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OS - Key Points by Danesh PDF
OS - Key Points by Danesh PDF
1
Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
(03312415069)
Technique of anesthesia in which local anesthetic solution is injected into the vein is--Intra
venous regional anesthesia.
Most common complication of rheumatoid arthritis involving TMJ is--Ankylosis.
Local anesthetic solution with highest tissue irritancy is--Bupivacaine.
In case of multiple extractions, teeth that should be removed last are--1st molar& canine
Vazirani akinosis technique--- for limited mouth opening
least desirable media for transporting an avulsed tooth—water
It is difficult to obtain anesthesia by infiltration technique in the presence of inflammation because
of—decrease pH
Sharp surgical instruments should not be sterilized by --- boiling
The” WINTER’S” classification for impacted third molar is done on the basis of inclination of long
axes of---Third molar to second molar
Recognized approach for an apicectomy--- Semilunar incision
In facial trauma, lingual or sublingual haematoma are typically associated with--Mandibular
fracture
Battle’s sign” is associated with displaced fracture of ----Condyle of mandible
Mouth remain closed with Maxilomandibular fixation (MMF)--- 5 weeks
Acute Mandibular dislocation typically---treated /corrected manually under local anaesthesia
The most common complication seen after the administration of local anesthetic agent is ---
Trismus
Most likely the cause of trismus is injury to-- Medial pterygoid muscle
Cause of Pseudo-ankylosis of temporomandibular joint can be---Mechanical obstruction or extra-
articular fibrosis
Preferred local anesthetic technique for hemophilic patient---Intraligamentory.
For diagnosis of zygomatic arch fracture, best view is---Submental vertex view
Heavy blow to the mandible sustaining a fracture of the right body of mandible. The 2nd most
likely fracture may be present could be---Left sub-condylar region
Loss of sensation in the lower lip may be caused by---Mandibular body fracture
Signs and symptoms that commonly suggest cardiac failure---Ankle edema and dyspnea
Oro-antral fistula treated by---Excision of the fistula and surgical closure
The roots of 3rd, 2nd & 1st molar are all below the level of the mylohyoid. Infection in these teeth
can pass through----space to reach the lateral pharyngeal space---Submandibular space
The most common pathognomic sign of mandibular fracture --- malocclusion
Closed reduction is best used in the treatment of--Favorable, non-displaced fractures
What determines whether muscle will displace fractured segments from their original position,---
Line of fracture
While extracting a mandibular 3rd molar, you notice that the distal root tip is displaced from
socket. The most likely area it can be found is---- sub Mandibular space
Termination of vertical incision at gingival crest must be---At the line angle of tooth
While administering first aid to a trauma patient with facial injury, priority must be given to---
Maintaining the patency of airway
Denture is ill fitting, generalized inflammation with whitish patches of oral cavity and poor oral
hygiene; indicates--- Candidosis infection
Sub condylar fracture on the left ---- inability to deviate mandible to the right
oblique facial clefts occur due to failure of fusion of-- maxillary process with lateral nasal proces
Sudden drooping of right corner of the mouth--- affected nerve= facial nerve
Direction of initial force with forceps placed on a tooth for a successful extraction—APICAL
The most difficult mandibular third molar impaction position--- Distoangular, maxillary= mesio
angular
Dental elevators are used for --- engage the tooth apical to the cemento enamel junction
manage a diabetic patient who loses consciousness before tooth extraction should be
administration of--- IV glucose immediately
2
Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
(03312415069)
Ameloblastoma in anterior mandible with size of 4X3cm--- Follicular type
A pregnant woman in 3rd trimester falls into syncope during extraction of upper molar, she should
be kept in--- Left lateral position
Salivary gland tumor common in children--- Mucoepidermoid Tumor
Local anaesthesia acts on nerve membrane by:--- Blocking conduction of sodium from
exterior to interior
Tuberosity fractured and extracted along with molar, management= Smooth the sharpen edges
of the remaining bone & suture the remaining soft tissues.
Ideal time to remove impacted 3rd molar is--- When the root is approx. 1/3rd formed
The root of which Maxillary tooth is most often dislodged into the maxillary sinus---- Palatal root
of maxillary 1st molar
Sutures placed intra orally are normally removed after--- 5 – 7 days postoperatively
Dislocation of mandible is reduced in which direction---- Downward & backward & upward
Regarding principles of suturing technique---- Tissue should not be closed under tension.
Non resorbable suture material= poly propylene
Resorbable suture= plain cat gut, chromic catgut & polyglycolic acid
HIV positive patient, flat, slightly blue patch with proliferation on plate-- Kaposi’s sarcoma
Condition Failure of fusion between
Midline upper lip cleft 02 median nasal process
Uni/ bilateral cleft lip Maxillary & median nasal
process
Oblique face cleft Maxillary & lateral nasal process
Isolated cleft lip 02 palatine shelves
Lip clefting Median & lateral nasal process
Hyperventilation syndrome management→ terminate dental treatment, patients in
upright position, diazepam, monitor vitals.
shortness of breath/ wheezing—full sitting posture, adrenal insufficiency patient—supine
position.
