14th MARCH 2019

B.P. Koirala Institute of Health Sciences, Dharan, Nepal
5th year BDS
Paper - IV 

Time - 2 Hours
 Total Marks: 80
Maximum Marks - 40
1. Explain the pathophysiology of osteomyelitis of jaws.   (4)

2. Discuss the clinical features of trigeminal neuralgia and enlist different treatment options. (2+3=5)

3. Enlist FOUR clinical features of zygomatic arch fracture. Add a note on Gillies temporal approach to indirect reduction. (2+3=5)

4. Enlist the clinical test to diagnose oro-antral communication and add a note on management of oroantral communication. (2+4=6)

5. Discuss briefly on different types of dislocation and enumerate the surgical procedures for the management of chronic recurrent temporomandibular joint dislocation . (3+3=6)

6. Mention the difference between ridge extension and ridge augmentation procedure based on their indication. Describe any one ridge extension procedure. (1+4=5)

7. With the help of a well labeled diagram, discuss WAR lines. (4)

8. Mention different theories of the mechanism of action of local anesthetic and explain the most accepted theory. (2+3=5)


Maximum Marks: 40
I. A 50-year-old male weighing 70 kg, presented to the maxillofacial clinic for extraction of grossly decayed 16. He also gave a history of coronary artery bypass graft surgery, which was done at BPKIHS 3 years back.
Q.1 Will this patient require antibiotic prophylaxis prior to extraction?     1
Q.2 Enlist the cardiac conditions requiring antibiotic prophylaxis for infective endocarditis as per the latest guidelines.     4
Q.3 Calculate the maximum number of cartridges of lignocaine with vasoconstrictor that is recommended for this patient.    5
Q.4 Enlist contraindications for exodontia.    5

II. A 45-year-old male presented to the OMFS department with a complaint of swelling over the right side of face from the last 6 months. There is no history of trauma or toothache.
On examination there .was a bony hard swelling over the right angle region with buccal and lingual cortices expansion with clinically missing 48.

OPG of the patient revealed a multilocular radiolucent area extending from distal of 47 till the ramus of the mandible with a radio-opaque tooth-like structure resembling 48 on the inferior aspect of the radiolucent lesion.

Aspiration from the lesion revealed a creamy white viscoid fluid.

Q.5 Enlist the differential diagnosis for this case.    (1)
Q.6 Formulate a provisional diagnosis and briefly discuss about findings to support the diagnosis.   (1+2=3)
Q.7 Discuss the different treatment options for a jaw cyst and its indications.      (3+3=6)
Q.8 Name the agents used to reduce the recurrence. Write down its composition and advantages. (1+2+2-5)

III. 31-year-old Mr. Rupesh visited the department of oral and maxillofacial surgery with a complaint of reduced mouth opening for 3 days. He also reports having a toothache in right lower wisdom tooth which was on and off from the last 6 months which used to regress on medications.

On examination, there was no appreciable facial swelling extra orally. However, he had significant trismus to make intraoral examinations impossible. With little to be seen intra-orally the uvula seemed to be pushed towards the left side.

OPG was taken which revealed an impacted mesioangularly impacted 48. No other abnormalities were detected in the OPG.
Q.9 Mention your provisional diagnosis for this case.    2
Q.10 Enlist the principles for the management of facial space infection.    5
Q.11 Enlist the life-threatening complication if it is untreated.     3

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