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461 Cards in this Set

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What kind of cartilage is located at the TMJ?
Fibrocartilage
How is fibrocartilage different from most articular cartilage/hyaline cartilage?
No Perichondrium
What other 2 joints in the body has this type of cartilage?
The acromialclavicular and sternoclavicular
What does the joint capsule prevent the TMJ from doing?
Sliding too far forward
What does the temporomandibular ligament prevent the TMJ from doing?
Sliding too far back and cracking the tympanic plate, mostly the Inner Horizontal portion.
What prevents the tympanic plate from being fractured?
A muscle (the upper head of the lateral pterygoid), A ligament (temporomandibular ligament specifically the Inner Horizontal Portion), and Proprioceptive fibers that sense stretch and nerve endings in the tissue between the jaw and the tympanic plate.
Of the masticatory muscles, which one is the only one to aid in depressing the mandible?
The lateral pterygoid
Where on the mandible does the inferior head of the lateral pterygoid muscle attach?
Ptergyoid fovea
What type of joint is the TMJ?
A ginglimoarthrodial (it hinges and slides)
Name the 6 specific movements of the TMJ?
Protrusion, Retrusion, Elevation, depression, Lateral and Medial Excursion.
What divides the upper and lower synovial compartments of the TMJ?
The meniscus or articular disc.
What are the two parts of the TMJ ligament?
The OOP or Outer Oblique Portion and the Inner Horizontal Portion
What does the IHP of the TMJ ligament do?
Prevents forceful retrusion of the condyle from breaking the tympanic plate.
What does the OOP of the TMJ ligament do?
It limits the extent of mouth opening?
What are the functional ligaments of the TMJ?
Collarteral Ligament, Capsular ligament, and Temporomandibular ligament
What do the Medial and Lateral Discal Collateral Ligaments (LDL and MDL) do?
Restrict movement of the articular disc restricting hinge-like movements.
What is the function of the capsular ligament?
To encompass the joint and retain synovial fluid
What are the accessory ligaments of the TMJ?
The sphenomandibular and the stymandibular ligaments.
What is Eagle’s Syndrome?
It is the calcification of the Styloid process and stylomandibular ligament it will affect the facial nerve first.
What ligament hides the lingula as it attaches to the internal mandible?
The sphenomandibular lig.
What nerves are responsible for sensory information from the TMJ?
The auriculotemporal, The masseteric, and the deep temporal nerves…sesory fiber hitchhike on the masseteric and the deep temporal nerves as these are motor nerves.
Where are the proprioceptive mechano receptors that detect condylar movements and position in the TMJ?
Retrodiscal area
How is pain perceived at the TMJ?
The posterior and posterolateral portions of the joint capsule have free nerve endings that sense pain and prevent excessive mandibular movements.
What 3 arteries and paralleled veins supply the TMJ?
Branches from the Superficial Temporal, The masseteric, and the deep temporal.
What are the 3 components of the articular disc?
Anterior Band, Posterior Disc Band, and the Intermediate Zone.
What 3 features are unique about the retrodiscal cartilage in the TMJ?
There are elastic fibers where synovial joint usually don’t contain elastic fibers and…The retrodiscal superior portion is vascularized and can regenerate to a certain extent unlike other cartilage. Most Cartilage isn’t innervated, but in the TMJ it is innervated to know when the condyle is slamming the tympanic plate.
What part of the articular disk is vascularized?
The superior portion
Where do hinge type movements occur?
The lower joint compartment
Where do translation type movements occur?
The upper joint compartment
What is the position of rest for the TMJ?
Occlusal surfaces of the teeth a few millimeters apart and the condyles rest lightly on the posterior slope of the articular eminence.
Where is the condyle during centric occlusion?
Sitting withing the mandibular fossa.
Where are the disk bands when the mouth is open?
The anterior band is near the apex of the articular eminence and the post disc band is at mid slope of the articular eminence.
Where are the disc bands when the mouth is closed?
The condyle is inferior to the posterior disk band, and the intermediate zone matches up with the slope of the articular eminence.
What composes the articular disc?
Mostly type I collagen and some type III. Glycosaminoglycans make up about 5% of weight. (80% chondrotin sulfate and 15% dermatan sulfate)
Where is the bilaminar zone of the articular disk located?
The posterior region also called the retrodiscal pad.
What are the 4 classic muscles of mastication?
The Temporalis, the Medial Pterygoid, Lateral Pterygoid and the Masseter.
What are the Origin and Insertion of the Temporalis?
O: temporal lines and fascia, I: Medial Coronoid Process and the anteromedial portion of the ramus of the mandible.
What are the actions of the temporalis?
Retrusion, Elevation, and Lateral Excursiion (due to roundness of the head)
Origins and Insertions for the Masseter?
O for superficial head: Zygomatic process of maxilla and zygomatic arch. O for deep head: zygomatic arch. I for superficial head: angle of the mandible and lower portion of ramus. I for deep head: upper portion of lateral ramus
What are the actions of the masseter?
Retrusion(deep fibers), protrusion, elevation, and lateral excursion.
Superior head of Lateral Pterygoids O and I?
O: g wing of sphenoid and Lateral portion of lateral pterygoid plate. I: articular capsule and disk and the anterior neck of condyle
Inferior Head of the Lateral Pterygoids O and I?
O: G. wing of Sphenoid and Lateral Lateral Pterygoid plate. I: Pterygoid Fovea
What are the actions of the upper and lower head of the Lateral Pterygoid muscles?
Upper: Stabilizer during retrusion. Lower: Protrusion, depression, and medial excursion. (pulls forward down articular eminence)
Medial Pterygoid O and I?
O: Medial Lateral pterygoid plate. I: Medial or the ramus
Actions of the Medial Pterygoid?
Elevation, medial excursion, and protrusion
Where is the Lingual nerve with respect to the lateral Pterygoid?
It runs between the lateral and medial pterygoid muscles just anterior and interior to the inferior alveolar nerve.
Where does the Buccal nerve run with respect to the Lateral pterygoid muscle?
It runs between the two heads. If the lingual nerve does this it causes major issues.
Where does the Maxillary Artery run with respect to the pterygoid muscles?
??
What is the “new” muscle of mastication?
The Sphenomandibularis.
What muscles depress the jaw?
The inferior head of the lateral Pterygoid and the Infra and suprahyiod muscles. Infra: Sternohyoid (medial) Omohyoid (lateral) Sternothyroid and thyrohyoid (both deep) Supra: The anterior digastrics ant and posterior, and the mylohyoid (deep)
In what direction does the anterior digastrics pull the jaw?
Down and Back/Posteriorly
What do you do if you break the coronoid process of your jaw?
Nothing as the Temporalis and the Medial Pterygoid will splint it in place.
What if you break your Jaw on an Oblique angle from the molars backward ?
Unfortunate break because the muscles that attach to each piece of the jaw pull in different directions. You would also experience parasthesia.
What if you break your Jaw on an Oblique angle from the premolars backward?
Unfortunate, will separate but you won’t get as much parasthesia as in the previous case.
What if you break your jaw on an Oblique angle from the molars forward?
Fortunate…might get some edema, but you won’t need to treat it further as it will be held in place by the opposing muscles.
What are Leforte Fractures?
types of facial fractures involving the maxillary bone and surrounding structures in a usually bilateral and either horizontal.
Where is the infra temporal fossa?
It is deep to the zygomatic arch and the mandible.
What is the lateral wall of the infratemporal fossa?
