferior rectus through forceps
• Ask the patient to look in all the direction
• Observe any obstruction

3. Hess Test:

• Patient’s motions of the eye are recorded over a Hess chart

Question 2. Lefort II fracture/ Pyramidal fracture.
Answer:

Lefort II Fracture/ Pyramidal Fracture:

Clinical Features of Lefort II Fracture:

• Gross edema of the middle third of the face
• Ballooning of face
• Black eye
• Bilateral subconjunctival hemorrhage
• Depressed nasal bridge
• Anterior open bite in case of impacted fracture
• If the fragment is displaced downward, it causes lengthening of face
• Bilateral epistaxis
• Loss of occlusion
• Difficulty in mastication & speech
• Airway obstruction
• CSF leak
• Paraesthesia of cheek
• Step deformity

Question 3. Splints.
Answer:

Types Of Splints:

1. Custom Made:
   • Fabricated for the individual patient
     • Indications:
       • Failure of wiring Edentulous patient
       • Pregnant patients Growing children
2. Acrylic:
   1. Types: Lateral compression splint
   2. Steps:
      • Make impression
      • Fabricate cast
      • Mark & cut the fracture line
      • Check for occlusion
      • Adapt wire to it
      • Fabricate the acrylic splint with the help of self cure acrylic
3. Gunning Splints:
   • Modification of dentures in case of edentulous patient
     • Fixation:
       • In mandibular circumferential wiringalges to athl
       • In maxilla pre alveolar wiring

Question 4. Miniplate osteosynthesis.
Answer:

Miniplate Osteosynthesis

Developed by Michelet in 1973

1. AIM:
   • To attain fracture adaptation
   • Application of the plate to the traction side of the bone
2. Principle:
   • Fixation by stability
3. Factors:
   • Location of dense cortical bone
   • Displacing forces acting on the mandible

Question 5. Favorable & unfavorable fractures.
Answer:

Favourable Fractures:

• Favourable Fractures is one in which the fracture lines run in such a way that the forces of the muscles bring the fracture frag ments closer instead of displacing them
• Favourable Fractures can be horizontal or vertical depending in the direction they are viewed
• If it is viewed from lateral surface of the mandible, it is horizontal
• If it is viewed from the occlusal surface, it is vertical

Unfavorable Fractures:

• Unfavorable Fractures is one in which the fracture line runs in such a way that the muscle forces tend to displace the fragments away from each other
• Unfavorable Fractures can also be horizontal or vertical depending in the direction they are viewed
• If it is viewed from the lateral surface of the mandible, it is horizontal
• If it is viewed from the occlusal surface, it is vertical

Question 6. Pathological fractures.
Answer:

Pathological Fractures

Occurring due to underlying disease

1. Tumors:
   • Giant cell tumor
   • Bone cysts
2. Infections:
   • Acute osteomyelitis
3. Metabolic Bone Diseases:
   • Hyperparathyroidism
   • Osteoporosis
   • Paget’s disease

Question 7. Wire osteosynthesis.
Answer:

Wire Osteosynthesis

Wire Osteosynthesis is nonrigid method of fixation

Technique Of Wire Osteosynthesis:

• Drilling of holes on either side of the fracture line
• Passing wire through each hole
• Prevent damage to nerves
• Bring both ends of the wires to the buccal surface
• Twist them together
• Cut & tuck them
• Irrigate the wound
• Retain the wires permanently
• IMF done

Question 8. Nonunion.
Answer:

Nonunion

Lack of bony fusion of fractured ends

• Etiology Of Nonunion:
  • Inadequate fixation
  • Infection of the fracture
  • Lack of adequate blood supply
  • Excessive periosteal stripping
  • Pathological fractures
• Features Of Nonunion:
  • Pain
  • Difficulty in occlusion
  • Difficulty in mastication
  • Abnormality mobility of fractured fragments
• Radiological Feature:
  • The gap between the fragments
• Management Of Nonunion:
  • Expose the site
  • Graft the space
  • Stabilize the fractured ends
  • Fixation
  • Immobilization

Question 9. Complications of fracture.
Answer:

1. Early Complications:

•  Local:
  • Hemorrhage- Internal or external
  • Damage to vital structures
  • Damage to surrounding tissues, nerves or skin
  • Haemarthrosis
• Systemic Complications:
  • Fat embolism:
    • Features
    • Sudden onset dyspnoea
    • Hypoxia
    • Fever
    • Confusion, coma, convulsions
    • Translent red-brown petechial rash affecting
  • Shock
  • Thromboembolism
  • Pneumonia

2. Late complications:

• Local Complications:
  • Delayed union
  • Non-union
  • When no signs of healing occur after 3-6 months it is called non-union
  • Local Complications Features:
    • Pain at the fracture site
    • Non-use of extremity
    • Tenderness and swelling
    • Joint stiffness
  • Malunion:
  • Myositisossificans:
    • Calcifications and bony masses develop within the muscle
    • Presents as pain, tenderness, focal swelling, and joint/muscle contractions
• Systemic Complications:
  • Gangrene, tetanus, septicaemia
  • Osteoarthritis

Maxillofacial Trauma Short Question And Answers

Question 1. Cap splint.
Answer:

Uses Of Cap Splint:

• Fixation of fractures
• Fracture of the mandible in children
• Fracture of the edentulous mandible

Cap Splin Technique Of :

• Impression of upper & lower arches
• Fabrication of cast & splint
• Reduction of fragments
• The casting of the splint
• Cementation of splint over occlusal surfaces of teeth

Question 2. Battle’s sign.
Answer:

Battle’s Sign

1. Location: Mastoid region
2. Cause: Condylar fracture
3. Feature: Ecchymosis in the pre-auricular region

Question 3. Bone plate.
Answer:

Bone Plate

• The semirigid type of fixation
• Depending on the fracture bone plates are fixed

The Technique Of Bone Plate:

• Incision
• Exposure of fracture site
• Reduction of fracture
• Adaptation of bone plates
• Fixation with the help of screws

Question 4. Subconjunctival ecchymosis.
Answer:

Subconjunctival Ecchymosis

• Fracture of orbital walls
• Subperiosteal hemorrhage
• Destruction of the periosteum of orbit
• Leads to subconjunctival hemorrhage
• Appears bright red in color due to the diffusion of oxygen

Question 5. Lag Screw.
Answer:

Lag Screw

• Introduced by Brons & Boring in 1970
• Lag Screw is a long screw driven into both sides of the fractured bone

Mechanism Of Lag Screw:

• As the screw is tightened, fractured ends are brought together
• Thus closes the space between them

The technique Of Lag Screw:

• Drilling of gliding hole in the proximal fragment
• Drilling of traction hole in distal fragment
• Engaging screw
• Tightening it
• Results in pulling of distal fragment through threads & proximal fragment by screw head

Question 6. Blow-out fracture.
Answer:

Blow-Out Fracture

Occurs when the object of diameter greater than the diameter of the object strikes

Pathogenesis Of Blow – Out Fracture:

• Fracture of the floor of the orbit
• Herniation of fat into antral cavity Increase in orbital volume
• Enophthalmos

Features Of Blow – Out Fracture:

• Enophthalmos
• Entrapment of muscles of orbit
• Restricted movement of orbit
• Diplopia
• Subconjunctival hemorrhage
• Paraesthesia
• Circumorbital edema
• Ecchymosis

Question 7. Dento alveolar fractures.
Answer :

Features Of Dento Alveolar:

• Mobility of dentoalveolar segment
• Subluxation on avulsion of teeth
• Splitting of teeth
• Occlusal derangement
• Laceration of gingiva

Management Of Dento Alveolar:

• Reduction of segment Occlusion correction
• Stabilizing with wiring
• Soft diet for 3 weeks

Question 8. Enophthalmos.
Answer:

Enophthalmos

Enophthalmos is inward sinking of the eye

Causes Of Enophthalmos:

• Decrease in the orbital volume due to herniation of orbital fat
• Increase in bony orbit due to fracture of its walls
• Loss of ligament
• Post traumatic fibrosis
• Combination of above

Clinical Features Of Enophthalmos:

• Hooding of the upper eyelid
• Anterior projection of globe

Treatment Of Enophthalmos:

• Surgical intervention
• Placing materials behind the globe

Question 9. Gunshot injuries.
Answer:

Gunshot Injuries

These are penetrating wounds

Classification Of Gunshot Injuries:

• Penetrating wounds: missile is retained in wound
• Perforating wounds: Missile exits from another wound
• Avulsive wound: Large amount of structure is destroyed

Etiology Of Gunshot Injuries:

• High velocity bullets
• Low velocity projectiles

Question 10. Geurin’s sign.
Answer:

Geurin’s Sign

• Location: In the region of greater palatine foramen
• Cause: Lefort 1 fracture
• Feature: Ecchymosis in the greater palatine foramen

Question 11. Coleman’s sign.
Answer:

Coleman’s Sign

• Location: Floor of the mouth
• Cause:
  • Blow in the chin
  • Base of skull fracture
  • Mandibular fracture
• Feature: Ecchymosis in the floor of the mouth

Question 12. Black eye.
Answer:

Black Eye

Feature of Lefort II fracture

• Appearance Of Black Eye:
  • Presence of bilateral circumorbital edema
  • Presense of bilateral circumorbital ecchymosis
• Diagnosis Of Black Eye: Difficult due to rapid development of swelling of eyelids

Question 13. Gunning splints.
Answer:

Gunning Splints

Gunning splints are retained in position by circumfer ential wiring or by peralveolar wiring,

• Indication Of Gunning Splints:
  • Fracture of edentulous mandible
• Contraindications Of Gunning Splints:
  • Unfavourable fracture lying outside the denture bear- ing area
  • Severe fracture displacement
• Construction Of Gunning Splints:
  • Upper and lower impressions are made
  • Casts are poured
  • Upper and lower base plates are adapted
  • Bite blocks are prepared only in posterior resgion
  • Hooks are incorporated over buccal side of the blocks Grooves are made over canine region to prevent the peralveolar and circumferential wires from slipping along the surface of the splint

Question 14. Epistaxis.
Answer:

Epistaxis

Epistaxis is defined as bleeding from the nose

Causes of Epitaxis:

Maxillofacial Trauma Viva Voce

1. The most common site of fracture of the mandible is the angle
2. The Lefort I fracture is a transverse fracture of the maxilla
3. Dish face deformity is commonly seen with a fracture of the middle third of face
4. Fractures of the coronoid process can occur due to reflex muscular contraction
5. The optimum length of the screw for fixation of the plate in the mandible is 4 mm
6. The contraindication to miniplate along the line of osteosynthesis would be a fracture in a 10 years old
7. Glasgow coma scale is used to ascertain level of consciousness
8. The best radiographic view for examination of fracture of the middle face is Water’s view
9. Geurin sign is the presence of ecchymosis at the greater palatine foramen area
10. The golden hour of trauma refers to the period of time exactly one hour after the trauma is sustained
11. Corman’s sign is ecchymosis in the lingual sulcus
12. Verill’s sign includes eyelid ptosis, blurring of vision, and slurring of speech
13. The inferior dental nerve is frequently damaged in fractures of the body and the angle of the mandible
14. Lefort I fractures mainly involves the tooth-bearing area of the maxilla
15. Lefort II involves maxilla, nasal and lacrimal bones
16. Lefort III involves maxilla, lacrimal, nasal and ethamoidal bones
17. The maxillary incisor region is a common site of dental fractures
18. Cracked pot sound on percussion is seen in alveolar fractures
19. Lag screws are used to immobilize oblique fractures
20. The use of acrylic cap splints with circumferential wiring is best method to treat mandibular fractures in children.

Maxillofacial Surgery Miscellaneous Short Essays

Question 1. TNM Staging.
Answer:

TNM Staging

•  T Size of the tumor
• N lymph node involvement
• M distant metastasis

• T0N0 tumor present
• This carcinoma in situ
• T1 Tumour 2 cm or less
• T2 Tumour between 2-4 cm
• T3 Tumour more than 4 cm
• T4 Tumour invading adjacent structures
• N0 No node involvement
• N1 ipsilateral lymph node involvement of 3 cm or less
• N2 ipsilateral lymph node involvement of more than 3 cm or less than 6 cm
• N3 Contralateral node involvement
• M0 no metastasis
• M1 metastasis present

Read And Learn More: Oral and Maxillofacial Surgery Question and Answers

Question 2. Cryosurgery.
Answer:

Cryosurgery

• Introduced by Barnard
• Temperature: 20 degrees to -180 degrees

Apparatus Of Cryosurgery:

• Cylinder carrying gases No or CO2
• Probe
• The cord connecting the above two

Technique Of Cryosurgery:

• Anesthetize the area
• Freeze the exposed nerve for 2 min
• Thaw it for 5 min
• Freeze is next for 3 minutes

Effects Of Cryosurgery: 

• Dehydration
• Denaturation pf lipid molicules
• Necrosis of tissues, capillaries, small arterioles and venules

Question 3. Champy’s osteosynthesis lines.
Or
Champy’s Lines
Answer:

Champy’s Osteosynthesis Lines

Introduced by Champy et al in France

• He advocated the use of small, thin malleable stainless steel plates used with monocortical screws, placed in specific areas in the mandible.
• The masticatory forces that are produced during the functional loading of the manciple produce a natural strain of compression along the lower border of the mandible
• Champy found that these are ideal osteosynthesis lines of the mandible
• Miniplates with monocortical screws must be placed only along these lines in the region of fracture to achieve maximum stability.

