NBDE Dental Boards Oral Surgery-27

8/12/2019 NBDE Dental Boards Oral Surgery-27

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ORAL SURGERYPart 1: Principles of Surgery

Indications for Dental Extractions1) Severe caries2) Pulpal necrosis irreversi!le pulpitis "#ere en$o can%t !e $one&) Severe perio $'

() Ort#o$ontic purposes *a'+ *an$+ 1P, an$ &r$

*olars)-) ,alpose$ teet#.) /rac0e$ teet#

) Preprost#etic e'tractions) 3*pacte$ teet#

4) Supernu*erary teet#15) 6eet# assoc+ " pat#ology11) Pre7ra$iation t#erapy 8uestiona!le teet# s#oul$ !e e'tracte$)

Contraindications to Dental Extractions1) Severe uncontrolle$ *eta!olic $iseases $ia!etes)2) En$7stage renal $isease&) A$vance$ car$iac con$itions unsta!le angina9 uncontrolle$ 6;9 recent ,3)

7s#oul$ "ait . *ont#s after /A


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Sequence of Extractions1) ,a'illary teet# !efore *an$i!ular teet#2) Posterior teet# !efore anterior teet#

Im acted Teeth7i*pacte$ teet# are ones t#at $on%t erupt into arc# in e'pecte$ ti*e

7teet# !eco*e i*pacte$ ! c a$?acent teet#9 $ense overlying !one9 or e'cessive soft tissue prevents eruption7ina$e8uate arc# lengt# is *ost co**on reason teet# fail to erupt7i*pacte$ teet# are retaine$ for pt%s lifeti*e unless surgically re*ove$

7*ost co**on i*pacte$ teet# are *an$+ & r$ *olars9 *a'+ & r$ *olars9 an$ *a'+ canines7unerupte$ teet# inclu$e !ot# i*pacte$ teet# an$ teet# in process of erupting

7e*!e$$e$ teet# is use$ interc#angea!ly " i*pacte$ teet# E*!e$$e$ teet# @ 3*pacte$ teet#)7i*pacte$ *a'+ & r$ *olars can !e $isplace$ into:

1) infrate*poral space7re*ove$ via #e*ostat

2) *a'illary sinus7re*ove$ via /al$"ell7Luc approac#

7*an$+ &r$ *olars can !e $isplace$ into:1) su!*an$+ space *ost li0ely)2) 3A canal&) cancellous !one space

Cald!ell"#uc Procedure7opening *a$e into *a'+ sinus !y incision into canine fossa a!ove *a'+ P, roots7after toot# root re*oval9 figure7 suture *a$e9 anti!iotics9 nasal spray9 an$ $econgestant given

7palatal root of *a'+ 1 st *olar is *ost often $islo$ge$ into sinus

Reasons to Extract Im acted Teeth1) Prevention of perio $' in a$?acent teet# -) Prevention of o$ontogenic cysts an$ tu*ors2) Prevention of caries .) 6reat*ent of pain of une'plaine$ origin&) Prevention of pericoronitis ) Prevention of ?a" fractures() Prevention of root resorption of a$?acent teet# ) acilitation of ort#o t't

Contraindications to Extracting Im acted Teeth1) E'tre*es of age preteen or over &- yrs ol$)2) /o*pro*ise$ *e$ical status&) Li0ely $a*age to a$?acent structures

Classifications of Im acted Teeth1) Angulation

a) ,esioangular least $ifficult for *an$+ an$ *ost $ifficult for *a'+9 *ost co**on) !) oriBontalc) =ertical$) >istoangular *ost $ifficult for *an$+ an$ least $ifficult for *a'+)7*ost *an$+ & r$ *olars angle$ to lingual

2) Pell an$ Gregory /lassification

a) Relations#ip to anterior !or$er of ra*usi) /lass 1: nor*al position anterior to ra*usii) /lass 2: #alf of cro"n is "it#in ra*usiii) /lass &: entire cro"n is "it#in ra*us

!) Relations#ip to occlusal planei) /lass A: toot# at sa*e plane as ot#er *olarsii) /lass


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Factors that $a%e Im action Surgery #ess Difficult1) ,esioangular i*paction ) Large follicle2) /lass 1 ra*us position ) Elastic !one&) /lass A $ept# 4) Separate$ fro* 2 n$ *olar () Roots 1 & to 2 & for*e$ 2 & is !est) 15) Separate$ fro* 3A nerve-) use$9 conic roots 11) Soft tissue i*paction

.) Ci$e P>LFactors that $a%e Im action Surgery $ore Difficult1) >istoangular ) 6#in follicle2) /lass & ra*us position ) >ense9 inelastic !one&) /lass / $ept# 4) /ontact " 2 n$ *olar () Long9 t#in roots 15) /lose to 3A canal-) >ivergent9 curve$ roots 11) /o*plete !ony i*paction.) ;arro" P>L

Princi les of Surgical Extractions1) E'posure

7surgeon *ust #ave a$e8uate visi!ility of surgical site *a0e flap)7incision s#oul$ !e *a$e over soun$ !one7envelope flap is *ost often use$9 !ut can also use releasing incisions

7vertical releasing incisions s#oul$ !e *a$e at line angle of toot# 9 never onfacial aspect or splitting papilla

7!ase of flap vesti!ule) s#oul$ al"ays !e "i$er t#an ape' crest) to *aintain !loo$ supply to soft tissues

2)


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4) E'cessive !lee$inga) in?ury to 3A artery

!) arteriolar !lee$ fro* elevating flapc) pt%s #e*ostasis "arfarin9 #e*op#ilia9 von Cille!ran$%s9 c#ronic liver $eficiency)

15) 3nfections rare)11) >ry soc0et localiBe$ alveolar osteitis)

7occurs in &D of *an$+ &r$

*olar e'tractions12) Air e*p#yse*a fro* nonsurgical #an$pieces)

Dry Soc%et7cause$ !y increase$ fi!rinolytic activity9 causing loss of !loo$ clot in e'traction site

7s*o0ing an$ oral contraceptives #ave !een in$icate$9 as "ell as rinsing9 #ot li8ui$s7*ost co**on in *an$i!ular *olars *ost co**on co*plication seen after *an$+ *olar e'traction)7signs: "orsening t#ro!!ing pain9 ra$iating pain9 !a$ o$or an$ taste9 poor #ealing e'traction site7treat*ent: irrigation " saline9 se$ative $ressing eugenol) c#ange$ every 2 $ays until asy*pto*atic9 an$analgesics no anti!iotics nee$e$)

Extraction Ti s7se8uence of e'traction s#oul$ !e *a'illary !efore *an$i!ular an$ posterior to anterior 7first force applie$ s#oul$ !e apical7