The Mandible
What are the borders of the ingratemporal fossa?
Roof: G wing of Spenoid and temporal bone, Medial: Lateral Pterygoid plate, Anterior: Posterior of the Maxilla, Posterior: stylomandibular ligament, and the lateral wall and floor are the mandible.
Why might you still have molar sensitivity after a successful IA injection?
There are some sensory fibers that hitchhike on the nerve to the mylohyoid and innervate the molars as it passes in close proximity
Where does the chorda tympani lie with respect to the IA nerve?
The chorda tympani is deep to the IA.
The nerve to the mylohyoid branches off of what nerve and where?
It branches off the IA nerve just before the IA enters the mandibular canal.
To what nerve are the IA, Long buccal, Auriculotemporal, the nerve to the mylohyoid, and the Lingual Nerve branches of?
V3 or the Mandibular N of the Trigeminal.
Where does the IA artery run with respect to the stylomandibular ligament and the IA nerve?
It runs superficial to both of these structures.
What muscle attaches in the temporal fossa?
The temporalis
What makes up the pterygomaxillary fissure?
It is a triangular cleft between the G wing of the Spenoing, the Lateral Pterygoid plate and the Maxilla.
Where does the pterygomaxillary fissure lead?
It leads to the pterygopalantine fossa.
What foramen of the pterygopalantine fossa is visible via the pterygomaxillary fissure?
The sphenopalantine foramen (should be fissure because it is between two bones.)
What are the border for the pterygopalantine fossa?
Roof: G wing of sphenoid, Floor: Pyramidal process of the palantine bone. Medial: Vertical plate of the palantine bone, Lateral: Pterygomaxillary fissure, Anterior: The maxilla, Posterio: Lateral Pterygoid process and G wing of Sphenoid.
How could dry eyes result from a dental injection?
If you do a Maxillary nerve injection, anesthetic could enter the Greater palantine canal into the pterygopalantine fossa and then into the inferior orbital fissure to interfere with the lacrimal gland.
What does the palatovaginal canal connect?
The pterygopalatine fossa and the nasopharynx.
What are the foramen/fissure of the pterygopalantine fossa?
The Spenopalantine, The infraorbital fissure, the Pterygomaxillary fissure, the Palatovaginal canal (pharyngeal), the palantine canal, the pterygoid canal, and the foramen rotundum.
What travels in the pterygoid canal?
The nerve of the pterygoid canal or Vidian’s nerve and the artery of the pterygoid canal
What travels in the foramen rotundum?
V2 or the Maxillary nerve branch of the trigeminal
What travels in spenopalantine foramen?
The sphenopalantine artery and the Posterior, Superior nasal nerve.
What travels in the Inferior orbital fissure?
The infraorbital nerve and vessels
What travels in the Palatovaginal canal?
The pharyngeal nerve and artery…also called the pharyngeal canal
What is a good indication that you are below the orbit in a section?
The Maxillary sinuses.
What two bones do you see on the nasal midline above the orbit?
The Ethmoid and the nasal bones…vs the Vomer and the nasal bones below the orbits.
Where does the temporalis attach to the mandible?
On the medial coronoid process and the medial ramus. So once you see the mandible the temporalis will lie medial to the bone.
Where do CN IX-XII exit the brainstem?
They all exit below the pontomedullary junction from the medulla.
The book says that the Accessory nerve travels through the Foramen Magnum and the Jugular foramen, why is this technically not true?
The spinal accessory nerves leave as VPR of the spinal nerves and travel up through the foramen Magnum to merge with the accessory nerves leaving the brainstem, together they are considered CN XI and that is when they exit the Jugular foramen.
Put the following nerve structures in order from medial to lateral: Hypoglossal, Sympathetic Trunk, Accessory, and Vagus
Sympathetic Trunk, Vagus, Hypoglossal, and Accessory as view from the posterior.
What are the Nuclei and associated modalities for CN IX?
Solitary: visceral sensory and taste, The trigeminal: somatic sensory, Inferior Salivatory Nucleus: parasympathetic motor, and Nucleus Ambiguous: branchial motor. Note no somatic motor.
What are the Nuclei and modalities associated with CN X?
Solitary: visceral sensory and taste, The trigeminal: somatic sensory, Dorsal Motor nucleus of X: parasympathetic motor, and Nucleus Ambiguous: branchial motor. Note no somatic motor.
What are the Nuclei and modalities associated with CN XI?
Nucleus Ambiguous for the cranial portion and the Ventral horn cells of C1-c5 for spinal portion….Both do Branchial Motor.
What cranial nucleus is associated with CN XII and what modalities does it contain?
Hypoglossal Nucleus contains only somatic motor.
What motor modality is associated with the GlossoPharyngeal nerve and what does it innervate?
Branchial motor to the stylopharyngeus.
How does parasympathetic innervations reach the parotid gland?
Inferior Salivatory Nucleus via CN IX to the Tympanic N. branch to the Tympanic plexus then via the lesser petrosal nerve to the otic ganglion and then to the secretory branches of the parotid?
Where to general somatic modalities of CN IX travel to?
From the superior and inferior nuclei to the Spinal Nucleus of V.
What general somatic functions does CN IX have?
Post 1/3 of tongue, soft palate, and pharyngeal mucosa, mucosa of the tympanic cavity and Eustachian tube, and skin of ext ear and auditory canal and the internal surface of the tympanic membrane.
To what nuclei to pain and temperature travel to from the external ear?
The Spinal Nucleus of V.
What cranial nerve is responsible for the gag reflex?
The Glossopharygeal.
What is the path for special visceral afferent info in CN IX?
From the posterior 1/3 of tongue via the inferior ganglion of IX to the Solitary Nucleus and then ipsilateral to the insula.
Where does information from Baroreceptors in the coratid sinus and pressure receptors in the carotid bodies travel?
This is visceral afferent and it goes to the inferior ganglion of IX and then the Solitary Nuclues.
How do the Hypoglossal nerve, the Lingual nerve and the glossal pharyngeal relate to eachother in space?
From superior to inferior: The Lingual, The Glossalpharngeal, and the Hypoglossal. (5,9,12)
What nerve is the Lingual nerve a branch of?
V3 of the trigeminal.
The Stylopharyngeus and the Styloglossus run on either side of the Glossalpharyngeal nerve. Which one is innervated by CN IX?
The stylopharyngeus….the other is innervated by the Hypoglossal.
What are the 4 main branches of CN IX?
The Tympanic N/Lesser Petrosal, The N to the carotid sinus, N. to the stylopharyngeus, and the Pharyngeal and Lingual branches.
Besides the glossalpharyngeal which other nerve carries sensory information from the coratid sinuses?
The Vagus
What 3 CN nerves carry sensory information from the external ear?
VII, IX, and X
The Vagus does general somatic afferent from what area?
Posterior portion of Dura, the mucosa of the ext. auditory canal and the small area of skin behind the ear.
Where does taste from the epiglottis travel?
It travels via the Vagus to the nodose ganglia and then terminates in the solitary nucleus.
Where does general visceral Afferent travel for CN X?
Also travels to via the Nodose ganglia to the solitary nucleus.
What areas does the Vagus pull visceral sensory from?
Lower Pharynx, Larangeal mucosa below and above the vocal folds, pressure and chemo receptors from the aorta and para-aortic bodies, and the thoracic and abdominal viscera to about the mid transverse colon.
What nerves do visceral sensory above and below the vocal folds?
