 Welcome back. Let's continue our question paper discussion of Overland Maxillofacial Surgery. A long essay question from local anaesthesia can always be expected and the most frequently asked questions are based on the classification, contents, inferior alveolar nerve block and complications of local anaesthesia. For serious superior alveolar nerve block, another technique commonly asked for in the exams. Before starting the discussion, I want to inform you that the only textbook referred to discuss local anaesthesia is local anaesthesia by Stanley F. Malami. Let's now move on to discussion. The first question is to describe nerve conduction, mechanism of action of local anaesthetics, the theories of local anaesthesia and classification of local anaesthetics based on their action. So here you can explain the electrophysiology of nerve conduction with four figures which has been given in the textbook that forms the first part of your answer. The second part of the question, which is the mechanism of action of local anaesthetics, again you can enumerate the eight steps that explains the mechanism of action. Then you need to list out the theories of local anaesthesia. Here you need not explain each theory. You can just list out the names of each theories of local anaesthesia. And lastly you need to classify local anaesthetics and the question is specified. It is based on their action. So here do not write the classification based on the chemical nature of local anaesthetic molecule like esterine amide. Do not write that classification but you need to classify local anaesthetics according to their biological action. So you classify them. There are four classifications. There are four classes. Then you write what each class is and then give example. This is how you write your first law. The second question again, you have been asked to classify local anaesthetics. So here because they having specified any classification, you can discount the classification according to action or due to chemical nature of local anaesthetics. The second part of the question. Discuss the bio transformation, excretion and adverse effects of lignokine. You know lignokine is an amide. Therefore you can list out the pharmacopinetics and adverse effects of amides which is given in the pharmacology of local anaesthetics chapter in malignment. Then you are asked to add a noton contents of local anaesthetic solution used in dentistry. For this you can refer to the chapter on cartridge where the components of local anaesthetic solution has been listed out in a tabulated form. So you mention all the contents of local anaesthetic solution. What is their action? This is how you write this answer. In the adverse effects part, you are expected to write the cns effects of lignokine or amides which again is given in tabulated form. Enumerate the ideal requirements of a local anaesthetic agent. Discuss the classic technique of IA&B nerve block. Discuss the local complications associated with this particular nerve block. So this is the question. The ideal properties of local anaesthetic agent can be referred from malignment. It is given in the first chapter in the first page. So list out all the 10 ideal properties. Next you discuss the classic technique of IA&B. So any local anaesthetic technique asked can be or should be explained under the following headings. Area of insertion, target area, landmarks, the position of the patient and the operator and then they proceed here. You can hold certain diagrams to emphasis on the landmarks or to describe the procedure. Diagrams are very important. Coming on to the complications. Here you have been asked to write the complications associated with inferior alveolar nerve block, not the local or systemic complications associated with local anaesthesia in general. So be specific. There are three different complications associated with IA&B which has been described in the textbook. So list out all of them. Write one or two lines about each of the complications. We have already discussed the content of local anaesthetic solution. Discuss the factors that guide in the selection of an appropriate local anaesthetic agent. For this you refer to the chapter on specific clinical agents of local anaesthesia and you need to elaborate your answer on the duration and maximum dose of local anaesthetic solution. So how does the duration of action and the maximum dose varies according to different agents? This is what you are supposed to or expected to answer in the second part of the question. In the third part you need to add a note on the role of antioxidant in LA solutions. You need to understand that the antioxidant in local anaesthetic solution is sodium metabysulfide and the antioxidant is used to prevent the oxidation of the vasoconstrictor used in the local anaesthetic solution and not the local anaesthetic agent. So you can just elaborate on sodium metabysulfide and its action. Coming to the next question. Enumerate the complications of local anaesthetics. Here they haven't specified whether it is local or systemic complications. So it is down all the complications both local and systemic. Then discuss the causes prevention and management of prismas in detail. So after you enumerate all the complications you expand your answer only for prismas. As they have asked in the question which is very direct the cause prevention and management. So explain it and your answer is complete. Describe in detail the posterior supire alveolar nerve block and mention its complications. So you can explain the answer under the following headings. The nerves and the area anesthetized, indications