Remove blood & other fluids from field---High volume suctioning with a relatively small tip
Principle of Incision Description
First Principle Usage of sharp blades with proper size & shape
2nd principle Firm, continuous stroke is used.
3rd Principle Avoid accidentally cutting important structures
4th Principle Incision through epithelial surfaces that surgeon plan to re
approximate should be made with blade held at 90° to epithelial
surface.
5th principle Incisions in oral cavity should be properly placed.
Prevention of flap necrosis by → 1) Height of flap should NEVER be greater than base unless
a major artery in base. 2) Height of flap should be no more than twice the width of base (length
shouldn’t exceed width). 3) Axial blood supply should be included in base of flap. 4) Base
shouldn’t be twisted, stretch or grasped.
Prevention of flap dehiscence→ by approximating edges pf flap over healthy bone by gently
handling the edges of flap, & not by placing edges of flap under tension.
Prevention of flap tearing→ flap should be large enough, if it’s not providing sufficient space,
then it should be lengthened & releasing incision is made.
Hematomas ----place pressure on wounds, decreasing vascularity; they increase tension on the
wound edges; and they act as culture media.
Healing by 1° intension→good scar, use of suture, no tissue loss, less infection, same anatomic
position e.g well-repaired lacerations or incisions & well-reduced bone fractures.
Healing by 2° intension→ tissue loss, no suture is used, poor scar, gap between edges,slower
healing,e.g extraction socket, poorly reduced fracture, deep ulcers, Large avulsive injury.
Healing by 3° intension→ delayed primary intension, healing via graft.
3
Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
(03312415069)
Healing of extraction socket→ 1st week= inflammatory phase, fibroplasia,osteoclastic
accumulation. 2nd week= large amount of Granulation tissue.
Phase of wound healing Features
Inflammatory phase/ For 3-5 days, vascular & cellular events, initial vasoconstriction, histamine, E1 &
lagphase E2 cause vasodilation, edema, cardinal sign ( redness, swelling, warm, pain),
diapedesis, degranulation, no gain in wound strength, fibrin hold wound
together.
Fibroblast/ proliferative For 2-3 weeks, criss cross of blood coagulation derived fibrin strands, laying
phase down of ground substance (mucopolysaccharide) + tropo collagen, increase in
wound strength(70-80%), stiff & erythromatous wound/ angiogenesis,
Granulation tissue into type 3 collagen.
Remolding / maturation For months, replacement of randomly laid collagen fibers, increased strength
phase (80-85%), decrease in vascularity, loss of elasticity, wound contractions, type 3
to type 1 collagen
The surface of pure titanium implants is completely covered by---- a 2000-Å-thick layer of TiO.
Nerve healing by degeneration----- ( segmental demyelination & wallerian degeneration)&
regeneration( Rate= 1-1.5 mm/day).
Mostly injured nerves→ inferior alveolar nerve & lingual nerve.
Wallerian degeneration→occurs after trauma, Axon of nerve distal to site of nerve trunk
undergoes disintegration.
Least severe nerve injury= neuroprexia ( by blunt injury or traction) & most severe
type=neurotmesis(complete loss & by displaced fracture, bullets, knife, iatrogenic)
Axonotomesis = axon disturbance but not sheath, by severe blunt trauma, nerve crushing,
extreme traction.
Paresthesia Spontaneous & subjective altered sensation that a
patient doesn’t find painful.
Dysthesia Spontaneous & subjective altered sensation that a
patient finds uncomfortable.
Hyperesthesia Excessive sensitivity of a nerve to stimulation
Most infectious hepatic disease--- by Hepatitis A, B, C, and D viruses
Most serious risk of transmission for unvaccinated dentists--- hepatitis B
Hepatitis A is spread primarily by --- feces,. Hepatitis C-- feces / blood, Hepatitis B and D viruses
are spread by contact with any human secretion.
All patients infected with HIV who have CD4+ T lymphocyte counts of ---less than 200/µL.
Asepsis ----breakdown of living tissues, 02 types , medical & surgical asepsis.
Antiseptic ---- substances that prevent multiplication of organisms to living tissues.
Disinfectant--- substances that prevent multiplication of organisms to objects.
Sanitization---- reduction of the number of viable microorganisms to levels judged safe by public
health standards.
Decontamination--- similar to sanitization, except that it is not connected with public health
standards.
Sterilization Method/ Usage
disinfectant
Chlorhexidine, iodophors Dis infecting surgeon’s hand prior to surgery
70% ethanol Dis infecting skin prior to veni puncture
Ethylene oxide Surgical instrument, Endo scope etc
Autoclave Non heat sensitive, gown, drapes, bulky items
Filtration IV solution
UV light Dis infecting air in operation room
Sliver sulfadiazine Clean burn wound
Test the reliability of heat sterilization----spore of Bacillus stearothermophilus
4
Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
(03312415069)
Moist heat/ autoclaving is more efficient than heat, because it’s effective at---- low temperature &
require less time.
Autoclave--at a pressure = 15 lb/in , temperature =121°C for 15 to 20 minutes.