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Princi les of Suturing1) ;ee$le s#oul$ !e perpen$icular "#en entering tissue2) Sutures s#oul$ !e place$ at e8ual $istance fro* "oun$ *argin 27&**) an$ at e8ual $ept#s&) Sutures s#oul$ !e place$ fro* *o!ile to non*o!ile tissue() Sutures s#oul$ !e place$ fro* t#in tissue to t#ic0 tissue-) Sutures s#oul$ not !e overtig#tene$ or close$ un$er tension

.) Sutures s#oul$ !e 27&** apart) Suture 0not s#oul$ !e on t#e si$e of t#e "oun$7suturing usually not necessary on single7toot# e'traction unless severe !lee$ing or gingiva torn

7if !lee$ing persists for long ti*e9 #ave t#e* !ite on tea !ag ! c tannic acid pro*otes #e*ostasis

Sutures7as suture $ia*eter $ecreases9 strengt# $ecreases

7siBe 5 suture is average siBe7a$$ing 5%s *eans t#ey are getting s*aller (75 s*aller t#an &75)7assigning positive nu*!ers *eans suture siBe increases 29 &9 -9 etc)

7s*allest $ia*eter suture t#at is sufficient to 0eep "oun$ close$ s#oul$ !e use$7&75 an$ (75 *ost co**on in $ental surgery

7can !e resor!a!le or nonresor!a!le1) resor!a!le: gut9 polyglactin vicryl)9 polyglycolic aci$ $e'on)9 poly$i'anone

7plain gut *a$e for* s#eep intestine an$ rapi$ly $igeste$7c#ro*ic gut is c#ro*itiBe$ to !e *ore resistant to proteolytic enBy*es

2) nonresor!a!le: nylon9 sil09 polypropylene7*ust !e re*ove$ in -7 $ays

Interru ted 's Continuous Suture Techniques1) 3nterrupte$: eac# suture is in$epen$ent

7offers strengt# an$ fle'i!ility in place*ent7if one suture co*es loose9 integrity of re*aining sutures not co*pro*ise$7$isa$vantage: re8uires *ore ti*e

2) /ontinuous: *any sutures place$ t#at are connecte$7ease an$ spee$ of place*ent7$istri!utes tension over "#ole suture line7gives *ore "atertig#t closure t#an interrupte$ pattern

Dead S ace7any area t#at re*ains $evoi$ of tissue after closure of "oun$7create$ !y re*oving tissues in $ept#s of "oun$ or not reappro'i*ating tissue planes $uring closure7$ea$ space usually fills in " !loo$ to for* #e*ato*a " #ig# potential for inf'n7can eli*inate $ea$ space !y:

1) closing "oun$ in layers2) apply pressure $ressings&) use $rains() place pac0ing into voi$ until !lee$ing stops

Wound )ealing

1) Pri*ary intention: occurs in closely appro'i*ate$ "oun$ e$ges7lo"er ris0 of inf'n an$ *ini*al scar for*ation

2) Secon$ary intention: occurs "#en large gap !t" incision e$ges7re8uires larger a*t of epit#elial *igration9 collagen $eposition9 contraction9 an$ re*o$eling7slo"er #ealing an$ *ore scar for*ation granulation tissue)

7granulation tissue is "ea0er t#an original tissue7factors t#at i*pair "oun$ #ealing: foreign *aterial9 necrotic tissue9 isc#e*ia9 tension9 syste*ic con$itions


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Stages of Wound )ealing1) 3nfla**atory stage: fro* ti*e of in?ury to 27- $ays

7#e*ostasis vasoconstriction9 clot for*ation) an$ infla**ation vaso$ilation9 p#agocytosis)7neutrop#ils an$ ly*p#ocytes pre$o*inate

2) Proliferative stage: 2 $ays to & "ee0s7epit#elialiBation9 angiogenesis9 granulation tissue for*ation9 an$ collagen $eposition

7fi!ro!lasts pre$o*inate&) Re*o$eling ,aturation stage: & "ee0s to 2 years7collagen fi!ers increase tensile strengt# an$ contraction occurs

Stages of )emostasis1) =ascular p#ase: vasoconstriction2) Platelet p#ase Pri*ary #e*ostasis): platelet an$ collagen interaction lea$ing to platelet plug&) /oagulation p#ase Secon$ary #e*ostasis): casca$e of coagulation factors() Repair process: gro"t# of fi!ro!lasts an$ s*oot# *uscle9 fi!rinolysis of clot

)o! to &chie'e )emostasis1) Pressure .) Gelatin sponge Gelfoa*)2) Sutures )


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1) Osseointegration: $irect an$ f'nal connection !t" living !one an$ i*plant surface7*ost pre$icta!le long7ter* sta!ility

2) i!ro7osseous integration: /67encapsulate$ i*plant "it#in !one7-5D success rate over 15 yrs

&)


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Part 2: 6rau*a SurgeryTooth Fractures1) /ro"n craBe crac0 infraction): no loss of toot# structure2) oriBontal or vertical cro"n fracture: can !e confine$ to ena*el9 or inclu$e $entin an$ or pulp&) /ro"n7root fracture: *ay or *ay not involve pulp

a) ,ore t#an 1 & root involve$: e'tract

!) Less t#an 1 & root involve$: R/6c) Pri*ary teet#: e'tract() oriBontal root fracture: locate$ in apical9 *i$$le9 or cervical coronal t#ir$

a) /oronal: re*ove seg*ent an$ perfor* R/6 !) Apical *i$$le: rigi$ splint for 27& *ont#s

-) /oncussion: in?ury to toot#7supporting structure causing sensitivity to percussion !ut no*o!ility $isplace*ent

7no t't nee$e$.) Su!lu'ation: in?ury to toot# supporting structures resulting in *o!ility !ut no $isplace*ent

7splint for 715 $ays) 3ntrusion: $isplace*ent of toot# into soc0et

7often assoc+ " co*pression fracture of soc0et7splint for 1( $aysF *ay nee$ to a"ait re7eruption or re8uire ort#o$ontic e'trusion7no t't for intru$e$ pri*ary teet#9 ?ust let t#e* re7erupt

) E'trusion: partial $isplace*ent of toot# out of soc0et7splint for 1( $ays

4) La!ial or lingual $isplace*ent: alveolar "all fractures pro!a!le15) Lateral $isplace*ent: $isplace*ent of toot# in *esial or $istal $irection

7alveolar "all fractures pro!a!le11) Avulsion: co*plete $isplace*ent of toot# fro* its soc0et

7*ay #ave alveolar "all fracture7replant an$ splint 715 $ays7$o not replant pri*ary teet#

12) Alveolar process fracture7re$uce $entoalveolar seg*ent an$ rigi$ splint arc# !ar) for (7. "ee0s

