Oral and Maxillafacial Surgery,Radiology,Pathology and Oral Medicine 3rd edition by Coulthard, Paul- Ebook PDF Instant Download/Delivery: 0702046000, 9780702046001
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ISBN 10:0702046000
ISBN 13: 9780702046001
Author:Coulthard, Paul
Master Dentistry is designed as a revision guide for dental students and presents the key elements of the curriculum in an easy-to-digest format. Based on sound educational principles, each volume in the series is fully illustrated throughout and is supported by extensive self-assessment questions which allow the reader to assess their own knowledge of the topic and perfect their exam techniques. This third edition has been fully updated throughout and addresses the oral and maxillofacial surgery, radiology, pathology and oral medicine aspects of dentistry. The Master Dentistry volumes are perfect for undergraduate students, vocational trainees and those preparing for post-graduate examinations such as the MJDF in the UK or international equivalent, and the ORE.
Oral and Maxillafacial Surgery,Radiology,Pathology and Oral Medicine 3r Table of contents:
- Front Matter
- Preface
- Using this Book
- Philosophy of the book
- Layout and contents
- Approaching assessment
- The main types of assessment
- Multiple choice questions
- Extended matching items
- Short notes
- Essays
- Oral examinations
- Dedication
- 1 Evidence-based practice
- Chapter Contents
- Overview
- 1.1 Decision making
- Learning objectives
- Evidence-based medicine
- Best research evidence
- Clinical expertise
- Patient values
- Benefits and limitations of evidence-based medicine
- Fig. 1.1 Strength of evidence from some research designs.
- 1.2 Randomised controlled trials
- Learning objectives
- Fig. 1.2 Illustration of randomised controlled trial method.
- Components of the randomised controlled trial
- Randomisation and allocation concealment
- Blinding
- Completeness of follow-up
- Sample size calculation
- Inclusion and exclusion criteria
- Estimate of effect
- Different types of randomised controlled trial
- Efficacy and effectiveness
- Phase I, II and III trials
- Parallel, cross-over and split-mouth design
- Bias and assessment of randomised controlled trials
- Bias
- Assessing the quality of randomised controlled trials
- 1.3 Other research methods
- Learning objective
- Cohort studies
- Case-control studies
- Cross-sectional surveys
- Case reports
- 1.4 Systematic reviews
- Learning objectives
- Cochrane Collaboration
- Fig. 1.3 Cochrane Collaboration logo.
- Box 1.1 Components of a Cochrane systematic review
- 1.5 How to read a paper
- Learning objective
- Appraisal questions
- CONSORT
- Box 1.2 Appraisal questions generally applicable to all types of research methods
- Fig. 1.4 The CONSORT flowchart.
- Table 1.1 CONSORT checklist of items to be included when a randomised trial is reported
- 1.6 Clinical practice guidelines
- Learning objectives
- Problems with guidelines
- Table 1.2 Levels of evidence and grades of recommendations for therapies
- 2 Assessing patients
- Chapter Contents
- Overview
- 2.1 History
- Learning objectives
- The complaint
- History of the complaint
- Past dental history
- Social and family history
- Medical history
- 2.2 Extraoral examination
- Learning objectives
- Fig. 2.1 Principal lymph nodes in the head and neck. The dotted lines indicate the outline of the sternocleidomastoid muscle.
- Lymph node examination
- Temporomandibular joint
- Salivary glands
- Problem-specific examination
- Swelling/lump
- Fig. 2.2 Cutaneous sensory innervation of the head and neck by the trigeminal and cervical nerves.
- Paraesthesia/anaesthesia
- Paralysis/motor disturbance
- Fig. 2.3 Patient with Bell’s palsy.
- 2.3 Intraoral examination
- Learning objectives
- Swelling/lump
- Fig. 2.4 Clinical photograph of a squamous cell carcinoma of the tongue. Note the raised edges and necrotic centre.
- Ulcer
- Fig. 2.5 Clinical photograph of a traumatic ulcer of the lingual mucosa. Note the superficial nature of the ulcer. Its base is covered by fibrous exudates and the surrounding area is inflamed.
