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When, Why and Where in Oral and Maxillofacial Surgery WHEN, WHY AND WHERE IN ORAL AND MAXILLOFACIAL SURGERY WHEN, WHY AND WHERE IN ORAL AND MAXILLOFACIAL SURGERY PREP MANUAL FOR UNDERGRADUATES AND POSTGRADUATES PART III 111 GOLD COINS AND 1651 QUESTIONS WITH ANSWERS KC Gupta MDS Professor and Head Department of Oral and Maxillofacial Surgery Modern Dental College and Research Center Indore, Madhya Pradesh, India ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • London • Philadelphia • Panama ® Jaypee Brothers Medical Publishers (P) Ltd. Headquarters Jaypee Brothers Medical Publishers (P) Ltd. 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. Medical Ltd. Jaypee-Highlights Medical Publishers Inc. 83, Victoria Street, London City of Knowledge, Bld. 237, Clayton SW1H 0HW (UK) Panama City, Panama Phone: +44-2031708910 Phone: +507-301-0496 Fax: +02-03-0086180 Fax: +507-301-0499 Email: [email protected] Email: [email protected] Jaypee Medical Inc. Jaypee Brothers Medical Publishers (P) Ltd. The Bourse 17/1-B, Babar Road, Block-B, Shaymali 111, South Independence Mall East Mohammadpur, Dhaka-1207 Suite 835, Philadelphia, PA 19106, USA Bangladesh Phone: +267-519-9789 Mobile: +08801912003485 Email: [email protected] Email: [email protected] Jaypee Brothers Medical Publishers (P) Ltd. Bhotahity, Kathmandu, Nepal Phone: +977-9741283608 Email: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2014, Jaypee Brothers Medical Publishers The views and opinions expressed in this book are solely those of the original contributor(s) author(s) and do not necessarily represent those of editor(s) of the book. All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photo copying, recording or otherwise, without the prior permission in writing of the publishers. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. Medical knowledge and practice change constantly. This book is designed to provide accurate, authori- tative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contra indications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book. This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought. Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. Inquiries for bulk sales may be solicited at: [email protected] When, Why and Where in Oral and Maxillofacial Surgery: Part III First Edition: 2014 ISBN: 978-93-5090-998-0 Printed at Dedicated to My parents Preface “A good teacher is the one who creates the interest in his subject.” Round the year, students read the textbooks very thoroughly. At the time of examination, there is little time for revision and also it is difficult to remember all the points. In this book, I have tried to highlight the important points from the examination point of view so that students can revise all the topics in the short span of time. Lastly, Gold Coins may help students from academic as well as clinical points of view. KC Gupta Acknowledgments I am deeply grateful to all my postgraduate students for their untimely support and suggestions. I am also thankful to my family members—my wife Sadhana, my daughter Jeenal and my son Kunal for their support and encouragement. I am also thankful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr Tarun Duneja (Director-Publishing), Mr KK Raman (Production Manager), Mr Sunil Kumar Dogra (Production Executive), Mr Neelambar Pant (Production Coordinator), Mr Akhilesh Kumar Dubey, Mr Gyanendra Kumar (Proofreaders), Mrs Yashu Kapoor, Mr Inder Jeet (Typesetters), and staff of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for showing personal interest and trying to the level best to bring the book in present form. Contents 1. Gold Coins in the Form of Key Points 1 2. Basic Science 11 3. Basic Oral Surgery 36 4. Local Anesthesia 58 5. Exodontia 80 6. Impaction 96 7. Odontogenic Infection 111 8. Disease of Paranasal Sinuses 132 (Disease of Maxillary Sinus) 9. Salivary Gland Disorders 141 10. Nerve Disorders 154 11. Temporomandibular Joint Disorders 164 12. Cysts of the Jaws and Oral Cavity 178 13. Tumors 190 14. General Maxillofacial Trauma 202 15. Preprosthetic Surgery 248 16. Precancerous Lesion/Condition and Oral Cancer 254 17. Cleft Lip/Palate, Dental Implants and 265 Distraction Osteogenesis 18. Orthognathic Surgery 278 19. General Anesthesia 284 20. Miscellaneous 299 Gold Coins in the chapter Form of Key Points 1 1. The LOGIC in reference of radiograph: The radiograph should be read as follows: L—Localization O—Observation G—General consideration I—Interpretation C—Clinical consideration. 