Facial Fractures

7facial fractures s#oul$ al"ays !e consi$ere$ after car acci$ents9 fig#ts9 falls9 or sports acci$ents7signs of facial fracture inclu$e:

1) pain -) a!nor*al *o!ility of !one 4) *alocclusion2) contour $efor*ity .) nu*!ness /; =7&) 15) step $efect&) ecc#y*osis ) crepitation 11) *o!ility of *an$i!le seg*ents() laceration ) #e*ato*a ecc#y*osis of O,

7"#en t#ere is lip laceration " fracture$ toot#9 al"ays ta0e soft tissue ra$iograp# to $etect any !ro0enfrag*ents of toot# *aterial7t't goals of *a'illofacial fractures: control #e*orr#age9 restore occlusion9 re$uction an$ sta!iliBation offracture$ seg*ents7fat e*!olis* is *ost often a se8uelae of fractures7#ig#est inci$ence of fractures occurs in *ales !t" 1-72( yrs ol$ fro* trau*a

,ygomatic &rch Fractures7!est visualiBe$ !y su(mental 'ertex 'ie!7co*plications: parest#esia *ost co**on) sinus #e*ato*a9 i*paire$ ocular *uscles


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$andi(le Fractures7can al*ost al"ays !e seen on PA; ra$iograp#9 !ut s#oul$ !e visualiBe$ in at least t"o ra$iograp#s

7PA;9 6o"nes9 P7A s0ull9 lateral o!li8ue7*alocclusion is *ost pat#ogno*ic sign of *an$+ f'7*an$i!le is 2 n$ *ost co**on fracture$ facial !one an$ -5D are *ultiple fractures7*ost co**on sites for *an$i!le fractures:

1) /on$yle: 24D -) Alveolar process: &D2) Angle: 2-D .) Ra*us: 2D&) Sy*p#ysis: 22D ) /oronoi$: 1()


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() Jygo*atico*a'illary co*ple' fracture J,/): c#ee0 !one f' " flattening of *alar process7Bygo*atic arc# f' #as HCI $efor*ity on su!*ental verte' ra$iograp# an$ /6 scan

7*a'illa9 or!it9 an$ Bygo*atic f's re8uire rigi$ internal fi'ation7isolate$ Bygo*atic f's can often !e re$uce$ " *inor surgery an$ " o use of plates an$ scre"s

7Gillies approac#: long elevator inserte$ t#roug# superficial te*poral fascia to popBygo*atic arc# !ac0 into position

7si*ple nasal fractures are repaire$ " internal an$ e'ternal splints7nasal !one fracture is *ost co**on facial fracture

*one )ealing1) Pri*ary !one #ealing: $irect atte*pt !y corte' to re7esta!lis# itself2) Secon$ary !one #ealing: involves classical stages of f' #ealing7p#ases of !one #ealing:

1) e*orr#age: !loo$ clot organiBation an$ proliferation of vessels occurs in first 15 $ays2) /allus for*ation: pri*ary callus for*e$ in 15725 $ays an$ secon$ary callus for*s in 257.5$ays&) 'nal reconstruction: *ec#anical forces cause aversian syste*s to line up accor$ing to stresslines

7e'cess !one is re*ove$ an$ s#ape of !one *ol$e$7ta0es 27& yrs to co*pletely refor* f'

Ina ro riate *one )ealing1) >elaye$ union: satisfactory #ealing t#at re8uires greater t#an nor*al . "0 perio$2) ;on7union: failure of f' seg*ents to unite properly&) ,al7union: $elaye$ or co*plete union in i*proper position

Reasons for Fractures /ot )ealing1) 3sc#e*ia2) E'cessive *o!ility&) 3nterposition of soft tissue() 3nfection

Part &: Ort#ognat#ic SurgeryE'aluating /eed for +rthognathic Surgery7pts evaluate$ accor$ing to nor*al facial proportions

7vertically9 face is $ivi$e$ into e8ual t#ir$s7#oriBontally9 face is $ivi$e$ into e8ual fift#s

&ngle Classifications of +cclusion1) Angle class 3: nor*al $ental occlusion " straig#t ort#ognat#ic) profile2) Angle class 33: *an$+ 1 st *olars an$ canines are in posterior position relative to *a'+ counterparts

7face appears posteriorly convergent retrognat#ic)&) Angle class 333: *an$+ 1 st *olars an$ canines are in anterior position relative to *a'+ counterparts

7face appears anteriorly convergent prognat#ic)

Imaging for +rthognathic Surgery

7lateral cep#s are *ain i*aging use$9 alt#oug# PA;s9 A7P cep#s9 an$ PAs are ta0en as nee$e$7cep#alo*etric analysis #elps $eter*ine "#ic# ?a" is involve$ pri*arily in $efor*ity9 $irection of gro"t#of ?a"s9 an$ *ost i$eal proce$ure for pt


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Diagnoses of Dentofacial Deformities1) ,a'+ #yper #ypoplasia2) ,an$+ #yper #ypoplasia&) Anterior open !ite apertognat#ic)() =ertical *a'+ e'cess *a'+ too long " gu**y s*ile)-) oriBontal transverse $iscrepancy pt #as posterior cross!ite)

.) ,acrogenia c#in too !ig) or *icrogenia c#in too s*all)) /ant vertical asy**etry)

$axillary Surgery7referre$ to Le orte 3 osteoto*ies7*a'illa can !e *ove$ for"ar$ an$ $o"n *ore easily t#an up or !ac0 7*a'illa can also !e sectione$ into t"o or t#ree seg*ents to !etter position t#e occlusion

$andi(ular Surgery7*ost often $one using one of t"o osteoto*ies:

1) Sagittal split osteoto*y: ra*us is $ivi$e$ !y #oriBontal osteoto*y on *e$ial aspect an$ verticalosteoto*y on lateral aspect

7lateral an$ *e$ial aspects t#en separate$ an$ *an$+ a$vance$ or set !ac02) =ertical ra*us osteoto*y: ra*us cut vertically an$ *an$+ positione$ for"ar$ or !ac0

7*an$i!le can !e *ove$ anteriorly to correct retrognat#ia class 33) or posteriorly to correct prognat#iaclass 333)

7c#in can !e *ove$ using a genial osteoto*y genioplasty) to correct *acrogenia or *icrogenia

Distraction +steogenesis7involves cutting an osteoto*y to separate seg*ents of !one an$ application of an appliance t#at "illfacilitate t#e gra$ual an$ incre*ental separation of !one seg*ents "#ic# "ill fill in "it# ne" !one

Cleft #i and Palate7cleft L3P *ore co**on in *ales

7/L is $efect in fusion of lateral an$ *e$ial nasal processes7cleft PALA6E *ore co**on in fe*ales

7/P is lac0 of fusion !t" palatal s#elves7*ost co**only foun$ on Asians an$ least co**on in AA7/L P surgery follo"s rule of 15s: surgery perfor*e$ "#en c#il$ is at least 15 "ee0s ol$9 "eig#s at least15 l!s9 an$ #as at least 15 g $L !

