Oral and Maxillofacial Surgery
What the exam tests
Oral and Maxillofacial Surgery tests safe assessment, extraction planning, complication management, trauma priorities, and appropriate referral. The exam rewards systematic ABCDE-style thinking and documentation of consent and nerve risk.
Core rules
- Assess airway, breathing, circulation, disability, and exposure first in trauma; then examine the face, occlusion, TMJ, sensation, and dentition.
- For third molars, decide whether removal is justified by pathology, caries, periodontal disease, orthodontic need, or prosthodontic need. Document inferior alveolar nerve proximity; use CBCT when the panoramic image suggests intimate contact.
- For surgical extraction, plan flap design, bone removal, tooth sectioning, and haemostasis. Warn about pain, swelling, bruising, trismus, bleeding, infection, dry socket, and nerve injury.
- Manage bleeding with pressure, local measures, and sutures; investigate anticoagulants. Dry socket needs irrigation and a dressing, not repeated antibiotics.
- In mandibular fractures, assess occlusion and condylar status; a unilateral angle fracture may show a step, malocclusion, and lip paraesthesia.
- Prescribe antibiotics when indicated by spreading infection or systemic involvement, alongside drainage.
Worked example
A 28-year-old presents after an assault with limited opening, malocclusion, a step at the right mandibular angle, and numbness of the right lower lip. The priorities are airway and cervical spine, analgesia, and imaging (CT). The step and paraesthesia suggest a displaced angle fracture. Plan: document nerve status, consider IV antibiotics if compound, provide soft diet and analgesia, and refer for open reduction and internal fixation or closed management according to displacement and occlusion. Reassess occlusion and sensation.
Traps
- Missing a condylar fracture when the angle is obvious.
- Extracting a third molar without documenting nerve risk.
- Treating dry socket with systemic antibiotics alone.
- Ignoring airway compromise in spreading infection.