- Paraesthesia/anaesthesia
- Paralysis/motor disturbance
- Tooth problems
- Fig. 2.6 Sensory innervation of the oral cavity is principally from the trigeminal nerve (V) while the glossopharyngeal nerve (IX) supplies the posterior third of the tongue. NB: Taste sensation in the anterior two-thirds of the tongue is provided by fibres of VII nerve origin passing through the lingual nerve.
- 2.4 Special investigations
- Learning objectives
- Chair-side laboratory investigations
- Evidence-based laboratory medicine
- Microbiology
- Viruses
- Bacteria
- Fungi
- Aspiration biopsy
- Incisional/excisional biopsy
- Excisional biopsy
- Incisional biopsy
- Haematology
- Biochemistry
- Immunology
- Imaging
- Table 2.1 Important haematological values in dentistry
- Conventional radiography
- Contrast investigations
- Computed tomography
- Table 2.2 Guidelines on plain radiographic projections available for maxillofacial uses
- Fig. 2.7 A typical computed tomographic scan.
- Cone beam computed tomography
- Fig. 2.8 CBCT imaging. The data are displayed in four windows, representing (clockwise from lower left) axial, coronal, sagittal and volume-rendered (‘3D’) images.
- Diagnostic ultrasound
- Radioisotope imaging
- Fig. 2.9 Radioisotope scan of the salivary glands. Frontal view. Foci of activity are visible in the four major salivary glands, in the mouth and, at the bottom of the image, the thyroid gland.
- Magnetic resonance imaging
- 2.5 Making a referral
- Learning objectives
- Fig. 2.10 An example of a referral letter.
- 3 Human disease and patient care
- Chapter Contents
- Overview
- 3.1 Medical assessment
- Learning objectives
- Medical history
- Table 3.1 The American Society of Anesthesiologists’ classification of physical status
- Physical examination
- Observe the patient in general
- Check the cardiovascular system
- Social history
- Hospital setting
- Medical risk assessment
- 3.2 Dental relevance of the medical condition
- Learning objectives
- The cardiovascular system
- Congenital and rheumatic heart disease
- Table 3.2 Medical questionnaire incorporating the American Society of Anesthiologists’ classification of physical status
- Management
- Fig. 3.1 An electrocardiogram showing atrial fibrillation.
- Hypertension
- Management
- Cardiac failure
- Management
- Arrhythmias
- Management
- Angina and myocardial infarction
- Management
- The respiratory system
- The upper airway
- Chronic obstructive airways disease
- Management
- Asthma
- Fig. 3.2 Chest radiograph of patient with chronic obstructive pulmonary disease.
- Management
- Other respiratory diseases
- Upper or lower respiratory tract infections
- Cystic fibrosis
- Pulmonary tuberculosis
- Haematological disorders
- Anaemia
- Management
- Sickle cell anaemia
- Leukaemia
- Management
- Lymphoma
- Management
- Bleeding disorders
- Management
- Thrombocytopenia
- Specific coagulation defects
- Emergency management of a bleeding patient
- Anticoagulant therapy
- Management
- Antiplatelet therapy
- Endocrine disease
- Diabetes mellitus
- Management
- Hypothyroidism and hyperthyroidism
- Management
- Hypoparathyroidism and hyperparathyroidism
- Hypoparathyroidism
- Hyperparathyroidism
- Hepatic disease
- Clotting dysfunction
- Drugs
- Cross-infection
- Renal disease
- Management
- Gastrointestinal disease
- Bone disease
- Radiotherapy
- Management
- HIV/AIDs
- Management
- Cross-infection
- Neurological disorders
- Epilepsy
- Management
- Psychiatric disorders
- Organic pathology
- Psychological orgin
- The psychoses
- The neuroses
- Personality disorders
- Other psychiatric disorders
- Medications
- Routine medication
- Steroid drugs
- Contraceptive pill
- Allergies
- Pregnancy
- Treatment
- 3.3 Medical emergencies
- Learning objectives
- Emergency drugs and equipment
- Fig. 3.3 Emergency drugs in preloaded syringes.
