Oral & Maxillofacial Surgery

A 27-year-old man presents with rapidly progressive submandibular swelling, dysphagia, muffled “hot-potato” voice, and drooling after a recent molar infection. Floor of mouth is elevated and tender.

A 19-year-old woman with pericoronitis around a partially erupted mandibular third molar has trismus and localized swelling without systemic toxicity.

A 63-year-old man on warfarin (INR 2.3) requires simple dental extraction of a mobile lower incisor.

A 36-year-old man develops severe pain 2 days after difficult molar extraction; socket appears empty with exposed bone, halitosis present.

A 24-year-old man sustains midface trauma in a fight. Findings: periorbital ecchymosis, mobility of maxilla, malocclusion, epistaxis.

A 52-year-old woman with painful swelling over the angle of the mandible and fever after untreated dental abscess. CT shows cortical destruction and sequestra.

A 45-year-old woman reports paresthesia of the lower lip after third molar extraction 2 weeks ago.

A 34-year-old man has oroantral communication (OAC) noted after maxillary molar extraction (3 mm). No sinusitis symptoms.

A 30-year-old woman with impacted mandibular third molar shows Class II, Position B (Pell & Gregory) on panoramic radiograph.

A 60-year-old man presents with unilateral facial swelling crossing the midline of the hard palate. Lesion is firm, painless; palatal torus suspected.

A 41-year-old woman has chronic non-healing ulcer on lateral tongue >3 weeks, non-smoker but with persistent irritation from a broken tooth edge.

A 29-year-old man after zygomaticomaxillary complex fracture reduction develops infraorbital nerve hypoesthesia.

A 72-year-old woman with diabetes presents with painful black eschar on hard palate and facial pain after COVID-19 treatment with steroids.

A 33-year-old man with mandibular angle fracture has malocclusion and mobile segments.

A 58-year-old man with painless, slow-growing parotid mass, mobile, rubbery.

A 25-year-old woman after extraction develops persistent epistaxis and periorbital ecchymosis; OPG suggests displaced maxillary tuberosity fracture.

A 47-year-old man complains of clicking and pain in the TMJ with limited opening after stress.

A 53-year-old woman with bisphosphonate therapy for osteoporosis needs multiple extractions.

A 39-year-old man presents with fluctuant submandibular abscess from mandibular molar.

A 62-year-old smoker has an erythroplakia patch on the floor of mouth.

A 26-year-old man with facial swelling after mandibular third molar extraction develops fever and trismus; CT shows lateral pharyngeal space abscess.

A 45-year-old woman with a radiolucent well-circumscribed lesion at mandibular angle associated with impacted third molar.

A 55-year-old man has limited mouth opening (25 mm) and pain after recent radiotherapy for oral cancer.

A 32-year-old pregnant woman (28 weeks) requires incision and drainage of a buccal space abscess.

A 61-year-old man with uncontrolled hypertension presents for elective extraction. BP 190/110 mmHg.

A 22-year-old man with blunt trauma has diplopia, enophthalmos, and infraorbital numbness; CT shows orbital floor “blowout” fracture with muscle entrapment.

A 40-year-old woman develops profuse bleeding from extraction site 30 minutes post-procedure. She is not anticoagulated.

A 17-year-old male athlete presents with mandibular parasymphysis fracture, intact teeth, and good occlusion.

A 48-year-old woman with persistent TMJ locking in closed position after yawning.

A 52-year-old man with painless, slowly enlarging radiolucency in posterior mandible; histology shows keratinized cyst lining.

A 60-year-old woman on dual antiplatelet therapy (aspirin + clopidogrel) after recent stent (2 months) needs urgent extraction for abscess.

A 35-year-old man with suspected mandibular fracture after assault. Best initial imaging?

A 44-year-old woman has chronic sinus tract associated with mandibular molar extraction site; radiograph shows retained root fragment.

A 28-year-old man experiences syncope and pallor during injection of local anesthesia.

A 50-year-old woman with painful swelling over parotid with purulent discharge from Stensen’s duct, dehydrated.

A 31-year-old man requires removal of supernumerary mesiodens causing diastema.

A 42-year-old woman with severe trismus and pericoronitis has airway difficulty; mouth opening 15 mm.

A 59-year-old man with firm, ulcerated lesion on lower lip, smoker.

