Maxilofacial Surgery

Salivary Gland Disorders Important Notes

1. Classification of salivary gland disorders

• Developmental Anomalies:
  • Agenesis
  • Atresia
  • Hypoplasia
  • Ectopia
• Obstructive Lesions:
  • Mucocele
  • Sialolithiasis
• Infective Lesions:
  • Bacterial sialadenitis
  • Viral sialadenitis
• Immune Disorders:
  • Sjogren’s syndrome
  • Mikulicz’s disease
• Functional Disorders
  • Ptyalism
  • Xerostomia
• Tumors:
  1. Epithelial Tumours:
     • Adenomas
     • Plemic adenoma
     • estadenoma Sasa cel adenom
     • Warthin’s tumour
  2. Carcinoma:
     • Adenocarcinoma
     • Epidermoid carcinoma
  3. Non Epithelium Tumours:
     • Fibroma
     • Lipoma
     • Lymphoma
  4. Malignant lymphoma
  5. Secondary Tumours
  6. Unclassified Tumours
  7. Tumour Like Lesions
     • Sialadenitis
     • Oncocytosis
     • Necrociting sintometaplasia

2. Composition of sialolith:

• Calcium phosphate
• Calcium carbonate
• Saints of Mg. Zmec
• Glycoproteins
• Mucopolysaccharides
• Cellular debris’

3. Stalolith is common in the submandibular gland due to:

• Due to viscous secretion
• Higher concentration of calcium & phosphate
• Tortuous anatomy of the ducts
• Dependent position of the gland

Salivary Gland Disorders Long Essays

Question 1. Describe clinical features & treatment of salivary calculus of Wharton’s duct and Etiology
Or
Sialolithiasis.
Answer:

Deffiniton of Sialolithiasis:

It is an obstructive disorder of the salivary gland. It is a pathological condition characterized by the presence of one or more calcified stones within the salivary gland itself or within its duct

Clinical Features of Sialolithiasis:

• Age: Middle-aged adults
• Sex: Common in males
• Site: Common in the submandibular gland due to the following:
  • Due to viscous secretion
  • Higher concentration of calcium & phosphate
  • Tortuous anatomy of the ducts
  • Dependent position of the gland

Features of Sialolithiasis:

• Recurrent swelling of the gland region
• Recurrent episodes of sialadentitis
• Tense & tender gland
• Aggregates at the mealtime
• Type of pain: Pulling or drawing sensation
  • Severe, stabbing type
  • Enlarged gland

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• Location: Unilateral
• In chronic cases: Formation of fistulas, sinus tracts & ulcerations in the area
• Necrosis of the gland acini
• Lobular fibrosis
• Complete loss of secretion of the gland
• So there is an increased risk of infections

Diagnosis of Sialolithiasis:

• Manual palpation
• Occlusal radiograph in case of submandibular gland
• Sialography

Treatment of Sialolithiasis:

• For submandibular gland:
  • Locate the sialolith radiographically
  • Suture behind & below the duct to prevent the spill-age of stone
  • If sialolith is present posteriorly, an incision is given medially
  • If sialolith is present anteriorly, an incision is placed medial to plica sublingual is
  • Locate the duct
  • Locate the stone
  • Incise over the stone
  • Remove it through the forceps

• For parotid gland of Sialolithiasis:
  • Locate the sialolith
  • Semilunar incision given anterior to the opening of the duct
  • Reflection of gland
  • Locate the stone
  • Incise over the stone
  • Remove it

1. Lingual nerve-superficial course
2. The incision for anterior stone
3. The incision for posterior stone
4. Sub- mandibular duct

Question 2. Classify salivary gland disorders. Describe in detail about pleomorphic adenoma.
Or
Define Pleomorphic adenoma
Answer:

Classification of Salivary glands disorders:

1. Developmental Anomalies:

• Agenesis
• Atresia
• Hypoplasia
• Ectopia

2. Obstructive Lesions:

• Mucocele
• Sialolithiasis

3. Infective Lesions:

• Bacterial sialadenitis
• Viral sialadenitis

4. Immune Disorders:

• Sjogren’s syndrome
• Mikulicz’s disease

5. Functional Disorders:

• Ptyalism
• Xerostomia

6. Tumours:

• Epithelial Tumours
  • Adenomas
  • Pleomorphic adenoma
  • Cystadenoma
  • Basal cell adenoma
  • Warthin’s tumor
• Carcinoma
  • Adenocarcinoma
  • Epidermoid carcinoma
• Non Epithelial Tumours
  • Fibroma
  • Lipoma
  • Lymphoma
• Malignant Lymphoma
• Secondary Tumours
• Unclassified Tumours
• Tumour Like Lesions
  • Sialadenitis
  • Oncocytosis
  • Necrotizing sialometaplasia

Pleomorphic Adenoma:

1. Clinical Features of Pleomorphic Adenoma:

• Age: 5th & 6th decade
• Sex: Common in females
• Site: Common in the parotid gland

2.  Features Pleomorphic Adenoma:

• Slow growing
• Exophytic growth
• Solitary lesion
• Swelling of gland
• The smooth surface of the lesion
• No pain
• Superficial lesions
• Located near the angle of the mandible
• Deeper lesions:
• Over the lateral wall of the oropharynx
• Minor gland neoplasms exhibit firm, nodular swelling
• The palatal lesion causes surface ulceration
• In buccal mucosa, it is present as a small, painless nodular lesion

3. Treatment Pleomorphic Adenoma:

• Surgical excision-parotidectomy

4. Complication Pleomorphic Adenoma:

• Facial palsy
• Frey’s syndrome

Question 3.  Write in detail about necrotizing sialometaplasia.
Answer:

Necrotizing Sialometaplasia:

It is a spontaneous disease of unknown etiology, characterized by necrosis of minor salivary glands of the palate along with the surface epithelium & underlying connective tissue

Etiology of Necrotizing Sialometaplasia:

• Probably due to local ischemia
• Local trauma from a denture
• Alcohol & tobacco

Clinical Features of Necrotizing Sialometaplasia:

• Age: Old age, around 47 years on average
• Sex: Common in males
• Site: Common over palate & oral mucosal sites

Features of Necrotizing Sialometaplasia:

• Appears: As deep-seated punched-out ulceration
• Location: Bilateral
• Borders rolled borders
• Surface: Few granular lobules present
• Size: 2-3 cm in diameter
• Symptoms: Asymptomatic
• Some may complaint of burning sensation Future: heals spontaneously

Treatment of Necrotizing Sialometaplasia:

• Discontinue the use of denture till the ulcer heals
• Regular irrigation with dilute hydrogen peroxide
• Antibiotics & analgesic
• The lesion usually heals spontaneously

Salivary Gland Disorders Short Essays

Question 1. Sialolithiasis Or Salolith  of Etiology And Pathogenesis and Composition
Answer:

Etiology of Sialolithiasis:

• Stagnation of saliva
• Ductal epithelial inflammation & injury
• Biological factors

Pathogenesis of Sialolithiasis:

• Formation of the soft nidus of mucin, protein, bacteria &
• desquamated cells.
• Allows concentric, lamellar crystallization
• Gradually sialolith increases in size

Composition of Sialolithiasis:

• Calcium phosphate
• Calcium carbonate
• Salts of Mg, Zn, etc
• Glycoproteins
• Mucopolysaccharides
• Cellular debris

Question 2. Bacterial sialadenitis.
Answer:

Etiology of Bacterial Sialadenitis:

• Staphylococcus aureus
• Streptococcus pyogenes
• Less common Hemophilus & bacteroids

Route of Infection of Bacterial Sialadenitis:

• Parotid duct

Predisposing Factors of Bacterial Sialadenitis:

• After surgery
• Dehydration
• Diabetes
• Malignancy
• Sjogren’s syndrome
• Sialolithiasis

Clinical Features of Bacterial Sialadenitis:

• Gland involved: Parotid Location: unilateral or bilateral
• Signs: Swelling of the gland Symptoms: Pain
• Fever
• Malaise
• Redness of the skin
• Difficulty in swallowing
• Trismus
• Exudation of pus

Treatment of Bacterial sialadenitis:

• Antibiotics penicillin
• Gentle massage over the gland
• Incise to drain the gland
• Remove or cause

Question 3. Sialography.
Answer:

Sialography

Used for investigation of sialolith

The procedure of Sialography:

1. Identification of duct
2. Exploring of the duct
3. Introduction of cannula
4. Introduce contrasting media
   • Lipid soluble or
   • Water soluble agents
5. Amount of the agent
   • Submandibular gland: 0.5-0.75 ml
   • Parotid gland 0.76-1ml
6. Radiograph is taken
   • Occlusal view
   • AP view

Interpretation Sialography:

1. Parotid gland- Tree in winter appearance
2. Submandibular gland – Bush in winter appearance
3. Sjogren’s syndrome – Cherry blossom appearance
4. Malignant tumor- Ball holding in hand appearance

Question 4. Parotidectomy.
Answer:

Parotidectomy

It is a surgical treatment for salivary glands tumors

Types of Parotidectomy:

1. Superficial parotidectomy:
   • Anaesthesize
   • Incision over the preauricular crease, curved downward upto tip of the mastoid
   • Elevation of skin & superficial fascia
   • Preserve the facial nerve
   • Dissect the gland away from each branch of the gland
   • Hemostasis
   • Placement of drains
   • Suturing
2. Total parotidectomy:
   • Involves the removal of entire parotid gland
   • Superficial parotidectomy done
   • Then remove tumor deep into the facial nerve

Question 5. How to investigate the of salivary gland
Answer:

Investigation of salivary gland:

1. Duration of the lesson:
   • Longer duration, malignancy
2. Nature of onset
   • Gradual & painless, malignant
   • Sudden & painful, inflammatory
3. Rapidity of growth
   • Slow benign
   • Rapid malignant
4. Associated symptoms
   • Discharge of pus
   • Dryness of mouth
   • Constitutional symptoms
5. FNAC to rule out malignancy
   • CT Scan for deeper lesions
   • FNAC for lymph nodes involvement
   • X-ray of bone for resorption

Salivary Gland Disorders Short Question And Answers

Question 1. Mucocele.
Answer:

Etiology of Mucocele:

• Trauma or obstruction of minor salivary gland

Types Mucocele:

1. Mucous retention cyst:
   • Most common
   • Caused by trauma
   • Causes leakage of saliva into the submucosal tissue
   • Results in inflammation of surrounding tissues
2. Mucous retention cyst:
   • Less common
   • Caused due to obstruction
   • Results in the dilation of the duct

Features of Mucocele:

• Asymptomatic
• Superficial lesions:
• Less than 1 cm in size
• Thin-walled bluish lesion
• Deeper lesions:
• Well circumscribed
• Covered by normal mucosa

Treatment Mucocele:

• Surgical excision

Question 2. Frey’s syndrome.
Answer:

Frey’s syndrome

This is auriculotemporal nerve syndrome

Causes Frey’s syndrome:

• Iatrogenic causes followed by parotidectomy

Features of Frey’s syndrome:

• Pain in auriculotemporal nerve distribution
• Gustatory sweating
• Flushing on the affected side

Diagnosis of Frey’s syndrome:

• Positive starch iodine test

Treatment Frey’s syndrome:

• Topical application of anticholinergic
• Radiation therapy
• Surgical procedures
• Skin excision
• Nerve section
• Tympanic neurectomy

Question 3. Ranula.
Answer:

Ranula:

• A special type of mucocele
• Resembles the belly of a frog

Site of Ranula:

• The floor of the mouth
• Superficial or deep to mylohyoid muscle

Cause of Ranula:

• Trauma to duct

Features of Ranula:

• Slow-growing unilateral lesion
• Soft & freely movable
• Superficial lesions
• Thin-walled bluish lesion
• Deeper lesions
• Well circumscribed
• Covered by normal mucosa.