Intermediate disinfectants are effective against all microbes except---- bacterial spores
LA→MOA= block sensory nerve function, raise membrane firing threshold, the nerve membrane
remains in polarized state unable to conduct impulses.
LA work best at---- neutral pH, LA pH without Vasoconstrictor is ----6.5.
LA less effective at---- inflammatory site
Acidification of LA produce---- burning syndrome.
Short acting (< 60 min) --> procaine
Medium acting (60-120 min)--> lidocaine, articaine mepivacaine, prilocaine, trimecaine.
Long acting(> 120 min)-->bupivacaine, tetracaine, etidocaine, ropivacaine.
Esters-->procaine, tetracaine, benzocaine
Amides-->lidocaine, trimecaine, articaine, mepivacaine, prilocaine, bupivacaine,ropivacaine,,
etidocaine.
Vasoconstrictors are added to LA to -----prolonging the drug duration.
Local Anesthesia Composition
Parts Function
Lignocaine Hcl Anesthetic
Adrenaline Vasoconstrictor
Sodium Reducing agent
metabisulphite
Thymol Fungicide
Salts (NaCI) lsotonicity & minimize discomfort during injection
Distilled Water Vehicle
Methyl Preservative
parahydroxybenzoate
Lidocaine 2% with 1:100000 EN→ maximum amount= 5mg/kg, cartridge for 70kg adult= 10 & for
20 kg child.
Procaine→ highest irritability & anesthetic agent in pregnancy→ Xiylocine
LA affect all types of nerve & may cause hypotension, convulsions & myocardial depression.
Lingual soft tissue of all teeth by ---lingual nerve, all Mandibular teeth --- inferior alveolar
nerve,
Lingual soft tissues of molar & PM by---- greater palatine & lingual tissues of incisor & canine by -
---nasopalatine nerve.
Maxillary PM& portion of 1st molar innervated by → middle superior alveolar nerve
Dialysis—after 24 hours
Most common impacted teeth= Max & Mand 3rd molar Maxillary canine Mandibular Pre molar
Most common cause of lower 3rd molar impaction—failure of rotation from mesio angular to
vertical direction.
Indications for removal of impacted tooth--- prevention of periodontal disease, caries,
pericoronitis, & root resorption, tooth under prosthesis, prevention of cyst & jaw fracture.
Contraindications for removal of impacted teeth—extreme age, compromised health, damage to
adjacent structure, treatment planning.
Mandibular % Description
Angulation
Mesioangular 43% Common and easiest, proximity of 2nd molar
impaction
Horizontal impaction 3% Uncommon and more difficult, immediately adjacent to the root
of 2nd molar—90°
Vertical Impaction 38% Covered posterior aspect with bone of the anterior ramus—O°
Distoangular impaction 6% Uncommon, most difficult, Occlusal surface in ramus
Easy--- 1, A, mesio angular, difficult--- 3, C, disto angular impaction.
5
Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
(03312415069)
Maxillary angulation—vertical= 63%, disto angular= 25%, mesio angular—12%( most difficult).
Most common Incision for reflect soft tissue for removal of impacted 3rd molar--- envelope
incision
Bur to remove the bone underlying impacted tooth—No-08
Pell & Gregory Classification
Class 1 The mandibular 3rd molar has sufficient anteroposterior room (i.e anterior-to-anterior border
of ramus) to erupt.
Class 2 Approximately half is covered by the anterior portion of the ramus of the mandible.
Class 3 The impacted third molar is completely embedded in the bone of the ramus of the mandible.
Class A The occlusal plane of impacted tooth is at the same level as the occlusal plane of the 2nd
molar.
Class B The occlusal plane of impacted tooth is between the occlusal plane & cervical line of 2nd
molar.
Class C The impacted tooth is below the cervical line of the second molar.
Factors making impaction surgery difficult Distoangular position, class 2 or 3 ramus, class
B or C depth, Long, thin ,Divergent, curved roots, Narrow periodontal ligament, Thin, dense, in
elastic follicle, Contact with 2nd molar, Close to inferior alveolar canal, Complete bony
impactions.
Most common factor that causes difficulty with maxillary 3rd molar removal is ----a thin, nonfused
root with erratic curvature.
Austin & Minnesota retractors ---most commonly used for flap retraction when removing
mandibular third molars.
Steps—reflecting flap removing underlying bone selecting tooth delivery of sectioned tooth
with elevator preparing for wound closure.
The closure of incision made for an impacted third molar is usually –-- primary closure
Post operative pain control--- dexamethasone- 0.75-1.25 mg twice a day after impaction surgery.
Dry socket/ osteitis sicca--- Rx= minocycline
Impaction surgery--edema in the area of the surgery for 3 to 4 days, with swelling completely
dissipating by about 5 to 7 days.
Analgesics for post extraction pain—mild pain= ibuprofen (400-800mg), acetaminophen (325-
500mg)
Moderate pain—codeine& hydrocodone, severe pain= oxycodone & tramadol.
