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    NervesClassification of axons – conduction speed Erlanger & Gasser 1937A α 70 – 120 m/sec.A β 30 –70 m /sec.Aγ A δ Large sensory fibresB Autonomic fibresC Unmyelinated fibres 0. – 2 m / sec. !C fibers"

    Classification of axons – size of axon Lloyd 1943#rou$ % A α & – 20 µ m. diameter #rou$ %% Aβ & – 20 µ m.#rou$ %%% Aδ 1 – & µ m.#rou$ %' C and B fibres smaller diameter fibres

    Size of fi res in decreasing orderA α > A β > Aγ > A δ > B > C

    ()e conduction s$eed of a ner*e fibre is a$$ro+imately & times t)e diameter of t)e fibre. ()us a 1 µ m. ner*e fibreconducts im$ulse at ,0 m/s.

    Classification of ner!e fi res ased on nu" er of fascicles-onofascicular $attern one large fascicle. .g. %ntra cranial $art of facial ner*e.

    ligofascicular $attern 2 – 10 fascicles.olyfascicular $attern 10 fascicles. .g. %nferior al*eolar ner*e Lingual ner*e. ! 14 – 21 fascicles "

    #$ysiologic conduction loc% focal conduction loc%' Lund org 19(( Contro!ersies in )ral & *axillofacial surgery+ #age ,79+'

    (y$e A %ntraneural circulatory arrest or metabolic !ionic" bloc5 6it) no ner*e fibre $at)ology. e*ersibleimmediately. -anaged by t)era$ies to im$ro*e t)e circulation to t)e ner*e trun5 decrease oedemaor re*erse *asos$asm.

    (y$e B %ntraneural oedema resulting in increased endoneurial fluid $ressure or metabolic bloc5 6it) little or noner*e fibre $at)ology. e*ersible 6it)in days or 6ee5s. ()era$ies to decrease oedema and

    $romote *enous drainage.

    -ntra.operati!e grading of perip$eral ner!e lesions Sa"ii 19(/1 8i*ided $eri$)eral ner*e

    a" %n9ury to e+amination inter*al : 3 6ee5s b" %n9ury to e+amination inter*al 3 6ee5s

    2 Lesion in continuityc" %n9ury to e+amination inter*al : 3 mont)sd" %n9ury to e+amination inter*al 3 mont)s

    3 -i+ed 1 and 2

    Classification of nerve injuries Seddon1943 ;euro$ra+ia Local conduction bloc5 at t)e site of in9ury 6it)out

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    Classification of ner!e in0uriesSunderland 19 1

    1st degree Corres$onds to =eddon>s neura$ra+ia (y$e % Conduction bloc5 due to ano+ia from interru$tion of t)e segmental or e$ineural blood

    *essels but t)ere is no a+onal degeneration or demyelination. esulting from ner*e trun5mani$ulation mild traction or mild com$ression. eco*ery is ra$id follo6ing restoration ofsensation.

    (y$e %% Conduction bloc5 due to intrafascicular oedema follo6ing ru$ture of endoneurialca$illaries as a result of trauma of sufficient magnitude. eco*ery of senses 6it)in 1 – 2 daysfollo6ing resolution in t)e intrafascicular oedema.

    (y$e %%% =egmental demyelination or mec)anical disru$tion of t)e myelin s)eat)s follo6ingse*ere mani$ulation traction or com$ression. eco*ery ta5es 1 – 2 mont)s

    2nd degree A+on and myelin are interru$ted but t)e endoneural s)eat) and ot)er su$$orting connecti*e tissuestroma including e$ineurium and $erineurium are $reser*ed.

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    Classification of ner!e in0uries y location of fi rosis *illesi et al 19(9+ Contro!ersies in )ral & *axillofacial surgery+ #age ,(3+'

    esignation Location #rognosis

    A $ifascicular e$ineurium #ood $rognosis

    B%nterfascicular e$ineurium rognosis de$ends onoriginal damage

    C ndoneurium oor.

    ; %n a =underland class %'in9ury t)e e$ineuralconnecti*e tissue t)atmaintains continuity can beinfiltrated by neuroma.

    oor

    =Continuity in class %' in9urymaintained only by scartissue.

    oor.

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    #rade A B C are used in combination 6it) =underland>s classification % A % B? %% A %% B and %%% A %%% B %%% C.#rade C fibrosis occurs only 6it) class %%% in9ury.

    Classification of ner!e in0uries #at$op$ysiologic classification Contro!ersies in oral & *axillofacial surgery+ #age ,(3+'

    Com$ressionCom$artment syndrome=tretc) in9ury(ransection laceration ru$ture and a*ulsionC)emical in9ury

    ;er*e in9ection in9uryAnatomically maintained $ainCentral neuro$at)y

    Grading of sensory recovery Mackinnon Clin #last+ Surg 19(9= 0 ;o reco*ery= 1 eco*ery of dee$ cutaneous $ain= 2 eturn of some su$erficial $ain / tactile sensation= 2D eturn of some su$erficial $ain / tactile sensation 6it) o*er reaction= 3 eturn of some su$erficial $ain / tactile sensation 6it)out o*er reaction and t)e $resence of static t6o $oint

    discrimination !2$d" 1 mm= 3D As $er = 3 6it) good localisation of stimulus !2$d" E 7 1 mm= @ As $er = 3D !2$d" E2 & mm=ensory score eFual to or greater t)an = 3 is defined as useful sensory reFuirement

    ssess"ent of ner!e reco!ery . ritis$ *edical :esearc$ Council ClassificationClassification 8escri$tion

    *otor :eco!ery

    - 0 ;o contraction- 1 eturn of $erce$tible contraction in $ro+imal muscles.- 2 eturn of $erce$tible contraction in bot) $ro+imal and distal muscles.- 3 eturn of function in bot) $ro+imal and distal muscles of a degree t)at all im$ortant

    muscles are sufficiently $o6erful to act against resistance- @ eturn of function as in stage 3 6it) addition t)at all synergetic and inde$endent mo*ements are $ossible.- Com$lete reco*ery.

    Sensory :eco!ery= 0 Absence of sensibility in t)e autonomous area.= 1 eco*ery of dee$ cutaneous $ain sensibility 6it)in t)e autonomous area of t)e ner*e.= 2 eco*ery of some su$erficial cutaneous $ain and tactile sensibility 6it)in t)e autonomous area of t)e

    ner*e.= 3 eco*ery of su$erficial cutaneous $ain and tactile sensibility t)roug)out t)e autonomous area 6it)

    disa$$earance of any $re*ious o*er res$onse.= 3 D eco*ery of sensibility as in = 3 6it) t)e addition of some reco*ery of t6o $oint discrimination 6it)in t)eautonomous area.

    = @ Com$lete reco*ery.

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    Pain#ain classification - S# -nternational association for t$e study of #ain'+

    ur%et #age 3,7Categorises $ain into *arious $arameters.A+is % egions ! t)e body region or site of t)e re$orted $ain ".A+is %% =ystems ! t)e body system 6)ose abnormal function $roduces $ainA+is %%% (em$oral ! tem$oral c)aracteristics of $ain and t)e $attern of occurrence. "A+is %' atient>s statement. ! time since onset and intensity of $ain".A+is ' Aetiology. ! t)e $resumed aetiology of t)e $ain $roblem ".

    Classification of c$ronic orofacial pain+ur%et #age 3,(

    ;euralgiasrimary trigeminal neuralgia !tic douloureu+".

    =econdary trigeminal neuralgia !central ner*ous system lesions or facial trauma".er$es Goster ost)er$etic neuralgia

    #eniculate neuralgia !'%%"#losso$)aryngeal neuralgia ! %H"=u$erior laryngeal neuralgia ! H"

    cci$ital neuralgia.ain of -usculos5eletal origin

    Cer*ical steoart)ritis(em$oromandibular disorders

    (-I )eumatoid art)ritis(-I steoart)ritis

    -yofacial $ain dysfunctionJibromyalgiaCer*ical $ain or )y$ere+tension=tylo)yoid ! agle>s" syndrome.

    rimary *ascular disorders-igraine 6it) aura

    -igraine 6it)out auraCluster )eadac)e(ension ty$e )eadac)e

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    Cysts & TumoursClinical and functional staging of oral su "ucous fi rosisS+ *+ 5aider; +

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    b" retention ty$ei. mucocoeleii. ranula

    2. dental origina" $eriodontal

    i. $eria$icalii. lateral

    iii. residual b" $rimordialc" dentigerous

    Lucas? classification 19@4' %ntra osseous cysts

    A" Jissural cystsa" median mandibular

    b" median $alatalc" naso $alatined" globuloma+illarye" naso labial

    B" dontogenic cysts

    a" 8e*elo$mentali. $rimordialii. dentigerous

    b" inflammatoryc" radicular

    C" ;on e$it)elial bone cystsa" solitary bone cyst

    b" aneurysmal bone cyst

    Gorlin?s classification 197/'A" dontogenic cysts

    1. dentigerous cyst2. eru$tion cyst3. gingi*al cyst of t)e ne6 born infants@. lateral $eriodontal and gingi*al cyst

    . 5eratinising and calcifying odontogenic cysts!cystic 5eratinising tumour"

    &. radicular !$eria$ical cyst"7. odontogenic 5eratocyst

    a" $rimordial cyst b" #orlin #oltG syndrome

    B" ;on odontogenic and fissural cysts1. globuloma+illary !$rema+illa ma+illary" cyst2. naso al*eolar !naso labial / Mlestadt>s" cyst3. naso $alatine !median anterior ma+illary" cyst@. median mandibular cyst

    . anterior lingual cyst&. dermoid and e$idermoid cyst7. $alatal cysts of ne6 born infants

    C" Cysts of nec5 oral floor and sali*ary glands1. t)yroglossal duct cyst2. lym$)oe$it)elial !branc)ial cleft" cyst3. oral cyst 6it) gastric / e$it)elial e$it)elium@. sali*ary gland cyst – mucocoele and ranula

    8" seudocysts of 9a6s1. aneurysmal bone cyst2. static !de*elo$mental / lateral" bone cyst

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    3. traumatic !)aemorr)agic / solitary" bone cyst

    A5) classification pu lis$ed in B5istologic typing of odontogenic tu"ours? 2ra"er; #ind org; S$ear –199,'%. Cysts of t)e 9a6s

    A" $it)elial1. de*elo$mental

    a" odontogenici. gingi*al cysts of infantsii. odontogenic 5eratocyst !$rimordial cyst"iii. dentigerous !follicular" cysti*. eru$tion cyst*. lateral $eriodontal cyst*i. gingi*al cyst of t)e adults*ii. botryoid odontogenic cysts*iii. glandular odontogenic !sialo odontogenic / mucoe$idermoid

    odontogenic" cysti+. calcifying odontogenic cyst

    b" non odontogenici. naso $alatine duct !incisi*e canal" cyst

    ii. naso labial !naso al*eolar" cystiii. mid$alatine ra$)ae cyst of infantsi*. median $alatine median al*eolar and median mandibular cysts*. globuloma+illary cyst

    2. inflammatoryi. radicular cyst !a$ical / lateral"ii. residual cystiii. $aradental !mandibular infected buccal" cysti*. inflammatory collateral cyst

    B" ;on e$it)eliali. solitary !traumatic/sim$le/)aemorr)agic" bone cystii. aneurysmal bone cyst

    %%. Cysts associated 6it) t)e ma+illary antruma" benign mucosal cyst of t)e ma+illary antrum

    b" $ost o$erati*e ma+illary cyst !surgical ciliated cyst of t)e ma+illa"%%%.Cysts of t)e soft tissues of t)e mout) face and nec5

    a" dermoid and e$idermoid cyst b" lym$)oe$it)elial !branc)ial cleft" cystc" t)yroglossal duct cystd" anterior median lingual cyst !intralingual cyst of fore gut origin"e" oral cyst 6it) gastric / intestinal e$it)elium !oral alimentary tract cyst"f" cystic )ygromag" naso $)aryngeal cysts)" t)ymic cystsi" cysts of t)e sali*ary glands

    i. mucous e+tra*asation cystii. mucous retention cystiii. ranulai*. $olycystic !degenerati*e" disease of $arotid

    9" $arasitic cystsi. )ydatid cystii. cysticerus cellulosaeiii. tric)inosis

    8i ro.osseous lesions C$arles Aaldron =)*S 19(9; 1993'1. Jibrous dys$lasia

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    a a. olyostotic b. -onostotic.2. Jibro osseous !Cemental " lesions. eacti*e !dys$lastic " lesion arising in t)e toot) bearing area. ()ey are

    $resumably arising from $eriodontal ligament. ()ey are di*ided into t)ree ty$es based on t)eir radiologicfeatures alt)oug) t)ey re$resent t)e same $at)ologic $rocess.

    b a. eria$ical cemental !Cemento osseous "dys$lasia.c b. Jocal !local" cemento osseous lesions !dys$lasia". – $robably reacti*e in nature.d c. Jlorid cemento osseous dys$lasia !gigantiform cementoma".3. Jibro osseous neo$lasms. ()ey are of uncertain or debatable relations)i$ to t)ose arising in t)e $eriodontal

    ligament. ()ey are 6idely designated as cementifying fibroma ossifying fibroma or cemento ossifyingfibroma.

    e a. Cementoblatoma steoblastoma and steoid osteoma.f b. NIu*enile acti*e ossifying fibroma> and ot)er so called O aggressi*eP Oacti*eP ossifying / cementifying

    fibromas.