and complications of the technique, advantages and disadvantages and the technique itself. Under the headings which we have already discussed for inferior alveolar nerve block. Then you list out. You just need to mention the complications. Do not expand every complication. You list out the complications and then explain in detail hematoma following a PSA nerve block. So when you mention the complications associated with PSA do not list out all the complications of local anaesthesia. As I have mentioned earlier also just mention the complications associated with PSA in specific. And then you can elaborate on hematoma management which is given in the chapter of chapter on local complications of anaesthesia. This is how you answer this particular question. Discuss the various techniques of inferior alveolar nerve block. So you mention all the different techniques of IAMP. You just list them out and explain them under indications, landmarks and the technique in brief. So for the appropriate diagrams you can show the difference between each technique also using diagrams. What are the differences in the landmarks? What is the difference in techniques? All these can be explained with diagram. What are the systemic complications of local anaesthesia? How do you manage a case of an aflux? So the answer for this question can be referred from the chapter on systemic complications of local anaesthesia in the textbook of Melamed. You first classify all the systemic complications. Then note down the relevant features of generalized an afluxes. You mention all the signs and symptoms associated with this condition. And then briefly explain the management part. Briefly explain what is P, A, B and C and then in detail the definitive management. All these answers, all these points can be referred from the same chapter, the systemic complications of local anaesthesia. These are the short to say questions from local anaesthesia. We have covered a majority of these questions under long assay. There is a question on infrarbital nerve block which needs to be answered like that for IAMP or PSA. There is another question where management of facial nerve palsy has been asked. The answer for which can be referred from chapter on local anaesthesia complications, the local complications of local anaesthesia. The next two questions are on vasoconstrictors in local anaesthetic solution. So you describe all the five popular reasons for using VC in local anaesthetic solution and mention what are the conditions in which VC is contraindicated. You can then list down all the vasoconstrictors used in local anaesthetic solution. All these are direct questions. They are all direct picks from the textbook. So I don't think there was a need for detail or elaborate explanation. The next question is to discuss the mechanism of action of local anaesthesia which is a repeat and what are the factors affecting the action of local anaesthesia. For this you are expected to explain about dissociation of local anaesthetic molecule and a note on effect of pH change. What happens when the pH of blood increase or decrease? So this can be again referred from the chapter on neurophysiology which is the first chapter in the textbook. Explain the answer using appropriate diagrams. We have recently asked short note questions. We have discussed most of them under long essay and short essay. Next topic for discussion is maxillopaceae trauma. This is a very important topic from which sometimes multiple questions come for the same example. As you can see question on mandibular fractures is highly common. There are also questions on ZMC zygomatic or maxillary complex fractures and orbital fractures. There are two questions here on classification of mandibular fractures and description of the clinical features diagnosis and management of angle fractures. So the difference here is that in the first question what has been asked is displaced or unfavorable angle fracture and the second question is on favorable mandibular fracture angle fracture. There are a number of classifications given in textbooks. You can mention just one of them here. Then you explain what is unfavorable or what is favorable fracture depending on the question. You need to diagrammatically represent the favorability of fracture horizontally and vertically. Then you list out all the clinical features of angle fracture. Coming on to the diagnosis we need to elicit a proper history to diagnose what kind of fracture is, what is the type, what is the direction and what is the impact of force that has acted upon the patient. You also need to mention what are the supporting radiographs required. Moving on to management you need to first list out what are the fixation techniques used for treating a displaced angle fracture. You know that a displaced or unfavorable angle fracture can only be managed using open direction and internal fixation techniques. This can be done with or without intermaxillary fixation. So you list out all the techniques and explain only the relevant techniques. You can explain two to three techniques. For management of favorable fracture you can mention that favorable fractures can be managed using closed reduction methods. List out all the closed reduction methods and explain each of them and give diagrams where all necessary. Diagrams are very important. I need not keep stressing upon that. Diagrams are very important and that will help you reach more marks. A detailed lecture on manual fracture management has been uploaded earlier in this channel. Please use them for reference. The next question is on condylar fractures. Describe the clinical features