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OMS Residency > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Branches of External Carotid-8

A

Some American Ladies Found Our Pyramids Most Satisfactory

S: superior thyroid artery

A: ascending pharyngeal artery

L: lingual artery

F: facial artery

O: occipital artery

P: posterior auricular artery

M: maxillary artery

S: superficial temporal artery

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2
Q

Branches of Maxillary artery? 17

A

rom EXTernal carotid

DAM I AM Piss Drunk But Stupid Drunk I Prefer, Must Phone Alcoholics Anonymous.

1st portion: mandibular or bony
Deep Auricular
Anterior Tympanic
Middle Meningeal
Inferior Alveolar
Accessory Meningeal

2nd: pterygoid or muscular
Masseteric
Pterygoid
Deep Temporal (ant, post)
Buccal/ Buccinator

3rd: Pterygopalatine
Sphenopalatine (terminal branch)
Descending Palatine
Infraorbital
Posterior Superior Alveolar
Middle Superior Alveolar
Pharyngeal
Anterior Superior Alveolar
Artery of Pterygoid Canal

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3
Q

Facial nerve CN7

A

Zygomaticotemporal and Cervicofacial divisions:

  • Temporal
  • Zygomatic
  • Buccal
  • Marginal Mandibular
  • Cervical
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4
Q

Dingman and Grabb (1961) relationships

A

In 81% of specimens, marginal mandibular n. (CN VII) nerve ABOVE inferior border before crossing facial a.

98% nerve was SUPERFICAL to the posterior facial v.

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5
Q

Al-Kayat (1979) findings

A

Mean distance between temporal branch and anterior border of bony external auditory canal 0.8 – 3.5cm Temporal branch located beneath superficial muscular aponeurotic system (SMAS) layer/ temporoparietal fascia Becomes superficial to SMAS layer: 1.5-3cm ABOVE zygomatic arch 1.5cm LATERAL to orbital rim

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6
Q

Hayes Martin maneuver

A

facial vein is divided and slung superiorly to protect the marginal mandibular nerve (Hayes Martin maneuver)

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7
Q

Distance from inferior border of mandible to IAN canal:

A

7mm at first molar 7mm at second molar 11mm at base of coronoid notch

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8
Q

Where does the IAN enter the mandible?

A

IAN enters the mandible 8.3 +/- 0.22mm below the tip of the lingula; 4mm above the occlusal plane

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9
Q

Buccal and lingual cortex thickness at first molar, second molar, and coronoid?

A
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10
Q

Trigeminal Nerve Fibers

A

A alpha- biggest, fastest, position, fine touch

A beta- proprioception

A delta- superficial (first) pain, temperature

C unmyelinated- deep (second) pain, temperature

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11
Q
A
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12
Q

Roods Criteria-7

A
  1. Darkening of root*
  2. Deflection of root*
  3. Narrowing of root
  4. Dark and bifid root apex
  5. Interruption of white line of the canal*
  6. Diversion of the canal
  7. Narrowing of the canal

*most significant predictors

Up to 10% of possible IAN injury: 1 or more radiographic findings

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13
Q

What is the diameter of IAN?

A

2.4mm

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14
Q

When is the IAN closest to the buccal cortex?

A

In third molar region and ascending ramus

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15
Q

Where is the lingual n.(V3) located in the region of the third molar?

A

In third molar region (Miloro et al.):

  • 2.5mm medial to lingual plate
  • 2.5mm inferior to lingual crest
  • Above lingual crest in 10% of cases
  • In direct contact with lingual plate in 25% of cases.
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16
Q

Lingual nerve function

A

Sensory, supplies the mucous membranes of the mandibular lingual gingiva, floor of the mouth and the ipsilateral two-thirds of the tongue.

Chorda tympani=taste

17
Q

Sunderland Nerve Injury Classification-5

A
  1. 1st degree=to endoneurium (rapid recovery w/in days to months)
  2. 2nd=through endo
  3. 3rd=to perineurium
  4. 4th=through peri
  5. 5th=through epineurium

injury from inside out

18
Q

Sunderland versus Seddon Classification

A

neurapraxia= 1st degree

Classification correlate histo changes of nerve injury w/ expected clinical outcomes

axonotemesis=2-4 degree

neurotemesis= 5th degree

19
Q

What type of nerve injury causes the different levels of classification?

A

neuropraxia= first degree block- conduction block, resulting from mild nerve manipulation, traction or compression

Classification correlate histo changes of nerve injury w/ expected clinical outcomes

Axonotmesis- difference in degree of axonal damage

  • 2nd –traction/compression resulting in ischemia, edema, or demyelination –thru endoneurium
  • 3rd – peritneurium intact- recovery variable, may take months and be incomplete
  • 4th –epineurium intact, near complete transection injury- spont recovery unlikely, min improvement may occur in 6-12 months

Neurotmesis- complete transection, traverses entire fascile, loss of epineurium

20
Q

What are the three layers of the nerve?