2. Luxation is the best policy for extraction of tooth “to avoid fracture of tooth and to have atraumatic extraction”. 3. Patient position for mandibular teeth—occlusal plane should be parallel to the floor and for maxillary teeth, occlusal plane should be 45° to the floor. 4. In case of routine extraction; if there is no pathology-related and oral hygiene is moderate to fair or periodontium is healthy, then no antibiotic therapy is required postoperatively. 5. After any tooth extraction, socket should be compressed with finger pressure “to recontour the expanded socket and to control bleeding”. 6. Three basic principles of elevator and three basic steps in tooth extraction can be correlated in the following way: a. Wedge principle—to luxate the tooth b. Lever and fulcrum—to elevate the tooth c. Wheel and Axle principle—to deliver the tooth from socket. 7. Elevator should be applied on cemento-enamel junction (CEJ) in predetermined direction with finger guard. Never use the adjacent tooth as fulcrum. 2 When, Why and Where in Oral and Maxillofacial Surgery 8. Perfect suturing can increase 40% success rate and surgeon skill. In 99% cases, interrupted suturing is indicated or advised and is advantageous. Suturing avoids food lodgment, delay healing and infection. 9. Collection of anything, e.g. pus, blood, saliva may cause infection; therefore, dependent drainage should always be provided. 10. There is no hard and fast rule that the impacted tooth should be removed with dental elevator; sometimes tooth extraction can be done with the help of extraction forceps also. 11. Irrigation of any wound or cavity as local care—Last irrigation with H2O2 should be avoided, otherwise it may cause periapical emphysema due to release of nascent O2 which results of increase in pressure in cavity and the patient may complain of severe pain. Thus, last irrigation should be either with normal saline or betadine. 12. In suppurative conditions, whenever possible, avoid suturing. 13. If the patient is diabetic and, in emergency, if fluid replacement is required in case of hypoglycemic shock, then IV DNS is advisable. Best treatment for hypoglycemic unconscious patient is IV 50% Dextrose in water. 14. Radiation therapy should start after 2-3 weeks of tooth extraction. And if the patient is on radiation therapy, extraction should be avoided for at least 3 months. 15. In the management of dry socket, avoid unduly curettage or antibiotic therapy. 16. If an abscess is present and is treated with antibiotic alone and without I and D (where required), it may cause “formation of antibioma”. 17. Basic principle: Before closure of any surgical wound, hemo- stasis should be achieved. 18. Any intraoral dressing should be changed maximum within 72 hours, otherwise it may act as a source of infection, delayed healing or may act as foreign body. 19. Initially, antibiotic therapy should be prescribed for minimum three days (unless the patient is allergic); frequent changes may Gold Coins in the Form of Key Points 3 cause “Antibioma”. The strength of antibiotic therapy depends upon severity and age of the patient. The dose should be repeated after definite intervals. 20. The golden hour of the trauma refers to “the period of time which is exactly one hour after the trauma is sustained”. 21. The most frequent cause of airway obstruction in an unconscious patient is the “Tongue”. 22. The ABCD of basic life support (BLS) is: A – Airway B – Breathing C – Circulation D – Defibrillation/Drug therapy/Definite treatment. 23. A victim, whose heart and breathing have stopped, has the best chance for survival if the emergency medical services (EMS) are activated and CPR is given within 4 minutes. 24. The three major signs of cardiac arrest are: a. No response b. No adequate breathing c. No signs of circulation. 25. In case of neck injury, airway can be established by three basic maneuvers are: a. Head tilt b. Chin lift c. Jaw thrust. 26. No surgical intervention should be done in acute conditions; otherwise infection may spread to deep fascial spaces resulting in life-threatening conditions, e.g. Ludwig’s angina, cavernous sinus thrombosis. 27. The cause of uncontrolled bleeding at the scalp region is because of its rich blood supply and also the vessels are bound firmly in the dense connective tissue, making it difficult to control the vessel.
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