Oral and Maxillofacial Surgery
Oral and Maxillofacial Surgery
This domain covers the core surgical procedures: exodontia, biopsy techniques, management of odontogenic infections, cyst and tumor enucleation, and implantology. You must know the indications, contraindications, and complications of each. For third molar surgery, understand the classification (Winter's, Pell & Gregory), the surgical steps, and the management of complications like dry socket, nerve injury, and hemorrhage. Biopsy principles: incisional vs excisional, fine-needle aspiration, and the importance of sending specimens for histopathology.
Traps: Questions often ask about the most common complication of third molar surgery (dry socket) or the nerve most commonly injured (inferior alveolar nerve). Another trap is the management of osteomyelitis-antibiotics alone are insufficient; surgical debridement is often needed. In implantology, know the difference between immediate, early, and delayed placement, and the concept of osseointegration.
Rule of thumb: For any swelling in the maxillofacial region, always consider the source (odontogenic vs non-odontogenic) and the spaces involved. For incision and drainage, place the incision in a dependent area and in a esthetic line (e.g., along the mandibular border).
Worked example: A patient presents with a swelling in the submandibular space and trismus. The most likely source is a mandibular molar. Treatment includes antibiotics, incision and drainage, and removal of the offending tooth. The submandibular space is bounded by the mandible, hyoid, and digastric muscles.