- Common medical emergencies
- Syncope
- Signs and symptoms
- CLINICAL BOX FIRST-LINE TREATMENT OF FAINT
- CLINICAL BOX FIRST-LINE TREATMENT OF HYPERVENTILATION
- CLINICAL BOX FIRST-LINE TREATMENT OF POSTURAL HYPOTENSION
- CLINICAL BOX FIRST-LINE TREATMENT OF CHOKING AND ASPIRATION
- CLINICAL BOX FIRST-LINE TREATMENT OF EPILEPTIC SEIZURE
- CLINICAL BOX FIRST-LINE TREATMENT FOR ADRENAL INSUFFICIENCY
- CLINICAL BOX FIRST-LINE TREATMENT OF ACUTE ASTHMA
- CLINICAL BOX FIRST-LINE TREATMENT OF ANAPHYLAXIS
- CLINICAL BOX FIRST-LINE TREATMENT FOR BENZODIAZEPINE OVERDOSE
- CLINICAL BOX FIRST-LINE TREATMENT OF ANGINA AND MYOCARDIAL INFARCTION
- CLINICAL BOX ABCDE APPROACH TO THE SICK PATIENT
- Sequence of actions
- First steps
- Airway (A)
- Breathing (B)
- Circulation (C)
- Going for assistance
- Disability (D)
- Exposure (E)
- Basic life support
- Theory of chest compression
- Basic airway management
- Fig. 3.6 Head tilt and chin lift airway manoeuvre.
- Fig. 3.7 Chest compressions: shown from above (A) and in cross-section (B).Toxic
- Fig. 4.1 Diagram of pterygomandibular space illustrating the need to inject an adequate dose of local anaesthetic for a reliable block of inferior alveolar and lingual nerve conduction. (A) The area covered by 1 ml of local anaesthetic, which is not sufficient to block conduction.
- Oral sedation
- Fig. 4.2 Typical instructions for patients undergoing intravenous sedation.
- Inhalation sedation
- Fig. 4.3 (A) A typical flow meter to administer nitrous oxide and oxygen inhalation sedation (Image courtesy of Cestradent McKesson); (B) a digital version of the inhalational sedation apparatus (Image courtesy of Matrx by Parker/Parker-Parker).
- Fig. 4.4 Physiological lung volumes. Tidal volume can be increased by taking a deeper breath in or out, using the inspiratory capacity or expiratory reserve volume, respectively. The volume of air breathed out after the largest possible inspiration followed by the largest expiration is the vital capac
- Fig. 4.5 Intravenous cannulation of the dorsum of the hand. (A) The cannula. (B, C) The cannulation procedure. (D) Using the junction of tributaries, if this is evident, may help to stabilise veins.
- 4.4 General anaesthesia
- Table 4.5 Day case or inpatient general anaesthesia
- Fig. 4.6 Compromised airway in patient at rest because of small mandible and soft tissues of the neck.
- Fig. 4.7 Typical instructions given to a patient who will undergo morning day case surgery under general anaesthesia.
- Fig. 4.8 The haemoglobin dissociation curve.
- Chapter Contents
- Overview
- 5.1 Pulpitis
- Fig. 5.1 Radiograph of internal resorption in a lateral incisor as shown on (A) periapical radiograph and (B) small volume CBCT examination.
- Fig. 5.2 Histopathology of chronic pulpitis as seen in a section through the pulp.
- 5.2 Periapical inflammation
- Fig. 5.3 Radiograph of loss of lamina dura on the fractured central incisor.
- Radiology
- Pathology
- Fig. 5.4 Radiograph of rarefying osteitis associated with the lower right central incisor.
- Fig. 5.5 Radiograph of widened periodontal ligament on the lateral incisor with intact lamina dura.
- Fig. 5.6 Radiograph of granuloma on a central incisor.
- Fig. 5.7 Radiograph of condensing (sclerosing) osteitis relating to the grossly carious molar. The vertical radiolucent line is a vascular channel.
- Fig. 5.8 Histopathological section of apical granuloma showing cholesterol clefts.
- External resorption5.3 Pericoronal inflammation
- Learning objective
- Box 5.1 Apicectomy surgical procedure
- Clinical features
- Fig. 5.9 Typical flap design for apicectomy.
- Fig. 5.10 Apicectomy of tooth and retrograde restoration.
- Radiology
- Fig. 5.11 Radiograph of hypercementosis affecting the premolar tooth.
