Oral Board Review Flashcards
What causes anosmia after facial trauma?
Cribriform plate fracture damaging olfactory nerves.
Why are acrylic splints used in pediatric trauma?
Provide fixation when teeth are absent or insufficient for arch bars.
When are titanium plates removed in pediatric patients?
Around 2–3 months post-op to reduce growth interference.
What systemic conditions may present with TMJ symptoms?
Rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.
What is the typical IMF duration in children?
1–2 weeks for condylar fractures; 2–3 weeks for other sites.
What is an indication for Gunning splints?
Edentulous patients with mandibular fractures.
What is the main difference in management of pediatric mandibular fractures?
More conservative treatment due to developing dentition and bone growth.
What can mimic entrapment symptoms post-trauma?
Edema or hematoma without true incarceration.
What surgical instrument is used for orbital floor elevation?
Periosteal elevator or balloon dissection.
What indicates need for urgent release of entrapped muscle?
Restricted gaze with oculocardiac reflex.
What muscles are commonly entrapped in orbital floor trauma?
Inferior rectus or inferior oblique.
What is the role of the infraorbital nerve in trauma?
Paresthesia indicates floor or ZMC fracture.
What are signs of orbital apex syndrome?
Vision loss, ophthalmoplegia, and CN II–VI involvement.
What is a risk of posterior table frontal sinus fractures?
Dural tear and CSF leak.
What is the Gonty classification for frontal sinus fracture?
Type 1: Anterior table only; Type 2: Anterior and posterior; Type 3: Posterior only; Type 4: Comminuted.
What are key signs of frontal sinus fracture?
Anterior table step-off, CSF leak, and supraorbital paresthesia.
What imaging helps identify CSF leak in nasal trauma?
Beta-2 transferrin assay and CT of paranasal sinuses.
What causes persistent mobility post-fixation?
Nonunion or hardware failure.
What is the most common complication of mandibular fracture repair?
What test confirms CSF rhinorrhea?
Halo test and beta-2 transferrin.
What is the second most common mandibular fracture site?
Angle of the mandible.
What is the most common site of mandibular fracture?
What is a trapdoor fracture?
Linear, minimally displaced fracture with soft tissue entrapment, typically in children.
What approach provides the least eyelid malposition risk for orbital floor access?
Transconjunctival approach.
What is the oculocardiac reflex and when is it seen?
Bradycardia, nausea, and syncope from muscle entrapment, especially in children.
What is the ideal imaging for facial trauma?
Thin-cut (1 mm) CT scan with axial, coronal, and sagittal reconstructions.
How are isolated arch fractures typically treated?
Closed reduction via Gillies or Keen approach.
What are clinical signs of orbital floor fracture?
Diplopia, enophthalmos, infraorbital numbness, and hypoglobus.
What complication can arise from poor orbital floor reduction?
Enophthalmos due to increased orbital volume.
In ZMC fractures, what is the recommended order of fixation?
Frontozygomatic suture, zygomaticomaxillary buttress, infraorbital rim, orbital floor.
What is Guerin’s sign and what does it indicate?
Ecchymosis in the maxillary vestibule, indicating Le Fort I or ZMC fracture.
What is the minimum number of fixation points for ZMC fracture repair?
Two points of fixation are generally sufficient.
What are signs of ZMC fracture on exam?
Malar flattening, trismus, step deformity, infraorbital paresthesia, and periorbital ecchymosis.
What is the Zingg classification for ZMC fractures?
A1–A3: Incomplete; B: Monofragment; C: Comminuted zygoma.
What is the Knight and North classification used for?
Classifies ZMC fractures based on direction and displacement.
What is the most common type of orbital fracture?
Blowout fracture of the orbital floor.
What is a 'white-eyed' blowout fracture?
Minimal external signs, often seen in children with inferior rectus entrapment and oculocardiac reflex.
What are the criteria for repairing an orbital blowout fracture?
Defect >50% of orbital floor, enophthalmos >2 mm, or diplopia in primary gaze.
What additional nerve is affected in orbital apex syndrome?
CN II, resulting in vision loss.
What cranial nerves are affected in superior orbital fissure syndrome?
CN III, IV, VI, and V1.
How is a retrobulbar hematoma managed emergently?
Lateral canthotomy and cantholysis to decompress the orbit.
What are symptoms of retrobulbar hematoma?
Proptosis, decreased vision, pain, and afferent pupillary defect.
What is the classification used for condylar process fractures?
Wassmund Scheme: I–V based on displacement and capsular integrity.
What is the indication for ORIF in mandibular fractures?
Displaced, comminuted, or unstable fractures; fractures preventing normal occlusion.
How are pediatric condylar fractures typically managed?
Conservative treatment with observation and soft diet, especially in non-displaced fractures.
What is a hallmark sign of bilateral condylar fractures?
Anterior open bite with loss of mandibular projection.
What is the most common cause of condylar fractures?
Indirect trauma to the mandible, such as a blow to the chin.
What are the three types of NOE fractures based on Manson and Markowitz classification?
Type I: Intact medial canthal tendon with non-comminuted central fragment; Type II: Intact tendon with comminuted central fragment; Type III: Avulsed tendon with comminuted central fragment.
What is the significance of the bow-string test in NOE trauma?
It evaluates the integrity of the medial canthal tendon.
What is the most reliable imaging modality for evaluating NOE fractures?
CT scan with 1.5 mm axial and coronal cuts.
What clinical sign indicates medial canthal tendon disruption in NOE fractures?
