Head, Neck, and Orofacial Infections - An Interdisciplinary Approach (Nov 16, 2015)_(0323289452)_(Elsevier Science)

Use best practices in effectively treating infections of the head, neck, and orofacial complex! Head, Neck, and Orofacial Infections: An Interdisciplinary Approach is the only resource on the market with in-depth guidelines to the diagnosis and management of pathology due to severe infections. No longer do you have to search through journal articles and websites, as this comprehensive, full-color reference covers both cutting-edge and time-tested approaches to recognizing and handling infections. From well-known OMS educator James Hupp and oral surgeon Elie Ferneini, and with chapters written by expert contributors, this book is ideal for use in the classroom, as preparation for the NBDE and specialty exams, and as a clinical resource for patient care. UNIQUE! Comprehensive coverage of head, neck, and orofacial infections addresses the diagnosis and management of pathology due to infections of the head and neck and orofacial complex. Expert contributors are drawn from the disciplines of oral and maxillofacial surgery, head and neck surgery, plastic surgery, and otolaryngology, and they provide state-of-the-art guidance based on extensive experience with current techniques as well as technological advances in managing head, neck, and orofacial infections. Over 500 photographs, radiographs, and illustrations demonstrate pathologies, procedures, and outcomes. A logical organization addresses these topics: 1) issues that are common to all infections of the head and neck region, 2) infections of specific parts of the region, and 3) infections related to certain procedures, types of patients, unusual organisms, and medical-legal implications. Key chapters include: Odontogenic Infections of the Fascial Spaces chapter focuses on the etiology, clinical manifestations, anatomic considerations, and treatment of odontogenic infections. Nasal and Para-Nasal Sinus Infections chapter discusses the pathophysiology and management of nasal and paranasal sinus infections. Microbiologic Considerations with Dental Implants chapter reviews the issues associated with the prevention of infection with surgical implant placement, including the factors that are known to cause infection, the putative bacteria involved and means to control infection once it occurs. Front Cover Head, Neck, and Orofacial Infections: An Interdisciplinary Approach Copyright Contributors Dedication Preface Head, Neck, and Orofacial Infections: An Interdisciplinary Approach Key Features Acknowledgments Contents Part I - General Topics Related toHead, Neck, and Orofacial Infections 1 - Immunobiology of Infectious Disease Introduction Cells of the Immune System Primary and Secondary Lymphoid Tissues Innate Immunity Adaptive Immunity Antigens, Epitopes, and Antigen Receptors Antigen Presentation and the Major Histocompatibility Complex Clonal Selection T Cell Maturation in the Thymus Cellular Immunity Humoral Immunity Regulation of the Immune Response References Bibliography 2 - Bacteriology of the Head and Neck Regions Commensal Flora of the Head, Neck, and Oral Cavity Pathogenesis of Acute and Chronic Bacterial Infections Acute Infection Surface Adhesion Virulence Factor Production Surviving the Host Response to Infection Chronic Infection and Biofilm Formation Common Bacterial Pathogens of the Ear, Sinuses, and Contiguous Regions Streptococcus pneumoniae Moraxella catarrhalis Haemophilus influenzae Streptococcus pyogenes Staphylococcus aureus Common Bacterial Pathogens of the Teeth, Mouth, and Pharynx Viridans Group Streptococci Actinomyces Species Prevotella Species Fusobacterium Species Capnocytophaga Species Conclusions References 3 - Nonbacterial Microbiology of the Head, Neck, and Orofacial Region Viral Infections Herpesviruses Herpes Simplex Virus Clinical Manifestations Diagnosis Treatment Varicella-Zoster Virus Clinical Manifestations Diagnosis Treatment Epstein-Barr Virus Clinical Manifestation Treatment Cytomegalovirus Clinical Manifestations and