Oral Surgery Exam 3

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ATLS primary
survey includes
which five factors?

Airway, Breathing, Circulation,

Disability, Environment (ABCDE)

19.

avulsed teeth

tooth is completely out of the mouth

20.

five factors for

reimplanting
avulsed teeth

no perio ds, socket intact, ortho

contraindications, root development
should be evaluated (open is better), 2
hours in the external envt before its
useless

2.

battle's sign

bruising behind the ear right over the

mastoid, need a CT to rule out back of
skull fracture

3.

Marcus Gunn pupil

during a swinging light test, the affected

side and the contralateral side will dilate
instead of constrict when light is shown
on them

21.

length of time
since avulsion
injury

<20 mins-rinse and reimplant

>20 mins-HBBS for 30mins, then doxy for
5mins then reimplant
>2hrs-do not reimplant

4.

why are septal

hematomas
dangerous?

the nasal cartilage is avascular, so a

hematoma can cause necrosis of the
cartilage along with the normal fullness
symptoms

22.

how long do we
stabilize a wide
apex avulsed
tooth?

2-3weeks with penicillin

5.

abrasion

frictional injury, epithelium but

sometimes deeper layers, minimal
bleeding, painful due to nerve endings

23.

7-10days

6.

contusion

subcutaneous/submucosal
hemorrhage, no soft tissue break, blunt
trauma, no need for antibiotics due to
containment (unless contusion
secondary to dentoalveolar trauma)

how long do we
stabilize an
adult closed
apex avulsed
tooth?

24.

alveolar process
fracture

tear in (sub)epithelial tissue usually

from a sharp object, treat hard tissue
first

reduce segment, splint segment (at least

4wks), if root apices are denuded w/in the
fracture we should do endo within 1-2wks
to prevent resorption

25.

bone healing by
primary
intention

bone segments need to be less than or

equal to 1mm from eachother

26.

bone healing by
secondary
intention

bone segments are greater than 1mm

apart from each other

27.

fibroblastic
stage of bone
healing

osteocellular differentiation, capillary

budding, collageln laid down, fibrous
matrix, callus forms, need
oxygenation/nonmobility (or else cartilage
forms)

28.

remodeling
stage of bone
healing

removal of unnecessary bone and laying

down of new bone, haversian system,
callus shrinks

1.

7.

laceration

where do we put
the first suture on
a full thickness lip
laceration?

at the vermilion border, this way we

know that this part will match, work
form the inside out, three layered
closure

9.

degloving

shearing forces that causes a flap of

tissue

10.

avulsion

tissue ends up missing, animal

bites/blast injury for example

11.

crown crack

limited to the enamel, no treatment

needed except for esthetics, recalls for
pulpal diagnosis

horizontal/vertical
crown fracture

depth is key, pulp checking often

should be done

29.

crown-root
fracture

location of fracture determines

treatment

greenstick
fracture

incomplete fracture, usual children, less

mobility

30.

simple fracture

complete but minimal frature

14.

horizontal root
treatment

the more apical the better the prognosis

(middle-apical third)

31.

comminuted
fracture

multiple segmented fracture

15.

subluxations

intrusion, extrusion

32.

orthodontically erupt it or let it erupt

passively, if primary then extract

fractures that communicate with the

external environment

16.

tx of intrusion

compound
fracture

33.

tx of extrusion

manually seat it back in, splint for a

couple weeks and then endo

muscle function will actually reduce the

fracture, aka reducing the fracture

17.

favorable
mandibular
fracture

18.

displaced teeth

manually reposition tooth and alveolus,

usually a ledge you need to get it over

8.

12.

13.

34.

unfavorable
mandibular fracture

muscle function will actually displace

the fracture

35.

mandibular
fractures usually
come in pairs, where
are the most
common locations?

angle of the mandible and

contralateral subcondylar area

closed reduction
fracture fixation

more favorable, reducing blindly

(casting an arm), in the mandible we
put them into occlusion and wire the
jaws shut, can do this under LA

open reduction
fracture fixation

requires seeing the fracture (incision),

done if mandible is extremely
comminuted or has condition
preventing intermaxillary fixation
(seizures, vomitous)

36.

37.

38.

39.

40.

41.

42.

43.

period of immobility
for closed reduction
of fracture fixation

elderly-5+ weeks
adults-4-6wks
children-2wks

disadvantage to
closed reduction

longer IMF time, patient

noncompliance, altered diet, hygiene,
CI'd in patients with concomitant
conditions (Seizures, sleep apnea, etc)

vestibular approach
for an open
reduction

from symphysis to angle we can incise

through the vestibule, careful of the
mental nerve

submandibular
approach for an
open reduction

parasymphisis to angle of the

mandible, can directly see the
fracture, easier angulation, can
damage the IAN and CNVII, can scar

retromandibular
approach for an
open reduction

angle to subcondyle, direct vision,

easier angulation, difficult dissection,
can damage CNVII or
retromandibular vein

preauricular
approach for an
open reduction

accesses TMJ, condyle, and condylar

neck, best visualization of higher
structures but much higher chance of
dissectiong CNVII

rigid fixation of the

mandible

bone does not move, lag screws (two

screws), two plates, or one large plate,
can be done on unfavorable
fractures

45.

functionally stable
fixation of the
mandible

one miniplate, used for minimal

displacement and put on spots of
tension (usually on top), requires
favorable fractures

46.

vertical stress
bearing areas of the
face

zygomaticomaxillary, nasomaxillary,
pterygomaxillary

44.

