BDS Oral and Maxillofacial Surgery Flashcards

24 sample cards from the Oral and Maxillofacial Surgery deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. Differentiate primary, secondary, and tertiary intention wound healing.

   Primary: wound edges approximated directly (sutured). Secondary: wound left open to granulate and contract. Tertiary (delayed primary): wound left open initially, then closed after a few days (e.g., contaminated wounds).

2. What are the two basic techniques for tooth extraction?

   Intra-alveolar (forceps/elevator) extraction — 'closed' or simple; and trans-alveolar (surgical/open) extraction — raising a flap and removing bone/tooth division.

3. State the three principal movements used to luxate and deliver a tooth with forceps.

   Apical pressure (to expand the socket and shift the centre of rotation), buccolingual/labiopalatal rocking, and rotation (for single-rounded-rooted teeth like maxillary incisors).

4. What are the three orders of the lever/elevator principle used in extractions?

   First-order lever (fulcrum between load and effort), wheel-and-axle, and wedge principles — elevators use these to expand bone and displace the tooth.

5. Name three common indications for the removal of a tooth.

   Gross caries/unrestorable tooth, advanced periodontal disease with mobility, and impaction/pericoronitis; also orthodontic, pre-prosthetic, or focus-of-infection reasons.

6. What is a dry socket (alveolar osteitis), and when does it typically present after extraction?

   A painful post-extraction complication from breakdown/loss of the blood clot exposing bone, typically presenting 3–5 days after extraction, most common after lower third molar removal.

7. State the Le Fort classification of mid-face fractures.

   Le Fort I: horizontal, above the teeth apices (floating palate). Le Fort II: pyramidal, through the nasal bones and infraorbital rims. Le Fort III: craniofacial disjunction, separating the facial skeleton from the cranial base.

8. What is the commonest site of mandibular fracture, and what associated fracture is often present?

   The condyle/subcondylar region and the angle are common; fractures are frequently bilateral — e.g., a parasymphyseal fracture on one side with a contralateral condylar fracture (a 'guardsman's fracture' pattern with symphysis and both condyles).

9. What are the two main principles guiding fracture treatment in maxillofacial trauma?

   Reduction (restoring anatomical alignment and occlusion) and fixation/immobilisation (holding the reduction) — achieved by open reduction and internal fixation (ORIF) with plates or closed reduction with intermaxillary fixation (IMF).

10. Define orthognathic surgery.

    Surgery to correct dentofacial skeletal deformities by repositioning the maxilla, mandible, and/or chin to establish normal occlusion, function, and facial aesthetics — usually combined with orthodontics.

11. Name the standard osteotomy used to reposition the mandible in orthognathic surgery.

    The bilateral sagittal split osteotomy (BSSO) of the mandibular ramus, allowing advancement or setback.

12. Which osteotomy is used to reposition the maxilla in orthognathic surgery?

    The Le Fort I osteotomy, allowing the maxilla to be advanced, impacted, or downgrafted.

13. What is a genioplasty?

    An osteotomy of the chin (mandibular symphysis) to reposition the chin point (advancement, setback, vertical change, or asymmetry correction) for aesthetic/functional balance.

14. Distinguish an autograft, allograft, and xenograft in reconstructive surgery.

    Autograft: tissue from the same individual. Allograft: from another individual of the same species. Xenograft: from a different species. Autografts avoid rejection and are the gold standard.

15. What is a free flap (free tissue transfer) in maxillofacial reconstruction?

    Tissue detached with its vascular pedicle and re-anastomosed microsurgically to recipient vessels — e.g., the fibula free flap for mandibular reconstruction.

16. Which free flap is considered the workhorse for mandibular reconstruction and why?

    The fibula free flap — it provides a long segment of vascularised bone that can be osteotomised to contour the mandible and support dental implants, with a reliable pedicle (peroneal vessels).

17. Give three examples of intraoperative complications during OMFS procedures.

    Haemorrhage, nerve injury (e.g., inferior alveolar or lingual nerve), fracture of the mandible or maxillary tuberosity, damage to adjacent teeth, and displacement of a tooth/root (e.g., into the maxillary sinus or submandibular space).

18. What intraoperative complication can occur when extracting an upper molar with roots close to the antrum?

    Oroantral communication/fistula — a pathological connection between the mouth and maxillary sinus, and possible root displacement into the sinus.

19. List three important postoperative complications after maxillofacial surgery.

    Infection, haemorrhage/haematoma, swelling and trismus, wound dehiscence, nerve paraesthesia/anaesthesia, and delayed/non-union of osteotomies or fractures.

20. Differentiate primary, reactionary, and secondary post-extraction haemorrhage by timing.

    Primary: at the time of surgery. Reactionary: within a few hours (as vasoconstriction/anaesthetic effect wears off). Secondary: several days later, usually due to infection eroding a vessel/clot.

21. Outline the general management of a wound/surgical infection after OMFS.

    Establish drainage (incision and drainage of any collection), remove the source, take cultures, and give appropriate antibiotics; support with analgesia, hydration, and treat any airway compromise urgently.

22. What is the immediate management of an oroantral communication smaller than about 2 mm versus a larger one?

    Small (<2 mm): often heals spontaneously — encourage clot, avoid nose-blowing, antibiotics/decongestants. Larger (>~3–5 mm) or established fistula: surgical closure with a flap (e.g., buccal advancement or palatal rotation flap).

23. Classify pain as acute versus chronic and give the usual time distinction.

    Acute pain has recent onset, is protective, and resolves with healing (typically <3 months). Chronic pain persists beyond expected healing (>3 months) and may lack ongoing tissue damage.

24. Differentiate nociceptive, neuropathic, and psychogenic pain relevant to OMFS.

    Nociceptive: from actual tissue damage/inflammation (e.g., pulpitis, post-op pain). Neuropathic: from nerve injury/dysfunction (e.g., trigeminal neuralgia, post-surgical paraesthesia/dysaesthesia). Psychogenic: pain influenced predominantly by psychological factors (e.g., atypical facial pain).

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