Part (: acial Pain an$ ;europat#ologyPhysiology of Pain1) 6rans$uction: activation of A7$elta an$ /7fi!ers to spinal cor$ or !rain ste*2) 6rans*ission: pain info in /;S is sent to t#ala*us an$ corte' for processing of sensory e*otionalaspects&) ,o$ulation: li*its rostral flo" of pain info fro* spinal cor$ an$ trige*inal nucleus to #ig#er corticalcenters7acute pain lasts & *ont#s or less7c#ronic pain is pain lasting longer t#an (7. *ont#s

Classification of +rofacial Pain1) So*atic pain: increase$ sti*ulus lea$s to increase$ pain

a) *usculos0eletal pain 6, 9 perio9 *uscular) !) visceral salivary glan$9 pulp)

2) ;europat#ic pain: pain in$epen$ent of sti*ulus activity7$a*age to pain pat#"ays trige*inal neuralgia9 trau*a9 stro0e)

&) Psyc#ogenic pain: cause$ !y intrapsyc#ic $istur!ance7conversion r'n9 psyc#otic $elusion9 *alingering

() Atypical pain: facial pain of un0no"n cause


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Trigeminal /euralgia 0Tic Douloureaux17a trigger point e'ists "#ere pain typically presents as electrical9 s#arp9 s#ooting sensation

7triggere$ !y "in$9 tactile9 or t#er*al sti*ulation7pain is episo$ic secon$s to *inutes) follo"e$ !y refractory perio$7usually unilateral7no *otor or sensory $eficits present

7treat*ent: 1) anticonvulsant $rugs: ga!apentin9 car!a*aBepine 2) surgically: *icrovascular $eco*pression anetta proce$ure)9 ga**a 0nife ra$iosurgery &) /onservative: nig#t guar$9 soft $iet9 *otion e'ercises9 *oist #eat9 *assage9 ;SA3>s

&ty ical +dontalgia 0+dontalgia Secondary to Deafferentation17occurs as result of trau*a or surgery R/6 or e'traction)7t#ese result in $a*age to afferent pain trans*ission syste*7propose$ *ec#anis*s:

1) perip#eral #yperactivity at surgical site2) /;S #yperactivity secon$ary to c#anges in 2 n$7or$er nerve in trige*inal nucleus

Posther etic /euralgia7se8uelae of #erpes Boster inf'n7pain is !urning9 ac#ing9 or electric s#oc07li0e7treat*ent: 1) anticonvulsants

2) anti$epressants &) sy*pat#etic !loc0s

7Ra*say7 unt syn$ro*e: #erpes Boster inf'n of sensory an$ *otor !ranc#es of /; =33 an$ =3339 resultingin facial paralysis9 vertigo9 $eafness9 an$ cutaneous eruption of e'ternal au$itory canal

/euromas7can occur after a nerve in?ury7 pro'i*al section of transecte$ nerve for*s sprouts fille$ " Sc#"ann cells7!eco*es very sensitive to sti*uli an$ can cause c#ronic neuropat#ic pain

*urning $outh Syndrome7pts co*plain of pain9 $ryness9 !urning of *out# an$ tongue9 an$ altere$ taste7*ost co**on in post*enopausal fe*ales7t#oug#t to !e secon$ary to $efect in pain *o$ulation7sy*pto*s of -5D of pts resolve " o t't in 27yr perio$

7#or*one t#erapy9 anticonvulsants9 an$ anti$epressants ;O6 useful

Chronic )eadaches1) ,igraine

a) Onset: acute !) Location: unilateralc) Sy*pto*s: nausea9 vo*iting9 p#otop#o!ia9 p#onop#o!ia$) Pain: t#ro!!inge) >uration: prolonge$f) >iagnostic test: c#ec0 for #' of sy*pto*s

g) Prior #' of #ea$ac#es: yes2) /luster

a) Onset: acute !) Location: unilateralc) Sy*pto*s: r#inorr#ea9 lacri*ation of ipsilateral si$e$) Pain: s#arp9 sta!!inge) >uration: &5 *ins to 2 #rsf) >iagnostic test: #istory of sy*pto*sg) Prior #' of #ea$ac#es yes


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&) 6ensiona) Onset: c#ronic

!) Location: glo!al an$ unilateralc) Sy*pto*s: *ultiso*atic co*plaints$) Pain: ac#inge) >uration: $aily

f) >iagnostic test: noneg) Prior #' of #ea$ac#es: yes() 6e*poral Arteritis

a) Onset: acute or c#ronic !) Location: localiBe$c) Sy*pto*s: "eig#t loss9 poly*yalgia9 fever9 vision pro!le*s9 ?a" clau$ication$) Pain: severe t#ro!!ing paine) >uration: prolonge$f) >iagnostic test: eryt#rocyte se$i*entation rate test ESR)9 ten$er te*poral arteriesg) Prior #' of #ea$ac#es: no7can lea$ to !lin$ness on affecte$ si$e if not treate$ 8uic0ly

/er'e In2uries1) Anest#esia: loss of sensation2) Parest#esia: a!nor*al sensation !urning9 tingling9 etc+)&) yperest#esia: increase in sensitivity() >ysest#esia: painful sensation to nor*al sti*ulus-) ;eurapra'ia: *il$ in?ury " no a'onal $a*age spontaneous recovery "it#in ( "ee0s).) A'onot*esis: a'onal $a*age !ut intact en$oneural an$ perineural s#eat#

7Callerian $egeneration occurs $istal to in?ury7Potential for recovery in 17& *ont#s

) ;eurot*esis: co*plete severance of a'on "it# a gap create$7no recovery e'pecte$ " o surgery

Part -: 6e*poro*an$i!ular >isor$ersT$37classifie$ as gingly*oart#ro$ial ?oint " !ot# translational an$ rotational *ove*ent

7synovial ?oint7anato*y:

1) 6, : articulation !t" con$yle of *an$i!le an$ s8ua*ous portion of te*poral !one2) Articular surface of te*poral !one: f'nal aspect of 6, *a$e of $ense fi!rous /6

a) concave portion: articular fossa glenoi$ *an$i!ular fossa) !) conve' portion: articular e*inence tu!ercle)

&) Articular $isc: $ense fi!rocartilagenous /6 avascular an$ aneural)7separates ?oint into inferior an$ superior ?oint spaces7anterior posterior !an$s: t#ic0 post+ !an$ t#ic0er an$ attac#e$ to retro$iscal tissues)7inter*e$iate Bone: t#in center of $isc)