Factors Considered Of Champy’s Osteosynthesis:

• Thickness of bone
• Position of the inferior alveolar canal
• Root apices

Lines Of Champy’s Osteosynthesis:

• Superolateral aspect along the external oblique ridge
• Inferior border of the mandible

Question 4. Antibiotics for oral infection.
Answer:

Antibiotics For Oral Infection:

Question 5. Antiseptics.
Answer:

Antiseptics: Antiseptics is a chemical that is applied to living tissues such as mucous membranes to reduce the number of microorganisms present, through inhibition of their activity

Requirements Of Antiseptics:

• A broad spectrum of activity
• Fast acting
• Not affected by physical factors
• Nontoxic
• Surface compactable
• Easy to use
• Odourless
• Economical

Agents Of Antiseptics:

• Alcohols: Ethyl alcohol
• Iodophorspovidone iodine
• The hepatitis virus is not susceptible to it
• Formulated as 1% iodine solution
• Not stable at high temperature
• Hexachlorophene
• Toxic
• Used in patients who are sensitive to iodine
• Chlorhexidine0.075%

Question 6. Syncope diagnosis and management.
Answer:

Predisposing Factors Of Syncope:

• Pain
• Anxiety
• Fatigue
• Fasting
• Upright position
• Sight of instruments
• Sight of blood

Presentation Of Syncope:

• Feeling of warmth
• Sweating
• Dilated pupils
• Cold extremities
• Bradycardia
• Dizziness
• Loss of consciousness

Management Of Syncope:

• Loosening of clothes
• Monitor vital signs
• Place cotton soaked in ammonia near the patient’s nose
• Reassure the patient
• Discharge the patient on that day

Question 7. Indication for blood transfusion.
Answer:

Indication For Blood Transfusion

• Acute hemorrhage
• Major road accidents
• Chronic blood loss
• Preoperatively
• Intraoperatively
• In severe malnutrition
• In erythroblastosis fetal
• In anaemic patients
• Postoperatively
• During chemotherapy in malignancies

Question 8. Medical emergency drug tray.
Answer:

Primary Emergency Drugs:

1. Injectable:

• Anaphylactic: Epinephrine 0.3-0.5 ml of 1: 1000 IM
• Antiallergic: Chlorpheramine malate10 mg/ml

2. Noninjectable:

• Oxygen 1-liter cylinder
• Vasodilator
• Nitroglycerine 0.4 mg sublingually
• Antihyperglycemic
• Dextrosebolus form

Secondary Emergency Drugs:

1. Injectable:

• Anticonvulsant: Diazepam5 mg/ml
• Analgesic: Meperidine 10 mg/ml
• Vasopressor: Phenylephrine 10 mg/ml
• Corticosteroid: Dexamethasone50 mg/ml

2. Non Injectable:

• Respiratory stimulant
• Ammonia 0.3 ml/vaprole

Question 9. Cardiac arrest.
Answer:

Cardiac Arrest

Cardiac Arrest is an emergency

Management Of Cardiac Arrest:

• Cardiac arrest includes ABC

1. Airway Maintenance:

• The airway is kept patent
• Steps
  1.  Head Tilt:
     • Place the palm on the patient’s forehead
     • Other to support the patient’s neck
     • Tilt the head backward
  2. Chin Lift:
     • Place hand over the bony chin
     • Pull the mandible forward
  3.  Jaw Thrust:

2. Breathing:

• Mouth-to-mouth respiration Mouth-to-nose respiration
• To inflate the lungs
• Monitor vital signs
• Check carotid pulse
• If absent, cardiac massage

3. Circulation:

• Through external cardiac compression
• Apply pressure over the lower half of the adult sternum

Effects Of Cardiac Arrest:

• Increased pressure within the thorax
• Increased cardiac output

Question 10. Significance of liver failure.
Answer:

Significance Of Liver Failure

• Drugs play an important role in surgery
• They are either preoperatively intraoperatively or postoperatively
• These undergoes metabolism
• Thereby reaching the target site
• Many drugs are synthesis in the liver
• Thus liver plays an important role
• If the patient is suffering from liver failure drugs cannot reach the target site
• Hence its action is hampered
• Also, the liver plays an important role in the synthesis of many Vitamins
• As vitamins are essential nutrients in our diet, the liver plays an important role in

Question 11. Radiolucent lesions of angle of mandible.
Answer:

Radiolucent Lesions Of Angle Of Mandible

It includes

1. Ameloblastoma:

Clinical Features Of Ameloblastoma:

• Swelling & pain in the region
• Inflammation
• Tension.
• Dental trauma
• Ulceration of mucosa
• Loosening of teeth
• Epistaxis
• Nasal obstruction

Radiological Features Of Ameloblastoma:

• Unilocular or multi locular radiolucency
• Soap bubble appearance of the lesion
• Border is clear
• Resorption of the teeth

2. Dentigerous Cyst:

Clinical Features Of Dentigerous Cyst:

• Sex: Common in males
• Age: 1st& 3rd decade
• Site: Mandibular 3rd molar, maxillary canines, maxillary 3rd molar
• Expansion of bone
• Facial asymmetry
• Displacement of adjacent teeth.
• Resorption of adjacent teeth

Radiological Features Of Dentigerous Cyst:

• The unilocular, well-defined radiolucency
• Marginssclerotic

Types Of Dentigerous Cyst:

• Centralcovering the crown of an unerupted tooth
• Circumferentialcovering the crown from all sides
• Lateralcovering crown from side

Odontogenic Keratocyst:

1. Clinical Features Of Odontogenic Keratocyst:

• Asymptomatic
• If secondary infected, causes expansion of cortical plates
• Mobility of teeth
• Pain & tenderness of the site

2. Radiological Feature Of Odontogenic Keratocyst:

• Unilocular or multilocular radiolucency
• Margins: Well-defined sclerotic margins
• Expansion of cortical plates
• Soap bubble appearance

Question 12. Dry socket.
Answer:

Definition Of Dry Socket:

Dry socket is focal osteomyelitis of the tooth socket in which the blood clot has disintegrated or been lost

Other Names Of Dry Socket:

• Fibrinolytic alveolitis
• Alveolar osteitis
• Alveolar osteomyelitis

Etiology Of Dry Socket:

1. Born’s Hypothesis:

2. Nitzan’s Theory:

• States that there is a possible relationship between the fibrinolytic activity of anaerobic bacteria & dry socket

Pre-Disposing Factors Of Dry Socket:

• Infection
• Decreased blood supply
• Debilitating conditions

Clinical Features Of Dry Socket:

• Loss of blood clot
• Bare of granulation tissue
• Radiating pain
• Foul odor
• Metallic taste

Management Of Dry Socket:

• Irrigation of socket
• Smoothening of bony margins
• Packing with pom pom
• Analgesics
• Hot saline mouth bath
• Chemical cauterization Regular follow-up

Question 13. Indications of laser therapy.
Answer:

Indications Of Laser Therapy

• Incision
• Excision
• Biopsy of cystic lesions
• Vaporise excess tissue
• Frenectomy
• Remove/reduce hyperplastic tissues
• Hemostatic
• In the treatment of Hemangioma

Question 14. Von Willebrands disease.
Answer:

Von Willebrands Disease

Deficiency of Factor VIII von Willebrand factor

Clinical Features Of Von Willebrands:

• Epitaxis
• Menorrheoa
• Bleeding followed by minor trauma

Lab Investigations Of Von Willebrands:

• Bleeding time increased
• Prothrombin time – normal
• 8th  Creduced
• ve reduced

Treatment Of Von Willebrands:

• Administration of vasopressin
• 6th infusion of factor 8th
• Administration of von Willebrand factor
• Avoid cryoprecipitate

Question 15. Root in the antrum.
Answer:

Root In antrum

Commonly Affected Teeth: Maxillary first molar

Causes Of Root In Antrum:

• Improper grip over force
• Excessive application of forces
• A sudden movement of the patient
• Slippage of root

Pathogenesis Of Root In Antrum:

• The root piece slips as an orange seed
• An attempt to remove it leads to deep penetration of it

Treatment Of Root In Antrum:

• If it small piece, it exhales out
• If a large root piece is fractured, it leads to oro antral fistula

Management Caldwell Luc Operation:

• Procedure:
  • Anesthetized
  • The semilunar incision is given in the mesiobuccal fold in the canine region
  • Reflection of flap
  • Creation of window
  • Removal of sinus lining for biopsy
  • Antrostomy
  • Packing the sinus cavity through ribbon gauze pregnant in benzoin
  • Smoothening of bony margins
  • Replace the flap
  • Suturing

Question 16. Analgesics.
Or
Opioid Analgesics
Answer:

Analgesics

• Analgesics is a drug which relieves pain without loss of consciousness
• Analgesics only affords symptomatic relief from pain without affecting the cause

Classes of Analgesics:

1. Opioids Example: Morphine:

• Opioids is abused

Actions Of Opioids:

• Analgesic
• Sedative
• Hypnotic
• Respiratory depressant
• Depresses cough center
• Emetic
• Miotic
• Stimulates vagal center
• Produces convulsants

Contraindications Of Opioids:

• COPD
• Branchial asthma
• Head injuries
• Hypovolaemic shock

2. Nonopioids Example: Aspirin:

Actions Of Nonopioids:

• Analgesia
• Antipyretic
• Anti-inflammatory
• Antiplatelet action

Uses Of Nonopioids:

• Toothache
• Arthralgia
• Fever
• Anti-inflammatory
• Osteoarthritis
• Post myocardial infarction
• Locally as a keratolytic agent

Question 17. Hemophilia.
Answer:

Hemophilia

Bleeding disorder occurring due to X-linked genetic disorder

Types Of Hemophilia:

• Hemophilia A
• Hemophilia B
• Von Willebrand disease

Clinical Features Of Hemophilia :

• Easy bruising
• Prolonged bleeding
• Soft tissue hemartoma
• Epistaxis
• Gastric hemorrhage Recurrent hemarthrosis
• Joint deformity
• Spontaneous hematuria
• Intracranial hemorrhage

Oral Manifestation Of Hemophilia:

• Bleeding gums
• Bleeding followed by nerve block
• Recurrent subcutaneous hematoma
• High caries index
• Oropharyngeal bleeding

Lab Investigation Of Hemophilia:

• Prolonged clotting time
• Prothrombin consumption decreased
• Thromboplastin generation increased

Complications Of Hemophilia:

• Airway obstruction
• Intestinal obstruction
• Intracranial bleeding
• Paralysis
• Death

Treatment Of Hemophilia:

• Immediate transfusion of factor 8 or 9 Transfusion of packed RBC
• Control bleeding with the help of fibrin foam
• Analgesics & corticosteroids
• Joint immobilization
• Local chilling
• Use of 4 desmopressin

Question 18. Antibiotic prophylactic.
Or
OpharyngealEndocarditis prophylaxis.
Answer:

Prophylaxis Required For:

• Dental extraction
• Periodontal surgeries
• Endodontic procedures beyond the apex
• Dental implant placement
• Subgingival placement
• Intraligamentary injections

Prophylactic Not Required For:

• Restorative dentistry
• Non intraligamentary injection
• Placement of rubber dam
• Placement of removable appliances
• Suture removal
• Making impressions
• Shedding of primary teeth

Question 19. Blood groups.
Answer:

Major Blood Groups:

• ABO system
• Rh system
• ABO system

Rhesus System:

• This blood group contains the D antigen
• Individuals who are D-positive are considered Rh-positive
• Individuals with D negative are Rh-negative

Minor Blood Groups:

• Lewis system
• P system
• I system
• MNS system
• Kell & Duffy system
• Luthern system

Question 20. Tooth Transplantation.
Answer:

Tooth Transplantation

Tooth Transplantation is the removal of a tooth from one socket & transplanting into another socket

The Technique Of Tooth Transplantation:

• Asepsis should be followed
• The socket of the transplanted site is curetted & irrigated with saline
• The tooth is placed gently in the socket with light finger pressure
• Check with a radiograph
• Placement of splint
• Prescribe analgesic & antibiotic
• Check after 24 hours

Question 21. Post-injection hematoma.
Answer:

Post-Injection Hematoma

• Injury to any blood vessel may result in the escape of blood into extravascular spaces resulting in a hematoma
• Occurs after inferior alveolar nerve block & posterior superior alveolar nerve block

Features Of Post Injection:

• Intraoral swelling, trismus after inferior alveolar nerve block
• Extraoral swelling After posterior superior alveolar nerve block

Management Of Post Injection:

• Immediate Management: Pressure application
• It resolves itself within 7 – 14 days
• Antibiotics for a large hematoma
• After 1-2 days of fomentation

Question 22. Shock-septic.
Answer:

Definition Of Shock-Septic:

When acute cardiovascular failure is superimposed on bacteremia, it is called septic shock

Clinical Features Of Shock-Septic:

• Fever
• Tachycardia
• Tachypnea
• Respiratory alkalosis
• Hypoxaemia
• Hypotension
• Oliguria
• Icterus

Pathogenesis Of Shock-Septic:

• Low cardiac filling
• Decreased vascular resistance

Results Of Shock-Septic:

• Hypovolaemia
• Myocardial depression
• Abnormal distribution of blood flow

Management Of Shock-Septic:

• Administration of oxygen
• Removal of the septic nidus
• Empirical antibiotics
• Vasoactive Drugs: Phenoxybenzamine
• Inotropic Agents: Dopamine
• Corticosteroids: Prednisolone15 mg/kg
• Mechanical ventilation
• Fluid replacement

Question 23. Anaerobic antimicrobial.
Answer:

Anaerobic Antimicrobial

• Metronidazole is the drug of choice
• Anaerobic Antimicrobial is nitromidazole deravitive

Mechanism Of Anaerobic Antimicrobial:

Micro-organism reduces its nitro group & converts it into a cytotoxic drug which damages DNA & inhibits protein synthesis

Uses Of Anaerobic Antimicrobial:

• Orodental infection
• AUG
• Periodontitis
• Pericoronitis
• Peptic ulcer
• Amoebiasis
• Liver abscess

Adverse Reactions Of Anaerobic Antimicrobial:

• Anorexia
• Metallic taste
• Headache, dizziness
• Glossitis
• Dryness of mouth
• Peripheral neuropathy

Contraindications Of Anaerobic Antimicrobial:

• Neurological disease
• Blood dyscrasias
• The first trimester of pregnancy
• Chronic alcoholism
• Dose: 200-400 mg TDS

Question 24. Diclofenac sodium.
Answer:

Diclofenac Sodium

• Diclofenac Sodium is an aryl acetic acid derivative
• Diclofenac Sodium is an analgesic antipyretic & anti-inflammatory drug

Mechanism Of Diclofenac Sodium:

• Inhibits PG synthesis
• Short-lasting anti-platelet action
• Neutrophil chemotaxis & superoxide production at
• Inflammatory sites are reduced

Uses Of Diclofenac Sodium:

• Rheumatoid & osteoarthritis
• Toothache
• Bursitis
• Ankylosing spondylitis
• Dysmenorrhea
• Post-traumatic & post-operative inflammatory conditions

Adverse Reactions Of Diclofenac Sodium:

• Epigastric pain
• Headache
• Dizziness
• Rashes
• Dose: 50 mg TDS

Trade Name:

• Voveran
• Diclonac
• Movonac

Question 25. Penicillin.
Answer:

Penicillin

Lactum Antibiotic

Mechanism Of Penicillin:

• Inhibit cell wall synthesis
• Inhibit transpeptidase thus inhibiting the synthesis of peptidoglycan

Classification Of Penicillin:

• NaturalPenicillin G
• Semisynthetic
• Acid resistant – Penicillin 5
• Penicillin resistant Methicillin
• Aminopenicillin Ampicillin
• Antipseudomonal penicillin Carbenicillin

Uses Of Penicillin:

• Orodental infections
• Syphilis
• Gonorrhea
• Streptococcal infections
• Tetanus
• Prophylactic Gangrene

Adverse Reaction Of Penicillin:

• Hypersensitivity
• Anaphylaxis
• Local pain at the site of injection
• Suprainfection
• Jarish Herxheimer reaction

Question 26. CSF Rhinorrhoea.
Answer:

CSF Rhinorrhoea

CSF Rhinorrhoea is typically a high level of Lefort III fracture

Causes Of CSF Rhinorrhoea:

• Dislocation of nasal bone
• Disruption of cribriform plates
• Tear of durometer
• This leads to leakage of CSF

Etiology Of CSF Rhinorrhoea:

1. Congenital encephalocele
2. Acquired Traumatic
   • Infection
   • Iatrogenic
   • Tumors
3. Spontaneous Increased intracranial pressure

Sites Of CSF Rhinorrhoea:

• Cribiform plate of ethmoidal roof
• Sphenoidal sinus
• Frontal sinus

Clinical Features Of CSF Rhinorrhoea:

• Unilateral watery nasal discharge
• Headache
• Visual disturbance
• Salty taste
• Positional variation
• Inflammatory paranasal sinus discharge

Clinical Examination:

• Tram line effect on the face
• Clear fluid stream
• A halo sign is seen in blood fluids
• Glistening moist nasal mucosa

Diagnosis Of CSF Rhinorrhoea:

• Biochemical test
• Low protein
• High glucose
• Beta trans protein
• Intratracheal fluorescin
• Nasal endoscopy Imaging

Treatment Of CSF Rhinorrhoea:

• Conservative
• Bed rest
• Head elevation
• Laxatives
• Antitussives
• Subarachnoid drainage
• Surgical
• Composite graft

Complications Of CSF Rhinorrhoea:

• Pneumocephalus
• Tension cephalus
• Infection
• Intracranial hypertension
• Persistent & recurrent CSF leak
• Post-traumatic CSF cyst

Question 27. Aspirin.
Answer:

Aspirin

Salicylic acid derivative

Actions Of Aspirin:

• Analgesia
• Anti pyretic
• Anti-inflammatory
• Antiplatelet action

Adverse Reactions Of Aspirin :

• GIT upset
• Allergic reactions
• Hemolysis
• Nephrotoxicity
• Hepatotoxicity
• Reye’s syndrome

Uses Of Aspirin:

• Toothache
• Arthralgia
• Fever
• Anti-inflammatory
• Osteoarthritis
• Post myocardial infarction
• Locally as a keratolytic agent

Question 28. Healing of extraction wound.
Answer:

Immediate Reaction Of Extraction Wound:

• Coagulation of blood
• Entrapment of RBC into fibrin mesh
• Vasodilation & engorgement of blood vessels
• Mobilization of leukocytes
• Presence of areas of contraction of clot

First Week Of Extraction Wound:

• Growth of fibroblast into the wound
• Formation of granulation tissue
• The proliferation of epithelium at the periphery
• The osteoblastic activity of alveolar bone
• Organization of blood clot

Second Week Of Extraction Wound:

• Penetration of new capillaries into the center of the clot
• Degeneration of remnants of PDL
• Fraying of the bony socket
• Epithelium proliferation at the periphery
• Fragments of necrotic bone

Third Week Of Extraction Wound:

• Complete formation of granulation tissue
• Presence of young trabeculae Early bone formation
• Remodeling of cortical bone

Fourth Week Of Extraction Wound:

• Bone filling
• Healing of crest of the bone

Question 29. Minor oral surgeries in hemophilic & diabetic
Answer:

Hemophilic Patients:

• Laboratory Investigations
• Immediate transfusion of factor 8 or 8 Transfusion of packed RBC
• Control bleeding with the help of fibrin foam Analgesics & corticosteroids
• Joint immobilization
• Local chilling
• Use of  4 desmopressin

Diabetic Patients:

• Monitor blood & urine glucose
• Risks:
• Hyperglycemia
• Hypoglycemia
• Delayed wound healing
• Infection

Management:

• Check fasting sugar
• Advice from physician
• Normal meal before surgery
• Routine medication before treatment
• Prophylactic antibiotic to prevent infection
• Antibiotics are also prescribed after treatment

Question 30. Blood transfusion reactions.
Answer:

Blood Transfusion Reactions

1. Simple pyrexial reactions
2. Allergic reactions
3. Sensitization to leukocytes & platelets
4. Major incompatibility
   • Hematuria
   • Pain in loins
   • Fever with chills
   • Oliguria
5. Transmission of diseases
   • Thrombophlebitis
   • Inflammation of superficial veins
   • Tender cord-like vein
   • Fever
6. Congestive cardiac failure
   • In chronic anemic patients
7. DIC
   • Disseminated intravascular coagulation
8. Adult respiratory distress syndrome

Reactions Caused By Massive Transfusion:

• Acid-base imbalance
• Hyperkalaemia
• Citrate toxicity
• Hypothermia
• Failure of coagulation

Question 31. Squamous cell carcinoma of Lip.
Answer:

Clinical Features Of Lip:

• Age/sex: Elderly males
• Nonhealing ulcer
• Edge is everted
• Induration present
• The floor is covered with slough
• Bleeding spots present
• Fix to underlying subcutaneous tissue
• Cervical lymphadenopathy

Differential Diagnosis Of Lip:

• Keratoacanthoma
• Ectopic salivary gland tumor
• Pyogenic granuloma
• Leukoplakia

Treatment Of Lip:

• Surgery
• Abbe flap
• Estlander flap
• Radiotherapy
• Dose: 4000-6000 cGy units

Question 32. Management of patient on long-term steroid therapy.
Answer:

Management Of Patient On Long-Term Steroid Therapy

• Prevention of infection by encouraging the patient to maintain good oral hygiene
• Advice frequent dental visit
• Aggressive treatment for acute infections
• Consult the patient’s physician if adrenal suppression is suspected

Mild Surgeries Of Steroid Therapy:

• Double the dose of steroids on the day of treatment
• Return to normal dose on the next day

Moderate Surgeries Of Steroid Therapy:

• 100 mg of Hydrocortisone before the procedure
• Half the dose on the following day

Severe Surgeries Of Steroid Therapy:

• 200 mg Hydrocortisone
• Half the dose on the following day

Question 33. Ibuprofen.
Answer:

Ibuprofen

Propionic acid derivative

Mechanism Of  Ibuprufen:

• Inhibit PG synthesis
• Inhibit platelet aggregation
• Prolongs bleeding time

Uses Of Ibuprofen:

• Analgesia
• Tooth extraction
• Fractures
• Postoperative swelling
• Dose: 400-600 mg TDS

Trade Name Ibuprufen:

• Brufen
• Ibugesic

Question 34. Hemostatic agents.
Answer:

Mechanical Of Agents:

1. Pressure pressure through gauze piece
2. Use of hemostat
3. Sutures & ligation
4. Embolization of the vessels
   • Through steel coils
   • Alcohol foam
   • Gel foam
   • Silicon spheres

Thermal Of Agents:

• Cautery: Transmission of heat by conduction of tissues
• Electrosurgery: Through induction from electric current
• Cryosurgery: Temperature used (-20°C) (180°C)
• Argon Beam Coagulator: Flow of argon gas is used
• Laser 

Chemical Agents:

1. Local Agents:
   • Astringents
   • Bone wax
   • Thrombin
   • Gel foam Oxycel
   • Surgicel
2.  Systemic Agents:
   • Whole blood transfusion
   • Platelet-rich plasma
   • Fresh frozen plasma
   • Cryoprecipitate

Question 35. Nerve supply to maxillary teeth.
Answer:

Nerve supply To Maxillary Teeth

• Incisors central, lateralAnterior superior alveolar nerve
• Canine Anterior superior alveolar nerve
• Premolar – Middle superior alveolar nerve
• Molars Posterior superior alveolar nerve

Question 36. Cancrum oris.
Answer:

Cancrum Oris

• Cancrum Oris is an extensive ulcerative disease of cheek mucosa occurring in malnourished children
• Precipitating Factors:
• Malnutrition
• Major diseases like diphtheria
• Vincent’s organism

Treatment Or Cancrum Oris:

• Ryle’s tube-feeding
• Improve the nutrition
• Antibiotics: Metronidazole-400 mg TID for 7-10 days
• Reconstructive surgery

Complications Of Cancrum Oris:

• Fibrosis
• Septicaemia
• Restricted jaw movement
• Death

Question 37. Principles of antibiotic therapy.
Answer:

Principles Of Antibiotic Therapy Can Be Divided Into The Following Groups:

1. Clinical evaluation and diagnosis for antimicrobial-biological etiology
   • Antibiotics specific for particular organisms should be used
2. Study of Culture and Sensitivity
   • Causative organisms are cultured and tested against a range of antibiotics for maximum sensitivity
3. Age of the patient
   • Certain drugs like chloramphenicol may cause serious toxic effects in infants
4. Pregnancy and neonatal period
   • Many antibiotics cross the placental barrier
   • They should be used only when extremely necessary
5. Severity of disease
   • Antimicrobial therapy should be considered for patients with established orofacial infections
   • Initially, a bacteriostatic agent should be used
6. Nature of the drug
   • Preferable to use bacteriocidal drug
7. Possibility of drug resistance
   • Alternative drugs should be used in such cases
8. History of previous allergic reaction
   • Alternative drugs should be used in such cases
9. Risk of toxicity of the drug
   • Patients should be informed about the side effects of the drug
10. Cost
    • Proper selection of suitable drugs is done
11. Use of narrow-spectrum antibiotic
    • It minimizes the risk of superinfection

Miscellaneous Short Question And Answers

Question 1. Idiosyncracy.
Answer:

Idiosyncrasy

• Idiosyncrasy is genetically determined abnormal reaction
• Example: Patients with G6PD deficiency
• In some cases, a person may be sensitive to low doses
• While in some patients even high doses don’t produce any reactions

Question 2. Fluid & electrolytes.
Answer:

Fluid & Electrolytes

• Body consists of 50-70% liquids & 30-50% solids by weight
• Liquid varies with age, sex & body habits Infants > adults 80% Vs 60%
• Males > Females 60% Vs 50%
• Thin > Obese
• Out of the total liquid
• Intracellular water 40%
• Extracellular portion 20%
• 5% plasma
• 15% interstitial fluid

Fluid & Electrolytes Water Regulation:

• Water ingested by regulation of thirst center
• Water excreted by regulation of ADH

Fluid & Electrolytes Replacement:

• Fluid requirement during starvation 2ml/kg/hour
• Maintenance requirement 2mg/kg/hour of surgery
• Minor surgery 4ml/kg/hour
• Moderate 6ml/kg/hour
• Severe -8ml/kg/hour
• Blood loss is replaced by blood transfusion

Fluid & Electrolytes Electrolytes:

Question 3. Neurogenic shock.
Answer:

Pathophysiology Of Neurogenic Shock :

Damage To Organs:

• Increase in myocardial contractibility

Question 4 . Hyperventilation.
Answer:

Clinical Features Of Hyperventilation:

• Age: 15-40 years
• Sex common in females

Features Of Hyperventilation:

• Anniery
• Paim
• Increased depth of respiration
• Excessive exchange of gases in lungs
• Decreased level of carbon dioxide
• Increased pH
• Decreased cerebral blood flow – Hypotension

Management Of Hyperventilation:

• Stop the dental procedure
• Make the patient comfortable
• Caver the mouth & nose with a paper bag
• Ask the patient to breathe

Question 5. Carcinoma in situ.
Answer:

Carcinoma In Situ

Carcinoma In Situ is the most severe stage of epithelial dysplasia, which involves the entire thickness of the epithelium with the basement membrane intact

Clinical Features Of Carcinoma:

• Age: Elderly patients
• Sex: Common in males

Presentation Of Carcinoma:

• Appears as white plaques or ulcerated areas
• Site: The floor of the mouth, tongue, lip, etc
• Appears as leukoplakia or erythroplakia

Treatment  Of Carcinoma:

• Surgery
• Radiotherapy
• Electrocautery

Question 6. Classification of NSAID/NSAIDs.
Answer:

Nonsteroidal anti-inflammatory drugs are aspirin-type or non-opioid analgesics

Classification Of NSAID:

1. Nonselective COX inhibitors
   • Salicylic acid derivatives
     • Aspirin, sodium salicylate, diflunisal
   • Para-aminophenol derivatives
     • Paracetamol
   • Pyrazolone derivative
     • Phenylbutazone, azapropazone
   • Indole acetic acid derivative
     • Indomethacin. etodolac
   • Arylacetic acid derivative
     • Diclofenac, aciclofenac, ketorolac
   • Propionic acid derivative
     • Ibuprofen, carprofen, naproxen, ketoprofen
   • Anthranilic acids
     • Flufenamic acid, mefanamic acid
   • Oxicams
     • Piroxicam tenoxicam
   • Alkanones
     • Nabumetone
2. Selective COX-2 inhibitors
   • Nimesulide, celecoxib, rofecoxib

Mechanism Of Action:

• NSAIDs inhibit prostaglandin synthesis by inhibiting the enzyme cyclo-oxygenase

Question 7. Submucous fibrosis.
Answer:

Submucous Fibrosis

Submucous Fibrosis is a pre-cancerous condition

Submucous Fibrosis is characterized by juxta epithelial inflammatory reaction in the oral mucosa followed by a fibro elastic transformation of the lamina propria leading to mucosal atrophy, rigidity & trismus

Etiology Of Fibrosis:

• Consumption of red chilies
• Consumption of areca nuts Nutritional deficiencies Immunological factors
• Genetic factors

Features Of Fibrosis:

• Burning sensation
• Difficulty in mastication Referred pain in the ear
• Depapillation of tongue
• Restricted movement of floor of mouth
• Shrunken uvula
• Fibrous bands
• Restricted mouth opening
• Stiffness of buccal mucosa

Management Of Fibrosis:

• Quit the habit
• Antioxidant Oxyace1 capsule/ day
• Multivitamin therapy
• Sterold Betnovate 0.12%
• Tumeric application
• Intralesional injection of Hyaluronidase 1500 U
• Physiotherapy
• Splitting of fibrous bands
• Laser

Question 8. Cherubism.
Answer:

Clinical Features Of Cherubism:

• Painless, bilateral swelling of the mandible
• Maxillary swelling
• Pressure on orbit
• Heavenward look
• Increased cheek fullness
• Expansion & widening of the alveolar ridge.
• Flattening of palatal vault
• Chronic lymphadenopathy
• Premature exfoliation of deciduous
• Delayed eruption of permanent
• Hypodontia of teeth
• Difficulty in mastication, speech, swallowing
• Associated with Noonan syndrome
• Affects young children

Treatment Of Cherubism:

• Self-limiting disease

Question 9. Diazepam.
Answer:

Diazepam

Diazepam is benzodiazepine

Actions Of Diazepam:

• Sedation & hypnosis Reduction in anxiety
• Muscle relaxant
• Anticonvulsant
• Amnesia

Mechanism Of Diazepam:

• Binds to GABA receptor
• Increases frequency of chloride channel opening Increases flow of chlorine
• Hyperpolarization

Adverse Reactions Of Diazepam:

• Drowsiness
• Blurred vision.
• Amnesia
• Lethargy
• Ataxia
• Tolerance & dependence

Uses Of Diazepam:

• Insomnia
• Anxiety
• Anticonvulsants
• Muscle relaxant
• Pre-anesthetic medicament
• During alcohol withdrawal

Question 10. Dead space management.
Answer:

Dead Space Management

Dead space is a space left in the body as a result of a surgical procedure

Management Of Dead Space:

• Dead Space Management depends on size, location, and cause
• Treatment options are
  1. No treatment
  2. External bandage compression
     • Involves the application of mildly compressive bandages to compress
  3. Suture closure
     • Can avoid post-surgical care and overall cost factors associated with the use of surgical drains
  4. Use of drainage systems
     • Protects wounds
     • Penrose drains are used to control small to moderate-sized areas of dead space
     • Normally used to manage dead space for 3-5 days
  5. Aspiration
     • Hypodermic needle aspiration may be used alone or in combination

Question 11. Enbloc resection.
Answer:

Enbloc Resection

• Dead Space Management is the resection of a large bulky tumor virtually without dissection surgery
• Dead Space Management is used in certain cancers to remove
• Primary lesion
• Contagious draining lymph nodes

Question 12. Papilloma.
Answer:

Papilloma

• Papilloma is a common benign neoplasm of the oral cavity arising from epithelial tissue
• Papilloma is characterized by exophytic growth with a typical cauliflower-like appearance

Clinical Features Of Papilloma:

• Age- Third, fourth, and fifth decade of life Sex-both sexes are equally affected
• Site involved
• Tongue
• Lips
• Buccal mucosa
• Gingiva
• Hard and soft palate
• Present as slow growth, exophytic, soft, pedunculated, painless, nodular growth with a cauliflower-like appearance
• Have numerous finger-like projections over the surface
• It appears as ovoid swelling with a corrugated surface
• Size- a few mm to 1 cm in diameter
• The base of the lesion may be pedunculated or sessile
• Color-white in color
• Surface- highly keratinized
• Superficial ulceration and secondary infection occur
• Rarely papilloma grows inward

Question 13. Eburnation.
Answer:

Eburnation

• Eburnation describes a degenerative process of bone commonly found in patients with osteoarthritis or non-union of fractures
• It is an ivory-like reaction of bone occurring at the site of cartilage erosion
• Osteoarthritis is a degenerative disease of the joints characterized largely by central loss of cartilage and compensatory peripheral bone formation
• Over time, as the cartilage wears away and subchondral bone is revealed
• Eburnation describes the bony sclerosis that occurs in the areas of cartilage loss

Question 14. Nutrition for post-surgical patients.
Answer:

Nutrition For Post-Surgical Patients

Nutrition requirements for post-surgical patients increase than normal requirements

1. Calorie:
   • Increases to 30-40 kcal/kg
   • Patients on ventilators usually require fewer calories- 20-25 kcal/kg
2.  Protein:
   • Increases to 1-1.8 grams/kg
3. Fluids:
   • Start clear liquids when signs of bowel function return
   • Clear liquids are intended for short-term use due to inadequacy
4. Vitamin Supplements:
   • Vitamin supplements promote healing Avoid long-term supplements due to the high risk of toxicity

Minerals Of Post-Surgical Patients:

• Zinc loss occurs due to large wounds, chest tubes, and wound drains
• Prolonged zinc supplementation interferes with copper absorption

Clinical Topics Definition

 Local Anesthesia: It is loss of sensation in a circumscribed area of the body characterized by depression of excitation of nerve ending & inhibition of the conduction process of peripheral nerve.