Blood in sub mucosal & sub Mucous tissue--- ecchymosis
Sutures removal—after one week
Root most commonly displaced into unfavorable space—Maxillary molar root
Removal of root tip via—caldwell luc or endo scopic approach
Lingual cortical bone over root of Molars become thinner as it progress—posteriorly
Avoid fracture to adjacent structure—avoid excessive torsional force
The most likely places for bone fractures during exodontia are--- buccal cortical plate over
maxillary canine & 1st molar, portions of floor of maxillary sinus & maxillary tuberosity, & labial
bone over mandibular incisors.
Confirmation of oro antral communication--- by nose blowing test
Oro antral Management
communication
< 2mm Non surgical Rx, avoid blowing & violent sneeze, smoking
2-6( moderate) Additional measure, gelatin sponge, antibiotics- amoxicillin,
cephalexin, Clindamycin- for 05 days, decongestant nasal
spray
>7mm( large) Repair with flap procedure
Prevention of oro antral communication---X ray pre operatively, early surgical extraction, root
sectioning, less apical pressure on maxillary posterior.
Normal INR--- 2-3 , perform extraction on patients having INR of 2.5 or less without reducing
anticoagulant dose.
6
Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
(03312415069)
Occurance of dry socket( high fibrinolytic activity)--- 2% of extraction
Distance Implant placement
1mm Inferior to floor of max & nasal sinus
5mm Anterior to mental foramen
2mm Superior to Mandibular canal
3mm Adjacent implant
1.5mm From roots of Adjacent structure
Implants need 1.5 mm of space from the outer surface of implant to the adjacent root surface
and 3 mm of space between adjacent implants.
Maintain bone temperature at implant site—below 47°C
Bone for implant—D2
Probing depths in a healthy implant--- 1 to 2 mm < total measured dimension from crest of sulcus
to alveolar bone crest.
Minimum bone need for implant—1mm
Scribing technique—wash hands & arms
Double dose—corticosteroids day before & on day of surgery
1st dose of LA symptoms— black arm, artery infection
Pallor—vaso vagal syncope—Rx= ammonia
Lingual spilt technique—chisel
Bulbous root extraction—remove bone up to furcation area
Primary force for exodontia--- towards apical
Rule of 10--- 10 week, 10 g, 10lb
Palatal tori--- Y incision
Labial frenectomy—RX= localized vestibulo plasty with secondary epithelialization
Optional time for removal of 3rd Molar in pericoronitis—root 2/3 rd formed
Thick tuberosity—difficulty in Removal of 3rd molar
Impacted canine—palataly placed—SLOBE rule—tube distally
Wheel & axles elevator—4.6 times
ASA-1--- Hb-14, normal X ray
Parasymphysis fracture---geniohyoid & genioglossus muscle affected
Condyle fracture, overlap>5mm—angulation>37°-- open reduction with IMF
Through & through laceration of Lower lip--- 03 layered suture
Brusing, battle sign— condylar fracture
Edentulous, para symphysis fracture, no denture--- Gunning type splint
High severity infection--- compression of airway
Swelling in right maxillary posterior region--- space= infra temporal
Labial alveolar mucosa--- supply by mental nerve
Bony expansile swelling at body of Mandible, multi locular radiolucency—do aspiration cytology
Calcifying epithelial odontogenic tumor--- at body with lingual expansion, radiopaque flecks
Gold standard for predicting malignant potential for pre cancerous lesion—degree of dysplasia
Carcinoma spread by local infiltration, peri neural invasion, hematogenous spread & less
commonly through lymph—basal cell carcinoma
Malignancy involving lymph nodes—do FNAC
Multiple neuro fibroma, with café au lait spots—Von Recklinghausen disease of skin
TCA--- In TMJ—decrease nocturnal bruxism
Buccal spcae infection—maxillary due to—molar infection
Trismus, carious 3rd molar, swelling at anterior tonsillar pillar--- pterygomandibular space
Most common used for drain of intra oral spce—1/4 inch sterile penrose drain
1st choice for prophylaxis before surgery--- amoxicillin
Prophylaxis for endocarditis – 2g amoxicillin orally- 1 hour before surgery
MPDS--- nocturnal bruxism, masticatory pain
Most common cause of ankylosis--- macro trauma
7
Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
(03312415069)
Condyle fracture—reverse town view
Ear bleeding, peri auricular pain on one side—unilateral Condyle fracture
Herefordt syndrome--- uveitis, facial pasly, Parotid gland enlargement
Bone Resorption near sinus angulation for implant--- sinus lift & grafting
Smoking history, stabbing pain, runny nose, lacrimation—cluster headache
Cold air trigger, sharp lancinating pain, like current—trigeminal neurologia
Mandibular prognathic—surgery= BSSO
Sulphur granules—actinomyces
Soft palate closure—8-18 months
Midline cyst—dermoid cyst
Smooth, child, increased swelling in midline—thyroglossal cyst
Denture patients for evolution for aveloplasty—palpation
SSC—treatment based on – staging
Betal nut habit, limited mouth opening, fibrous band—OSF—buccal mucosa
White lesion, 2mm, Incisional biopsy—by border of ulcer
Dry socket-- saline , analgesics packing
Complication of radiotherapy on bone—compromise vascularity
Most common bone involved in orbital blow out fracture--- ethmoid
Abrasion on angle of mouth during extraction—no Rx
Displaced tooth in sinus—OPG
Caldwell technique—canine fossa
GCS—level of consciousness
Faint , patient position—Trendelenburg position
Reverse status epileptic—by LA overdose,-- diazepam
Slow growing, gradually enlarging, non tendoe Mandible—ameloblastoma
Peri Coronal infection of maxillary 3rd molar—infra temporal space
Salivary glands ingrowth appear in 8th week of gestation.