- Fig. 5.12 Clinical photograph of pericoronitis (intraoral).
- Management
- Fig. 5.13 Radiograph showing sclerosing osteitis around the follicle of the third molar. The patient had chronic pericoronitis.
- 5.4 Soft tissue infections of the face
- Fig. 5.14 Histopathological section of a dental abscess showing pyogenic membrane and necrosis (lower centre of picture).
- Floor-of-mouth tissue spaces
- Fig. 5.15 Potential tissue spaces about the floor of the mouth.
- Fig. 5.16 Inferior view of the floor of the mouth.
- Fig. 5.18 Postoperative photograph showing drains in right and left submandibular spaces.
- Fig. 5.20 Radiograph of acute osteomyelitis. This occurred after extraction of the first molar.
- Fig. 5.21 Occlusal radiograph of the lower right molar region in chronic osteomyelitis. Note the bone destruction within the jaw and sequestration lingually. Buccally there is periosteal new bone formation.
- Fig. 5.22 Radiograph taken of the patient in Case history 1.
- Fig. 5.23 Radiograph taken of the patient in Case history 4.
- 6.1 Dental extractions
- Box 6.1 Checklist of situations where a pre-extraction radiograph is reasonable
- Fig. 6.1 Elevators commonly used in oral surgery.
- Box 6.2 Technique for surgical tooth removal by transalveolar approach
- Fig. 6.2 A typical instruction leaflet given to patients after an extraction.
- Loss of tooth
- Fig. 6.3 Intraoral film of a patient with persistent postextraction infection. The bone of the crest of the socket is detached, acting as a sequestrum.
- 6.2 Impacted and ectopic teeth
- Box 6.3 Surgical technique for removal of lower third molar
- Maxillary canines
- Fig. 6.4 Examples of various types of third molar impactions. (A) Vertical impaction with unfavourable root morphology requiring bone removal and vertical sectioning
- Fig. 6.5 Path of withdrawal of maxillary third molar.
- Fig. 6.6 Surgical approach for the removal of an impacted palatal canine. (A) An incision is made about the palatal gingival margins. Greater palatine
- 6.3 Preprosthetic surgery
- Fig. 6.7 Fraenoplasty technique for prominent labial fraenum of the edentulous maxilla.
- Fig. 6.8 Fraenoplasty for prominent lingual fraenum using a Z-plasty technique.
- Fig. 6.9 Fraenectomy technique for orthodontic purposes where there is a prominent maxillary fraenum and midline diastoma.
- 6.4 Dental implant surgery
- Fig. 6.10 Four anterior mandible implants with gingival formers after surgical exposure and prior to restoration.
- Fig. 6.11 Cross-sectional reconstructed images of the jaws, produced from a computed tomographic scan using ‘dental’ software.
- Fig. 6.12 Bone harvesting from the anterior mandible to augment the anterior maxillary alveolus.re
- Fig. 6.13 Coronal section to show sinus lift procedure.
- Fig. 6.14 A surgical guide or stent.
- Fig. 6.15 Implant placement technique.
- Box 6.4 Technique for implant placement
- Fig. 6.16 Implant exposure with attachment of healing abutment.
- Fig. 6.17 Radiograph showing patient in Case history 1.
- Fig. 6.18 Intraoral photograph showing patient in Case history 2
- Fig. 6.19 Photograph showing a corticocancellous block of iliac crest graft bone fixed in place as a buccal onlay at surgery for the patient in Case history
- 7 Diseases of bone and the maxillary sinus
- Chapter Contents
- Overview
- 7.1 Diseases of bone
- Learning objectives
- Normal jaw skeleton
- Fig. 7.1 Stafne bone cavity. This radiograph shows the typical appearance of a rounded well-defined radiolucency with corticated margins, below the inferior dental canal.
- Fig. 7.2 Torus mandibularis. (A) Clinical appearance. (B) True occlusal radiograph of the mandible showing bilateral protruberances of the lingual cortical bone.
- Pathology
- Fig. 7.3 Bone structure as seen at low magnification in a histological section.
- Fig. 7.4 Clinical picture of a fibrous dysplasia.
- Fig. 7.5 Periapical radiograph of a patient with fibrous dysplasia of the right maxilla. T
- Fig. 7.7 Mosaic histopathology in Paget’s disease.
