Oral and Maxillofacial Surgery
What the exam tests
Safe surgical judgement: patient assessment, difficulty prediction, management of third molars, and recognition and first-line handling of complications and infections.
Core rules
- Pre-operative assessment covers medical history, bleeding risk, anticoagulants, bisphosphonate or denosumab exposure, and airway. Anticoagulated patients usually continue therapy with local haemostatic measures after the international normalised ratio is checked.
- Impacted third molars are described by Pell-Gregory depth (A: above cervical line, B: at cervical line, C: below) and ramus relationship (Class I, II, III), plus Winter's angulation. Deep Class C, lingual position and close proximity to the inferior alveolar canal raise nerve risk; cone-beam CT and possible coronectomy are options.
- Odontogenic infection: drain and remove the cause. Ludwig's angina is bilateral submandibular and sublingual cellulitis with tongue elevation and airway threat - secure the airway first, then IV antibiotics and surgical decompression.
- Oroantral communication after maxillary molar extraction: a small defect heals spontaneously; 2-6 mm is closed with a figure-of-eight suture and an acrylic plate; larger defects need flap closure. Never close an infected communication.
- Dry socket is managed by irrigation, debridement and a medicated dressing; antibiotics are not routine.
Worked example
A 40-year-old develops a 4 mm oroantral opening after removal of 26, with no sinus infection. Reasoning: the defect is in the 2-6 mm range and the sinus is not infected, so immediate closure with a figure-of-eight suture over a stable blood clot, an acrylic plate for protection, and instructions not to blow the nose, sneeze with the mouth open or drink through a straw. Review at 7-10 days; a persistent defect needs flap closure.
Traps that cost marks
- Closing a communication over an established sinus infection.
- Treating an abscess with antibiotics and no drainage.
- Overlooking airway signs in bilateral submandibular swelling.