Acinus→ collecting cell→ intercalated duct→ striated duct→ excretory duct
Minor salivary glands → develop fortieth day in utero, larger major glands develop slightly
earlier @ thirty-fifth day in utero & acini→ 7/8 months
Sublingual→ mucus (thick & more viscous saliva) , parotid→ serous & minor salivary glands& sub
mandibular → MIXED
Number of minor salivary glands- 800-1000, present throughout oral cavity except anterior third of
hard palate, the attached gingiva & the dorsal surface of the anterior third of the tongue.
Locations of the minor salivary glands are ----as labial, buccal, palatine, tonsillar (Weber glands),
retromolar(Carmalt glands) & lingual glands.
The lingual glands are divided into 03 groups of glands--: (1) inferior apical glands (of Blandin and
Nuhn), (2) taste buds (Ebner glands), and (3) posterior lubricating gland.
Serous cells --- cuboidal cells with eosinophilic secretory granules and produce thin, watery
secretions with a low viscosity (1.5pa).
Mucous cells---- clear low columnar cells with nuclei polarized away from the lumen of acini &
produce a thick secretion with high viscosity(13.4 pa).
Submandibular gland→ intermediate secretion= 3.4 pa
Submandibular gland providing 70%, the parotid gland 25%, the sublingual gland 3% to 4%,
minor salivary glands -- trace amounts of saliva.
Parotid gland concentrations---higher than submandibular gland, except for submandibular gland
Ca concentration, twice concentration of parotid calcium levels.
Highest viscosity saliva→ sublingual glands, 2nd= sub Mandibular , LOWEST viscosity= Parotid
Saliva begins to decrease gradually after the age of 20 years because of--- increased
intraparenchymal fibrosis & decreased neural secretory stimulation.
Sympathetic innervation→ superior cervical ganglion nerve via vast arterial vascular plexus.
Parasympathetic of Parotid gland→ tympanic branch of the glossopharyngeal nerve (IX)
8
Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
(03312415069)
Salivary Gland Anatomical Features
PAROTID GLAND 1.Lie superficial to posterior aspect of the masseter muscles & ascending rami of
Parasympatheticmandible,in “inverted&triangular”
of sub Mandibular shapesuperior
sublingual→ below zygomatic arch.
salivatory nucleus,which travels
2. Peripheral
via facial nerve (chorda tympaniportions may
branch) extend to the mastoid
to submandibular process, along anterior aspect of SCM
ganglion.
muscle→identify
Plain-Film Radiographs & aroundsalivary
posteriorstones,
border80%
of mandible into
to 85% of all pterygomandibular
stones → radiopaque,space.
3. The
mandibular occlusal facial nerve
radiograph branches
is most useful divide gland into
for detecting superficial
sublingual& & deep lobes.gland
submandibular
calculi. 4. The Stensen duct( diameter= 1-3 mm & L= 6cm) courses superficial to masseter
PA can show calculi muscle thensalivary
in each curves gland
sharplyorat anterior
duct, edgeminor
including of masseter
salivarymuscle
glandsto pierce buccinator
muscle &enter oral cavity @ Maxillary 2nd Molar.
5. Structure passing through parotid gland→ facial nerve & it’s branches, retro mandibular
vein & external carotid artery, auriculotemporal nerve parts, superficial & deep parotid
lymph nodes.
6. The parotid gland receives neural innervation from 9th CN (glossopharyngeal) nerve via
auriculo-temporal nerve from the otic ganglion.
SUB MANDIBULAR 1. Located in “submandibular triangle” , formed by anterior & posterior belly of the
GLAND digastric & inferior border of mandible superiorly.
2. Wharton duct(length= 5cm & diameter= 2-4mm) passes forward along superior surface
of mylohyoid muscle in sublingual space, adjacent to lingual nerve.
3. Glossopharyngeal → posterior 1/3rd of tongue, & chorda tympani branch of the facial
nerve provides taste sensation to anterior 2/3rd of tongue.
4. In a medial position, Wharton duct is vulnerable to injury in the third molar region.
5. The Wharton duct opens into floor of mouth via a muscular punctum located close to
mandibular incisors at most anterior aspect of junction of lingual frenum & floor of mouth.
6. The punctum is a constricted portion of the duct, & it functions to limit retrograde flow of
bacteria-laden oral fluids into the ductal system.
SUB LINGUAL 1. Located on superior surface of mylohyoid muscle, in sublingual space, & separated
GLAND from oral cavity by a thin layer of oral mucosa in anterior floor of the mouth.
2. The main acinar ducts of sublingual glands are called Bartholin ducts and in most
instances coalesce to form 8 to 20 ducts of Rivinus which open on plica sublingualis.
