Oral and Maxillofacial Surgery and Anesthesia
Oral and Maxillofacial Surgery and Anesthesia tests extraction technique, complications, odontogenic infection, trauma, temporomandibular disorders, local anesthesia and sedation safety.
Core concepts
- Forceps extraction uses expansion, rotation and traction; the mandibular third molar is the most commonly impacted tooth.
- Dry socket (alveolar osteitis) presents 2–4 days after extraction with severe pain and an empty socket; treatment is irrigation and a medicated dressing, not routine antibiotics.
- Odontogenic infections spread along fascial planes. Ludwig angina involves bilateral submandibular, sublingual and submental spaces, with floor-of-mouth elevation and airway risk. Airway assessment comes before extraction.
- Maxillary fractures: Le Fort I is a low transverse fracture, II is pyramidal, and III is craniofacial dysjunction.
- Local anesthesia complications include syncope, needle breakage, hematoma, nerve injury, trismus and infection.
- ASA classification guides sedation risk; malignant hyperthermia is linked to succinylcholine and volatile anesthetics.
Worked example
A patient with a swollen floor of the mouth, drooling and fever after a lower molar infection needs urgent airway evaluation and drainage. Reasoning: Ludwig angina is a clinical diagnosis; antibiotics alone are insufficient when airway compromise is possible.
Traps
Do not extract an acutely infected tooth without considering drainage and airway. Do not confuse dry socket with osteomyelitis. Do not give a mandibular block without aspirating. Do not overlook anticoagulant and bisphosphonate history.