MAX FAX Flashcards

Question

What are the grades of mucositis?

Answer 1

Grade 0 = no alterations grade 1 = pain and erythema grade 2 = erythema and ulcers grade 3 = ulcers (liquid diet) grade 4 = unable to feed

Answer 2

Avoid: - Smoking - Spirits - Spicy food - Tea and coffee - Non-prescription mouthwash (esp those with alcohol) Topical: - Lignocaine gel - Saline mouthwash (good for use in radiotherapy) - Sodium bicarbonate mouthwashes (good for use in radiotherapy) - Caphosol (manmade mucous/saliva sub) - Tea tree oil mouthwash - Cooling using ice cubes low level laser light therapy

Answer 3

1. Involvement of the surrounding soft tissue; * Simple: surrounding soft tissue intact * Compound: fracture exposed to the surrounding environment (soft tissue breached) Need AB’s * Comminuted: multiple small fragments e.g. from gunshot 2. No of fractures * Single * Double * Multiple 3. side of fracture * Unilateral * Bilateral 4. Site of fracture * Angle * Below condyle (subcondyle) * Parasymphyseal (in the middle) * Body * Ramus * Coronoid * Condylar fracture (intra/extra caspular) * Alveolar process 5. Direction of fracture line * Favourable: direction of fracture line limits the displacement of the fracture by the action of the surrounding muscles * Unfavourable: direction of fracture line encourages the displacement of the fracture 6. Specific fractures * Green stick fracture: soft bone (children) very unlikely to completely fracture = still attachment in one of the cortices * Pathological: fracture caused by pathology e.g. osteoporosis, osteomyelitis, Padgets, expanding cystic lesion 7. Displacement of the fracture * Displaced: requires surgical tx * Undisplaced: may not require surgical intervention

Answer 4

Control pain and infection - analgesia and antibiotic (if a compound fracture) 1. Undisplaced = usually no tx 2. Displaced or mobile fracture = surgical intervention a) Closed reduction + fixation: reduce the fractured segments to their normal anatomical orientation without exposing the fracture line (we judge it using Intermaxillary fixation = if teeth go into ICP ) b) Open reduction + internal fixation Reflect ST and expose the bone to reduce the segment Open reduction and internal fixation (ORIF) = most common

Answer 5

Pain, asymmetry, diplopia, altered sensation, swelling, nose bleed, mobility.

Answer 6

Type 1 – horizontal maxillary fracture spreading teeth from upper face (floating palate) Type 2 – pyramidal fracture involving nasofrontal suture (floating maxilla) Type 3 – transverse craniofacial disjunction where maxilla is detached from base of skill (floating face) Surgical Classifications: Le Fort I osteotomy (most common) - LF1 = Cut the maxilla from the base of the skull and move it in any direction - LF2 = maxilla and nose moved together - LF3 = Maxilla, nose and cheek bone moved together

Answer 7

occipitomental view 15* & 30*

Answer 8

A pathological cavity having fluid, semi-fluid or gaseous contents & which is not created by the accumulation of pus. Allows it to gradually increase in size

Answer 9

(Odontogenic) radicular cysts (&residual cysts) Inflammatory collateral cysts - paradental cyst - buccal bifurctaion cyst

Answer 10

Odontogenic: dentigerous cysts odontogenic keratocysts lateral periodontal cyst non-dontogenic nasopalatine duct cyst

Answer 11

nasopalatine duct cyst solitary bone cyst aneurysmal bone cysts

Answer 12

1. Enucleation What is it? All of the cystic lesion is removed (entire cyst lining removed with the associated tooth/root if present) Treatment of choice for most cysts What are the Advantages? * Whole lining can be examined pathologically * Primary closure * Little aftercare needed What are the Contraindications/disadvantages? * Risk of mandibular fracture with very large cysts * (Dentigerous cyst) wish to preserve tooth * Old age/ill health can’t be put under GA * Clot-filled cavity may become infected * Incomplete removal of lining may lead to recurrence * Damage to adjacent structures * Daughter cysts in the keratocyst lining – to remove all of these would cause damage to adjacent structures/anatomy = have to use marsupialisation 2. Marsupialisation (less invasive and can be done under LA) Requires cooperation - Creation of a surgical window in the wall of the cyst, removing the contents of the cyst & suturing the cyst wall to the surrounding epithelium - Encourages the cyst to decrease in size & may be followed by enucleation at a later date - Always a window present with something inside for up to 6 months e.g. an obturator to prevent tissues growing back over it What are the Advantages? * Simple to perform * May spare vital structures What are the Contraindications/disadvantages? * Opening may close & cyst may reform * Complete lining not available for histology * Difficult to keep clean & lots of aftercare needed * Long time to fill in