Above: the superior laryngeal nerve and below: inferior laryngeal branch or the recurrent Laryngeal N.
Where do the motor fibers to the Larynx come from?
The nucleus ambiguous….pry travels in CN XI and X because damage to XI cause problems speaking.
What is the pharyngeal plexus?
A fancy way of saying XI via X.
Which muscles are innervated vial the pharyngeal plexus?
The pharyngeal constrictors, the muscles of the soft palate except for the tensor veli palatine, the cricothyroid, and the motor to the larynx.
What branches of X is the pharyngeal plexus associated with?
The Pharyngeal, the superior laryngeal and its branch the external Laryngeal, and the recurrent laryngeal.
What is the path of the Superior laryngeal N. branches?
The internal Laryngeal enters the Thyrohyoid membrane and the External branch innervates the cricothyroid muscle.
What innervates the cricothyroid muscle?
The External Laryngeal branch of the Superior Laryngeal N.
Where does the Hypoglossal nerve run with respect to the external carotid artery and the posterior belly of the digastrics?
It runs external to the Ext. carotid Artery and internal to the Post digastric.
Where does the recurrent Laryngeal nerve end?
At the inferior aspect of the epiglottis.
What are the 4 main branches of the Vagus?
Meningeal branch, auricular branch, pharyngeal branch, superior laryngeal branch w/two branches, and the recurrent Laryngeal branch.
What will the cervical portions of CN XI eventually supply?
Sternocleidomastoid and the trapezius.
What will the cranial portions of CN XI eventually supply?
The muscles of the Larynx and Pharynx.
What nerve/nerves innervate the hypoglossus, styloglossus, genioglossus, and palatoglossus?
The first 3 are innervated by the Hypoglossal, the 4th is innervated by the pharyngeal plexus
Why do the above muscles of the tongue have different innervations?
It goes back to their embryologic development. The classical muscles of the tongue developed from occipital somites.
How do the lingual artery, the ant digastrics, the mylohyoid, the hypoglossal n., and the hyoglossus relate in space?
From superficial to deep: Ant. Digastrics, Mylohyoid, Hypoglossal N., Hyoglussus, and Lingual Artery.
How will damage to the left Hypoglossal nerve present in the tongue?
When you stick the tongue out it will deviate to the left. It goes to the ipsilateral side as the damage.
What are the names of the arches on either side of the uvula?
The palatoglossal and the palatopharyngeal arch.
The arches mentioned above are medial extensions of what?
The lateral pharyngeal space…so infections can spread into this space and beyond with a risk of asphyxiation.
What is located between the palatoglossal and palatopharyngeal arches?
The palantine tonsils (very large lymph nodes)
What can occur if the labial frenum runs too close to teeth?
Gum recession.
Where does wharton’s duct enter?
Aka the submandibular duct enters at the sublingual papilla, about 1/3 way up the lingual frenum.
What condition might exist at the foramen cecum?
A patent thyroglossal duct, a connection to the thyroid.
What are the extrinsic muscles of the tongue?
The styloglossus, genioglossus, and hyoglossus
What is ankyloglossia?
The lingual frenum connected to tip of tongue (tongue tied)
Origin, Insertion, and Action of the Styloglossus:
O: styloid process, I: lateral aspect of tongue, A: Elevates and retracts tongue and makes a trough.
Origin, Insertioin, Action of the Genioglossus:
O: superior genial tubercle(mental spine), I: Dorsal tongue and hyoid bone, A: Protrudes and depresses, retracts extreme tip.
Origin, Insertion, Action for the Hyoglossus:
O:Hyoid bone, I: Lateral tongue, A: depression and retrusion of the tongue.
Origin, Insertion, Action of the palatoglossus:
O: Palantine aponeurosis, I: Lateral tongue, A: Elevates posterior tongue to help close the oropharyngeal isthmus. Innervated by Vagus….or XI via X
What direction do the intrinsic muscles of the tongue run?
Longitudinal fibers run antero-posteriorly(in two layers), Transverse fibers run perpendicular to the longitudinal, and the inferior fibers run from the dorsum of tongue inferiorly.
What actions do the longitudinal, transverse, and vertical fibers or the intrinsic tongue muscles perform?
Longitudinal-shorten and lengthen, Transverse-curl , and vertical flattens the tongue.
How do fungiform and filiform papillae differ?
As opposed to filiform, the fungiform are larger with a CT core and contain some taste buds.
What is unique to circumvallate papilla?
The have a cleft or trough surrounding them, they are larger and they have the most taste buds.
What are Von Ebner’s Glands?
They are minor salivary serous glands that secrete into the clefts of the circumvallate papilla allowing food to wash over the taste buds.
What type and % of product do the submandibular glands secrete?
They secrete a sero-mucous fluid ~ 60% of salivary production secreted through Whartons.
What are Serous demilunes?
Surround mucous portion/cells in the submandibular gland.
What type of secretion does the parotid gland make?
It secretes serous fluid. ~30% of salivary secretion
What other gland does the parotid gland look like histologically?
It looks like the pancrease with all dark cells, but the pancreas has the islets of Langerhans to distinguish it.
What is geographic tongue?
Increased hyperkeratosis and fissuring due to varying heights of the papilla.
What is fissured tongue?
Pry related to geographic tongue. Filliform papilla degenerate.
What causes coated tongue and hairy tongue?
Keritin on the filliform papilla.
What can cause contact stomatitis?
Cinnamon flavor
What areas of the palate are innervated by what nerve?
Ant: Nasopalatine, Middle: Greater palatine, Posterior: Lesser Palatine.
Name 5 muscles of the soft palate
Palatopharyngeus, Palatoglossus, Levator Palati, Tensor Palati, and the Uvular muscle.
What innervates the muscles of the soft palate?
They are all innervated by the pharyngeal plexus/ XI via X, except for the tensor palate that is innervated by a branch of V3
What does the uvular muscle do?
It pulls the uvula superior to help seal the nasopharynx.
What action do all of the muscles of the soft palate share?
They all work to elevate the palate to seal the nasopharynx.
Which muscles aid to open the auditory tubes?
The lavator palate and the Tensor Palati
If the muscles of the soft palate are functioning properly, but you still have fluid coming out the nose when you drink, what might be the cause?
You could have an open oral nasal fistula.
Where is sesamoid cartilage located?
It is a generic term for cartilage that connects other cartilage…similar to the generic term emissary veins.
What are the 3 types of cells found in the olfactory mucosa?
Olfactory receptor cells, sustentacular cells, and Basal cells.
What other tissue has receptor cells, sustentacular cells, and basal cells?
Taste Buds
What 5 pieces make up the nasal septum?
Perpendicular plate of the ethmoid, The vomer, The septal nasal cartilage, Nasal crest of the palantine, and the nasal crest of the maxilla.
What lies directly posterior to the perpendicular plate of the ethmoid?
The sella tursica.
What is the hole located in the anterolateral part of the nasopharynx?
The Eustacian tube, auditory canal, or the tympanopharyngeal canal.
What makes up the lateral wall of the nasal cavity?
The superior and middle conchae and meatuses of the ethmoid bone, the inferior concha and meatus, The vertical plate of the palatine bone, and the frontal process of the maxilla.
Where do the sphenoid and Ethmoid sinuses drain to?
They drain into the sphenoethmoidal recess directly above the superior concha.
What is the maxillary orifice?
The opening via the hiatus semilunaris that drains the frontal, ethmoidal, and maxillary sinuses.
Where does the nasolacrimal duct empty?
