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Missing Slides. Group-5. What is heparin?  A naturally occurring anticoagulant produced by basophils and mast cells. Heparin medication is usually fabricated from pig intestine and works by activating antithrombin III, which prevents thrombin from clotting blood. 

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  1. Missing Slides

  2. Group-5 What is heparin?  A naturally occurring anticoagulant produced by basophils and mast cells. Heparin medication is usually fabricated from pig intestine and works by activating antithrombin III, which prevents thrombin from clotting blood.  How should a patient taking heparin be managed?  Consult the physician to determine the safety of stopping heparin therapy for the perioperative procedure. Any invasive procedures should be deferred at least 6___ after heparin is stopped. The other option available is to reverse the effects of heparin by using protamine. Heparin therapy should normally be restarted once a good, stable clot has formed. What test should be administered for those patients taking heparin?  The proper test that should be ordered is a PTT [partial thromboplastin time]. Heparin works on intrinsic factors VIII, IX, XI. A PTT test is often used as a starting place when investigating the cause of a bleeding or thromboplastic event. A decreased PTT is evident when factor VIII is elevated. Elevated PTT can indicate a deficient factor VIII, vonWillebrand's Disease, and possibly leukemia. 

  3. Diagnosis Criteria-for BRONJ To distinguish BRONJ from other delayed healing conditions, the following working definition of BRONJ has been adopted by the AAOMS: • Patients may be considered to have BRONJ if all of the following three characteristics are present: • 1. Current or previous treatment with a bisphosphonate; • 2. Exposed, necrotic bone in the maxillofacial region that has persisted for more than eightweeks; and • 3. No history of radiation therapy to the jaws.

  4. Subluxation • Hyper mobility • Cause- • Anatomy-short posterior slope articular eminence followed by a longer ,flatter anterior slope • Spontaneous Dislocation • Mouth is opened beyond its normal limit • Mandible locks • Patient cannot close the mouth

  5. Hypomobility-Ankylosis • True Ankylosis • Causes: • Trauma • Intracapsular fracture-common in children • Medially displaced condylar fracture-Common in adults • Obsteritic trauma • Intracapsular fibrosis • Infection-Otitis media, parotitis, suppurative arthritis, osteomyelitis • Systemic dieases • Small pox • Typhoid • Ankylosingspondilitis • Inflammation • Rheumatoid artheritis, still’s disease, Osteoartheritis • Surgical • Post operative complications of TMJ or Orthognathic surgery • Prolonged immobilization • Prolonged trismus

  6. Ankylosis • Intracapsular • Fusion of condyle, disc, Fossa Complex • Partial reduction to complete immobility • Etiology-Trauma***,Previous surgical treatment, Rarely infections (otitis media) • C/F-Resticted Jaw opening • Deviation to affected side • Fibrous Ankylosis-jaw opening is present • Bony Ankylosis- No movement • Extracapsular • Condylar hyperplasia • Enlarged cornoid process

  7. Ankylosis- clinical features • Restricted jaw movements • Inadequate masticatory (chewing) function • Restricted mouth opening • Inhibited facial and physical growth • Impaired speech • Reduced growth of mandible resulting in “Bird Face” • Facial asymmetry if only one side is affected • Difficulty in breathing and swallowing • Snoring and difficulty in sleeping on lying down • Insufficient access for dental care resulting in multiple decayed teeth • Misaligned teeth because of lack of space for the eruption of the normal component of teeth • Other emotional, social and psychological disturbances.

  8. Surgical approach • Preauricular approach • Combination of preauricular and submandibular approach • Nerve Simulator used during dissection • Diseased TMJ is removed • Replaced with autogenous graft.

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