Answer 13

Always associated with a non-vital tooth and always attached to a tooth - Initiated by chronic inflammation at apex of tooth due to pulp necrosis - Proliferating epithelium with central necrosis (bringing fluid in) OR epithelium surrounds fluid area - Continued growth - Osmotic effect with semi-permeable wall - Cytokine mediated growth

Answer 14

Radiographically: * Well-defined, round/oval radiolucency * Corticated margin continuous with lamina dura of non-vital tooth * Larger lesions may displace adjacent structures * Long-standing lesions may cause external root resorption &/or contain dystrophic calcification Histologically: - Epithelial lining (often incomplete) = non k stratified squamous epithelium - Connective tissue capsule - Inflammation in capsule Dark blue dots nuclei of inflammatory cells Cholesterol clefts Mucous metaplsia Hyaline/rushton bodies (Niamh)

Answer 15

* Pt with aesthetic or functional concerns * Growth completed * Moderate/Severe skeletal discrepancy - A-P - Transverse - Vertical

Answer 16

Relapse Nerve damage Bleeding Unobtainable results for patients with high expectations Infections TMJD

Answer 17

Radiographs: * OPT * Cephalographs * Periapicals * Occlusal * CT scanning All patients have a CBCT nowadays. * Study Models (casts) * Photographic (2D, 3D) Stereophotogrammetry = 3D imaging

Answer 18

* Advancement = Sagittal split mandibular osteotomy - Ramus is split from the body to allow the anterior part of the (body and the dentition) mandible to move in any direction. - Equivalent of the LF1 osteotomy * vertical subsigmoidal osteotomy (VSSO)

Answer 19

LF 1-3 * Le Fort I osteotomy (most common) - Cut the maxilla from the base of the skull and move it in any direction - LF2 = maxilla and nose moved together - LF3 = Maxilla, nose and cheek bone moved together Anterior maxillary osteotomy - Can’t move the whole maxilla back because of the pterygoid plates, only the anterior part is moved back

Answer 20

pain/pressure before mealtime thick viscous saliva salty saliva dry mouth swelling of duct which is fixed

Answer 21

Submandibular most commonly than parotid due to position of gland as; the duct has a long uphill Path of saliva secretion = flow is slow and saliva can stagnate Saliva is thicker and more mucous like hilum present (90 degree bend) in some cases

Answer 22

To remove the stone: * It must be mobile * Located - within the lumen on the main duct distal to the posterior border of the mylohyoid -Distal to the hilum -At the anterior border of the parotid gland. If it is inflamed/ enlarged then refer patient to max fax.

Answer 23

Parasympathetic innervation from the chorda tympani branch of facial nerve which unifies with lingual branch of mandibular nerve at the submandibular ganglion.

Answer 24

Mixed - serous and mucous

Answer 25

Sensory innervation – auriculotemporal nerve and greater auricular nerve o Parasympathetic – glossopharyngeal nerve and auriculotemporal nerve

Answer 26

Parasympathetic – chorda tympani of facial nerve which unifies with lingual branch of mandibular nerve at submandibular ganglion.

Answer 27

predominantly mucous but some serous

Answer 28

How long swelling has been present?(continued swelling after 48hrs= infection) cause - how did it start Pain Hx- SOCRATES fluctuation in size Feeling generally unwell Problems with breathing/swallowing (straight to A&E) Palpation (firm/mobile) Pus Heat Colour. Fever- Any suspicion of sepsis?-urgent referral to A &E. MH- any allergies DH- any previous treatment that could have caused this ? Record: Temperature Respiratory rate Heart rate pulse O2 saturation

Answer 29

size location Firm or soft if mandible can be palpated is it causing orbital swelling encroaching on the soft tissues of the neck = airway compromised

Answer 30

SIRS-systemic inflammatory response syndrome - Increased HR pulse >90/min - Increased respiratory rate > 20/min - temperature < 36 or >38 degrees - WCC < 4000 or > 12000/mm3