The inferior meatus. This is why you can taste your tears.
What ganglion hangs from the lingual nerve?
The submandibular ganglion.
What lines the sinuses?
Ciliated Pseudostratified columnar epithelium with goblet cells.
What layers are found in the sinus lining?
The epithelium, with a thin or no submucosa and a very thin lamina propria that fuses to the periosteum of the surrounding bone.
How are the frontal sinuses oriented?
They are variable and are NOT SYMMETRICAL
What is the design problem with the Maxillary sinus?
It drains from the top into the hiatus semilunaris so it almost always has stagnate fluid in the bottom that can serve as a reservoir for bacteria.
What are the border of the maxillary sinus?
Roof: orbit floor, Floor: Maxilla, Posterior: infratemporal surface of the maxilla, Base: Lateral wall of nasal cavity, Apex: The Zygoma. Pyramidal shaped.
How do the sinuses affect dentists?
Referred pain from a sinus infection to the teeth, infections from teeth can get into sinuses, roots can grow into sinuses making extractions tricky.
How many ethmoid sinuses do we have?
It is varyiable. Usually there are multiple and sometimes called ethmoid air cells.
What is the lamina paperacia?
It is the very thin lamina between the ethmoid sinuses and the orbit that may be blown out in forceful pressurizing/blowing of the nose.
What is the Pharynx and what are 3 associated functions?
An element of the digestion system made of muscles and soft tissues that are important for Respiration, Deglutination, and Regurgitation.
What is the Larynx?
Cartilage, muscle and associated soft tissues that are important for vocalization, respiration, and deglutination.
What critical functions does the Pharynx have?
Deglutination, Phonation, and Exhalation.
How can we understand why milk or soda comes out your nose if you laugh while drinking?
Understanding the Pharynx will explain this.
Where is the pharynx?
Between the Esophagus, the mouth and the base of the skull. It is suspended from the base of the skull and forms the back of the throat.
What are the 3 parts of the pharynx?
The nasopharynx, The oropharynx, and the laryngopharynx
What structure equalizes the pressure in middle ear and serves as a conduit for infections to the middle ear?
The Pharyngeotympanic tube/Eustachia/auditory tube.
Where is the piriform recess located?
It is on the lateral wall of the Laryngopharynx. (food gets stuck)
Where is the Laryngopharynx?
Between the superior epiglottis and the bottom of the larynx
What muscles make up the two muscle layers of the pharynx?
The inner longitudinal: stylopharyngeus, palatopharyngeus, and salpingopharyngeus, The outer circular layer from inside to out: The superior, middle, and inferior pharyngeal constrictors.
What is the action of the pharyngeal muscles?
Lift the pharynx and allow the bolus to move down.
Why are the pharyngeal constrictors nested?
To allow a smooth transition for the continuous movement of food and so there aren’t any places that food can get stuck.
Which pharyngeal constrictor is the most important to dentists and why?
The superior constrictor, because it shares its attachment (origin) with the buccinators at the pterygomandibular raphe.
Where do all three pharyngeal constrictors insert?
The median pharyngeal raphe.
Where do the middle and inferior pharyngeal constrictors originate?
Middle: Hyoid bone and styloid ligament, Inferior: Thyroid and Cricoid cartilages.
Give an example of a physiological sphincter
The fibers from the inferior pharyngeal constrictor are continuous with the esophagus and acts as a sphincter to open during swallowing.
Why is the physiological sphincter above so important?
It prevents acid reflux and Barrett’s esophagus (epithelial dysplasia)
Where are the gaps in between the muscles of the pharynx?
One: between the skull and superior constrictor, Two: Between the superior and middle constrictors, Three: between the middle and inferior constrictor and Four: between the inferior constrictor and the esophagus.
What structures are located in the 1st pharyngeal muscle gap?
The auditory tube, Levator palate, and the ascending palantine branch of the facial artery.
What structures are found in the 2nd pharyngeal muscle gap?
The stylopharyngeus and the glossalpharyngeal nerve. That they run together makes sense b/c this nerve innervates this muscle.
What structures go through the 3rd pharyngeal muscle group?
Internal laryngeal branch of X and the superior laryngeal branch of the superior thyroid artery
What structures run through pharyngeal gap 4?
The recurrent Laryngeal N. and the inferior branch of the inferior thyroid artery.
What innervates the majority of the muscles of the Larynx?
The recurrent laryngeal or a branch of this nerve called the inferior laryngeal nerve.
Where does motor innervations to the pharynx come through?
All come via the pharyngeal plexus except the stylopharygeus (CN IX)
Where does sensory innervations of the pharynx come from?
The palate and pharyngeal roof come from V2 via the lesser palatine and the pharyngeal branches. Most of the remainder comes from IX. The area of the laryngeal inlet is pharyngeal plexus. These all do pain, pressure, distension, and temp.
Where is the Larynx?
It is between the mandible and the trachea, hanging off the hyoid bone to form the adams apple which has no function.
At what level does the Common carotid bifurcate?
Near the horn of the thyroid cartilage.
What does the internal laryngeal n.carry through the thyrohyoid membrane?
It does sensory only.
What are the three major components of the larynx from top to bottom?
The hyoid bone, the thyroid cartilage, and the cricoids cartilage.
Why is it best to perform a tracheotomy below the second ring of the trachea?
To avoid injury to the vocal cords.
What do the Arytenoids do?
They rotate to change the length of the vocal cords. (voice tone)
Where are the Arytenoids found?
They are pyramidal and sit on the cricoids cartilage and rotate.
What is the function of the false vocal cords?
These ventricular fold are the last option to protect the true vocal folds.
What type of tissue are the vocal folds made of and what direction do they run?
Fibroelastic and anteroposterior.
What are the 3 tracheal spaces from top to bottom?
The vestibule above the vestibular fold, the ventricle between the vestibular fold and the vocal fold and the Infraglottic space below the vocal folds.
What is the name for the aperture between the vocal folds?
The Rima Gottidis
What is the name of the aperture between the vestibular folds?
The Rima Vestibuli
What should you inspect to ensure proper functioning of the vocal folds?
The Rima Glottidis
What two cartilaginous structures are connected via the vocal ligament/fold?
The arytenoids and the thyroid cartilage.
What do the extrinsic laryngeal muscles do and what muscles do they include?
They move the larynx as a whole and include the supra and infrahyoid muscles.
What is the function of the intrinsic muscles of the larynx?
To move the cartilage parts of the larynx.
What are the 7 intrinsic muscles of the larynx?
The oblique and transverse arytenoids, the posterior cricoarytenoids, the aryepiglottidis, the Thyroarytenoid, the lateral cricoarytenoid, and the cricothyroid.
What innervates the intrinsic muscles of the Larynx?
The pharyngeal plexus specifically the cricothyroid is innervated by fibers that travel on the external Laryngeal branch and all the others via fibers off the recurrent laryngeal branch…(specifically the inferior branch of the recurrent)
Sensory innervations of the larynx?
Above: the vocal fold/rima glottidis via the interna branch of the superior laryngeal. Below: via the recurrent laryngeal.
What can loosen the CT in the vocal folds and lower the tone of the voice?
Testosterone
What are some possible effects to the pharynx and larynx due to damage to CN IX?
Loss of gag reflex, Dysphagia, glossopharyngeal neuralgia, and the palate and uvula will deviate toward the normal side.
What effect can nerve damage to the vagus have on the palate, larynx, and pharynx?