    TNM classification()e (;- system is used to describe t)e anatomical e+tent of a malignant disease. %t is based on t)e

    assessment of t)ree com$onents( – t)e e+tent of $rimary tumour ( – $rimary tumour

    ; – t)e absence or $resence and e+tent of regional lym$) node metastasis- – t)e absence or $resence of distant metastases.5ead and nec% cancer< #ri"ary tu"or size

    Lip and oral cavity

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour (is Carcinoma in situ

    ( 1 (umour 2 cm or less in greatest dimension

    ( 2 (umour more t)an 2 cm but not more t)an @ cm in greatest dimension

    (3

    (umour more t)an @ cm in greatest dimension

    ( @ Li$ (umour in*ades ad9acent structures e.g. t)roug) cortical bone tongue s5in of nec5.ral ca*ity (umour in*ades ad9acent structures e.g. t)roug) cortical bone into dee$ !e+trinsic" muscles

    of tongue ma+illary sinus s5in

    Pharynx (oropharynx)

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour

    ( is Carcinoma in situ

    ( 1 (umour 2 cm or less in greatest dimension

    ( 2 (umour more t)an 2 cm but not more t)an @ cm in greatest dimension

    ( 3 (umour more t)an @ cm in greatest dimension

    ( @ (umour in*ades ad9acent structures e.g. t)roug) cortical bone soft tissues of nec5 dee$ !e+trinsic"muscles of tongue

    Pharynx (nasopharynx)

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour

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    ( is Carcinoma in situ

    ( 1 (umour limited to one subsite of naso$)aryn+

    ( 2 (umour in*ades more t)an one subsite of naso$)aryn+

    ( 3 (umour in*ades nasal ca*ity and/or oro$)aryn+

    ( @ (umour in*ades s5ull and/or cranial ner*es

    Maxillary sinus

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour

    ( is Carcinoma in situ

    ( 1 (umour limited to t)e antral mucosa 6it) no erosion or destruction of bone

    ( 2 (umour 6it) erosion or destruction of t)e infrastructure including t)e )ard $alate and/or t)e middlemeatus.

    ( 3 (umour in*ades any of t)e follo6ing s5in of c)ee5 $osterior 6all of t)e ma+illary sinus floor or medial6all of t)e orbit anterior et)moid sinus

    ( @ (umour in*ades t)e orbital contents and/or any of t)e follo6ing cribriform $late $osterior et)moid ors$)enoid sinuses naso$)aryn+ soft $alate $terygoma+illary or tem$oral fossae base of s5ull

    Salivary glands

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour

    ( 1 (umour 2 cm or less in greatest dimension

    ( 2 (umour more t)an 2 cm but not more t)an @ cm in greatest dimension

    ( 3 (umour more t)an @ cm but not more t)an & cm in greatest dimension

    ( @ (umour more t)an & cm in greatest dimension.()e classification a$$lies only to carcinoma of t)e ma9or sali*ary glands $arotid submandibular and

    sublingual glands. (umours arising in minor sali*ary glands !mucous secreting glands in t)e lining membrane of t)eu$$er aerodigesti*e tract" are not included in t)is classification.

    6 – :egional ly"p$ nodes()e definitions of t)e ; categories for all )ead and nec5 sites e+ce$t t)yroid gland are

    ; + egional nodes cannot be assessed.

    ; 0 ;o regional node metastasis

    ; 1 -etastasis in a single i$silateral lym$) node 3cm or less in greatest dimension

    ; 2 -etastasis in a single i$silateral lym$) node more t)an 3cm but not more t)an & cm in greatestdimension or in multi$le i$silateral lym$) nodes none more t)an &cm in greatest dimension or in bilateralor contralateral lym$) nodes none more t)an &cm in greatest dimension

    ; 2a – -etastasis in a single i$silateral lym$) node more t)an 3cm but not more t)an & cm in greatestdimension

    ; 2 b – -etastasis in multi$le i$silateral lym$) nodes none more t)an &cm in greatest dimension

    ; 2c – -etastasis in bilateral or contralateral lym$) nodes none more t)an &cm in greatest dimension ;3 -etastasis in a lym$) node more t)an & cm in greatest dimension ; 3 ba – Clinically $ositi*e i$silateral node!s" one more t)an& cm in diameter. ; 3b – Bilateral clinically $ositi*e nodes! in t)is situation eac) side of t)e nec5 s)ould be staged se$arately" ; 3c – contralateral clinically $ositi*e node!s" only.

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    Note: Midline nodes are considered ipsilateral nodes.

    * – istant "etastasis-etastasis in any lym$) node ot)er t)an regional is classified as distant metastasis. ()e definition of -

    8istant -etastasis is t)e same for all ty$es of cancer.

    - + resence of distant metastasis cannot be assessed

    - 0 ;o distant metastasis- 1 8istant metastasis

    ()e category - 1 may be furt)er s$ecified according to t)e follo6ing notationulmonary! UL" Bone marro6!-A " sseous! =="

    Lym$) nodes!LQ-" e$atic ! " eritoneum! "Brain!B A" =5in!=M%" leura! L " t)er! ( "

    )t$er tu"ours)steosarco"a

    ! Pri"ary tu"our

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour ( 1 (umour confined 6it)in t)e corte+

    ( 2 (umour in*ades beyond t)e corte+()e classification a$$lies to all $rimary malignant bone tumours e+ce$t multi$le myeloma 9u+tacorticalosteosarcoma and 9u+tacortical c)ondrosarcoma

    Soft tissue sarco"as ! Pri"ary tu"our

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour

    ( 1 (umour cm or less in greatest dimension

    ( 2 (umour more t)an cm in greatest dimension

    S%in tu"ours ! Pri"ary tu"our

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour

    ( is Carcinoma in situ

    ( 1 (umour 2 cm or less in greatest dimension

    ( 2 (umour more t)an 2 cm but not more t)an cm in greatest dimension

    ( 3 (umour more t)an cm in greatest dimension

    ( @ (umour in*ades dee$ e+tradermal structures i.e. cartilage s5eletal muscle or bone Note: In the case of multiple simultaneous tumours, the tumour with the highest T category will be classified and thenumber of separate tumours will be indicated in parenthesis e.g. T 2 (5

    *elano"a ! Pri"ary tu"our

    ()e e+tent of tumour is classified after e+cision. ()is is a $at)ological tumour classification.

    ( + rimary tumour cannot be assessed

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    ( 0 ;o e*idence of $rimary tumour

    ( is -elanoma in situ !Clar5>s le*el %" !aty$ical melanocytic )y$er$lasia se*ere melanocytic dys$lasia notan in*asi*e malignant lesion"

    ( 1 (umour 0.7 mm or less in t)ic5ness and in*ading t)e $a$illary dermis !Clar5>s le*el %%"

    ( 2 (umour more t)an 0.7 mm but not more t)an 1. mm in t)ic5ness and/or in*ading t)e $a$illary

    reticular dermal interface !Clar5>s le*el %%%"( 3 (umour more t)an 1. mm but not more t)an @.0 mm in t)ic5ness and/or in*ading t)e reticular dermis

    !Clar5>s le*el %'"

    ( 3a – (umour more t)an 1. mm but not more t)an 3.0 mm in t)ic5ness

    ( 3 b – (umour more t)an 3.0 mm but not more t)an @.0 mm in t)ic5ness

    ( @ (umour more t)an @.0 mm in t)ic5ness and/or in*ading subcutaneous tissue !Clar5>s le*el '" and/orsatellites 6it)in 2cm of t)e $rimary tumour.

    ( @a – (umour more t)an @.0 mm in t)ic5ness and/or in*ading subcutaneous tissue

    ( @ b – =atellites 6it)in 2cm of t)e $rimary tumour ;ote %n case of discre$ancy bet6een tumour t)ic5ness and le*el t)e ( category is based on t)e less fa*ourable

    finding.6 – :egional ly"p$ nodes

    ; + egional nodes cannot be assessed.

    ; 0 ;o regional node metastasis

    ; 1 -etastasis 3 cm or less in greatest dimension in any regional lym$) node!s"

    ; 2 -etastasis more t)an 3 cm or less in greatest dimension in any regional lym$) node!s" and/or in transitmetastasis

    ; 2a -etastasis more t)an 3 cm or less in greatest dimension in any regional lym$) node!s"

    ; 2 b %n transit metastasis

    ; 2c – Bot) ;ote %n transit metastasis in*ol*es s5in or subcutaneous tissue more t)an 2cm from t)e $rimary tumour but beyond t)e regional lym$) nodes

    * – istant "etastasis

    - + resence of distant metastasis cannot be assessed

    - 0 ;o distant metastasis

    - 1 8istant metastasis

    - 1a -etastasis in s5in or subcutaneous tissue or lym$) node!s" beyond t)e regional lym$) nodes

    - 1 b 'isceral metastasis

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    Salivary gland disease

    Classification of ec$o patterns of palatal sali!ary gland tu"ours ))) 1999 =anIunic)i %s)ii et al(y$e % -i+ed $attern? cystic $atterns 6it)in ec)ogenic solid $attern(y$e %% ;odules are seen in t)e tumour ec)o(y$e %%% Acoustic s)ado6 is seen in t)e tumour ec)o(y$e %' y$o ec)oic $attern 6it) )omogenous internal ec)oes

    Sialograp$ic grading of sialadenitisRou et al – 1,,2?

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    c" =tricture – stenosisd" Joreign body

    !%%%" =ystemic granulomatous diseasesa" (uberculosis

    b" Actinomycosisc" Jungal infectiond" U*eo$arotid fe*er

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    Defects and clefts Classification of "id.facial defects(y$e % Loss of midfacial s5in only ? buttress of t)e ma+illa orbital floor and $alate intact(y$e %% artial ma+illectomy 6it) intact $alate and orbital floor (y$e %%% artial ma+illectomy 6it) resection of a $ortion of $alate ? orbital floor and Loc56ood>s ligament remain

    intact(y$e %' (otal ma+illectomy and $alatectomy ? orbital su$$ort remains intact(y$e ' (otal ma+illectomy and $alatectomy 6it) loss of orbital su$$ort or eye

    Classification of cleft lip and palate+'arious classifications systems )a*e been $ro$osed but only a fe6 )a*e found 6ide acce$tance.

    %. %n t)e classification of a!id and :itc$ie 19,,' congenital clefts 6ere di*ided into t)ree grou$saccording to t)e $osition of t)e clefts in relation to t)e al*eolar $rocess.

