Maxilofacial Surgery Miscellaneous Question And Answers

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

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

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

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: It 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

It is an emergency

Management of Cardiac arrest:

• It 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:

It 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

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

Classes of Analgesics:

1. Opioids Example: Morphine:

• It 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

It 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
• It 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

• It is an aryl acetic acid derivative
• It 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

It 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

• It 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

• It 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

Water Regulation:

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

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

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

It 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

It is a pre-cancerous condition

It 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

It 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:

• It 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

• It is the resection of a large bulky tumor virtually without dissection surgery
• It 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
• It 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