Answer 31

- Spot and Diagnose (Take OBS e.g. O2 sat) - Urgent call for advice/referral to Max Fax Hospital: - Sepsis 6 1. Give high flow oxygen 2. Take blood cultures 3. Give IV AB’s 4. Give a fluid challenge 5. Measure lactate 6. Measure urine output

Answer 32

Bilateral cellulitis (infection/swelling) of the sublingual and submandibular spaces (from dental infection) - Swelling on both sides = compromise airway Features: What are the extra-oral features? - Diffuse redness - Bilateral swelling in submandibular region What are the intra-oral features? - Raised tongue - Difficulty breathing - Difficulty swallowing - Drooling

Answer 33

Maxillary Spaces: buccal space. the palate (maxillary sinus) infraorbital space Infratemporal region Mandibular Spaces: * Mental space * Submental space * Buccal space * Submasseteric space * Sublingual space * Submandibular space * Lateral pharyngeal space

Answer 34

Pain management, avoid nose blowing, finish course of antibiotics. ?observe for retrobulbar haemorrhage?

Answer 35

Rests of Serres from dental lamina.

Answer 36

* Wall - Daughter/satellite cysts found within the wall * epithelial lining: keratinised– parakeratinised Multicentric growth – parts of epithelial lining grows faster than other sites and have finger like projections (not a nice balloon shape) * No rete pegs within the epithelium (allows the epithelium to separate from the wall) * Palisading arrangement (basal cells at same height)

Answer 37

* Well defined and well corticated radiolucent lesion * A/P growth along the body, angle and ramus of the mandible * Truly multilocular * Can cause displacement of adjacent teeth * Scalloped margins **The cyst has no specific relationship to teeth **

Answer 38

High risk of recurrence Multicentric growth – parts of epithelial lining grows faster than other sites and have finger like projections If projections left behind = reoccurrence Daughter/satellite cysts found within the wall – if left behind they form a new keratocyst Risk To IDN - pressure pathological fracture of jaw

Answer 39

Basal cell naevus syndrome/Gorlin-Goltz syndrome

Answer 40

Epithelial rests of Malassez from HERS (hertwig’s epithelial root sheath)

Answer 41

Dental follicle at reduced enamel epithelium and crown.

Answer 42

* Thin non-keratinised stratified squamous epithelium * May resemble radicular cyst if inflamed - however no inflammation usually * Attached to the ACJ of the unerupted tooth * flat basement membrane * no rete pegs

Answer 43

- Radiolucent with well-defined corticated margins which - associated with cemento-enamel junction of an unerupted/impacted tooth (neck of the tooth) - Larger cysts may begin to envelope root of tooth - May displace the involved tooth - Tend to be symmetrical initially - Larger cysts may begin to expand unilaterally - Variable displacement of cortical bone (i.e. bony expansion) - Unilocular

Answer 44

Unerupted M3M and U3s.

Answer 45

Ameloblastoma folicular ameloblastoma - Islands present within a fibrous tissue background - Islands Bordered by cells that resemble the ameloblast e.g. columnar cells with a dark staining nucleus - Tissues in the middle of the follicle are loose (resemble stellate reticulum of tooth germ) - Can be cystic changes within the follicle - Other changes within the stellate reticulum like tissue involve squamous metaplasia or cells become granular etc - No connective tissue capsule (in any of the types) = cells can grow and infiltrate into the jaw bone = reason for high recurrence rate plexiform ameloblastoma: - Amelobastoma cells arranged in strands - Between the strands there is stellate reticulum like tissue - Some Cells can form back to back with hardly any SR like tissue between - No connective tissue capsule (in any of the types) = cells can grow and infiltrate inot the jaw bone = reason for high recurrence rate adenomatoid odontogenic tumour: - Epithelial cells arrange in duct like structures, sheets or rosette appearance - There is a degree of calcification which are reflected in the radiological appearance - Has a well developed fibrous tissue capsule surrounding therefore removal is easier and has a lower recurrence rate calcifying epithelial odontogenic tumour * Loose myxoid tissue (connective tissue) with stellate cells within * May contain islands of inactive odontogenic epithelium (vital but inactive) * No fibrous tissue capsule  locally invasive into adjacent bone and can cause problems with surgical removal and recurrence

Answer 46

odontogenic myxoma

MAX FAX Flashcards

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