Clinical Topics Important Notes

1. Types Of Nerve Blocks:

2. Inferior Nerve Block:

• Areas Anaesthesized:
  • LA is deposited near the main trunk
  • LA is deposited near a large branch of the peripheral nerve
  • LA is deposited near small nerve endings
  • The body of the mandible and the inferior portion of the ramus
  • Mandibular teeth
  • Mucous membrane and underlying tissues anterior to the 1st mandibular molar
• Complications:
  • Hematoma
  • Trismus
  • Transient facial paralysis

3. Gow Gates Technique:

• Gow Gates Technique is open mouth technique
• Landmarks
  • Extraoral
    • The lower border of the tragus
    • Corner of mouth
  • Intraoral
    • Mesiolingual cusp of the maxillary second molar
    • Penetration of needle just distal to maxillary second molar

Read And Learn More: Oral and Maxillofacial Surgery Question and Answers

4. Hematoma:

• Hematoma is commonly associated with a posterior superior alveolar nerve block and inferior nerve block
• Hematoma formation in the posterior superior alveolar nerve block is due to injury of the pterygoid plex which results in immediate swelling of the face
• To avoid this short needles are used

5. Extra Oral Techniques:

• Maxillary: In this, the needle is directed anterior to the lateral pterygoid plate into the pterygopalatine fossa
• Mandibular: In it the needle is inserted from below the zygomatic arch and is directed posterior to the lateral pt plate below the foramen ovale

6. Advantages Of Adding Vasoconstrictor Agents:

• Prevents rapid absorption of LA
• Prolongs the duration of action
• Reduces the toxicity of LA
• Bleeding in the area is minimized

7. Composition Of LA:

• Local anesthetic-Ester or amide
• Vasoconstrictor- Epinephrine
• Antioxidant- Sodium metabisulphite.
• It competes with the vasoconstrictor for the available oxygen died to sodium bisulfate
• Preservative Methylparaben
• Fungicisde – Thymol
• Salt- Sodium chloride
• Vehicle- Distilled water or Ringer’s lactate solution

8. Theories Of Anesthesia:

• Surface charge theory
• Specific receptor theory Acetylcholine theory
• Membrane expansion theory
• Calcium displacement theory

9. Theories Of Pain:

• Specificity theory
• Pattern theory
• Gate control theory

10. Vazirani Akinosi Technique:

• Vazirani Akinosi Technique is closed mouth mandibular nerve block
• Used in patients with a limited mandibular opening as a result of infection, trauma, or postinjection trismus
• Nerves anesthetized are
  • Inferior alveolar
  • Incisive
  • Mental
  • Lingual
  • Mylohyoid

Clinical Topics Long Essays

Question 1. Describe the technique of inferior dental nerve block anesthesia. Enumerate complications of the technique.
Answer:

Inferior Alveolar Nerve Block:

• Nerves anesthetized: Inferior alveolar nerve & its branches
• Areas to be anesthetized: Mandibular teeth & its supporting tissues

Landmarks Of Nerve Block:

• Mucobuccal fold
• Anterior border of coronoid process
• Coronoid notch
• Pterygomandibular raphe
• Retromolar pad
• Retromolar triangle
• External oblique ridge

The technique Of Nerve Block:

• Position the patient in a semi-reclined position
• Move your index finger over the mesiobuccal fold up to the external oblique ridge
• Move it up & down to obtain depression
• This is a coronoid notch
• Retract the cheek
• Support the mandible
• Insert 1 5/8 inch 25 gauge needle from the lingual side
• Aspirate & Slowly deposit the solution

Positive Aspiration: 10-15%:

• Symptoms:
  • Subjective: Tingling & numbness over the lower lip & lateral border of the tongue
  • Objective: Instrumentation demonstrates the absence of pain

Complications Of Nerve Block: 

• Trismus
• Hematoma
• Transient facial paralysis

Question 2. Describe in detail the surgical anatomy, indications & contraindications & technique of the inferior alveolar nerve block.
Answer:

Surgical Anatomy:

• Surgical Anatomy is a branch of the posterior division of the mandibular nerve i.e division of a trigeminal nerve
• Surgical Anatomy passes between the medial pterygoid muscle & ramus of the mandible
  Passes through the mandibular foramen
• On reaching the anterior teeth it divides into incisive & mental branches
• Before entering into the mandibular foramen it gives out a mylohyoid branch to supply the mylohyoid muscle
• Inferior Alveolar Nerve Block

Indications Of Surgical Anatomy:

• Any surgery related to multiple mandibular teeth
• Buccal soft tissue anesthesia
• Lingual soft tissue anesthesia

Contraindications Of Surgical Anatomy:

• Infections
• Lip biting
• Young children
• Physical & mentally handicapped children
• Nerves Anesthetized: Inferior alveolar nerve & its branches
• Areas To Be Anesthetized: Mandibular teeth & its supporting tissues

Landmarks Of Surgical Anatomy:

• Mucobuccal fold
• Anterior border of coronoid process
• Coronoid notch
• Pterygomandibular raphe
• Retromolar pad
• Retromolar triangle
• External oblique ridge

The Technique Of Surgical Anatomy:

• Position the patient in a semi-reclined position
• Move your index finger over the mesiobuccal fold up to the external oblique ridge
• Move it up & down to obtain depression
• This is a coronoid notch
• Retract the cheek
• Support the mandible
• Insert 1 5/8 inch 25 gauge needle from the lingual side
• Aspirate & Slowly deposit the solution
• Positive Aspiration: 10-15%:

Question 3. Write the course of the maxillary nerve. And write the landmarks for the posterior superior nerve block.
Answer:

Maxillary Nerve:

• Originates at the middle of the semilunar ganglion
• Continues in the lower part of the cavernous sinus
• Passes to the foramen rotundum
• Enters pterygopalatine fossa
• Enters the inferior orbital fissure to enter the orbit

Branches of Maxillary Nerve:

1. In Middle Cranial Fossa:

• Middle meningeal nerve to supply

2. In Pterygopalatine Fossa:

• Zygomatic Nerve:
  • Passes anteriorly & laterally
  • Divides into
    • Zygomaticofacial nerve- Pierces the orbicular oris & supplies prominence of cheek Zygomaticotemporal nerve
  • Enters the temporal fossa & supplies the skin over the anterior temporal fossa region
• Pterygopalatine Nerve:
  • Branches:
    • Orbital Branches: Using inferior orbital fissure, supplies periosteum of orbit, posterior ethmoid cells & sphenoid sinus
    • Nasal Branches: Divides into posterior superior lateral & medial or septal branches
• Palatine Branches:
  • Descends in the pterygopalatine canal, divides into
    • Greater or anterior palatine- supply hard palate
    • Middle palatine-sensory to soft palate
• Posterior Palatine:
  • Supplies mucous membrane to tonsil.

3. Posterior Superior Alveolar Nerve:

• Divides into many branches & descends downward to supply maxillary molars & their supporting gingivae

4. Branches In Infraorbital Groove & Canal: 

• Middle Superior Alveolar Nerve:
  • Supplies the posterior part of the maxillary sinus
  • Descends downward
  • Divides & supplies maxillary bicuspids

5. Terminal Branches On Face:

• Inferior palpebral- Supplies lower eyelid
• External or lateral nasal –  Supplies side of the nose
• Superior labial – Supplies upper lip

Landmarks Of Posterior Superior Alveolar Nerve Block:

• Zygomatic process of maxilla
• Mucobuccal fold
• infratemporal process of maxilla Coronoid process of mandible

Question 4. Enumerate the course of the mandibular branch of the trigeminal nerve & explain the technique of inferior alveolar nerve block.
Answer:

1. Divided Nerve:

• Anterior Division
  • External pterygoid
  • Masseter
  • Temporal
  • Buccal
• Posterior
  • Inferior alveolar
  • Auriculotemporal
  • Lingual

2. Undivided Nerve:

• Nervus spinosus
• Internal pterygoid

Inferior Alveolar Nerve Block:

• Nerves Anesthetized: Inferior alveolar nerve & its branches
• Areas To Be Anesthetized: Mandibular teeth & its supporting tissues

Landmark of Nerve Block:

• Mucobuccal fold
• Anterior border of coronoid process
• Coronoid notch
• Pterygomandibular raphe
• Retromolar pad
• Retromolar triangle
• External oblique ridge

The technique of Nerve Block:

• Position the patient in a semi-reclined position
• Move your Index finger over the mesiobuccal fold up to the external oblique ridge
• Move it up & down to obtain depression
• This is a coronoid notch Retract the cheek
• Support the mandible
• Insert 1 5/8 inch 25 gauge needle from the lingual side
• Aspirate & Slowly deposit the solution
• Positive Aspiration: 10-15%

Question 5. Describe in detail the extracranial course of the trigeminal nerve.
Answer:

• The trigeminal nerve is the fifth cranial nerve
• It divides into three branches as it proceeds from the convex border of the semilunar ganglion.

Branches Of Trigeminal Nerve :

1. Ophthalmic Branch:

• Passes upward & enters the orbit through the superior orbital fissure
• It divides into
  • Lacrimal branch- supplying the lacrimal gland
  • Frontal branch- further divides into
    • Supraorbital & Supratrochlear
  • Supplies canthus of eye & side of the face
  • Nasociliary Nerve: Divides into

2. Orbital Branches:

• Long ciliary ganglion
• Long ciliary nerve
• Posterior ethmoid- Supply posterior ethmoidal cells & sphenoidal sinus
• Anterior ethmoidal- Supply anterior ethmoidal cells & frontal sinus
• Divides into internal & external nasal

3.  Nasal Branches:

• Supplies vomer & nasal mucosa

4. Terminal Branches On Face:

Supplies lower eyelid, upper lip & side of nos

Question 6. Definition, composition & ideal properties of local anesthesia. Describe its mechanism of action.
Answer:

Definition Of Anesthesia:

It is loss of sensation in a circumscribed area of the body characterized by depression of excitation of nerve endings & inhibition of the conduction process of peripheral nerve

Composition Of Anaesthesia:

• Local anesthetic – Ester or amide
• Vasoconstrictor- Epinephrine
• Antioxidant- Sodium metabisulphite
• Preservative- Methylparaben
• Vehicle- Distilled water or Ringer’s lactate solution

Ideal Properties Of Anaesthesia:

• Nonirritant
• No permanent damage to the nerve
• Low systemic toxicity
• Effective
• The short onset of action
• Long-lasting effect
• Potent
• Free of allergens
• Stable & biocompactible
• Able to sterilize it

Mechanism Action Of Anaesthesia:

• Displacement of calcium ions from sodium channel receptor site which permits
• The binding of the LA molecule to this site produces
• Blockade of the sodium channel & a
• Decrease in sodium conductance, which leads to
• Depression of rate of electrical depolarization
• Failure to achieve the threshold potential level along with a
• Lack of development of propagated action potential which is called
• Conduction blockade

Question 7. Classify local anesthetic drugs. Discuss lignocaine hydrochloride.
Answer:

Based On The Site Of Action:

• Class 1: Agents acting on the external surface of the membrane
  • Example: Biotoxins
• Class 2: Agents acting on the internal surface of the membrane
  • Example: Quaternary ammonium compounds
• Class 3: Agents acting by an independent mechanism
  • Example: Benzocaine
• Class 4: Agents acting by combination mechanisms
  • Example: Articaine, Bupivacaine

Based On Group of Drugs:

1. Esters:
   • Esters Of Benzoic Acids:
     • Butacaine
     • Cocaine
     • Hexylcaine
     • Tetracaine
   • Esters Of Paraamino Acids:
     • Chloroquine
     • Procaine
2.  Amides:
   • Atricalno
   • Bupivacaine
   • Etidocaine
3. Quinolone:
   • Centbucridine

Lidocaine HCL:

• Classification: Amide
• Potency: 2
• Metabolism: Microsomal oxidase
• PKA: 7,9
• pH Of Plain Solution:6.5
• pH Of Vasoconstrictor: 5-5.5 Plasma Half-Life 16-hour
• Effective Concentration: 2%
• Maximum Recommended Dose: 7 mg/kg body weight

Question 8. Write about it Indications & contra-indications of local anesthesia.
Answer:

Indications Anesthesia:

• Periodontal surgery
• Extraction
• Impaction
• Endodontic procedures Implant placement
• Minor surgical procedures

Contraindications Of Anesthesia:

1. Absolute Contraindications:
   • Local anesthetic agent allergy
   • Bisulfite allergy
2. Relative Contraindications:
   • Liver disorders
   • Renal disorders
   • Cardiac disorders
   • Methemoglubenimela

Question 9. Write in detail about local & systemic complications of local anesthesia.
Or
Post Operative complications of LA
Answers:

Local Complications:

1. NeedleBreakages:

• Due to the sudden movement of the patient’s Narrow gauge needle
• Broken needle
• Bent needle

eedleBreakages Management: 

• Due to the sudden move
• Radiograph to locate it
• Expose the site and remove it

2. Facial Nerve Paralysis  

Facial Nerve Paralysis Causes :

• Insertion of needle into the parotid capsule

Facial Nerve Paralysis Management: 

• Self-curing
• The eye can be protected with the help of a keypad

3. Paraesthesia:

Paraesthesia Cause:

• Injury to the nerve

Paraesthesia Management:

• Self-recovery by regeneration of nerve:

4. Trismus:

Trismus Cause:

• Trauma to medial pterygoid muscle:
• Contaminated needle

Trismus Management:

• Analgesic
• Muscle relaxants
• Hot fomentation
• Physiotherapy

5. Pain On Injection:

Pain On Injection Cause:

• Blunt needle
• Broader gauge needle

Pain On Injection Management:

• Use of short, narrow-gauge needle

6. Burning On Injection:

Burning On Injection Cause:

• An acidic solution of LA
• Contaminated needle

Burning On Injection Management:

• Isotonic solution by addition of bicarbonate
• Use of disposable needle

7. Soft Tissue Injury:

Soft Tissue Injury Cause:

• Due to being unaware of numbness of lips patient tries to do lip-biting

Soft Tissue Injury Management:

• Explain to the patient the numbness
• Use of lifeguards in children

8. Hematoma:

Hematoma Cause:

• Injury to blood vessels

Hematoma Management:

• Assure of proper anatomy of landmarks & nerve
• Massage the area
• Antibiotics
• Hot fomentation

9. Infection:

Infection Causes:

• Contaminated needle

Infection Management:

• Use of disposable needle
• Antibiotics
• Drainage of space involved
• Physiotherapy

10. Necrosis Of Tissues:

Necrosis Of Tissues Causes:

• Seen in palatal injection
• This region is tightly bound to the underlying bone
• Thus excessive pressure is required for the insertion of the needle
• This leads to the blanching of the area
• Vasoconstriction & localized necrosis

11. Edema:

Edema Causes:

• Injury to nerve
• Contaminated needle

Edema Management:

• Subsidies on their own
• Avoid application of hot fomentation
• Application of cold fomentation
• As it acts as vasoconstrictor & analgesic

12. Post Anaesthetic Lesions:

• Ulcers
• Allergic reactions

Post Anaesthetic lesions Causes:

• Trauma
• Allergy to LA agent

Systemic Complications:

1. Overdose:

Causes Of Overdose:

• Excessive dose of LA
• Systemic disorders of metabolism

Features of Overdose:

• Nausea
• Vomiting
• Diplopia
• Tremors
• Acidosis
• Respiratory distress
• Chest pain
• Bradycardia
• Hypotension
• Dizziness

Management of Overdose:

• Reassure the patient Maintain the patient’s airway
• Intubate if necessary
• Cardiac life support given
• IV fluids & vasopressors were given for hypotension

2. Hypersensitivity:

Causes Of Hypersensitivity:

• Allergy to LA
• Allergy to preservatives used

Features Of Hypersensitivity:

• Pruritis
• Utricaria
• Dyspnoea
• Wheezing
• Nausea, vomiting

Management of Hypersensitivity:

• Stop the procedure
• Mild allergy- Corticosteroids
• Severe allergy- Epinephrine 1: 1000 of 0.3-0.5 ml
• SC If symptoms continue 5 ml of 1: 10000 epinephrine given IV

Question 10.  Discuss the metabolism of ester & amide groups of anesthesia.
Answer:

Metabolism Of Ester Group:

• Metabolized by hydrolysis by plasma pseudocholinesterase
• The end product of it is PABA
• If the patient is allergic to it alternative drug is used
• Examples- Cocaine, cocaine, etc.

Metabolism Of Amide Group:

• Metabolized in the liver by microsomal enzymes
• Used with caution in patients with liver disease
• Example of enzyme: P-450 3A4
• Example of drugs: Lidocaine

Question 11. Discuss in detail about infraorbital nerve block. Write its landmarks, technique, and complications.
Answer:’

Nerve Of Anaesthesize:

• Infraorbital nerve
• Inferior palpebral
• Super labial

Areas Of Anaesthesized:

• Maxillary incisors, canines
• Underlying periosteum
• Side of nose Upper lip Lower eyelid

Landmarks Of Anaesthesized:

• Mucobuccal fold
• Infraorbital notch Infraorbital foramen

The Technique Of Anaesthesized:

• Position the patient
• The maxillary occlusal plane must be parallel to the floor
• Palpate infraorbital foramen, below the infraorbital ridge
• Below feel the depression
• Simultaneously retract the upper lip
• Insert a 15/8 inch 25 gauge needle by either placing the
  needle parallel to incisors or bisecting
• Slowly deposit the solution
• Positive Aspiration: 0.79%

Complications Of Anaesthesized:

• Hematoma may develop across the lower eyelid and the tissues between it and the infraorbital foramen
• Complications Of Anaesthesized is a very rare complication

Question 12. Write nerve supply to maxillary teeth.
Answer:

Nerve Supply To Maxillary Teeth:

Symptoms Of Maxillary Teeth:

• Subjective: No subjective symptoms
• Objective: Instrumentation demonstrates the absence of pain

Complications Of Maxillary Teeth:

• Hematoma
• Produces by inserting the needle too far posteriorly Into the pterygoid plexus
• Varying degrees of mandibular anesthesia
• Produces due to deposition of solution lateral to the desired location

Question 13. Explain In detail the theories and mechanism of action of local anesthesia.
Or
Theories of local anesthetic action
Answer:

 Theories Of Local Anesthesia:

1. Acetylcholine Theory:
   • States that besides being a neurotransmitter, it helps the inaction of local anesthetic agent
   • It has not proved yet
2. Calcium Displacement Theory:
   • States that calcium displaces sodium ions from the receptor site
   • But when demonstrated in calcium baths gave false results
3. Surface Charge Theory:
   • States that the LA agent binds to the ions on the membrane surface & causes a change in electric potential
   • But action of
   • LA occurs inside the membrane rather than outside
4. Membrane Expansion Theory:
   • LA agents enter the membrane & bind to the hydrophobic groups of the membrane & expand it
   • Accepted one
5. Specific Receptor Theory:
   • LA binds to the specific receptors present over the sodium channels

Mechanism Of Action:

• Displacement of calcium ions from sodium channel receptor site which permits
• The binding of the LA molecule to this site produces
• Blockade of the sodium channel & a
• Decrease in sodium conductance, which leads to
• Depression of rate of electrical depolarization Failure to achieve the threshold potential level along- with a
• Lack of development of propagated action potential which is called
• Conduction blockade

Clinical Topics Short Essays

Question 1. Classification & indications of corticosteroids.
Answer:

Classification Of Corticosterolds:

1. Short Acting:
   • Cortisone
   • Hydrocortisone
2. Intermediate Acting:
   • Prednisolone
   • Methylprednisolone
3. Long Acting:
   • Paramethasone
   • Dexamethasone

Indications Of Corticosterolds:

• Rheumatoid arthritis
• Osteoarthritis
• Eye diseases
• Bronchial asthma
• Collagen diseases
• GIT diseases
• Renal diseases
• Organ transplantation
• Lung diseases
• Malignancies
• Allergic diseases
• Skin diseases

Question 2. Gow gates technique.
Answer:

Nerves To Be Anaesthesized:

• Inferior alveolar nerve
• Mental
• Incisive
• Lingual
• Mylohyoid
• Buccal
• Auriculotemporal

Areas To Be Anaesthesized:

• All mandibular teeth & its associated parts

Landmarks Anaesthesized:

• Extraoral:
  • Corner of mouth
  • Intertragic notch
• Intraoral:
  • Coronoid process
  • Maxillary occlusal plane

Technique of Anaesthesized: 

• Locate intraoral & extraoral landmarks
• Make the patient open his mouth widely
• Insert needle such that it coincides with extraoral & intraoral landmarks
• The depth of penetration of the needle is increased by at least 3/4th of its length
• Aspirate
• Slowly deposit the solution

Symptoms of Anaesthesized:

• Subjective
• Tingling & numbness in the area
• Objective
• Instrumentation demonstrates the absence of pain

Question 3. Cephalosporins.
Answer:

Cephalosporins

• Group of semisynthetic antibiotics

Mechanism Of Cephalosporins:

• Bactericidal
• Inhibits cell wall synthesis by inhibiting transpeptidase enzyme

Generations Of Cephalosporins:

• 1st ^generation
  • High activity against gram-positive
• 2^nd Generation
  • High activity against gram-negative
• 3^rdGeneration
  • More active against gram-negative
• 4^th Generation
  • Effective against gram-positive & gram-negative

Uses Of Cephalosporin:

• Dental infections
• Prophylaxis
• Respiratory infections
• UTI
• Septicaemia
• Typhoid
• Nosocomial infection

Adverse Reactions Of Cephalosporin:

• Pain after injection
• Diarrhea
• Nephrotoxicity
• Bleeding
• Low WBC count
• Disulfiram-like reaction with alcohol

Question 4. Electrophysiology Of nerve conduction.

Answer:

Step 1: Excitation

1. Initially Slow Depolarization:
   • Interior of the membrane becomes less negative than the outside
2.  The Rapid Phase Of Depolarization:
   • Also called Threshold potential/firing potential
3. Reversal Of Potential:
   • Interior becomes more positive i.e. + 40 mV

Step 2: Repolarization Outside:

• The interior of the membrane becomes more negative than
• Upto resting potential reaches 70 mV’

Question 5. Metabolism of local anesthesia.
Answer:

Metabolism Of Local Anesthesia

Question 6. Forcep design.
Answer:

Forcep Design:

• Forcep is designed in such a way that it delivers teeth from the socket
• Parts: HBeaks, Joint & Handles
• Cross-hatching on handles is present for grip overhand
• Serrations are present interiorly to obtain a grip over the tooth
• Beaks are pushed apically to form a grip

Types Of Forcep Design:

Type 1:

•  Mandibular Forceps:
  • Beaks are at a right angle to the handles
• Maxillary Forceps:
  • The beaks are in the same line as the handles

Type 2:

• American Forceps:
  • The Joint is designed in a horizontal pattern Used for upper extractions
• English Type:
  • Joint present in a vertical pattern
  • Used for lower extractions

Question 7. Role of vasoconstrictors in local anesthetics.
Answer:

Role Of Vasoconstrictors In Local Anesthetics

• Actions of vasoconstrictor in local anesthesia.
• By constricting blood vessels, vasoconstrictors decrease blood flow to the site of drug administration.
• Absorption of local anesthetic into the cardiovascular system is slowed resulting in lower anesthetic blood levels.
• Decreases the risk of local anesthetic toxicity.
• Increases duration of action of local anesthetics.
• Decreases bleeding at the site of administration.

Question 8. Ester group of local anesthetic agents.
Answer:

1. Esters Of Benzoic Acids:

• Butacaine
• Cocaine
• Hexylcaine
• Tetracaine.

2. Esters Of Para-Amino Acids.

• Chloroquine
• Procaine.

Metabolism Of Benzoic Acids:

• Metabolized by hydrolysis by plasma pseudo-choli-esterase
• The end product of it is PABA
• If the patient is allergic to it alternative drug is used
• Example: Coccaine, procaine, etc.

Clinical Topics Short Question And Answers

Question 1. Eutectic mixture of local anesthesia.
Answer:

Eutectic Mixture Of Local Anesthesia

• Topical application of anesthesia
• Contains 2.5% prilocaine & 2.5% lignocaine

Uses Of Local Anesthesia:

• Needle phobic patients
• Painful superficial procedures
• Circumcision
• Leg ulcer debridement
• Gynecological procedures

Contraindications Of Local Anesthesia:

• Methemoglobinaemia
• Infants of less than 12 months may lead to methemoglobinemia

Question 2. Adrenaline.
Answer:

Adrenaline Mode Of Action: On α & β adrenergic receptors

Adrenaline Actions:

• ↑ Systolic & diastolic pressure
• ↑ Cardiac output
• ↑ Stroke volume
• ↑ Heart rate
• ↑ Contraction
• ↑ Myocardial oxygen consumption

Adrenaline ADR: Bronchodilation

• Anxiety
• Dizziness
• Headache
• Tremors
• Weakness

Uses of Adrenaline: Allergic reactions

• ↑Depth of anesthesia
• ↑Duration of anesthesia
• Bronchospasm
• Cardiac arrest
• Hemostasis

Question 3. Bupivacaine.
Answer:

Bupivacaine

• Classification: Amide
• Potency: 4 times of lignocaine
• Metabolism: Hepatic amidase
• PKA: 8.1
• pH Of Plain Solution: 4.5-6 pH of
• Vasoconstrictor: 3-4.5
• Plasma Half-Life: 2.7 hours
• Effective Concentration: 0.5%
• Maximum Recommended Dose: 1.3 mg/kg body weight

Question 4. Inferior alveolar nerve block complication.
Answer:

Inferior Alveolar Nerve block Complication

• Transient Facial Nerve Paralysis: If the needle is inserted into the parotid capsule
• Trismus: Due to spasm of medial pterygoid muscle
• Hematoma: Due to injury to vessels

Question 5. Landmarks for extraoral maxillary nerve block.
Answer:

Landmarks For Extraoral Maxillary Nerve Block

• The lower border of the zygomatic arch
• Coronoid process of mandible
• Sigmoid notch
• Lateral pterygoid plate

Question 6. Vasoconstrictor./ Use of vasoconstrictor in local anesthesia.
Answer:

Use Of Vasoconstrictor In Local Anesthesia

• Actions of Vasoconstrictor in local anesthesia
• By constricting blood vessels, vasoconstrictors decrease blood flow to the site of drug administration
• Absorption of the local anesthetic into the cardiovascular system is slowed resulting in lower anesthetic blood levels
• Decreases the risk of local anesthetic toxicity Increases duration of action of local anesthetics
• Decreases bleeding at the site of administration

Question 7. Posterior superior alveolar nerve block.
Answer:

The Technique Of Nerve Block:

• Position the patient
• Area of insertion- Height of mesiobuccal fold above the maxillary second molar
• Retract the patient’s cheek.
• Insert a 27-gauge needle into the height of the mesiobuccal fold over the second molar
• Advance the needle slowly in an upward, inward, and backward direction
• Advance the needle to the desired depth Aspirate in two planes
• Slowly deposit 0.9-1.8 ml of anesthetic solution Slowly withdraw the needle

Clinical Topics Viva Voce

1. The posterior portion of the hard palate and overlying structures upto the first premolar on the injected side are anesthetized by greater palatine nerve block
2. A decrease in interstitial fluid pH will decrease the effectiveness of a local anesthetic block
3. Epinephrine is added to local anesthetics because it decreases the rate of absorption of the local anesthetic at the injection site
4. The maxillary branch of the trigeminal nerve passes through the foramen rotundum
5. A nerve is refractory during depolarization
6. The local anesthetics act on the nerve membrane
7. Tachyphylaxis occurs due to repeated use of local anesthesia
8. Local anesthetics are excreted through the kidneys
9. The rebound phenomenon is most commonly seen with the use of epinephrine
10. Bupivacaine is the least toxic local anesthetic
11. Bupivacaine is a long-acting local anesthetic agent
12. Local infiltration should be para periosteal
13. In greater palatine nerve block needle should be perpendicular to the mucosa
14. Gow Gates technique is for mandibular nerve block
15. The target of the Gow Gates technique is the neck of the condyle
16. For extraoral maxillary nerve block, the target area is anterior to lateral pterygoid plate
17. Aspiration should be done in at least two planes
18. Local anesthetics produce anesthesia by inhibiting the influx of sodium ions through the nerve membrane
19. The most potent vasodilator local anesthetic agent is procaine
20. Amide type of local anesthetic agents undergo biotransformation primarily in the liver
21. Infiltration in the maxillary first molar region is not effective due to zygomatic buttress bone in the region
22. The most common complication after surgical removal of a mandibular tooth is

Orofacial And Neck Infections Definition

Ludwig’s Angina: Ludwig’s Angina is rapidly spreading cellulitis involving simultaneously all three spaces i.e. Submandibular, sublingual & submental spaces

Cellulitis: Cellulitis is a nonsuppurative infection spreading along subcutaneous tissues & connective tissue planes & caused by hemolytic streptococcus

Osteomyelitis:  Infection of bone that results in inflammation of bone involving the surrounding periosteum & Haversian system

Osteoradionecrosis: Osteoradionecrosis is necrosis of bone occurring secondary to radiation exposure

