Oral and Maxillofacial Surgery: Emergencies, Trauma and Infection
Oral and Maxillofacial Surgery in the MDCN assessment tests emergency recognition and safe referral: odontogenic infection, maxillofacial trauma, cysts and tumours, temporomandibular joint problems, and salivary gland disease. The exam favours airway-first thinking and clear criteria for admission over detailed operative steps.
Odontogenic infection
Assess airway, swelling, trismus, dysphagia, drooling, fever, and systemic upset. Dangerous spaces include sublingual and submandibular spaces (Ludwig's angina), canine fossa, buccal, pterygomandibular, and temporal spaces. Principles are secure the airway, give intravenous antibiotics according to local protocol, incise and drain, and remove the causative tooth when safe.
Maxillofacial trauma
Follow ATLS priorities: airway, cervical spine, and haemorrhage. For midface fractures, check for a mobile segment, malocclusion, infraorbital numbness, and CSF rhinorrhoea. For mandibular fractures, check occlusion and look for condylar, angle, and parasymphyseal fractures. Document cranial nerve status before and after intervention.
Worked example
A patient has floor-of-mouth swelling, tongue elevation, drooling, and fever of 39°C. The reasoning is Ludwig's angina with airway threat: urgent admission, anaesthetic review, intravenous amoxicillin-clavulanate plus metronidazole (or local protocol), and drainage of the submandibular and sublingual spaces. Extract the cause only once the airway is secure.
Traps that cost marks
- Prescribing oral antibiotics and discharging a patient with trismus and dysphagia.
- Missing a condylar fracture because a panoramic radiograph looks normal.
- Forgetting to record cranial nerve examination and occlusion.