Flaccid soft palate, Unilateral paralysis of pharyngeal constrictors, and a twang in the voice.
What are some effects on the palate/pharynx/larynx from nerve damage to the accessory nerve?
Ipsilateral vocal cord is abducted, dysphonia (often reduced to a whisper), and other sensory deficits.
Why do few long term problems occur when inserting an airway on the midline?
You might cut the thyroid gland, but it is an endocrine gland and secretes into it’s lateral blood supply. The parathyroids are lateral. The Thyroid Ima Vein is on the midline, but not crucial to survival….
Where do you incise to perform a cricothyrotomy?
You insert between the thyroid and cricoids cartilage.
How do you attempt to protect the vocal folds during a tracheotomy or cricothyrotomy?
You insert the tube facing down and preferable enter below the second tracheal ring.
What is a potential problem between the orbit and the maxillary sinus?
The division is very thin and it could be damaged with too much pressure.
What are the borders of the orbit?
Roof: Frontal bone, and lesser wing of the Sphenoid, Medial: Ethmoid and Lacrimal bones, Lateral: frontal process of the zygomatic bone, and greater wing of the sphenoid. Inferior: Maxilla, Posterior: the lesser wing of the Sphenoid at the optic canal.
What is the area where the eyelids meet called?
The Canthus
What is the Conjunctiva?
The mucous membrane lining the eyelids and sclera of the anterior surface of the eye. Helps to protect the eye from bacteria and viruses and also produces some mucus and tears.
Where is the lacrimal sac located?
It is superolateral to the eye.
What path does parasympathetic control of the lacrimal gland follow?
CN VII toThe greater petrosal nerve to The pterygopalantine ganglion via the V2 to the zygomatic nerve to the lacrimal nerve of V1 to the lacrimal gland.
What is the path of tears?
They are secreted via excretory ducts to the conjunctival sac to form the lacrimal lake. The lacrimal puntum near the medial angle of the eye drain fluid via the lacrimal canaliculi to the lacrimal sac and then to the orifice in the inferior nasal meatus.
Name 3 sets of glands that help to keep the eyeball moist
Glands of Moll (modified sweat glands to eyelashes), Glands of Zeis (modified sebaceous glands to eyelashes), and Meibomian or Tarsal glands (secrete sebaceous fluid at tarsus of each eye incorporated into tears to prevent evaporation.)
Where are the anterior and posterior chambers of the eye located?
Anterior: in front of the iris. Posterior: Between the iris and the lens.
Where is the vitreous chamber located in the eyeball?
It is posterior to the lens.
What occurs with elevated pressure in the vitreous?
Glaucoma.
What are the 3 general layers of the eye?
The Fibrous layer, the Vascular layer, and the inner or neuronal layer.
What does the fibrous layer of the eye consist of?
The sclera and cornea
What does the vascular layer of the eye consist of?
The choroid, Ciliary body, and iris
What makes up the inner layer of the eyeball?
The retina.
What is the Sclera?
The opaque part of the fibrous layer that covers 5/6 of the eye…the whites
What is the cornea?
The transparent part of the fibrous layer that cover the anterior 1/6.
What is the Choroid?
The dark brown or reddish layer between the sclera and retina. Lots of vessels, causes red eye from reflection in photos. Firmly attached to retina.
What is the ciliary body?
Structure that connects choroid with circumference of iris, provides attachment to the lens so that the ciliary muscle can shape the lens
What fluid fills the anterior and posterior chambers and produces this fluid?
Aqueous humor, ciliary processes
How does fluid drain from the anterior and posterior chambers?
Through the canal of schlemm
What is the iris?
The colored portion of the eye which regulates transmission of light
What is the name for the area where the optic nerve exits the eye?
Optic disc
Does the macula lutia contain rods or cones?
Cones
What is the area of highest visual acuity?
Fovea centralis in the macula lutia
What part of the eye is the fundus?
The posterior part of the eyeball
Which photoreceptors are in the optic disc?
None it’s the blind spot
What is the name for the anterior termination of the optic portion of the retina?
Ora serrata
How many retinal layers are there?
10-12
Which extraocular muscle is the most medial?
Superior oblique
What muscle sits on top of the superior rectus?
Lavatory palpebrae superioris
What two extraocular muscles are not innervated by CN III?
Superior oblique CN IV, lateral rectus CN VI
What eye muscles are involved in abduction?
Lateral rectus, superior oblique, inferior oblique
What eye muscles are involved in adduction?
Medial rectus, superior rectus and inferior rectus
Which eye muscles are depressors?
Inferior rectus, superior oblique
What eye muscles are elevators?
Superior rectus, inferior oblique
How will an eye appear in a pt with oculomotor nerve palsy?
Affected eye will have a downward and outward gaze, dilated pupil, and ptosis
How will abducent nerve palsy present?
Affected eye will be turned medially
What are the Motor eye fields involved in?
plans voluntary eye movement not dependent on visual stimuli. Participates in fast saccadic eye movements, movement on command, movements in which eyes are searching for an object to fix on.
What are the occipital cortex and superior colliculus involved with?
Control of eye movements in response to visual stimuli. Participates in tracking an ongoing motion. Occipital cortex also participates in vergence
What helps coordinate contractions of the neck musculature with the movements of the eyes?
Vestibulo-ocular reflexes
What are the parts of the external ear?
Slide 40 in lecture
What are two additional names for the auditory tube?
Pharyngeotympanic, and eustacian tubes
What 2 muscles act on the auditory tube?
Levator and tensor palate
What nerve runs on the surface of the malleus?
Chorda tympani
What are the borders of the middle ear?
Roof: tegmen tympani, floor: separates tympanic cavity from internal jugular: lateral wall: Tympanic membrane: Medial(laryrinthine) wall: initial turn of cochlea, oval and round windows, Anterior(carotid) wall: separates tympanic cavity from carotid canal, posterior: opening into mastoid antrum.
What is the fascia?
CT that form continuous bands that surround structures within the head and neck
What are formed between fascial layers and why are they important?
Potential spaces which can be areas that infections or cancer can spread.
What are the two divisions of fascia in the head and neck?
Superficial and deep
Which fascia contains the cutaneous branches of the cervical plexus?
The superficial fascia AKA tela subutanea, the platysma is also in this layer.
What other fascia is the superficial fascia continuous with inferiorly?
That of the pectoral and deltoid regions
Superiorly what does the superficial fascia surround?
Muscles of facial expression and the nerves and vessels associated with them.
Which fascia covers these structures?
Anterior and posterior triangles of the neck surrounds the muscles forming the borders of these triangles and the trapezius
What are the deep cervical fascias?
Investing fascia, Pretracheal fascia, prevertebral, alar fascia, carotid sheath
What does the pretracheal fascia surround?
(AKA visceral fascia) Majority of the viscera of the neck – thyroid glands, larynx, trachea, pharynx and esophagus. Bblends with the posterior layers of the investing fascia and covers the infrahyoid muscles
Which fascia encases the posterior aspect of the esophagus surrounds the scalene muscles, deep muscles of the back, nerves of the brachial plexus?
Prevertebral also surrounds the vertebral column itself
Which fascia is a derivative of the vertebral fascia?
The Alar fascia it extends from tip of transverse process of the vertebrae from side to side and is continuous upward from infrahyoid region to base of the skull.
The carotid sheath is composed of outcroppings of what 3 fascias?
Investing, alar, and pervertebral
What does the carotid sheath enclose?