Diagnosis Treatment Human Herpesvirus-8 Clinical Manifestations, Diagnosis, and Treatment Human Immunodeficiency Virus Treatment Human Papilloma Virus Clinical Manifestation, Diagnosis, and Treatment Coxsackie Virus Clinical Manifestation Diagnosis and Treatment Mumps Clinical Manifestation Diagnosis and Treatment Fungal Infections Yeast Candida Species Clinical Manifestations Pseudomembranous Candidiasis Diagnosis Treatment Histoplasma capsulatum Clinical Manifestations Diagnosis Treatment Cryptococcus neoformans Clinical Manifestations Diagnosis Treatment Coccidioides immitis Clinical Manifestations Diagnosis Paracoccidioides brasiliensis Clinical Manifestations Diagnosis Treatment Penicillium marneffei Clinical Manifestations Diagnosis Treatment Fusarium Species Diagnosis Treatment Other Yeasts Molds Aspergillus Species Clinical Manifestations Diagnosis Treatment Mucormycosis Clinical Manifestations Diagnosis Treatment Parasitic Infections Myiasis Encephalitozoon hellem Clinical Manifestations Diagnosis Treatment Trypanosoma cruzi Diagnosis Treatment Toxoplasmosis Leishmaniasis Clinical Manifestations Diagnosis Treatment Echinococcus granulosus References 4 - Anatomy Relevant to Head, Neck, and Orofacial Infections Epithelial Surfaces Scalp Skin Internal Lining Mucosa Fascial Layers, Boundaries, and Anatomic Compartments and Spaces Dentition and Dentoalveolar Complex: Primary Odontogenic Space Infections Masticator Space Vestibular Space Buccal Space Palatal Space Canine Space Mental Space Submandibular Space Cavernous Sinus Orbit and Surrounding Spaces Ear Auricle (Pinna) Middle Ear (Tympanic Cavity) Inner Ear Mastoid Air Cells Nose and Paranasal Structures Pterygoid Venous Plexus Nasolacrimal Apparatus Nasal Cavity and Paranasal Sinuses Pharynx Salivary Glands Parotid Submandibular Sublingual Neck Larynx Thyroid Lymphatic System Bibliography 5 - Introduction to the Laboratory Diagnosis of Infectious Diseases Specimen Collection and Test Ordering Virology Bacteriology Mycology Advances in Diagnostics Acknowledgments References 6 - Imaging for Head, Neck, and Orofacial Infections Imaging Modalities Plain Film and Tomography Computed Tomography Cone-Beam Computed Tomography Radiation Safety Magnetic Resonance Imaging Ultrasound Nuclear Techniques Imaging for Common Inflammatory Disease Processes Local Odontogenic Infections Osteomyelitis Deep Space Neck Infections Infections of the Salivary Glands Pathology of the Paranasal Sinuses References 7 - Principles of Antimicrobial and Surgical Infection Management Principles of Surgical and Medical Management of Head and Neck Infections Step 1: Determine the Severity of Infection Airway Patency Anatomic Location Radiographic Evaluation Rate of Progression Step 2: Evaluate Host Defenses Step 3: Determine the Setting of Care Step 4: Support Medically Step 5: Treat Surgically Progression of Head and Neck Infections Technique of Incision and Drainage Timing of Incision and Drainage Steps 6 and 7: Choose and Administer Appropriate Antibiotic Therapy Step 8: Reevaluate Frequently Summary References 8 - Principles of Antibiotic Therapy for Head, Neck, and Orofacial Infections Principles of Antibiotic Therapy Principle 1: Surgery to Remove the Cause and Establish Drainage Is Primary; Antibiotics Are Adjunctive Treatment Principle 2: Use Therapeutic Antibiotics Only When Clinically Indicated Principle 3: Use Specific Antibiotic Therapy as Soon as Possible Principle 4: Use Evidence-Based Medicine and Guidelines When Available Principle 5: Use the Narrowest Spectrum Empiric Antibiotic Effective Againstthe Most Likely Pathogens Principle 6: Use the Least Toxic Antibiotic, Considering Drug Interactions Principle 7: Use Combination Antibiotics Only When Necessary Principle 8: Minimize the Duration of Antibiotic Therapy Principle 9: Use the Most Cost-Effective, Appropriate Antibiotic New Antibiotics and Antimicrobial Strategies in Development Antimicrobial Stewardship Programs Summary References 9 - Antimicrobial Pharmacology for Head, Neck, and Orofacial Nonbacterial Infections Antifungals