    #rou$ % – re al*eolar clefts – unilateral !rig)t or left" bilateral or median#rou$ %% – ost al*eolar clefts – in*ol*ing soft $alate only

    in*ol*ing soft and )ard $alatessubmucous cleft

    #rou$ %%% – Al*eolar clefts – unilateral !rig)t or left" bilateral or median.

    %%. eau 1931' suggested a classification t)at di*ides cleft $alates into four grou$s.#rou$ % – Cleft of soft $alate only.#rou$ %% – Cleft of )ard and soft $alate e+tending no furt)er t)an incisi*e foramen t)us in*ol*ing

    secondary $alate alone.#rou$ %%% – Com$lete unilateral cleft e+tending from t)e u*ula to t)e incisi*e foramen in t)e midline t)en

    de*iating to one side and usually e+tending t)roug) t)e al*eolus at t)e $osition of t)e futurelateral incisor toot).

    #rou$ %' – Com$lete bilateral cleft resembling #rou$ %%% 6it) t6o clefts e+tending for6ards from t)eincisi*e foramen t)roug) t)e al*eolus.

    %%%. 2erna$an and Star% 19 (' recognised t)e need for a classification based on embryology rat)er t)anmor$)ology.

    A. %ncom$lete cleft of secondary $alate

    B. Com$lete cleft of secondary $alateC. %ncom$lete cleft of $rimary and secondary $alates8. Unilateral com$lete cleft of $rimary and secondary $alates

    . Bilateral com$lete cleft of $rimary and secondary $alates

    %'. 2erna$an 1971' subseFuently $ro$osed a stri$ed NQ> classification. ()e incisi*e foramen 6)ic) is t)edi*iding line bet6een $rimary and secondary $alate is ta5en as t)e reference and forms t)e 9unction of t)e NQ>. t)e system $ro*ides ra$id gra$)ic re$resentation of t)eoriginal $at)ologic condition and renders itself to com$uter gra$)ic $resentation.

    '. "erican ssociation of Cleft #alate :e$a ilitation Classification C#:'+ ()e classificationsuggested by ar5ins and associates !1,&2" and endorsed by t)e American Association of Cleft alate

    e)abilitation Classification !AAC " is based on t)e same $rinci$les used by Merna)an and =tar5.

    %. Cleft of $rimary $alate a" Cleft li$ – unilateral bilateral median $rolabium congenital scar b" Al*eolar cleft – unilateral bilateral median

    %%. Cleft of $alate $ro$er a" %n*ol*ing soft $alate b" %n*ol*ing )ard $alate

    %%%. -andibular $rocess cleft !i" -andibular cleft li$ !ii" -andibular cleft

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    !iii" Lo6er li$ $its%'. ;aso ocular cleft – e+tending from narial region to t)e medial cant)al region'. ro ocular cleft – e+tending from t)e angle of t)e mout) to6ards t)e $al$ebral fissure'%. ro aural cleft – e+tending from t)e angle of t)e mout) to6ards t)e ear.

    '%. Spina 1974' modified t)e 8a*id and itc)ie classification.

    #rou$ % – re incisi*e foramen cleftsA. Unilateral B. Bilateral C. -edian#rou$ %% – (rans incisi*e foramen clefts !in*ol*ing li$ al*eolus and $alate"

    A. Unilateral B. Bilateral#rou$ %%% – ost incisi*e foramen clefts

    A. (otal B. artial#rou$ %' – are facial clefts

    '%%.

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    Preprosthetic surgery

    l!eolar ridge classification Ca>ood & 5o>ellClass % 8entateClass %% %mmediate $ost e+tractionClass %%% Con*e+ ridge form 6it) adeFuate )eig)t and 6idt)Class %' Mnife edge ridge form inadeFuate )eig)t and 6idt)Class ' Loss of basal bone t)at may be e+tensi*e and follo6s no $redictable $attern.

    one Duality classification Le%$ol" and ar 19( =)*S 1997S1 8ense )omogenous cortical bone 6it) a small trabecular boneS2 Large dense layer of cortical bone surrounding dense trabecular coreS3 ()inner layer of cortical bone around dense trabecular coreS@ ()in cortical layer surrounding lo6 density trabecular bone.

    l!eolar ridge deficiency.Classification and treat"ent

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    C Unfa*ourable in

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    J 3 Ji+ed $rost)esis re$laces missing cro6ns and gingi*al colour and $ortion of t)e edentulous site $rost)esismost often uses denture teet) and acrylic gingi*a but may be $orcelain to metal.

    @ emo*able $rosat)esis o*erdenture su$$orted com$letely by im$lant.emo*able $rost)esis o*erdenture su$$orted by bot) soft tissue and by im$lant.

    Clinical i"plant "o ility scaleConte"porary i"plant dentistry Carl E+ *isc$ #age ,3=cale 8escri$tion0 Absence of clinical mobility 6it) 00 g in any direction.1 =lig)t detectable )oriGontal mo*ement.2 -oderate *isible )oriGontal mobility u$ to 0. mm.3 =e*ere )oriGontal mo*ement greater t)an 0. mm.@ 'isible moderate to se*ere )oriGontal and any *isible *ertical mo*ement.

    -"plant Duality scale *isc$ 1993Conte"porary i"plant dentistry Carl E+ *isc$ #age ,9

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    Trauma 35

    Urine out$ut !ml / )r " 30 or more 20- 30 5 - 15 Negligi"le

    C;= mental status #ligh l$ an io&s 'ild an io&s(n io&s and

    con)&sed*on)&sed +

    le hargicJluid re$lacement !3 1

    rule "*r$s alloid cr$s alloid *r$s alloid ,"lood

    *r$s alloid ,"lood

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    Glasgo> Co"a scale =ennet &

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    Co"a Scale Systolic +#+ :espiratory rate Coded !alue

    13 1 4, 10 – 2, @, – 12 7& – 4, 2, 3 & –4 0 – 7 & – , 2@ – 1 – @, 1 – 1 3 0 0 0%t is a modification of (rauma score rating. %t eliminated ca$illary refill assessment and res$iratory

    mo*ement.

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    -n0ury Se!erity scoreeterson – rinci$les of oral -a+illofacial surgery. age 271.

    8e*elo$ed to deal 6it) multi$le traumatic in9uries and com$are t)e deat) rates from blunt trauma using t)edata t)at rated t)e se*erity of in9ury in eac) of t)e t)ree most se*erely in9ured organ systems.

    rgan systems e*aluated include :espiratory; Central ner!ous syste"; cardio!ascular; a do"inal;extre"ities and s%in .

    ()e grading is1 -inor 2 -oderate3 =e*ere non life t)reatening@ Life t)reatening sur*i*al $robable

    =ur*i*al non $robable& Jatal cardio*ascular C;= or burn in9uries.

    ()e t)ree )ig)est scores are sFuared and added to gi*e t)e %==. ()e lo6est $ossible %== is 3 and )ig)est%== score is 104. -ortality rates increases 6it) increase in %== and age.

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    Classification of open fractures ased on extent of soft tissue in0ury+ Gustilo & nderson 197@#rade % $en fracture 6it) a 6ound less t)an 1 cm long clean.#rade %% $en fracture 6it) a laceration more t)an 1 cm long 6it)out e+tensi*e soft tissue damage fla$s or

    a*ulsions.#rade %%% it)er an o$en segmental fracture or an o$en fracture 6it) e+tensi*e soft tissue damage or

    traumatic am$utation.#rade %%% A AdeFuate soft tissue co*erage of a fractured bone des$ite e+tensi*e soft tissue laceration of fla$s or

    )ig) energy trauma irres$ecti*e of t)e siGe of t)e 6ound.#rade %%% B +tensi*e soft tissue in9ury loss 6it) $eriosteal stri$$ing and bone e+$osure. ()is is usually

    associated 6it) massi*e contamination.#rade %%% C $en fracture associated 6it) arterial in9ury reFuiring re$air.

    *idface fracturesClassification of "idface fractures :MnM Le 8ort 19/1Milley fractures of middle t)ird of face age 11 Le Jort % Lo6 le*el fracture Le Jort %% yramidal or =ubGygomatic Jracture Le Jort %%% ig) (ra*erse or =u$raGygomatic Jracture

    Classification of "idface fractures Aass"und 19,7MrVger =c)illi. age 107 113.

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    Classification of "idface fractures :o>e & Aillia"s 19(Milley fractures of middle t)ird of face age 13 A. Jractures not in*ol*ing t)e occlusion 1. Central region 2. Lateral region B. Jractures in*ol*ing t)e occlusion 1. 8ento al*eolar 2. =ubGygomatic a. Le Jort % !lo6 le*el or #uXrin" b. Le Jort %% !$yramidal" 3. =u$raGygomatic a. Le Jort %%% !)ig) le*el or craniofacial dys9unction"

    Si"pler classification of "idface fractures #eter an%s 19(7Milley fractures of middle t)ird of face age 11. 8ento al*eolar fractures2. Rygomatic com$le+ fractures3. ;asal com$le+ fractures@. Le Jort % #uXrin or lo6 le*el fractures

    . Le Jort %% $yramidal or infraGygomatic fractures.&. Le Jort %%% or su$raGygomatic fractures.

    *odified Le 8ort Classification *arciani : 19938ental secrets. age 1&1 / Jonseca. ral -a+illofacial surgery. 'ol. 3. age 2 1Le Jort % Lo6 ma+illary fractures % a Lo6 ma+illary fractures / multi$le segments.Le Jort %% yramidal fractures %% a yramidal and nasal fractures %% b yramidal and nasoorbitoet)moidal !; " fracture.Le Jort %%% Craniofacial dys9unction. %%% a Craniofacial dys9unction and nasal fracture %%% b Craniofacial dys9unction and ;Le Jort %' Le Jort %% or %%% fracture and cranial base fracture %' a =u$raorbital fracture %' b Anterior cranial fossa and su$raorbital rim fracture %' c Anterior cranial fossa and orbital 6all fracture.

    Classification of palatal fractures #aul 6+ *anson et al #S: 199((y$e % Al*eolar fractures(y$e %% =agittal fractures(y$e %%% ara sagittal fractures(y$e %' ara al*eolar fractures(y$e ' Com$le+ fractures(y$e '% (rans*erse fractures

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    ygo"atic co"plex & or ital fracturesClassification of ygo"atic co"plex fractures 2nig$t & 6ort$ 19@1

    Based on direction of dis$lacement in 6aters *ie6 radiogra$).eterson. ! rinci$les of ral -a+illofacial surgery 'ol. %. age @, ".

    #rou$ % 6ondisplaced fractures – cases in 6)ic) t)ere is no clinical or radiogra$)ic e*idence of dis$lacement? notreatment reFuired.

    #rou$ %% rc$ fractures – A $ure fracture of t)e Gygomatic arc). ()e classical t)ree fracture lines $roduce a N'>s)a$ed deformity.

    #rou$ %%% Nnrotated ody fractures – Caused by a direct blo6 to t)e Gygomatic $rominence. Rygoma isdri*en $osteriorly and medially $roducing a flattening of t)e c)ee5. s *ie6 s)o6s adis$laced infra orbital rim inferiorly and medially at t)e buttress.

    #rou$ %' *edially rotated ody fractures – Caused by a blo6 from abo*e t)e )oriGontal a+is of t)eGygoma. Bone is dri*en medially inferiorly and $osteriorly 6it) rotation. ()e H rays s)o6sdis$lacement inferiorly at t)e infraorbital rim and eit)er out6ard at t)e malar buttress or in6ard att)e frontoGygomatic suture.

    #rou$ ' Laterally rotated ody fractures – Caused by a blo6 belo6 t)e )oriGontal a+is of t)e bone. Rygoma isdis$laced medially and $osteriorly 6it) lateral rotation. ()e radiogra$) indicates u$6arddis$lacement at t)e infraorbital rim and lateral dis$lacement at t)e frontoGygomatic suture.