Common carotid, internal and external carotid arteries, ingernal jugular vein, vagus nerve and sympathetic fibers
What are the fascial spaces of the neck?
Pretracheal space, retropharyngeal space, parapharyngeal space, prevertebral space
Which space is known as danger space #4?
The prevertebral space
Where is the pretracheal space located?
Between the trachea and esophagus. Superior border is the attachment is where the infrahyoid muscles attach to the hyoid bone and the inferiorly it extends into the thoracic cavity.
What are the borders of the retropharyngeal space?
Anterior: superior constrictor and buccopharyngeal fascia, Posterior: alar fascia, Superior: skull, Inferior mediastinum, Lateral: slip of fascia extending poteriorly from the carotid sheath, Medial: pharyngeal fascia
Why are infections in the retropharyngeal space so dangerous?
They can spread to the mediastinum.
Which area contains the contents of the carotid sheath and deep cervical chain of lymph nodes?
Parapharyngeal space
Where do infections from the parapharyngeal space(lateral pharyngeal space) travel to?
Primarily to the retropharyngeal space
Danger space #4 lies between which two fascias?
Alar anteriorly and prevertebral posteriorly
What are the fascial spaces located in the head and face?
Facial vestibule of the mandible, space of body of mandible, mentalis space, buccal space, parotid space, submandibular space, sublingual region, masticator region, infraorbital area, periorbital area and base of upper lip
What fascial spaces are included in the masticator region?
Superficial temporal space, Deep temporal space, pterygomandibular space, submasseteric space
From where to infections in the facial vestibule spread from?
Abscesses superficial to the bone
Where do facial vestibule infections spread?
To the buccal space
Where do infections in the body of the mandible spread to?
Sublingual, submental, buccal, mentalis, facial vestibule, and submandibular spaces
Where do infections in the mentalis space originate?
The 4 mandibular incisors
Where do infections of the mentalis space spread to?
To the submental and submandibular spaces
Where do infections in the buccal space travel from?
Maxillary or mandibular molars and from the pterygomandibular space, submasseteric space, deep and superficial temoral spaces, and the lateral pharyngeal space
What is the spread of infection from the buccal space dependent upon?
The location of the attachment buccinators in relation to the roots of the maxillary molars. Attachment above the root spread to vestibule common in kids. Attachment below the root spread is to the buccal space common in adults
Infections in which space are not normally of odontogenic origin?
Parotid space infections
Where do parotid space infections spread to?
Skin, subcutaneous fascia, parapharyngeal and depp temporal spaces.
The submandibular space shows a possible continuity with which other spaces?
Superficial cutaneous spaces, sublingual region and the masticator region.
Submandibular infections originate in which teeth?
Molars which have roots below the mylohyoid muscle 3rd, 2nd, and one root of the 1st molars
What is the separating line for the submandibular and sublingual spaces?
The myllohyoid line
In which region/space is the submandibular gland located?
The sublingual region
Which teeth are the origin of infections in the sublingual space?
Mandibular teeth with roots above the mylohyoid
How is the masticator region possible continuous with 1. The cavernous sinus and 2 the orbit ?
1. Via foramen ovale 2. Veins passing through the inferior orbital fissure
To which spaces to infections in the superficial temporal space spread?
Ptyergomandibular, submasseteric and parapharyngeal spaces
Which space has a similar pattern of spread to the deep temporal space?
The superficial temporal space.
In which teeth do infections in the pterygomandibular space originate?
2nd and 3rd molars
To which spaces do pterygomandibular space infections travel?
Temporal spaces, parapharyngeal, buccal, submasseteric, infratemporal, and submandibular
Which potential space is even more of a potential space than the others?
Submasseteric space
What is the origin of infections in the submasseteric space?
Impacted 3rd molars
What allows for an infection in the submasseteric space to cause detachment of the masseter from the ramus?
Muscle is less dense in this area.
Where to infections in the submasseteric space travel to?
Temporal spaces and buccal space
To which space will the tonsillar region send and receive infections?
Retropharyngeal region
What is the source of infections in the infraorbital area?
Max canines and 1st molars
What is the main reason for concern with infraorbital infections?
Infection can spread to the cavernous sinus. Rarely infection will spread to the periorbital area
Which vein branches connect the face with the cavernous sinus?
Pterygoid plexus, inferior ophthalmic and superior ophthalmic veins
What can an infection in the cavernous sinus cause?
A cavernous sinus thrombosis
Since the base of the upper lip really isn’t a fascial space where do infections that spread to this area reside?
Between the muscles of the upper lip
What is the pattern of spread for upper lip infections?
Maxillary molars, base of upper lipand then to the infraorbital and periorbital areas to the cavernous sinus
What is Nociception?
The noxious stimulus originating from the sensory receptor which travels in the primary sensory neuron.
Where is Pain perceived?
Pain (the perception of unpleasant sensation) is sensed in the cerebral cortex.
Is pain always in response to a Nociceptive impulse?
It usually is but pain can occur with out it
What describes how an individual reacts to the perception of pain?
Suffering
How is pain behavior characterized?
The actions and verbal responses that communicate the extent of suffering to others.
What are the 2 types of pain and how do they differ?
Primary and Heterotrophic. Primary pain is sensed at the site of injury. With heterotrophic pain the site of sensation and the site of injury are separate.
What are the 3 types of heterotrophic pain?
Central, projected, and referred pain
What is a common cause of central pain?
Tumors and other defects in the CNS which can cause pain in the face, neck and shoulders
What symptoms can accompany central pain associated with a CNS tumor?
Nausea, Muscle weakness, numbness and problems with balance.
Sciatica is an example of which type of heterotrophic pain?
Projected pain(other examples include pain from slipped discs)
How is projected pain defined?
Pain associated with the peripheral distribution of a nerve root that has been damaged
How is referred pain different than projected pain?
Referred pain is not felt in the involved nerve but in other branches of that nerve or in entirely different branches
What are two examples of referred pain?
Heart attack pain, cutting tip of finger and feeling it in your palm.
What color was George Washington’s white horse?
(Thought it was time for a confidence booster) White
To what area of the face can angina be referred to?
From the sternum toward the mandibular symphisis
What are the names of the 5 facial neuralgias and related disorders discussed in lecture?
Trigeminal Neuralgia, Geniculate Neuralgia, Glossopharyngeal Neuralgia, Occipital Neuralgia, Postherpetic Neuralgia, Parry-Romberg Syndrome.
What is another name for Tic Douloureux?
Trigeminal Neuralgia
How is Trigeminal Neuralgia defined?
Unilateral spasmodic excruciation pain normally a couple of seconds in duration but can last upwards of 15 minutes or more.
Who most frequently gets trigeminal neuralgia?
People >50 yrs
Which nerve is Tic Douloureux associated with?
One or more divisions of CN V Usually V2 and V3
What triggers pain associated with Trigeminal Neuralgia?
Touching the face, brushing teeth, shaving, drinking, chewing or moving a portion of the face.
For which neuralgia can trigger zones be blocked by local anesthetic?
Trigeminal neuralgia this may lead you to ascribe dental cause rather than neuralgia
An unnamed important study attributed what to the cause of trigeminal neuralgia?
An aberrant branch of the middle meningeal artery compressing the trigeminal ganglion
What type of nerve damage is seen in trigeminal neuralgia?
Focal demyelination caused by pressure on CN V and its branches
What are the dental considerations for trigeminal neuralgia?
Recognize pain is trigeminal neuralgia and not something associated with the dentition. Avoid unneeded dental treatment.