47.

horizontal stress
bearing areas of
the face

zygomatic, frontal, maxillary

48.

what fracture
must be present
in order for it to
be a le fort
fracture?

pterygoid plates must be fractured

49.

Le Fort I

least complicated, lateral antral and nasal

walls with lower 1/3 of septum, pterygoid
plates

50.

Le Fort II

nasal and maxillary bone, palatine

bones, lower 2/3 of septum,
dentoalveolus, pterygoid plates

51.

Le Fort III

nasal bones, zygoma, maxilla, plataline,

pterygoid plates, essentially seaparates
face form base of skull

52.

access to Le Fort I

through the maxillary vestibule

53.

access to Le Fort
II

could be vestibular,
transcutaneous/transconjuncitval, or
coronal (for comminuted)

54.

access to Le Fort
III

requires coronal approach

55.

what is the most

common orbital
fracture site?

inferior and medial (medial orbital wall)

56.

emergencies
around the eye

inferior rectus entrapment (can necrose

due to lack of blood, CNV cardiac reflex
(pushing on trigem slows HR) can also
happen), loss of vision, retrobulbar
hematoma

57.

what can happen

from a zygomatic
arch fracture?

trisumus due to coronoid impingement,

approached via Gilles or Keens approach

58.

gilles approach

access to zygomatic arch through

temporal incision

59.

Keens approach

access to zygomatic arch through

intraoral incision

60.

traumatic
telecanthus

drifting apart of the eys due to nasoorbital fracture

61.

what are the two

most common
locations of oral
cancer?

lateral border of the tongue

floor of the mouth

62.

which three
characteristics of
lesions raise the
suspicion of
malignancy?

erythroplakia, leukoplakia, and

leukoerythroplakia

63.

how many
days until we
absolutely
need to
biopsy an
ulcer?

2wks (15days)

76.

two types of
cysts we think
about in the oral
cavity

1) those arising from odontogenic

epithelium
2) those from oral epithelium that is
trapped between fusing processes during
embryogenesis
usually asymptomatic

64.

aspiration
biopsy

needle penetrates lesion and grabs a piece

but no specific diagnosis can be given, can
only show malignancy

77.

enucleation

65.

cytology
biopsy

oral brush or aspirational, no specific

diagnosis can be given, can only show
malignancy

taking the cyst lining out only, attempt to

remove cyst in one piece (without
rupture, shelling out), good for low
recurrence and low chance for anatomical
risk

78.

marsupialization

creating a surgical window on the wall of a

cyst so it can continually drain, only
portion removed is the segment removed
for the window, decreased cystic pressure
and increases shrinkage, enucleation
usually done once its shrunk enough
because the cystic lining will be much
thicker

66.

incisional
biopsy

biopsy of a specimen of the leasion, NOT the

entire lesion, to allow treating doctors to have
something to work with

67.

excisional
biopsy

removal of entire lesion with perimeter of

normal tissue surrounding lesion (2-3mm)

68.

indications
for an
excisional
biopsy

small benign lesions, removability without loss

of function, pigments/small/vascular lesions

79.

indications for
marsupialization

how to
anesthetize a
lesion for
biopsy

do not inject right into the lesion, inject 1cm

surrounding the tissue

too large to remove all in once, extent

could cause pathologic fracture,
anatomical risk, loss of function, simple to
do but we don't get rid of the entire lesion

80.

what syndrome
are OKCs
associated with?

never use
suction
when
performing a
biopsy

so it doesnt get sucked up and you lose the

specimen

Gorlin syndrome (nevoid basal

syndrome)-palmar pits, chest concavity,
multiple basal cells that could turn
cancerous

81.

marginal
resection

removal of tumor without bony disruption

82.

surgical
closure of a
biopsy

undermine the wound margins by at least the

width of the ellipse in each direction, this will
decrease the tension after suturing, obtain
primary closure except for attached mucosal
surfaces (secondary is fine)

segmental
resection

removal of tumor by incising through

uninvolved tissues around it, will
discontinue the bone

83.

composite
resection

resection of tumor with bone adjacent soft

tissues, and lymph node channels

84.

enucleation and
curretage

local removal of tumor by instrumentation

in direct contact with lesion

85.

enucleation and
peripheral
ostectomy

local removal of tumor by instrumentation

in direct contact with lesion in addition to
mechanical removal of at least 2mm of
peripheral bone

86.

autogenous graft

tissue obtained from the same individual,

ideal grafting material due to lack of
immune response, vascularized or nonvascularized

87.

where,
anatomically,
can we get the
most bone?

posterior iliac crest (60-80cc)

88.

when would we
use a rib graft?

mostly in pediatric patients, it will wear

away more in adults

69.

70.

71.

definition of
cyst

closed sac like structures with liquid inside

73.

hamartoma

dysmorphic proliferation of native tissue

which will get to a certain size and then stop
growing

74.

choristoma

dysmorphic proliferatio of NON-native tissue

which will get to a certain size and then stop
growing

75.

difference
between
benign and
malignant
neoplasms

malignancies possess proteins required for

metastasis whereas benign do not

72.

89.

how are maxillary reconstructions for major defects

cured?

a surgical obturator is used with a final prosthesis

90.

why is it important to have a soft tissue bed for a nonvascularized bone graft?

to avoid contamination and have vascularity to the site, incision is done until
healthy soft tissue is encountered

91.

soft tissue reconstruction is indicated when?

primary closure is not feasible, lots of radiation to that area, preparing for
secondary bone grafting

92.

what is a successful reconstruction?

complete return to adequate function with appropriate esthetic results