    #rou$ '% Co"plex fractures – t)ese )a*e additional fractures across t)e body of Gygoma.

    Classification of ygo"atic co"plex fractures :o>e & 2iley 19@(eterson. ! rinci$les of ral -a+illofacial surgery 'ol. %. age @,@".

    -odified ;ort) Mnig)t classification by gi*ing consideration to t)e $eriosteal en*elo$e of t)e bone andadeFuacy of t)e bony a$$osition at t)e fracture interface.

    Classification of ygo"atic co"plex fractures Oanagisa>a 1973eterson. ! rinci$les of ral -a+illofacial surgery 'ol. %. age @,@".

    #rou$ % 6ondisplaced fractures – no treatment reFuired.#rou$ %% rc$ fractures – A $ure fracture of t)e Gygomatic arc).#rou$ %%% *edial or lateral rotation around a !ertical axis+#rou$ %' *edial or lateral rotation around a longitudinal axis+#rou$ ' *edial or lateral displace"ent 6it)out rotation.#rou$ '% -solated ri" fracture.

    #rou$ '%% All Co"plex fractures.

    Classification of "alar fractures Spiessl & Sc$roll 197,Mruger =c)illi ! traumatology 'ol %% ". age 1 4.

    (y$e % Rygomatic arc) fracture(y$e %% Rygomatic com$le+ fracture no significant dis$lacement(y$e %%% Rygomatic com$le+ fracture $artial medial dis$lacement !5in5ing at t)e JR suture"(y$e %' Rygomatic com$le+ fracture total medial dis$lacement. !Com$lete W of JR suture".(y$e ' Rygomatic com$le+ fracture dorsal dis$lacement. !2 W sites in Gygomatic arc)".(y$e '% Rygomatic com$le+ fracture inferior dis$lacement.(y$e '%% Rygomatic com$le+ fracture Comminuted fracture

    Classification of ygo"atic co"plex fractures Larsen &

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    a. ;o significant dis$lacement b. artial medial dis$lacement c. (otal medial dis$lacement d. 8orsal dis$lacement e. %nferior dis$lacement f. Comminuted fractures2. Jractures of Rygomatic arc)3. Com$le+ fractures a. Centrolateral midface fractures b. Rygomatico ma+illary fractures c. Rygomatico mandibular fractures.

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    Classification of )r ital fractures :o>e & Aillia"s 19(o6e

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    (y$e %% fractured large fragments medial cant)al tendon attac)ed to t)e fractured segment.(y$e %%% fracture in*ol*ing t)e central fragment of bone 6)ere t)e medial cant)us attac)es.

    Classification of 6asal fractures=c)6enGer !1,&7" classified central mid face fractures into

    1. Al*eolar fractures of t)e ma+illa2. LeJort % fracture3. =agittal fracture of t)e ma+illa@. yramidal fracture of t)e ma+illa !LeJort %%"

    !a"

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    ne classification based on fracture se*erity is by -anson . !1,4&"A. Jracture of one nasal bone 6it) infero lateral dis$lacementB. =e$aration of nasal bone from t)e frontal $rocess of ma+illa but t)e nasal se$tum is intactC. Jracture of se$tum $ermitting flattening and s$reading of nasal bones !o$en boo5 fracture"8. Jracture of t)e t6o nasal bone 6it) $ostero lateral dis$lacement

    . Comminuted fracture of t)e nasal bones frontal $rocesses and nasal se$tum – dis$lacement is $osterior and inferior

    J. Jracture of nasal se$tum 6it) se$aration of nasal bones from t)e frontal $rocess of t)ema+illa and ele*ation of t)e nasal bridge

    #. +tensi*e comminuted nasal fractures e+tending to in*ol*e t)e naso et)moidal region !nasoet)moidal fractures"

    %n 1,4& -urray and -aran described a $at)ological classification of nasal fractures follo6ing e+$erimentson fifty embalmed cada*ers. ()ey found se*en different $atterns of nasal fracture 6it) *arying degrees of se$talin*ol*ement. ()ey em$)asised t)e de*iation of nasal $yramid from midline as t)e clinical $redictor of t)emanagement outcome.

    Classification of naso.et$"oid fracturesJacial fractures are c)aracterised as naso et)moid fractures 6)en t)ey isolate a central bone fragment to

    6)ic) t)e medial cant)al tendon is attac)ed ! as5ert et al –1,44 -ar5o*itG –1,,1". %nstability and dis$lacement of

    t)is central fragment creates t)e naso et)moidal in9ury c)aracterised by telecant)us central globe dis$lacement ands)ortened $al$ebral fissure.()e literature consists of many classifications of *aried nature. An elaborate but com$licated classification

    6as gi*en by #russ !1,4 " 6)o di*ided naso et)moidal fractures into fi*e ty$es. -anson in 1,4 $ro$osed asim$le classification of naso et)moid fractures di*iding t)em into Nisolated or e+tended> and Nunilateral or

    bilateral> t)e $atterns of e+tension being su$erior !frontal" lateral !Gygomatic" and LeJort and combinations of anyor all.

    Bo6erman et al !1,4 " classified naso et)moid fractures into1. %solated naso et)moid and frontal ner*e in9ury 6it)out ot)er fractures of t)e mid face

    a" Bilateral b" Unilateral

    2. Combined naso et)moid and frontal region in9ury 6it) ot)er fractures of t)e mid face!a" Bilateral

    !b" Unilateral()is is essentially t)e same as -anson>s classification in content.

    ()ree distinct $atterns of naso et)moid in9ury )a*e been identified and described by -ar5o*itG -ansonand =argent in 1,,1. ()e fractures are ty$ically noted to be unilateral or bilateral and sim$le or comminuted.Type - naso-ethmoid fractures

    ()is is t)e sim$lest form of naso et)moid fractures in*ol*ing only one $ortion of t)e medial orbital rim6it) its attac)ed medial cant)al tendon. %t may be unilateral or bilateral. %n bilateral (y$e % fractures t)ere is nomedial cant)al tendon dis$lacement and trans nasal 6iring is not reFuired. =tabilisation of t)e osseous mono bloc5is enoug).Type -- naso-ethmoid fractures

    ()ese also may occur unilaterally or bilaterally and may $roduce large segments or comminution. -ostcommonly t)e cant)us remains attac)ed to t)e large central fragment. eduction is usually accom$lis)ed by

    $ositioning and controlling t)is bony segment 6)ic) is associated 6it) t)e medial cant)al tendon.Type --- naso-ethmoid fractures

    ()is ty$e in*ol*es comminution in*ol*ing t)e central fragment of bone 6)ere t)e medial cant)al tendonattac)es. ()e cant)us is rarely a*ulsed com$letely but is attac)ed to bone fragments t)at are too small to be utilisedin reconstruction. %n t)is circumstance trans nasal 6iring of t)e cant)us is reFuired as is osseous reconstruction.

    'ariants of ty$es %. %% and %%% fractures may occur on one side or t)e ot)er in con9unction 6it) eac) ot)er. %fsuc) is t)e case t)e ty$e of in9ury and its se*erity guides t)e treatment.

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    Condylar fracturesClassification of in0uries to t$e

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    8is$lacement 6it) medial or lateral o*erla$ 8is$lacement 6it) anterior or $osterior o*erla$ ;o contact bet6een fractured segments

    elations)i$ bet6een condylar )ead #lenoid fossa ;ondis$laced 8is$lacement 8islocation

    *andi ular fracturesClassification of "andi ular fractures 2azangia and Con!erseClinics in plastic surgery 199,; ad!ances in craniofacial "anage"ent+ #age@,+Class % (eet) $resent on bot) sides fracture lineClass %% (eet) $resent on only one side.Class %%% fracture occurs in an area 6it)out dentition

    Classification of "andi ular fractures ased on type of fractureeterson. ! rinci$les of ral -a+illofacial surgery 'ol. %. age @0,".

    =im$le fracture =ingle fracture line t)at does not communicate 6it) t)e e+terior.Com$ound fracture ()ese fractures )a*e communication 6it) t)e e+ternal en*ironment usually by

    $eriodontal ligament of a toot) or#reenstic5 fracture ()is ty$e freFuently occurs in c)ildren 6it) incom$lete loss of continuity of bone.

    Usually one corte+ is fractured and t)e ot)er is bent leading to distortion 6it)outcom$lete section. ()ere is no mobility bet6een distal and $ro+imal segment.

    Comminuted fractures -ulti$le fragmentation of bone at one fracture site. Usually as a result of greater force.Com$le+ or com$licated W 8amage to ad9acent structures of bone li5e *essels ner*es or 9oint structures.(elesco$ed or im$acted W one bone is dri*en into anot)er. are in mandible.8irect fractures Jractures at t)e site of im$act%ndirect fracture Jractures at a $oint a6ay from site of im$act.

    at)ological fracture W occurring as a result normal force or minimal trauma as a result of bone 6ea5ened by $at)ology.

    Classification of "andi ular fractures ased on site of fracture 2elly & 5arrigan #$%&eterson. ! rinci$les of ral -a+illofacial surgery 'ol. %. age @10".

    Condylar $rocessAscending ramusAngle fractureBody fracture=ym$)ysis fracture

    Classification of "andi ular fractures ased on "uscular pull 8rye et al 194,Clinics in plastic surgery 199,; ad!ances in craniofacial "anage"ent+ #age@,+

    oriGontally fa*ourable directed do6n6ard and for6ard.oriGontally unfa*ourable directed do6n6ard and bac56ard

    'ertically fa*ourable e+tends from $osterior laterally to anterior medially.'ertically unfa*ourable e+tends from anterior laterally to $osterior medially.

    Classification of "andi ular fractures ) Classification+%nternal fi+ation of mandible. Bernd =$iessl. 1,4,.J ;umber of fractures.L Location ! site".

    cclusion= =oft tissue in*ol*ementA Associated fractures.

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    ()e combination of t)e com$onents results in ig)t / Left

    1. Jracture formula JL2. =oft tissue formula J=3. #rade of se*erity % – '.

    .g. J 1L2 3=2A1

    Categories of fractures. ! J ".J 1 =ingle fracture.J 2 -ulti$le Jractures ! segmental fractures".J 3 Comminuted Jracture.J @ Jracture 6it) bone defect.

    Categories of localisation ! L "L1 recanine.L2 Canine.L3 ostcanineL@ Angular L =u$ra angular L& rocessus articularisL7 rocessus muscularisL4 Al*eolar $rocess

    Categories of cclusion ! ".0 ;o malocclusion.1 -alocclusion.2 ;one+istent occlusion ! edentulous mandible "

    Categories of soft tissue in*ol*ement ! = "=0 Closed.=1 $en intraorally.=2 $en e+traorally.=3 $en intrae+traorally.=@ =oft tissue defect.

    Categories of associated fracture ! A "A ;oneA1 Jracture and / or loss of toot).A2 ;asal bone.A3 Rygoma.A@ Le Jort %A Le Jort %%A& Le Jort %%%

    #rade of se*erity ! % ' "Grade of se!erity Soft tissue for"ula Clinical presentation

    % A J0=0% B J1=0

    Closed fracture%% A J2=0%% B J3=0

    %%% A J0=1 / J 1=1 / J 2=1 / J 0=2 / J 1=2 / J 2=2

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    %%% B J0=3 / J 1=3 / J 2=3 $en fracture

    %' A J 3=1 / J 3=2 %' B J 3=3

    ' A J @=1 / J @=2 / J @=3 $en fracture 6it) bone defect.

    ' B J @=@ #un s)ot 6ound

    Classification of frontal sinus fracturesAnterior table fracture Linear

    8is$lacedosterior table fracture Linear

    8is$lacedutflo6 tract in9ury

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    Infection):6 *arx 19(3 =)*S(y$e % 8e*elo$s s)ortly after radiation? is due to synergistic effects of surgical trauma and radiation in9ury(y$e %% 8e*elo$s years after radiation and follo6s a traumatic e*ent? rarely occurs before 2 years after treatment?

    most commonly occurs after & years? due to $rogressi*e endarteritis and *ascular effusion.(y$e %%% ccurs s$ontaneously 6it)out a $receding traumatic e*ent? usually occurs bet6een & mont)s and 3 years

    after radiation. ? due to immediate cellular damage and deat) due to radiation treatment.