diagnosis and management of unilateral condylar fractures. Promote the word unilateral condylar fractures. So the clinical features will change accordingly for unilateral and bilateral. You write down all the clinical features and the diagnosis. How do you diagnose this condition? What are the different investigations needed? So this forms the first part of your answer. In the second part you need to explain the management of unilateral condylar fractures. So the examiner hasn't specified as to whether you need to explain on conservative or surgical options. So you have to describe everything in brief. So first you mention what are the conservative methods or what is the closed reduction method of condylar fractures. What are the different measures taken and what are the various immobilization methods. All they should be mentioned under the heading conservative or closed reduction. Coming to surgical or open reduction. There are certain indications given by Zyda and Ken as to which case of condylar fracture needs to be treated surgically. So you need to mention at least five to six indications specified for surgical reduction or surgical treatment of condylar fractures. And then you list out all the fixation methods of condylar fractures. What are the different fixation techniques used and explain one or two a month. That will complete your answer on condylar fracture management. Describe the clinical features diagnosis and management of lefout 1 fracture. So you first describe the fracture line of lefout 1 with diagram. You need to explain how the fracture line runs in case of a lefout 1 fracture. When you list down all the clinical features of lefout 1 fracture there are at least six to eight clinical features you need to mention. Coming to the diagnosis part mention what are the radiative what are the different imaging techniques used to detect a lefout 1 fracture and how can a CTB useful a completed homography can be useful in case of lefout 1 fracture. In the management part you need to write how you reduce the fracture and how you fix the fracture. So what are the different reduction techniques. You can apply finger pressure or holes with action forceps or a Hayton Williams instrument. So all these are the reduction techniques which you need to elaborate for a long answer. And the different fixation techniques are direct fixation and suspension variants. Here also you first enumerate what are the different techniques of fixation and then elaborate on few relevant ones. Here you can see questions on management of zygoma fractures. It can also be asked like management of zygomatic fractures or ZMC zygomatic or maxillary complex fractures. Unless it is specified as zygomatic arch fracture as in the third question you always explain on ZMC fractures. So there are at least 10 to 15 clinical features which you need to mention that is the clinical features of ZMC fractures. Then come into a diagnosis mention what are the different imaging techniques used what are the different value graphs that supports and diagnosis of zygoma fractures. And while explaining management by the answer under the following headings like approaches which can be intraoral or extroval closed reaction methods using either Gillies approach or Keynes approach and fixation. It can be done using one point fixation two point three point or four point fixation. So this is a detailed explanation of ZMC fractures. In one of the questions you have been asked to discuss Gillies temporal approach in detail. So elaborate on Gillies temporal approach and the rest all can be just mentioned in brief. Coming on to zygomatic arch fracture the management of which is little different from that of ZMC fracture. So here you first briefly explain the anatomy of zygomatic arch mention its articulations what are its associated bones. Add a note on the fracture pattern which is usually a depressed weak kind of pattern and what are the clinical features associated with this particular fracture pattern. Right what are the causes of zygomatic arch fracture and the usually employed technique for management of zygomatic arch fracture is closed reduction. So write a note upon it. So this is how you answer questions on zygomatic or maxillary complex fracture or zygomatic arch fracture. The next question is on orbital blowout fractures. So this can be asked in a short essay or for a short note answer. So first you write what are the two mechanisms associated with orbital blowout fractures using diagrams. Beautiful diagrams have been given in the textbooks. You explain this part of the question using diagrams. Then you list out all the clinical signs associated with orbital blowout fractures. Give special mention about the altered load level, the anti-mangloids land and of thalamus why it happens and then dyplopia. All these needs to be mentioned under the clinical features of blowout fractures. Coming to the management you list down what are the different approaches to the orbit and the orbital flow. Enumerate all the approaches and then explain regarding orbital flow reconstruction which is the most important aspect of a blowout fracture. Blowout fracture will always result in the fracture of the orbital flow and the orbital contents will herniate into the maxillary sinus. So here you need to carry out orbital flow reconstruction. So explain about the reconstruction and list down all the materials what are the reconstruction materials used for orbital flow. These are some of the short note questions asked. We have covered a majority of them under long essay and short essay. There are certain terminologies related to fractures