Topics:

💀 Oral & Maxillofacial Surgery

📖 CBSE Exam Material

🔬Oral Pathology

🫀Anatomy

💉Anesthesia

🚑 ATLS (Advanced Trauma Life Support)

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6.21.24

Quick Review #155 - #pathology #oralpathology #doctorgallagher #oralsurgery #oralsurgeon #dentist #dentistry #dental

Miloro et al. (2022):

Ludwig’s angina is a serious, potentially life-threatening condition characterized by cellulitis involving the submandibular space bilaterally and spreading to the sublingual space. This condition often arises secondary to odontogenic infections, particularly from the second and third molars due to their anatomical proximity to these spaces.

Pathophysiology and Presentation:

The infection causes intense inflammatory edema and cellulitis without abscess formation in the early stages. Clinically, patients present with bilateral submandibular swelling, firm induration of the floor of the mouth, elevation, and posterior displacement of the tongue. These symptoms result in dysphagia, odynophagia, and potential airway obstruction, making early recognition crucial.

Management:

The management of Ludwig’s angina is a medical emergency. Initial treatment priorities include securing the airway, often requiring endotracheal intubation or tracheostomy. Broad-spectrum intravenous antibiotics covering aerobic and anaerobic bacteria are essential. In most cases, surgical intervention to drain the infection and relieve pressure are necessary.

Neville et al. (2015):

Ludwig’s angina is described as a severe, diffuse cellulitis involving the submandibular, sublingual, and submental spaces. It is typically of odontogenic origin, arising from infections of the mandibular molars. The rapid spread of infection in these spaces can lead to severe complications, including airway obstruction.

Pathophysiology and Presentation:

Patients with Ludwig’s angina present with marked swelling of the neck and floor of the mouth, firm induration, and elevation of the tongue, leading to a characteristic “woody” hard feel of the submandibular area. Trismus, dysphonia, and drooling are common symptoms. The rapid progression of swelling can cause airway obstruction, making early diagnosis and treatment critical.

Management:

Effective management involves securing the airway, often necessitating advanced techniques such as fiber-optic intubation or surgical airway management (tracheostomy). High-dose intravenous antibiotics targeting both aerobic and anaerobic pathogens are initiated promptly. Surgical drainage and debridement are often required to manage the infection and prevent further spread.

References:

1. Southwest Journal of Pulmonary, Critical Care & Sleep. (2019, April 2). Medical image of the month: Ludwig’s angina. Southwest Journal of Pulmonary, Critical Care & Sleep.

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. Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2015). Oral and Maxillofacial Pathology (4th ed.). Saunders.

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Topics:

🦷 General Dentistry INBDE Boards Question Concepts

🔬Oral Pathology

🫀Anatomy

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6.20.24 - 👉 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 🤜🤛

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⛈ 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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🦷 Oral & Maxillofacial Surgery Resident

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6.20.24

Quick Review #154 - #pathology #oralpathology #doctorgallagher #oralsurgery #oralsurgeon #dentist #dentistry #dental

Clinical Features:

Ameloblastoma:

• Slow-growing, benign but locally aggressive tumor.

• Commonly occurs in the mandible, especially the molar-ramus area.

• Painless swelling or expansion of the jaw.

• Can cause tooth displacement and root resorption.

Odontogenic Keratocyst (OKC):

• Also known as keratocystic odontogenic tumor.

• Aggressive behavior with a high recurrence rate.

• Often asymptomatic, but may present as swelling or pain if infected.

• Commonly found in the posterior mandible, often associated with an impacted tooth.

Radiographic Features:

Ameloblastoma:

• Multilocular (soap bubble or honeycomb appearance) radiolucency.

• May present as unilocular radiolucency.

• Well-defined and corticated margins.

• Possible cortical bone expansion and perforation.

Odontogenic Keratocyst:

• Unilocular or multilocular radiolucency.

• Smooth, corticated margins.

• Tendency to grow along the length of the bone without significant expansion.

• Can be associated with an unerupted tooth.

Histopathological Features:

Ameloblastoma:

• Follicular pattern: Islands of odontogenic epithelium with peripheral palisading and reverse polarization.

• Plexiform pattern: Interconnected strands or cords of odontogenic epithelium.

• Stroma is typically fibrous and may contain cystic changes.

Odontogenic Keratocyst:

• Lined by a uniform layer of parakeratinized stratified squamous epithelium.

• Corrugated surface of the epithelial lining.

• Basal layer is palisaded and hyperchromatic.

• Cyst wall often contains daughter cysts or epithelial rests.

Treatment:

Ameloblastoma:

• Surgical resection with wide margins to prevent recurrence.

• Options include enucleation with curettage, marginal resection, or segmental resection depending on the size and location.

• Close long-term follow-up due to potential for recurrence.

