General Surgery and Medicine as Applied to OMFS
General Surgery and Medicine as Applied to OMFS
OMFS patients often have systemic comorbidities that affect surgical planning and anesthesia. You must understand cardiovascular diseases (hypertension, ischemic heart disease, valvular disease), diabetes mellitus, respiratory diseases (asthma, COPD), bleeding disorders, and medication effects (anticoagulants, bisphosphonates). Know the ASA physical status classification and its implications for outpatient surgery. Also, understand wound healing in compromised patients and the principles of antibiotic prophylaxis for infective endocarditis and prosthetic joints.
Traps: Questions often test the management of patients on warfarin or DOACs-know when to stop, bridge, or continue. Another trap is bisphosphonate-related osteonecrosis of the jaw (BRONJ)-risk factors include IV bisphosphonates, duration, and dental extractions. Also, know that uncontrolled diabetes impairs healing and increases infection risk; aim for HbA1c <7% before elective surgery.
Rule of thumb: For patients on anticoagulants, consult with the prescribing physician; do not stop without a plan. For antibiotic prophylaxis, follow AHA guidelines: only for high-risk cardiac conditions.
Worked example: A patient on warfarin for atrial fibrillation needs a tooth extraction. INR is 2.5. Management: check INR within 24 hours; if INR <3.5, proceed with local measures (atraumatic extraction, sutures, hemostatic agents). Do not stop warfarin routinely.