A 21-year-old woman with facial trauma has step deformity and paresthesia over cheek; CT shows displaced zygomatic arch fracture impinging masseter.

A 70-year-old man with uncontrolled diabetes presents with necrotic gingival lesions, facial pain, and foul odor; CT shows sequestration of maxilla.

A 34-year-old woman with inherited von Willebrand disease presents with persistent bleeding 2 hours after a simple premolar extraction despite gauze pressure.

A 29-year-old man becomes agitated, perioral numb, then has a generalized seizure shortly after multiple local anesthetic injections with suspected intravascular delivery.

A 21-year-old man under GA for mandibular fracture repair develops rapid hypercarbia, muscle rigidity, rising temperature, and tachycardia.

A 30-year-old woman with long-standing inability to open the mouth (<25 mm), facial asymmetry, and history of childhood trauma. CT shows bony ankylosis of TMJ.

A 42-year-old man has foul nasal discharge and unilateral maxillary sinusitis 3 weeks after an untreated 4-mm oroantral communication post-molar extraction.

A 38-year-old man with displaced unilateral mandibular condylar neck fracture and malocclusion after assault.

A 9-year-old boy with nondisplaced greenstick mandibular body fracture, intact occlusion, minimal pain.

A 67-year-old denture wearer presents with redundant folds of inflamed tissue in the labial vestibule related to ill-fitting denture flange.

A 28-year-old pregnant woman (second trimester) requires urgent drainage of a buccal space abscess.

A 16-year-old with a palatally impacted maxillary canine; orthodontist requests exposure to enable traction.

A 45-year-old man has a large mandibular cyst extending close to the inferior alveolar canal with thinning of cortices.

A 23-year-old develops a rapid cheek swelling and ecchymosis after a posterior superior alveolar nerve block.

A 32-year-old woman experiences persistent tingling of the tongue after a difficult IAN block; exam suggests lingual nerve neurapraxia.

A 67-year-old man on apixaban for atrial fibrillation needs two simple extractions.

A 64-year-old woman received head-and-neck radiotherapy (60 Gy) and now needs extraction of a non-restorable molar in the field.

A 35-year-old man has a multilocular “soap-bubble” radiolucency in posterior mandible; biopsy confirms ameloblastoma.

A 40-year-old woman presents with painful swelling of submandibular gland; occlusal film shows distal Wharton’s duct calculus.

A 59-year-old man has electric shock-like facial pain triggered by light touch on the maxillary area; neuro exam is normal.

A 47-year-old febrile patient with acute preauricular swelling, trismus, and severe TMJ pain after recent dental infection.

A 36-year-old man with canine space infection develops periorbital edema, ocular pain, and restricted eye movements.

A 25-year-old woman experiences sudden needle breakage during an IAN block; a small fragment is not visible intraorally.

A 19-year-old develops cyanosis and chocolate-brown blood appearance after prolonged topical benzocaine; SpO₂ ~85% unresponsive to oxygen.

A 58-year-old man on denosumab for metastatic disease requires extraction of a painful, mobile molar.

A 6-year-old undergoing minimal sedation with oral midazolam becomes paradoxically agitated and disinhibited.

A 33-year-old with panfacial trauma arrives unstable.

A 24-year-old with facial trauma has pyramidal midface mobility, infraorbital numbness, and nasal bridge involvement on exam.

A 37-year-old woman has persistent complete anesthesia of the lower lip and chin 4 months after IAN injury during surgery with no improvement.

A 10-year-old boy with minimally displaced intracapsular condylar fracture and normal occlusion.

A 54-year-old woman with firm parotid mass and facial nerve weakness; FNA suggests high-grade mucoepidermoid carcinoma.

A 22-year-old scheduled for IV sedation asks about fasting.

A 70-kg adult will receive lidocaine 2% with epinephrine for multiple extractions.

A 40-year-old with odontogenic cellulitis is allergic to penicillin (immediate-type).

A 35-year-old sustains a contaminated facial laceration from rusty metal; tetanus status unknown.

A 15-year-old requires extraction of an impacted canine; he arrives without a guardian.

A 23-year-old shows painless unilateral facial swelling; CT reveals “ground-glass” appearance of posterior maxilla with expansion.

A 31-year-old man with canine space infection develops proptosis, severe headache, and cranial nerve deficits.

A 58-year-old smoker with poorly controlled diabetes seeks immediate implant after extraction of a molar with acute purulence.