Read And Learn More: Oral and Maxillofacial Surgery Question and Answers

Orofacial And Neck Infections Important Notes

1. Classification of fascial spaces:

• According To Killey & Kay:
  1. In Relation To Mandible: Submental
     • Submandibular
     • Sublingual
     • Buccal
     • Submassetric
     • Pterygomandibular
     • Peritonsillar
  2. In Relation To Maxilla:
     • Canine space
     • Palatal space
     • Parotid space Infratemporal space
• According To Topazlan:
  1. Face
     • Buccal
     • Canine
     • Masticator
     • Masseter
     • Pterygold
     • Zygomaticotemporal
     • Parotid
  2. Suprahyold
     • Sublingual
     • Submandibular
     • Pharyngomaxillary
  3. Infrahyoid
     • Anterovisceral
  4. Spaces of total neck
     • Retropharyngeal
     • Danger space

2. Boundaries Of Pterygomandibular Space:

• Medially: Medial pterygoid
• Laterally: Ramus of the mandible
• Superiorly: Lateral pterygoid
• Inferiorly: Medial pterygoid
• Posteriorly: Parotid gland
• Anteriorly: Pterygomandibular raphe

3. Masticatory Space Consists Of:

• Pterygomandibular space
• Sub masseteric space
• Superficial temporal space
• Deep temporal spaces

4. Primary Spaces:

1. Mandibular Spaces:
   • Submental
   • Sublingual
   • Submandibular
   • Buccal
2. Maxillary Spaces:
   1. Canine space
   2. Buccal space
   3. Infratemporal space

5. Ludwig’s Angina:

• Described by Wilhelm Fredrich Von Ludwig in 1836
• Ludwig’s Angina is rapidly spreading cellulitis involving simultaneously all three spaces i.e.
• Submandibular, sublingual & submental spaces

Clinical Features:

• Generalized Symptoms:
  • Dehydration
  • Fever
  • Dysphagia
  • Dyspnoea
  • Hoarseness of voice
  • Stridor
• Extraoral Features:
  • Brawny hard swelling of the neck involving all three spaces
  • Erythematous skin covering it
  • Tender
  • Local rise in temperature
  • Drooling of saliva
  • Respiratory distress
• Intraoral Features:
  • Trismus
  • Raised floor of the mouth
  • Airway obstruction
  • Increased salivation

6. Hyperbaric Oxygen Therapy

• Involves intermittent daily inhalation of 100% oxygen at 2-3 atmospheric pressure

Advantages Of Hyperbaric Oxygen Therapy:

• Increases vascular supply
• Increased oxygen perfusion to ischaemic areas of infection
• Increased bactericidal and bacteriostatic action of increased oxygen concentration

7. Treatment Of Osteomyelitis:

• Antibiotic therapy
• Hyperbaric oxygen
• Incision and drainage
• Sequestrectomy
• Saucerization

8. Teeth Involved In Different Space Infections:

9. Cavernous Sinus Thrombosis:

• Cavernous Sinus Thrombosis is the infectious thrombosis of the cavernous sinus
• Infections to cavernous sinus can spread to two routes
  • The anterior route is composed of ophthalmic veins and facial veins.
  • Angular vein, infraorbital vein, inferior palpebral vein
  • The posterior route constitutes of pterygoid venous plexus
• Diagnosis Criteria:
  • Known site of infection
  • Paralysis of 3,4,6 nerves
  • Proptosis of the eye due to increased venous pressure in superior and inferior veins of the orbit

10. Sites Of Secondary Infections From Pterygomandibular Space Infection Are:

• Infratemporal space
• Retropharyngeal space
• Buccal space
• Submandibular space

11. Hot Potato Voice Is Seen In:

• Retropharyngeal space infection
• Lateral pharyngeal space infection
• Ludwig’s angina
• Peritonsillar abscess
• Acute epiglottitis
• Laryngeal tumors

12. Uses Of Incision And Drainage:

• To get rid of toxic purulent material decompress the edentulous tissues
• To allow better perfusion of blood containing antibiotics and defensive elements
• To increase oxygenation of the infected area

Orofacial And Neck Infections Long Essays

Question 1. Classify fascial spaces. Describe in detail Ludwig’s angina.
Or
Classify fascial spaces. Write clinical features, etiology, and management of Ludwig’s angina. Add a note on systemic complications
Or
Define Ludwig’s angina. Describe etiology, clinical signs & symptoms & steps in its management.
Or
Write etiopathogenesis, microbiology & management of Ludwig’s angina.
Or
Define cellulitis. Write etiopathogenesis, microbiology & management of Ludwig’s angina.
Answer:

Classification Of Fascial Spaces:

1. According To Killey & Kay:

• In Relation To Mandible:
  • Submental
  • Submandibular
  • Sublingual
  • Buccal
  • Submassetric
  • Pterygomandibular
  • Peritonsillar
• In Relation To Maxilla:
  • Canine space
  • Palatal space
  • Parotid space
  • Infratemporal space

2. According To Topazian

• Face:
  • Buccal
  • Canine
  • Masticator
  • Masseter
  • Pterygoid
  • Zygomaticotemporal
  • Parotid
• Suprahyoid:
  • Sublingual
  • Submandibular
  • Pharyngomaxillary
• Infrahyoid:
  • Anterovisceral
•  Spaces Of Total Neck:
  • Retropharyngeal
  • Danger space

Cellulitis:

• Cellulitis is a nonsuppurative infection spreading along subcutaneous tísues & connective tissue planes & caused by hemolytic streptococcus

Ludwig’s Angina:

Described by Wilhelm Fredrich Von Ludwig in 1836 It is rapidly spreading cellulitis involving simultaneously all three spaces i.e. Submandibular, sublingual & submental spaces

Etiology Of Ludwig’s Angina:

• Odontogenic infection
• Traumatic injuries
• Infective conditions
• Pathologic conditions

Microbiology Of Ludwig’s Angina:

• The microorganism involved is streptococci
• They produce hyaluronidase & fibrinolysin
• This causes the destruction of hyaluronic acid & fibrin This spreads through tissues
• This later changes into an anaerobic infection
• Other organisms involved are pseudomonas, staphyloma-crocus, bacteroids, peptostreptococci, fusospirochaetes

Clinical Features Of Ludwig’s Angina:

• Generalized Symptoms:
  • Dehydration
  • Fever
  • Dysphagia Dyspnoea
  • Hoarseness of voice
  • Stridor
• Extraoral Features:
  • Brawny hard swelling of the neck involving all three spaces
  • Erythematous skin covering it
  • Tender
  • Local rise in temperature
  • Drooling of saliva
  • Respiratory distress Intraoral features Trismus
  • Raised floor of the mouth
  • Airway obstruction
  • Increased salivation

Management Of Ludwig’s Angina:

1. Airway Maintenance:
   • Intubation is contraindicated
   • Tracheostomy is advisable
2.  Parenteral Antibiotics:
   • Penicillin G: 2-4 million units IV 4-6 hourly
   • Gentamycin 80 mg IM BD
   • For anaerobic infections: metronidazole 400 mg 8 hourly
   • Erythromycin 600 mg 6-8 hourly
   • Amoxicillin 500 mg 6-8 hourly orally
3.  Surgical Management:
   • The semilunar incision is given over the swelling to drain pus, and to relieve pressure over the airway
4. Hydration Of Patient:
   • IV fluids are given
5. Removal Of Cause:
   • The offending tooth is removed

Complications Of Ludwig’s Angina:

• Death
• Abscess
• Septicemia
• Mediastinitis
• Carotid blow out

Question 2. Describe Classify osteomyelitis classification, features & management.
(or)
Define & classify osteomyelitis. Discuss features & management of it.
Or
Clinical features and management of chronic Osteomyelitis
Answer:

Definition Of Osteomyelitis:

Infection of bone that results in inflammation of bone involving the rounding periosteum & Haversian system

According To Duration & Severity:

• Acute
• Chronic

Clinical Types:

• Acute suppurative
• Primary chronic
• Secondary chronic
• Nonsuppurative

Presence Of Pus:

• Suppurative
  • Acute
  • Chronic
  • Infantile
• Nonsuppurative
  • Sclerosing
  • Garre’s
  • Actinomycotic

Etiology Of Osteomyelitis:

• Odontogenic infections
• Traumatic injury
• Periostitis
• Hematogenous spread

Predisposing Factors Of Osteomyelitis:

• Conditions reducing host defenses
  • Diabetes
  • Malnutrition
  • Leukemia
  • Alcoholism
• Conditions compromising vascularity
  • Radiation
  • Paget’s disease
  • Fibrous disease
  • Malignancy

Pathogenesis Of Osteomyelitis:

Features Of Osteomyelitis:

• NoNontoxiconstitutional symptoms: fever, tachycardia
• Pus discharge
• Age: Before 20 years
• Site: Mandibular first molar is common
• The affected tooth is carious

Radiographic Features Of Osteomyelitis:

• Presence of sequestrum
• Presence of involucrum
• Motheaten appearance

Management Of Osteomyelitis:

1. Medical Management:

• Systemic Antibiotics:
  • Penicillin
  • Metronidazole
  • Clindamycin
  • Given for about 2-4 months
•  Local Application Of Antibiotics:
  • Due to decreased blood supply, systemic antibiotics cannot reach the desired area.
  • So topical application is done
•  Antibiotic-Impregnated Beads:
  • Poly methyl methacrylate beads are impregnated with antibiotics & are placed into the desired bone
  • This provides an increased concentration of antibiotics in the desired area

2. Surgical Management:

• Sequestromy:
  • Sequestrum is a dead bone
  • Sequestromy may get infected
  • Sequestromy may get revascularized
  • Sequestromy may get resorbed
  • As it is avascular, antibiotics cannot reach it
  • Thus antibiotics are continued till sequestrum is completely formed
  • Then it is removed surgically
• Saucerization:
  • Saucerization is to eliminate dead space which is created after the removal of the sequestrum
  • Bony margins are trimmed to create saucer shaped defect
  • This cannot accumulate blood clot
  • The area is packed with medical dressings & replaced periodically
• Decortication:
  • In it l, lateral & inferior cortical bone is removed
  • Irrigate the underlying bone
  • Debride effectively
• Resection & Reconstruction:
  • Resection & Reconstruction is done if the above procedures fail
  • Resect the infected part
  • Reconstruct it with an autologous graft
• Hyperbaric Oxygen:
  • Hyperbaric Oxygen is effective because:
    • It enhances lysosomal degradation
    • Oxygen-free radicals are toxic
    • Oxygen neutralizes the exotoxins
    • Elevates tissue oxygen levels
    • Helps in neoangiogenesis

Question 3. Define osteonecrosis. Describe the l effects of radiation on oral & perioral structures.
Answer:

Definition Of Osteonecrosis:

Osteonecrosi is necrosis of bone occurring secondary to radiation exposure

Radiation Effects On Oral Tissues:

• Oral Mucous Membrance:
  • Mucositis
  • Desquamation of epithelial layer Infection of the oral cavity
  • Candidiasis
  • Atrophic mucosa
  • Ulceration
  • Radiation necrosis
• Taste Buds:
  • Degeneration
  • Loss of taste sensation
• Salivary Glands:
  • Xerostomia
  • Loss of salivary secretion
  • Difficult & painful swallowing
  • Decreased buffering capacity
  • Susceptibility to radiation caries
• Teeth:
  • Retards growth of teeth Inhibit cellular differentiation
  • Premature eruption
  • Retard root formation
  • Fibroatrophy of pulp
  • Radiation Caries
• Bone:
  • Osteonecrosis
  • Hypocellularity
  • Hypoxia
  • Hypovascularity

Pathogenesis Of Osteonecrosis:

• Decreased salivary flow
• Decreased pH
• Decreased buffering action
• Increased viscosity
• Decreased cleansing action
• Radiation caries

Types Of Osteonecrosis:

• Superficial
• Involving cervical region
• Dark pigmentation

Question 4. Describe the read of odontogenic infections and in detail about pterygomandibular space infections.
Answer:

Spread Of Odontogenic Infection

• The pathway Of The Spread Of Infection Is As Follows:
  • Invasion of the dental pulp by bacteria after the decay of a tooth
  • Inflammation, edema, and lack of collateral blood supply
  • Venous congestion or avascular necrosis
  • Reservoir for bacterial growth
  • Periodic egress of bacteria into surrounding alveolar bone

Pterygomandibular Space Infection:

1. Boundaries Of Infection:

• Medially: Medial pterygoid
• Laterally: Ramus of the mandible
• Superiorly: Lateral pterygoid
• Inferiorly: Medial pterygoid
• Posteriorly: Parotid gland
• Anteriorly: Pterygomandibular raphe

2. Spread Of Infection:

• From the lower third molar

3. Features Infection:

• Extreme trismus
• Minimum extraoral swelling
• Intraoral swelling over the ramus of the mandible

4. Management Infection:

• The intraoral incision is given at the angle of the mandible
• Insertion of sinus force
• Drainage of pus
• Extraorally: Incision is given 2 cm below the lower border of the mandible
• Insertion of sinus forceps
• Pus is drained

Orofacial And Neck Infections Short Essays

Question 1. Submandibular space.
Or
Submandibular space infection.
Answer:

Submandibular space is the potential space between the mesial surface of the posterior aspect of the mandible

Boundaries Of Submandibular Infection:

• Laterally: Body of the mandible
• Medially: Hyoglossus
• Anteriorly: Mylohyoid muscle
• Inferiorly: Digastric muscle
• Posteriorly: Hyoid bone

Spread Of Submandibular Infections:

• Infected lower molars
• Maxillary sinus
• Upper molars
• Cheek
• Palate
• The floor of the mouth

Clinical Features Of Submandibular Infection:

• Brawny swelling
• Intraoral pus discharge
• Vital teeth

Management Of Submandibular Infection:

• The incisions are given 2cm below the border of the mandible

Question 2. Buccal space.
Or
Spread of infection from mandibular third molar
Or
Spread of infection from lower first molar its management.
Answer:

Boundaries Of Buccal Space:

1. Anteromedially: Buccinator muscle
2. Pusteromedially: Masseter
3. Inferiorly: Deep cervical fascia
4. Superiorly: Zygomatic process

Spread Of Buccal space:

• From lower & upper molar

Features Of Buccal Space:

• Firm swelling in the cheek
• Extend: from angle of mouth to masseter anteroposte rich From zygomatic process to lower border of man

Management Of Buccal Space:

• Usually, an intraoral incision is given in the buccal vestibule
• Can be extraoral also
• The incision is placed over the angle of the mandible
• Penetrate deep into the skin & subcutaneous tissue
  Insert closed forceps
• Open the forceps
• Placement of drain

Question 3. Submassetric Space.
Answer:

Boundaries Of Submandibular Infection:

• Superiorly: Zygomatic arch Inferiorly: masseter
• Medially: Lateral of ramus

Spread Submandibular Infection:

• From the lower third molar

Features Of Submandibular Infection:

• Swelling
• Extend: From the angle of mouth to masseter anteroposteriorly.
• From the geomatic process to loathing the lower border of the mandible
  Complete trismus
• Reddening of the overlying skin
• Tenderness
• Pus drainage
• In chronic cases, osteomyelitis occurs

Management Submandibular Infection:

• The intraoral incision is given along the anterior border of the mus
• Extraorally: Incision is given behind the mandible

Question 4. Cavernous sinus Thrombosis
Answer:

Etiology Of Thrombosis:

• Furunculosis
• Infected hair follicle
• Extraction of the tooth in the presence of infection

Route Of Transmission:

• External Route:
  • Infection from the face & lip
  • Passes through facial & angular veins
  • Reaches superior orbital fissure through a superior ophthalmic vein
  • Reaches cavernous sinus
• Internal Route:
  • Dental infection
  • Reaches pterygoid plexus
  • Enters inferior orbital fissure
  • Through the inferior ophthalmic vein enters the  thsuperioror orbital fissure
  • Finally reaches the cavernous sinus

Features Of Thrombosis:

• Exophthalmos
• Chemosis
• Periorbital edema
• Loss of corneal reflex
• Brudanski’s sign
• Constitutional symptoms: Fever, chills, delirium, shock

Investigations Of Thrombosis:

• Leucocytosis
• Parameningeal inflammation.