Azoles Imidazoles Triazoles Polyenes Amphotericin B Nystatin Echinocandins Pyrimidine Analogues Antivirals Interferons Pyrophosphate Analogue Nucleoside Analogues Herpes Simplex Virus References Part II - Infections of the Head,Neck, and Orofacial Region 10 - Infections of the Dental Pulp Etiology of Pulpal Infections Epidemiology of Pulpal and Periapical Disease Diagnosis of Pulpal and Periapical Disease Contemporary Nonsurgical Endodontic Treatment and Retreatment Contemporary Endodontic Surgery Prognosis of Endodontic Treatment Prognosis of Nonsurgical Treatment Prognosis of Endodontic Surgery Pulpal Infection in Immature Teeth Endodontic Periodontal Infections References 11 - Infections of the Periodontal Apparatus Infections of the Periodontium Overview of Periodontal Anatomy Microbiology of the Periodontium Chronic Infections of the Periodontium Plaque-Induced Gingivitis Periodontitis Etiology of Periodontal Diseases Treatment Approaches for Gingivitis and Periodontitis Acute Infections of the Periodontium Abscesses of the Periodontium Gingival Abscess Periodontal Abscess Pericoronal Abscess (Pericoronitis) Necrotizing Periodontal Diseases Necrotizing Ulcerative Gingivitis Necrotizing Ulcerative Periodontitis Periodontic-Endodontic Abscesses Primary Herpetic Gingivostomatitis Gingival Diseases of Specific Bacterial Origin Gingival Diseases of Fungal Origin References 12 - Odontogenic Infections of the Fascial Spaces Pathways of Dental Infection Treatment of Odontogenic Infections Incision and Drainage Antibiotic Therapy Anatomic Considerations in Dentoalveolar Infections Fascial Space Infection Canine Space Cavernous Sinus Thrombosis Buccal Space Masticator Spaces Submandibular and Sublingual Spaces Submental Space Infections Associated with Impacted Third Molar Teeth Ludwig’s Angina Pharyngeal Space Infection Retropharyngeal Space Mediastinitis Summary References 13 - Osteomyelitis and Osteonecrosis of the Jaws Infection-Induced Osteomyelitis Acute Osteomyelitis Secondary Chronic Osteomyelitis Surgery Antibiotic Therapy Altered Immune Response Hyperbaric Oxygen Primary Chronic Osteomyelitis Radiation-Induced Osteonecrosis and Osteoradionecrosis Staging Treatment Stage I Stage II Stage III Prevention Diagnosis Treatment Stage II: Moderate Stage III: Severe References 14 - Salivary Gland Infections Salivary Gland Infections General Considerations Bacterial Salivary Gland Infections Acute Bacterial Parotitis Acute Bacterial Submandibular Sialadenitis Chronic Recurrent Bacterial Parotitis Chronic Recurrent Submandibular Sialadenitis Actinomycosis Cat-Scratch Disease Acute Allergic Sialadenitis and Radiological Parotitis Viral Salivary Gland Infections Viral Sialadenitis, Epidemic Parotitis, Mumps HIV-Associated Salivary Gland Infection Cytomegalovirus Mycobacterial Salivary Gland Infections Tuberculosis Atypical Mycobacterial Infections Parasitic Salivary Gland Infections Filariasis Immunological Salivary Gland Disorders Collagen Sialadenitis (Systemic Lupus Erythematosus) Sarcoidosis Granulomatosis with Polyangiitis References 15 - Nasal and Paranasal Sinus Infections Nasal and Paranasal Sinus Anatomy and Physiology Etiology and Pathophysiology Acute Rhinosinusitis History and Physical Cultures Imaging Treatment: Medical Management Antibiotics Adjunctive Therapies Chronic Rhinosinusitis and Recurrent Acute Rhinosinusitis History and Physical Examination Diagnostic Tests Nasal Endoscopy Imaging Allergy and Immune Function Testing Treatment Nasal Saline Antibiotics Corticosteroids Surgery Odontogenic Sinusitis Fungal Rhinosinusitis Localized Fungal Colonization Fungal Ball Allergic Fungal Rhinosinusitis Acute Invasive Fungal Rhinosinusitis Chronic Invasive Fungal Rhinosinusitis Granulomatous Invasive Fungal Rhinosinusitis Complications of Sinusitis Preseptal Cellulitis Orbital Cellulitis Subperiosteal Abscess Orbital Abscess Cavernous Sinus Thrombosis Pott’s Puffy Tumor Epidural Abscess and Subdural Empyema Meningitis Cerebritis and Cerebral Abscess Infections of the Soft Tissues of the Nose Nasal Vestibulitis, Furunculitis, and