OS

Oral Surgery — 30-Min Notes (Expanded)

Indications: caries, fracture, periodontal disease, orthodontic reasons. Proper case selection prevents complications.
Principles: atraumatic technique, adequate anesthesia, proper leverage, and tooth elevation.
Complications: dry socket, infection, nerve injury (esp. inferior alveolar nerve), bleeding. Early recognition ensures prompt management.
Maxillary sinus: Upper molars close to sinus → risk of oroantral communication.
Pre-op assessment: radiographs, medical history, coagulation status.
Forceps selection: choose correct shape for tooth and root morphology.
Post-op care: ice packs, soft diet, analgesics; sutures if needed.
Tip: Always check for retained root fragments after extraction.
High-yield: mandibular 3rd molars → most common extraction complications.

Indications: impacted teeth, fractured roots, malpositioned teeth. Requires flap reflection, bone removal, and sectioning if necessary.
Flap designs: envelope, triangular, or trapezoidal depending on access.
Bone removal: minimal to prevent weakening of jaw; use round bur or chisel carefully.
Tooth sectioning: multi-rooted teeth may need sectioning for atraumatic removal.
Hemostasis: pressure, sutures, local agents like oxidized cellulose.
Post-op instructions: avoid vigorous rinsing, smoking; monitor for infection.
Healing: primary intention preferred; secondary if open socket.
Tip: Surgical extraction reduces risk of root fracture compared to forceps alone.
High-yield: impacted mandibular 3rd molars → post-op trismus, paresthesia.

Mandibular fractures: dentate (use arch bars, IMF) vs edentulous (plates, reconstruction). Stabilization is key.
Midface fractures: Le Fort I, II, III; zygomatic complex fractures. Step deformity, mobility, malocclusion are clinical signs.
Diagnosis: radiographs (OPG, CBCT) + clinical exam.
Soft tissue injuries: irrigation, debridement, layered closure prevents infection and scarring.
Open fractures: early antibiotics, surgical fixation to prevent osteomyelitis.
Complications: malunion, nonunion, infection, nerve injury.
Tip: Always assess airway and hemodynamic stability first in trauma patients.
High-yield: condylar fractures → conservative management if mild displacement; surgery if functional deficit.
Arch bar fixation: commonly used in dentate fractures for occlusal stability.

Odontogenic infections: pulpitis → abscess → cellulitis; spreads via fascial spaces.
Ludwig’s angina: bilateral submandibular space infection; can compromise airway → emergency management.
Common bacteria: Streptococcus, Staphylococcus, anaerobes.
Management: incision & drainage, antibiotics (penicillin + metronidazole), analgesics.
Airway: priority in deep neck infections; may need tracheostomy in severe cases.
Complications: sepsis, mediastinitis, osteomyelitis if untreated.
Tip: Submandibular space infections often originate from mandibular molars.
High-yield: prompt drainage reduces risk of systemic spread.
High-yield: posterior maxillary infections → can involve orbit or cavernous sinus.

Odontogenic cysts: radicular (most common, non-vital tooth), dentigerous (impacted teeth), keratocyst (high recurrence, aggressive).
Benign tumors: ameloblastoma (expansile, multilocular), odontoma (most common odontogenic tumor, usually asymptomatic).
Malignant lesions: squamous cell carcinoma common; non-healing ulcer, bleeding, induration.
Radiographic features: unilocular vs multilocular, cortical expansion, root resorption.
Management: surgical enucleation, marsupialization for cysts; excision ± reconstruction for tumors.
High-yield: keratocyst → recurrence rate high → long-term follow-up essential.
Tip: Always biopsy suspicious lesions to rule out malignancy.
High-yield: radicular cyst → most common odontogenic cyst in adults.
High-yield: dentigerous cyst → associated with impacted 3rd molars or canines.

Causes: trauma, parafunction (bruxism), arthritis, disk displacement.
Symptoms: pain, clicking, crepitus, limited mouth opening, deviation on opening.
Management: conservative first — soft diet, physiotherapy, occlusal splints; surgery if refractory.
High-yield: anterior disk displacement → clicking if with reduction, limited opening if without reduction.
Imaging: MRI gold standard for soft tissue (disk) evaluation.
Tip: Avoid overuse of NSAIDs long-term; consider alternative analgesics.
Other causes: myofascial pain, osteoarthritis, trauma.
High-yield: arthrocentesis or arthroscopy indicated if conservative therapy fails.
Rehabilitation: jaw exercises post-treatment for mobility improvement.

Soft tissue injuries: manage hemorrhage, irrigate, debride, suture layers properly.
Dental trauma: luxation, avulsion, crown/root fractures.
Permanent teeth avulsion: replant ASAP; store in HBSS, milk, or saliva if delayed.
Primary teeth avulsion: do not replant; risk damaging permanent tooth germ.
Fractured alveolar bone: stabilize with splints or arch bars.
High-yield: concussion vs subluxation vs extrusion — differentiate for management.
Tip: Monitor for pulp necrosis or root resorption post-trauma.
High-yield: prompt replantation improves prognosis for avulsed permanent teeth.
Follow-up: radiographs at 1, 3, 6 months for healing assessment.

Local anesthesia: infiltration vs nerve block; lidocaine 2% + epinephrine common; max dose 7 mg/kg.
Topical anesthesia: benzocaine, lignocaine gel for mucosal procedures.
Hemostasis: pressure, sutures, topical agents (oxidized cellulose, thrombin), systemic correction if coagulopathy.
Systemic conditions: liver disease, hemophilia → consult before surgery.
High-yield: monitor for allergic reactions, especially with ester-type anesthetics.
Tip: Always aspirate before injection to avoid intravascular injection.
Post-op: avoid anticoagulants, control hypertension if possible for bleeding prevention.
Local infiltration preferred for minor procedures; nerve block for major extractions/surgery.
Emergency: keep reversal agents, oxygen, and epinephrine ready in clinic.

Impacted mandibular 3rd molars → common post-op complications (trismus, paresthesia)
Maxillary molars → sinus proximity
Ludwig’s angina → airway first
Radicular cyst → most common odontogenic cyst
Avulsed permanent teeth → replant ASAP
Flap, bone removal, tooth sectioning → surgical extractions
Soft tissue laceration → layered closure
Mandibular condylar fractures → conservative if mild, surgery if functional deficit
Kerato-odontogenic cyst → high recurrence → long-term follow-up
Dental trauma follow-up → monitor pulp vitality & root resorption

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