Oral and Maxillofacial Surgery
Oral and maxillofacial surgery questions favour complications, anatomy and the correct sequence of management.
Exodontia and third molars
- Third molars are described by Pell and Gregory depth A-C and ramus relation I-III, plus Winter's angulation.
- Complications: dry socket with clot loss on days 3-5, treated by irrigation and dressing, not curettage; bleeding; oroantral communication; inferior alveolar or lingual nerve injury; root displacement into the sinus.
- Ludwig angina: bilateral submandibular, sublingual and submental swelling from a lower molar with tongue elevation and airway risk; intravenous antibiotics and surgical drainage, not extraction alone.
Trauma and reconstruction
- Le Fort I is low, through the maxilla above the apices and pterygoid plates; Le Fort II is pyramidal through the nasal bones; Le Fort III is craniofacial dysjunction.
- Mandibular angle fractures are fixed along Champy's line on the external oblique ridge, with attention to the inferior alveolar nerve.
- Condylar fractures are managed by observation, closed treatment or open reduction depending on displacement and occlusion.
Pathology and medication
- Cysts are enucleated, or marsupialised when large and near vital structures.
- MRONJ: conservative debridement, antibiotics and risk-factor cessation, with AAOMS staging guiding surgery.
- Incisional biopsy for large lesions, excisional for small ones, with margins for suspected malignancy.
Worked example
A 28-year-old has a parasymphyseal and angle fracture after a road accident, with altered occlusion and lip numbness. The angle fracture runs through the canal and the numbness indicates inferior alveolar nerve involvement. Fixation with a single miniplate on the external oblique ridge after establishing occlusion addresses the tension side; the inferior border is the compression band.
Traps
Curetting a dry socket; ignoring airway signs in Ludwig angina; mislabelling Le Fort levels; extracting a third molar without assessing nerve proximity; delaying antibiotics in a fascial space infection.