Nasal Abscess Nasal Septal Abscess Rhinosporidiosis Tuberculosis Leprosy Syphilis Leishmaniasis Rhinoscleroma References 16 - Oropharyngeal and Tonsillar Infections Introduction Anatomy Etiologies Viral Bacterial History and Examination Diagnosis Bacterial Causes Viral Causes Treatment (Medical versus Surgical) Medical Surgical Complications Suppurative Nonsuppurative Conclusion References 17 - Laryngitis, Epiglottitis, and Tracheitis Anatomy Supraglottitis (Including Epiglottitis) Epidemiology and Etiology Symptoms Evaluation Management Antibiotics Laryngitis (Including Laryngobronchial Tracheitis) Symptoms Bacterial Tracheitis Other Forms of Infectious Laryngitis References 18 - Infections of the Thyroid Gland Congenital or Anatomical Anomalies Associated with Thyroid Infections Tuberculous Thyroid Infection Infections of the Thyroid Gland in the Immunocompromised Host References 19 - Infections of the Ear and Mastoid Overview Anatomy14 Acute Otitis Media Epidemiology Pathophysiology Microbiology Diagnosis Treatment Medical Surgical Mastoiditis: A Complication of AOM Management of Mastoiditis Other Complications of Acute Otitis Media and Mastoiditis Intracranial Meningitis Lateral or Sigmoid Sinus Thrombosis Epidural Abscess or Brain Abscess Otitic Hydrocephalus Extracranial (Extratemporal) Subperiosteal Abscess Bezold Abscess Extracranial (Intratemporal) Facial Paralysis Acute Suppurative Labyrinthitis Petrous Apicitis Acute Otitis Externa Epidemiology Pathophysiology Microbiology Diagnosis Treatment Medical Surgical Complications Malignant Otitis Externa Conclusions References 20 - Orbital Infections Bacterial Orbital Cellulitis Microbiology Examination Treatment Complications Fungal Orbital Cellulitis References 21 - Brain and Meningeal Infections Meningitis Encephalitis Rhombencephalitis Cerebritis Brain Abscess Neurocysticercosis Prion Diseases Progressive Multifocal Leukoencephalopathy Immunosuppression-Related Infections Toxoplasmic Encephalitis Cytomegalovirus Encephalitis Tuberculous Meningitis Cryptococcal Meningitis References 22 - Infections of the Facial Skin and Scalp Anatomy of Facial Skin, Fascia, and Muscle Pathophysiology of Soft Tissue Infections Manifestations of Soft Tissue Infections Acne Clinical Presentation and Diagnosis Treatment Folliculitis Clinical Presentation Diagnosis Treatment Anthrax Clinical Course Diagnosis Treatment Cellulitis and Erysipelas Clinical Presentation Diagnosis Treatment Options Streptococcal Infections Scarlet Fever Clinical Presentation Diagnosis Treatment Necrotizing Fasciitis Clinical Features and Presentation Pathogenesis Diagnosis Treatment Lyme Disease Clinical Features and Presentation Early Localized Phase Early Disseminated Phase Chronic Disease Pathogenesis Diagnosis Treatment Actinomycosis Clinical Features and Presentation Pathogenesis Diagnosis Treatment Tinea Faciei Clinical Presentation Diagnosis Treatment Herpes Simplex Virus Type I Infection Clinical Presentation Primary Infection Recurrent Infections Diagnosis Treatment Primary Infections Recurrent Infections Herpes Zoster Clinical Presentation Diagnosis Treatment Impetigo Clinical Presentation Pathogenesis Diagnosis Treatment Molluscum Contagiosum Clinical Features and Presentation Pathogenesis Diagnosis Treatment References 23 - Neck Infections Related to Vascular Interventions Carotid Endarterectomy and Stenting Introduction Carotid Stenting Carotid Pseudoaneurysm Thrombophlebitis References Part III - Special Topics Related to Head, Neck, and Orofacial Infections 24 - Infection in the Craniomaxillofacial Trauma Patient Historical Perspective Principles Classification of Maxillofacial Trauma Wounds Epidemiology of Infections in Maxillofacial Trauma Bacterial Flora Risk Factors Timing of Repair Prevention Systemic Wound Management Cross-Infection Debridement Prophylaxis Postoperative Antibiotics Soft Tissue Injury Lacerations Intraoral Ear Neck Eye Bite Burn Hard Tissue Injury Dentoalveolar Mandible Midface Orbit Cranial Base Frontal Sinus Temporal Osteomyelitis High-Velocity Injury Hardware