NEET MDS Oral and Maxillofacial Surgery Syllabus

What is a dry socket (alveolar osteitis) and when does it typically present?

Painful loss/breakdown of the blood clot exposing alveolar bone, typically 2–4 days after extraction (commonly mandibular molars); managed with irrigation and obtundent dressings.

What are Le Fort fractures I, II, and III?

Le Fort I: horizontal fracture of the maxilla above the teeth (floating palate). Le Fort II: pyramidal fracture involving nasal bridge and maxilla (floating maxilla). Le Fort III: craniofacial disjunction separating facial skeleton from skull base.

What is the immediate priority in managing a patient with maxillofacial trauma?

Airway management (with cervical spine protection) following ATLS principles — ABCDE — as facial trauma can compromise the airway.

What is the gold-standard treatment for displaced facial fractures?

Open reduction and internal fixation (ORIF) using titanium miniplates and screws to restore anatomy and occlusion.

What is orthognathic surgery and its main goal?

Surgical repositioning of the maxilla and/or mandible to correct dentofacial deformities and malocclusion, restoring proper jaw relationship, function, and facial aesthetics.

What is the most common surgical procedure to correct mandibular prognathism or retrognathism?

Bilateral sagittal split osteotomy (BSSO) of the mandibular ramus.

What osteotomy is used to reposition the maxilla in orthognathic surgery?

Le Fort I osteotomy.

What is the 'reconstructive ladder' in maxillofacial reconstruction?

A graded approach from simplest to most complex: secondary healing, primary closure, skin grafts, local flaps, regional/pedicled flaps, and free tissue transfer (microvascular flaps).

Which free flap is most commonly used for mandibular reconstruction?

The free fibula osteocutaneous flap (vascularized fibula), allowing bone with skin paddle and implant placement.

Name common intraoperative complications in OMFS.

Hemorrhage, nerve injury (e.g., inferior alveolar/lingual), damage to adjacent teeth/structures, fracture of mandible/tuberosity, instrument breakage, aspiration of foreign bodies, and oroantral communication.

What is an oroantral communication and how is a small fresh one managed?

An abnormal opening between the oral cavity and maxillary sinus (often after upper molar extraction); communications <2 mm may close spontaneously with clot support, whereas larger defects need a buccal advancement or palatal flap.

List common postoperative complications after oral surgery.

Pain, swelling (edema), bleeding, infection, trismus, dry socket, paresthesia, hematoma, and wound dehiscence.

What is trismus and a common cause after oral surgery?

Restricted mouth opening due to spasm/inflammation of the muscles of mastication; commonly caused by surgical trauma, hematoma, infection, or inferior alveolar nerve block.

What is the difference between acute (nociceptive) and chronic pain?

Acute pain is short-term, protective, tied to tissue injury and resolves with healing; chronic pain persists beyond normal healing (>3 months) and may be neuropathic with no protective function.

What is neuropathic pain and give an orofacial example.

Pain caused by a lesion or disease of the somatosensory nervous system; an orofacial example is trigeminal neuralgia.

What is the WHO analgesic ladder?

A stepwise approach to pain: Step 1 non-opioids (NSAIDs/paracetamol) ± adjuvants; Step 2 weak opioids (codeine/tramadol); Step 3 strong opioids (morphine), each ± adjuvants.

What is the first-line drug for trigeminal neuralgia?

Carbamazepine (an anticonvulsant).

Name non-pharmacologic methods of orofacial pain management.

Physical therapy, TENS, heat/cold application, occlusal splints, acupuncture, biofeedback, relaxation, cognitive behavioral therapy, and patient education.

What is the most common cause of odontogenic infections?

Polymicrobial flora, predominantly anaerobic and aerobic streptococci (e.g., viridans group) and anaerobes, usually from dental caries/pulpal or periodontal origin.

What is Ludwig's angina?

A rapidly spreading bilateral cellulitis of the submandibular, sublingual, and submental spaces, often of odontogenic origin, that can cause airway obstruction — a surgical emergency.

Give an example of a non-odontogenic head and neck infection.

Infections such as tonsillar/peritonsillar abscess, sinusitis, salivary gland infection (sialadenitis), or skin/lymph node infections not arising from teeth.

What are the principles of managing odontogenic infections?

Remove the source (extraction/endo/drainage), establish drainage (incision and drainage), administer appropriate antibiotics, support the patient medically, and ensure airway protection in severe cases.

What is the most common odontogenic cyst?

