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57 Cards in this Set
- Front
- Back
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Salivary gland differences
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Parotid is most serous and has more electrolytes than submandibular except for calcium
Sublingual is mostly thick secretions Submandibular is mixed and produces most of the saliva |
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Sialogram phases & judgement
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Ductal - Immediately after injection for visualization of major ducts
Acinar - Gland parenchyma begins to fill Evacuation phase - Assesses normal secretory clearance function of gland Retention of iodine contrast medium beyond 5 minutes is considered abnormal |
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Sialodochitis, Sialadenitis & tumors
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Sialodochitis shows sausage link pattern
Sialadenitis shows pruning or more branching Tumor shows ball in hand due to tumor displacing ductal anatomy |
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Contraindications of sialogram
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Acute salivary gland infections
History of iodine sensitivity Before a thyroid gland study |
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Ranula
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Most common lesion of sublingual gland
May reach a larger size than mucoceles because overlying ucosa is thicker and less trauma in floor of mouth Has potential to extend through mylohyoid into neck and compromise airway. Usual treatment is marsupialization |
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Salivary gland infections
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Bacterial is swelling with erythema
Viral has no erythema |
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Necrotizing Sialometaplasia
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Must differentiate from malignant carcinoma
Ulcerations heal spontaneously within 6 to 10 weeks |
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Sjogrens syndrome
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Primary is dry mouth and eyes
Secondary has a connective tissue disorder like rheumatoid arthritis Parotid gland is most sensitive |
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Types of oral biopsies
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Cytologic - Exfoliative & Oral brush
Incisional for greater than 1cm Excisional take 2-3mm of normal tissue Aspiration |
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Oral brush biopsy results
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Negative
Positive Atypical can mean benign inflammatory lesion like lichen planus |
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Surgical management of cysts
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Enucleation - Caution when near max sinus or inferior alveolar canal. Concave surface facing bone while convex surface does stripping.
Marsupialization - aka partsch procedure has less tissue injury. Can be opened into maxillary sinus or nasal cavity Enucleation after marsupialization - if not fixed after marsupialization, and can take advantage of thickened cystic lining. Enucleation with curettage - Remove 1-2mm of bone. Do for odontogenic keratocyst & recurring cysts. |
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Maxilla vs mandibular lesion
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Maxilla is worse b/c max sinus provides space for asymptomatic growth
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Three choices for immediate reconstruction
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1) Entire procedure intraorally
2) Remove tumor by intra and extraoral. Close oral and graft through extraoral 3) When tumor has not destroyed alveolar crest and no extension into soft tissue. Extract involved teeth and wait 6-8wks for gingival healing. Graft defect extraorally. * Only type by which oral contamination can be avoided. |
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Soft tissue injuries
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Abrasion
Contusion - Most don't need antibiotic, but if due to dentoalveolar trauma, coagulated blood is ideal culture medium so give systemic antibiotics. Laceration - No need to suture palate, inner lip or tongue. If vermillion is involved, first suture at mucocutaneous junction. If full thickness, suture from inside out. Muscle layer use resorbable sutures. |
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Periorbital ecchymosis & subconjunctival hemorrhage
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Indicative of orbital rim or zygomatic complex fractures
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Ecchymosis in floor of mouth
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Anterior mandible fracture
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Uneven pupils & Asymmetric pupils
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Uneven pupils in lethargic patient means intracranial bleed
Irregular pupil is caused by globe perforation |
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Frequency and types of mandibular fractures
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Most common at condyle, then symphysis
Greenstick - Minimal mobility when palpated and incomplete Comminuted - Fractured bone is left in multiple segments. Compound - Communicates with outside environment |
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Distraction osteogenesis phases
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Osteotomy or surgical phase
Latency period - 7 days usually Distraction phase - 0.5mm twice a day or 1mm per day Consolidation phase Appliance removal Remodeling phase |
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Rule of 10s
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10 weeks old
10 pounds of weight 10g/dL hemoglobin in blood |
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Most common metastasis to jaw
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Paired breasts & lungs
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HIV and cancer
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Squamous cell carcinoma & Karposi's sarcoma
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Routes of metastasis
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Blood
Lymph Aspiration Perineural |
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Clinical signs of oral cancer
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Ulceration
Indurated growth Erythroplakia Leukoplakia |
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Etiology of oral cancer
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Alcohol
Tobacco |
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TNM system
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TX - No primary tumor assessed
T0 - No primary tumor T1 - <2cm T2 - 2-4cm T3 - >4cm T4 - Invades adjacent structures N1- single ipsilateral lymph node less than 3cm N2a - Single ipsilateral node 3-6cm N2b - Multiple ipsilateral node no more than 6cm N2c - Bilateral or contralateral node no more than 6 N3 - Greater than 6 M0 - no metastasis M1 - Metastasis |
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Cancer staging
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1 - T1N0M0
2 - T2N0M0 3 - T3N0M0 or T1, T2 with N1 4 - T4M0N0, any N2 or N3, or M1 |
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Incisoinal vs Excisional biopsy
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Incisional for unknown or large lesions
Excisional for known or small lesions |
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Mucositis
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Radiation side effect occuring on 10-14th day
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Direct vs indirect radiation injury
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Indirect is due to low salivary flow
Radiation caries and Osteoradionecrosis |
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Radiation caries and treatment
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Most commonly affects cervical and incisal edge or cusp tips resulting in amputation of crown
Gold standard is flouride trays with neutral pH 1% flouride gel. |
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Osteoradionecrosis cause & management
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Open area of exposed bone due to radiation present for atleast 3 months.