Removal Summary 25 - Microbiologic Considerations with Dental Implants Prophylaxis and Surgical Preparation Overview of Implant Infections Early Implant Infections Apical Implantitis Periimplantitis Other Infections Associated with Implant Surgery 26 - Infections Associated with Aesthetic Facial Surgery Introduction Skin Resurfacing Soft Tissue Fillers Rhinoplasty Facelift and Forehead Lift Blepharoplasty Otoplasty Facial Implants Hair Transplantation Summary References 27 - Infections Following Head and Neck Reconstruction Introduction Limitations of the Literature Disease Characteristics Health Status Transfusion Radiation and Chemotherapy Mucosal Involvement Osteomyelitis Reconstruction Options Free Flap Pedicle Flaps Nonvascularized Bone Grafts Distraction Osteogenesis Fixation Biomaterials Dental Implants Computer-Assisted Design Infectious Complications Microbes Hospital-Acquired Conditions and Remote Infections Prevention Prophylaxis Methicillin-Resistant Staphylococcus aureus Topical Antibiotics Nutrition Hyperbaric Oxygen Summary References 28 - Infections in Critically Ill Patients Nosocomial Infections Etiologies Epidemiology Risk Factors Clinical Presentation Diagnosis Treatment Prevention Ventilator-Associated Pneumonia Epidemiology Risk Factors Clinical Presentation Diagnosis Differential Diagnosis Treatment Prevention Catheter-Related Bloodstream Infections Epidemiology Risk Factors Clinical Presentation Diagnosis Treatment Prevention Determinants of Infection Risk Clostridium Difficile Colitis Epidemiology Risk Factors Clinical Presentation Diagnosis Polymerase Chain Reaction Enzyme Immunoassay for Clostridium difficile Glutamate Dehydrogenase Enzyme Immunoassay for Clostridium difficile Toxins A and B Cell Culture Cytotoxic Assay Selective Anaerobic Stool Culture Treatment Prevention Sepsis and Septic Shock Initial Resuscitation Diagnosis Antimicrobial Therapy Source Control References 29 - Head, Neck, and Orofacial Infections in Pediatric Patients Bacterial Infections Skin Infections Impetigo Erysipelas Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Bite Wounds Cat Bites Dog Bites Human Bites Acne Intraoral Bacterial Infection Acute Necrotizing Ulcerative Gingivitis and Periodontitis Aggressive Localized Periodontitis Odontogenic Abscess Osteomyelitis Chronic Nonbacterial Osteomyelitis Viral Infections Human Papillomavirus Parvovirus B19 Molluscum Contagiosum Coxsackie Virus Paramyxovirus Primary and Secondary Herpetic Gingivostomatitis Fungal Infections Oral Candidiasis Tinea Capitis Parasitic Infections Lice and Scabies Tickborne Infections (Bacterial/Parasitic) Lyme Disease (Vector: Ixodes scapularis; Pathogen: Borrelia burgdorferi) Rocky Mountain Spotted Fever (Vector: Dermacentor variabilis; Pathogen: Rickettsia rickettsiae) Pharyngitis and Tonsillitis Infections of the Sinuses Dacryocystitis Conjunctivitis Airway Infections Otitis Externa Otitis Media Cervical Lymphadenitis Antibiotic Considerations in Pediatric Populations References 30 - Head, Neck, and Orofacial Infections in Immunocompromised Patients Host Response to Infection Primary Immunodeficiency States Acquired Immunodeficiency States Granulocyte Disorders Humoral Immunodeficiency Cellular Immunodeficiency Non-neoplastic Conditions Associated with Acquired Immunodeficiency Splenectomy Diabetes Mellitus Alcohol Abuse and Liver Disease Renal Disease Intravenous Drug Abuse Malnutrition Aging Organ Transplant Recipients Collagen Vascular Disease Corticosteroid Use HIV and AIDS Neoplastic Conditions Associated with Acquired Immunodeficiency Prevention and Management of Infection in the Immunocompromised Host References 31 - Tuberculosis and Mycobacterial Infections of the Head and Neck Cervical Lymphadenitis Tuberculous Lymphadenitis Nontuberculous Lymphadenitis Mycobacterial Otic Infections Mycobacterial Ocular Infections Laryngeal Tuberculosis Nasal Tuberculosis Pharyngeal Tuberculosis Salivary Gland Tuberculosis Oral Cavity Tuberculosis Summary References 32 - Anesthetic Considerations in Head, Neck, and Orofacial Infections Importance