Final Flashcards
(139 cards)
1
Q
Which myelinated nerve fiber for proprioception?
A
A-beta
2
Q
Which myelinated nerve fiber is responsible for fine touch?
A
A-alpha (position & fine touch)
3
Q
For the following nerve fibers, state which ones are myelinated vs. unmyelinated & what they’re responsible for:
A-Alpha:
A-Beta:
A-Delta:
C:
A
A-Alpha:
-myelinated
-postion, fine touch
A-Beta:
-myelinated
-proprioception
A-Delta
-thin myelination
-superficial (first) pain
-temp
C:
-deep (second) pain
-temp
4
Q
Nerve fiber responsible for temp:
A
A-delta, C
5
Q
Nerve fiber responsible for position & fine touch:
A
A-Alpha
6
Q
Nerve fiber responsible for proprioception:
A
A-Beta
7
Q
Nerve fiber responsible for superficial (first) pain:
A
A-Delta
8
Q
Nerve fiber responsible for deep (second) pain:
A
C
9
Q
Your patient has a nerve injury, what do Level A, B and C testing include?
A
Level A: statistic two-point discrimination (normally around 6mm) and brushstroke direction
Level B: contact detection
Level C: pinprick nociception, thermal discrimination
10
Q
This test is used to determine the response of the slowly adapting larger myelinated fibers (A-alpha):
(the patients ability to discriminate between two points is measured)
A
Level A: two-point discrimination test
11
Q
What is considered a normal value for the Level A: two-point discrimination test?
A
6mm
12
Q
-Assesses the quanity & density of functional sensory receptors and afferent fibers
-Can be performed with a fine sable or camel hair brush
-The brush is gently stroked across the area of involvement at a constant rate, and then the patient is asked to indicate the direction of the movement (i.e. to the left or right) and the correct number of patient statements out of 10 is recorded
A
Level A: brush stroke directional discrimination
13
Q
What is used for Level B: contact detection?
A
Von Frey Filaments
14
Q
What tests are included in Level C?
A
- thermal discrimination
- pinprick nociception
15
Q
What tests are included in Level A?
A
- Two-point discrimination
- Brush-stroke direction
16
Q
How is surgical nerve repair performed?
A
Epineural neurorrhaphy
17
Q
Identification & repair of severed nerve endings in a tension-free manner:
A
Epineural neurorrhaphy
18
Q
With epineural neurorrhaphy, nerve repair is completed under _______ in a ______.
Magnification using _____ or ______ with fiberoptic lighting
Repair using _____ in epineural fashion
A
general anesthesia; OR setting
3/5x loupes; operating microscope
8-0 nylon suture
19
Q
How is surgical nerve repair performed?
A
Epineural neurorrhaphy- after removing pathology from the nerve, sew ends of nerve together with 8-0 nylon suture with no tension
20
Q
When you perform a nerve graft, which donor nerve is best?
A
The sural nerve (30mm) is preferred since it most appropriately matches the nerve diameter and the fascicular number and pattern of the trigeminal nerve
Greater auricular nerve (15mm) also great option
21
Q
When does a nerve graft need to be performed?
A
Grafting is necessary if tension free nerve repair is unable to be accomplished
22
Q
Seddon 1942 nerve injury classifications include:
A
- neuropraxia (conduction block)
- axonotmesis (axons divided)
- neurotmesis (nerve divided)
23
Q
-A conduction block resulting from mild insults to nerve trunk
-Temporary paralysis of a nerve caused by lack of blood flow or by pressure on the affected nerve with no loss of structural continuity
A
Neurapraxia (Sedon 1942)
24
Q
-There is no axonal degeneration, and sensory recovery is complete in a matter of hours to several days
-The sensory deficit is usually mild and characterized by paresthesia
A
Neurapraxia (Sedon 1942)
25
Neural tube intact, but axons are disrupted:
Axonotmesis
26
Afferent nerve fibers undergo degerenation, but the nerve trink is grossly intact
Axonotmesis
27
-Sensory recovery is good but incomplete
-The period of recovery is related to the rate of axonal degeneration and usually takes several months
-The sensory deficit is usually characterized by severe paresthesia
Axonotmesis
28
The neural tube is severed:
Neurotmesis
29
The most severe kind of nerve injury in which complete nerve disruption takes place:
Neurotmesis
30
-The sensory deficit is characterized by anesthesia
-Injuries are likely permanent without repair
Neurotmesis
31
-Conduction block, nerve is in-continuity, Wallerian degeneration does not take place
-Recovery period: 3 months or less
Sunderland I; Seddon neuropraxia
32
-Axon not continuous, nerve itself remains intact, axonal sprouting, wallerian degeneration
-Recovery period: 1 inch per month
Sunderland II; Seddon axonotmesis
33
-During healing, excessive scarring of the endoneurium occurs that hinders axon regeneration
-Recovery period: less than 1 inch per month where it is slowed by the scar tissue; determined by the degree of scarring and involved fascicles
Sunderland III
34
-Nerve is still in-continuity, scar build up blocks, nerve regeneration
-Recovery: surgical intervention required to re-establish nerve transduction by removing scar tissue and reconnecting nerve segments
Sutherland IV
35
-Rupture of the nerve, it is no longer one continuous fiber
-Recovery: requires surgical intervention
Sunderland V; Seddon Neurotmesis
36
Sunderland I matches:
Seddon neuropraxia
37
Sunderland II matches:
Seddon axonotmesis
38
Sunderland V matches:
Seddon neurotmesis
39
What is the incidence of IAN injury with third molar extractions?