What diseases imitate trigeminal neuralgia?
MS, Tumors, Lyme disease, Atypical facial pain (Dr. Zoller seemed to like Lyme disease and MS the most)
What treatment types are available for those with trigeminal neuralgia?
Psychological counseling, Medication, Surgery, Alternative treatments (acupuncture not marijuana)
Why might trigeminal neuralgia cause personality and behavioral changes?
Association fibers travel from the post central gyrus to the pre-frontal cortex
What types of medications are used to treat Neuralgias?
Anticonvulsants, Antispastics,, Tricyclic Antidepressants
What surgical techniques are available to treat trigeminal neuralgia?
GammaKnige radiosurgery, Percutaneous needle rhizotomy, balloon compression, sectioning of CN V branches, Removal or redirection of source of compression
Which surgery option is characterized by inserting a needle under local anesthesia many times through the foramen ovale?
Percutaneous needle rhizotomy (glycerol is deposited around the trigeminal ganglion causing localized damage.
How effective is percutaneous needle rhizotomy?
Most experience relief but damage is not total and pain may recur necessitation repetition of procedure
How is balloon compression performed?
Under general anesthesia, a larger needle with a balloon is inserted, balloon is inflated to compress and mechanically injure CN V root and ganglion
Pain associated with V1 is effectively treated using which method?
Balloon Compression
What are side effects of balloon compression?
Small chance of permanent loss of sensation to the cornea, Temporary weakness of the muscles of mastication, facial numbness is more severe than with glycerol rhizotomy.
What is another name for Geniculate neuralgia?
Why?
What is the probable etiology of geniculate neuralgia?
Compression of the nerve a few mm lateral to exit from pons
Which virus causes/precedes geniculate neuralgia?
Herpes zoster
Vesicular eruptions on eardrum and external canal proceed with neuralgia by 1-2 days?
Geniculate neuralgia
Where is pain localized in geneculate neuralgia?
Unilateral, Stabbing, electric-like shock felt deep in the ear
What are triggers for geniculate neuralgia?
Non-noxious stimulation of the ear canal, swallowing or talking
How much pain does the patent experience between attacks?
Zero
What strange symptoms have patents reported with geniculate neuralgia?
Aberrant salivation, bitter taste, tinnitus and vertigo
Why are tinnitus and vertigo associated with geniculate neuralgia?
CN VIII can also become compressed
Can you block the geniculate ganglion with local anesthetics?
No
A suboccipital craniectomy with exploration of the nervus intermedius is treatment for which neuralgia and what is the hope of such a surgery?
Geniculate neuralgia, in hopes of finding the source of compression
What is the cause of Vagal and Superior laryngeal neuralgia?
Probable compression of the auricular branch and superior laryngeal branches of CN X. possible compression of CN X as it exits the brainstem or upon entry to the jugular foramen.
Which neuralgia has the following symptoms paroxysms of pain associated with the side of the thyroid cartilage, angle of the jaw, rarely the ear and upper thorax. Pt may have hiccups, excessive salivation, coughing and stridor. Pt may incure pain upon moving the head or swallowing?
Vagal and superior laryngeal neuralgia
Why is the Dx of vagal/superior laryngeal neuralgia difficult?
Confusion with other neuralgias or Eagle’s syndrome
What surgical option is avalible for vagal/superior laryngeal neuralgia?
Decompression
What is the name of the syndrome that causes severe pain in the tongue,pharynx, throat, ear and tonsils that lasts from a few seconds to a few minutes at a time?
Glossopharyngeal neuralgia.
How often is the source in irritation found in glossopharyngeal neuralgia?
Most cases it is never found.
What are the possible causes of Glossopharyngeal neuralgia?
Compression of CN IX or its branches by blood vessels, growths at the base of skull, tumors or infections in throat of mouth.
Why would a pt with glossopharyngeal neuralgia experience cardiac arrhythmias and asystole during a pain attack?
CN IX plays a role in regulation of heart rate and blood pressure (carries sensory from carodid bodies)
What triggers glossopharyngeal neuralgia?
Chewing, coughing, laughing, speaking, and swallowing.
What is the surgical treatment for glossopharyngeal neuralgia?
Decompression or removal of tumors or infections impinging upon the nerve
What makes Occipital neuralgia different from other neuralgia?
May be bilateral and more of a chronic pain
What symptoms are associated with occipital neuralgia?
Headache with piercing, throbbing or electric-shock type of chronic pain in the neck, back of the head and behind the ears
What are the trigger points for occipital neuralgia?
Scalp, forehead and areas around the eyes
What is the distribution of the pain in occipital neuralgia?
Area of the greater and lesser occipital nerves
What can cause the pain in occipital neuralgia?
Irritation or injury to the nerves from trauma or compression from osteoarthritis, tumors or lesions in the neck. Other causes can be gout, diabetes, blood vessel inflammation and even keeping the head in an inferior position for a long period of time.
Which neuralgia has a treatment quite different from the others?
Occipital neuralgia treatment includes massage, rest and antidepressants of steroid injections. Postherpetic neuralgia treatment acyclovir
What can occipital neuralgia be confused with?
Tension headaches caused by myofascial pain
Which Neuralgia is associated with shingles affecting the trigeminal ganglia?
Postherpetic neuralgia
What syndrome is related to postherpetic neuralgia?
Ramsay-Hunt syndrome
What is the age timeline association with postherpetic neuralgia?
Negligible <50, 50% of pt >60, 75% >70 following a shingles episode
What anecdotal evidence is associated with trigeminal neuralgia?
It may be caused by active herpes simples lesions along the nerve
What is the treatment for postherpetic neuralgia?
Antivirals such as acyclovir
Progressive facial hemiatrophy is also known as?
Parry-Romberg syndrome
How is parry-romberg syndrome characterized?
By slowly progressive atrophy of soft tissue of half the face.
What are the changes first noticed in parry-romberg syndrome?
Facial changes involving tissue above the maxilla or between the nose and nasolabial fold.
What does parry-romberg syndrome progress to effect?
Angle of the mouth, areas around eye, brow, ear and neck
Are changes unilateral of bilateral with parry-romberg syndrome?
Mostly unilateral
What causes the pain in parry-romberg syndrome?
Muscle wasting
How far does parry-romberg syndrome progress?
Variable but it usually reaches a point and stops
What coloration abnormalities accompany parry-romberg?
Hyperpigmentation or depigmentation
What indicates parry-romberg is of an embryologic origin?
Some experience atrophy of lip, and tonge with wasting of roots of teeth.
What neurological syndromes are associated with parry-romberg syndrome?
Severy headaches, visual abnormalities, nausea, vomiting, migrains, facial pain similar to trigeminal neuralgia, uncontrolled bursts of muscle spasms
How do you treat parry-romberg syndrome?
Purely symptomatic
What neuralgias have the same medical treatments?
Trigeminal, geniculate, vagal/superior laryngeal, glossopharyngeal,
What other facial neurologic defects are caused by compression of neuronal pathways?
Anesthesia Dolorosa, Acoustic Neuroma, Eagles syndrome, Bell’s palsy
What condition is a possible complication of neurosurgery for trigeminal neuralgia?
Anesthesia dolorosa.
What sensations are eliminated and which persist in anesthesia dolorosa?
Sensation(temp pressure and touch are what he said but that doesn’t quite match the symptoms) is lost. Pain remains and may even be exacerbated
What are the symptoms of anesthesia dolorosa?