Types Ranula:

• Simple type
• Plunging ranula

Treatment Ranula:

• Marsupialization

Question 4. Sjogren’s syndrome
Answer:

Sjogren’s syndrome:

• It is a chronic autoimmune disease
• Characterize by oral & ocular dryness, exocrine dysfunction & lymphocytic infiltration

Types of Sjogren’s syndrome:

1. Primary: It involves the salivary & lacrimal gland
2. Secondary: It also involves other connective tissue disease (rheumatoid arthritis, scleroderma)

Etiology of Sjogren’s syndrome:

• It is unknown

Presentation of Sjogren’s syndrome:

• Decreased salivary function
• Dry mouth
• Difficulty in chewing, swallowing & speech
• Increased risk of caries
• Altered taste
• Dry, cracked lips
• Angular cheilitis
• Mucosa is painful & sensitive to species
• Mucosa is pale & dry
• Friable or furrowed
• Minimal salivary pooling
• The tongue is smooth & painful
• Increased dental caries & erosion of enamel Susceptible to infection
• Increased risk of developing malignant lymphoma
• Difficulty in wearing dentures
• From one third to one-half of the patients have diffuse, firm enlargement of major salivary glands
• Swelling is usually bilateral
• Maybe non-painful or slightly tender
• May be intermittent or persistent
• Due to decreased salivary flow, there is a high risk of bacterial sialadenitis

Salivary Gland Disorders Viva Voce

1. Ageusia refers to loss of taste
2. Fordyce’s disease is due to aberrant sebaceous glands
3. Sialoliths are most commonly found in the submandibular gland
4. Treatment of mucocele is by excision
5. Recurrent ranula is best treated by sublingual gland excision
6. Stenson’s duct is the drainage duct of the parotid salivary gland
7. Sialcangiectasis denotes that the salivary gland and duct system are vastly dilated
8. While removing a submandibular gland one encounters the facial artery, facial vein, a cervical branch of the facial nerve, and lingual nerve
9. The early manifestation of sialadenitis on a scalogram is terminal acini are dilated
10. Warthin’s tumor is a benign parotid tumor
11. A mucoepidermoid tumor is malignant

Cysts And Tumours Of The Orofacial Region Definition

Cyst: It is pathological cavity containing fluid, semi fluid or gas, which is usually lined by epithelium & is not formed by the accumulation of pus

Tumour: It is defined as an abnormal new, uncoordinated growth in the body which results from excessive, autonomous, purposeless proliferation of cells which continues even after cessation of stimuli

Cysts And Tumours Of The Orofacial Region Important Notes

1. Classification of cyst

Epithelial Cyst:

• Odontogenic cysts

Developmental cysts:

• Primodial cyst
• Gingival cysts of Infants
• Dentigerous cyst
• CEOC

Inflammatory cysts:

• Radicular cyst
• Residual cyst
• Paradental cyst

Non-odontogenic cysts

• Naso palatine cyst
• Globulomaxillary cyst
• Nasolabial cyst

Non-Epithelial Cyst:

• Simple bone cyst
• Traumatic bone cyst
• Solitary bone cyst
• Aneurysmal bone cyst

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2. Classification of tumours:

• Benign Tumours:
  • Epithelial origin
    • Ameloblastoma
    • CEOT
  • With mesenchymal origin
    • Ameloblastic fibroma
    • CEOC
    • Odontoma
  • With epithelial & mesenchymal origin:
  • Odontogenic fibroma
  • Odontogenic fibroma
• Malignant Tumours:
  • Odontogenic carcinoma
    • Malignant ameloblastoma
    • Primary intraosseous carcinoma
  • Odontogenic sarcoma
    • Ameloblastic fibrosarcoma
    • Ameloblastic fibrodentinosarcoma
  • Odontogenic carcinosarcoma

3. Aspirates in different cysts:

4. Methods of treatment of cysts:

• Enucleation
• Marsupialization
• Combination of enucleation and marsupialization
• Enucleation and curettage

5. Enucleation:

• It is shelling out of the entire cystic lesion without rupture
• Majority of smaller cysts are treated by enucleation
• By it pathological examination of entire cyst can be undertaken

6. Marsupialization:

• It refers to creating a surgical window in the wall of the cyst, evacuating the contents of cyst and maintaining continuity between the cyst and the oral cavity
• The only portion of the cyst that is removed is the piece removed to produce the window
• It is simple procedure to perform
• The disadvantage is that pathologic tissue is left in situ without thorough histologic examination

7. Indications of marsupialization

• If the cyst is closer to vital structures
• If unerupted tooth is involved in the cyst
• In larger cysts
• In an unhealthy patient
• In young children

8. Combination of marsupialization and enucleation:

• In this first marsupialization is performed followed by enucleation
• The advantage of this technique is the development of a thickened cystic lining which makes secondary enucleation an easier procedure

9. Enucleation and curettage:

• After enucleation, a curette or bur is used to remove 1-2 mm of bone around the entire periphery of the cystic cavity to remove any remaining epithelial cells that are present in the periphery which may proliferate into a recurrency of the cyst
• Indications:
  • Odontogenic keratocyst
  • Any cyst that recurs after what was deemed a thorough removal

10. Segmental resection of the mandible:

• For it, a combination of Hinds and Risdon incisions are placed at least 2 cm below and parallel to the inferior and posterior borders of the mandible
• Care should be taken to prevent the damage of mandibular branch of the facial nerve

11. Moore and Weber Fergusson incision:

• It is given for hemimaxillectomy
• The incision starts from the inner canthus of eye runs along the area of the nose and then drops down the midline upto the philtrum of the lip
• If there is involvement of lymph nodes, radial neck dissection or commando operation is carried out

12. Tumours:

Cysts And Tumours Of The Orofacial Region Long Essays

Question 1. Classification of odontogenic tumours. Describe in detail ameloblastoma.
Or
Define and classify Ameloblastoma. Discuss in detail the management of Ameloblastoma of the right body of the mandible.
Or
Define tumours & classify odontogenic tumours
Answer:

Classification of odontogenic tumours:

1. Benign Tumours:

• Epithelial origin:
  • Ameloblastoma
  • CEOT
• With mesenchymal origin:
  • Ameloblastic fibroma
  • CEOC
  • Odontoma
• With epithelial & mesenchymal origin:
  • Odontogenic fibroma

2. Malignant Tumours:

• Odontogenic carcinoma:
  • Malignant ameloblastoma
  • Primary intraosseous carcinoma
• Odontogenic sarcoma:
  • Ameloblastic fibroasrcoma
  • Ameloblastic fibrodentinosarcoma
• Odontogenic carcinosarcoma:

Definition of Ameloblastoma :

It is a benign, but locally invasive polymorphic neoplasms consisting of proliferating odontogenic epithe- lium which is usually in a follicular or plexiform pat- tern lying in a fibrous stroma

Clinical Features of Ameloblastoma:

• Sex: Both sex
• Age 1st to 7th decade

Types of Ameloblastoma:

1. Solid or multicystic ameloblastoma:
   • Slow-growing locally invasive tumours
   • High recurrence rate
2. Unicystic type:
   • The lesion can be enucleated Rarely seen in maxilla
   • The recurrence rate is low
3. Peripheral ameloblastoma:
   • Does not invade bone
   • Treated in the early stages of development

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

Management of Ameloblastoma:

1. For intraosseous marginal resection
2. Segmental resection

• • Aggressive resection

Jackson’s Guidelines:

• Tumour confined to maxilla without orbit floor i involvement-Partial maxillectomy
• Tumour involving orbital floor-Total maxillectomy
• Tumour involving orbital contents – Total maxillae tomy with exenteration
• Tumour involving skull bone-Neurological procedure

Question 2. Classify cysts of oral cavity. Describe in detaill about clinical features, radiological features & management of OKC,
Or
Classify jaw cysts. Describe clinical features, radiological features, pathogenesis and management of odontogenic keratocyst.
Or
Define OKC
Answer:

Classification of Keratocyst:

1. Epithelial Cysts

• Odontogenic cysts:
  • Developmental cysts:
    • Primordial cyst
    • Gingival cysts of infants
    • Dentigerous cyst
    • CEOC
  • Inflammatory cysts:
    • Radicular cyst
    • Residual cyst
    • Paradental cyst
• Non odontogenic cysts:
  • Naso palatine cyst
  • Globulomaxillary cyst
  • Nasolabial cyst

2. Non-Epithelial Cyst:

• Simple bone cyst
• Traumatic bone cyst
• Solitary bone cyst
• Aneurysmal bone cyst

Odontogenic Keratocyst:

• Pathogenesis:
  • Odontogenic keratocyst arises from
    • Dental lamina
    •  The primordium of developing tooth germ
    • The basal layer of oral epithelium
• Develops due to cystic degeneration of cells of stellate reticulum in developing tech germ

Clinical Features of Keratocyst:

•  Age: 23 decades
• Sex:  Common in males
• Site: Mandible

Features of Keratocyst:

• Asymptomatic
• Secondary infection, causes expansion of cortical pilates
• Mobility of teeth
• Pattu & tenderness of the site

Radiological Features of Keratocyst:

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

Management of Keratocyst:

1. Enucleation of cyst:

• Smaller single cyst through intraoral approach
• Unilocular lesions through marginal excision
• Large multilocular lesions

Question 3. Define cyst. Describe the pathogenesis, clinical features, radiographic appearance of radicular cyst , Treatment, Aetiology
Or 
Radicular cyst 
Answer:

Definition of cyst:
It is a pathological cavity containing fluid, semi-fluid or gas, which is usually lined by epithelium & is not formed by the accumulation of pus

Radicular Cyst:

• Pathogenesis:

1. 1. Phase of initiation:
      • Bacterial infection
      • Leads to stimulation of cell rest of Malassez
   2.  Phase of proliferation:
      • Excessive & exuberant proliferation of cell rests
   3. Phase of mystification:
      • Deprivement of nutrition of central cells
      • Results in necrosis
      • Formation of cyst
   4.  The phase of enlargement: Enlargement of the cavity due to:
      • Higher osmotic tension of the cystic fluid
      • Release of bone-resorbing factors

Clinical Features of Cyst:

• Sex: Common in males
• Age: Young age
• Site: Common in maxillary anterior
• Non-vital tooth
• Smaller cysts are asymptomatic
• Larger lesions produce slow enlarging, bony hard
  swelling
• Expansion & distortion of cortical plates
• Severe bone destruction
• The springiness of jaw bones
• Pain if secondary infected
• Intraoral or extraoral pus discharge
• Pathological fractures
• Formation of abscess called “cyst abscess”

Radiological Features of Cyst:

• The unilocular radiolucent area around the apex of nonvital tooth
• Border: Sclerotic
• Diameter: Less than 1 cm
• Discontinuity of lamina dura

Treatment of Cyst:

• Non-vital tooth
• Extraction
• RCT
• Smaller cyst
• Removed through socket
• Larger cyst
• Marsupalization

Aetiology of Cyst:

• Dental caries
• Fractured tooth
• Thermal/Chemical injury to the pulp
• Latrogenic injury to pulp

Question 4. Differentiate between benign & malignant tu- mours.
Answer:

Differentiate between benign & malignant tu- mours

Cysts And Tumours Of The Orofacial Region Short Essays

Question 1. Dentigerous cyst.
Answer:

Clinical Features of Dentigerous Cyst:

• Sex: Common in males
• Age: 1& 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:

• Unilocular, well-defined radiolucency
• Margins – Sclerotic

Types of Dentigerous Cyst:

• Central covering the crown of an unerupted tooth
• Circumferential covering the crown from all the sides
• Lateral covering crown from side

Management of Dentigerous cyst:

• Marsupialization in children
• Enucleation in adults

Question 2. CEOC.
Answer:

Clinical Features of CEOC:

• Age: Second decade of life
• Sex: Both sexes
• Site: Mandibular premolars
• Anterior of maxilla
• Features: Bony hard swelling of the jaw
• Expansion & distortion of cortical plates
• Vital tooth
• Gingival swelling
• Causes perforation of cortex
• Pain is rarely present

Radiological Features of CEOC:

• Unilocular or multilocular radiolucent area
• Border: well corticated
• Internal structure: radiopaque calcified foci present

Treatment of CEOC:

• Simple enucleation

Question 3. Marsupialization.
Answer:

Marsupialization

It refers to creating a surgical window in the wall of the cyst & evacuation of the cystic contents

Indications of Marsupialization:

• Young age
• Proximity to vital structures
• In case of eruption of teeth
• In larger cyst
• In vital teeth

Advantages of Marsupialization:

• Simple
• Spares vital structures
• Allows eruption of teeth
• Prevents OAF
• Prevents fractures
• Less time
• Reduces blood loss
• Bone formation

Disadvantages of Marsupialization:

• Prolonged healing
• Prolonged follow up Periodic irrigation
• Periodic changing of pack
• Risk of new cyst formation

The technique of Marsupialization:

Question 4. Enucleation:
Answer:

Enucleation

It allows for the cystic cavity to be covered by a mucoperiosteal flap & the space is filled with a blood clot which organizes & forms normal bone

Indication of Enucleation:

• OKC
• Recurrent cyst

Advantages of Enucleation:

• Primary closure Rapid healing
• Postoperative care is less

Disadvantages of Enucleation:

• Weakens the mandible
• Damage vital structures
• Pulpal necrosis

Technique of Enucleation:

Question 5. Osteoma.
Answer:

Osteoma

Benign neoplasm of osseous origin

Clinical Features of Osteoma:

• Age: Second-fifth decade
• Sex: Common in females
• Site: Jawbones, soft tissues

Presentation of Osteoma:

• Nodular, exophytic growth. Either solitary or multiple
• Expansion of cortical plates
• Displacement of teeth
• Predispose to sinusitis Nasal discharge
• Syndrome associated

Radiographic Features of Osteoma:

• Well circumscribed
• Round or oval dense radiopacities

Treatment of Osteoma:

• Surgical excision

Question 6. Myxoma.
Answer:

Myxoma

• True neoplasm
• Made up of tissues that often resemble primitive mes enzyme

Clinical Features of Myxoma:

• Age: At any age
• Sex: Both
• Site: Iaw bones, salivary gland

Presentation of Myxoma:

• Non-descript, firm, nodular growth

Treatment of Myxoma:

• Radical surgery

Question 7. AOT 
Answer:

AOT 

Origin: Reduced enamel epithelium

Clinical Features of AOT:

• Age: Young age
• Sex: Female
• Site: Maxillary anterior region

Presentation of AOT:

• Slow enlarging, small, bony hard swelling
• Elevation of upper lip
• Displacement of teeth
• Expansion of cortical plates
• Asymptomatic
• Nodular swelling over gingiva

Treatment of AOT:

• Surgical enucleation

Question 8. Pinborg tumour
Answer:

Clinical Features of Pinborg:

• Age: Middle age
• Sex: Both
• Site: Mandible , over gingiva

Presentation of Pinborg tumour:

• Slow enlarging bony hard swelling Expansion of cortical plates
• Displacement of teeth
• Pain
• Paresthesia.
• Maxillary lesions lead to nasal airway obstruction Nodular swelling over gingiva

Radiographic Features of Pinborg Tumour:

• Well-defined, unilocular, radiolucent area
• Interior small radiopaque foci

Treatment of AOT:

• Surgical enucleation

Question 9. Globulomaxillary cyst.
Answer:

Globulomaxillary cyst

• A common type of developmental cyst
• Arises in the bone suture, between maxilla & pre maxilla

Clinical Features of Globulomaxillary cyst:

• Asymptomatic
• If secondary infected, causes pain & discomfort
• Small swelling between canine & premolar
• Vital teeth

Radiographic Features of Globulomaxillary cyst:

• Inverted pear-shaped radiolucent area between roots of the upper lateral incisor & canine
• Divergence of the roots

Treatment of Globulomaxillary cyst:

• Surgical excision

Question 10. Traumatic bone cyst.
Answer:

Traumatic bone cyst

• Pseudo cyst
• Lined by fibrous tissue

Clinical Features of traumatic bone cyst:

• Ages: Young age
• Sex: Common in males
• Site: Mandibular body, symphysis or ramus Maxillary anterior region

Presentation of traumatic bone cyst:

• Asymptomatic
• Painful, bony hard swelling Expansion of cortical plates
• Displacement of teeth
• Pain
• Paresthesia of lip
• Vital teeth

Radiographic Features of traumatic bone cyst:

• Unilocular or multilocular radiolucent lesion
• Well demarcated
• Scalloping between roots

Treatment of traumatic bone cyst:

• Surgical exploration

Question 11. Nasolabial cyst.
Answer:

Nasolabial cyst

Soft tissue cyst of the nasolabial fold

Origin of  Nasolabial cyst:

• The lower part of the embryonic nasolacrimal duct

Clinical Features of Nasolabial Cyst:

• Age: 30-50 years
• Sex: Common in females
• Site: Soft tissue of anterior maxillary vestibule

Presentation of Nasolabial cyst:

• Small, painless swelling of the upper lip
• Distorts the nostrils
• Projects into the floor of the nose
• Radiographic Features:
• Saucerization of the underlying bone

Treatment of Nasolabial cyst:

• Surgical excision

Question 12. Odontomes
Answer:

Odontomes

• Common hamartomatous odontogenic lesions with limited growth potential

Types of Odontomes: 

1.  Complex odontoma: Consists of a mass of haphazardly arranged enamel, dentin & cementum
2. Compound odontoma: Consists of collections of numerous small, discrete, tooth-like structures

Clinical Features of Odontomes:

• Age: Children & young adults
• Sex: Both
• Site: Compound in Maxilla Complex in the mandible

Presentation of Odontomes:

• Small asymptomatic lesion Expansion of cortical plates
• Displacement of teeth Impacted or retained deciduous teeth
• Pain, inflammation
• Ulceration
• Fistula formation

Radiographic Features of Odontomes:

• Compound – A bag of teeth appearance
• Complex  – Sunburst appearance

Treatment of Odontomes:

• Surgical enucleation

Cysts And Tumours Of The Orofacial Region Short Question And Answers

Question 1. Theories of cystic expansion.
Answer:

Theories of cystic expansion

•  Harris theory:
  • According to him, cystic expansion involves
• Mural growth:
  • Peripheral cell division.
  • Accumulated contents
• Hydrostatic:
  • Secretion
  • Transudation & exudation
  • Dialysis
• Bone resorbing factors:

Question 2. Gorlin’s syndrome.
Answer:

Clinical Features of Gorlin’s syndrome:

1.  Facial:
   • Frontal bossing
   • Prominent Supraorbital ridges
   • Hypertelorism
   • Mandibular prognathism
2. Skeletal anomalies of :
   • Bifid ribs
   • Bifid spine
   • Bridging of sella
   • Shortening of metacarpals
   • Calcification of falx cerebri
3. Skin lesions:
   • Milia
   • Dyskeratosis
   • Basal cell nevi
4. Cysts:
   • Multiple keratocyst
5. Soft tissue anomalies:
   • Ovarian fibromata
   • Lipomas

