7.17.24

Quick Review #181 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental #mxillofcil

The study “What Is the Relationship Between Maxillofacial Injury Location and Associated Injuries?” by Färkkilä et al. (2024) investigates the relationship between specific maxillofacial injury locations and the incidence of associated injuries.

1. Upper Face Injuries:

• Frontal and Orbital Regions: 68% of patients with fractures in the frontal and orbital regions had associated cranial and intracranial injuries. This high percentage highlights the need for thorough neurological assessments in these patients (Ellis & Zide, 1995).

• Statistics: Specifically, 45% had intracranial hemorrhages, and 23% had skull fractures (Färkkilä et al., 2024).

2. Midface Injuries:

• Zygomatic Complex and Maxilla: 54% of midface fracture cases had associated ocular injuries. These often included orbital floor fractures, which occurred in 38% of these cases (Manson & Hoopes, 1990).

• Ocular Damage: 20% of these patients experienced significant ocular damage requiring ophthalmologic intervention (Färkkilä et al., 2024).

3. Lower Face Injuries:

• Mandibular Fractures: 35% of patients with mandibular fractures had concurrent cervical spine injuries. This finding underscores the importance of cervical spine evaluation in mandibular trauma cases (Fonseca & Walker, 2013).

• Statistics: Additionally, 15% had spinal fractures, and 20% had cervical soft tissue injuries (Färkkilä et al., 2024).

4. Nasal Injuries:

• Less Severe Systemic Injuries: While nasal fractures were common, only 12% of these cases had severe systemic injuries. However, 40% of nasal fracture cases also presented with other facial fractures (Färkkilä et al., 2024).

• Statistics: Among these, 25% had associated maxillary fractures and 15% had zygomatic fractures (Färkkilä et al., 2024).

5. Multiple Injuries:

• Higher Incidence of Systemic Injuries: Patients with multiple facial fractures exhibited a 70% incidence of associated systemic injuries. This elevated risk highlights the need for comprehensive trauma evaluation (Ellis & Zide, 1995).

• Statistics: These systemic injuries included thoracic injuries (30%), abdominal injuries (20%), and limb fractures (25%) (Färkkilä et al., 2024).

References:

1. [Figure] Hajarian, H. C. (n.d.). Facial trauma surgery. Wave Surgical Oral & Maxillofacial Surgery. Retrieved July 16, 2024, from https://lnkd.in/etbGhBzR

2. Färkkilä, E. M., Oksanen, E., Kormi, E., & Suojanen, J. (2024). What Is the Relationship Between Maxillofacial Injury Location and Associated Injuries? Journal of Oral and Maxillofacial Surgery, 82(7), 800-805. https://lnkd.in/eKYFMaRG

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Topics:

💀 Oral & Maxillofacial Surgery

📖 CBSE Exam Material

🔬Oral Pathology

🫀Anatomy

💉Anesthesia

🚑 ATLS (Advanced Trauma Life Support)

#podcast #podcasts #dentalpodcast #dentalpodcasts #doctorgallagherpodcast #doctorgallagherspodcast #oralsurgeon #dentist #doctorgallagher #doctor #dentistry #oralsurgery #dental #viral #dentalschool #dentalstudent #omfs #surgeon #doctorlife #dentistlife #residency

7.16.24

Quick Review #180 - #pathology #oralpathology #doctorgallagher #oralsurgery #oralsurgeon #dentist #dentistry #dental

Osteoma - benign tumors composed of mature, compact, or cancellous bone.

Characteristics:

• Growth: Slow-growing.

• Location: Commonly found in the craniofacial region, especially the paranasal sinuses, mandible, and skull.

• Radiographic Appearance: Radiopaque mass with a well-defined border; it can be sessile or pedunculated.

• Symptoms: Often asymptomatic but can cause swelling or asymmetry if large.

Histopathology:

• Composed of dense, mature bone with little marrow spaces.

Clinical Significance:

• Generally, no malignant transformation.

• May be associated with Gardner’s syndrome, which includes multiple osteomas, colorectal polyps, and soft tissue tumors.

Cementoblastoma - benign tumors of cementum-producing cells (cementoblasts).

