Oral Surgery 2 Midterms

Oral Surgery 2 (Midterms)

• Post-Operative Surgical Complications:

  • Fat Pad Prolapse: Incision extends beyond the MGJ, allowing fat from the cheeks to protrude.
  • Fractured Maxillary Tuberosity: Excessive force on forceps can detach part of the maxilla. If the detached portion is not attached to the rest of the maxilla, it should be removed.
  • Soft Tissue Injuries: Tearing of mucosal flaps, puncture wounds, or stretch/abrasion injuries are possible.
  • Surgical Emphysema: Excessive air or water during surgery can enter soft tissue spaces. Use preventative measures like 45 degree handpiece, milk the flap, or give antibiotics.

• Soft Tissue Injury Prevention:

  • Pay close attention to soft tissues during procedures, especially angular cheilitis (common in 3rd molar surgeries).
  • Use appropriate instruments while retracting soft tissue.
  • Appropriate sized flaps prevent tearing.

• Tooth Extraction Complications:

  • Root Fracture/Displacement:
    • Excessive force can lead to root fracture during tooth extraction.
    • Root displacement is also possible.
    • Buccal delivery helps prevent these complications.

• Oro-Antral Communications:

  • Oro-Antral Perforation/Fistula: Communication between oral cavity and maxillary sinus.
  • If <2 mm: primary closure, secure clot, and decongestants.
  • If >2 mm: primary closure, watertight closure, reduce bone for better coaptation, decongestants, and antibiotics.

• Injuries to Adjacent Teeth During Extraction:

  • Advise the patient about possible fracture of restorations or luxation of adjacent teeth to prevent these issues.

• Maxillary Sinus Disorders and Management:

  • Maxillary Sinus (Antrum of Highmore): Air-filled cavities in the maxilla, with tubular sacs in embryos and pyramidal shape in adults. Its volume is typically 15-20 ml.
  • Innervation: Maxillary sinus innervation is similar to teeth, so pain might be misidentified.
  • Communication: Ensure proper maxilla pneumatization, especially with 3rd molar surgeries.

• Orofacial Infections:

  • Odontogenic Infections:
    • Common bacteria include aerobic, anaerobic, and mixed.
    • The course can be acute, subacute, or chronic.
    • Acute: involves pain, borders (diffuse or specific), large size, red color, and increasing edema.
    • Chronic: involves pain, borders (localized), small size, shiny center, and decreasing edema.
    • Cellulitis: Most severe of chronic infections and can be from aerobic and anaerobic bacteria.

• Chronic Oro-Antral Fistula Management:

  • Flush out content of max sinus using sterile normal saline (NSS) through perforation using 20 cc syringe and thin tube.
  • Administer antibiotics that address bacterial infections.
  • Know the different bacteria involved.
  • Closure of oro-antral fistula involves care of the perforation site.

• Odontogenic Infections:

  • Cause: From bacterial infection of the tooth, or its surrounding tissue.
  • Clinical Course: Acute, Sub-Acute, Chronic.

• Periodontitis:

  • Gingival (diffused or localized)
  • Periodontitis (no bone loss)
  • Periodontitis (horizontal bone loss with pocket)
  • Periodontitis (vertical bone loss with pocket)
  • Mobility and suppuration

• Surgical Management of Cellulitis:

  • Mild: Remove cause, and administer antistreptococcal antibiotics.
  • Severe: Remove cause, incision and drainage, and administer antistreptococcal antibiotics.

• Acute Periapical Abscess:

  • Affected cortical area, apical only.
  • Curettage is a common technique for removal of pathogens.

• Probing Fistula/Cutaneous Fistula:

  • Fistula has diffuse edges and a high probability of being the location of an abscess.
  • Can be diagnosed by palpation.

• Drainage of Abscess:

  • Low/high attachment of buccinator muscle affects drainage location (buccal space vs vestibule).

• Factors Determining Route of Pus Drainage:

  • Bone thickness overlying infection
  • Level of site of bony perforation

• Primary/Secondary/Tertiary Spaces:

  • Pterygopalatine space, infratemporal space, canine space
  • Superficial/Deep/Submental/Submandibular spaces.

• Pseudo Ludwig's Angina/True Ludwig's Angina:

  • Pseudo: Extra-oral swelling w/o floor of mouth infection.
  • True: Infection/swelling of the floor of the mouth.

• Osteomyelitis: Bone inflammation extending from the marrow to the periosteum, potentially due to loss of blood supply from tissue/nerve compression.

• Saucerization: Surgical creation of a depression/opening in an infected area that allows pus to drain.

• Decortication: Removal of infected cortical plate of bone around a tooth or infection site.

• Cysts: A fluid-filled sac in the jaw. These are classified based on their formation (odontogenic, non-odontogenic) as well as features. Specific categories include radicular cysts, dentigerous cysts, and others.

• Cyst management/treatment: Enucleation, saucerization, and marsupialization.

  • Enucleation: Removing the entire cyst.
  • Saucerization: Creating a saucer-like opening in the cyst to allow for drainage.
  • Marsupialization: Creating a flap on the cyst to expose it to the mouth and facilitate drainage.

• Complications of Dental Abscesses:

  • Cavernous sinus thrombosis
  • Ludwig's angina
  • Necrosis
  • Necrosis and cell death.