opath3.txt

• melanocytes stimulated by polycyclic amines (nicotine, benzpyrine) for protection
• reverse smokers where melanocytes lost have depigmented red mucosa

• pigmentation in anterior facial gingiva
• histo: increased melanin in basal layer sim to melanotic macule

unexpected pigmentation location: hard palate or increased density (surface elevation)

• stimulate melanocytes
• deposition of metabolites

• discolor bone/teeth
• dark green bone through oral mucosa -> linear band above the facial attached gingiva near mucogingival juntion and broad zone discoloration of hard palate.
• http://mydental.uw.edu/oralpath/caseofthemonth/april-05/images/Fig_1.jpg

• 7-10 years (vary states)
• pediatric: until majority

personal recognition

natural, accidental, suicide, homicide

• anatomic, restorative, pathological components.
• patern of palatal ridge, ridges on lip surface and radiographic outline of max & frontal sinuses.
• ID markings on removable prosthesies

• tools: long-handled pruners, 8-10" knife
• Photos: head/face, occlusal planes, unusual pathology, restorative
• impressions & resection: not necessarily required, use 10% formalin

• use reciprocating (stryker) saw or osteotome and mallet to create LeFort I maxilla fracture
• place above inferior nasal spine and malar process to enure apices aren't transected.
• cut high on rami to avoid damage to impacted thirds

• NDMS: national disaster medical system: establish morgue, ID and dispose remains to funeral via 10 regional DMORTs (disaster morturary operational response team)
• dental team: assemble antemortem, interpret, postmort

• I: enamel
• II: dentin
• III: pulp
• IV: root

• Luxation: perio
• Hard dental: enamel, crown, root (complicated implies endo)
• Supporting bone:intrusion, socket, jaw fractures, alveolar (DA)
• gingiva & oral mucosa: contusion(no epithelial break), abrasion, laceration

no epithelial break

• concussion
• subluxation
• extrusive/lateral/intrusive luxation
• avulsion

Angle Class II, Div 1 are 3x more prone

Complicated Crown Fracture (hard tissue)

• 25-30% prevalence
• <20 yrs (8-12 especially MIXED dentition)

• normal (w/o pulp & periradicular disease) developing roots of immature teeth
• necrotic pulp: before root growth is complete, dentin stops and growth arrested
• dev anomalies: dens in dente

vital pulp therapy: promoting root groth to lenth and maturation of apex

• Pulp necrosis: uninfected via coagulation/ischemia or liquefaction (infection)
• Pulp canal obliteration: accelerated deposition of hard tissue along the pulp canal walls
• external inflammatory root resporption

• result of removal of injured periodontal ligament tissue next to the root surface by macrophages and osteoclasts
• results in a saucer-shaped cavity on the root surface mostly involving cementum.
• resorption cavity will subsequently be fully or partially repaired by new cementum with insertion of new Sharpey’s fibers.

• hx:
• clinical:
• radio: esp resorptive and calcific changes
• photographs: esp for abuse & litigation
• follow up: varied recall 1 week, 2 week, 6 weeks, 3, 6 12 months, then yearly, pulp vitality
• ENDO:
• subjective: chief complaint, med/dent hx
• objective: pulp tests, radio, bite test, cracked tooth, refrerred pain

• perio pockets
• uniformly widened lamina dura

• pulpal: CO2, Ice, EPT
• color: gray v yellow
• mobility
• percussion
• palpation
• perio
• transillumination: fractures
• radiographic

• supporting structures w/o loosening
• marked reaction to percussion
• good prognosis: 100% open, 95% closed

• LOOSE not displaced
• good prognosis: 100% open, 90% closed(>1yr)

• partial OUTWARD displacement
• ok prognosis: 90% open, 50-40% closed

• displacement other than axial w/ communication or fracture of alveolar socket
• ok pulp prognosis (worse than extrusive): 90% open, 25% closed
• pulp survival higher though than extrusive for open apices

• displacement into alveolar bone w/ communication or fracture of alveolar socket
• poor prognosis: 40% open, 0% closed

• complete displacement out of socket (Exarticulation)
• worst pulp prognosis 30 % open, 0% closed
• PDL healing: 40% open, 20% closed
• Must be reinserted quickly (<30 mins) and wet stored (socket, saline, saliva, milk)

• 1. dental
• 2. soft tissue
• 3. bone fractures

3 months

apexgenisis: vital pulp therapy

• Closed apex: RCT
• Open: apexification: Root end closure & obturation or Regenerative endo

root end closure to induce root end formation (apical calcific barrier) when pulp is necrotic

Alveolar, nasal, mandible, zygomatic & orbit, maxillary

condyle, symphisis (& contralateral condyle)

submandibular swelling, ecchymoses, lacerations, anterior open bite

• closed reduction: wiriing jaw (MMF), splint
• open reduction: direct surgical reaaprox (ORIF), wire or rigid fixation
• fixate much shorter time for children

• mal-union
• non-union rare
• infection: raare
• TMJ ankylosis
• growth arrest (asymmetry)

Kazanjian (WWI)

• violence>MVA>accidents
• men>women

• greenstick: young bend, not break
• simple: not displaced
• compound: displaced
• communited: multiple fracture lines & fragments

• body (41%), angle (23%), condyle (18%), parasympheseal (9%), alveolar process (3%), coronid (0.4%)
• parasympheseal/ sympheseal- in the region btw the canines
• sympheseal = midline
• weak points: condyl, ramus, mental foramen

• favorable: muscles tend to draw bony fragments together
• unfavorable: displaced by muscle forces

• dentoalveolar fracture: only involving bone investing roots of teeth
• Le Fort 1: horizontal maxillary fracture, running through entire maxilla above apices of teeth; posteriorly, it crosses the pterygoid plate
• Le Fort 2: pyramidal fracture, crossing inferior orbital nerve & nasal & lacrimal bones, medial wall of the orbit
• Le Fort 3: the most serious, where entire midface has separated from base of the skull
• zygomatic complex- zygomatic bone articulates w maxillary & temporal bone
• orbital- fracture of thin orbital floor
• nasoethmoidal- anything affecting the nasal zone & ethmoidal region

• secure airway
• hemostasis: direct pressure, swab
• stabilization: barton bandage, bridle wire

half of interpupillary

• basilar skull fracture
• may present later

mastoid bruising (posterior basilar skull base injury)

• filter paper: separates from blood -> ring, double ring or halo
• test for glucose or beta-2 transferrin

beta-2 transferrin

• bilateral condylar or angle fractures
• posterior and inferior displacemnt of facial bones (lefort III)

IAN and Infraorbital

increased distance between medial anthi(corners of eye)

• widened nasal bridge
• epistaxis
• telecanthus
• periorbital edema
• subconjunctival hemmorhage

• diplopia: double vision
• enopthalmus: posterior displacement of eyeball

intraoral: buccal uper molars to ID displacement or collapse of arch

• upper: axial/coronal CT, skull, waters
• midface: axial/coronal CT, waters,, bumental, posteroanterios occlusal
• mandible: pano mandible series, elongated towne.
• use lateral oblique if pano isn't available

lateral oblique

one fracture or dislocation implies another

• opacification or increased fluid levels in maxillary sinus
• tear drop: orbital floor fracture