3. The sublingual & submandibular glands are innervated by facial (VII) nerve through
submandibular ganglion via chorda tympani nerve.
Head tilt process—to ensure patent airway
Amide biotransformation—by liver
Spontaneous bleeding post extraction—because of fracture of max Tuberosity
Most common cause of removal of 3rd molar—recurrent pericoronitis
Direction Of chisel during cutting--- towards bone to scarified
During removing pleomorphic adenoma—complication because of injury to auriculotemporal
nerve—gastatory sweating
Condition of contraindicated to LA—hypersensitivity to drug
LA suitable for hypertensive patient--- without adrenaline
Allergy by amide LA--- by methylperaben
Small, oval, multiple ulcers--- aphthous ulcer
Highest malignancy rate—erythroplakia
Unilateral, angled displaced fracture, distal to last standing molar—Rx= ORIF
Decreased mouth opening—may Also because of 3rd molar
Extraction of Distoangular impaction of mand 3rd molar—cause fracture of ramus of Mandible
Fracture tuberosity, but attached—Rx= if intact blood supply—reposition& stabilize suture
Odontogenic infection—by s- milleri
Hard ,tender, red, deep tissue infection--- cellulitis
Odontogenic deep facial infection--- sub Mandibular infection
Anterior open bite--- displaced bilateral Condyle fracture
Fracture Features
Lefort-1 Mobility at ANS, Mobility of alveolus, involve lower 1/3rd & upper 2/3rd of
pterygoid plate, palate, naso maxillary, epistaxis, Buccal ecchymosis,
9
Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
(03312415069)
malocclusion, Maxillary crepitus & mobility, Upper lip swelling, Positive guerin
sign.
Lefort -2 Pyramidal , nose + palate, mobility at infra orbital margin, crepitus of midface,
facial lengthening, Bilateral epistaxis, infraorbital nerve paresthesia, buccal,
periorbital & sub conjunctival ecchymosis, widening of inter canthal space,
cerebral fluid rhinorrhea, dish face, ballooning/ moon shaped, middle 3rd of
pterygoid plate
Lefort-3 Craniofacial disjunction, transverse fracture, bilateral epistaxis, lateral orbit
rim defect, Peri orbital & sub conjunctival ecchymosis, mobility at fronto
zygomatic suture, no posterior limit , Hooding of eye, ponda face & raccoon
eye, @ root origin of pterygoid plate
Bilateral un displaced Condylar fracture--- max & mand fixation, with eric arch bar
Gun shot & committed fracture—close reduction with gunning splint
Lateral & retro pharyngeal space—direct threat to airway
Basic management of odontogenic infection—support medically, Surgical, antibiotics
Most common treatment of ranula—Marsupialization
Lip switch process--- Temporal flap vestibulo plasty
Dean technique—intra septal aveloplasty
Complication of RA--- involving TMJ—ankylosis
Facial palsy, vertigo, deafness, herpes, vesicular rash -- ramshy hunt syndrome
Throbbing, temporal pain, increase ESR—gaint cell arthritis
Complication of posterior sup alveolar nerve block--- hematoma
Go gets Mandibular nerve block—corner of mouth & tragus of ear
Redness, swelling of face, shallow breathing—anaphylatic reaction
Normal face growth--- down ward & forward
Parasymphysis fracture, occlusal distrubance—IMF for 03 days
Unfavorable fracture of Mandibular angle--- distraction of fracture segment by muscle pull
Type of fracture Technique
Condyle fracture Reverse town view
Zygomatic fracture Sub mantovertex view
Orbital blow out Occipitomental view
Step deformity in molar Lateral oblique view
Body + angle fracture & type of displacement Posterio anterior
Fracture between symphysis & canine Rotational posterio anterior
Relationship to teeth to line of fracture Peri apical
Relation of tooth root to the fracture Occlusal
Fracture of body proximal to canine,condyl & L & R oblique lateral
ramus fracture
11
Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
(03312415069)
Multiple Mandible fracture--- 05 eyelets in each jaw
Gold standard—autogenic bone
Class 3—SSO
Multiple pre malignant lesion—field cancerization
Dentigerous cyst & radicular cyst--- Rx Enucleation+ IMF
OKC—currettage
Instrument Indication/ uses
Austin retractor Right-angle retractor that can be used to retract the cheek, tongue, or flaps.
Allis tissue forceps useful for grasping and holding tissue that will be excised
Rongeurs bone-cutting forceps that have spring-loaded handles
mallet and chisel For removing bone
needle holde To hold needle, grasps the curved needle two-thirds of the
distance from the tip of the needle. Have locking handle and a short, blunt beak.
Iris scissors small, sharp-pointed scissors.
Molt, mouth prop used to open the patient’s mouth when the patient is unable to cooperate
Triangular elevators Pairs of instruments & are therefore used for mesial or distal roots.
Cryer)
Crane pick used to elevate whole roots or even teeth after the purchase point has been
prepared with a burr.
root-tip pick used to tease root tip fragments from the socket
Forceps used to remove maxillary teeth are held with the palm under the handle.
