The primary indication for this type of surgery is a

painful TMJ with a reducing disc.

Condylotomy of the TMJ

- create a fracture then put them in guiding elastics

Describe the following fractures in terms of the areas of the face they include:

Le Fort 1

Le Fort II

Le Fort III

Le Fort I: midface horizontal fracture, above maxilla and below nose

Le Fort II: Pyramidal, up through the zygomatico-maxillary suture and through the nose

Le Fort III: Craniofacial dysjunction, through frontal zygomatico suture, floor of orbit, orbital wall, and across the nose

A tennis ball to the eye may result in this type of fracture, characterized by damage to the floor of the orbit and dropping of its contents into the maxillary sinus.

Blowout fracture

What is the Caldwell-Luc approach used to treat?

Midface fractures

- especially blowout fractures where contents of orbit have fallen into max sinus

- intraoral approach where mesh is placed to raise up the eye

What is enopthalmos?

What kind of vision does it result in?

It is a recession of the eye within the orbit, such as in a blowout fracture.

It may result in diploplia, or double vision.

Which mechanism of bone formation is BMP2 used for?

A. Osteoinduction

B. Osteoconduction

C. Osteogenesis

A. Osteoinduction

- BMP2 is an osteoinductive agent used to transform connective tissue cells into osteocompetent cells.

Which mechanism of new bone formation uses transplanted osteocompetent cells?

Osteogenesis

- osteocompetenet = osteoblasts

List 2 examples each of alloplastic and allogenic cribs.

Alloplastic:

 dacron-coated polyurethane, titanium, stainless steel

Allogenic:

split-thickness ribs, ileum

For every cm of bone needed for reconstruction, how many cc's of uncompressed harvested bone are needed?

For every 1 cm of space needed to fill, about 10 cc of uncompressed cancellous bone is needed.

How many cc's of uncompressed cancellous bone can be harvested from the anterior iliac crest?

The posterior iliac crest?

Anterior: 50 cc

Posterior: 100-110 cc

Maintaining airway and cervical fracture are the major concerns in maxillofacial injury.

When could you use an oropharyngeal airway and when could you use a nasopharyngeal airway to help a patient breathe?

oropharyngeal airway - unconscious patieint

nasopharyngeal - conscious patient

Cricothyroidectomy is indicated in emergencies when proper surgical equipment is not around. What surgical procedures are indicated when pt cannot breathe in a hospital situation?

Endotracheal intubation - extensive soft tissue injury/artificial ventilation

- also for unstable flail chest

Tracheotomy/Tracheostomy - for prolonged artificial ventilation, in case of serious hemorrhage to airway, to facilitate anesthesia for surgical repair

Which indicates a poor prognosis on the Glasgow Coma Scale, a low or a high score?

low score (8 or less) = poor prognosis

mild head injury = 13-15

- scale measures eye, motor, and verbal response to speech and pain, and spontaneous or no response

"Battle sign" is associated with which type of head injury?

Raccoon eyes?

battle sign - Basilar skull fracture

raccoon eyes - ecchymosis in LeFort III fracture

What type of fracture should be suspected with a patient presenting with anesthesia of unilateral upper lip, nasal mucosa at the vestibule, lower eyelid, and maxillary teeth upon palpation?

Ipsilateral fracture of orbital rim

or

blowout fracture

What is hyphema?

Blood in anterior chamber of the eye

- constitutes ophthalmic emergency

- correlates with significant loss of vision

- teardrop shaped pupil indicates ruptured or penetrated globe

What type of radiograph would be used to visualize a blowout fracture?

Zygomatic arch fractures?

 blowout - Waters view

zygomatic arch - SMV or "jug handle"

- CT also good for midface fractures

True or false?

The intercanthal distance should be half of the interpupillary distance.

True

- white men33-34 mm

- white women 32-33 mm

What is the most common cause of mandibular fractures?

Trauma (99%)

- pathology ~1%

What is the difference between a simple and a compound mandibular fracture?

Simple - no communication between intraoral and extraoral environment

Compound - communication present

* any frx through a tooth socket condsidered compound

What is the difference between a comminuted and complicated mandibular fracture?

Comminuted - occurs in pieces (i.e. gunshot wound)

Complicated - involves vital structure

What is the most commonly broken part of the mandible?

A. coronoid process

B. symphysis

C. condyle

D. ramus

E. angle

C. condyle

then angle, then symphysis

- least common is coronoid process

What is a good radiograph to take for a mandibular symphyseal fracture?

Occlusal radiograph

What extraoral radiographic film would be used to visualize condylar neck fractures?

Reverse Towne

The acronym AWSHIT is used to remember the sequence of general preliminary care for mandibular fractures. What does it stand for?

Air

Way

Shock

Hemmorhage

Intrathoracic, Cranial, Abdominal (bleeding)

Teeth

Most mandibular fractures should be reduced and immobilized for how long?

What is the exception?

Most should be immobilized for 6 weeks

- condylar fractures should be less, to avoid ankylosis

True or False?

Overfill or escape of cement from a root canal is an indication for an apicoectomy.

False

- only if associated with persistent pain, check occlusion first

True or False?

Apical resorption with vital pulp is an indication for an apicoectomy.

True

- area should be biopsied

- need for biopsy of apical tissues is an indication for an apico (paresthesia, history of malignancy, area that does not resolve or enlarges, etc.)

True or False?

When retrofilling with amalgam, you should bevel the apex of the root at a 45 degree angle for retention.

False

- old method, too many dentinal tubules exposed

- now we cut straight across at 90 degrees

When using an ultrasonic instrument to prepare an apicoectomy, you should remove _____ mm of gutta percha from the tip and avoid cutting with pressure.

2-3 mm

What is the aim of using a root end filling material for apicoectomies?

Which of the following materials has the highest success rate as a root end filling material?

A. Amalgam

B. IRM

C. Super EBA

Aim is to inihibit leakage of residual bacteria and irritants.

C. Super EBA

- has 95% success rate

- excellent marginal integrity

What is an advantage of using microsurgery for apicoectomies?

A disadvantage?

advantage: smaller instruments means less bone loss and better crown:root long-term

disadvantage: ex$pen$ive to set up in office

Which type of TMJ disorder has limited opening (particularly translation) without any clicking noises?

A. Disc displacement with reduction

B. Disc displacement without reduction

B. Disc displacement without reduction

Name 5 different surgical management techniques for TMJ disorders

Arthrocentesis 

- lavage, good for acute closed lock of TMJ

Operative Arthroscopy

- scope into joint and do lavage (gold standard)

Arthroplasty

- similar to arthroscopy, open joint surgically

Condylotomy

- fracture condyle and displace ant and inf in glenoid

Total Joint Reconstruction

- with prosthesis, when anatomy not salvagable