- Fig. 7.8 Intraoral radiograph of the mandible of an edentulous patient with Paget’s disease of bone. There are two main features to note. There is an altered trabecular pattern with an impression of linearity/parallel lines. Mesially and distally there are densely radio-opaque areas (‘cotton wool’ radio-opacities).
- Fig. 7.9 Panoramic radiograph of a patient with Paget’s disease of bone. There are several dense radio-opacities within the mandible. The largest, in the lower left third molar region, subsequently underwent infection and sequestration.
- Fig. 7.10 Granuloma. (A) A panoramic radiograph of a 20-year-old female who presented with a painless swelling of the anterior mandible with
- Fig. 7.11 Parts of two edentulous mandibles as seen on panoramic radiographs. (A) A thick cortex can be seen at the lower border of the jaw. (B) The thinned cortex here is typical of a patient with osteopenia or osteoporosis.
- Genetic disorders
- Fig. 7.12 Histopathology of the brown tumour of hyperparathyroidism, showing numerous multinucleate giant cells.
- Fig. 7.13 Brown tumours of hyperparathyroidism.
- Box 7.1 Simple classification of bone swellings in the jaws
- 7.2 Diseases of the maxillary sinus
- Fig. 7.14 Normal maxillary sinus on CBCT (clockwise, from top left: coronal, sagittal, volume-rendered and axial). The maxillary sinus is uniformly radiolucent, representing air.
- Fig. 7.15 Periapical radiograph of the left upper molar region.
- Fig. 7.16 Chronic maxillary sinusitis affecting the maxillary sinuses on CBCT. The peripheral radio-opaque bands in both sinuses are mucosal thickening; this contrasts well with the central air space.
- Fig. 7.17 Acute maxillary sinusitis affecting the left maxillary antrum. There is an obvious fluid level in the left sinus, along with mucosal thickening on the lateral and medial walls. The right sinus is hypoplastic, but normal.
- Fig. 7.18 Mucus retention cyst of the right antrum.
- Fig. 7.19 Antral carcinoma. Intraoral (A) and extraoral (B) views. Note loss of nasolabial fold on the right side.
- Fig. 7.20 Panoramic radiograph of a patient with a squamous-cell carcinoma of the left maxillary sinus. There is complete absence of bone supporting the upper left third molar tooth and the sinus floor is not visible.
- Fig. 7.21 Displaced root within the maxillary sinus on CBCT imaging. Note the opacity filling much of the sinus, representing reactive inflammation. Only a few locules of air can be seen at the top of the maxillary sinus.
- Fig. 7.22 The Caldwell–Luc surgical procedure showing the site of the window into the anterior antrum.
- Fig. 7.23 Buccal advancement procedure to close an oroantral fistula.
- Fig. 7.24 The palatal flap procedure to close an oroantral fistula.
- Fig. 7.25 Panoramic radiograph of the child in Case history 3.
- Oral examination answers
- 8 Oral and maxillofacial injuries
- Chapter Contents
- Overview
- 8.1 Assessment of the injured patient
- Fig. 8.1 Trauma management primary survey.
- Breathing
- Fig. 8.2 Needle cricothyroidotomy.
- Circulation
- Fig. 8.3 Insertion of tracheostomy tube.
- Fig. 8.4 Examples of some dental injuries.
- 8.3 Facial soft tissue injuries
- 8.4 Facial fractures
- Fig. 8.5 Altered occlusion observed in a fracture of the condyle of the mandible.
- Fig. 8.6 A step in the occlusion observed in a fracture of the parasymphysis of the mandible.
- Fig. 8.7 Subconjunctival haemorrhage associated with a fracture of the zygomatic complex.
- Fig. 8.8 Common sites of fracture in the mandible.
- Fig. 8.9 Gillies’ temporal approach for the elevation of a depressed fracture’s zygomatic complex.
- Fig. 8.10 Mini-plating of the zygomatic-frontal (Z-F) and infraorbital regions for fixation after reduction of a fractured zygomatic complex. (A) Two-point fixation of fractured zygomatic complex. (B) Fracture of Z-F. (C) Reduced and plated Z-F. (D) Fracture of infraorbital rim. (E) Reduced and plated infraorbital rim. (F) Wound closure.