    )steonecrosis Epstein et al 19(7 =)*S)ct ,/// =)*S #age 1/93

    1. esol*ed )ealed osteonecrosis ;o $at)ologic fracture at)ologic fracture2. C)ronic $ersistent and non $rogressi*e osteonecrosis ;o $at)ologic fracture at)ologic fracture3. Acti*e $rogressi*e osteonecrosis ;o $at)ologic fracture at)ologic fracture

    )r ital cellulitis C$andler – 197/'#rinciples of )*8S ol+ 1 #age 1(1#rou$ 1 bstructi*e non tender oedema contrasted 6it) inflammation and cellulitis#rou$ 2 %nflammatory oedema and orbital cellulitis#rou$ 3 =ub $eriosteal $us#rou$ @ us in orbital tissue#rou$ Ca*ernous sinus t)rombosis

    )steo"yelitis 5udson 1993Jonseca. 'ol . age @4%" Acute forms of osteomyelitis !=u$$urati*e or nonsu$$urati*e"

    A. Contiguous focus.

    1. (rauma.

    2. =urgery.

    3. dontogenic infection

    B. rogressi*e

    1. Burns.

    2. =inusitis.

    3. 'ascular insufficiency.

    C. ematogenous !metastatic"

    1. 8e*elo$ing s5eleton !c)ildren".2. 8e*elo$ing dentition

    %%" C)ronic forms of osteomyelitis

    A" ecurrent multifocal

    1. 8e*elo$ing s5eleton !c)ildren".

    2. scalated osteogenic acti*ity !:age 2 ".

    B" #arrXs osteomyelitis

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    1. UniFue $roliferati*e sub$eriosteal reaction.

    2. 8e*elo$ing s5eleton !c)ildren to adult".

    C" =u$$urati*e or nonsu$$urati*e.

    1. %nadeFuate treated forms.

    2. =ystemically com$romised forms

    3. efractory forms !c)ronic refractory osteomyelitis C -".

    8" =clerosing

    1. 8iffuse

    a. Jastidious micro organisms.

    b. Com$romised )ost and $at)ogen interface.

    2. Jocal

    a. redominantly odontogenic

    b. C)ronic localised in9ury.

    )steo"yelitis Classification and Staging Cierny; *ader; #ennic% 19(Jonseca. 'ol . age @4%" Anatomic ty$e.

    =tage 1 -edullary osteomyelitis – in*ol*ed medullar bone 6it)out cortical in*ol*ement usually)ematogenous.

    =tage 2 =u$erficial osteomyelitis – less t)an 2 cm bony defect 6it)out cancellous bone.

    =tage 3 Localised osteomyelitis – less t)an 2 cm bony defect on radiogra$) 6)ic) does not a$$earto in*ol*e bot) cortices.

    =tage @ 8iffuse osteomyelitis – defect larger t)an 2 cm $at)ologic fracture infection nonunion.%%" )ysiologic class%%%" =ystemic or local factors t)at affect immune sur*eillance metabolism and local *ascularity

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    emporomandi"&lar .oin

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    C" Anatomic/ $at)ologic +cellent anatomic form slig)t anterior dis$lacement $assi*e incoordinationdemonstrable.

    %% arly %ntermediate stageA" Clinical ne or more e$isodes of $ain beginning ma9or mec)anical $roblems consisting of mid to late o$ening

    loud clic5ing transient catc)ing and loc5ing.B" adiologic =lig)t for6ard dis$lacement beginning dis5 deformity of slig)t t)ic5ening of $osterior edge

    negati*e tomograms.

    C" Anatomic/ $at)ologic Anterior dis5 dis$lacement early anatomic dis5 deformity good central articulatingarea.

    %%% %ntermediate =tage.A" Clinical -ulti$le e$isodes of $ain ma9or mec)anical sym$toms consisting of loc5ing !intermittent or fully

    closed " restriction of motion and difficulty 6it) function.B" adiologic Anterior dis5 dis$lacement 6it) significant deformity or $rola$se of dis5 ! increased t)ic5ening of

    $osterior edge" negati*e tomograms.C" Anatomic/ at)ologic -ar5ed anatomic dis5 deformity 6it) anterior dis5 dis$lacement no )ard tissue

    c)anges.%' Late %ntermediate stage.A" Clinical =lig)t increase in se*erity o*er intermediate stageB" adiologic %ncrease in se*erity o*er intermediate stage $ositi*e tomograms s)o6ing early to moderate

    degenerati*e c)anges – flattening of eminence deformed condylar )ead sclerosisC" Anatomic/ at)ologic %ncrease in se*erity o*er intermediate stage ard tissue degenerati*e remodelling of bot) bearing surfaces !osteo$)ytosis" multi$le ad)esions in anterior and $osterior recesses no $erforation ofdis5 or attac)ments

    ' Late =tage.A" Clinical C)aracterised by cre$itus *ariable and e$isodic $ain c)ronic restriction of motion and difficulty 6it)

    functionC" adiologic 8is5 or attac)ment $erforation filling defects gross anatomic deformity of dis5 and )ard tissues

    $ositi*e tomograms 6it) essentially degenerati*e art)ritic c)angesC" Anatomic/ at)ologic #ross degenerati*e c)anges of dis5 and )ard tissues $erforation of $osterior

    attac)ment multi$le ad)esions osteo$)ytosis flattening of condyle and eminence subcortical cyst formation.

    ariations of fi rosis & fi rous ad$esions in

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    e & Aillia"s #age 4 7Jibrous =)ort / LongBony %ntraca$sular / +traca$sular

    istologic *ariationsJibrousJibro osseous

    sseoussteocartilaginous

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    Syngnat$ia "axillo"andi ular fusion ' o>son et al 1997 Q 199@ -=)*S 8e ,//1 3/ 1 page 7 – 79'

    (y$e 1 =im$le syngnat)ia – no ot)er congenital anomalies in )ead nec5.(y$e 2 Com$le+ syngnat)ia

    (y$e 2 a =yngnat)ia co e+istent 6it) aglossia (y$e 2 b =yngnat)ia co e+istent 6it) agenesis or )y$o$lasia of t)e $ro+imal mandible.

    Syngnat$ia "axillo"andi ular fusion ' Laster et al ,/// Q ,//1 -=)*S 8e ,//1 3/ 1 page 7 – 79'

    (y$e 1 Anterior syngnat)ia (y$e 1a =im$le anterior syngnat)ia Bony fusion of al*eolar ridges only 6it)out ot)er

    congenital deformities(y$e 1b Com$le+ anterior syngnat)ia Bony fusion of al*eolar ridges only associated

    6it) ot)er congenital deformities(y$e 2 Rygomatico mandibular syngnat)ia (y$e 2a =im$le Rygomatico mandibular syngnat)ia – Bony fusion of mandible to

    Gygomatic com$le+ – causing mandibular micrognat)ia. (y$e 2b Com$le+ Rygomatico mandibular syngnat)ia – Bony fusion of mandible to

    Gygomatic com$le+ – associated 6it) clefts or (-I an5ylosis.

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    General"erican Society of naest$esiologist p$ysical status classification syste" Sc$iender 19(3

    #rinciples of oral & *axillofacial Surgery+ ol+ -+ #age 1,@+A=A % A $atient 6it)out systemic disease normal )ealt)y $atient.A=A %% A $atient 6it) mild systemic disease no functional limitation.A=A %%% A $atient 6it) se*ere systemic disease definite functional limitation.A=A %' A $atient 6it) a se*ere systemic disease t)at is a constant t)reat to life.A=A ' A moribund $atient unli5ely to sur*i*e 2@ )ours 6it) or 6it)out o$eration.A=A mergency o$eration of any *ariety? t)e Y Y $recedes t)e $atient>s $)ysical status.

    rterio!enous "alfor"ation clinical staging Sc$o ingerGra & S"it$+

    =tage % Blus)/ stain 6armt) and A' s)unting by continuos 8o$$ler or 20 - G colour 8o$$ler =tage %% =ame as stage % D enlargement tortuous tense *eins $ulsation t)rill and bruit.=tage %%% =ame as stage %% D eit)er dystro$)ic c)anges ulceration bleeding $ersistent $ain or destruction=tage %' =ame as stage %% D cardiac failure.

    ental treat"ents – classificationConte"porary i"plant dentistry Carl E+ *isc$ #age 4@

    (y$e 1 +aminations radiogra$)s study model im$ressions oral )ygiene instruction su$ragingi*al $ro$)yla+is sim$le restorati*e dentistry.

    (y$e 2 =caling root $laning endodontics sim$le e+tractions curettage sim$le gingi*ectomy ad*ancedrestorati*e $rocedures sim$le im$lants.

    (y$e 3 -ulti$le e+tractions gingi*ectomy Fuadrant $eriosteal reflections im$acted teet) e+tractionsa$icocetomy $late form im$lants multi$le root form im$lants ridge augumentation unilatralsinus grafting unilateral sub$eriosteal im$lants.

    (y$e @ Jull arc) im$lant !com$lete sub$eriosteal im$lants ramus frame im$lants full arc) endostealim$lants" ort)ognat)ic surgery autogenous bone grafting bilateral sinus grafting.

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    Impacted teethAinter?s classification 19,@+

    ased on t$e relation of long axis of i"pacted toot$ to t$e , nd "olar+'ertical-esioangular 8istoangular

    oriGontal%n*ertedBuccoangular Linguoangular

    #ell & Gregory 1933+:elations$ip of 3 rd "olar to ra"us+Class % ()ere is sufficient amount of s$ace bet6een ramus and t)e distal side of t)e second molar for t)e

    accommodation of t)e mesiodistal diameter of t)e t)ird molar.Class %% ()e s$ace bet6een t)e ramus and t)e distal side of t)e second molar is less t)an t)e mesiodistal diameter of

    t)e cro6n of t)e t)ird molar Class %%% All or most of t)e t)ird molar is located 6it)in t)e ramus.:elati!e dept$ of 3 rd "olar in one+

    osition A ()e )ig)est $ortion of t)e 3rd molar toot) is on a le*el 6it) or abo*e t)e occlusal line.osition B. ()e )ig)est $ortion of t)e 3rd molar toot) is belo6 t)e occlusal $lane but abo*e t)e cer*ical line

    of t)e 2nd molar.osition C. ()e )ig)est $ortion of t)e 3rd molar toot) is belo6 t)e cer*ical line of t)e 2nd molar.ased on t$e long axis of t$e 3 rd "olar to t$at of , nd "olar fro" Ainter?s classification'+

    oriGontal 6it) Bucco*ersion 'ertical Linguo*ersion -esioangular (orso*ersion 8istoangular %n*erted Buccoangular Linguoangular

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    ifficulty index for re"o!al of i"pacted "andi ular 3 rd "olar #edersen G A 19((ral surgery edersen # <

    ()is inde+ is based on ell #regory classification and aids in assessing difficulty in surgical remo*al oft)ird molar

    Classification alue Spatial relationship

    -esioangular 1

    oriGontal / (rans*erse 2'ertical 38istoangular @

    'epthLe*el A 1Le*el B 2Le*el C 3

    a"us relationship Space availa*leClass % 1Class %% 2Class %%% 3

    otal score out of #+,8ifficulty inde+

    'ery difficult 7 – 10.-oderately difficult –7.-inimal difficult 3 – @.