A 46-year-old candidate for mandibular implant has panoramic film showing roots near the inferior alveolar canal; exact relationship uncertain.

A 62-year-old woman presents with early peri-implant infection 2 weeks after placement (pain, swelling, mobility absent).

A 27-year-old develops sudden cheek and neck swelling with crepitus during subgingival curettage using an air-driven handpiece.

A 60-year-old man on daily aspirin presents with prolonged oozing after molar extraction despite initial pressure.

A 33-year-old woman develops rapidly expanding submandibular swelling and fever; mouth opening is limited. CT shows multiloculated collection threatening airway.

A 45-year-old man with painful bilateral preauricular swelling after starting anticholinergic medication; no pus from duct, afebrile.

A 26-year-old with mandibular symphysis fracture has step deformity and mobile segments but stable airway.

A 58-year-old man post-radiotherapy (66 Gy) for base-of-tongue cancer presents with exposed, nonhealing mandibular bone after extraction.

A 17-year-old with impacted mandibular third molar shows distal caries on second molar and pericoronitis episodes.

A 40-year-old woman reports persistent nasal regurgitation and fluid leakage after tooth extraction 1 month ago.

A 29-year-old man sustains a dentoalveolar fracture of maxillary anterior segment with tooth mobility and occlusal interference.

A 67-year-old woman presents with recurrent painless submandibular swelling during meals; ultrasound shows 6-mm proximal duct stone.

A 52-year-old man with mandibular body fracture and poor dentition has comminution and contamination.

A 36-year-old presents with persistent draining sinus at mandibular angle after prior submandibular abscess; sulfur granules on discharge.

A 24-year-old woman has sudden swelling and urticaria with wheeze immediately after latex contact during procedure.

A 48-year-old man complains of numbness of lower lip after bilateral sagittal split osteotomy 3 months ago with no improvement.

A 70-year-old on rivaroxaban needs surgical removal of an impacted canine under local anesthesia.

A 32-year-old man has a fluctuant sublingual swelling elevating the tongue, bluish hue; history of prior floor-of-mouth trauma.

A 55-year-old smoker presents with persistent leukoplakia on buccal mucosa not resolving after removing irritants.

A 21-year-old with midface trauma has mobility of entire facial skeleton including zygomas and orbits; CSF rhinorrhea present.

A 46-year-old with chronic mandibular infection shows sequestrum on radiograph and draining sinus. Culture grows mixed flora.

A 37-year-old woman develops persistent TMJ pain and clicking exacerbated by chewing; exam shows myofascial tenderness.

A 50-year-old man requires removal of a mandibular cyst close to IAN; CBCT shows intimate relation.

A 62-year-old woman with painful ulcerated mass at retromolar trigone has weight loss and tobacco history.

A 28-year-old man develops progressive dysphagia and neck swelling after attempting to drain a dental abscess himself.

A 31-year-old patient with class III malocclusion undergoes orthognathic planning. What is the key preoperative step?

A 45-year-old with maxillary sinusitis fails medical therapy; CBCT shows odontogenic source from molar periapical lesion.

A 59-year-old on chronic steroids presents for surgical extraction.

A 23-year-old with pain and localized swelling over anterior maxilla; radiograph: radiopaque mass with radiolucent rim attached to tooth root.

A 50-year-old man with COPD requires IV sedation for multiple extractions; baseline SpO₂ 92%.

A 41-year-old woman has painful swelling over left cheek and trismus; CT shows infratemporal space abscess.

A 65-year-old edentulous man complains of burning palate under new complete denture; erythematous palatal mucosa with pinpoint papules.

A 14-year-old with avulsed permanent maxillary incisor arrives within 45 minutes in milk.

A 38-year-old man presents with firm, painless, slow-growing midline floor-of-mouth mass; ultrasound shows cystic lesion above mylohyoid.

A 56-year-old woman with painful ulcerated lesion at lower lip is diagnosed with SCC; staging shows T2N0.

A 47-year-old with bleeding disorder (hemophilia A) needs multiple extractions.

A 35-year-old woman with history of trisomy 21 requires sedation; she has atlantoaxial instability on prior imaging.

A 72-year-old with osteoporosis on oral alendronate for 6 years needs extraction of a non-restorable premolar.

A 28-year-old presents with multiple mucoceles on lower lip after chronic biting habit.