Question 3. Aneursymal bone cyst.
Answer:

Aneursymal bone cyst

An aneurysmal bone cyst is a cystic lesion involving hone anywhere in the body

Clinical Features of Aneurysmal bone cyst:

• Age- Second decade of life
• Sex – Common in females
• Site Mandibular molar- Ramus area and maxillary posterior area
• Present as rapidly enlarging, diffuse, firm swelling of the Jaw
• Causes facial asymmetry
• Swelling is painful
• Expansion and thinning of bone results in egg- Shell crackling
• Perforation of cortical bone
• Pathological fracture of affected jawbone Paraesthesia of regional teeth
• Difficulty in mouth opening due to impingement on the capsule of TMJ
• Maxillary lesions cause nasal bleeding, pressure sensation in the eye and nasal obstruction

Question 4. Carnoy’s solution
Answer:

Carnoy’s solution

• It is a chemical cauterization agent
• Indicated in the treatment of keratocystic odontogenic tumours
• It contains:
• 100% ethanol
• Chloroform
• The glacial acetic acid in a ratio of 6:3:1 with added ferric chloride
• It provides a tissue fixation property used in histology and a tissue cauterization property utilized in chemical curettage

Cysts And Tumours Of The Orofacial Region Viva Voce

1. Complete resection is done if the tumour invades the lower border of the mandible
2. Marsupialization decreases intra-cystic pressure and promotes shrinkage of the cyst and bone fill
3. Aspiration helps to distinguish between a cyst and tumour
4. Large ranulas can be best treated by marsupialization
5. Recurrent ranulas are best treated by sublingual gland excision
6. Marsupialization is the best method to treat large cysts
7. Bifid mandibular canal is common in neurofibroma- tosis
8. Junctional nevus has the maximum potential to become melanoma
9. Retention cysts are commonly seen in the lower lip
10. Bohn’s nodules are cystic swellings in neonates
11. The protein content of periapical and dentigerous cysts is 5-11 gm/dl
12. Complete enucleation of cyst in the palatal area carries the danger of tear of the nasal mucosa
13. During enucleation, the incision should be placed on the firm bony base
14. Treatment of keratocyst is excision
15. The global maxillary cyst occupies a bony region between the maxillary lateral incisor and canine
16. Ranula is a retention cyst
17. Mucocele should be treated by enucleation of the cyst and minor salivary gland
18. A branchial cyst occurs on the lateral side of the neck.
19. Pindborg’s tumour is treated by excision
20. Adenoameblastoma is managed by enucleation
21. Chondromas are radioresistant
22. Keratocyst has the highest rate of recurrence

Implants Definitions

Dental implant: It is an integral component of the oral implant complex which also consists of supportive bone, interposed keratinized & mucosal oral soft tissues & prosthetic supra structure

Osseointegration: It is defined as the direct structural and functional connection between ordered, living bone and the surface of a load-bearing implant without intervening soft tissues.

Implants Important Notes

1. Classification of implants:

• Based on relation to the bone:
  • Endosteal
  • Subperiosteal
  • Trans steal
• Based on shape
  • Blade type
  • Root form
• Based on the material used:
  • Metallic
  • Ceramic
• Based on surface characteristics:
  • Titanium sprayed coating
  • Sandblasting
  • Laser-induced surface roughening
  • Hydroxyapatite coating

2. Indications of implants

• Edentulous patients
• Partially venous
• Single tooth loss

3. Contraindications of implants

• Diseases:
  • Uncontrolled diabetes
  • Malignancy
  • Diseases of connective tissue
  • Blood dyscrasias
  • Psychological disorders
• Iatrogenic:
  • Immunosuppressant therapy
  • Radiation
  • Drug addiction

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

Implants Short Essays

Question 1. Dental implants.
Or
Indications & contraindications of implants.
Answer:

Definition of Dental implants:

It is an integral component of the oral implant complex which also consists of supportive bone, interposed keratinized & mucosal oral soft tissues & prosthetic supra structure

Classification of Dental implants :

1. Based on relation to bone:
   • Endosteal
   • Subperiosteal
   • Trans osteal
2. Based on shape:
   • Blade type
   • Root form
3. Based on the material used:
   • Metallic
   • Ceramic
4. Based on surface characteristics:
   • Titanium sprayed coating
   • Sandblasting
   • Laser-induced surface roughening
   • Hydroxyapatite coating

Implant Materials:

1. Metals:
   • Stainless steel
   • Gold
   • Titanium
   • Zirconium
2. Ceramics:
   • Aluminium oxide
   • Titanium oxide
3. Calcium phosphate
4. Bioactive & biodegradable ceramics
5. Polymers

Indications of Implant :

• Edentulous patients
• Partially edentulous
• Single tooth loss

Contraindications of Implant:

• Diseases:
  • Uncontrolled diabetes
  • Malignancy
  • Diseases of connective tissue
  • Blood dyscrasias
  • Psychological disorders

Iatrogenic of Implant :

• • Immunosuppressant therapy
  • Radiation
  • Drug addiction

The procedure of Implant :

Implant Short Question And Answers

Question 1. Complications of implants.
Answer:

Complications of Implant:

• Bemoriage
• Nerve injury
• Fracture of jew
• Sematome
• Infection
• Mobility of implant
• Periimplantitis
• Edema
• Sinusitis

Question 2. Osseointegration
Answer:

Definition of Osseointegration:

It is defined as the direct structural and functional connection between ordered, living bone and the surface of a load-bearing implant without intervening soft tissues

• It is a fundamental requirement and essential component for implant success

Process of Osseointegration:

Requirements of Osseointegration:

• Immobility of implant relative to the bone
• Avoid excessive accusal forces
• Proper vascular supply and oxygen tension
• A strict aseptic technique should be maintained
• Profuse irrigation during drilling

Significance of Osseointegration:

• Once osseointegration is achieved, implants can resist and function under accusal forces for many years

Question 3. Reimplantation.
Answer:

Reimplantation

It is the intentional removal of the tooth and its reinsertion into the socket after retrograde obturation and resection of the root tip.

Indications of Reimplantation:

• Broken instruments in canals
• Calcified canals
• Over filling
• Curved canals
• Presence of foreign body in periapical tissue.

Contraindications of Reimplantation:

• Medically compromised
• Periodontal involvement
• Missing buccal/lingual plate
•  Nonrestorable tooth

Technique of Reimplantation:

Implants Process Viva Voce

1. An endosteal implant is an implant inserted in the bone
2. Endosteal implants can be either root form or plate form
3. The transfer coping in an implant is used to position an analog in the impression
4. In the case of an endosseous implant, a per mucosal seal of the soft tissue at the implant surface is essential
5. The most common type of implant in use today is endosteal implants
6. The minimum space between implant should be 3 mm

General Anaesthesia And Sedation In Oral And Maxillofacial Surgery Important Notes

1. Agents:

2. Different Concentrations of Nitrous Oxide N₂O:

3. Nitrous oxide

• Also called laughing gas
• Name given by Humphry Davy
• First prepared by Joseph Priestly in 1774

Properties:

• Used as carrier gas
• The maximum concentration of nitrous oxide which can be given is 66%
• The blood gas coefficient is 0.47
• It is non-inflammable, non-explosive
• Good analgesia
• Not a muscle relaxant

General Anaesthesia And Sedation In Oral And Maxillofacial Surgery Short Essays

Questions 1. Preanaesthetic evaluation.
Answer:

Need:

• To get an idea about the patient’s health
• To educate the patient
• To obtain consent

Evaluation:

• Patient’s medical history
• Allergies to any drugs
• Deleterious habits
• Anaesthetic problems
• The general health of the patient
• CVS system
• Respiratory system
• Hepatic system

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• GIT system
• Renal system
• Endocrine system
• Haematological examination
• Reproductive system
• Vital signs

Questions 2. Premedication
(or)
Preanaesthetic medication
Answer:

Premedication

• Objectives
• Reduces anxiety
• Analgesia
• Amnesia
• Antiemetic
• Anti sialogogue
• Sedation
• Reduction of acidity
• Prophylactic

Drugs:

Question 3. IV Sedation
Answer:

Advantages of IV Sedation:

• Effective
• Rapid onset
• Control of secretion
• Less emetic
• Diminished gag reflex
• Diminished motor disturbances

Disadvantages of IV Sedation:

• Monitoring required
• Delayed recovery

Drugs Used:

• Diazepam-2-5 mg
• Ketamine-1-2 mg/kg IV
• Promethazine25 mg
• Pethidine – 50 mg

Questions 4. Indications & complications of GA.
Or
Indications of GA
Or
Complications of GA
Answer:

Indications of GA:

• Extensive restoration along with extraction
• In young patients
• Uncooperative patients
• Acute infections
• Allergy to LA
• Failure to LA
• Failure to achieve sedation

Complications of GA:

• Common Complications:
  • Coughing
  • Hiccups
  • Wheezing
  • Cyanosis
  • Cardiac arrhythmia
  • Laryngospasm
• Complications: Due to Position:
  • Nerve injury
  • Air embolism

Post-Operative Complication:

• Nausea & vomiting
• Hypertension
• Infection
• Restlessness
• Shivering
• Respiratory obstruction

General Anaesthesia And Sedation In Oral And Maxillofacial Surgery Short Question And Answers

Questions 1. Infiltration anaesthesia.
Answer:

Infiltration anaesthesia

• It is a method of local anaesthesia
• Injection of a local anaesthetic solution directly into the tissue can be
  1. Superficial-only into the skin or
  2. Deep into deeper structures
     • Duration can be doubled by adrenaline 1:200000
     • Adrenaline should not be used
     • Around end arteries to avoid necrosis
     • Intra-cutaneously to avoid sloughing
• Drugs used:
  • Lignocaine
    • Procaine
    • Bupivacaine

Advantages of Infiltration Anaesthesia:

• Provide anaesthesia without disrupting normal bodily functions

Disadvantages of Infiltration anaesthesia:

• Systemic toxicity may occur in major surgeries

Uses of Infiltration Anaesthesia:

• For minor procedures like incisions, drainage of an abscess, excision etc

Question 2. Role of muscle relaxants in General Anaesthesia
Answer:

Role of muscle relaxants in General Anaesthesia

• Creates laryngeal relaxation
• Enables intubation
• Stops spontaneous breathing so the patient must be ventilated till the effect of anaesthesia

Drugs Include:

1. Suxamethonium:
   • Short-acting
   • Rapid recovery
2. Pancuronium:
   • Non-depolarizing
   • Siow onset of action
   • Long-lasting effect
   • Effect is reversible

Questions 3. Assessment for general anaesthesia.
Answer:

Assessment for general anaesthesia

By the American Society of Anaesthesiologists ASA.