Result of reduction of blood flow to an area of bone secondary to radiation Conservative debridement and possible antibiotics. Gold standard is pre and post extraction hyperbaric oxygen therapy. |
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Adjunctive procedures for jaw lesions
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Carnoy's solution - Fixative solution that eradicates cells in cyst of tumor cavity
Cryosurgery - Use of liquid nitrogen to freeze and kill soft tissue remaining in cyst or tumor cavity Steroids and Interferons to reduce size of jaw tumors |
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Sites for Autogenous graft
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Fibula
Iliac Crest Radius |
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Surgical management of Jaw lesions and types of treatment
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Enucleation +/- Curretage - Odontogenic tumors, Fibroosseous lesions, Other benign lesions
Marginal resections - Aggresive benign tumors, Benign chondroblastoma, Hemangioma Composite resection - Malignant tumors and squamous cell carcinoma with bone invasion |
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Incidence of nerve dysfunction following odontectomy
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IAN is more common but Lingual is more permanent
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Classification of neural injuries
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Neuropraxia - Transient disruption due to ischemia from swelling or compartment syndrome
Axonotmesis - Outer nerve sheath is in tact by damage is on the inside Neurotmesis - Complete separation |
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Latency till nerve surgery
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Wait 3 months for lingual and 6-12 months for IAN
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Indications for microneurosurgery
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-Witnessed nerve injury with anesthesia or pain.
-Dysthesia alleviated by diagnostic block. Wait a couple of weeks for healing of initial surgery then do nerve surgery |
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Inferior alveolar nerve surgery
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Decortication is common for Implant damage. Then use Sural nerve from leg as graft.
Can also to saggital split Osteotomy to gain access. Won't damange facial nerve like going through neck, but will have to break jaw. |
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Treatment sequence of clefts
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Max orthopedics vs lip adhesion from 4-6wks
Definitive lip repair from rule of 10s Repair of soft and then hard palate at 12-18 months Ear tubes Speech therapy Orthodontics Velopharyngeal incompetence Dentoalveolar cleft repair before canine eruption Orthognathic surgery Nasal surgery and lip revisions |
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RankL and Osteoprotegrin
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RankL reacts with osteoclasts to make them differentiate
Osteoprotegerin is police that inhibits RankL when osteoclast activity is high |
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BRONJ staging
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0 - no evidence of exposed/necrotic bone but has non specific findings of bone pain
1 - Exposed bone that is asymptomatic 2 - Exposed bone with pain and soft tissue or bone infection 3 - Pathologic fracture with soft tissue infection or pain that is not manageable with antibiotics. Extra oral fistula or osteolysis extending to inferior border of sinus floor. |
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Causal factors for TMJ disease
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Acute injury-macro trauma
- Motor vehicle accidents, Assaults, Injury Chronic Injury-Micro trauma - Primarily female in 30s to 50s |
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Joint Imaging
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Pan
Conventional Xrays MRI |
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TMJ surgical goals
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Reduce pain
Restore function Arrest arthritic degeneration - Restore joint anatomy, promote internal repair |
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TMJ evaluation using contrast medium and one that has no radiation
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TMJ arthrography
MRI |
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DJD possible mechanisms
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Direct mechanical trauma
Hypoxia reperfusion injury Neurogenic inflammation |
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Systemic arthritic conditions affecting TMJ
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Rheumatoid arthritis and Lupus commonly affects TMJ bilaterally
DJD affects unilaterally |
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Disk displacement disorders
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Anterior displacement with reduction will get click on opening and closing
Without reduction will have no clicking, restricted opening and deviation to affected side |
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Types of TMJ ankylosis
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Intracapsular - Condyle, disk, fossa
Extracapsular - Coronoid process, temporalis |
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Splint therapy
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Autorepositioning splints - reduce force on TMJ area by providing a flat surface with even contact in all areas of occlusion. Usually used in patients with class 2 malocclusion.
Anterior repositioning splint - Provides temporary relief and maybe a long term cure for anterior disk displacement with reduction. Forces mandible to function in a protruded position |
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Arthrocentesis procedure and indication
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Placing ports into superior space of TMJ to lavage the joint and break up fine adhesions.
Used for anatomically normal joints with inflammation that is non responsive to conservative care. |
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Arthroscopy procedure and indication
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Insertion of small cannula followed by a arthroscope for direct visualization of superior joint space.
Also lyses adhesions and lavages joint like arthrocentesis. Indicated for chronic pain and dysfunction with minimal anatomic change |
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Arthroplasty indications and procedures
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Indicated for chronic pain and dysfunction with significant anatomical change.
Condylar-meniscal fusion Menisectomy Muscle graft repair |
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Robin Anomilad
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Glossoptosis
Cleft palate Micrognathia |
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Open Bite
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Apertognathia
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