Numbness, constant horrendous pain, pressure and heaviness, eye pain, sensation of cold increases
What drugs are used to treat anesthesia dolorosa?
Topical capsaicin, clonidine or EMLA (anesthetic used to numb skin before inserting IV). Paroxetine, carbamazepine, Various opioids. Basically heavy pain killers
Why wouldn’t surgery normally be considered for anesthesia dolorosa?
It usually makes the situation worse
When surgery is used what 2 drastic procedures are options?
Thalamotomy, and Cinulotomy
What other names are given to Acoustic neuroma?
Acoustic neuroinoma and vestibular schwannoma
In Acoustic neuroma where does the initially growth occur?
On the vestibulocochlear nerve, unilaterally
When acoustic neuroma is seen bilaterally what else does the patent normally have?
Neurofibromatosis type 2 (a genetic disease that is not passed on)
At what rate does acoustic neuroma occur?
5 in every million
What is the growth pattern of acoustic neuroma?
Slow growing, nonmalignant tumor that begins in the internal auditory meatus and grows towards the internal aspect of the skull as it does this it impinges on VII. Once in the skull it can compress CN V then the brainstem. Once on the brainstem it is deadly.
How is the Dx made for acoustic neuroma?
By MRI in patents with unilateral hearing loss.
What are other symptoms of acoustic neuroma?
Spasm of muscles of facial espression, facial pain in areas ranging from external aspect of the face to the mandible, teeth and mucosa.
Why might acoustic neuroma be confused with dental pain?
Pain can affect mandible, teeth and mucosa
An acoustic Neuroma that is <1.5 cm is classified as?
Entirely intracanalicular
How large is an acoustic neuroma that extends into the cranium?
1.5-2 cm
At what sixe do acoustic neuroma’s distort the brainstem?
>2cm
If an acoustic neuroma is caught and treated early hearing will be saved and the brainstem will not be threatened. When caught how are acoustic neuromas treated?
Microsurgical removal and stereotactic radiation
Name the syndrome - Foreign body sensation in the throat, dysphagia, intermittent facial pain or pain behind the ear, intermittent spasm of muscles of facial expression, taste disturbance, pain along distribution of carotid artery?
Eagle’s syndrome
What is the cause of eagles syndrome?
Ossified stylohyoid ligament W/ poss radial rings of calcified tissue
What % of population have elongated styloid processes and how many of those are symptomatic?
4% and 4-10%
How is Eagle’s syndrome diagnosed?
Radiographic imaging and physical examination
What is the nonsurgical treatment for Eagle’s syndrome?
NSAIDs or steroid injections
What surgical methods are used for Eagles syndrome?
Transpharyngeal approach which is less obtrusive but controversial b/c of pharynx scarring and infection. Extraoral approach which has less possibility of deep space neck infections
What are the characteristics of bell’s palsy?
Unilateral facial paralysis, lasts 1-3 moths, 25% of cases have unknown triggers, and familial occurrences are known but rare
What are the possible causes of bell’s palsy?
HSV or HZV in geniculate ganglion. Compression leading to nerve demyelination, Nerve edema or ischemia, Autoimmune damage to nerve, Vasospasm of vessels associated with nerves.
What is the frequency of Bells plasy?
24 in 100000
What time of year show increase in Bell’s palsy cases?
Fall and winter
Who is most likely to get bell’s palsy?
all are susceptible but middle-aged people and Individuals with demyelinating diseases such as MS, 1in 5 cases (so women 71% to 29%)
What else can cause facial nerve compression or damage?
Forceps delivery, parotid surgery, facial surgery, Mumps, Tumors
That are the triggers for bells palsy?
Acute otitis media, changes in atmospheric pressure, cold exposure, ischemia of nerve near stylomastoid foramen, infections, pregnancy (early eclampsia)
What is childhood bells palsy usually associated with?
Viral infection, lyme disease, and earache
What treatments can shorten duration of bells palsy?
Histamine and other vasodilators, systemic corticosteroids, hyperbaric oxygen therapy, surgical decompression, Antiviral therapy
Other treatments for bells palsy that relieve secondary symptoms are?
Topical ocular antibiotic artificial tears, closure of eyelid, and psychological reassurance
What is the prognosis for bell’s palsy?
82% recover completely in 6 months if symptoms remain for 1 year they will probably remain until the resurrection when our bodies will be made perfect.
What is Melkersson-rosenthal syndrome?
Orofacial granolomatosis ex. Non-tender persistent swelling of the upper lip. Fissured tongue. Unilateral (occasional bilateral) paralysis of muscles of facial expression
What is Ramsay-Hunt syndrome?
HSV of the face of external auditory canal. Cutaneous lesions of the external auditory canal. Ipsilateral paralysis of CN VII and CH VIII.
What symptoms are seen with Ramsay-Hunt syndrome?
Facial paralysis, vertigo and hearing deficits
What would be the signs of Frey syndrome?
Facial redness and sweating along sites of cutaneous distribution of the auriculotemporal nerve in response to gustatory stimuli.
What is a common cause of Frey syndrome?
Injury to auriculotemporal nerve (parotid gland surgery)
In an Extraoral exam you what structures do you palpitate?
The TMJ, The masseter(body, ant. Border, and deep layer), The temporalis (ant and posterior bundles), The medial Pterygoid, Posteriorb belly of the digastrics, the sternocleidomastoid (body and tendon)
In an Intraoral exam what will you palpitate?
The Lateral Pterygoid (pterygoid window)
Describe key features of Leukodema?
It occurs mostly in blacks, It disappears when stretched (you will do this if you suspect this condition during an intraoral exam), it occurs bilaterally on the buccal mucosa, it doesn’t rub off, there is not treatment indicated.
What is the most frequent cause of macroglossia?
Vascular malformities
What are the clinical features associated with macroglossia?
Hypothyroidism, Lymphangiomas, Amyloidosis, neoplasms, down syndrome, and neurofribromatosis
What is ankyloglossia?
Lingual frenum may be short and thick and anchor the tongue to the floor of the mouth or the frenum might be long and connect to the tip of the tongue. Usually no treatment is indicated but could do a frenectomy.
What is a lingual Thyroid?
The primitive thyroid gland or portion of the gland fails to descend. It occurs at the foramen cecum.
Where is the maxillary orifice located?
The middle meatus…it is the opening of the hiatus semilunaris
Where to infections from the K9’s come from?
The maxillary incisors
What could occur w/ masticator space infections?
Pain and Trismus
What spaces get infected from the mandibular molars?
Vestibule, buccal space, the mandible, pterygomandibular space, submasseteric, and parapharyngeal space.
Why are sinuses so easily infected by maxillary molar infections?
The infection only has to cross a layer of epithelium, a small or non-existent submucosa, and the periosteum to gain entrance
What spaces are involved in Ludwig’s Angina?
The submandibular, the sublingual, and the submental must all 3 be infected to cause Ludwigs
What nerves are affected in a cavernous sinus infection?
III, IV, V1, V2, and VI. VI runs through the middle and is often the 1st nerve affected and the optic nerve also approximates the sinus and can mess up the meninges of the optic nerve to cause dizziness and vomiting.
Where is the buccal space located?
Lateral to the buccinators and anterior to the masseter
Why are infections of the mandible hard to dx?
Because you cant see them and due to referred pain.
Which type of facial space infections hurt?
The ones associated with the muscles of mastication
Which nerve might you cut when incising a large infection of the mentalis space?
Marginal Mandigular.