of the Airway in Maxillofacial Infections Airway Examination Initial Airway Assessment History Physical Examination Diagnostic Tests Criteria for Assessment of Airway Compromise Airway Management Strategies Triage Total or Near-Total Obstruction Corticosteroids in Airway Management Patient Age Local Anesthesia Biological Basis for Failure of Local Anesthesia Local Anesthesia in Infected Sites . The nerve block technique for establishment of local anesthesia of infected areas has several advantages over infiltration. Fi... . The oral cavity is one of the most highly innervated areas of the body. At several sites in the oral cavity, accessory innerva... . By increasing the total amount of local anesthesia in proximity to the nerve tissues, the local anesthetic dissociation equati... . Successful use of local anesthesia in infected cases depends primarily on the accurate deposition of local anesthetic in close... Patient Communication Sedation and Analgesia Techniques Ketamine Dexmedetomidine Intubation Techniques Topical and Regional Airway Local Anesthesia Nasotracheal versus Orotracheal Intubation Nasoendotracheal Intubation Lighted Stylet Tracheal Intubation Video Laryngoscope Fiberoptic Intubation General Anesthesia Preoxygenation Oxygen Insufflation Trismus Glottic Visualization Sellick Maneuver Mask Induction of General Anesthesia Laryngeal Mask Airway Surgical Airway: Cricothyrotomy versus Tracheotomy Complications of Cricothyrotomy and Tracheotomy Jet Ventilation Criteria for Extubation Effect of Anesthetics on the Immune System Pulmonary Aspiration of Infected Material References 33 - Perioperative Infection Control Health Care–Associated Infections Central Line–Associated Bloodstream Infection Ventilator-Associated Pneumonia Catheter-Associated Urinary Tract Infection Surgical Site Infection Hand Hygiene Methicillin-Resistant Staphylococcus Aureus Outcomes Assessment Focus on Surgical Site Infections Prophylactic Antibiotics Skin Care Hair Removal Skin Preparation (Patient) Skin Preparation (Surgical Team) Temperature Control Glucose Control Oxygenation Tissue Damage Topical Antibiotics/Irrigation Drains Transfusions Orthognathic Surgery Facial Fractures Third Molars Conclusions References 34 - Medicolegal Issues Related to Orofacial Infections Failure to Make a Timely Diagnosis Failure to Ensure Patient Safety Failure to Treat Adequately Failure to Prescribe Antibiotics Prescribing Unnecessary Antibiotics Informed Consent General Recommendations Related to Risk Management Appendix I - Illustrative Case Reports Postextraction Infection Pericoronitis in an Immunocompromised Patient Comments Canine Space Infection Canine Space Infection Buccal Space Infection Masticator Space Infection Temporal Space Infection Sublingual Space Infection Necrotizing Fasciitis Submental Space Infection Ludwig’s Angina Ludwig’s Angina, Sepsis, Disseminated Intravascular Coagulation Ludwig’s Angina Lateral Pharyngeal and Masticator Space Infection Multiple Fascial Space Infections Multiple Fascial Space Infections Multiple Fascial Space Infections/Mediastinitis References Appendix II - Case Reports Related to Osteomyelitis and Osteonecrosis Infection-Induced Osteomyelitis Radiation-Induced Osteonecrosis Drug-Induced Osteonecrosis Index A B C D E F G H I J K L M N O P Q R S T U V W Y Z Use best practices in effectively treating infections of the head, neck, and orofacial complex! Head, Neck, and Orofacial Infections: A Multidisciplinary Approach is the only resource on the market with in-depth guidelines to the diagnosis and management of pathology due to severe infections. No longer do you have to search through journal articles and websites, as this comprehensive, full-color reference covers both cutting-edge and time-tested approaches to recognizing and handling infections. From well-known OMS educator James Hupp and oral surgeon Elie Ferneini, and with chapters written by expert contributors, this book is ideal for use in the classroom, as preparation for the NBDE and specialty exams, and as a clinical resource for patient care