 Welcome back to question paper discussion of oral and maxillofacial surgery. For every question discussed here, I have framed an outline as to what to include and how to answer. Almost every answer has been structured as per the textbooks of oral and maxillofacial surgery by Neelima Malik and SM biology. Any references other than from these books has also been quoted in the presentation. After going into the discussion, let's have a look at how to present an answer. Yes, it's your knowledge preceding skill that is assessed and not your writing skill. Generally, your questions, especially the long essays, are very specific. So you answer them specifically too. Answer what is asked and only what is asked. Do not be around the bush. List your answers in bullets as you see in this slide as well as the following slides. Look at how answers to each question in this presentation are outlined. Follow the same. Avoid paragraphs because nobody has the time or patience to read stories. Answer again in points. Underline the main headings and subheadings so that it catches the attention of the evaluator. Because nobody will search for an answer, you need to highlight it for them. Make use of flow charts and label diagrams to describe the particular technique, surgical procedure and anatomy. This helps you to express a complete answer accurately. It will help you fetch more marks and most importantly, it saves time. Tabulate your answers for questions like indications, confindications, advantages and disadvantages. And finally, know that it's your answer that counts and not the pages. Therefore, short, neat and precise answers will favour you than your excess and overfilled pages. Last but not the least, write Legible, which I think requires no further explanation about. In this video, first we shall discuss the questions from the topic, general anesthesia and sedition. As you can see here, the most frequently asked questions from this topic are on pre-anesthetic evaluation and pre-anesthetic medication. The other questions are from general anesthetic agents and complications. Moving on to the first question, which is a short essay question. Describe the importance of pre-anesthetic evaluation before administering general anesthesia. So here you first write what is the purpose of a pre-op pre-anesthetic evaluation. Which includes obtaining information about the patient's medical history, mental condition, need for a medical consultation, consent for anesthesia. So all these comes under what is the purpose of pre-op evaluation. Then you write about what is the history that you obtain from the patient. You take a brief history of the patient which includes the current problems, the chief complaint, the present treatment the patient is undergoing, drug history, allergy history, habits and history of any prior anesthesia. So all these comes under the history part. Then you evaluate each organ system. So you write what is the importance of evaluating CVS. So here you can rule out any cardiac conditions like angina, hypertension, any congenital heart disease. So all that should be included while writing about CVS. Then under respiratory system. You can ask the patient about history of recent cough, cold, asthma. You are clear. All this comes under respiratory system. Moving on to CNS. Ask the patient about history of headache, any frequent headache, epilepsy, dizziness. So it is important to evaluate the CNS also. Under endocrine system you can mention about diabetic melitis or any thyroid dysfunction. So these are the importance of evaluating each organ system. Finally you write about airway assessment. Write about melampides airway assessment with help of a diagram. There are four classifications which you need to mention with diagram. So this is how you answer the question on the importance of pre-anesthetic evaluation before administering GA. The next question is classification of GA agents. They have been asked to enumerate complications during and after GA and also to add a note on respiratory obstruction. Classification of general anesthetic agents can be referred from any of the pharmacology textbooks. Commentary complications of general anesthesia during the perioperative and postoperative period. For this you can refer to either Neelima Malik or SM biology textbooks. Both of these books have tabulated the complications. So just enumerate them. Don't explain each point except for respiratory obstruction which you have to elaborate. Write this topic under the science and management. You need to write what are the signs of upper airway obstruction or respiratory obstruction and also the management part. So this completes your answer. Name the drugs used in pre-anesthetic medication. For this you can refer to the textbook of oral surgery by SM biology where the six days of pre-medication has been described. So you list out all the six days of pre-medication with one or two examples. This forms the first part of your answer. In the second part you have been asked to describe the role of acropin and sedatives which are used as pre-medication. So here you are expected to explain anti-cholinergic properties of acropin. What are the anti-cholinergic properties of acropin? It has vagulitic effects and anti-syllagogue actions. So explain these two actions of acropin. Regarding sedatives, you mentioned some of the commonly used sedatives in pre-medication. For example, benzodiazepines, diazepam, flumazanil, all these are the commonly used sedatives in pre-medication. And you explain one or two lines about each example. So this completes your answer. Enumerate the indications for GA in dentistry. You know that almost every maxillofacial surgical procedures are performed under general anesthesia. So you list out all the major surgical procedures. Some third molar surgeries are also carried out under GA which has clear indications. GA is also administered in patients with anxiety, challenging behavior, intellectual disability in children and also in patients who are allergic to local anesthesia. So include all these points under indications. Moving on to the second part of the question. We have already seen the importance of pre-anesthetic evaluation. So here you write about the information that you are trying to obtain through a proper