Semi rigid fixation—healing by secondary intension, callus formation
Body—Quick healing & symphysis- late healing.
5% Infection rate—after Mandibular fracture
Closed reduction—simple, comminuted, favorable fracture
Open reduction—unfavorable fracture, basal triangle fracture, periodontal compromised,
edentulous
Diameter pf suture for oral mucosa--- 3-0
Spontaneous sockets wound, as barrier—figure of 08
Antidote for heparin—protamine sulfate
All level of sedation—Inhalation
% of NO—20%
Conscious sedation with IV benzodiapine--- pupillary reaction
Intra capsular fracture—complication= TMJ ankylosis
Fracture at zygomatic temporal suture—Gillis temporal approach
Pull, displacing fracture segment—unfavorable fracture
Marble appearance, limited mouth opening, white bends—OSF
Easily managed SCC—lower lip
Malignant lymph nodes—FNAC
T1, N2, M0--- Stage 4
Substernal pain, facial pallor—angina pectoris
Propofol--- day care surgery
50 kg—LA- 10 dose
Burning pain, surgical tooth extraction, boring pain—atypical odontolygia
Maximum dose of lignocaine without adrenaline—4mG/kg
Socket post extraction healing time—2-3 weeks
Fracture Features
Direct impact to TMJ Condyle fracture, comminuted
Lateral impact on body Same side body fracture, opposite side- condyl fracture
Impact from below on chin Symphysis/ para symphysis with bilateral Condyle fracture
From anterior Mandible Bilateral body fracture along with bilateral Condyle fracture
Unilateral Condyle fracture Chin & mandibular midline deviation towards affected side, posterior teeth
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Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
(03312415069)
gagging affected side, posterior Open bite on opposite side, unable to perform
lateral movement associated with opposite side body fracture.
Bilateral Condyle fracture Posterior teeth gagging on both sides, anterior open bite, no protusion,
symphysis fracture
Clinical features of Pain, swelling, tenderness, characteristics hollow ( after subside edema),
Condyle fracture hematoma- Battle sign, Ear bleeding, Reverse town view.
Right Mandibular angle Colman’s sign
fracture
Impact from anterior Bilateral body fracture with bilateral Condyle fracture
Mandible
Angle fracture Tenderness, swelling at angle, hematoma at angle, step defrormity at last
molar, lower lip paresthesia, de arranged occlusion, painful mandibular
movements
Symphysis & Para Soft tissue injury on chin & lip, lingual hematoma, bone tenderness,
symphysis fracture associated with Condyle fracture
Dento alveolar injuy Avulsion, sub luxation, fracture of Teeth, laceration of upper & Lower teeth,
alveolar fracture.
Body fracture Swelling, tenderness, step defrormity, anesthesia & paresthesia of lip & intra
oral hemorrhage
Ulceration because of instruments—abrasion
Reactive—Plain & chronic gut
20-40% NO—symptoms--. Euphoria
IANB--- muscle pierce—buccinator
Most alarming respiratory condition—apnea
IANB--- absolutely contraindicated in hemophilic patient
Leg screw for—oblique mandibular fracture
IMF – eyelet in each jaw—05 eyelets
Elevator & retrusive of Mandible—Temporalis
Masseter—elevation of Mandible
Lateral pterygoid—protusion& depression of Mandible
Medial pterygoid—elevation& protusion of Mandible
Pregnant lady fall in syncope—sit in lateral left position
Syncope—hypoxia
ASA-3 – not incapacitated patients
Ineffective against spore forming clostridium—ethylene oxide
Unresponsive, choking—start CPR( cardio pulmonary resuscitation).
Plugging Rannula—perforate mylohyoid muscles.
Sub lingual & minor salivary glands—90% tumor malignant
Sub Mandibular & Parotid gland—Majority benign tumors
At junction of upper 3rd & middle 3rd of Anterior border of SCM muscles--- bronchial cyst
Neonate—cystic hygroma
move up on swelling—thyroglossal duct cyst—Rx = Sisternuk operation
Non specific ulcer= shelving edge ulcer
TB= undermined edges
Squamous cell carcinoma= Everted, heaped up—marjolin ulcers
Syphilis+ Arterial disease= punched out
Warfarin- PT
Heparin-- aPTT
Basal cell carcinoma= rolled edge—rodent ulcer
Corney solution—60% ethanol, 30% chloroform, 10% acetic acid—decrease reoccurrence of
OKC
Chin laceration—symphysis fracture
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Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
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Abscess complication--- cavernous sinus thrombosis
LA on buccal side--- supra periosteal technique
AVPU— alertness, voice, pain & unconscious
TMJ internal de arrangements— analysis by MRI
Injured structure in excision of ranula—sub mandibular duct
AED—for arrhythmia
Hyper baric oxygen—for osteocardio necrosis
Moth eating appearance Osteomyelitis, osteosarcoma
Honey comb appearance Odontogenic cyst,
ameloblastoma
Cotton wool appearance Peget disease
Egg shell crackling Radicular cyst & ameloblastoma
Ruston bodies Radicular cyst
Crocodile tear Bells palsy
Tennis ricket appearance Odontogenic myxoma
Speckled appearance Heterogeneous leukoplakia
Rippled appearance Homogeneous leukoplakia
Cobble stone appearance Crohn’s disease
Snow storm & cherry blossom Sjogren syndrome
Floating teeth HED
Crumb like appearance Alveolar osteitis
Hanging drop sign Oribital blow out
Ground glass appearance Fibrous dysplasia
Wickam straie, saw tooth Lichen planus
appearance
Snow cap appearance Amelogenesis imperfecta
Swiss disease pattern Adenoid cystic carcinoma
Radicular type Peri apical cyst
Follicle type Dentigerous cyst
Extra radicular/ primordial OKC
Episton Pearl Gingival cyst—in neonate
Bunch of grape Lateral periodontal cyst
Heart shape Naso palatine cyst
Saucer shaped Stephen idiopathic cyst
Bag of Teeth, denticles Compound odontome
Sun brust appearance Complex odontome- in
mandible
RADICULAR CYST—non keratinized epithelium, unilocular,straw color fluid.