0.4 - 5%
average: 1/2%
40
What is the incidence of injury to the lingual nerve associated with third molar extractions?
0.5 - 6%
average: 0.9%
41
How do injure inferior alveolar nerve?
1. extraction of third molars (most common)
2. administtration of local anesthetic injection
3. placement of endosseous dental implants, plates and screws
4. RCT
42
How do you injure lingual nerve?
1. extraction of lower third molars
2. placement of dental implants through lingual cortex
3. local anesthetic injection
43
Secondary alveolar bone grafting:
1. done before eruption of:
2. usually when the root of the canine is:
3. usually between ages:
1. permanent canines
2. 1/3 to 2/3 formed
3. 9-11 years
44
VPI:
Velopharyngeal incompetence
45
Palatal cleft defect that results in scar tissue formation on the soft palate (velum). The result is that the velopharygneal mechanism is incapable of separating the oral and nasal cavities during swallowing and speech:
Velopharyngeal incompetence
46
What procedure is done for VPI:
Pharyngoplasty (pharyngeal flap surgery_
47
What are the statistics on pharyngeal flap surgery (pharyngoplasty):
-done in 25% of cases of VPI
-improves velopharyngeal competence
-done between 6 & 9 years of ageq
48
When is a pharyngoplasty indicated with VPI?
When patient proves that speech therapy alone is insufficient
(additionally if patient has a short and immobile or easily fatigued patale)
49
surgical closure of cleft palate:
palatoplasty
50
What age is ideal for palatoplasty?
11 to 12 months
51
In palatoplasty we achieve a three layered closure, what are the layers?
1. nasal layer
2. muscle
3. oral layer
52
CLP patients usually have a restricted growth of:
maxilla
53
With a CLP patient, what occurs at 3 months:
Hearing test
54
With a CLP patient, what occurs at 3-4 months?
Primary closure of lip
-done by OMFS
-tens rule
55
With a CLP patient, what occurs at 11-12 months?
Primary closure of palate
-done by OMFS
56
With a CLP patient, what occurs at 1-3 years?
Indirect speech therapy
-speech therapist & parents
57
With a CLP patient, what occurs at 3-6 years?
1. speech therapy (speech therapist)
2. possible nasopharyngoscopy (ENT)
3. possible pharyngoplasty (OMFS or plastic surgeon)
58
With a CLP patient, what occurs at 6-9 years?
1. speech therapy (speech therapist)
2. possible nasopharyngoscopy (ENT)
3. possible pharyngoplasty (OMFS or plastic surgeon)
59
With a CLP patient, what occurs at 9-11 years?
1. Ortho treatment (orthodontist)
2. alveolar bone grafting (OMFS)
60
With a CLP patient, what occurs at 14 years?
Comprehensive orthodontics (orthodontist)
61
With a CLP patient, what occurs at 18 years?
Orthognathic surgery
Lip revision
Nose revision
(OMFS or plastic surgery)
62
What is the most commonly used surgical technique to close a cleft lip?
Millard's rotation advancement flap
63
A cleft lip develops when there is failure of fusion of what fetal structures?
1. Medial nasal process
2. Maxillary processes
64
A cleft palate develops when there is failure of fusion of?
1. Lateral palatine processes
2. Nasal septum
3. Pre-maxilla (primary palate)
65
Incidence of CLP in USA aording to different ethnic groups:
1:750 live births in US
male> female
1. Native north Americans
2. Asians
3. Caucasions
4. Africans
66
Anatomic classification of cleft lip and palate is based on:
1. location
2. completeness (incomplete or complete)
3. extent
67
List the different cleft classifiations:
1. Unilateral or bilateral cleft of lip
2. Unilateral cleft of lip & palate
3. Bilateral cleft of lip & palate
4. Cleft palate alone
5. Submucous cleft
6. Bifid uvula
68
What are the three types of salivary glands and what do they secrete?