() Retro$iscal tissues: loose /6 t#at is vascular an$ innervate$

$yofascial Pain Disorder

7*ost co**on cause of *asticatory pain 6, pain an$ co*pro*ise$ f'n7$iffuse9 poorly localiBe$ pain in preauricular region9 often involving *uscles of *astication7pain an$ ten$erness result fro* a!nor*al *uscle f'n an$ #yperactivity9 as "ell as spas* an$ $ysf'n

7parafunctional #a!it *ay !e etiologically relate$ "ear facets often seen)7if pt #as nocturnal parafunctional #a!it9 sy*pto*s are "orse in *orning7can also !e result of $isc $isplace*ent $isor$ers an$ $egenerative art#ritis

7is stress7relate$ $isor$er increase$ stress causes increase$ *uscle tension !ru'is*)


14/27

Disc Dis lacement Disorders7assoc+ " synovial infla**ation7$isc $isplace*ent is en$ result of infla**ation an$ c#ronic ?oint overloa$ing7$isc *ost often $isplace$ in anteromedial direction1) >isc $isplace*ent " re$uction: $isc returns to nor*al $isc7to7con$yle relations#ip

7nor*al interincisal opening " o $eviation can !e seen

7opening clic0 correspon$s to con$yle *oving over posterior portion of anteriorly $isplace$ $iscre$uction)7secon$ clic0 occurs "#en ?a" is close$ an$ $isc fails to *aintain its nor*al re$uce$ relations#ipto con$yle

2) >isc $isplace*ent " o re$uction: $isc $oesn%t return to nor*al position7results in li*ite$ range of *otion an$ ipsilateral $eviation on opening7no popping or clic0ing o!serve$

&) 3nternal $erange*ent: a!nor*al relations#ip of articular $isc to *an$+ con$yle an$ fossa7posterior !an$ of $isc is anteriorly $isplace$ in front of con$yle as $isc translates anteriorly9

posterior !an$ re*ains in front of con$yle lea$ing to infla**ation of retro$iscal tissue causing$ecrease$ pro$uction of synovial flui$ an$ $ecrease$ *o!ility

Degenerati'e 3oint Disease 0DID11) Osteoart#ritis2) Syste*ic Art#ritic /on$itions

a) Syste*ic lupus SLE) !) R#eu*atoi$ art#ritisc) /rystalline art#ropat#ies calciu* pyrop#osp#ate $e#y$rate pseu$ogout))

&) 6, an0ylosis7*ost co**only cause$ !y trau*a

Chronic Recurrent Dislocation7occurs "#en *an$+ con$yle translates anterior to articular e*inence7assoc+ " pain an$ *uscle spas*7re8uires *ec#anical *anipulation to ac#ieve re$uction

7"#en pro!le* !eco*es c#ronic *ultiple recurrences)9


15/27

Surgical Treatments for T$D1) Art#rocentesis: !enefits pts " internal $erange*ent

7nee$les place$ into superior ?oint space an$ saline in?ecte$ to re$uce infla*e+ *e$iators7t#oug#t to $isten$ ?oint capsule9 release a$#esions9 an$ re*ove c#e*ical *e$iators

assoc+ " ?oint pat#ology2) Art#roscopy: place*ent of t"o cannulas to allo" access for intracapsular instru*entation of superior

?oint space7lysis of a$#esions9 steroi$ in?'n9 an$ *otoriBe$ s#aving of osteoart#ritic fi!rillation tissue&) >isc repositioning surgery Open art#oplasty): $isc is *o!iliBe$ an$ posterior "e$ge *ay !e re*ove$an$ $isc repositione$ into *ore $esira!le position

7use$ in pts " painful9 persistent clic0ing7popping an$ close$ loc0 () >isc repair re*oval >iscecto*y): in$icate$ "#en $isc is severely $a*age$

7if $isc is re*ove$9 it can !e replace$ " autogenous *aterials te*poralis *uscle9 fat9 articularcartilage) or prost#etics

-) /on$yloto*y: acco*plis#e$ !y perfor*ing an intraoral vertical ra*us osteoto*y7allo"s soft tissues to passively reposition t#e con$yle an$ $isc into *ore f'nally neutral position

.) 6otal ?oint replace*ent: in$icate$ in severely pat#ologic ?oints r#eu*atoi$ art#ritis9 $eg+ oint+ >'9an0ylosis9 neoplasia)

7costoc#on$ral !one graft reconstruction is *ost co**on autogenous *aterial use$7totally prost#etic ?oints can also !e *a$e

7s#oul$ A=O3> occlusal a$?ust*ents9 prost#etic restorations9 ort#o t't9 an$ ort#ognat#ic surgery

& roaches to Ex ose T$31) Pre7auricular incision: perpen$icular incision anterior to e'ternal ear

7is !est "ay to e'pose 6,2) Su!*an$i!ular approac# Ris$on approac# ): stan$ar$ approac# to ra*us an$ nec0 of con$yle

7not !est "ay to approac# ?oint space

Part .: O$ontogenic 3nfections$icroorganisms Causing +dontogenic Infections7poly*icro!ial infections1) Anaero!ic -D)

a) Gra* neg+ ro$s: *ost


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#ud!ig.s &ngina7!ilateral inf'n of su!*an$i!ular9 su!lingual9 an$ su!*ental spaces7can lea$ to !loc0age of air"ay

Six Treatment Princi les for +dontogenic Infections1) >eter*ine severity of inf'n

2) Evaluate state of pt%s #ost $efense *ec#anis*s&) >eter*ine "#et#er pt s#oul$ !e treate$ !y general $entist or specialist() 6reat inf'n surgically

7re*ove source of inf'n an$ $eco*press $rain purulence7goal is to get a$e8uate $rainage so sprea$ of inf'n can !e !roug#t un$er control7speci*en for culture an$ sensitivity s#oul$ !e o!taine$

-) Support pt *e$ically7air"ay *anage*ent9 #y$ration9 electrolytes9 anti!iotics9 analgesics

.) /#oose an$ prescri!e appropriate anti!iotics7Pen =K is preferre$ $rug for o$ontogenic inf'ns

7if allergic9 t#en clin$a*ycin or clarit#ro*ycin are goo$7narro" spectru* agents are !etter t#an !oar$ spectru* for o$ontogenic inf'ns ! c alter nor*alflora less7!acterici$al agents !etter t#an !acteriostatic

Indications for &nti(iotic Use1) Rapi$ly progressing s"elling () ascial space involve*ent2) >iffuse s"elling -) Severe pericoronitis&) /o*pro*ise$ #ost $efenses .) Osteo*yelitis7pseu$o*e*!ranous colitis /+ $ificile) can result fro* anti!iotic use of a*o'icillin9 clin$a*ycin9 an$cep#alosporins