that you need to be familiar with like Gwerin sign, Kalliman sign, Patel sign, what is Gardman's fracture. So Gwerin sign is a classical feature of Lefort 1 fracture. So while answering this question describe what a Lefort 1 fracture line is. Describe what the sign is, where it is seen, why it is seen and if needed you can briefly describe the management also of Lefort 1 fracture. Coming on to Kalliman sign again similar to Gwerin sign describe its significance and what are the associated signs. So Kalliman sign is found in mandibular fractures. You can also mention what are the other signs and what are the associated signs of mandibular fractures. Next question on CSF rhino area while answering this question. These are the headings under which this question needs to be explained, but if it is asked for a short note you can just brief them. You need not explain everything in detail. You can just list the contents in each heading that is sufficient but for a short answer or for a short essay you can elaborate on each of these points. So you first mentioned what is CSF fluid. The question is CSF rhino area. So you say what CSF fluid is and then what is CNS rhino area. You list down the contents of CSF fluid, what are the causes of rhino area, why does CSF rhino area happen, what are the bedside tests for confirming CSF rhino area, what are the chemical markers, what are the imaging studies done and how this managed. So this forms the complete structure of CSF rhino area. You answer according to the marks of the question. Then regarding malunion, nonunion and delayed union. These are certain complications of mandibular or any fracture just not mandibular fracture of any fracture. These are the certain complications associated. So in this question paper they have asked regarding malunion but you can also be asked for nonunion and delayed union. You first define these conditions, say what are the causes for this particular condition, how is it managed and what are the future complications. This is how you answer all these short note questions. Moving on to the questions from cysts and tumors of oral facial region. The three most important cysts to be considered are the radiculocyst, lentigerocyst and autogenic keratocyst and the most frequently asked tumor for exam cysts amyloblastoma. Procedures like enucleation, mass supply session, maxlectomy and mandibular procedures for tumor resection are repeatedly asked questions and hence should not be overlooked. The first long assay question is what is cyst? Describe the features and management of radiculocyst. So you define cyst according to grammar. Then you list down all the clinical and radiological features of radiculocyst. When it comes to management part enumerate the treatment options for radiculocyst. For example extraction, endodontics, enucleation with primary closure and Waldron's procedure. Waldron's procedure is nothing but mass supply session followed by enucleation. As I have mentioned it in the previous video also you present the surgical steps in flow charts and using diagrams. So this is how you write a long assay on management of radiculocyst. So this applies to other cysts also. Even if you are asked to write on lentigerocyst or okc this is how you write or frame the answer. The repeatedly asked question is amyloblastoma. Here you have been asked to classify auto genetic tumors, mention the features and management of amyloblastoma in the mandible. Note that the question is management of amyloblastoma in the mandible and not maxilla. So whenever you are preparing an answer for long assay on amylo blastoma always try to include the following headings all these headings in your answer. Do not mention them unless asked for. You can find the classification of auto genetic tumors in any of your oral pathology or surgery textbooks. Define amyloblastoma according to Robinson. You add a note on the pathogenesis of amyloblastoma and enumerate the histological variants of this condition. You can then write down the clinical features and radiological features of amyloblastoma and if they haven't specified anything in the question as to which amyloblastoma that you need to explain about you can always write down the radiological features of conventional amyloblastoma. That is the sobubble appearance and honeycomb appearance all that comes in conventional amyloblastoma and you can list down the features of unicistic amyloblastoma only if they have mentioned it specifically in the question. Coming to the management part first list down all the treatment options for amyloblastoma which includes enucleation, cutotage, end block, segmental resection, amyloblastoma followed by reconstruction. You can explain all these procedures in grief using diagrams. For the question of amyloblastoma in maxilla everything up till the management remains the same. In the management aspect you need to explain that's the only difference. The detailed description of surgical procedures of jaw tumors has been already uploaded in this channel so you may have a look at them for reference. Here is a question on keratocystic or ontogenic tumor which is nothing but ontogenic keratocyst. So you will list down all the clinical features of OKC in which you need to give special mention on the syndromes related to this particular cyst. OKC is associated with several syndromes which you need to mention. In the management aspect first you list out all the treatment modalities as it was explained in the question for rhinoculosis. Then you briefly explain the procedures of masculization and enucleation. Carnoid solution needs a special mention whenever you are