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PBL session 3 "Where is the root?", Masseter, temporalis,…

- - - - Infections causing trismus may be of an odontogenic or non-odontogenic nature.
        
        Odontogenic infections have three major origins: pulpal, periodontal and pericoronal.
        
        The presence of an oral infection, particularly around an erupting mandibular third molar, is the most common cause.
        
        Severe odontogenic infections involving the muscles of mastication are often accompanied by trismus at initial presentation.
- - - - CT scan was taken and confirmed the position of the of the root on the lateral aspect of the medial pterygoid muscle, close to its inferior attachment in the 48 region
      - Buccal and lingual mucoperiosteal flaps were raised in the 48 region. The granulation tissue was curetted from the socket.
      - lingual wall of the socket was sectioned with burs and removed. The inferior attachment of the medial pterygoid muscle was exposed following further removal of bone with burs.
      - With blunt dissection using fine curved mosquito artery forceps the root fragment was retrieved from the medial pterygoid muscle, close to its attachment to the lower border of the mandible.
      - Primary closure was achieved and the patient was placed on a week course of Amoxycillin. Post-operative recovery was uneventful.
  - - - CT scan of her jaw revealed an intact 3rd molar, displaced lingually and inferiorly in the sublingual pouch.
        
        Procedure done via intraoral approach under GA
        
        Exact position of tooth located by bimanual palpation
        
        Incision placed directly over lingual pouch, avoid causing lingual nerve injury
        
        Retrieval of tooth using curette
        
        Wound irrigated with normal saline and sutured with 3-0 Vicryl suture
        
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  - - - CT scan revealed a fracture of the lingual plate near the third molar region and a hyperdense fragment situated medial edge of the submandibular space
        
        Procedure done under LA
        
        ID n. block, lingual n. block, long buccal n. infiltration given
        
        Exact displaced root fragment was palpated
        
        Buccal flap was raised from the mandibular first molar to the external oblique ridge distally
        
        Lingual flap was raised mesially up to the first premolar and distally adjoined with the buccal flap
        
        Lingual flap was reflected up to submandibular region until root fragment could be visualized with good illumination
        
        Root was pushed outward and removed with curette
        
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- - - - Level B
      - Level C
      - Level A
    - - Class I
      - Class II
      - Class III
- - - - Intraoral
      - Extraoral
    - - LA
      - GA
    - - raise a flap
      - removal of bone
      - retrieve root / fragment
      - wound suturing
      - prescribe post-op antibiotics
- - - - Absence of all sensory modalities
    - - Abnormal sensation (tingling) when provoked or spontaneously
    - - Unpleasant abnormal sensation when provoked or spontaneously
    - - Two type of duration of nerve injury
        
        Temporary
        
        To be resolved within the first 6 months.
        
        Permanent
        
        If no improvement is seen after 2 years of follow up, a complete loss of sensory function
      - Type of nerve injury
        
        Axonotmesis
        
        It is loss of the relative continuity of the axon and its covering of myelin,but preservation of
        the connective tissue framework of the nerve.
        
        Neurotmesis.
        
        It is loss of continuity of not only the axon, but also the encapsulating connective tissue
        
        Neuropraxia
        
        It is an interruption in conduction of the impulse down the nerve fiber. The recovery in such
        cases takes place without Wallerian degeneration, hence, it is considered to be the
        mildest form of nerve injury.