Oral and Maxillofacial Surgery
This domain covers exodontia, surgical complications, odontogenic infection, maxillofacial trauma and basic implant or preprosthetic principles. The exam tests safe decision-making more than operative minutiae.
Assessment and exodontia
- Obtain medical history, including anticoagulants, antiplatelets, bisphosphonates, diabetes and previous radiotherapy. Take a radiograph and explain risks: bleeding, bruising, dry socket, nerve injury and sinus communication.
- Use adequate anaesthesia, a planned flap, controlled bone removal and tooth sectioning for impacted teeth. Sutures should appose tissue without tension.
Infection and complications
- Odontogenic infection spreads through fascial spaces. Ludwig's angina is bilateral submandibular and sublingual cellulitis with a raised floor of mouth, dysphagia and airway risk; it is an emergency.
- Dry socket presents with severe pain three to five days after extraction, empty socket and exposed bone. Treat by irrigation and a medicated dressing.
- Nerve injury may involve the inferior alveolar or lingual nerve. Bleeding is managed with pressure, local measures and reversal of anticoagulation only after consultation.
Worked example
A patient has a lower molar abscess with submandibular swelling, raised floor of mouth and difficulty swallowing. Reasoning: bilateral floor-of-mouth involvement and airway symptoms indicate Ludwig's angina. The priority is airway assessment, urgent drainage and intravenous antibiotics, not oral antibiotics alone.
Traps that cost marks
Antibiotics do not replace drainage or removal of the source. Not every impacted third molar needs removal. Do not extract in severe acute infection without considering drainage first. Bisphosphonate history matters for osteonecrosis. Consent and documentation are part of surgical care.