answering a question on OKC. So you applied carnoid solution after the procedure of enucleation. So whenever you answer OKC these are the points to be kept in mind. Moving on to radiological features of dentigerocyst. Here you are expected to explain all the three variants of dentigerocyst with good diagrams. All these questions are given in your textbooks under the same headings. So it shouldn't be very difficult for you to write an answer for all these. If a question on masculization or enucleation is asked or for that matter if any surgical procedure is asked write down the indications, advantages, disadvantages, types or modifications of that particular technique and also explain the stepwise procedure with the help of flow charts and diagrams. This is how you need to explain or elaborate upon any surgical procedure if asked. Ashley's flap is the only question that has been asked from Max Larry Sinus in the recent years. Whenever a question on flap is asked you first mention what type of flap it is. For example if it is a palatal flap or buckle flap what are the indications and advantages, how is the technique performed and add a note on modification if any. You can press into an answer with good label diagrams. From Max Larry Sinus this is not the only flap that is important you have to read and practice writing all kinds of flap but this is the only recently asked question from this particular topic. Similarly with great prosthetic surgery only vestibular plastic has been seen in the recent question papers but other procedures like which augmentation procedures, which correction procedures, angular plastic all these are very important topics. So when you have to write an answer on vestibular plastic first you define or say what is vestibular plastic, what are the techniques of vestibular plastic in both maxilla and mandible because here it's asked for short note you can just enumerate the technique names. In maxilla and mandible separate and diagrammatically present two to three techniques with diagram. Here you need not elaborate on the technique because it is asked only for four marks you can just present it with diagrams. vestibular plastic is also known as the rich extension procedure which not be confused with other rich augmentation procedures or rich correction procedure. vestibular plastic can also be asked as rich extension procedure. The three very important topics from the chapter facial neuropathology are trigeminal neuralgia, facial nerve palsy, and nerve injuries. Here we are discussing only trigeminal neuralgia because that is the most repeatedly and frequently asked recent question. So you first define trigeminal neuralgia, list down the other names of this condition. There are a few other names for trigeminal neuralgia which you mentioned. What is the etiology of trigeminal neuralgia and what are the theories associated with the etiology? In the clinical features, trigger points need a special mentioning. When it comes to diagnosis, what are the imaging techniques used to diagnosis condition and what is Swede's criteria? Swede's criteria and trigger points are very important while writing an answer on trigeminal neuralgia. So do not miss to mention them in your answer. When it comes to management part, this condition can be managed in two different ways. There is medical management as well as surgical management. So first you enumerate what are the options in medical treatment and what are the options in surgical treatment and explain which you think is very relevant. If they have asked specifically one kind of treatment, either medical or surgical, just explain whatever is asked. The only question asked for oral malignancy is TNM staging and classification. If you are answering a short note, the TNM classification of oral cancer will be sufficient. You mentioned what TNM and what age component is and what is the classification of each component. If you are answering a short essay, along with TNM classification, you also add a note on TNM staging. That is how the disease is classified into four stages based on the TNM classification. Two important questions from the topic implantology is osteointegration and dental implants. So for this, you need to know the definition of osteointegration and dental implant, preferably the GPT-9 classification. You define osteointegration and enumerate the types of dental implants. There are different classifications given for dental implants. Here you can classify based on the design of dental implants. The surgical procedure for implant placement is also given elaborately in textbooks. You first mentioned all the main headings of the procedure and explain it very briefly with diagrams. That will be sufficient for short essay. And if dental implants is asked for short note, you can just define dental implants and mention the components of dental implant. You will draw a dental implant and label it properly. Show what all parts are there in dental implant. You can also just enumerate the surgical steps in points. If it is asked for short essay, explain it briefly. Dear students, here I would like to tell you all that this video is not a substitute to your textbook and class notes reading. This is not your syllabus either. This presentation is only to guide you through how to answer a particular question if asked. There are several other topics which having been asked recently but are still important for your exams. The content of this video can help you to answer questions from those topics as well. Hope you all benefit from this discussion. That's all for part three. We shall continue in the next video. Thank you.