7treat " vanco*ycin or *etroni$aBole

+steomyelitis7infla**ation of *e$ullary portion of !one7osteo*yelitis sprea$s via inf'n9 infla**ation9 an$ isc#e*ia

7*ost co**on initiating causes are o$ontogenic inf'ns an$ trau*a7inf'n !egins in *e$ullary space of cancellous !one9 t#en sprea$s to cortical !one9 periosteu*9 an$ softtissues7occurs *ore often in i**unoco*pro*ise$ an$ in *an$i!le over *a'illa7causative agents are si*ilar to o$ontogenic inf'ns Strep9 anaero!ic cocci an$ gra*7 ro$s)7treat*ent $one !y $e!ri$e*ent an$ anti!iotics

/ecroti4ing Fasciitis7rapi$ly progressing inf'n of s0in an$ fascia " #ig# *ortality rate &57-5D)7cause$ !y group7A strep or /+ perfringens7treate$ " surgical $e!ri$e*ent an$ anti!iotics

Ca'ernous Sinus Throm(osis7retrogra$e inf'n fro* !ac0flo" of *aterial $raine$ fro* face

7/; 3339 3=9 =719 an$ =3 involve$

Sinusitis1) Acute less t#an 1 *ont#)

7S+ pneu*onia9 + influenBae9 ,+ catarr#alis2) /#ronic over & *ont#s)

7results fro* o!struction of sinus $rainage7$ia!etics *ay $evelop *ucor*ycosis fungal inf'n)

&) 6't: a*o'icillin or aug*entin a*o'icillin clavulanate)9 anti#ista*ines9 or surgery to esta!lis# $rainage() /o*plications of sinusitis: or!ital cellulitis9 cavernous sinus t#ro*!osis9 *eningitis9 osteo*yelitis


17/27

&nimal *ite Infections7cause$ !y Pasteurella *ultici$a7t't " a*picillin or a*o'icillin

Part :


18/27

Part : Surgical ,anage*ent of /ysts an$ 6u*ors+'er'ie!7goals of surgical *anage*ent are era$ication of pat#ology an$ est#etic functional re#a!ilitation7cysts can !e classifie$ as fissural an$ o$ontogenic

7o$ontogenic 0eratocysts ten$ to act *ore aggressively an$ #ave #ig#er recurrence rates t#anfissural cysts an$ cysts of o$ontogenic infla**atory origin

7cysts of ?a" are treate$ " eit#er:1) Enucleation &) Stage$ enucleation an$ *arsupialiBation2) ,arsupialiBation () Enucleation an$ curettage

Enucleation1) >escription: s#elling out lesion " o rupture2) 3n$ications: use$ "#en it can safely !e $one " o sacrificing a$?acent structures&) Pros: is a $efinitive t't an$ easier postop "oun$ care() /ons: *ay "ea0en ?a" an$ $a*age a$?acent structures

$arsu iali4ation1) >escription: surgical "in$o" *a$e9 follo"e$ !y $eco*pression an$ evacuation2) 3n$ications: $one if enucleation "oul$ $a*age a$?acent structures or it "oul$ !e unsuccessful&) Pros: si*ple an$ *ay spare vital structures() /ons: $ifficult "oun$ care an$ so*e pat#ologic tissue *ay !e left

Staged Enucleation and $arsu iali4ation1) 3n$ications: $one if cyst is not totally o!literate$ after initial *arsupialiBation #eals

Enucleation and Curettage1) >escription: s#elling out lesion " o rupture9 follo"e$ !y 172** curettage of a$?acent !one2) 3n$ications: OK/s or any cyst t#at recurs after enucleation&) /ons: *ay recur an$ *ore $estructive to a$?acent structures

$alignant Tumors of 3a!7*ost co**on are epi$er*oi$ carcino*as S//)7salivary glan$s9 !loo$ vessels9 ly*p#atics9 *uscle9 !one9 an$ ot#er /6 can give rise to pri*ary*alignancies of #ea$ an$ nec0 7cancer of !reast9 prostate9 lung9 0i$ney9 t#yroi$9 #e*atopoietic syste*9 an$ colon can *etastasiBe to #ea$an$ nec0 7"#en a pri*ary cancer of #ea$ nec0 is $iagnose$9 clinical staging s#oul$ !e perfor*e$ prior to $efinitivet't

7can inclu$e /6 scans9 PE6 scan9 c#est '7rays9 an$ en$oscopy7co*!o of surgery9 ra$iation9 an$ c#e*o are *o$alities use$ to treat pri*ary cancers of #ea$ nec0

Reconstruction7opti*ally $one !efore perfor*ing any $efinitive t't7can range fro* no reconstruction " "oun$ *anage*ent an$ secon$ary #ealing to co*ple' reconstruction" place*ent of en$osseous i*plants

Sialolithiasis7salivary glan$ stones7*ost often affects su!*an$i!ular glan$ -D)7causes pain an$ s"elling "#ic# "orsens "#en saliva flo" is sti*ulate$7glan$ can !eco*e infecte$9 causing purulence9 eryt#e*a9 O, e$e*a9 an$ ly*p#a$enopat#y


19/27

Part 4: Local Anest#esia#ocal &nesthetics7$rugs "#ic# reversi!ly !loc0s t#e con$uction of nerve i*pulses7$ental concern is sensory nerve !loc09 !ut *otor nerves can !e !loc0e$ in #ig# conc+7local anest#etics !loc0 so$iu* c#annels7all LAs are *a$e of a lipop#ilic aro*atic ring lin0e$ to a #y$rop#ilic a*ino group

7!on$ is eit#er an ester or a*i$e !on$ "#ic# $eter*ines class of LAClasses of #ocal &nesthetics1) A*i$es: *eta!oliBe$ !y *icroso*al P7(-5 enBy*e in liver

a) li$ocaine !) *epivicaine c) !upivicaine7a*i$es #ave letter H3I follo"e$ !y7HcaineI in na*e

2) Esters: *eta!oliBe$ !y pseu$oc#olinesterase in plas*aa) novocaine !) procaine c) !enBocaine $) tetracaine

7esters are far *ore co**on to #ave allergic r'n

Dosages for #ocal &nestheticsmg/carp max dose (mg/kg) max dose (mg)

2% lido (xylocaine) 36 4.5 300

2% lido w/ 1:100k 36 5003% mepi!icaine (car"ocaine) 54 5.5 4002% mepi!icaine w/1:20k 36 5.5 4004% prilocaine (#i$anes$) 2 6004% prilocaine w/ 1:200k 2 6000.5% "&pi!icaine w/ 1:200k ('arcaine) 1.3 01.5% e$idocaine w/ 1:200k ( &ranes$) 2 5.5 4004% ar$icaine w/ 1:100k (*ep$ocaine) 6 500