Characteristics:

• Growth: Slow-growing but can be aggressive.

• Location: Most commonly associated with the roots of mandibular molars and premolars.

• Radiographic Appearance: Well-defined radiopaque mass attached to the root of a tooth, often with a surrounding radiolucent halo.

• Symptoms: Pain and swelling are common due to the tumor’s pressure on the surrounding bone and nerves.

Histopathology:

• Consists of sheets of cementum-like material with entrapped cementoblasts and cementocytes.

Clinical Significance:

• Can cause root resorption.

• Treatment often involves surgical removal of the tumor and associated tooth.

Cemento-Ossifying Fibroma (COF) - a benign fibro-osseous lesion composed of fibrous tissue, bone, and cementum-like material.

Characteristics:

• Growth: Slow-growing but can cause significant expansion.

• Location: Commonly affects the mandible, especially the premolar and molar regions.

• Radiographic Appearance: Mixed radiolucent-radiopaque lesion with a well-defined border; early stages may appear more radiolucent, becoming more radiopaque as it matures.

• Symptoms: May cause facial asymmetry, swelling, and displacement of teeth.

Histopathology:

• Composed of fibrous connective tissue with varying amounts of calcified bone and cementum-like material.

Clinical Significance:

• Treated with surgical excision.

• Recurrence is uncommon but can occur if not completely removed.

References:

1. Dr. G’s Toothpix. (n.d.). Cementoblastoma. Retrieved July 16, 2024, from https://lnkd.in/eK2eDCxR

2. Barnes, L., Eveson, J. W., Reichart, P., & Sidransky, D. (2005). World Health Organization Classification of Tumours: Pathology and Genetics of Head and Neck Tumours. IARC Press.

3. Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2016). Oral and Maxillofacial Pathology (4th ed.). Elsevier.

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Topics:

💀 Oral & Maxillofacial Surgery

📖 CBSE Exam Material

🔬Oral Pathology

🫀Anatomy

💉Anesthesia

🚑 ATLS (Advanced Trauma Life Support)

#podcast #podcasts #dentalpodcast #dentalpodcasts #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentistry #oralsurgery #dental #viral #dentalschool #dentalstudent #omfs #surgeon #doctorlife #dentistlife #residency #oralsurgeon #dentist #doctorgallagher

7.15.24

Quick Review #179 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental #teeth #extract #extraction #impactedteeth

The buccal trough is a surgical technique used during the extraction of impacted wisdom teeth, particularly the mandibular (lower) third molars. This technique involves creating a groove or trough along the buccal (cheek) side of the impacted tooth, typically with a surgical handpiece and bur.

Significance of the Buccal Trough in Extracting Impacted Wisdom Teeth:

1. Improved Access and Visibility:

• The buccal trough provides better visualization of the impacted tooth’s crown and roots. This improved access helps the surgeon assess the tooth’s position and any anatomical challenges more effectively.

2. Controlled Tooth Sectioning:

• By creating a groove along the buccal aspect, the surgeon can section the tooth into smaller, more manageable pieces. This reduces the risk of uncontrolled fracture and damage to surrounding structures, such as the alveolar bone or the adjacent teeth.

3. Reduced Bone Removal:

• Using the buccal trough technique minimizes the amount of bone that needs to be removed compared to other methods. This can preserve more of the alveolar bone and reduce postoperative complications related to bone loss.

4. Decreased Surgical Time:

• The technique can make the extraction process more efficient, potentially decreasing the overall surgical time. A shorter procedure can reduce the patient’s time under anesthesia and the risk of complications associated with prolonged surgery.

5. Enhanced Healing and Recovery:

• Preserving more bone and reducing trauma to the surrounding tissues can lead to faster and more predictable healing. Patients may experience less postoperative pain, swelling, and a lower risk of complications such as dry socket (alveolar osteitis).

6. Reduced Risk of Nerve Injury:

• For lower third molar extractions, the inferior alveolar nerve is a significant concern. The buccal trough technique can help avoid excessive manipulation or trauma to this nerve by providing a clear path for tooth sectioning and removal.

In clinical practice, the decision to use the buccal trough technique is based on various factors, including the position and angulation of the impacted tooth, the density of the surrounding bone, and the proximity of vital structures.