Management Of Thrombosis:

• Broad spectrum antibiotics
• Heparin therapy
• Steroids to reduce inflammation
• Treat the primary cause

Question 5. Osteoradionecrosis / ORN.
Answer:

Definition Of Osteoradionecrosis:

Osteoradionecrosis is necrosis of bone occurring secondary to radiation exposure

Pathophysiology Of Osteoradionecrosis:

Changes Of Osteoradionecrosis:

1. At cellular level
   • Cell may die
   • DNA damage
2. At the tissue level:
   • Hylanization
   • Thrombosis of vessels
3. At the organ level:
   • Hypocellular
   • Hypoxia
   • Hypovascular

Clinical Features Of Osteoradionecrosis:

• Chronic pain
• Necrosis of bone
• Infection of tissues
• Hypovascularity of site
• Sequestration of bone
• Bone deformity

Treatment Of Osteoradionecrosis:

• HBO Therapy protocol
• Stage 1: 30 dives of HBO given
• If response, the remaining 30 dives are given
• If doesn’t respond, enter stage 2
• Stage 2: 30 dives
• Sequestromy
• If the condition improves, the remaining 30 dives
• If not, enentertage 3
• Stage 3
• Resection
• Remaining 30 dives
• After 10 weeks additional 60 dives are given
• Chemotherapy
• Bleomycin
• Cisplatin
• 5 Fluorouracil

Question 6. HBO.
Or
Hyper baric oxygen
Answer:

Hyper Baric Oxygen

Used in the treatment of osteomyelitis & osteonecrosis

Reasons Of HBO:

• Enhances lysosomal degradation
• This leads to the formation of oxygen-free radicals
• These are toxic to the anaerobic organism
  • Elevated pressure of oxygen inactivates exotoxins released from pathogens
    • Helps in the healing of tissues
    • Helps in neoangiogenesis
    • Improves vascularity

Technique Of HBO:

• The patient is made to breathe 100% oxygen through the lot’s mask
• The patient is exposed to 2.4 atmospheres of absolute pressure
•  Oxygen exposure is for 90 minutes, once a day for 5 days a week
• Each exposure to hyperbaric oxygen HBO is called a “Dive”

Question 7. Sublingual space.
Answer:

Boundaries Of Sublingual Space:

• Anteriorly & Laterallymedial surface of the mandible
  Superiorly: Sublingual mucosa
• Inferiorly: Mylohyold muscle
• Posteriorly: Hyoid bone
• Medially: Genioglossus, geniohyoid, styloglossus

Spread Of Sublingual Space:

• Lower anterior
• Lower premolars
• Rarely lower first molar

Clinical Features Of Sublingual Space:

• Painful swelling in the floor of the mouth
• Elevation of tongue
• Difficulty in swallowing
• Enlarged submental & submandibular lymph nodes

Management Of Sublingual Space: 

• Extraction of the offending tooth
• Incision & drainage
• The incision in the floor of the mouth

Question 8.Pericoronitis.
Answer:

Definition Of Pericoronitis:

Inflammation of gingival & surrounding soft tissues of an incompletely erupted tooth

Types Of Pericoronitis:

• Acute
• Chronic
• Subacute

Features Of Pericoronitis:

• Red, erythematous lesion
• Tenderness
• Radiating pain
• Difficulty in closing jaws
• Foul taste
• Swelling of the cheek region

Sequele Of Pericoronitis:

• Pericoronal abscess
• Cyst formation
• Lymphadenitis
• Cellulitis
• Ludwig’s angina

Treatment Of Pericoronitis:

• Cleanse the area Anesthetize the area
• Reflection of flap
• Debridement
• Postoperative instructions
• Recall
• Next visit decide whether to retain or extract the tooth
• For extraction impaction
• For retaining
• Wedge-shaped incision
• Removal of tissue
• Placement of periodontal dressing

Question 9. Epulis.
Answer:

Epulis

Epulis is swelling situated on the gums

Types Of Epulis:

• Granulomatous Epulis:
  • Due to caries tooth, dentures, poor oral hygiene
  • Soft to firm swelling
  • Bleeds on touch
• Epulis Treatment:
  • Maintenance of oral hygiene
  • Restoration of carious tooth

2. Fibrous Epulis:

• Fibroma arising from the periodontal membrane
• Undergoes sarcomatous change
• Firm. Polypoid mass
• Slowly growing
• NoNontenderreatment:
  • Surgical Excision.

3. Giant Cell Epulis:

• Synonym: Myeloid epulis
• Soft to firm swelling over gums
• Expansion of bones
• May ulcerate
• Treatment:
  • Small Tumors: Curettage
  • Large Tumors: Radical excision

4. Carcinomatous Epulis:

• Arises from the mucous membrane of the alveolar margin
• Nonhealing, painful ulcer
• Infiltrate bone
• Lymph node involvement
• Treatment:
  • Wide excision
  • Radiotherapy

Question 10. Garre’s Osteomyelitis.
Answer:

Garre’s Osteomyelitis

• Represents reactive periosteal osteogenesis in response to low-grade infection or trauma
• Characterized by focal thickening of the involved bone due to subperiosteal new bone deposition

Factors Of Garre’s Osteomyelitis:

• Chronic periapical abscess
• Chronic periapical granuloma
• Chronic periapical cyst
• Chronic parotid abscess
• Chronic periodontal infection
• Chronic trauma

Clinical Features  Of Garre’s Osteomyelitis:

• Age: Children & young adults
• Site: Common in the mandible

Presentation Of Garre’s Osteomyelitis:

• Involved teeth carious, nonvital
• Swelling
• Thickness of bone upto 1 cm
• Slight tenderness
• The overlying skin is normal
• Slight pyrexia
• Moderate leukocytosis

Radiographic Features:

• Radiolucent lesion
• Bony overgrowth duplication of the cortex
• Onion skin appearance

Treatment Of Garre’s Osteomyelitis:

• Elimination of the causative agent
• Extraction of the offending tooth
• Spontaneous re-modeling of the cortical swelling

Question 11. Incision & drainage.
Answer:

Technique Of Incision:

Orofacial And Neck Infections Short Question And Answers

Question 1. Peritonsillar abscess/ Quinsy.
Answer:

Peritonsillar abscess

Infection in the connective tissue between tonsil & superior constrictor

Spread Of Peritonsillar Abscess:

• From the lower third molar

Features Of Peritonsillar Abscess:

• Acute pain in the throat
• Radiates to ear
• Dysphagia
• Nausea
• Constipation
• Poor oral hygiene Body aches & headache
• Enlarged lymph nodes
• Dyspnoea
• Trismus
• Deviation of uvula
• Hoarseness of voice
• Foul breath

Management Of Peritonsillar Abscess:

• Antibiotics
• Incision over the most prominent part
• Analgesics
• Warm saline gargles
• IV fluids
• Tonsillectomy

Question 2. Microbiology of odontogenic infections.
Answer:

Microbiology Of Odontogenic Infections

Microorganisms involved are

• Gram +ve:
  • Streptococci
  • Staphylococci
• Gram -ve:
  • Neisseria
  • Corynebacterium
  • Hemophilia
• Anaerobic:
  • Gram +ve
    • Streptococci
    • Peptostreptococci
  • Gram -ve
    • Actinomycetes
    • Fusobacterium

Question 3. Sequestrum.
Answer:

Sequestrum

• A fragment of dead tissue, usually bone, that has separated from healthy tissue as a result of injury/disease
• Sequestrum is avascular

Types Of Sequestrum:

• Primary Of Sequestrum:
  • A piece of dead bone that completely separates from sound bone during the process of necrosis
• Secondary  Of Sequestrum:
  • A piece of dead bone that is partially separated from sound bone during the process of necrosis but may be pushed back into position
• Management Of Sequestrum:
  • It appears as radiopaque foci
  • It is surgically removed by sequestrum

Question 4. Involucrum.
Answer:

Involucrum

• Involucrum is an enveloping sheath/ membrane such as the sheath of new bone that forms around a sequestra
• Occurs when the acute phase of disease subsides Formed over the inflammatory focus

Question 5. Masticatory space infection.
Answer:

Masticatory Space Infection

These are potential spaces present around the muscles of mastication.

• Involves infection from the third molar
• A common clinical feature is trismus due to spasms of muscles

Involves Of Masticatory Space:

• Sub masseteric space
• Pterygomandibular space
• Temporal space

Question 6. Infratemporal space.
Answer:

Infratemporal Space

Also called retro zygomatic space by Sicher

Boundaries Of Infratemporal Space:

• Laterally ramus of the mandible, temporalis muscle, and its tendons
• Medially- Medial pterygoid plate, lateral pterygoid muscle, medial pterygoid muscle, the lower part of the temporal fossa of the skull, and lateral wall of the larynx
• Superiorly- Infratemporal surface of the greater wing of the sphenoid and zygomatic arch
• Inferiorly-Lateral pterygoid muscle
• Anteriorly-Infratemporal surface of maxilla
• Posteriorly-Parotid gland

Spread Of Infratemporal Space:

• Buccal roots of maxillary second and third molars
• LA injections from contaminated needles in the tuberosity
• Other space infection

Features Of Infratemporal Space:

• Trismus
• Bulging of the temporalis muscle
• Marked swelling of the face on the involved side
• Proposed eye
• Swelling in the tuberosity area
• Elevated temperature

Question 7. Boundaries and contents of canine space
Answer:

Boundaries Of Canine Space:

• Superiorly
  • Levator labii superioris alaque nasi
  • Levator labii superioris
  • Zygomaticus minor muscle
• Inferiorly
  • Caninus muscle
• Anteriorly
  • Orbicularis oris
• Posteriorly
  • Buccinator muscle
• Medially
  • Anterolateral surface of maxilla

Contents Of Canine Space:

• Infraorbital foramen
• Branches of infraorbital nerves and vessels

Orofacial And Neck Infections Viva Voce

1. A deficit of the function of the abducent nerve is one of the early signs of cavernous sinus thrombosis
2. RoThe roof pterygomandibular space is formed by lathe lateral pterygoid
3. The severe complication of canine space infection is cavernous sinus thrombosis
4. Osteoradionecrosis occurs due to damage to the blood vessels
5. Infection from a maxillary first molar region spreads to buccal space
6. Fascial spaces are filled by loose connective tissue
7. The characteristic feature of Infection of masticator space is trismus
8. Incision and drainage of masticator space should be attempted extraoral in the angular region
9. Infections from the mandibular 1st molar spread to sub-lingual space
10. In Ludwig’s angina, submandibular, sublingual a, and submental spaces are involved bilaterally
11. In Ludwig’s angina, the incision should be placed deep upto mucous membrane of the floor of the mouth
12. Infection of lateral pharyngeal space can transverse to the posterior mediastinum
13. Infections from submandibular space and submental space usually transverse to the anterior mediastinum
14. Osteomyelitis begins as an inflammation of the medullary bone
15. Osteomyelitis is common in the mandible
16. Osteomyelitis is most commonly caused by staphylococcus
17. In treating osteomyelitis, hyperbaric oxygen used consists of 100% oxygen at 3 atm
18. Dangerous area of the face the area of the upper lip, commissure, and lower lip
19. Danger space potential space between the alar space and prevertebral fascia.

Facial Neuropathology Definition

 Trigeminal Neuralgia: Trigeminal Neuralgia is a sudden, severe, brief, stabbing, recurrent pain along the distribution of the trigeminal nerve

Facial Neuropathology Important Notes

1. Trigger Zones For Trigeminal Neuralgia:

• Vermillion border of lips
• Around eyes
• Ala of nose

2. 5 hypotheses Of Bell’s Palsy:

• Rheumatic
• Cold
• Ischaemia
• Immunological
• Viral

Read And Learn More: Oral and Maxillofacial Surgery Question and Answers

3. Classification Of Nerve Injuries:

• Seddon’s Classification:
  • Neuropraxia:
  • Axonotmesis
  • Neurotmesis
• Sunderland’s Classification:
  • First-degree injury
    • Type 1: Mild compression of the nerve trunk
    • Type 2: Moderate compression
    • Type 3: Severe compression
  • Second-degree nerve injury
  • Third-degree nerve injury
  • Fourth-degree nerve injury
  • Fifth-degree nerve injury

Facial Neuropathology Long Essays

Question 1. Describe in detail bout trigeminal neuralgia, its etiology, clinical features & management.
Or
Define trigeminal neuralgia & describe in brief its etiology, clinical signs & symptoms & management.
Or
Tic Dolourex
Answer:

Trigeminal Neuralgia Of Definition:

Trigeminal Neuralgia is a sudden, severe, brief, stabbing, recurrent pain along the distribution of the trigeminal nerve

Etiology Of Trigeminal Neuralgia :

• Pathological:
  • Dental pathosis
  • Allergic
  • Traction on divisions of the trigeminal nerve
  • Irritation to the ganglion
  • Ischaemia
  • Secondary lesions
  • Aneurysm of internal carotid artery

Clinical Features Of Trigeminal Neuralgia:

• AGE: Around 35 years
• Sex: Common in female
• Site: Right lower portion of the face, usually unilateral
• Duration: A few seconds to a few minutes
• As time passes duration between the cycles decreases
• Nature: stabbing or lancinating
• Aggravating Factors: Activation of Trigger Zones These are the vermillion border of the lip, around the eyes, ala of the nose

Interference With Other Activities:

• The patient avoids shaving, washing their face, and chewing. Brushing, as these may aggregate pain
• These lead to a poor lifestyle
• Extreme cases: leads to “Frozen or Mask Like Face”

 Medical Management Of Trigeminal Neuralgia:

• Medical:
  • Carbamazepine: Initial dose: 100 mg twice daily until relief is achieved
  • Dilantin: 300-400 mg in single or divided doses
  • Gabapentin: 11200-3600 mg/day TID/QID
  • Baclofen: 10 mg TID
  • Amitriptyline: 25-75 mg/day QID
  • Combination Therapy: Dilantin + carbamazepine
• Surgical:
  • Injection of alcohol in gasserian ganglion
  • Nerve avulsion: Performed on lingual, buccal, or mental nerve
  • Part of the nerve is sectioned
  • Electrocoagulation of gasserian ganglion: Radiotherapyy is done
  • Rhizotomy: Trigeminal sensory root is sectioned
  • Newer technique: Tens
  • Low-intensity current is used at high frequency and is applied to the skin through electrodes attached by a conduction paste

Facial Neuropathology Short Essays

Question 1. Facial nerve palsy. 
Answer:

Etiology Of Facial Nerve Palsy:

• Congenital
• Traumatic
• Infections
• Inflammation
• Neoplastic
• Idiopathic

Clinical Features Of Facial Nerve Palsy:

• Unable to raise eyebrows
• Unable to blow cheeks
• Expressionless face
• Absence of wrinkling
• Absence of function of the mandibular nerve
• Lack of movement of the upper lip
• Unable to close one eye
• Absence of nasolabial fold
• Absence of taste sensation
• Drooling of the lower lip on the affected side