Odontogenic Keratocyst:

• Enucleation with or without adjunctive therapies (Carnoy’s solution, liquid nitrogen cryotherapy).

• Marsupialization or decompression followed by enucleation for large lesions.

• Long-term follow-up due to high recurrence rate.

References:

1. Kitisubkanchana, J., Reduwan, N. H., Poonsawat, S., Pornprasertsuk-Damrongsri, S., & Wongchuensoontorn, C. (2020). Odontogenic keratocyst and ameloblastoma: Radiographic evaluation. Oral Radiology, 37(1), 55-65. https://lnkd.in/eqEgmJ4M

2. Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2015). Oral and Maxillofacial Pathology (4th ed.). Saunders.

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

4. ChatGPT. 2024. #podcast #podcasts #dentalpodcast #dentalpodcasts #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentistry #oralsurgery #dental #viral #dentalschool #dentalstudent #omfs #surgeon #doctorlife #dentistlife #residency #oralsurgeon #dentist #doctorgallagher

6.20.24 - 👉 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 🙌🙏🙌

🤠 @doctorgallagher

https://www.instagram.com/doctorgallagher/

🦷 Oral & Maxillofacial Surgery Resident

🏔 Top Professionals Cofounder

🗺️ PreDent Mentor Map

🗺️ predentmentormap.org

🎙 Dr. Gallagher’s Podcast

🍷@topwineries

🎀 BAE Marketing Agency

👨‍⚕️@doseofdentalpodcast

👀

Instagram: https://www.instagram.com/doctorgallagher/

LinkedIn: https://www.linkedin.com/in/brendan-gallagher-dds-bb8848a1

TikTok: https://www.tiktok.com/@doctorgallagher_?_t=8WfqIHAlDEE&_r=1

Podcast: https://open.spotify.com/show/6OaweNluu3Y36uTcqlTBkK?si=_EMcxf12R9ex1Hxwg9N99A

YouTube Shorts: https://youtube.com/channel/UCNqbFjVctSWlACMB-8wxymg

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

Topics:

🦷 General Dentistry INBDE Boards Question Concepts

🔬Oral Pathology

🫀Anatomy

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6.19.24

Quick Review #153 - #pathology #oralpathology #doctorgallagher #oralsurgery #oralsurgeon #dentist #dentistry #dental

Osmotic diuresis in the setting of diabetic ketoacidosis (DKA) refers to the increased urine output caused by the presence of high levels of glucose and ketones in the blood. Here’s how it happens:

1. Hyperglycemia: In DKA, there is a significant lack of insulin, which leads to high blood glucose levels. Insulin normally facilitates the uptake of glucose into cells for energy, but in its absence, glucose remains in the bloodstream.

2. Renal Threshold for Glucose: The kidneys filter blood to form urine. Normally, glucose is reabsorbed in the renal tubules and returned to the bloodstream. However, when blood glucose levels exceed the renal threshold (about 180 mg/dL), the renal tubules cannot reabsorb all the glucose, and it begins to appear in the urine.

3. Osmotic Effect: Glucose in the urine creates an osmotic gradient. Since glucose is an osmotically active substance, it draws water with it into the urine, increasing urine volume. This is osmotic diuresis.

4. Ketones: In DKA, the body also produces ketones (acetoacetate, β-hydroxybutyrate, and acetone) as alternative energy sources due to the lack of insulin. Ketones are also osmotically active and contribute to osmotic diuresis.

5. Dehydration and Electrolyte Imbalance: The increased urine output leads to significant loss of fluids and electrolytes (such as sodium, potassium, and phosphate), causing dehydration and electrolyte imbalances. This exacerbates the clinical manifestations of DKA.

Clinical Consequences:

• Dehydration: Patients with DKA can become severely dehydrated due to the excessive loss of water in the urine.

• Electrolyte Imbalances: The loss of electrolytes in the urine can lead to dangerous imbalances, such as hypokalemia (low potassium) and hyponatremia (low sodium).

• Acidosis: The accumulation of ketones, which are acidic, leads to metabolic acidosis, a hallmark of DKA.

Management:

• Fluid Replacement: To correct dehydration and restore renal perfusion.

• Insulin Therapy: To reduce blood glucose levels and halt ketone production.

• Electrolyte Replacement: To address imbalances, particularly potassium.

• Monitoring: Close monitoring of blood glucose, ketones, electrolytes, and acid-base status is essential.

References:

1. Biology Online. (n.d.). Diuresis. In Biology Dictionary. Retrieved June 18, 2024, from https://lnkd.in/ebXA5zdb.

2. Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009). Hyperglycemic crises in adult patients with diabetes. Diabetes Care, 32(7), 1335-1343.

3. Umpierrez, G. E., & Korytkowski, M. (2016). Diabetic emergencies—ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nature Reviews Endocrinology, 12(4), 222-232.

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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

6.19.24 - *PODCAST EXCLUSIVE*