7*a' a*t of 2D li$o " 1:1550 epi to #ealt#y 1-5 l! *an is ( *g 1& carps)7eac# 1+ cc carp of 2D li$o " 1:1550 epi contains 25*g cc li$ocaine9 &. *g li$ocaine9 an$ 5+51 *g epi

Clar%.s Rule for Pediatric #& Dosing7*a' pe$o $ose@ "eig#t of c#il$ in l! 1-5)' *a' a$ult $ose)7conversion of l! to 0g is 2+2 l! 0g

Contents of 6 Car ule of 78 #ido !5 696::% E i1) &. *g li$o2) 5+51 *g epi

Differential /er'e *loc%ade 0Critical #ength Conce t17$iff+ nerve !loc0a$e is *a' $istance an action potential can H?u*pI $o"n a nerve7in *yelinate$ nerve9 local anest#etic *ust !loc0 a *ini*u* successive nu*!er of no$es of Ranvier to

!loc0 t#e action potential of nerve7sensations $isappear an$ reappear in a $efinite or$er:

1) Pain first to $isappear an$ last to reappear)2) 6e*perature col$9 t#en "ar*)

&) 6ouc#() Pressure-) ,otor

7s*all9 un*yelinate$ nerve fi!ers pain9 te*p9 autono*ics) *ore sensitive to LA t#an larger9 *yelinate$fi!ers

$echanism of &ction of #ocal &nesthetics


20/27

7"#en in?ecte$ into tissue9 LA e'ists in !ot# ioniBe$ an$ non7ioniBe$ for*s7non7ioniBe$ for* penetrates tissue rea$ily ! c lipop#ilic aro*atic ring passes t#roug# nerves#eat# an$ *e*!rane

7re7e8uili!ration !t" ioniBe$ an$ non7ioniBe$ for*s occurs "it#in nerve cell7ioniBe$ for* t#en in#i!its nerve *e*!rane%s ;a c#annels9 preventing inflo" of ;a to preventfor*ation of action potentials

7inf'n causes tissue to !eco*e aci$ic9 resulting in increase$ ioniBe$ for* of LA at e'pense of non7ioniBe$for*7t#is prevents passage of LA t#roug# nerve *e*!rane9 $ecreasing effectiveness

7LA can !e *i'e$ " so$iu* !icar!onate to al0aliniBe t#e solution to $ecrease pain upon infiltration an$increase effectiveness7LA "or0 !est at p a!ove ! c $rop in P s#ifts LA to ioniBe$ for*

Pharmaco%inetics of #ocal &nesthetics7re$istri!ution of LA affecte$ !y:

1) $iffusion a"ay fro* site of action2) vascularity of in?ection site increase$ !loo$ flo" causes s#orter $uration of action)&) increase$ protein !in$ing increase$ lipi$ solu!ility increase$ $uration of action)

7$uration of LA is $irectly proportional to protein !in$ing an$ lipi$ solu!ility7t#e lo"er t#e pKa of LA9 t#e faster t#e onset

Systemic Toxicities of #ocal &nesthetics7LA to'icity $ue to elevate$ plas*a levels of LA $ue to intravascular in?'n or over$ose7c#il$ren an$ el$erly are at *ost ris0 for LA to'icity1) ,il$ to'icity: circu*oral nu*!ness9 tac#ycar$ia9 6;9 tinnitus9 *etallic taste9 tal0ative9 appre#ension9e'cita!ility9 slurre$ speec#9 $iBBiness9 $isoriente$2) ,o$+ to'icity: tre*or9 #allucination9 #ypotension9 !ra$ycar$ia9 $ecrease$ car$iac output&) Severe to'icity: seiBure9 car$iac an$ resp+ $epression9 co*a9 $eat#

7seiBures are *ost co**on si$e effect fro* syste*ic a!sorption of to'ic a*t of LA() Allergic Responses: ester LA #ave #ig# inci$ence -D)9 a*i$e LA #ave lo" inci$ence N1D)

7 p-aminobenzoic acid (PABA) in esters in$uce allergic r'n7if pt allergic to !ot# esters an$ a*i$es9 can give


21/27


22/27

1) Area of anest#esia: fro* canine to posterior aspect of #ar$ palate9 as "ell as fro* gingival *argin to*i$line of palate

7greater palatine fora*en locate$ #alf"ay !t" gingival *argin an$ *i$line palate -** anterior to ?'n of #ar$ an$ soft palates

2) 6ec#ni8ue: initially use topical an$ pressure anest#esia 25 secon$s *ini*u*) an$ penetrate at locationof greater palatine fora*en at $ept# of !one -**)

/aso alatine *loc% 1) Area of anest#esia: palatal tissue fro* canine to canine pre*a'illa area)2) 6ec#ni8ue: topical an$ pressure anest#esia initially9 t#en insert nee$le tip (- $egrees to palatal soft tissueat ?'n of palate an$ incisive papilla at $ept# of !one

$ental /er'e *loc% 0Incisi'e *loc%11) Area of anest#esia: soft tissue on !uccal fro* pre*olars to *i$line lip9 c#in9 periosteu*9 an$ !one2) 6ec#ni8ue: insert nee$le in $ept# of !uccal vesti!ule opposite *an$+ P, at -** $ept#

7use carpule

$andi(ular *loc% 0I& *loc%11) Area of anest#esia: pulps an$ !uccal soft tissue of *an$+ teet# e'cept area innervate$ !y !uccal nerve)9lip9 c#in9 periosteu*9 an$ !one in area2) 6ec#ni8ues

a) 6ra$itional alstea$) *et#o$7penetrate 171+- c* a!ove an$ parallel to *an$i!ular occlusal plane9 approac#ing fro*

contralateral pre*olars7nee$le en$point s#oul$ !e -5D of *esio$istal lengt# of ra*us7a$vance nee$le until #it !one9 "it#$ra" 1**9 aspirate9 an$ in?ect Q carp7"it#$ra" nee$le 1571-**9 aspirate9 an$ in?ect rest to #it lingual nerve7save tiny !it for long !uccal !loc0 if nee$e$

!) A0inosi 6ec#ni8ue7anest#etiBes 3A9 lingual9 an$ !uccal nerves

7useful in uncooperative c#il$ren an$ pts " tris*us7nee$le inserte$ parallel to *a'+ occlusal plane at level of *a'+ !uccal vesti!ule7penetrate #alf $istance of ,> lengt# of ra*us 2-**)