1. Parotid (largest)
-serous
2. Submandibular
-serous + mucus
3. Sublingual
-mucous
69
The facial nerve is associated with what gland?
The facial nerve is embedded within the superficial and deep lobes of the parotid gland
70
Excratory duct associated with the submandibular gland. Exits on the side of the lingual frenum.
Wharton's duct
71
Ultimately drains into punctum within the sublingual caruncles on either side of the lingual frenum. Punctum prevents retrograde flow of fluid:
Wharton's duct
72
The main excretory duct of the parotid gland:
Stenson's duct
73
What is the location of Stenson's duct?
near second maxillary molar
74
List three benign salivary gland tumors
1. Pleomorphic adenoma
2. Warthin's tumor (Adenolymphoma)
3. Canalicular adenoma
75
Most commonly observed benign salivary gland tumor:
Pleomorphic adenoma
(and often recurrent)
76
List four malignant salivary gland tumors:
1. Mucoepidermoid tumor
2. Adenoid cystic carcinoma
3. Acinic cell tumor
4. Squamous cell carcinoma
77
Most commonly observed malignant salivary gland tumor:
Mucoepidermoid tumor
78
How to treat sialodenitis:
1. non-surgical massage, sialogogues, moist heat, increased fluid intake, NSAIDs, antibiotics
2. transoral sialolithotomy with sialodochoplasty (surgical incision of the salivary duct to remove the salivary stone)
3. sialendoscopy
4. surgical removal of the salivary gland
79
Mucocele is usually found at:
Lower lip (70%) and buccal mucosa
(rarely upper lip)
80
Usually presents as a translucent blue, dome-shaped, fluctuant swelling in the tissues of the floor of the mouth:
Ranula
81
What gland is usually involved with a ranula?
Sublingual gland
82
What is the cause of a ranula?
Usually caused by severence of the sublingual gland duct, although severance of the submandibular duct may also be the cause
(or blockage with salivary stone may also cause this)
83
Mucocele that occurs on the floor of the mouth:
ranula
84
Treatment of ranulas usually involve:
surgical removal of sublingual gland
(or marsupulization)
85
Increased salivary flow:
Sialorrhea
86
What may cause sialorrhea?
1. psychosis
2. mental retardation
3. certain neurological diseases
4. rabies
5. mercury poisoning
87
What is the most common cause of mandibular fracture:
MVA (43%)
88
What is the second most common cause of mandibular fracture:
Assaults (34%)
89
List the types of mandiular fractures:
1. Greenstick fracture
2. Simple fracture
3. Comminuted fracture
4. Compound fracture
90
Incomplete fracture, periosteum intact (typically in children):
Greenstick fracture
91
Fracture in which the mucosa or skin is not violated:
Simple fracture
92
Fracture involving multiple fragments of bone which are independently dislocated:
Comminuted fracture
93
Fracture associated with bone exposure through tissue avulsions:
Compound fracture
94
List the four most common sites of mandibular fracture:
1. condylar (29.1%)
2. mandibular angle (24.5%)
3. symphysis & parasymphysis (22%)
4. mandibular body (16%)
(1, 3, 5, 4)
95
What muscles attach to the mandible:
1. masseter
2. temporalis
3. lateral/medial pterygoids
4. anterior belly of digastric
5. mylohyoid
6. geniohyoid
7. geniolgossus
96
Intraoral examination of mandibular fracture patient includes:
1. anesthesia of lower lip
2. abnormal mandibular movement
-unable to close
-trismus
3. lacerations, hematoma, echhymosis
4. loose teeth
5. palpation for step defects
6. bleeding
97
Clinical examination of occlusion while evaluating mandibular fracture patient:
1. anterior open bite
2. posterior open bite
98
An anterior open bite with a mandibular fracture is suggestive of:
bilateral condylar fractures
99
A posterior open bite with a mandibular fracture is suggestive of:
anterior alveolar process or parasymphyseal fracture
100
What is associated with an open bite on the opposite side and deviation of chin towards the side of the fracture during mouth opening?
Unilateral condylar neck fracture
101
Involves several stages of healing including:
-hematoma/inflammation
-soft callus
-hard callus
-remodeling
Secondary bone healing
102
This method of bone healing closely resembles endochondral ossification:
Secondary bone healing
103
Bone healing that involves a direct attempt by the cortex to re-establish itself after interruption WITHOUT the formation of a fracture callus.