    A5 :8E assess"ent of difficulty in surgical re"o!al of i"pacted 3 rd "olars+Srini!asan text oo% of oral surgery #age 73 Category =coreA inter's classification 'ertical 0

    -esioangular 18istoangular 2

    ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ oriGontal 25 eight of mandible 3 – 3, mm 0

    31 – 3@ mm 1

    1 – 30 mm 2ngulation of third molars 1o – 0o 0

    1o – &, o 170 o – 7, o 240 o – 4, o 3

    ,0 o D @: oot shape Conical 1

    Ja*ourable cur*ature 2 Unfa*ourable cur*ature 38 ollicles nlarged 0

    ossibly enlarged 1 ;ormal 2

    ath of E )it =$ace a*ailable 0-esial cus$ co*ered 18istal cus$ co*ered 2

    Bot) co*ered 3 ZZZZZZZZZZZZZZZ

    (otal score for out of 33ig)er score indicates difficult e+traction

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    Canine i"pactions 8ield and c%er"an 193)ral and *axillofacial Surgery ol+ -- aniel *+ Las%in #age (3*axillary canines

    a. labial $ositioni. cro6n in intimate relations)i$ 6it) incisorsii. cro6n 6ell abo*e t)e a$ices of incisors

    b. $alatal $osition

    i. cro6n near surface in close relations)i$ 6it) t)e roots of incisorsii. cro6n dee$ly embedded in close relations)i$ to t)e a$ices of incisors

    c. intermediate $ositioni. cro6n bet6een lateral incisor and first $remolar rootsii. cro6n abo*e t)ese teet) 6it) cro6n labially $laced and root $alatally $laced and

    *ice *ersa.d. unusual $osition

    i. nasal or antralii. infra orbital region.

    *andi ular caninesa. labial $osition

    i. *erticalii. obliFue

    iii. )oriGontal b. unusual $ositioni. at inferior border ii. in t)e mental $rotuberanceiii. migrated to t)e o$$osite side

    *axillary canine i"pactions)ral and *axillofacial Surgery ol+ - rc$er #age 3,

    Class % %m$acted toot) located in t)e $alate

    1. oriGontal.2. 'ertical3. =emi*ertical

    Class %% %m$acted toot) in t)e labial or buccal surface of t)e ma+illa.1. oriGontal.2. 'ertical3. =emi*ertical

    Class %%% %m$acted toot) located in bot) t)e $alatal and labial or buccal ma+illary bone. .g. cro6n is on t)e $alatalas$ect and t)e root $asses bet6een t)e roots of t)e ad9acent teet) in t)e al*eolar $rocess endingin a s)ar$ angle on t)e labial or buccal surface of t)e ma+illa.

    Class %'%m$acted cus$ids located in t)e al*eolar $rocess usually *ertically bet6een t)e incisor and first bicus$id.Class ' %m$acted cus$ids located in an edentulous ma+illa.

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    Supernu"erary teet$ i"paction classification=+ Canadian ental ssociation; ec 99' Gra!ey et al

    1. =ingle• Conical• Com$osite odontoma

    1. Com$le+2. Com$ound

    • (uberculate• =u$$lemental

    2. -ulti$le• ;on =yndrome

    1. (uberculate2. =u$$lemental

    • =yndrome1. Cleft Li$/ alate2. Cleidocranial 8ys$lasia3. #ardner =yndrome

    *axillary t$ird "olar i"pactions)ral and *axillofacial Surgery ol+ - rc$er #age 311

    A classification based on t)e anatomic $ositionased on relati!e dept$ of t$e i"pacted "axillary t$ird "olar in one+

    Class A ()e lo6est $ortion of t)e cro6n of t)e im$acted ma+illary t)ird molar is on line 6it) t)e occlusal $lane ofsecond molar

    Class B ()e lo6est $ortion of t)e cro6n of t)e im$acted ma+illary t)ird molar is bet6een t)e occlusal $lane ofsecond molar and t)e cer*ical line

    Class C ()e lo6est $ortion of t)e cro6n of t)e im$acted ma+illary t)ird molar is at or abo*e t)e cer*ical line of t)esecond molar

    ased on t$e long axis of t$e t$ird "olar in relation to t$e long axis of second "olar

    C ased on t$e relations$ip of i"pacted t$ird "olar and "axillary sinus+=A !=inus a$$ro+imation" ;o bone or t)in $ortion of bone bet6een t)e ma+illary t)ird molar and t)e

    ma+illary sinus. ;=A !;o sinus a$$ro+imation" 2mm or more t)ic5ness of bone bet6een t)e im$acted ma+illary t)ird molar and

    t)e ma+illary sinus.

    1. 'ertical2. oriGontal

    3. -esioangular @. 8istoangular

    . %n*erted&. Buccoangular 7. Linguoangular

    ()ese may also occur simultaneously ina" Buccal *ersion.

    b" Lingual *ersionc" (orso*ersion

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    MedicamentsCarnoy?s solution

    Milley May $art %% $age.

    Absolute alco)ol & $artsC)loroform 3 $arts#lacial acetic acid 1 $art

    one >ax 5orsley?s'Milley May $art %% $age. @2.

    Bees6a+ !yello6" 7 $arts by 6eig)tli*e oil 2 $arts)enol 1$art

    A$ite$ead?s !arnis$Milley May $art %% $age. @1.

    BenGoin 10 $arts=tora+ 7. $artsBalsam of (olu $arts%odoform 10 $arts=ol*ent et)er to ma5e 100 $arts.

    onney?s lue-c#regor $rinci$les of lastic =urgery. age

    #entian *iolet 10 gBrilliant green 10 gAlco)ol , , 0 ml

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    )s puru"Milley May $art %% $age. 14&.

    Bone in 6)ic) some of t)e organic elements )a*e been remo*ed

    norganic one()is is $re$ared by boiling bone in et$ylenedia"ine for se*eral days. ()is can be stored 6it)out

    refrigeration. ()is can be trimmed 6it) scal$el and cut into c)i$s.

    2iel oneBo*ine bone treated 6it) $ydrogen peroxide and a de fattening agent.

    oplant oneBo*ine bone treated 6it) propiolactone to sterilise it and de.fattening is by detergents and organic

    sol*ents.

    one antigen

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    NervesClassification of axons – conduction speed Erlanger & Gasser 1937A α 70 – 120 m/sec.A β 30 –70 m /sec.Aγ A δ Large sensory fibres

    B Autonomic fibresC Unmyelinated fibres 0. – 2 m / sec. !C fibers"

    Classification of axons – size of axon Lloyd 1943#rou$ % A α & – 20 µ m. diameter #rou$ %% Aβ & – 20 µ m.#rou$ %%% Aδ 1 – & µ m.#rou$ %' C and B fibres smaller diameter fibres

    Size of fi res in decreasing orderA α > A β > Aγ > A δ > B > C

    ()e conduction s$eed of a ner*e fibre is a$$ro+imately & times t)e diameter of t)e fibre. ()us a 1 µ m. ner*e fibreconducts im$ulse at ,0 m/s.

    Classification of ner!e fi res ased on nu" er of fascicles-onofascicular $attern one large fascicle. .g. %ntra cranial $art of facial ner*e.

    ligofascicular $attern 2 – 10 fascicles.olyfascicular $attern 10 fascicles. .g. %nferior al*eolar ner*e Lingual ner*e. ! 14 – 21 fascicles "

    #$ysiologic conduction loc% focal conduction loc%' Lund org 19(( Contro!ersies in )ral & *axillofacial surgery+ #age ,79+'

    (y$e A %ntraneural circulatory arrest or metabolic !ionic" bloc5 6it) no ner*e fibre $at)ology. e*ersibleimmediately. -anaged by t)era$ies to im$ro*e t)e circulation to t)e ner*e trun5 decrease oedemaor re*erse *asos$asm.

    (y$e B %ntraneural oedema resulting in increased endoneurial fluid $ressure or metabolic bloc5 6it) little or no

    ner*e fibre $at)ology. e*ersible 6it)in days or 6ee5s. ()era$ies to decrease oedema and $romote *enous drainage.

    -ntra.operati!e grading of perip$eral ner!e lesions Sa"ii 19(/2 8i*ided $eri$)eral ner*e

    e" %n9ury to e+amination inter*al : 3 6ee5sf" %n9ury to e+amination inter*al 3 6ee5s

    2 Lesion in continuityg" %n9ury to e+amination inter*al : 3 mont)s)" %n9ury to e+amination inter*al 3 mont)s

    3 -i+ed 1 and 2

    Classification of nerve injuries Seddon1943 ;euro$ra+ia Local conduction bloc5 at t)e site of in9ury 6it)out

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    Classification of ner!e in0uriesSunderland 19 1

    1st degree Corres$onds to =eddon>s neura$ra+ia (y$e % Conduction bloc5 due to ano+ia from interru$tion of t)e segmental or e$ineural blood

    *essels but t)ere is no a+onal degeneration or demyelination. esulting from ner*e trun5mani$ulation mild traction or mild com$ression. eco*ery is ra$id follo6ing restoration ofsensation.

    (y$e %% Conduction bloc5 due to intrafascicular oedema follo6ing ru$ture of endoneurialca$illaries as a result of trauma of sufficient magnitude. eco*ery of senses 6it)in 1 – 2 daysfollo6ing resolution in t)e intrafascicular oedema.

    (y$e %%% =egmental demyelination or mec)anical disru$tion of t)e myelin s)eat)s follo6ingse*ere mani$ulation traction or com$ression. eco*ery ta5es 1 – 2 mont)s

    2nd degree A+on and myelin are interru$ted but t)e endoneural s)eat) and ot)er su$$orting connecti*e tissuestroma including e$ineurium and $erineurium are $reser*ed.

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    Classification of ner!e in0uries y location of fi rosis *illesi et al 19(9+ Contro!ersies in )ral & *axillofacial surgery+ #age ,(3+'

    esignation Location #rognosis

    A $ifascicular e$ineurium #ood $rognosis

    B%nterfascicular e$ineurium

    rognosis de$ends on originaldamage

    C ndoneurium oor.

    ; %n a =underland class %' in9uryt)e e$ineural connecti*e tissuet)at maintains continuity can beinfiltrated by neuroma.

    oor

    = Continuity in class %' in9urymaintained only by scar tissue.

    oor.

    #rade A B C are used in combination 6it) =underland>s classification % A % B? %% A %% B and %%%A %%% B %%% C.#rade C fibrosis occurs only 6it) class %%% in9ury.

    Classification of ner!e in0uries #at$op$ysiologic classification Contro!ersies in oral & *axillofacial surgery+ #age ,(3+'

    Com$ressionCom$artment syndrome=tretc) in9ury(ransection laceration ru$ture and a*ulsionC)emical in9ury

    ;er*e in9ection in9uryAnatomically maintained $ainCentral neuro$at)y

    Grading of sensory recovery Mackinnon Clin #last+ Surg 19(9= 0 ;o reco*ery= 1 eco*ery of dee$ cutaneous $ain= 2 eturn of some su$erficial $ain / tactile sensation= 2D eturn of some su$erficial $ain / tactile sensation 6it) o*er reaction= 3 eturn of some su$erficial $ain / tactile sensation 6it)out o*er reaction and t)e $resence of static

    t6o $oint discrimination !2$d" 1 mm= 3D As $er = 3 6it) good localisation of stimulus !2$d" E 7 1 mm= @ As $er = 3D !2$d" E2 & mm=ensory score eFual to or greater t)an = 3 is defined as useful sensory reFuirement

    ssess"ent of ner!e reco!ery . ritis$ *edical :esearc$ Council ClassificationClassification 8escri$tion

    *otor :eco!ery- 0 ;o contraction- 1 eturn of $erce$tible contraction in $ro+imal muscles.- 2 eturn of $erce$tible contraction in bot) $ro+imal and distal muscles.

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    - 3 eturn of function in bot) $ro+imal and distal muscles of a degree t)at allim$ortant muscles are sufficiently $o6erful to act against resistance

    - @ eturn of function as in stage 3 6it) addition t)at all synergetic and inde$endent mo*ements are $ossible.

