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ORAL & MAXILLOFACIAL SURGERY, 5th Year BDS FINAL EXAMINATION, MARCH 2019, BPKIHS

14th MARCH 2019

B.P. Koirala Institute of Health Sciences, Dharan, Nepal
5th year BDS
FINAL EXAMINATION, MARCH 2019
Paper - IV 
(ORAL & MAXILLOFACIAL SURGERY)

Time - 2 Hours
 Total Marks: 80
SHORT ANSWER QUESTIONS
SECTION - 'A'
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)


SECTION 'B'
MODIFIED ESSAY QUESTIONS

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
***

Moth eaten appearance is seen in all except:

# Moth eaten appearance is seen in all except:
A. Osteomyelitis
B. Hemorrhagic cyst
C. OKC
D. Osteosarcoma


The correct answer is C. OKC


'Moth eaten appearance' is seen in lesions of bone which shows lytic activity. 
Seen in:
- Osteomyelitis - Acute suppurative and chronic both
- Osteosarcoma
- Osteoradionecrosis
- Ewing Sarcoma
- Langerhans cell histiocytosis
- Hemorrhagic cyst

Radiolucency between maxillary central incisors

# A radiolucency seen between the maxillary central incisors is most commonly due to:
A. Periapical cyst
B. Nasopalatine cyst
C. Globulomaxillary cyst
D. Nasoalveolar cyst


The correct answer is B. Nasopalatine cyst


Nasopalatine cyst (Incisive canal cyst) - Most common fissural cyst, usually asymptomatic, may complain of tender swelling of palate. Radiographic characteristics- well demarcated round, oval or heart shaped radiolucency between and above maxillary central incisors; rarely just lateral to the midline; lesion crosses midline, teeth are vital. 

Dentin Desensitizing Agent

# The dentin desensitizing agents that acts by precipitating proteins in dentinal tubular fluid is: (MHCET 2014)
A. Strontium chloride
B. Potassium oxalate
C. Fluoride
D. Hydroxyethyl methacrylate


The correct answer is A. Strontium chloride.

After professional diagnosis, dentinal hypersensitivity can be treated simply and inexpensively by home use of desensitizing dentifrices.

Strontium Chloride Dentifrices
Ten percent strontium chloride desensitizing dentifrices are found effective in relieving the pain of tooth hypersensitivity.

Potassium Nitrate Dentifrices
Five percent potassium nitrate dentifrices are found to alleviate pain related to tooth hypersensitivity.

Fluoride Dentifrices
Sodium monofluorophosphates dentifrices are effective mode of treating tooth hypersensitivity.


Strontium chloride is the most important constituent in home care dentifrices intended to be used for the treatment of dentinal hypersensitivity. Topical application of concentrated strontium chloride on an abraded dentin produces a deposit of strontium that penetrates dentin to a depth of approximately 10-20 micrometers and extend into dentinal tubules. 

Ref: Textbook of OPERATIVE DENTISTRY, Nisha Garg, 3rd Edition, Page 445

Direct Pulp Capping

# Which of the following are true about direct pulp capping?
A. Mechanically exposed teeth have a greater success rate than carious exposures
B. Final restorative materials do not affect success
C. Generally, individual teeth involved in a fixed prosthesis are candidates for direct pulp capping
D. All of the above


The correct answer is A.  Mechanically exposed teeth have greater success rate than carious exposures.


What is Fluoride bomb?

# The ‘FLUORIDE BOMBS’ is related to:
A. A fluoride  capsule with high ppm of fluoride varnish
B. A hypoplastic lesion on tooth seen in fluorosis areas
C. Undiagnosed hidden caries
D. Procedure to treat rampant caries


The correct answer is C. Undiagnosed hidden caries.


  • Occult or hidden caries is used to describe such lesion which is not clinically diagnosed but detected only on radiographs.
  • Occult lesions are seen with low caries rate which is suggestive of increased fluoride exposure.
  • It is believed that increased fluoride exposure encourages remineralization and slows down the progress of the caries in the pit and fissure enamel while the cavitation continues in dentin, and the lesions become masked by a relatively intact enamel surface.
  • These hidden lesions are called 'fluoride bombs' or fluoride syndrome.

# Calcium hydroxide is advocated as an inter appointment intracanal medication because of

# Calcium hydroxide is advocated as an inter appointment intracanal medication because of:
A. Its ability to dissolve necrotic tissue
B. Its antimicrobial property
C. Its ability to stimulate hard tissue formation
D. Its powerful bleaching effect


The correct  answer is B. Its antimicrobial property. 

Most studies report culture reversals during the interappointment period when active antibacterial dressing is not used in the root-canal system between appointments. The reversals are due to regrowth of residual bacteria or recontamination by bacterial leakage around the access cavity
dressing. 

Classical and well-controlled studies (Sundqvist’s group) evaluated the effect of various root-canal treatment procedures on the microbiota both qualitatively and quantitatively. They tested the effect of mechanical preparation, saline or sodium hypochlorite irrigation (0.5%, 5.0%, 5.0% with EDTA), the addition of ultrasonic activation to the irrigation and calcium hydroxide dressing; each addition to the chemical canal preparation improved the antibacterial effect, reducing residual bacteria further. They found the antibacterial action to reduce the number of bacteria from an initial range of 10^2–10^8 cells to 10^2–10^3 fewer cells after initial debridement, further reducing down to no recoverable cells (from the prepared part of the root-canal system) after interappointment dressing with calcium hydroxide.

Reference: Endodontics, 4th Edition, Kishor Gulabivala, Yuan-Ling Ng, Page no. 83