Bell’s Palsy:

• Idiopathic paralysis of the facial nerve of sudden onset

Etiology: 5 Hypothesis:

• Rheumatic
• Cold
• Ischaemia.
• Immunological
• Viral

Clinical Features Of Bell’s Palsy:

• Pain in post auricular region
• Sudden onset
• Unilateral loss of function
• Loss of facial expression
• Absence of wrinkling Inability to close the eye
• Watering of eye Inability to blow the cheek
• Obliteration of nasolabial fold
• Loss of taste sensation
• Hyperacute
• Slurring of speech

Management Bell’s Palsy:

1. Physiotherapy
   • Facial exercises
   • Massaging
   • Electrical stimulation
2.  Protection To The Eye:
   • Covering of eye with a bandage
3. Medical Management:
   • Prednisolone – 60-80 mg per day
   • 3 tablets for 1st 4 days
   • 2 tablets for 2nd 4 days
   • 1 tablet for 3rd 4 days
4. Surgical Treatment:
   • Nerve decompression
   • Nerve grafting

Question 3. Diagnosis of trigeminal neuralgia.
Answer:

• Paroxysmal Unilateral Facial Pain:
  • Distribution of pain along branches of the trigeminal nerve
  • Trigger zones positive
  • Absence of symptoms between attacks
  • No neurological deficit MRI for vascular lesions
• White & Sweet Criteria:
  • Paroxysmal pain
  • Stimulation of trigger zones causes pain
  • Pain along the distribution of nerve
  • Unilateral pain
  • Normal neurological examination

Question 4. Ginwalla’s technique.
Answer:

Ginwalla’s Technique

Used for the management of trigeminal neuralgia

The Extent Of Incision Of Ginwalla’s Technique:

• Anterior border of the ramus up to the retromolar area
• It is split into 2 halves
• One extends lingually & the other buccally
• Results in Y-shaped incision

The Technique Of Ginwalla’s:

• Incision is given
• Expose the ramus
• Ligate the inferior alveolar nerve at two ends
• Divide it between ligatures
• Cauterize superior end
• Hold the inferior end with a hemostat
• Similarly, ligate mental nerve
• Avulse mental nerve
• Excise the remaining inferior alveolar nerve
• Closure of wound

Question 5. Nerve injuries in oral surgery.
Answer:

Seddon’s Classification:

1. Neuropraxia:
   • Results from mild insult to a nerve
   • No axon degeneration occurs
   • Mild paraesthesia present
2.  Axonotmesis:
   • Severe injury
   • Degeneration of afferent fibers
   • Severe paraesthesia present
3. Neuromimesis:
   • Most severe injury of the nerve
   • Complete destruction of nerve structure
   • Anesthesia is present
   • If the nerve is present within the bony canal, recovery can occur by the process of nerve degeneration

Sunderland’s Classification:

1. First-Degree Injury:

• Type 1:
  • Mild compression of the nerve trunk
  • Results in ischemia & conduction block
  • No axonal degeneration
  • Recovery within a day
• Type 2:
  • Moderate compression
  • Results in enema & conduction block
  • Recovery within 1–2 days
• Type 3:
  • Severe compression
  • Disruption of myelin sheath
  • Sensory loss
  • Recovery in 1-2 months

2. Second-Degree Nerve Injury:

• Synonymous with Seddon’s axonotmesis
• Axonal damage occurs
• Epineurium, perimetrium & endoneurium is intact
• Paraesthesia & anaesthesia present
• Spontaneous recovery

3. Third-Degree Nerve Injury:

• Synonymous with Seddon’s axonotmesis
• Axonal damage
• Damage to epineurium
• Paraesthesia & anesthesia present
• Regeneration of axon is blocked
• Incomplete sensory recovery Surgical repair needed

4. Fourth-Degree Nerve Injury:

• Synonymous to Seddon’s axonotmesis Damage epineurium, endoneurium & axons
• Intact epineurium
• Sensory impairment
• Poor recovery
• Surgical intervention needed

5. Fifth-Degree Nerve Injury:

• No conduction of impulses
• Even epimerism is destroyed
• Poor prognosis

Facial Neuropathology Short Question And Answers

Question 1. Bell’s sign.
Answer:

Bell’s Sign

• Seen in Bell palsy
• The inability to close the eye occurs in it
• On attempting to close the eye, the eyeballs roll upwards
• This peculiar sign is called the “Bells Sign”

Question 2. Trigger zones.
Answer:

Trigger Zones

• These are cutaneous zones located along the distribution of divisions of the nerve
• Stimulation of these zones occurs by the following
• Shaving, washing face, chewing, brushing, applying lotion, cosmetics, eating, touching, strong breeze
• Leads to pain

Question 3. Neurectomy.
Answer:

Neurectomy

• This is palliative treatment in which peripheral branches of the nerve are avulsed
• This prevents transmission of the peripheral impulses to the central trigeminal system
• Neurectomy can be done over
• Infraorbital nerve
• Mental nerve
• Inferior alveolar nerve
• Lingual nerve

Facial Neuropathology Viva Voce

1. Classic Bell’s palsy results from a lesion involving the glossopharyngeal nerve
2. The trigeminal nerve is a mixed nerve
3. A gasserian ganglion is found in a space known as Merkel’s cavity
4. The initial stage of paralysis of the facial nerve is the tongue deviates to the same side on the protrusion
5. Tic douloureux treatment includes carbamazepine
6. Damage to a seventh cranial nerve is associated with Bell’s palsy
7. Trigeminal neuralgia is characterized by sharp pain when pressure is applied to the affected area

Clefts Lip And Palate Important Notes

1. Classification Of Cleft Lip And Palate

• Veau’s Classification:
  • Group 1- Cleft of soft palate only
  • Group 2 – cleft of hard and soft palate
  • Group 3 – Complete unilateral cleft
  • Group 4 – complete bilateral alveolar cleft

Read And Learn More: Oral and Maxillofacial Surgery Question and Answers

2. Management Of Protocol:

• Immediately after birth
  • Pediatric consultation
• First few weeks
  • Hearing testing
• At 10–12 weeks
  • Surgical repair of lip
• Before 1 year or 18 months
  • Surgical repair of the palate
• 3 months after palate repair
  • Speech-language repair
• 3-6 years
  • Soft palate lengthening
• 5–6 years
  • Pharyngeal surgery
• At 7 years
  • Orthodontic treatment phase 1
• 9–11 years
  • Pre-alveolar bone grafting
• 12 years or later
  • Full orthodontic treatment phase 2
• 15–18 years:
  • Placement of implant
• 18–21 years
  • Surgical advancement
• Final nose & lip revision
  • Rhinoplasty

Cleft Lip And Palate Surgery

Clefts Lip And Palate Short Essays

Question 1. Management protocol of cleft patients.
Answer:

Management Protocol Of Cleft Patients

1. Immediately After Birth:
   • Pediatric consultation
2. First Few Weeks:
   • Hearing testing
3. At 10–12 Weeks:
   • Surgical repair of lip
4. Before 1 Year Or 18 Months:
   • Surgical repair of the palate
5. 3 Months After Palate Repair:
   • Speech& language repair
6. 3–6 years:
   • Soft palate lengthening
7. 5–6 years:
   • Pharyngeal surgery
8. At 7 years:
   • Orthodontic treatment phase 1
9. 9–11 years:
   • Pre-alveolar bone grafting
10. 12 Years Or Later:
    • Full orthodontic treatment phase 2
11. 15–18 Years:
    • Placement of implant
12. 18–21 Years:
    • Surgical advancement
13. Final Nose & Lip Revision:
    • Rhinoplasty

Cleft Lip And Palate Surgery

Question 2. Cleft palate.
Answer:

Cleft Palate

• Cleft Palate is a congenital disorder
• Cleft Palate involves a breach in the continuity of the palate formed during the development of the face
• Corrected entirely surgically

Etiology Of Cleft Palate:

• Hereditary
• Sex
• Maternal age
• Syndrome associated
• Environmental factors

Clinical Features Of Cleft Palate:

• Facial deformity
• Inability to feed
• Defective speech
• Nasal regurgitation of fluids
• Otological problems
• Dental problems
• Malformed teeth
• Malocclusion
• Congenital anomalies

Timing Of Repair: 12–24 months

Clefts Lip And Palate Short Question And Answers

Question 1. Millard’s rule / Timing of repair.
Answer:

Millard’s Rule / Timing Of Repair

Timing Of Repair is a rule for the management of cleft patients stating the timing for operating

Rule Of 10:

• 10 gm% of Hb
• 10 weeks of age
• 10 pounds of weight

Reasons For Millard’s Rule:

• The lip is large & thick enough for easy repair
• Baby is sufficient to bear operation assault & accept GA
• Feeding with a dropper post-operatively is not difficult
• Facilitate sucking
• Helps in developing alveolus
• Defective speech is avoided
• Reduction of the gap in the palate

Maxillary Sinus And Its Implications Definitions

Oroantral Fistula: Oroantral Fistula is an epithelioid, pathological, unnatural communication between the oral cavity & maxillary sinus

Maxillary Sinus And Its Implications Important Notes

1. Radiographic Features Of Maxillary Sinusitis:

• Acute Sinusitis:
  • Shows uniform opacity
  • Sometimes a fluid level is decreased
• Chronic Sinusitis:
  • Shows pansinusitis
  • Presence of fluid level
  • Thickened lining membrane
  • Opaque airspace may enclose polyps associated with mucosal thickening
  • In the case of the presence of a tooth or root the characteristic outline is seen within the sinus

Read And Learn More: Oral and Maxillofacial Surgery Question and Answers

2. Boundaries Of The Maxillary Sinus

• Roof: Formed by the floor of the orbit
• Floor: Alveolar process of maxilla
• Anterior Wall: The facial surface of the maxilla
• Posterior Wall: Sphenomaxillary wall
• Medial Wall: Lateral wall of the nasal cavity

3. Intranasal Antrostomy:

• Intranasal Antrostomy is performed to facilitate drainage at the conclusion os an operation
• To close oroantral fistula or
• To remove a tooth or root from sinus
• Surgical Procedure:
  • A small-sized osteotome or gouge is pushed through the inferior meatus in the nasal cavity into the maxillary sinus
  • A topical anaesthesia ointment is applied to the cotton wool which is inserted along the nasal floor adjacent to the lateral wall of the nose near the inferior turbinate
  • A sharp trocar and cannula are then introduced along the floor of the nasal cavity inferior to the inferior turbinate

4. Functions Of The Maxillary Sinus:

• Humidification of inspired air
• Resonance to voice
• Lightens skull bones
• Thermal insulator
• Protects eye & cranium

Maxillary Sinus And Its Implications Long Essays

Question 1. Write a note on the anatomy of the maxillary sinus. Describe in detail about Oro antral fistula.
(or)
Define boundaries of the maxillary sinus. Describe the technique for closure of oroantral communication.
(or)
Describe the surgical anatomy of the maxillary sinus. Write a note on oroantral fistula. Antrum of High more
Answer:

Maxillary Sinus:

• Maxillary Sinus is pyramidal with a base forming the lateral nasal wall & apex at the root of the zygote.
  • Capacity: 10-15 ml
  • Size: Height 3.5 cm
  • Width: 2.5 cm
• Anteroposterior Depth: 3.2 cm

Boundaries Of Maxillary Sinus:

• Roof: Formed by the floor of the orbit
• Floor: Alveolar process of maxilla
• Anterior Wall: Facial surface of maxilla
• Posterior Wall: Sphenomaxillary wall
• Medial Wall: Lateral wall of nasal cavity
• Vascular & Nerve Supply
• Blood Supply: Facial artery
  • Infraorbital artery
  • Greater palatine artery
• Nerve Supply:
  • Infraorbital nerve
  • Anterior, middle & posterior superior alveolar nerves
• Lymphatic Drainage: Submandibular lymph nodes

Definition Of Oro Antral Fistula:

Oro Antral Fistula is an epithelized, pathological, unnatural communication between the oral cavity & maxillary sinus

Question 2. Enumerate etiological factors of oro-antral fistula. Add a brief note on its management.
(or)
What are the causes of oro-antral communication? Describe any one method of surgical closure.
Or
Management of Oro antral fistula / Caldwellluc procedure
Answer:

Oro-Antral Fistula

Management Of Oro-Antral Fistula:

• Caldwell operation

Indications Of Oro-Antral Fistula:

• Chronic maxillary sinusitis
• Removal of foreign bodies
• Cyst & tumours
• For biopsy
• Recurrent cases
• Antral polyp

Contraindications Of Oro-Antral Fistula:

• Young age
• Acute infection
• Systemic cases

Procedure Of Oro-Antral Fistula:

• Anaesthetize
• Semilunar incision is given in mesiobuccal fold in the canine region
• Reflection of flap
• Creation of window
• Removal of sinus lining for biopsy
• Antrostomy
• Packing the sinus cavity through ribbon gauze pregnant in benzoin
• Smoothening of bony margins
• Replace the flap
• Suturing

Question 3. Write about Embryogenesis 
Answer:

Embryogenesis:

• In the early stages, the maxillary sinus is high in the maxilla Later gradually grows downward by a process of pneumatization.
• The expansion of the sinuses normally ceases after the eruption of permanent teeth.
• In adults, the apices of the posterior teeth may be external to the sinus cavity.

Maxillary Sinus And Its Implications Short Essays

Question 1. Acute sinusitis.
Answer:

Etiology Of Acute Sinusitis:

• Nasal infections
• Dental infections
• Trauma

Causative Organisms Of Acute Sinusitis:

• Streptococcus
• Pneumococci
• Staphylococci

Clinical Features Of Acute Sinusitis:

• Pain on lowering your head
• Tenderness in the canine fossa
• Redness of the area
• Nasal discharge
• Nose block
• Change in voice
• Dry cough
• Fever
• Malaise
• Headache

Investigations Of Acute Sinusitis:

• The water’s view shows the haziness of antrum
• Transillumination test: opacity of sinus
• Culture: Shows organisms

Management Of Acute Sinusitis:

• Antibiotics
• Decongestants
• Analgesics
• Antihistamines
• Steam inhalation
• Local heat application
• Antral lavage
• Irrigation of sinus through lukewarm water

Complications Of Acute Sinusitis:

• Chronic sinusitis
• Osteomyelitis
• Middle ear infection
• Cellulitis
• Abscess

Maxillary Sinus And Its Implications Short Question And Answers

Question 1. Functions of the maxillary sinus
Answer:

Functions Of The Maxillary Sinus

• Humidification of inspired air
• Resonance to voice
• Lightens skull bones
• Thermal insulator
• Protects eye & cranium

Question 2. Rohrmann’s Flap.
Answer:

Rohrmann’s Flap

Rohrmann’s Flap was described by Von Rohrmann in 1936

The Procedure Of Rohrmann’s Flap:

• Injection of LA in the mesiobuccal fold
• The incision is made around the fistulous tract 3-4 mm marginal to the orifice
• Two divergent incisions are taken with blade no 15 from each side of the orifice into the buccal sulcus
• The buccal flap is advanced
• Inspect the maxillary sinus
• Arrest of haemorrhage
• Closure of wound
• Prescribe the medicines

Maxillary Sinus And Its Implications Viva Voce

1. Arthroscopy is a technique by which the inside of a joint can be seen and operated on from the outside without any open surgery
2. Berger’s flap for OAF closure utilizes a buccal flap
3. A palatal flap has a high success rate in the management of OAF because a branch of the palatal artery is also mobilized