The radicular (periapical) cyst, an inflammatory cyst arising at the apex of a non-vital tooth.

Which odontogenic cyst is associated with an impacted tooth crown and is the most common developmental odontogenic cyst?

The dentigerous (follicular) cyst, which encloses the crown of an unerupted tooth at the cementoenamel junction.

Which lesion was formerly called odontogenic keratocyst and is now classified as a tumor; what syndrome is it linked to?

Odontogenic keratocyst (now odontogenic keratocystic tumor in older WHO terminology; reclassified as a cyst in 2017); multiple OKCs are associated with Gorlin (nevoid basal cell carcinoma) syndrome. It has a high recurrence rate.

Give an example of a non-odontogenic cyst of the jaws.

Nasopalatine duct (incisive canal) cyst, nasolabial cyst, or globulomaxillary cyst.

What is the most common benign odontogenic tumor and its key behaviors?

Ameloblastoma — locally aggressive, slow-growing, with a high recurrence rate; classically shows a 'soap bubble' or multilocular radiolucency. Treated with wide resection.

What is the most common malignant tumor of the oral cavity?

Squamous cell carcinoma (oral SCC), strongly associated with tobacco and alcohol use.

What is the standard general management approach for odontogenic cysts and benign tumors?

Enucleation (with or without curettage) for cysts/small lesions, marsupialization for large cysts, and resection (marginal or segmental) for aggressive/recurrent tumors like ameloblastoma — always with histopathologic confirmation.

Name the three major paired salivary glands and their primary secretion type.

Parotid (serous), submandibular (mixed, predominantly serous), and sublingual (mixed, predominantly mucous).

What is sialolithiasis and which gland is most commonly affected?

Salivary stone formation; most common in the submandibular gland/Wharton's duct due to its mucous-rich secretion and uphill, tortuous duct course.

What is the most common benign salivary gland tumor and where does it most often occur?

Pleomorphic adenoma (benign mixed tumor), most commonly in the parotid gland.

How is sialolithiasis of the submandibular gland typically managed?

Conservative measures (hydration, sialagogues, gland massage, warm compresses) for small stones; surgical removal (transoral duct stone removal or gland excision) and sialendoscopy for larger or recurrent stones.

Describe the anatomy and classification of the temporomandibular joint (TMJ).

A bilateral synovial, ginglymoarthrodial joint (combining hinge and gliding movement) between the mandibular condyle and the glenoid fossa/articular eminence of the temporal bone, with an interposed fibrocartilaginous articular disc.

What is internal derangement of the TMJ?

An abnormal positional relationship of the articular disc to the condyle and fossa, most commonly anterior disc displacement (with or without reduction), causing clicking, pain, or locking.

How are TMJ disorders diagnosed?

History and clinical exam (pain, clicking, crepitus, range of motion, deviation), palpation, and imaging — MRI for disc position/soft tissue and CT/CBCT for bony changes.

What is the typical first-line (conservative) management of TMJ disorders?

Reversible/conservative therapy: patient education, soft diet, rest, NSAIDs/muscle relaxants, moist heat, physiotherapy, and occlusal splints; surgery (arthrocentesis, arthroscopy, open surgery) reserved for refractory cases.

What is a cleft lip/palate and what is the typical timing of repair?

A congenital craniofacial deformity from failure of fusion of facial/palatal processes; classic 'rule of 10s' guides lip repair (~10 weeks, 10 lb, Hb 10), and palate repair is usually done around 9–18 months.

Name common craniofacial syndromic deformities involving craniosynostosis.

Crouzon syndrome, Apert syndrome, and Treacher Collins syndrome (the latter from first/second branchial arch maldevelopment).

What is the multidisciplinary team approach in craniofacial deformity management?

Coordinated care among oral/maxillofacial surgeons, plastic surgeons, orthodontists, ENT, speech therapists, audiologists, geneticists, pediatricians, and psychologists to address function, aesthetics, speech, and development.

What is distraction osteogenesis in craniofacial surgery?

A technique that gradually lengthens bone by surgically creating an osteotomy and slowly separating the segments with a distractor device, allowing new bone to form in the gap (used for mandibular/midface hypoplasia).

What does an Aldrete or ASA classification assess in surgical planning?

The ASA Physical Status Classification grades a patient's preoperative fitness/medical risk (ASA I healthy to ASA VI brain-dead organ donor); the Aldrete score assesses postoperative recovery from anesthesia.