- Fig. 8.11 Le Fort classification of fractures to the maxilla.
- Open reduction and direct fixation in the mandible and maxilla
- Fig. 8.12 Radiograph showing bilateral severely displaced fractures of an edentulous mandible.
- 8.5 Gunshot wounds
- Fig. 8.13 Mini-plating of a fractured mandible.
- 8.6 Complications of facial injury
- Fig. 8.14 Patient described in EMI 2.
- Fig. 8.15 Patient described in Case history 3.
- Oral examination questions
- Fig. 8.16 Postoperative radiograph of the case described in Case history 4.
- Self-assessment: answers
- Multiple choice answers
- Extended matching items answers
- Case history answers
- Oral examination answers
- 9 Dentofacial and craniofacial anomalies
- Chapter Contents
- Overview
- 9.1 Congenital anomalies
- Learning objectives
- Aetiology
- Box 9.1 Incidence of dentofacial clefting
- Clinical management
- History
- Clinical examination
- Fig. 9.1 Deranged occlusion in a patient with severe asymmetry, caused by overgrowth of the left mandible.
- Investigations
- Imaging
- Cephalometric analysis
- Diagnosis
- Fig. 9.2 Cephalometric landmarks and lines for Caucasians.
- CLINICAL BOX TYPICAL DIAGNOSIS FOR A DENTOFACIAL ANOMALY
- Treatment planning
- 9.2 Orthognathic surgery
- Fig. 9.3 Sagittal split mandibular osteotomy technique.
- Genioplasty
- Maxillary surgery
- Fig. 9.4 Examples of genioplasty techniques A.
- Fig. 9.5 Le Fort I osteotomy technique for advancement of the maxilla.
- Postoperative care
- Airway management
- Analgesia
- Follow-up
- 9.3 Cleft lip and palate surgery
- Learning objective
- Table 9.1 Typical sequence of treatment for patients with cleft lip and palate
- 9.4 Craniofacial surgery and osteodistraction
- Learning objectives
- Osteodistraction techniques
- Technique
- 9.5 Cosmetic facial surgery
- Learning objective
- Scar revision
- Dermabrasion
- Fig. 9.6 Alveolar osteodistraction device.Overview
- 10.1 General features
- Box 10.1 Classification of cysts of the orofacial region
- 10.2 Examination
- Fig. 10.1 Photograph showing buccal swelling caused by residual cyst in maxilla.
- Table 10.1 Clinical features of cysts
- Fig. 10.2 An odontogenic keratocyst of the left mandible. (A) Part of a panoramic radiograph showing displacement of the third molar and inferior dental canal to the lower border of the mandible. (B) Part of a posteroanterior radiograph of the same lesion.
- 10.3 Specific cysts
- Fig. 10.3 A radicular cyst related to a retained root of a mandibular premolar. It is easy to imagine how the cyst has developed from the periodontal ligament and that its corticated margin is an extension of the lamina dura on either side of the root.
- Fig. 10.4 Photomicrograph of a radicular cyst.
- Fig. 10.5 Odontogenic keratocyst. The lesion is very well defined with a corticated margin. The wisdom tooth appears displaced, as does the inferior dental canal, visible at the inferior and posterior aspects of the cyst. The shape is not round or ovoid, but rather irregular with a separate locule below the crown of the wisdom tooth.
- Fig. 10.6 Photomicrograph of a keratocyst.
- Eruption cyst
- Radiology
- Fig. 10.7 Dentigerous cyst associated with unerupted second, third and a supernumerary fourth molar on a CBCT examination. Note the perforation of the buccal cortex on the volume-rendered view.
- Fig. 10.8 Dentigerous cyst showing origin from the amelocemental junction.
- 10.4 Surgical management of cysts
- Fig. 10.13 Ameloblastoma in the left lower molar region, displaying multilocularity and expansion of the bone. Note that the upper margin of the lesion is in contact with the occlusal surfaces of the maxillary teeth.
- Fig. 10.14 Compound odontome in the lower anterior region on a CBCT examination. This shows the typical appearance of a small mass of well-defined
- 10.7 Surgical management of odontogenic tumours
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