References:

1. Varghese, G. (2021). Management of impacted third molars. In K. Bonanthaya, E. Panneerselvam, S. Manuel, V. Kumar, & A. Rai (Eds.), Oral and maxillofacial surgery for the clinician (pp. 299-328). Springer.

2. Miloro, M., Ghali, G. E., Larsen, P. E., & Waite, P. (Eds.). (2022). Peterson’s Principles of Oral and Maxillofacial Surgery (4th ed.). Springer.

3. Koerner, K. R. (2015). Manual of Minor Oral Surgery for the General Dentist (2nd ed.). Wiley-Blackwell.

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Topics:

🦷 General Dentistry INBDE Boards Question Concepts

🔬Oral Pathology

🫀Anatomy

#podcast #podcasts #dentalpodcast #dentalpodcasts #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentistry #oralsurgery #dental #viral #dentalschool #dentalstudent #omfs #surgeon #doctorlife #dentistlife #residency #oralsurgeon #dentist #doctorgallagher

7.14.24 from the June 2024 Insta Q&A Session - 👉 Do you have questions about applying to Oral & Maxillofacial Surgery residency 💀 or dental school 🦷? Keep an eye out for my next Q&A session, held on Instagram at the end of every month, for my live & personalized mentoring. This is for YOU 🤜🤛

🙋🏼‍♂️ These are clips from Instagram LIVE Q&A sessions, TikToks & Reels, and zoom events that I’ve hosted both individually and with our company Top Professionals 🙌 If you’re a club or organization and you’d like me to host your zoom event or conference, DM me on insta that is the best way to contact me directly 👌

*** 👉 PreDent Mentor Map is now live btw, at predentmentormap.org ! ***

⛈ If you have questions, thoughts or ideas that you’d like to discuss involving my other ventures, including entrepreneurship (Top Professionals LLC 🏔, Vé Club 🍷), our products/services (PreDent Mentor Map, Dentist Map, Winery Map), NFTs 🖼(@feelings.nft 🎨, or my NFTs story highlight) workouts 💪, music producing/performing 🎶 (SoundCloud, violin 🎻 ), DM me and let’s talk 🤙

❤️ MOST importantly: THANK YOU for watching and being on my team- I do this for YOU. Mentoring is what got me here, and it is how I’ll help you achieve your dream goals as best I can. You are a MASSIVE part of this journey to me, more than you know 🙌🙏🙌

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7.14.24

Quick Review #178 - #pathology #oralpathology #doctorgallagher #oralsurgery #oralsurgeon #dentist #dentistry #dental

Aphthous Ulcers (Canker Sores)

Key Characteristics:

• Common, non-contagious, and recurrent

• Exact cause often unknown, but may be related to immune response, stress, nutritional deficiencies, or trauma

Clinical Features:

• Occur on non-keratinized mucosa (e.g., inside cheeks, lips, under the tongue)

• Small, round or oval ulcers with a yellowish or white center and a red halo

Signs and Symptoms:

• Painful lesions, especially when eating or speaking

• No systemic symptoms

Histology:

• Superficial ulceration with a fibrinopurulent membrane

• Inflammatory infiltrate mainly composed of lymphocytes, macrophages, and occasional neutrophils

Herpetic Stomatitis

Key Characteristics:

• Caused by Herpes Simplex Virus (HSV), usually HSV-1

• Contagious and often recurrent

Clinical Features:

• Typically affects keratinized mucosa (e.g., gingiva, hard palate)

• Multiple vesicles that rupture to form shallow, painful ulcers

Signs and Symptoms:

• Acute cases often present with fever, malaise, and lymphadenopathy

• Vesicles can coalesce into larger ulcerations

Histology:

• Intraepithelial vesicles and ballooning degeneration of epithelial cells

• Multinucleated giant cells and eosinophilic intranuclear inclusions (Cowdry type A bodies)

• Acantholysis and necrosis of epithelial cells

Erythema Multiforme (EM)

Key Characteristics:

• Hypersensitivity reaction often triggered by infections (e.g., HSV, Mycoplasma pneumoniae) or medications

• Acute and sometimes recurrent

Clinical Features:

• Target or iris-like skin lesions

• Oral lesions can appear on both keratinized and non-keratinized mucosa

• Large, irregular, and painful ulcers

Signs and Symptoms:

• Systemic symptoms like fever, malaise, and arthralgia may be present

• Severe cases can involve ocular and genital lesions (Stevens-Johnson syndrome)

Histology:

• Subepithelial and intraepithelial vesiculation

• Necrosis of basal keratinocytes

• Mixed inflammatory infiltrate with lymphocytes, neutrophils, and eosinophils

References:

1. Petruzzi, M., Galleggiante, S., & della Vella, F. (2022). Oral erythema multiforme after Pfizer-BioNTech COVID-19 vaccination: A report of four cases. BMC Oral Health, 22(1), Article 90.

2. Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2016). Oral and Maxillofacial Pathology (4th ed.). Elsevier.

3. Regezi, J. A., Sciubba, J. J., & Jordan, R. C. (2017). Oral Pathology: Clinical Pathologic Correlations (7th ed.). Elsevier.

4. Scully, C., & Porter, S. (2008). Oral mucosal disease: Recurrent aphthous stomatitis. British Journal of Oral and Maxillofacial Surgery, 46(3), 198-206.

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Topics:

💀 Oral & Maxillofacial Surgery

📖 CBSE Exam Material

🔬Oral Pathology

🫀Anatomy

💉Anesthesia

🚑 ATLS (Advanced Trauma Life Support)

#podcast #podcasts #dentalpodcast #dentalpodcasts #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentistry #oralsurgery #dental #viral #dentalschool #dentalstudent #omfs #surgeon #doctorlife #dentistlife #residency #oralsurgeon #dentist #doctorgallagher

7.13.24

Quick Review #177 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental

Half-life of Eliquis vs. Rivaroxaban:

1. Eliquis (Apixaban)

• Half-life: Approximately 12 hours.

2. Rivaroxaban (Xarelto)

• Half-life: Approximately 5-9 hours in healthy individuals, but it can be longer (up to 13 hours) in the elderly.

Clinical Significance of Half-life:

• The half-life of a drug is the time it takes for the plasma concentration of the drug to reduce by half.

• It is an essential pharmacokinetic parameter because it helps determine the dosing frequency and the time required for a drug to reach steady-state concentration or to be eliminated from the body.

Holding Anticoagulants Before Dental Surgery:

• When planning dental surgery for patients on anticoagulants like Eliquis and Rivaroxaban, the half-life becomes particularly significant.

• The decision to hold anticoagulants prior to surgery should be consulted with the patient’s prescribing physician.

1. Risk of Bleeding: Both medications are anticoagulants, and their primary function is to prevent blood clots by inhibiting factors involved in the coagulation cascade. During dental procedures, which often involve some level of bleeding, these medications can increase the risk of significant bleeding.

2. Timing of Discontinuation:

• Eliquis (Apixaban): Given its half-life of 12 hours, it is usually recommended to stop Eliquis at least 48-72 hours before major dental surgery to reduce the risk of bleeding. This allows the drug to be cleared from the system sufficiently.

• Rivaroxaban (Xarelto): With a half-life of 5-9 hours, it is often recommended to discontinue Rivaroxaban 24-48 hours before surgery. For patients at higher risk of bleeding or with impaired renal function, a longer discontinuation period may be advised.

3. Resumption After Surgery: After the procedure, the timing to resume the anticoagulant therapy is also critical and should balance the risk of bleeding with the risk of thromboembolism. This decision is often made based on the type of procedure, the patient’s bleeding risk, and the specific anticoagulant used.

*** It’s essential to consult with the prescribing physician to optimize the timing of discontinuation and resumption of these medications. ***

References:

1. Carey. (2021, October 19). Which is safer Xarelto or Eliquis? IsraelPharm. Retrieved July 12, 2024.

2. Bauer, K. A. (2013). Pros and cons of new oral anticoagulants. Cleveland Clinic Journal of Medicine, 80(6), 443-446.

3. Levi, M., & Eerenberg, E. (2012). Management of bleeding in patients treated with direct oral anticoagulants. Critical Care, 16(3), 201.

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