A 63-year-old man with displaced bilateral mandibular fractures has airway obstruction risk and copious oral bleeding.

A 30-year-old woman with painful swelling in submandibular triangle; CT shows abscess and adjacent caries in mandibular molar.

A 57-year-old with firm mobile submandibular mass; FNA suggests pleomorphic adenoma of submandibular gland.

A 25-year-old man has severe pain and medial canthus swelling after frontal sinus fracture with posterior table involvement on CT.

A 32-year-old man with trismus from acute pericoronitis requires mandibular molar extraction under local anesthesia. Mouth opening is <20 mm.

A 27-year-old woman develops sudden inability to close her mouth after yawning; the mandible is depressed and anteriorly displaced.

A resident sustains a needlestick during surgery; patient’s HBV status is unknown and the resident is unvaccinated.

An edentulous 78-year-old with a severely atrophic mandible sustains a displaced body fracture.

A 5-year-old presents with avulsion of a primary maxillary incisor 20 minutes ago.

A 16-year-old sustains lateral luxation of a permanent maxillary central incisor after a fall; tooth is displaced palatally and immobile.

A 28-year-old develops painful trismus 24 hours after an inferior alveolar block; no fever or swelling.

A panoramic radiograph shows mandibular third molar roots intimately contacting the IAN; the tooth is partially erupted and symptomatic.

A 22-year-old with a through-and-through cheek laceration after a fall.

A 54-year-old with prosthetic aortic valve presents for multiple extractions involving gingival manipulation.

During infiltration with lidocaine + epinephrine, a healthy patient reports palpitations and tremor; vitals stable.

A sedated patient becomes hypoventilated with pinpoint pupils after IV opioid analgesia.

A 58-year-old with rheumatoid arthritis has Mallampati IV, limited neck extension, and small mouth opening.

A polytrauma patient has panfacial fractures. What is the preferred fixation sequence?

A 62-year-old diabetic presents with rapidly progressive facial swelling, bullae, severe pain, and crepitus after dental infection.

A 30-year-old requires mandibular quadrant anesthesia when previous IAN blocks were unreliable.

A 48-year-old with a plate-fixed mandibular angle fracture returns with fever, purulent discharge, and mobility at the fracture.

A 59-year-old woman has a 1.0-cm intraglandular stone in the submandibular gland hilum with recurrent infections.

A 64-year-old on ACE inhibitors develops rapid tongue swelling and stridor during a procedure.

A 70-year-old with ITP has platelets 18,000/µL and needs urgent extraction for spreading infection.

A 58-year-old requires posterior mandibular implants with only 6–7 mm bone above the IAN canal.

A 23-year-old with multiple jaw osteomas, supernumerary/impacted teeth, and epidermoid cysts.

A 72-year-old with a total hip prosthesis asks about antibiotics before scaling and extraction.

A 34-year-old with TMJ internal derangement and persistent pain after 3 months of conservative therapy.

During ORIF of a mandibular angle fracture, a fully erupted third molar lies in the fracture line but is sound and not infected.

A patient develops immediate lower lip/chin anesthesia after posterior mandible implant placement; CBCT shows the implant tip in the IAN canal.

A 36-year-old has a painful, enlarging mandibular lesion with “sunburst” periosteal reaction on imaging.

A 10-week pregnant patient requests nitrous oxide sedation for elective third molar removal.

Office sterilization protocol needs optimization for surgical instruments.

A 24-year-old with excessive gingival display and vertical maxillary excess seeks surgical correction.

After intraoral laceration repair, which suture is preferred?

Mandibular molar remains sensitive despite proper IAN and long buccal blocks.

During third molar surgery, how to minimize lingual nerve injury risk?

A patient with ischemic heart disease will receive local anesthesia with epinephrine.

A known obstructive sleep apnea (OSA) patient undergoes outpatient IV sedation for multiple extractions.

A 29-year-old sustains a human bite to the lower lip during an altercation; wound is contaminated.

A 33-year-old adult has a minimally displaced intracapsular condylar head fracture with normal occlusion.

A midface trauma patient has CSF rhinorrhea and basilar skull fracture on CT.

A 35-year-old has a sharp laceration across the cheek overlying the parotid duct; clear saliva pools in the wound.

A 52-year-old develops gustatory sweating over the parotid region months after superficial parotidectomy.