7no !ony en$point en$s ?ust superior to lingula)7#u! of nee$le s#oul$ !e opposite *esial aspect of *a'+ 2 n$ *olar

c) Go"7Gates 6ec#ni8ue7anest#etiBes 3A9 lingual9 long !uccal9 auriculote*poral9 an$ *ylo#yoi$ nerves7#ave pt open as "i$e as possi!le to rotate an$ translate con$yle for"ar$7palpate con$yle an$ retract c#ee0 7!egin fro* contralateral canine an$ penetrate at >< cusp of *a' 2 n$ *olar 7insert nee$le 2-7&5** until contact !one9 "it#$ra" slig#tly7in?ect anest#etic9 "#ic# is not near nerve9 !ut aroun$ 1c* superior to it in superior

aspect of pterygo*an$i!ular space

Part 15: /onscious Se$ation&S& Physical Status Classifications

1) PS 3: nor*al9 #ealt#y pt2) PS 33: *il$ syste*ic $isease&) PS 333: severe syste*ic $isease t#at is not incapacitating() PS 3=: severe syste*ic $isease t#at is constant t#reat to life-) PS =: *ori!un$ pt "#o "ill $ie " o operation.) PS =3: !rain7$ea$ pt "#ose organs are !eing re*ove$ for $onor purposes

-uedel.s Signs5Stages of &nesthesia


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1) A*nesia an$ analgesia: preservation of protective refle'es7stage en$s " loss of consciousness7conscious se$ation falls un$er t#is stage

2) >eliriu* an$ e'cite*ent: involuntary *ove*ents9 o!tun$e$ refle'es9 irregular !reat#ing occurs7stage en$s " onset of total anest#esia7nausea an$ vo*iting co**on in t#is stage *ay lea$ to aspiration of vo*it)

&) Surgical anest#esia: can !e lig#t9 *e$iu* i$eal for invasive surgery)9 an$ $eep7s0eletal *uscles rela' an$ !reat#ing !eco*es regular () ,e$ullary paralysis pre*orte*: very $eep anest#esia " loss of car$iovascular f'n " i**inent $eat#stages 1 an$ 2 co*!ine$ are ter*e$ induction stage of anest#esia

/eurole t &nesthesia7co*!ine$ a$*inistration of:

1) ;euroleptic agent >roperi$ol)2) ;arcotic analgesic&) ;itrous o'i$e

7#as slo" in$uction of anest#esia9 !ut return to consciousness is 8uic0 after ;2O re*ove$

Inhalation &nesthetics7in#alation anest#esia upta0e $epen$ent on:

1) Solu!ilitya)


24/27

7nitrous o'i$e fro* !loo$strea* $iffuses into alveoli in lungs for eli*ination an$ *i'es " in#ale$ roo*air t#at contains 25D o'ygen9 resulting in #ypo'ia7prevente$ !y a$*inistering #ig# conc+ o'ygen $uring recovery perio$ of nitrous se$ation

+ccu ational Ris% from /itrous +xide7prolonge$ e'posure to ;O can result in:

1)


25/27

7is ;,>A receptor agonist an$ s#ort7acting7pro$uces dissociati'e anesthesia $issociation !t" t#ala*us an$ li*!ic syste*)

7pt appears a"a0e9 !ut is unconscious an$ $oesn%t feel pain7is 8uic0 for* of anest#esia goo$ for s#ort proce$ures

7is car$iovascular sti*ulant7can cause postop $isorientation an$ #allucinations

7often use$ in c#il$ren an$ young a$ultsChloral )ydrate7/;S $epressant use$ in c#il$ren7active *eta!olite is tric#loroet#anol7#as onset of &5 *ins to 1 #r an$ lasts for (7 #ours7to'icity causes #ypotension9 resp+ $epression9 #ypot#er*ia9 car$iac arr#yt#*ia9 an$ co*a7contrain$icate$ in #epatic an$ renal i*paire$ pts

+ ioids7narcotics t#at act as agonists on *u9 $elta9 0appa9 an$ sig*a receptors in /;S7provi$e analgesia an$ eup#oria7availa!le in oral an$ 3= for*s:

1) entanyl: 3=9 oral2) Sufentanil: 3=&) Alfentanil: 3=() ,orp#ine: 3=9 oral-) /o$eine: oral.) ,eperi$ine >e*erol): 3=9 oral

7naloxone is *u7receptor agonist t#at reverses effect of opioi$s

+ ioid &d'erse Effects1) Pruritis fro* #ista*ine release)2) ;ausea vo*iting&) Urinary retention() /onstipation-) ,iosis.) Resp+ $epression

+ ioid Withdra!al1) 6; .) Restlessness2) Piloerection9 c#ills ) ,y$riasis&) S"eating ) Lacri*ation an$ r#inorr#ea() ;ausea vo*iting 4) 3nso*nia-) A!$o*inal cra*ping7opioi$ "it#$ra"al is not life7t#reatening li0e alco#ol or !enBo "it#$ra"al is

Com lications of Sedation


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1) ,alignant #ypert#er*ia: prevents release of calciu* fro* sarcoplas*ic reticulu* of s0eletal *uscle9lea$ing to persistent contraction

7rigi$ity9 fever9 tac#ycar$ia9 #ypo'ia7triggere$ !y succinylc#oline an$ alot#ane7treate$ " >antrolene

2) P#le!itis: infla**ation of superficial veins t#at can occur after insertion of 3=

7 pain9 ten$erness9 in$uration9 eryt#e*a7treate$ " elevating li*!9 *oist #eat9 ;SA3>s&) Laryngospas*: forceful9 involuntary spas* of laryngeal *uscles cause$ !y oral flui$s triggeringlaryngeal refle' $uring lig#ter stages of anest#esia

7prevente$ !y using p#aryngeal !arrier an$ tonsil suction7treate$ " positive pressure o'ygen7supple*ente$ ventilation " face*as0

7if still persists9 use succinylc#oline or last resort cricot#yroto*y7*ost co**on co*plication of office7!ase$ anest#esia is loss of air"ay7*ost co**on $ental e*ergency is syncope

Synco e7transient loss of consciousness cause$ !y transient cere!ral #ypo'ia7t't: 1) place pt in supine position " feet slig#tly elevate$ 6en$elen!urg position) 2) Esta!lis# air"ay !y c#in left an$ a$*inister 155D o'ygen &) ,onitor vital signs

;ital Signs1) 6e*perature: nor*al oral te*p is 4 +. or & /2) eart rate: nor*al range is .57 5 !p*&)


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1) ypovole*ic: pro$uce$ !y re$uction in !loo$ volu*e7cause$ !y #e*orr#age9 $e#y$ration9 vo*iting9 $iarr#ea9 an$ flui$ loss fro* !urns

2) /ar$iogenic: circulatory collapse fro* pu*p failure of left ventricle7cause$ !y *assive *yocar$ial infarction

&) Septic: $ue to severe inf'n7cause$ !y gra*7 en$oto'ins

() ;eurogenic: results fro* severe in?ury trau*a to /;S-) Anap#ylactic: occurs " severe allergic r'n

Com lete *lood Count1) e*atocrit: percentage of R

Documents

NBDE Dental Boards Oral Surgery-27