history. Then you perform a physical examination. You examine all the organ systems like the CVS, CNS, Respiratory System and Endocrine System. You also perform an airway assessment. So add a note on the malamperty airway assessment. Then you mention about ASA. ASA is the American Society of Anesthesiologists Physical Status Scale. So this is a grading system and description of the physical status of a patient requiring anesthesia and surgery. So it has six classifications which you are supposed to mention in this part of your answer. Then you perform certain investigations as a part of pre-anesthetic evaluation. You perform basic investigations as well as some special investigations. So you write down what all investigations are basic and what all are additional or special investigations. So this makes up your answer. What are the complications during GA and how is it managed? Here you are supposed to write regarding infra-operative complications and not post-operative complications. For this refer to the textbook of surgery by Nelima Malik. Enumerate all the intra-operative complications and explain at least five to six complications in detail. You can explain each complication under the cause and management. Every complication will have a specific cause and definitive management. So this is a direct question and it can be answered also directly. This question is for short answer. Conscious sedation. You define conscious sedation. What are the indications and complications of conscious sedation? And enumerate the agents used for conscious sedation. So this is sufficient for a short answer. If it is asked for a short essay, you also include the technique of administering conscious sedation. The next topic of discussion is Exodontia and minor ov surgical procedures. The first essay question. They have asked the post-operative instructions, role of antibiotics and management of eye socket. So you first list out all the post-operative instructions under the following heading. Like there are few general comments you give to the patient. Then what are the instructions you give to manage bleeding, discoloration, pain, swelling, for any sharp bone projections on oral hygiene and diet. So these are the main headings. You need to explain or list out the instructions under these headings. That is what is expected of you. In the second part of the question, they have asked the role of antibiotics in routine extraction. So for this, you first mention what are the commonly administered antibiotics in bone surgery. Write the indications for antibiotic administration and then add a note on antibiotic profile access. What are the conditions in which you give profile access and what is the antibiotic dosage for that. So discussion on management of eye socket. You define what eye socket is and they have asked only management part. So you don't need to explain on the etiology and the clinical features. Under management, you need to write that the patient is first reviewed. Then mention how irrigation is performed. Add a note on intraagular paste used. What are the analgesics given and how is the regular follow-up or review performed. So this completes your essay on this particular question. The next question has three parts. In the first part, you describe the normal process of haemostasis. You explain about primary haemostasis and their role of platelet. The second way haemostasis can be explained under intrinsic and extrinsic coagulation pathway. You need to then enumerate the various tests carried out in a coagulation screening. Those tests are the bleeding time, throttling time, throttling time, partial thrombo-plastic time and INR. You can write a line each about each test, what is its significance and what are the normal values. In the third part of the question, you need to discuss the various local measures used to arrest a case of post-extraction bleeding. So list out all the haemostatic measures, the local haemostatic measures which are the mechanical, thermal and chemical. You can elaborate the answer by quoting two or three examples and explaining in detail about each of them. List the indications for tape extraction. Here you can list eight to ten indications. This is a direct question. In the second part of the question, you are asked to describe the principles involving closed method of extraction. Here do not get confused with the principles of elevators. You are asked to describe the principles of closed method of extraction, which are axis, controlled force and unimpeded path of removal. You can also add the mechanical principles of closed extraction, like expansion of the bleeding socket, using a zebra and fulcrum and insertion of the wedge or wedges. These mechanical principles are given in the book, The Expaction of the Bleed by Jeffrey L. This is regarding the principles of closed method of extraction. Do not confuse it with the principles of elevators. Here is the question on principles of elevators. So you explain in detail the lever, wedge and wheel and axle principles with diagrams. You also mention examples for each principle and also add a note on the mechanical advantage. The next question is to classify impacted maxillary canines. So this is also a direct question where you can write all the five classifications of impacted maxillary canines and explain them with that. Short answer list out at least 8 to 10 indications for removal of impacted mandibular third molar. For winters, war lines, explain what white, amber and red lines are using a diagram and explain what each of them signify. For ideal requirements of a flap, do not confuse it with the principles of incision. Write specifically to that of flap. The next topic is temporal mandibular misorders. As you can see, the long assay that has been asked consecutively for last 3 years is on joint ankylosis. We can discuss all of them together. A long assay on joint ankylosis can be explained under the following leggings. Definition, ecology, classification, clinical features, radiographs and management. When you write definition, write according to particular order or textbook. Do not make your own definitions. You can just enumerate the etiology. Do not write in paragraphs or don't explain any point. Just list them out. When it comes to classification, you can just