Primary bone healing
104
Primary bone healing only works when:
the fracture edges are touching exactly
105
Primary bone healing only works for:
1. ORIF
2. Green-stick fractures
106
What is the main objective of surgical treatment of a mandibular fracture?
Restoration of functional alignment of the bone fragments and anatomically precise position utilizing the present teeth for guidance
106
107
What are the key principle of surgical treatment of a mandibular fracture?
1. normal occlusion
2. anatomical reduction of fragments in good position
3. immobilization until bony union occurs
4. soft tissue repair
108
What muscles are involved with mandibular fracture?
1. temporalis
2. medial & lateral pterygoid
3. masseter
4. digastric muscle
109
Common indications to perform orthognathic surgery:
1. dentofacial deformities
2. growth disturbances
3. malocclusion from skeletal disharmonies
4. orthodontic problems that can't be fixed with ortho (transverse maxillary deficiency)
5. OSA
110
Corrective jaw surgery used to correct both jaw and facial deformities:
Orthognathic surgery
111
Goals of orthognathic surgery:
1. normalize the relationship o the jaws to each other and to the rest of the craniofacial complex
2. correct dental malocclusion
3. promote overall facial harmony
112
Pre-surgical growth assessment includes:
1. history
-shoe size changes
-secondary sex characteristics
2. hand/wrist films
3. serial lateral cephalograms
4. technetium bone scans
-to assess condylar activity
113
The main goal of orthognathic surgery is to restore ____ and _____
form; function
114
Correction of dento-facial deformities using ____ ____ and _____ treatment can provide dramatic changes in both cosmetic and functional aspects of the face
COMBINED orthodontic & surgical
115
With orthognathic surgery, the key to successful outcome is correct diagnosis of both:
dental & skeletal abnormalities
116
_____ can often mask an underlying skeletal deformity
dental compensation
117
The MB cusp of the upper first permanent molar, occludes in the buccal groove of the lower first permanent molar:
Class I
118
The MB cusp of the upper first permanent molar occludes ANTERIOR to the buccal groove of the lower first permanent molar:
Class II
119
The MB cusp of the upper first permanent molar occludes POSTERIOR to the buccal groove of the lower first permanent molar:
Class III
120
Mesial slope of upper canine coincides with the distal slope of the lower canine:
Class I
121
Distal slope of the upper canine coincides with the mesial slope of the lower canine:
Class II
122
Lefort I osteotomy can be used to: (5)
1. advance maxilla
2. set back maxilla
3. correct maxillary occlusal canting
4. superiorly reposition maxilla
5. inferiorly reposition maxilla
123
What hard tissue is cut for Lefort I?
The maxilla only (maxilla moves)
124
The most commonly performed MANDIBULAR osteotomy:
B/L sagittal split osteotomy
125
The most commonly performed MAXILLARY osteotomy:
Lefort I
126
Indications for B/L saggital split osteotomy:
1. mandibular advancement
2. mandibular setback
3. mandibular rotation
127
Components of the nasal complex:
1. perpendicular plate of ethmoid
2. vomer
3. septal cartilage
4. maxilla
5. palatine bone
128
Bones forming the orbit include:
1. frontal
2. zygomatic
3. ethmoid
4. lacrimal
5. maxilla
6. palatal
7. sphenoid
129
Epidemiology of midface fracture:
-males:females 4:1
-20s to 30s
-MVA > altercation > fall
-nasal>zyogma
130
In altercations the ____ is the most common fracture
Left zygoma
131
Common clinical finding when examining a midface fracture:
1. facial assymetry
2. peri-orbital ecchymosis
3. subconjunctival hemorrhage & chemosis
4. widened intercanthal distance
5. crepitation & step-deformity
6. maxillary mobility & malocclusion
7. battle sign
132
With a physical exam for a possible midface fracture, what needs to be ruled out and what is this?
Battle sign; mastoid ecchymosis - skull base fracture
133
Pattern of fractures of mid-face skeleton include:
1. Le Fort fracture (maxillary fractures)
2. orbital wall fractures
3. zygomatic complex fracture
4. naso-orbito-ethmoid fracture
134
Horizontal fracture through the maxilla above the level of the nasal floor & alveolar process:
Le Fort I
135
What bones are invovled in Le Fort I fracture?
1. Piriform rims
2. Anterior maxilla
3. Zygomatic buttresses
4. Pterygoid plates
136
With a Le Fort I fracture, we will commonly see disturbed:
occlusion
137
What bone is in common for all Le Fort fractures?
Pterygoid plates
138
