Oral and Maxillofacial Surgery
Oral and Maxillofacial Surgery tests extraction technique, impacted teeth, local anesthesia, odontogenic infection, trauma, and complications. Questions often ask for the next step or the structure at risk.
Core rules
- Inferior alveolar nerve runs in the mandibular canal; third molar roots with close radiographic proximity increase risk of paresthesia.
- Lingual nerve lies close to the lingual plate in the third molar region and can be injured by lingual retraction or flap design.
- Ludwig angina is bilateral submandibular and sublingual swelling with elevation of the tongue and airway risk; urgent airway and IV antibiotics are needed.
- Le Fort I fracture separates the maxilla at the pterygomaxillary junction and nasal floor; Le Fort II is pyramidal; Le Fort III is craniofacial separation.
- Dry socket presents with severe pain days after extraction and an empty socket; treatment is irrigation and dressing, not antibiotics alone.
Worked example
A mandibular third molar is horizontally impacted with roots overlapping the mandibular canal on panoramic radiograph. During extraction the patient reports lip numbness. The most likely cause is inferior alveolar nerve trauma. The radiographic overlap identifies risk, and sudden numbness during elevation suggests nerve contact. Management includes documenting the deficit, avoiding further manipulation, and follow-up; most sensory deficits improve over weeks to months.
Traps
- Do not confuse dry socket with infection; dry socket lacks pus and occurs 2-4 days after extraction.
- Lingual nerve injury causes tongue numbness and taste change, not facial palsy.
- In Ludwig angina, do not wait for fluctuation before airway protection.
- Maxillary third molar roots may enter the maxillary sinus; check for oroantral communication.