A

Epineurium: outermost layer, surrounds peripheral bundles and blood vessels.

  • Vasa nervorum
  • Protects against compressive and stretching forces.

Perineurium: surrounds groups of fascicles.

  • Provides structural support and acts as a diffusion barrier.

Endoneurium: surrounds individual nerve fibers and Schwann cells.

21
Q

3 levels for neurosensory test results and how are they tested?

A

Level A: 2pt discrimination and brush stroke, closest distance pt can tell there are two points- boley gauage, greater than 2mm=abnorm – norm= 1st deg

Level B: Contact detection, Semmes Weinstein monofilaments, narrowest diameter filament that requires the least amount of force to detect. -norm=2nd degree, mod impaired

Level C: Pain sensitivity, norm= 3rd deg, mod impairmenmt; abnorm=4th deg, severely impaired

22
Q

What fibers does each level of neurosensory tests test for?

A

Level A: large myelinated fibers (last to regain fxn in recovery phase)

  • 2pt discrimination- A alpha
  • Brush stroke- A alpha and A beta, slowly adapting large myelinated axons.

Level B: quickly adapting large myelinated fibers, A alpha

  • Contact detection

Level C: small myelinated A delta and non myelinated C fibers (most resistant to injury)

  • Pain sensitivity

Warm= A delta

Cold= C fibers

23
Q

Recovery times after injury, IAN versus lingual n?

A

IAN needs more time b/c it lies in a bony canal or physiologic conduit that can guide spontaneous regeneration.

  • consider surgery after 3-6 mon of no improvement

Lingual n. lies in soft tissue, NO conduit for recovery

  • consider surgery after 1-3 mon
24
Q

What is the diameter of lingual n?

A

3.2mm

25
Q

What donor nerve is best to graft for lingual n and IAN?

A

Greater Auricular cable, most similar in diameter=3.0mm

lingual n.=3.2mm

IAN=2.4

26
Q

How fast does a nerve regenerate?

A

1mm/day, 3cm/month

delayed w/ graft and indirect conduit repairs

27
Q

How many months does it take for most nerve injuries to resolve?

A

3-9 months, but only if improvement was observed within the first 3 months

28
Q

What 2 nerves are usually used for interpositional nerve grafting?

A
  • Sural (S1-S2)=2.1mm, can harvest up to 20cm in length
  • Greater Auricular (C1-C2)= 1.5mm/3.0mm cable, advantage if can be harvested from same incision for another procedure
    • patients are opposed to sacrificing sensation in the facial area
29
Q

How is the House-Brackmann score calculated and what do the measurements mean?

A

measurement is determined by measuring the upwards (superior) movement of the mid-portion of the top of the eyebrow, and the outwards (lateral) movement of the angle of the mouth.

1pt=0.25cm of movement to max 1cm

add for a max of 8pts

1=normal 8/8

2=slight 7/8

3=moderate 5-6/8

4=moderately severe 3-4/8

5=severe 1-2/8

30
Q

What order of layers are encountered when dissecting at level of TMJ? 8

A
  1. skin
  2. subcutaneous
  3. SMAS, superficial musculoaponeurotic system
  4. temporal branch of facial n
  5. temporoparietal fascia
  6. temporalis fascia (splits inferior to this point into superficial and deep)
  7. periosteum
  8. TMJ

temporoparietal fascia- lateral extension of galea and is continuous w/ superficial musculoaponeurotic (SMAS) system

31
Q

When does the temporal n. cross zygomatic arch?

A

nerve crosses 8-35mm from ANT concavity of external auditory canal to zygomatic arch

32
Q

What does the marginal mandibular nerve innervate?

A

Innervates muscles:

  • Depressor labii inferioris
  • Depressor anguli oris
  • Mentalis
33
Q

According to Dingman and Grabb, what % of cadavers had 2 major branches?

A

67%

52.9% had 2 branche in Ziarah Atkinson study

34
Q

3 parts of nose that make up MAJ nasal tip support

A
  1. Size, shape, and strength of lower lateral cartilages
  2. Attachment of medial crura to caudal septum
  3. Attachment of lower lateral cartilages to upper lateral
35
Q

FACE NEAR PAROTID/CONDYLE - retromandib approach

A

skin

subQ

Smas (DONT HAVE TO CLOSE)

parotidomasseteric fascia/parotid capsule (HAVE TO CLOSE or get sialocele/herniation)

Pterygomasseteric sling
periosteum

36
Q

Purpose of Al-Kayat study and safety measures?

A

-80% of cases neurovascular bundle (auriculotemporal n. and superficial temp vein/artery) 5-8mm anterior to midportion of tragus

37
Q

Mahan Sign

A

bite on tonger depressor w/ canines, if pain=positive

causes pain in contralateral joint= orthopedic jt problem and inflammation in joint space

IL-1beta, IL-6, TNF alpha

OMS Residency (10 decks)

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