Oral and Maxillofacial Surgery Flashcards

A trauma patient presents with mobility of the entire midface, including the zygomatic complex, resulting in a 'dish-face' deformity and craniofacial dysjunction. When the maxilla is grasped, the entire facial skeleton moves. This clinical presentation corresponds to which Le Fort fracture classification?

Answer: Le Fort III

A Le Fort III fracture, also known as craniofacial dysjunction, is the most severe type, involving a transverse fracture line that passes through the nasofrontal suture, maxillo-frontal suture, orbital wall, and zygomatic arch. This results in the complete separation of the facial bones from the cranial base, leading to the mobility of the entire face.

A 25-year-old female presents with a chief complaint of a 'long face' and inability to close her lips together without straining. Clinical examination reveals excessive gingival display upon smiling, a steep mandibular plane angle, and an anterior open bite. Which surgical procedure is most indicated to correct this vertical maxillary excess?

Answer: Le Fort I Osteotomy with impaction

A Le Fort I osteotomy allows for the entire maxilla to be repositioned. In cases of vertical maxillary excess ('long face syndrome'), the maxilla is moved superiorly (impaction) to reduce the facial height, correct the gummy smile, and allow for autorotation of the mandible to close the anterior open bite.

During the extraction of a maxillary first molar, a 2mm oroantral communication (OAC) is created. The patient is healthy with no history of sinus disease. Which of the following is the most appropriate immediate management?

Answer: Advise sinus precautions and allow for spontaneous closure.

For small oroantral communications (generally considered less than 2-3 mm) in a healthy patient, the most common approach is conservative management. This involves ensuring a stable blood clot forms in the socket and advising the patient on sinus precautions (e.g., no nose blowing, sneezing with the mouth open) to avoid dislodging the clot. Spontaneous healing is highly likely.

A 30-year-old patient reports a history of painful clicking in the right temporomandibular joint. Today, she presents with an inability to open her mouth more than 25 mm, and the mandible deviates to the right upon opening. The painful click is no longer present. This clinical presentation is most characteristic of which condition?

Answer: Disc displacement without reduction

The history of a click (indicating the disc was displacing and then reducing) that has now disappeared, combined with a sudden onset of limited opening (closed lock) and deviation of the mandible toward the affected side, is the classic presentation of anterior disc displacement without reduction.

Which of the following is the most critical factor for achieving successful primary osseointegration of a dental implant?

Answer: The primary stability of the implant at the time of insertion.

Primary stability refers to the initial mechanical stability of the implant in the bone immediately following placement. It is widely considered the most critical prerequisite for osseointegration because it prevents micromotion at the bone-implant interface, which would otherwise lead to the formation of fibrous tissue instead of direct bone-to-implant contact.

A 65-year-old male patient with well-controlled type 2 diabetes and hypertension is scheduled for multiple extractions under IV sedation. He takes metformin and lisinopril daily and has no other systemic symptoms or functional limitations. According to the American Society of Anesthesiologists (ASA) Physical Status Classification System, how would this patient be classified?

Answer: ASA II

An ASA II classification is for a patient with mild systemic disease that is well-controlled and does not cause substantive functional limitations. Well-controlled type 2 diabetes and hypertension fit this definition. ASA I is a normal healthy patient, ASA III involves severe systemic disease, and ASA IV is a patient with severe systemic disease that is a constant threat to life.