DENTIGEROUS CYST—unilocular, Mandibular 3rd molar, root Resorption, associated with
supernumerary tooth, yellow fluid
OKC—uni/ multilocular cyst, white cheesy fluid, associated with garlin syndrome.
Excisional Biopsy—< 1mm – For lump,, mucocele, pigmentation—removal of whole part, for
confirmation, lesion not at risky location.
Incisional Biopsy-- > 1mm, removal of part, for diagnosis, risky site, at great suspicion of
malignancy.
Most common malignant salivary— Muco epidermoid carcinoma- 2nd = polymorphous low grade
adenocarcinoma ( at junction of hard & soft palate)—3rf = adenoid cystic carcinoma
Warthin tumor/ papillary cystadenoma lymphomatosum—almost exclusively affect Parotid
glands
Most common salivary glands—benign- Pleo morphic adenoma
Facial paralysis by adenoid cystic carcinoma, as a result of neurotropism—basaloid cell
arrange in Cribriform/ swiss cheese pattern.
MANDIBULAR FRACTURE KEY POINTS
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Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
(03312415069)
CLASSIFICATION OF FRACTURE:
Type of fracture ( simple, compound, comminuted, pathological).
Site of fracture – most used classification/ linear fracture( dento alveolar, condyle, coronoid,
ramus, angle, body, para symphysis & symphysis.
Causes of fracture ( direct violence, indirect violence & excessive muscular contraction).
Fracture with gross communication- extensive loss
Fracture without gross communication- no extensive loss
Most common overall mandibular fracture is---- condylar fracture.
Simple fracture (closed fracture)→ linear fracture
Compound fracture (Open)→ fracture is communicating intra or extra orally. Via the periodontal
membrane involving socket.
Comminuted fracture→ shattering of bone into multiple pieces.
Pathological fracture→ results from minimal Trauma already weakened by osteomyelitis,
neoplasm
Greenstick fracture: only in children, Only one cortex broken.
Mandibular fracture more common than middle 3rd fracture.
Order of common facial fracture: mandible> maxilla> zygoma> nasal bones.
Unilateral fracture: by direct violence, one or more than one fracture.
Bilateral fracture: by direct and indirect violence, commonly involving angle & oppositecondylar
neck or canine region.
Multiple fracture: direct with indirect violence, common symphysis fracture & both condyle. Seen
also in epileptic patients & guardsman’s fracture.
Condyle is commonest site for mandibular fracture & angle fracture is the most frequent site,
when only one fracture is present.
Fracture of tooth bearing areas--- compound fracture
Compound fractures complicated by bone & soft tissue loss→ comminuted
In lamellar type fracture, osteosynthesis by 02 plates is done.
Impacted fracture which is driven into another portion of bone.
Indirect : a fracture at a point distant from the site of injury.
Complicated/complex fracture: damage to adjacent soft tissue, can be simple or compound.
Dentition Classification of fractures:
Developed by Kazanjian and Converse:
1) Class I: teeth are present on both sides of the fracture line.
2) Class II: Teeth present only on one side of the fracture line.
3) Class III: Patient is edentulous
Maxilla tolerance level--- 140lb, Mandible: 425lb & symphysis fracture—800-900lb
Coronoid process--- Temporalis
Ramus--- Masseter
Condylar Neck---- lateral pterygoid
Rami near angle--- medial pterygoid
Symphysis---- mylohyoid & geniohyoid
Parasymphysis--- geniogloss
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Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
(03312415069)
of digastric & mylohyoid muscles.
• Mandible blood supply by 1) periosteum (centripetal) & 2) inferior dental artery
(centrifugal).
• Facial palsy--- lower motor neuron injury, TMJ---- traumatic arthritis, synovial effusion,
fibrous/ bony ankylosis.
~ Compiled by Danesh Kumar-SIOHS/ JSMU (03312415069)
~Errors & Omission are accepted
~ Feedback is welcomed
BEST OF LUCK
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Oral Surgery Key Points By Danesh Kumar-SIOHS/ JSMU
(03312415069)