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How do you approach a pathologic lesion?
- blood: PTH, Alkaline phosphatase, rarely diagnostic
- Imaging: angiography, contrast, MRI(soft tissue), scans
- Aspiration: simple, distinguish benign from malignant
- Biopsy: most definitive
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What is segmental resection?
- geometric removal of tissue-> aggressive tumors
- marginal: just alveolar process
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What is partial resection?
- remove to leave gap-> large tumors
- must reconstruct
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What is carnoy's soln?
chemical coagulation: 60% EtOH, 30% Chloroform, 10% acetic acid
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What are indications for marsupialization?
- prevent injury, devitalization of teeth, erupt teeth
- difficult surgical access
- pathologic fracture
- med compromised
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Which MRI is good for fluid contrast?
T2
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What are risk factors of oral cancer?
tobacco, HPV, EBV
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What type of oral cancer does EBV increase risk?
Type II nonkeratinizing NPC (nasopharyngeal)
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What kind of leukoplakia is premalignant?
verrucous
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What is most erythroplakia?
invasive carcinoma, carcinoma in-situ or sever dysplasia
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Adv/disadv of surgery?
- physical remove, pathology, quick, no toxicity
- morbidity, anesthetic, may miss some
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Adv/disadv of radiation?
- tx both cancer and adj areas, preserves appearance function, sick elderly more tolerable
- long, toxicities, no pathology evaluation
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adv/disdv of chemo?
- systemic, presever appearance/function
- not effective for all, long tx, toxicity, no pathology eval
- not curative alone
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What are access aproaches for oral cancer surgery?
- intaoral: no scarring, limited access
- lip-splitting: best access
- visor flap: neck scarring only, long incision.
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What is en bloc resection?
- geometric
- marginal: alveolar process
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What is Weber-reguson?
access to maxilla, via insicion around nose up to orbit
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What type of surgery is done if node metastasis?
composite resection, radical neck dissection (including CN XI), modified (excludes CN XI), selective
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What is the process of grafting?
prepare recipient site, immobilize, prevent infection
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What are the phases of osteogenesis?
- I: remaining living graft cells
- II: BMP mobilized pluripotent cells to use graft as framework
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What are the phases of skin graftin?
- adhesion: fibrin
- nutritions: diffusion
- circuation:
- attachment: fibroblast
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Types of flaps?
- flap, composite of skin never separated from vascular supply
- random pattern: 2-3:1 length to base
- axial: known vascular axis 4-5:1
- Musculocutaneous: dominant blood supply for entire muscle
- composite free flap
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What is the biggest advance in H & N reconstruction?
- composite free flap: skin, fascia, muscle & bone supplied by vessels large enough for microvascular anastamosis
- Heals like fracture, not graft
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