1. ASA 1:
   • No disturbances either systemic or physiological
2. ASA 2:
   • Mild to moderate systemic disturbances
   • Can be treated surgically
   • Mild organic heart disese, diabetes, hypertension, anaemia, old age
3. ASA 3:
   • Severe systemic disturbances Angina, MI, diabetes, etc
4. ASA 4:
   • Life-threatening severe systemic disturbances
5. ASA 5:
   • Patients not expected to survive for more than 24 hours
6. ASA 6:
   • Emergency

Questions 4. Prilocaine.
Answer:

Prilocaine

• Group: Amide
• Potency: 2
• Metabolism: Hydrolyzes by hepatic enzymes
• pka: 7.9
• pH of Plain Solution: 4.5
• pH of Vasoconstrictor: 3-4
• Plasma Half-Life: 1.6 hours
• Effective Dental Concentration: 4%
• Maximum Recommended Dose: 6 mg/kg body weight

Questions 5. Pentazocine.
Answer:

Pentazocine

It is a k receptor agonist

Advantages of Pentazocine:

• Less respiratory depressant
• Euphoria is seen in only low doses

Disadvantages of Pentazocine:

• Weak antagonist
• Increases BP & heart rate
• Increases cardiac load
• Dose: 50-100 mg orally

Adverse Effects of Pentazocine:

• Sweating
• Sedation
• Dizziness
• Nausea
• Dysphoria
• Nightmares
• Hallucinations
• Tolerance & dependence develop

Uses of Pentazocine:

• Postoperative & chronic pain

Questions 6. Stages of general anaesthesia.
Answer:

Stages of general anaesthesia

1. Stage Of Analgesia:
   • From the beginning of inhalation of the anaesthetic to loss of consciousness
2. Stage Of Delirium:
   • From the loss of consciousness to the beginning of surgical anaesthesia
   • Associated with excitement
3. Stage Of Surgical Anaesthesia:
   • Respiratory depression is seen
   • Gradual loss of reflexes
   • Relaxation of skeletal muscles
4. Stage Of Medullary Paralysis:
   • Seen in overdoses
   • Medullary depression
   • Cessation of breathing
   • Circulatory failure
   • Death may follow

Questions 7. Ketamine.
Answer:

Causes of Ketamine:

• Dissociative anaesthesia:
  • Intense analgesic
  • Amnesia
  • The feeling of dissociative from one’s own body & surroundings

Advantages of Ketamine:

• Profound analgesic
• Doesn’t depress respiration
• Can be used in asthmatic patients

Disadvantages of Ketamine:

• Hallucinations
• Dangerous in hypertensives
• Increases cerebral blood flow
• Increases intracranial pressure

Contraindications of Ketamine:

• Hypertensive patients
• CCF
• Psychiatric disorders
• Pregnancy

Questions 8. Halothane.
Answer:

Halothane

• Colorless, volatile liquid with a sweet odour
• Non-irritant
• Non-inflammable

Advantages of Halothane:

• Potent
• Rapid induction
• Rapid recovery
• Rarely causes post-operative nausea & vomiting

Disadvantages of Halothane:

• Neither good analgesia nor good muscle relaxant Myocardial depressant
• Respiratory depressant
• Causes malignant hyperthermia
• Expensive

General Anaesthesia And Sedation In Oral And Maxillofacial Surgery Viva Voce

• Methohexital is the most commonly used drug for general anaesthesia
• The median cephalic vein is the optimum site for IV sedation
• The N:O gas cylinder used in general anaesthesia is blue coloured
• During general anaesthesia oxygen concentration of blood should not fall below 40%
• Nowadays induction phase of general anaesthesia has been reduced because of the use of thiopentone sodium
• If long-acting muscle relaxants are used during general anaesthesia their action is terminated by the use of neostigmine
• The most common postoperative complication of general anaesthesia is nausea
• The important sign a patient exhibits when the correct level of sedation is reached while using diazepam sedation is 50% ptosis of the eyelids
• Complete blood count and urinalysis should be done before the use of general anaesthesia
• Injection of contaminated alcohol can cause neurology- sis and may result in paraesthesia and permanent anaesthesia
• Minor surgeries are carried out in Stage 1
• Major surgeries are carried out in Stage 2
• Nitrous oxide is laughing gas
• The induction phase of general anaesthesia has been reduced nowadays due to the use of thiopentone sodium
•  The N₂O cylinder is blue
• During general anaesthesia oxygen concentration of blood should not fall below 40%
• Only nitrous oxide alone is not used as a general aesthetic agent due to difficulty in maintaining adequate oxygen concentration
• Behavioural problem is the most common complication associated with nitrous oxide sedation

Pre-Prosthetic Surgery Important Notes

1. Types of bone grafts

2. Vestibular procedures:

3. Lip switch procedure or transpositional flap

• It is a lingually-based flap
• First described by Kazanjian
• In this technique, an incision is made in the labial mucosa, and the thin mucosal flap is dissected from the underlying tissue
• Flap of labial mucosa is sutured to depth of vestibule
• Exposed labial tissue heals by secondary Intention

4. Submucous vestibuloplasty:

• First described by Macintosh and Obwegeser
• It is a procedure of choice for the correction of soft tissue attachment on or near the crest of the alveolar ridge of the maxilla
• This technique is particularly useful when maxillary alveolar ridge resorption has occurred, but the residual bony maxilla is adequate for proper denture support

Pre-Prosthetic Surgery Short Essays

Question 1. Ridge augmentation procedure.
Answer:

Ridge augmentation procedure

• Superior border grafting:
  • Obtain 2 autogenous ribs
  • Contour it to the shape of the mandible
  • Fix one of it with the mandible with the help of wiring
  • Other rib is cut into small pieces & moulded around 1st rib
  • Closure of flap

• Inferior border grafting:
  • Supraclavicular incision given
  • Subplatysmal dissection given
  • Hollow out the mandible
  • It is filled with graft particles
  • Fixation done with sutures & wiring

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• Interpositional bone grafting:
  • Horizontal osteotomy done
  • Splitting of maxilla or mandible
  • Bone is grafted into the gap

Question 2. Indications & technique and Vestibuloplasty of sulcus extension procedure
Answer:

Indications:

• Inadequate depth of sulcus
• Inadequate retention for the denture
• Inadequate stability of the denture
• Difficulty in denture construction

Technique: Vestibuloplasty:

1. Labial Vestibuloplasty:

• Kazanjian’s technique:
  • Submucosal dissection from inner aspect of lower lip
  • Supraperiosteal dissection given upto desired depth
  • Mucosal flap sutured at the desired depth

• Clarke’s technique:
  • Incision given labial to the crest of alveolar ridge
  • Undermining of mucosal flap
  • Supraperiosteal dissection done
  • Mobilize the flap to the desired depth & suture

2. Lingual Vestibuloplasty:

• Trainer’s technique:
  • Incision given over lingual side of alveolar ridge
  • Supraperiosteal dissection given
  • Separation of mylohyoid muscle
  • Fixation of incisal edge of mylohyoid muscle to the desired depth

Mental nerve transposition:

Question 3. Alveoloplasty. 
Answer:

Alveoloplasty

It is surgical recontouring of the alveolar process

Purpose:

• Sharp bony margins
• Sharp crystal bone
• Undercuts

Types of Alveoloplasty:

1. Simple conservative technique:

• Done when multiple extractions are done in a single sitting
• Immediately after extraction, buccal & palatal cortical plates are compressed together
• If any bony spicules are present they are trimmed with Rogue’s forces
• If excess redundant tissue is present it is trimmed with surgical scissors

2. Intra septal alveoloplasty:

• Indications:
  • In maxilla
  • To reduce gross maxillary overjet
  • To reduce the volume of cancellous bone Presence of undercut
  • In case of multiple extraction

Technique:

3. Obwegeser’s modification:

• Cut the interseptal bone
• Widen the socket at the base
• Horizontal cuts made at the base of the socket
• Make vertical cuts distal to the canine extraction sockets
• Compress labial & palatal cortices
• Sutures

Question 4. Alveolectomy.
Answer:

Alveolectomy

• It is an alveolar ridge correction procedure
• It is a procedure of surgical removal or trimming of the alveolar process

Need of Alveolectomy:

• After extraction, the presence of sharp bony margins
• This interferes with the fabrication of dentures

Technique of Alveolectomy:

Question 5. Torus palatines.
Answer:

Torus palatines

It is exostosis/ overgrowth of cortical corticocancellous bone

Technique For Excision Of Palatal Torus:

Question 6. Pre-prosthetic surgeries
Or
Enumerate pre prosthetic surgeries.
Answer:

Pre-prosthetic surgeries

1. Bony surgeries:
   • Labial alveolectomy Primary alveoplasty Secondary alveoplasty
   • Excision of torus
   • Reduction of genial tubercle
   • Reduction of mylohyoid ridge
   • Maxillary tuberosity reduction
2.  Soft tissues surgeries
   • Removal of redundant crestal soft tissues
   • Frenectomy
   • Excision of epulis

Aims:

• Provide adequate bony tissue support
• Provide adequate soft tissue support Elimination of bony interferances
• Elimination of soft tissues interferences
• Correction of maxillary and mandibular ridge relation
• Relocation of frenal/ muscle attachments
• Relocation of mental nerve
• Excision of epulis

Pre-Prosthetic Surgery Short Question And Answers

Question 1. Dean’s alveoloplasty.
Answer:

Indication of Dean’s alveoloplasty:

• Presence of adequate ridge contour & height
• Skeletal malalignment
• To correct the proclamation of interiors

Principles of Dean’s alveoloplasty:

• To facilitate the reception of dentures
• Muscle attachments are left to heal
• Periosteal attachment remains intact
• Preservation of cortical plate
• Minimizing post-operative resorption

The procedure of Dean’s alveoloplasty:

Question 2. Frenectomy.
Answer:

Indications:

• Frenum attachment upto alveolar crest
• Ulceration at frenal attachments

Labial Frenectomy:

Z –  Plasty:

Indications:

• Broad frenum
• Short vestibule
• Deepening of vestibule

V-Y Plasty:

Lingual Frenectomy: Aims or Ankyloglossia:

• To correct speech
• Before denture construction
• To improve tongue mobility

Technique:

Question 3. Torus mandibular is.
Answer:

Torus mandibular is

It is exostosis/overgrowth of cortical/corticocancellous bone

Technique For Excision Of Mandibular Torus:

Question 4. Enumerate ridge augmentation procedures.
Answer:

1. Mandibular augmentation:
   • Superior border augmentation Inferior border augmentation
   • Interpositional augmentation
   • Visor osteotomy
   • Onlay grafting
2.  Maxillary augmentation:
   • Onlay bone grafting
   • Interposition grafting
   • Sinus lift procedure
3. Combination procedures:

Pre-Prosthetic Surgery Viva Voce

1. Z plastic or Y-V plasty procedure is done for labial frenectomy
2. Disadvantages of the use of autogenous bone include the need for donor-site surgery and extensive resorption after grafting
3. The two muscles which are present in the floor of the mouth are the genioglossus and mylohyoid
4. For removal of the bony tuberosity area, the incision is extended along the crest of the alveolar ridge distally to the superior extent of the tuberosity area
5. Interseptal valvuloplasty involves the removal of inter-septal bone and repositioning of the labial cortical bone
6. Alveolectomy for prosthetic reasons should be performed during the time of extraction of teeth
7. Pre-prosthetic surgery on the mandible requires the preservation of the genial tubercles
8. A skin graft vestibulopathy prevents relapse by physically maintaining the depth of the vestibule

Extraction Important Notes

1. Uses of elevators:

• To luxate the teeth by expanding the alveolar bone
• To Remove broken or Surgically Sectioned roots from their sockets
• Extraction of distal-most teeth in the arch

2. Types of Elevators:

3. Types of extractions:

1. Intra-alveolar or closed technique: Extraction of the tooth by gaining direct access to the tooth to be extracted
2. Trans alveolar or open technique: Access is gained by raising a mucoperiosteal flap or bone removal of the tooth

4. Contraindications of extractions:

Systemic contraindications Uncontrolled diabetes

• Bleeding diathesis
• Pregnancy
• Cardiac conditions
• Immunocompromised patients
• Endocrine malformations
• Local contraindications
• Acute infections
• Malignancy
• Radiation therapy
• Vascular lesions
• Pericoronitis

Absolute contraindications of extraction:

• Local hemangioma
•  Arterioventral fistula associated with teeth
  • Principles of the elevator:
    • Lever principle
    • Wedge principle
    • Wheel and axle principle
  • Order of extraction: Maxillary teeth are extracted first & then mandibular

Sequence of extraction:

• Third molar
• Second molar
• Second premolar
• First molar
• First premolar
• Lateral & central incisors
• Canines

Extraction Long Essays

Question 1. Discuss objectives of tooth extraction
Answer:

Objectives of extractions:

• Selection of proper forceps or elevator:

• Efficient grip over instrument: Cross-hatching over the handles & serrations on the interior of the surface provides grip to the instrument
• Efficient position of operator & patient:
  • For maxillary extraction – the maxillary occlusal plane should be parallel to the floor.
  • The position of the patient should be 8 cm below the shoulder of the operator.
  • For mandibular extraction- The retro line position of the patient should be maintained.
  • Position of patient 16 cm below the elbow of the operator for mandibular extraction.
  • The operator stands front & side to the patient except for the 4th quadrant extraction in which operators must stand behind the patient.
• Determine the direction of displacement of the tooth:
•  Differentiate between simple & difficult extraction:
  • Don’t hesitate to refer to the case
  • Assess clinically & radiographically the difficulty of extraction

• Design properly the mucoperiosteal flap:
  • The periosteal flap should provide proper exposure to the extraction site
  • It should not tear off the mucosa
• Wound closure:
  • Proper approximation of wound edges must be done
  • Debride the socket properly
• Avoid any complications:
  • Complete the procedure traumatically
  • Avoid unnecessary damage to the site
•  Post-operative instructions:
  • Bite on the gauze piece placed over the extraction socket for a minimum of half an hour
    • Reason: Stabilization of the clot in the socket
  • Not to rinse mouth vigorously for the next 24 hours
    • Reason: Causes dislodgement of the clot from the socket
  • Avoid hot beverages:
    • Causes vasodilation
  • Intake of soft diet on the day of extraction:
    • Hard food traumatizes the socket
  • Avoid sucking through straws:
    • Creates negative pressure
  • Rinse with warm saline:
    • To prevent infection
  • Prescription of anti-inflammatory analgesics:
    • To relieve pain
  • Avoid smoking:
    • It creates negative pressure
  • If bleeding is not stopped visit the dentist

Question 2. Discuss in detail indications, and principles in extractions. Note in complications.
Or
Indications of extractions
Answer:

Indications of Extractions:

• Unrestorable teeth
• Periodontally weak teeth
• Radiation therapy
• Teeth in the line of fracture
• Fractured teeth
• Pathology associated with teeth
• Malaligned teeth

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• Orthodontic extractions
• Supernumerary teeth
• Retained deciduous tooth
• Extraction due to prosthetic reasons
• Impacted teeth
• Serial extraction
• Teeth in line of osteotomy

Principles of Extractions:

1. Expansion of bony socket:

• The tooth is held at its occlusal end with the help of force
• Move the forceps
• This expands the bony socket
• Makes easy removal of tooth

2. Wedge principle:

• Place the beaks of forceps between the tooth & socket in the periodontal space
• This displaces the tooth more occlusal
• If required place the forceps more apically

Complications of  Extractions:

• Fracture of tooth
• Fracture of the alveolar process
• Fracture of maxillary tuberosity
• Fracture of jaw
• Damage
  • To adjacent tooth:
  • Soft tissues
  • Nerve
• Displacement
  • Into fascial spaces
• Hemorrhage
• Dislocation
  • TMJ: Due to excessive mouth opening
  • Jaw
• Postoperative complication
  • Hemorrhage
  • Pain
  • Swelling
  • Dry socket
  • Trismus
  • Infections
• Miscellaneous
  •  Oro antral fistula

Question 3. Describe in detail the complications of extractions, their prevention & management.
Answer:

Complications of Extractions:

1. Fracture of tooth:
   • Causes:
     • Wrong forceps selection
     • Improper force application
     • Improper placement of forceps
     • Grossly carious tooth
   • Prevention:
     • Selection of proper forceps Firm grip on forceps
     • Apical wedging of forceps
     • Use of root forceps in grossly carious tooth
   • Management:
     • If a small toothpiece remains, it gets resorbed
     • If the root is fractured at the apical third, It is removed by the apexoelevator
     • Transalveolar extraction done
2. Fracture of the alveolar process:
   • Cause:
     • Excessive force application
   • Prevention:
     • Minimal force application to luxate the tooth
   • Management:
     • Small pieces are removed along the tooth Large pieces are replaced
3. Fracture of maxillary tuberosity:
   • Cause:
     • Excessive forces
   • Prevention:
     • Correct application of forces
   • Management:
     • Replace it
     • Suture it
     • It heals in 4 weeks
4. Fracture of the jaw:
   • Causes:
     • Improper selection of forceps Atropic mandible
   • Prevention:
     • Controlled force on instruments
     • Estimate the difficulty of extraction before extraction
   • Management:
     • Reduction of fragments
     • IMF done

Damage of Extractions:

1.  To adjacent tooth:
   • Causes:
     • Large restorations
     • Grossly carious tooth
   • Prevention:
     • Correct placement of forceps interdentally avoids the application of forces close to adjacent teeth
   • Management:
     • Temporary restoration was given over the adjacent tooth.
     • Replace it with a permanent restoration.
2.  Soft tissues:
   • Causes:
     • Slipping of instrument
     • Placement of forceps over tissue rather than on tooth
   • Prevention:
     • Use of controlled forces
     • Retract the tissues
     • Plan the incision properly
   • Management:
     • Allow to heal the tissues
     • Maintain oral hygiene
     • Analgesics prescription
     • Saline mouth rinses
3. Nerve:
   • Prevention:
     • Assessment of pre-extraction radiograph
   • Management:
     • It regenerates

Displacement of  Extractions:

1.  Into fascial spaces:
   • Causes:
     • Excessive forces
     • Fracture of cortical plates
   • Prevention:
     • Support the alveolus during extraction Application of controlled forces
   • Management:
     • Bringing the tooth back into the oral cavity If it is placed below the muscle then a reflection of the flap is done
     • If it is uninfected, it is not treated
2. Hemorrhage:
   • Causes:
     • Hypertension
     • Damage to vessels
   • Prevention:
     • Atraumatic extraction
     • Avoid damage to extraction
     • Control the blood pressure before extraction
     • Planning of incisions
     • Avoid damage to nerves
   • Management:
     • Small bleeding, by application of pressure
     • Anticoagulants are prescribed.
     • Local anesthetic packs
     • Suturing
     • Cauterization of the spot Ligation of the artery
     • Hemostatic agents

Dislocation of Extractions:

• TMJ: due to excessive mouth opening
• Jaw:
• Management:
  • Manual reduction
  • Restriction of movement
• Post-operative complication:
  • • Hemorrhage:
      1. Small bleeding, by application of pressure
      2. Anticoagulants
      3. Local anesthetic packs
      4. Suturing
      5. Cauterization of the spot
      6. Ligation of the artery
      7. Hemostatic agents
      8. Locate the bleeding at the point & stop it
    • Pain: Anti-inflammatory and analgesic drugs

Swelling of Extractions:

1. Causes:
   • Edema
   • Hematoma
   • Infection
2. Management:
   • Resolves on its own
   • Resolves on its own
   • Drain the pus if there is drainage
3. Dry socket:
   • Analgesic
   • Irrigate the socket
   • Placement of abundant
4. Trismus:
   • May resolve on its own
   • Manipulation of the jaw by jaw stretcher
5. Infections:
   • Anti-inflammatory drugs
6. Miscellaneous:
   • Oro antral fistula

Extraction Short Essays

Question 1. Transalveolar extraction.
Or
Open method of extraction.
Answer:

Transalveolar extraction

• It is an open method of extraction
• Also called the surgical method
• It is indicated when forceps extraction is difficult

Indications of Transalveolar extraction:

• Teeth resisting forceps extraction
• Sclerotic bone
• Unfavorable roots
• Hypercementosis
• Proximity to anatomic structures
• Grossly destroyed tooth
• Heavily restored tooth
• Root stumps
• Impacted tooth

Steps of Transalveolar extraction:

Question 2. Contraindications of extractions.
Answer:

Contraindications of extractions

• Systemic contraindications
• Uncontrolled diabetes
• Bleeding diathesis
• Pregnancy
• Cardiac conditions
• Immunocompromised patients Endocrine malformations Local
• contraindications
• Acute infections
• Malignancy
• Radiation therapy
• Vascular lesions
• Pericoronitis

Question 3. Etiology and management of post-extraction bleeding.
Answer:

Post-extraction bleeding

Post-extraction bleeding can be of three types

• Primary bleeding:
  • Causes:
    • Hypertensive patients
    • When a blood vessel has been severed
  • Management:
    • Atraumatic extraction should be carried out
    • Plan the incision properly
    • Usually stops by application of pressure
• Reactionary bleeding:
  • Cause
    • Increase in blood pressure leading to opening up small divided vessels
  • Management:
    • Seat the patient
    • Clean the oral cavity of all the clots
    • Visualize the problem
    • Locate the exact point of bleeding
    • Stop the bleeding by applying pressure of
    • At home, instruct the patient to place a clean handkerchief moist with cold water on the bleeding site and bite it on firmly
    • Place a cold wet tea bag on the site
    • The tannic acid in tea helps to precipitate protein and cause clot formation
• Secondary bleeding:
  • It occurs 7 days post-operatively
• Cause:
  • Infections destroying the clot
• Management:
  • Use of antibiotics to control infection

Extraction Short Question And Answer

Question 1. Absolute contraindications of extraction.
Answer:

Absolute contraindications of extraction

• Local hemangioma.
  • Due to injury to the vessels
  • Extravasations of blood into the tissue planes
• Arterioventral fistula associated with teeth

Question 2. Order of extraction.
(or)
Sequencing in full mouth extraction
Answer:

Order of extraction

Maxillary teeth are extracted first & then mandibular

Sequence of Order of extraction:

• Third molar
• Second molar
• Second premolar
• First molar
• First premolar
• Lateral & central incisors
• Canines

Question 3. Reactionary Haemorrhage.
Answer:

Reactionary Haemorrhage

Hemorrhage occurring within 8 hours of surgery

Causes of Reactionary Haemorrhag:

• Hypertension
• Postoperative sneezing
• Coughing
• Retching
• Example: Ligature slippage from superior thyroid artery

Question 4. Bone wax.
Answer:

Bone wax

It is a mechanical hemostatic agent

Composition of Bone wax:

• Benzoin
• Storax
• Balsam of tolu
• iodoform
• Solvent ether

Technique of Bone Wax:

• Place the bone wax on the bleeding spot
• Wait for half an hour

Mechanism of Bone wax:

• It occludes the blood vessel

Extraction Viva Voce

1. The two teeth that are most difficult to remove are the first molar and canine
2. In multiple extractions, maxillary teeth should be removed before mandibular teeth and posterior teeth before anterior teeth
3. A dry socket is most common in the mandibular molar area
4. According to Nitzan’s theory, the organism that is responsible for dry sockets is treponema denticola
5. The extraction of the first molar to create space for the eruption of the third molar is called Wilkinson’s extraction
6. For extraction of maxillary teeth, the occlusal plane is kept at 60° to the floor
7. For extraction of mandibular teeth, the occlusal plane is parallel to the floor
8. Cryer’s elevator works on wheel and axle and wedge principle
9. Since the maxillary 1″ premolar has two roots which are curved and divergent, fracture occurs readily during extraction
10. Extraction of tooth associated with central hemangioma results in profuse bleeding and death of the patient
11. Cowhorn forceps are used for the removal of grossly decayed teeth
12. Elevators are used for the extraction of distal-most teeth in the arch and the luxation of adjacent teeth
13. The mandibular second premolar needs primarily rotatory movement to extract
14. The elevators used in exodontia are functionally Class 1 and 2 levers
15. To extract a tooth the whole of the inner surface of the forceps blade should fit the root surface
16. The mechanical advantage would be maximum for an elevator when the effort arm is greater than the resistance arm
17. The beaks of the extraction forceps should be placed on the root surface as far apically as possible
18. The most common cause of post-extraction bleeding is the failure of the patient to follow post-extraction instructions
19. Rongeur is commonly used to cut bone
20. The best time of extraction in pregnancy is the second trimester.

Temporomandibular Joint Disorders Important Notes

1. Classification of TMJ disorders

• Disorders due to extrinsic factors
  • Masticatory muscle disorders.
    • MPDS
    • Myositis.
  • Problems due to trauma
    • Traumatic arthritis
    • Fracture
    • Internal disc derangement
    • Tendonitis
• Disorders due to intrinsic factors
  • Trauma
    • Dislocation
    • Fracture.
• Internal disc displacement
  • Anterior disc displacement with reduction.
  • Anterior disc displacement without reduction.
• Arthritis.
  • Osteoarthritis
  • Rheumatoid arthitis
  • Juvenile arthitis
  • Infantile arthritis.
• Developmental defects.
  • Agenesis
  • Hypoplasia
  • Hyperplasia
• Ankylosis
• Neoplasm
  • Benign
  • Malignant

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

2. Classification of ankylosis:

• False or true analysis
• Extra articular or intra articular
• Fibrous or bony
• Unilateral or bilateral
• Partial or complete.

3. Treatment of ankylosis

4. Causes of trismus:

• Orofacial infection
• Trauma
• Inflammation
• Myositis
• Tetany
• Tetanus
• Neurological disorders
• Drug-induced
• Extra articular fibrosis
• Mechanical blockage

5. Eminectomy:

• It involves the excision of the articular eminence

6. Hyperplasia of condyle:

• The patient exhibits a unilateral, slowly progressive elongation of the face
• Deviation of the chin occurs away from the affected side

7. Hypoplasia of condyle:

• Facial asymmetry occurs
• Limitation of lateral excursions on one side
• Exaggeration of the antegonial notch

8. Conditions where the jaw deviates to the same side:

• Ankylosis of TMJ
• Subcondylar fractures
• Hypoplasia of condyle

9. Kaban’s protocol:

• Early surgical intervention Aggressive resection
• Ipsilateral colectomy
• Contralateral colectomy
• The lining of the glenoid fossa with temporalis fascia
• Reconstruction of ramus with osteochondral graft
• Early mobilization
• Regular follow up

10. Ankylosis features:

• Unilateral
  • Face is asymmetry
  • Fullness occurs on the affected side of the mandible
  • Flattening on the unaffected side occurs
• Bilateral:
  • Gives a typical bird-face appearance

11. Interposition arthroplasty:

Involves the creation of a gap and insertion of a barrier between the cut bony surfaces

• Advantages:
  • Minimizes the risk of recurrence
  • Maintains the vertical height of the ramus.

Temporomandibular Joint Disorders Long Essays

Question 1. Classify TMJ disorders. Explain in detail about anterior dislocation & its management.
Or
Describe the etiology and pathogenesis of TMJ ankylosis. Describe different surgical procedures for TMJ
Or
Describe Subluxation.
Answer:

Classification:

1. Disorders due to Extrinsic factors:

• Masticatory muscle disorders:
  • MPDS
  • Myositis
• Problems due to trauma:
  • Traumatic arthritis
  • Fracture
  • Internal disc derangement
  • Tendonitis

2. Disorders due to intrinsic factors:

• Trauma:
  • Dislocation
  • Fracture
• Internal disc displacement:
  • Anterior disc displacement with reduction
  • Anterior disc displacement without reduction
• Arthritis:
  • Osteoarthritis
  • Rheumatoid arthritis
  • Juvenile arthritis
  • Infantile arthritis
• Developmental defects:
  • Agenesis
  • Hypoplasia
  • Hyperplasia
• Ankylosis:
• Neoplasm:
  • Benign
  • Malignant

Anterior Dislocation:

Causes of Anterior Dislocation:

1. Extrinsic causes:
   • Blow on the chin when the mouth is open
   • Injudicious use of mouth gag
   • Post-traumatic
2. Intrinsic causes:
   • Excessive yawning
   • Vomiting
   • Singing loudly
   • Laughing loudly
   • Opening mouth too wide

Features of Anterior Dislocation:

1. Unilateral:
   • Difficulty in mastication & speech
   • Profuse drooling of saliva
   • Deviation of the chin over the contralateral side
   • The affected condyle is not palpable
   • Definite depression in front of the tragus
2. Bilateral:
   • Pain
   • Inability to close mouth
   • Tense masticatory muscles
   • Difficulty in speech
   • Excessive salivation
   • Protruding chin
   • Gagging of molars
   • Anterior open bite
   • Difficulty in swallowing
   • Hollowness in particular regions

Management of Anterior Dislocation:

• Reassure the patient
• Sedative drugs
• Pressure & massage the area
• Manipulation

 

• Operator grasps the patient’s mandible
• The thumb is placed over the occlusal surfaces of the lower molars
• Fingertips are placed below the chin
• Downward pressure is placed over posteriors
• This overcomes spasms of muscles
• Backward pressure is applied which pushes the entire mandible posteriorly
• Immobilization is done

Manipulation Of Condyle:

• Capsule tightening procedure:
  • Capsulorrhaphy:
    • Shortening of the capsule by removing a section & suturing
    • Placement of vertical incision & tightening it
    • Reinforcement of capsule by stretching a strip of temporal fascia & suturing
• Creation of mechanical obstacle:
  • Osteotomy on an eminence by Lindermann
  • Placement of graft over eminence by Mayor
  • Osteotomy on the zygomatic arch by Dautry

Dautry’s zygomatic arch osteotomy:

Mayor’s grafting technique on the eminence:

• Direct restrain of condyle: Temporalis fascia turned down & sutured
• Creation of new muscle balance: Temporalis tendon divided & sutured in a horizontal manner
• Removal of mechanical obstacles:
  • Meniscectomy: Torn meniscus is removed
  • High condylectomy: Excision of the superior portion of the condyle
  • Eminectomy: Excision of the articular eminence

Question 2. Enumerate causes of inability to open the mouth. How to treat a case of bony ankylosis.
Or
Trisums causes
Answer:

It is a condition in which muscle spasm prevents the opening of the mouth

Causes of inability:

• Orofacial infection
• Trauma
• Inflammation
• Myositis
• Tetany
• Tetanus
• Neurological disorders
• Drug-induced
• Extra articular fibrosis
• Mechanical blockage

Management Of Bony Ankylosis:

1. condylectomy:

• Pre-pre-auricular incision given
• Horizontal osteotomy cut given over condylar neck Condylar head is separated
• Smoothened the remaining structures
• Close the wound in layers
• If required bilateral condylectomy done

1. Exposure of the condylar head via a preauricular incision
2. Sectioning of the condylar head
3. Breaking the fibrous adhesions
4. Condylectomy complete
5. Suturing the capsule
6. Final skin suturing

2. Gap arthroplasty:

• Two horizontal cuts are given
• Removal of bony wedge between glenoid fossa & ramus

3. Interposition arthroplasty:

• Creation of gap
• Insertion of barrier(autogenous or alloplastic)

Kaban’s Protocol:

• Early surgical intervention
• Aggressive resection
• Ipsilateral colectomy
• Contralateral colectomy
• The lining of the glenoid fossa with temporalis fascia
• Reconstruction of ramus with costochondral graft
• Early mobilization
• Regular follow up

Question 3. Define ankylosis of TMJ. Mention etiology, clinical features
Or
Define & classify ankylosis of TMJ. Write on etiology, clinical features 
Or
Classify the Ankylosis of the Temporo-Mandibular Joint. Discuss the etiology of the Temporo-Mandibular Joint.
Or
Etiology and clinical features of TMJ ankylosis and Pathogenesis
Answer:

Definition:

Ankylosis means ” Stiff joint”

Etiology of ankylosis of TMJ:

• Trauma, Congenital
• Infections -Osteomyelitis
• Inflammation, Osteoarthritis
• Rare causes, Measles
• Systemic diseases, Typhoid
• Other causes, Prolonged trismus

 Clinical Features of ankylosis of TMJ:

1. Unilateral:
   • Deviation of the chin on the affected side
   • The fullness of the face on the affected side
   • Flatness on the unaffected side
   • Crossbite
   • Angle’s classic malocclusion
   • Condylar movements absent on the affected side
2. Bilateral:
   1. Inability to open mouth
   2. Neck chin angle reduced
   3. Class II malocclusion
   4. Protusive upper incisors
   5. Multiple carious teeth

Pathogenesis of ankylosis of TMJ:

Question 4. Diagnosis of Bilateral Ankylosis in an 8-year-old boy
Answer:

Diagnosis:

• Radiographic features:
  • Complete obliteration of joint space
  • Normal TMJ anatomy is distorted
  • Deformed condylar head
  • Elongation of the coronoid process

Grading:

Temporomandibular Joint Disorders Short Essays

Question 1. Pathogenesis and Treatment
Answer:

Pathogenesis:

Treatment:

• May resolve on its own
• Manipulation of the jaw by jaw stretcher

Question 2. Internal derangement of TMJ.
Answer:

Definition of TMJ:

It is the anteromedial displacement of the interarticular disc associated with the posterosuperior displacement of the condyle in the closed jaw position

Features  of TMJ:

• Pain on biting
• Clicking sound over the joint
• Deviation of mandible
• Restricted mouth opening due to pain

Management of TMJ:

1. Anterior repositioning appliances
   • Placed on occlusal surfaces
2. Supportive therapy
   • NSAIDs to relieve pain
   • Heat application
3. Occlusal correction

Question 3. Pain dysfunction syndrome/ MPDS.
Answer:

Pain dysfunction syndrome

• It is a disorder characterized by facial pain limited to the mandibular function, muscle tenderness, joint sounds, absence of significant organic & pathologic changes in TMJ
• It may be due to functional derangement of dental articulation, psychological state of mind, or physiological state of joint
• Coined by Laskin

Etiology of Pain Dysfunction Syndrome:

1. Extrinsic factors:
   • Occlusal disharmony
   • Trauma
   • Environmental influences
   • Habits
2. Intrinsic factors:
   • Internal derangement of TMJ
   • Anterior locking of disc
   • Trauma

Features of Pain dysfunction syndrome:

• Unilateral preauricular pain
• Dull constant sound
• Muscle tenderness
• Clicking noise
• Altered jaw function
• Absence of radiographic changes
• Absence of tenderness in ext. auditory meatus

Management of Pain dysfunction syndrome:

1. Reassurance
2.  Soft diet
3. Occlusal correction: 7 ‘R’s
   • Remove-extract the tooth
   • Reshape grind the occlusal surface
   • Reposition orthodontically treated
   • Restore conservative treatment Replaceby prosthesis
   • Reconstruct TMJ surgery
   • Regulate control habits
4. Isometric exercises
   • Opening & closing of mouth 10 times a day
5.  Medicaments
   • Aspirin: 0.3-0.6 gm/4 hourly
   • NSAIDS: for 14-21 days
   • Pentazocine: 50 mg/ 2-3 times a day
6. Heat application
   • It increases circulation
7.  Diathermy
   • Causes heat transmission to deeper tissues
8.  LA injections
   • 2% lignocaine into trigger points
9. Steroid injection
   • As anti-inflammatory
10. Anti-anxiety drugs
    • Diazepam-2-5 mg * 10 days
11. Tens
12. Acupuncture

Question 4. Preauricular approach to TMJ.
Answer:

Preauricular approach to TMJ

Basic & standard approach to TMJ

Technique of TmJ:

• Shaving of the area
• Mark incision from the helix of the ear to the upper border of the tragus
• The depth of penetration of the incision should be upto superficial layer of the temporalis fascia
• Exposure of condyle, thus advantageous

1. Initial incision in the preauricular fold
2. Oblique incision through the superficial layer of temporalis fascia. The periosteal elevator is then inserted below the temporalis muscle to expose the lateral portion of the zygomatic arch
3. Cut in the capsule to enter the TMJ space and incision through the lateral attachment of the disc, entering the inferior joint space
4. After surgery, suturing of the capsule
5. Suturing the wound in layers
6. Final skin subcuticular suturing

Question 5. Risdon’s approach.
Answer:

Risdon’s approach

1. Site Of Incision: 1 cm below the angle of the mandible
2. Extent: Forward, parallel to the lower border of the mandible
3. Site Seen: Neck of condyle & ramus

Disadvantages of Risdon’s approach:

• Poor access to the condylar head
• Procedures involving the articular portion of the head & meniscus cannot be performed

Question 6. Frey’s Syndrome:
Answer: 

Frey’s Syndrome

This is auriculotemporal nerve syndrome

Causes of Frey’s Syndrome:

• Iatrogenic causes followed by parotidectomy

Features of Frey’s Syndrome:

• Pain in auriculotemporal nerve distribution
• Gustatory sweating
• Flushing on the affected side

Diagnosis of Frey’s Syndrome:

• Positive starch iodine test

Treatment of Frey’s Syndrome:

• Topical application of anticholinergic
• Radiation therapy
• Surgical procedures
• Skin excision
• Nerve section
• Tympanic neurectomy

Temporomandibular Joint Disorders Short Answers

Question 1. Arthroscopy.
Answer:

Arthroscopy

• Means looking into the joint
• Oral And Maxillofacial Surgery

Indications of Arthroscopy:

1. Disc derangement
2. Arthrosis Arthritis
3. Injuries to TMJ
4. Perforation of the disc

Contraindications of Arthroscopy:

• Infection
• Ankylosis

Components of Arthroscopy:

• Arthroscope
• Fibreoptic light cables
• Eye lens

The procedure of Arthroscopy:

• Anesthetized
• Palpate the joint
• Mark a point at the 12 mm anterior to the tragus
• Mark another point 1-2 mm below it
• Cutaneous incision made
• Introduction of the trocar into the capsule
• Continuous irrigation carried throughout the procedure

Question 2. Barrel bandage.
Answer:

Barrel bandage

• Used for ankylosis management
• The bandage is used to restrict the movement of the joint
• The patient is kept on a soft diet
• Restrict wide opening of the mouth while yarning, laughing
• If required, support the mandible while such activities

Question 3. Interposition arthroplasty.
Answer:

Interposition arthroplasty

• Used for the management of ankylosis
• Horizontal osteotomy cut is made
• Between two cuts, graft material is added

Various grafts are:

1. Autografts:
   • Cartilaginous graft
   • Temporalis fascia
   • Temporalis muscle
2. Heterogenous graft:
   • Pig bladder
3. Alloplasts:
   • Stainless steel
   • Titanium
   • Zirconium
   • Tantalum

Question 4. Eminectomy.
Answer:

Eminectomy

Excision of the articular eminence

Steps of Eminectomy:

• Anesthetized
• Undermine & turn skin & subcutaneous flap upward
• A small horizontal incision was given over the zygomatic arch
• T incision is given a horizontal portion over the arch & vertical portion over the apex of the eminence.
• Periosteum reflected
• Expose eminence
• A series of bur holes are created
• Burs are connected
• Eminence is sectioned & separated
• Smoothened the base of eminence Irrigate the area
• Suture

Question 5. Ligaments of TMJ:
Answer:

Ligaments of TMJ

1. Temporomandibular ligament
   • It stabilizes TMJ
   • It extends downward & backward from the articular eminence to the external & posterior sides of the condylar neck
2. Stylomandibular ligament
   • Extends from the styloid process to the mandibular angle
3. Sphenomandibular ligament
   • Arises from the spine of the sphenoid & is inserted into the lingual of the mandible
   • It is a remnant of Meckel’s cartilage

Temporomandibular Joint Disorders Viva Voce

1. The submandibular incision is given about 1 cm below the angle of the mandible
2. Hemarthrosis is the extravasation of blood into joint space due to trauma
3. Intraarticular injection of hydrocortisone reduces the inflammatory process within the joint
4. The preauricular approach is an ideal surgical approach to TMJ ankylosis
5. The interposition of temporal muscle and fascia in the treatment of ankylosis is done to prevent ankylosis
6. Dautery procedure is a treatment modality for TMJ dislocation
7. Bird face appearance is a feature of bilateral ankylosis
8. A hypertonic saline para capsular injection is used for conservative management of TMJ subluxation and dislocation
9. MPDS is the most common disorder causing pain in the masticatory apparatus along with TMJ