Traumatic telecanthus, defined by increased intercanthal distance >35 mm.
What is the function of Mitek anchors in TMJ surgery?
To fix the disk to the surrounding tissues in disk plication.
What is Swahney's classification for TMJ ankylosis?
A 4-class system based on extent and type of ankylosis used for surgical planning.
What is the second port landmark in arthrocentesis?
20 mm anterior and 10 mm below the tragus–canthus line.
What structure must be protected during preauricular incision?
Temporal branch of the facial nerve.
What is the landmark for first port of arthrocentesis?
10 mm anterior and 2 mm below the tragus–canthus line.
What is the role of hyaluronic acid in TMJ injection?
Improves lubrication and reduces inflammation.
What is the difference between deviation and deflection in TMJ exam?
Deviation returns to midline; deflection stays off midline.
What medications are useful for TMJ arthralgia?
NSAIDs, low-dose anxiolytics, and muscle relaxants.
What is the gender and age distribution of TMJ osteoarthritis?
More common in females over 50.
What are radiographic findings in TMJ osteoarthritis?
Joint space narrowing, subchondral sclerosis, and osteophytes.
What are signs of extra-articular TMJ hypomobility?
Trismus due to muscle fibrosis, tumors, or myositis ossificans.
How is TMJ osteoarthritis treated?
NSAIDs, physical therapy, injections, or joint replacement.
What is a common clinical sign of TMJ osteoarthritis?
Crepitus and pain that worsens with function.
What radiographic finding may suggest long-standing ankylosis?
Antegonial notching and coronoid hypertrophy.
What is the concern if the jaw is stuck open post-TJR?
Condyle dislocation from fossa requiring urgent reduction.
What muscle may be hypertrophied in chronic TMJ ankylosis?
Masseter, from persistent clenching and strain.
What complications can occur during arthroscopy?
Instrument breakage, hemotympanum, otitis externa/media.
How is disk perforation repaired?
If <3 mm, can be sutured; large or degenerative disks require removal.
What is the typical post-op protocol for condylotomy?
Short-term IMF, elastics, physical therapy, and follow-up imaging.
What is the average joint space volume for injection?
What fluid is used in arthrocentesis and why?
Lactated Ringer's because it mimics human serum and is well tolerated.
What is the rationale for condylotomy?
To unload the joint and allow condylar sag, increasing space and relieving pressure on the disk.
When is discectomy indicated?
Large disk perforation, fragmented or balled-up disk.
How is a disk plicated during arthrotomy?
Sutured posterolaterally to temporalis fascia using a non-resorbable suture or anchor.
What is heterotopic bone formation, and how is it prevented?
Bone forming in soft tissue after TJR; managed by early ROM, radiation, or fat graft.
What are postoperative risks after TJR?
Dislocation, infection, facial nerve injury, heterotopic bone, and malocclusion.
How is postoperative infection after TJR managed?
Superficial infections: drainage and antibiotics; deeper infections: debridement, cultures, and possible removal.
What are the FDA-approved TMJ prostheses?
Biomet® and TMJ Concepts®.
What are the indications for total joint replacement (TJR)?
Severe arthritis, failed prior surgeries, ankylosis, loss of vertical height, pathology, and agenesis.
What is the treatment for true TMJ ankylosis?
Surgical resection of the ankylotic mass with reconstruction using prosthesis or graft.
What are signs of true TMJ ankylosis?
Severely limited opening, firm preauricular mass, and radiographic bony fusion.
What imaging best identifies ankylosis extent?
Contrast-enhanced CT of the maxillofacial region.
What are types of TMJ ankylosis?
Fibrous and bony; intra-articular (true) and extra-articular (false).
What are causes of TMJ ankylosis?
Trauma, infection, arthritis, otitis media, prolonged immobilization, or surgery.
What is the purpose of arthroscopy in TMJ treatment?
Diagnose internal derangement, lyse adhesions, and perform minimally invasive surgery.
What is the Holmlund-Hellsing line used for?
Guides needle placement for arthrocentesis.
What agents may be injected after arthrocentesis?
Steroids, hyaluronic acid, morphine, and bupivacaine.
What is the preferred solution for TMJ lavage?
Lactated Ringer’s; 100–300 mL recommended.
What are contraindications for arthrocentesis?
Ankylosis, local infection, and inability to identify joint landmarks.
When is flap inset orientation adjusted?
Based on mucosal vs cutaneous defect and side of reconstruction.
What is arthrocentesis and when is it indicated?
Joint lavage procedure for acute closed lock, TMJ arthralgia, and Wilkes I–III.
What imaging is most useful for TMJ internal derangement?
MRI T1 and T2 views to assess disk position, shape, and osseous changes.
What is Wilkes stage III?
Frequent pain, limited range of motion, disk deformity, and no osseous changes.
What is Wilkes stage I?
Painless clicking with normal disk contour and no osseous changes.
What is the Wilkes classification used for?
It classifies internal derangement stages from I (mild) to V (severe) and guides treatment options.
What are signs of disk displacement without reduction?
Limited opening, deviation to the ipsilateral side, and restricted contralateral excursion.
How is disk displacement with reduction identified?
A click is heard during mouth opening as the condyle passes over the posterior portion of the displaced disk.
What are common causes of TMJ internal derangement?
Trauma, joint laxity, parafunctional habits, altered lubrication, disk adhesion, and myofascial pain disorder.
Why is implant placement challenging in fibula flaps?
Limited vertical height of the fibula bone.