    - Com$lete reco*ery. Sensory :eco!ery

    = 0 Absence of sensibility in t)e autonomous area.= 1 eco*ery of dee$ cutaneous $ain sensibility 6it)in t)e autonomous area of t)e ner*e.= 2 eco*ery of some su$erficial cutaneous $ain and tactile sensibility 6it)in t)e autonomous area of

    t)e ner*e.= 3 eco*ery of su$erficial cutaneous $ain and tactile sensibility t)roug)out t)e autonomous area 6it)

    disa$$earance of any $re*ious o*er res$onse.= 3 D eco*ery of sensibility as in = 3 6it) t)e addition of some reco*ery of t6o $oint discrimination

    6it)in t)e autonomous area.= @ Com$lete reco*ery.

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    Pain#ain classification - S# -nternational association for t$e study of #ain'+

    ur%et #age 3,7Categorises $ain into *arious $arameters.A+is % egions ! t)e body region or site of t)e re$orted $ain ".A+is %% =ystems ! t)e body system 6)ose abnormal function $roduces $ainA+is %%% (em$oral ! tem$oral c)aracteristics of $ain and t)e $attern of occurrence. "A+is %' atient>s statement. ! time since onset and intensity of $ain".A+is ' Aetiology. ! t)e $resumed aetiology of t)e $ain $roblem ".

    Classification of c$ronic orofacial pain+ur%et #age 3,(

    ;euralgiasrimary trigeminal neuralgia !tic douloureu+".

    =econdary trigeminal neuralgia !central ner*ous system lesions or facial trauma".er$es Goster ost)er$etic neuralgia

    #eniculate neuralgia !'%%"#losso$)aryngeal neuralgia ! %H"=u$erior laryngeal neuralgia ! H"

    cci$ital neuralgia.ain of -usculos5eletal origin

    Cer*ical steoart)ritis(em$oromandibular disorders

    (-I )eumatoid art)ritis(-I steoart)ritis

    -yofacial $ain dysfunctionJibromyalgiaCer*ical $ain or )y$ere+tension=tylo)yoid ! agle>s" syndrome.

    rimary *ascular disorders-igraine 6it) aura

    -igraine 6it)out auraCluster )eadac)e(ension ty$e )eadac)e

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    Cysts & TumoursClinical and functional staging of oral su "ucous fi rosisS+ *+ 5aider; +

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    i*. ranula@. dental origin

    d" $eriodontali*. $eria$ical*. lateral*i. residual

    e" $rimordial

    f" dentigerous

    Lucas? classification 19@4' %ntra osseous cysts

    8" Jissural cystsf" median mandibular g" median $alatal)" naso $alatinei" globuloma+illary

    9" naso labial" dontogenic cysts

    d" 8e*elo$mentaliii. $rimordial

    i*. dentigerouse" inflammatoryf" radicular

    J" ;on e$it)elial bone cystsc" solitary bone cystd" aneurysmal bone cyst

    Gorlin?s classification 197/'" dontogenic cysts

    4. dentigerous cyst,. eru$tion cyst10. gingi*al cyst of t)e ne6 born infants11. lateral $eriodontal and gingi*al cyst12. 5eratinising and calcifying odontogenic cysts !cystic 5eratinising tumour"13. radicular !$eria$ical cyst"1@. odontogenic 5eratocyst

    c" $rimordial cystd" #orlin #oltG syndrome

    J" ;on odontogenic and fissural cysts4. globuloma+illary !$rema+illa ma+illary" cyst,. naso al*eolar !naso labial / Mlestadt>s" cyst10. naso $alatine !median anterior ma+illary" cyst11. median mandibular cyst12. anterior lingual cyst13. dermoid and e$idermoid cyst1@. $alatal cysts of ne6 born infants

    #" Cysts of nec5 oral floor and sali*ary glands. t)yroglossal duct cyst

    &. lym$)oe$it)elial !branc)ial cleft" cyst7. oral cyst 6it) gastric / e$it)elial e$it)elium4. sali*ary gland cyst – mucocoele and ranula

    " seudocysts of 9a6s@. aneurysmal bone cyst

    . static !de*elo$mental / lateral" bone cyst&. traumatic !)aemorr)agic / solitary" bone cyst

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    A5) classification pu lis$ed in B5istologic typing of odontogenic tu"ours? 2ra"er; #ind org;S$ear – 199,'%. Cysts of t)e 9a6s

    C" $it)elial3. de*elo$mental

    c" odontogenic

    +. gingi*al cysts of infants+i. odontogenic 5eratocyst !$rimordial cyst"+ii. dentigerous !follicular" cyst+iii. eru$tion cyst+i*. lateral $eriodontal cyst+*. gingi*al cyst of t)e adults+*i. botryoid odontogenic cysts+*ii. glandular odontogenic !sialo odontogenic / mucoe$idermoid

    odontogenic" cyst+*iii. calcifying odontogenic cyst

    d" non odontogenic*i. naso $alatine duct !incisi*e canal" cyst*ii. naso labial !naso al*eolar" cyst

    *iii. mid$alatine ra$)ae cyst of infantsi+. median $alatine median al*eolar and median mandibularcysts

    +. globuloma+illary cyst@. inflammatory

    *. radicular cyst !a$ical / lateral"*i. residual cyst*ii. $aradental !mandibular infected buccal" cyst*iii. inflammatory collateral cyst

    8" ;on e$it)elialiii. solitary !traumatic/sim$le/)aemorr)agic" bone cysti*. aneurysmal bone cyst

    %%. Cysts associated 6it) t)e ma+illary antrumc" benign mucosal cyst of t)e ma+illary antrumd" $ost o$erati*e ma+illary cyst !surgical ciliated cyst of t)e ma+illa"

    %%%.Cysts of t)e soft tissues of t)e mout) face and nec5 5" dermoid and e$idermoid cystl" lym$)oe$it)elial !branc)ial cleft" cystm" t)yroglossal duct cystn" anterior median lingual cyst !intralingual cyst of fore gut origin"o" oral cyst 6it) gastric / intestinal e$it)elium !oral alimentary tract cyst"

    $" cystic )ygromaF" naso $)aryngeal cystsr" t)ymic cystss" cysts of t)e sali*ary glands

    *. mucous e+tra*asation cyst*i. mucous retention cyst*ii. ranula*iii. $olycystic !degenerati*e" disease of $arotid

    t" $arasitic cystsi*. )ydatid cyst*. cysticerus cellulosae*i. tric)inosis

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    8i ro.osseous lesions C$arles Aaldron =)*S 19(9; 1993'@. Jibrous dys$lasia

    g a. olyostotic b. -onostotic.

    . Jibro osseous !Cemental " lesions. eacti*e !dys$lastic " lesion arising in t)e toot) bearing area. ()eyare $resumably arising from $eriodontal ligament. ()ey are di*ided into t)ree ty$es based on t)eirradiologic features alt)oug) t)ey re$resent t)e same $at)ologic $rocess.

    ) a. eria$ical cemental !Cemento osseous "dys$lasia.i b. Jocal !local" cemento osseous lesions !dys$lasia". – $robably reacti*e in nature.

    9 c. Jlorid cemento osseous dys$lasia !gigantiform cementoma".&. Jibro osseous neo$lasms. ()ey are of uncertain or debatable relations)i$ to t)ose arising in t)e

    $eriodontal ligament. ()ey are 6idely designated as cementifying fibroma ossifying fibroma orcemento ossifying fibroma.

    5 a. Cementoblatoma steoblastoma and steoid osteoma.l b. NIu*enile acti*e ossifying fibroma> and ot)er so called O aggressi*eP Oacti*eP ossifying /

    cementifying fibromas.

    TNM classification()e (;- system is used to describe t)e anatomical e+tent of a malignant disease. %t is based on

    t)e assessment of t)ree com$onents( – t)e e+tent of $rimary tumour ( – $rimary tumour

    ; – t)e absence or $resence and e+tent of regional lym$) node metastasis- – t)e absence or $resence of distant metastases.5ead and nec% cancer< #ri"ary tu"or size

    Lip and oral cavity

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour (is Carcinoma in situ

    ( 1 (umour 2 cm or less in greatest dimension

    ( 2 (umour more t)an 2 cm but not more t)an @ cm in greatest dimension( 3 (umour more t)an @ cm in greatest dimension

    ( @ Li$ (umour in*ades ad9acent structures e.g. t)roug) cortical bone tongue s5in of nec5.ral ca*ity (umour in*ades ad9acent structures e.g. t)roug) cortical bone into dee$ !e+trinsic"

    muscles of tongue ma+illary sinus s5in Pharynx (oropharynx)

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour

    ( is Carcinoma in situ

    ( 1 (umour 2 cm or less in greatest dimension

    ( 2 (umour more t)an 2 cm but not more t)an @ cm in greatest dimension( 3 (umour more t)an @ cm in greatest dimension

    ( @ (umour in*ades ad9acent structures e.g. t)roug) cortical bone soft tissues of nec5 dee$!e+trinsic" muscles of tongue

    Pharynx (nasopharynx)

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour

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    ( is Carcinoma in situ

    ( 1 (umour limited to one subsite of naso$)aryn+

    ( 2 (umour in*ades more t)an one subsite of naso$)aryn+

    ( 3 (umour in*ades nasal ca*ity and/or oro$)aryn+

    ( @ (umour in*ades s5ull and/or cranial ner*es

    Maxillary sinus

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour

    ( is Carcinoma in situ

    ( 1 (umour limited to t)e antral mucosa 6it) no erosion or destruction of bone

    ( 2 (umour 6it) erosion or destruction of t)e infrastructure including t)e )ard $alate and/or t)emiddle meatus.

    ( 3 (umour in*ades any of t)e follo6ing s5in of c)ee5 $osterior 6all of t)e ma+illary sinus flooror medial 6all of t)e orbit anterior et)moid sinus

    ( @ (umour in*ades t)e orbital contents and/or any of t)e follo6ing cribriform $late $osterioret)moid or s$)enoid sinuses naso$)aryn+ soft $alate $terygoma+illary or tem$oral fossae baseof s5ull

    Salivary glands

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour

    ( 1 (umour 2 cm or less in greatest dimension

    ( 2 (umour more t)an 2 cm but not more t)an @ cm in greatest dimension

    ( 3 (umour more t)an @ cm but not more t)an & cm in greatest dimension

    ( @ (umour more t)an & cm in greatest dimension.()e classification a$$lies only to carcinoma of t)e ma9or sali*ary glands $arotid submandibular

    and sublingual glands. (umours arising in minor sali*ary glands !mucous secreting glands in t)e liningmembrane of t)e u$$er aerodigesti*e tract" are not included in t)is classification.

    6 – :egional ly"p$ nodes()e definitions of t)e ; categories for all )ead and nec5 sites e+ce$t t)yroid gland are

    ; + egional nodes cannot be assessed.

    ; 0 ;o regional node metastasis

    ; 1 -etastasis in a single i$silateral lym$) node 3cm or less in greatest dimension

    ; 2 -etastasis in a single i$silateral lym$) node more t)an 3cm but not more t)an & cm in greatest

    dimension or in multi$le i$silateral lym$) nodes none more t)an &cm in greatest dimension or in bilateral or contralateral lym$) nodes none more t)an &cm in greatest dimension

    ; 2a – -etastasis in a single i$silateral lym$) node more t)an 3cm but not more t)an & cm in greatestdimension

    ; 2 b – -etastasis in multi$le i$silateral lym$) nodes none more t)an &cm in greatest dimension

    ; 2c – -etastasis in bilateral or contralateral lym$) nodes none more t)an &cm in greatest dimension ;3 -etastasis in a lym$) node more t)an & cm in greatest dimension ; 3 ba – Clinically $ositi*e i$silateral node!s" one more t)an& cm in diameter.

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    ; 3b – Bilateral clinically $ositi*e nodes! in t)is situation eac) side of t)e nec5 s)ould be stagedse$arately"

    ; 3c – contralateral clinically $ositi*e node!s" only. Note: Midline nodes are considered ipsilateral nodes.