mention one classification, preferably the Sonny's classification. This is the grading of TMJ ankylosis based upon CT findings. But if classification is asked for 8 marks, if only classification is asked, then you can try 3-4 classifications. You can explain them as well. Coming on to clinical features. Read the question twice to see if they have asked bilateral or unilateral ankylosis, write accordingly. You will discover all the clinical features of bilateral or unilateral ankylosis. Then you mentioned what are the different radiographs taken to assess TMJ. For example, OPG, Lack of Libre View, DMJ View. You will discover all the different radiographs techniques used and also write a distinct feature for each technique. What are the distinct features of ankylosis that you can see in each of these radiographs? Coming on to management. You should know that joint ankylosis can be only treated surgically. There is no medical management for joint ankylosis. You cannot cure the condition by giving any medicines. The surgery is the only option. So you first mentioned what are the aims or objectives of managing a TMJ which is ankylosed. So why do you need to manage or treat ankylosis? Then you list out all the points of Kaban's protocol. Kaban's protocol is very important, so don't miss to write it. Moving on to the surgical steps. These are the surgical steps followed. You first give an incision, then perform condilectomy, followed by GAP-R4plasty and interpositional R4plasty. Explain all these steps using diagrams. There are beautiful diagrams given in textbooks. Go through them, learn those diagrams, learn how to label each of them and then that is how you present this answer. And finally, you can finish your answer by writing a list of interpositional materials. There are few interpositional materials that you can use for the interpositional R4plasty. So list out those materials in the tab. So this completes the answer. Before answering this particular essay, check the question once for what all have been asked. For example, every question will not ask all these findings. The first question they have asked are etiology, clinical features and management. So mention only these three aspects. The second question they have asked you to classify TMJ ankylosis and then clinical and videographical features. So do not write etiology and just don't write etiology in it. The rest of them are asked and management is common in all the three ways. So this is how you answer an essay on TMJ ankylosis. Another recently asked question from Temporomaniblia Joint Disorders is TMJ dislocation and subluxation of TMJ. So dislocation is a complete dislocation of joint and subluxation is incomplete dislocation. So when you write about etiology of dislocation, you first write what are the predisposing factors. For example, you can mention laxative of ligaments, ligament injury, degenerative joint diseases, all these as predisposing factors. Then you write the exact etiology of TMJ dislocation. So the causes for TMJ dislocation can be classified into intrinsic and extrinsic factors. So you list out all the points under intrinsic factors and extrinsic factors. So this will be enough for your first answer on etiology of TMJ dislocation. Coming to subluxation of TMJ, you first write the definition of subluxation. You should know how it is different from TMJ dislocation. The predisposing factors and causes are again the same as that of joint dislocation. So you can write mention what are the etological factors for subluxation and then write two or three points on the management of subluxation. This list has questions from both optonetic surgery and orophacial infections. There are all four short answers, so we shall discuss all of them together. Recent questions on optonetic surgical procedures are all four short answers. These questions can be asked for long essays and short essays as well. So these are the points under which you explain each technique. History, indications, the technique, osteotomy cuts and any different types if there are any. So we shall see them in general. For a long essay, elaborate on the history. You describe how the procedure has evolved over time for a long essay. And for a short answer, you mention only the person who advocated the technique first. Elaborate the indications for long essays and keep them in points for short answers. The surgical types can be elaborated for both short essay and long essay but just mention them in points for short answers. When it comes to technique, limit short answer to one to two labelled diagrams. You need not elaborate on every surgical procedure or the step. Just confine the answer to few labelled diagrams. No flowchart also required. But for long answers and for essay questions, you can describe in detail each surgical technique and each step using a flowchart. And diagrams also for each step. The osteotomy cuts also can be represented diagrammatically. Do not waste your time writing it. You can draw a mandible or a maxilla and show the osteotomy cuts with proper labelling. So this is how you answer any question on a panathic surgical technique in general. For hyperbaric oxygen therapy, you first describe what HBO is. Mention the pressure, duration and diures. Then you list out the indications and contraindications of oxygen therapy. Mention the mechanism of action. You describe what HBO does to the tissues and how it helps in tissue healing. You also add a note on Mark's protocol of 1983. About osteo-radio necrosis, you first define what osteo-radio necrosis is. Describe the pathogenesis of condition. You explain what the three Hs are for osteo-radio necrosis. List out all the clinical and radiographic features. You can mention HBO therapy again in the treatment aspect. For Gaddy's osteomyelitis, describe what the etiology is. List out the clinical and radiographic features and also the treatment. All these are direct questions from textbooks. You can refer to textbooks of Oval Surgery by Neelima Malik or SM Balaji for these questions. For topics on ortho-nathic surgical procedures, you can refer to lecture videos in this channel. The links of which is provided in the description box. That's all for the discussion today. We shall continue the discussion in the next video. Thank you.