    * – istant "etastasis-etastasis in any lym$) node ot)er t)an regional is classified as distant metastasis. ()e definition

    of - 8istant -etastasis is t)e same for all ty$es of cancer.- + resence of distant metastasis cannot be assessed

    - 0 ;o distant metastasis

    - 1 8istant metastasis

    ()e category - 1 may be furt)er s$ecified according to t)e follo6ing notationulmonary! UL" Bone marro6!-A " sseous! =="

    Lym$) nodes!LQ-" e$atic ! " eritoneum! "Brain!B A" =5in!=M%" leura! L " t)er! ( "

    )t$er tu"ours)steosarco"a

    ! Pri"ary tu"our ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour

    ( 1 (umour confined 6it)in t)e corte+

    ( 2 (umour in*ades beyond t)e corte+()e classification a$$lies to all $rimary malignant bone tumours e+ce$t multi$le myeloma 9u+tacorticalosteosarcoma and 9u+tacortical c)ondrosarcoma

    Soft tissue sarco"as ! Pri"ary tu"our

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour

    ( 1 (umour cm or less in greatest dimension

    ( 2 (umour more t)an cm in greatest dimension

    S%in tu"ours ! Pri"ary tu"our

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour

    ( is Carcinoma in situ

    ( 1 (umour 2 cm or less in greatest dimension

    ( 2 (umour more t)an 2 cm but not more t)an cm in greatest dimension

    ( 3 (umour more t)an cm in greatest dimension

    ( @ (umour in*ades dee$ e+tradermal structures i.e. cartilage s5eletal muscle or bone Note: In the case of multiple simultaneous tumours, the tumour with the highest T category will beclassified and the number of separate tumours will be indicated in parenthesis e.g. T 2 (5

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    *elano"a ! Pri"ary tu"our

    ()e e+tent of tumour is classified after e+cision. ()is is a $at)ological tumour classification.

    ( + rimary tumour cannot be assessed

    ( 0 ;o e*idence of $rimary tumour

    ( is -elanoma in situ !Clar5>s le*el %" !aty$ical melanocytic )y$er$lasia se*ere melanocytic dys$lasianot an in*asi*e malignant lesion"

    ( 1 (umour 0.7 mm or less in t)ic5ness and in*ading t)e $a$illary dermis !Clar5>s le*el %%"

    ( 2 (umour more t)an 0.7 mm but not more t)an 1. mm in t)ic5ness and/or in*ading t)e $a$illaryreticular dermal interface !Clar5>s le*el %%%"

    ( 3 (umour more t)an 1. mm but not more t)an @.0 mm in t)ic5ness and/or in*ading t)e reticular dermis!Clar5>s le*el %'"

    ( 3a – (umour more t)an 1. mm but not more t)an 3.0 mm in t)ic5ness

    ( 3 b – (umour more t)an 3.0 mm but not more t)an @.0 mm in t)ic5ness

    ( @ (umour more t)an @.0 mm in t)ic5ness and/or in*ading subcutaneous tissue !Clar5>s le*el '" and/orsatellites 6it)in 2cm of t)e $rimary tumour.

    ( @a – (umour more t)an @.0 mm in t)ic5ness and/or in*ading subcutaneous tissue

    ( @ b – =atellites 6it)in 2cm of t)e $rimary tumour ;ote %n case of discre$ancy bet6een tumour t)ic5ness and le*el t)e ( category is based on t)e less fa*ourablefinding.6 – :egional ly"p$ nodes

    ; + egional nodes cannot be assessed.

    ; 0 ;o regional node metastasis

    ; 1 -etastasis 3 cm or less in greatest dimension in any regional lym$) node!s"

    ; 2 -etastasis more t)an 3 cm or less in greatest dimension in any regional lym$) node!s" and/orin transit metastasis

    ; 2a -etastasis more t)an 3 cm or less in greatest dimension in any regional lym$) node!s" ; 2 b %n transit metastasis

    ; 2c – Bot) ;ote %n transit metastasis in*ol*es s5in or subcutaneous tissue more t)an 2cm from t)e $rimary tumour but beyond t)e regionallym$) nodes* – istant "etastasis

    - + resence of distant metastasis cannot be assessed

    - 0 ;o distant metastasis

    - 1 8istant metastasis

    - 1a -etastasis in s5in or subcutaneous tissue or lym$) node!s" beyond t)e regional lym$)nodes

    - 1 b 'isceral metastasis

    Classification of !ur"itt#s lymphoma=e*eral classification systems )a*e been used to stage non odg5in[s lym$)oma !Ultmann and Iacobs1,4 ? Mearns et al. 1,4&". ()ey include t)at of Lu5es and Collins !1,7@" of -ur$)y !1,40" and t)at ofAnn Arbor !Ultman and Iacobs 1,4 " 6)ic) carry some $rognostic rele*ance.

    A se$arate staging system for Bur5itt[s lym$)oma )as been de*elo$ed by Riegler !1,41" 6)ileLe*ine et al. !1,42" classified t)e cases of t)e American Bur5itt[s Lym$)oma egistry as follo6s=tage % single tumour mass !e+tra abdominal 1A or abdominal 2A". =tage %% t6o se$arate tumour masses on t)e same side of t)e dia$)ragm.

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    =tage %%% in*ol*ement of more t)an t6o se$arate masses or disease on bot) sides of t)edia$)ragm

    =tage %' $leural effusion ascites or in*ol*ement of t)e central ner*ous system !malignant cells int)e cerebros$inal fluid" or bone marro6.

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    Salivary gland diseaseClassification of ec$o patterns of palatal sali!ary gland tu"ours ))) 1999 =an =unic$i-s$ii et al(y$e % -i+ed $attern? cystic $atterns 6it)in ec)ogenic solid $attern(y$e %% ;odules are seen in t)e tumour ec)o(y$e %%% Acoustic s)ado6 is seen in t)e tumour ec)o(y$e %' y$o ec)oic $attern 6it) )omogenous internal ec)oes

    Sialograp$ic grading of sialadenitis ou et al – 199,R Aang et al – 199,'+!core "efinition0 ;ormal1 -ild? slig)t irregular dilation of t)e main duct often 6it) areas of local stenosis. ;o disease 6it)in t)e

    gland2 -oderate? more ductal c)anges t)an in t)e mild disease 6it) dilated branc)ing ducts and some $unctate

    sialectasis3 =e*ere? more 6ides$read c)anges t)an in moderate disease s$reading to most of t)e ducts 6it) com$lete

    sialectasis and formation of ca*ities.

    5istologic grading of sialadenitis -sacsson et al – 19(1R Seifert et al – 1977;19(@'+

    !core "efinition. ;ormal

    *. !light focal and periductal lymphocytic infiltration and slight increase in the diameter of the duct +. Moderate periductal inflammation and formation of lymphoid follicles$ interstitial fibrosis$ localised

    destruction of acini and moderated changes to ductal epithelium.. &educed lymphocytic infiltration$ formation of periductal and interlobular lymphoid follicles$

    periductal hyalinisation$ reduced ductal metaplastic changes and acinar destruction

    Classification of sali!ary gland disease()e diseases of sali*ary glands may be di*ided into

    3. 8e*elo$mental anomalies@. %nfections acute

    c)ronicsystemic

    3. ;eo$lasms benignmalignant

    &. Auto immune7. -iscellaneous necrotising sialometa$lasia

    cystic fibrosismucocele and ranula

    Classification of sialadenitis

    =ialadenitis infection of sali*ary gland tissue is a relati*ely common tissue. %t may be classified as!%'" Bacterial and *iral

    c" -um$s !*iral $arotitis"d" Bacterial $arotitis !sialadenitis"i. Acute

    ii. c)ronicc" ecurrent $arotitis of c)ild)ood

    !'" bstructi*e sialadenitise" =ialolit)iasisf" -ucous $lugsg" =tricture – stenosis)" Joreign body

    !'%" =ystemic granulomatous diseases

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    e" (uberculosisf" Actinomycosisg" Jungal infection)" U*eo$arotid fe*er

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    Defects and clefts Classification of "id.facial defects(y$e % Loss of midfacial s5in only ? buttress of t)e ma+illa orbital floor and $alate intact(y$e %% artial ma+illectomy 6it) intact $alate and orbital floor (y$e %%% artial ma+illectomy 6it) resection of a $ortion of $alate ? orbital floor and Loc56ood>s ligament

    remain intact(y$e %' (otal ma+illectomy and $alatectomy ? orbital su$$ort remains intact(y$e ' (otal ma+illectomy and $alatectomy 6it) loss of orbital su$$ort or eye

    Classification of cleft lip and palate+'arious classifications systems )a*e been $ro$osed but only a fe6 )a*e found 6ide acce$tance.

    '%%%. %n t)e classification of a!id and :itc$ie 19,,' congenital clefts 6ere di*ided into t)ree grou$saccording to t)e $osition of t)e clefts in relation to t)e al*eolar $rocess.

    #rou$ % – re al*eolar clefts – unilateral !rig)t or left" bilateral or median#rou$ %% – ost al*eolar clefts – in*ol*ing soft $alate only

    in*ol*ing soft and )ard $alatessubmucous cleft

    #rou$ %%% – Al*eolar clefts – unilateral !rig)t or left" bilateral or median.

    %H. eau 1931' suggested a classification t)at di*ides cleft $alates into four grou$s.#rou$ % – Cleft of soft $alate only.#rou$ %% – Cleft of )ard and soft $alate e+tending no furt)er t)an incisi*e foramen t)us in*ol*ing

    secondary $alate alone.#rou$ %%% – Com$lete unilateral cleft e+tending from t)e u*ula to t)e incisi*e foramen in t)e

    midline t)en de*iating to one side and usually e+tending t)roug) t)e al*eolus at t)e $osition of t)e future lateral incisor toot).

    #rou$ %' – Com$lete bilateral cleft resembling #rou$ %%% 6it) t6o clefts e+tending for6ardsfrom t)e incisi*e foramen t)roug) t)e al*eolus.

    H. 2erna$an and Star% 19 (' recognised t)e need for a classification based on embryology rat)ert)an mor$)ology.

    J. %ncom$lete cleft of secondary $alate#. Com$lete cleft of secondary $alate

    . %ncom$lete cleft of $rimary and secondary $alates%. Unilateral com$lete cleft of $rimary and secondary $alatesI. Bilateral com$lete cleft of $rimary and secondary $alates

    H%. 2erna$an 1971' subseFuently $ro$osed a stri$ed NQ> classification. ()e incisi*e foramen 6)ic)is t)e di*iding line bet6een $rimary and secondary $alate is ta5en as t)e reference and forms t)e

    9unction of t)e NQ>. t)e system $ro*ides ra$id gra$)icre$resentation of t)e original $at)ologic condition and renders itself to com$uter gra$)ic $resentation.

    H%%. "erican ssociation of Cleft #alate :e$a ilitation Classification C#:'+ ()eclassification suggested by ar5ins and associates !1,&2" and endorsed by t)e American Associationof Cleft alate e)abilitation Classification !AAC " is based on t)e same $rinci$les used byMerna)an and =tar5.

    '%%. Cleft of $rimary $alate

    a" Cleft li$ – unilateral bilateral median $rolabium congenital scar b" Al*eolar cleft – unilateral bilateral median'%%%. Cleft of $alate $ro$er

    a" %n*ol*ing soft $alate b" %n*ol*ing )ard $alate

    %H. -andibular $rocess cleft !i" -andibular cleft li$ !ii" -andibular cleft !iii" Lo6er li$ $its

    H. ;aso ocular cleft – e+tending from narial region to t)e medial cant)al region

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    H%. ro ocular cleft – e+tending from t)e angle of t)e mout) to6ards t)e $al$ebralfissureH%%. ro aural cleft – e+tending from t)e angle of t)e mout) to6ards t)e ear.

    H%%%. Spina 1974' modified t)e 8a*id and itc)ie classification.#rou$ % – re incisi*e foramen clefts

    A. Unilateral B. Bilateral C. -edian