Final Flashcards
(145 cards)
1
Q
Which myelinated nerve fiber is responsible for proprioception?
A
A-Beta
2
Q
Which myelinated nerve fiber is responsible for tine touch?
A
A-alpha
(position & fine touch)
3
Q
For the following nerve fibers, state which ones are myelinated vs. unmyelinated and what they are responsible for:
A-Alpha
A-Beta
A-Delta
C
A
A-Alpha
- Myelinated
- Position/fine touch
A-Beta
- Myelinated
- Proprioception
A-Delta
- Thin myelination
- Superficial (first) pain & Temp
C
- Unmyelinated
- Deep (second) pain & temp
4
Q
Nerve fiber responsible for temp:
A
A-delta and C
5
Q
Nerve fiber responsible for position and 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 ~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: 2-point discrimination test
11
Q
What is considered a normal value for the level A (2-point discrimination test)
A
6 mm
12
Q
Assesses the quantity and 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 (to the left or right), & the correct number of patient statements out of 10 is recorded
A
Level A- Brush stroke directional discrimination
13
Q
What are used for the 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
- 2-point discrimination
- Brush stroke direction
16
Q
How is surgical nerve repair performed?
A
Epineural Neurorrhaphy
17
Q
Identification and repair of severed nerve endings in a tension free manner
A
Epineural Neurorrhaphy
18
Q
With epieneural neurorrphaphy, nerve repair is completed under _____ in a ____ setting
Magnification using ____ or _____ with fiber optic lighting
Repair using ____ in epieneural 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 Neurorrphaphy- after removing pathology from the nerve, sew the ends of the nerve together using 8-0 nylon suture with no tension
20
Q
When performing a nerve graft, which donor nerve is best?
A
Sural nerve (30mm) is preferred since it most appropriately matches the nerve diameter in the fascicular number and pattern of the trigeminal nerve
Greater auricular nerve (15mm) also a good option
21
Q
When does a nerve graft need to be performed?
A
Grafting is necessary if tension free nerve repair is not an option
22
Q
Seddon 1942 Nerve injury classifications include:
A
- Neurapraxia (conduction block)
- Axonotmesis (axons divided)
- Neurotmesis (nerve divided)
23
Q
A conduction block due to mild insult 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
Neuropraxia (Seddon 1942)
24
Q
There is not axonal degeneration and sensory recovery is complete and occurs in a matter of hours to days
The sensory deficit is usually mild and characterized by paresthesia:
A
Neurapraxia (sedan 1942)
25
Neural tube intact, but axons are disrupted:
Axonotmesis
26
Afferent nerve fibers undergo degeneration, but the nerve trunk is grossly intact .
Axonotmesis
27
- sensory recovery is good but incomplete
- The period of recovery is related to axonal regeneration and usually takes several months
- The sensory defecit is usually characterized by severe paresthesia
Axonotmesis
28
The neural tube is severed:
Neurotmesis
29
The most severe type of nerve injury where complete nerve disruption takes place:
Neurotmesis
30
The sensory deficit is characterized by anesthesia and injuries are likely permanent without repair:
Neurotmesis
31
Conduction block, nerve is incontnuity, 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 2
Seddon Axonotmetsis
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
Sunderland IV
35
Rupture of the nerve, it is no longer a continuous fiber
Recover: Requires surgical intervention
Sunderland V
Seddon: Neurotmesis
36
Sunderland 1 matches:
Seddon neuropraxia
37
Sunderland 2 matches
Seddon Axonotmesis
38
Sunder 5 matches:
Seddon Neurotmesis
39
What is the incidence of IAN injury with 3rd molar extractions?
Between 0.4-5% with average of 1.2%
40
What is the incidence of injury to the lingual nerve associated with 3rd molar extractions?
0.5-6% with average of 0.9%
41
How do you injure inferior alveolar nerve?
1. Exraction of 3rd molars (most common)
2. Administration 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 3rd 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 canine
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 of the soft palate (vellum).
The result is that the vellopharyngeal mechanism is incapable of separating the oral and nasal cavities during swallowing and speech
Velopharyngeal incompetence
46
What procedure is done for VPI?
Pharyngoplast (Pharyngeal flap surgeryP
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 age
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 palate)
49
Surgical closure of cleft palate:
Palatoplasty
50
What age is ideal for palatoplasty?
11 - 12 months
51
In palatoplasty, we achieve 3 layered closure, what are the layers?
1. Nasal layer
2. Muscle
3. Oral layer
52
CLP patients usually have a restricted growth of the:
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
- 10s 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 (Parents with instruction from speech therapist)
57
With a CLP patient, what occurs at 3-6 years?
1. Speech therapy (speech therapist)
2. Nasopharyngoscopy (ENT) (possible)
3. Pharyngoplasty (OMFS) (possible)
58
With a CLP patient, what occurs at 6-9 years?
1. Speech therapy (speech therapist)
2. Nasopharyngoscopy (ENT) (possible)
3. Pharyngoplasty (OMFS) (possible)
59
With a CLP patient, what occurs at 9-11 years?
Ortho treatment & alveolar bone grafting
(orthodontist & 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 surgeon)
62
Most common surgical technique to close a cleft lip?
Millards Rotation Advancement Flap
63
A Cleft lip develops when there is failure of fusion of what fetal structures?
1. medial nasal processes
2. maxillary process
64
A cleft palate develps when there is failure of fusion of what fetal structures?
1. lateral palatine processes
2. nasal septum
3. pre-maxilla (primary palate)
65
Incidence of CLP in USA according to different ethnic groups are:
1:750 live births in US
Male> Female
1. Native north americans
2. asians
3. causcasians
4. africans
66
The anatomic classification of cleft lip and palate is based on:
1. Location
2. Completeness (incomplete/complete)
3. Extent
67
List the different cleft classifications:
1. Unilateral or bilateral cleft of the lip
2. Unilateral cleft of lip and palate
3. Bilateral clef of lip and palate
4. Cleft palate alone
5. Submucous cleft
6. Bifid uvula
68
What are the 3 types of salivary glands and what do they secrete?
1. Parotid (Largest) --> Serous
2. Submandibular --> Serous + Muscous
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
Excretory Duct associated with the submandibular gland. Exits on the sides of the lingual frenum:
Wharton's Duct
71
Ultimately drains into puncture within the sublingual caruncles on either side of the lingual frenum. Punctum prevents retrograde flow of fluid:
Wharton's Duct
72
Main excretory duct of the parotid gland:
Stenson's Duct
73
What is the location of Stenson's duct?
Near 2nd maxillary molar
74
List 3 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 4 malignant salivary gland tumors:
1. Mucoepidermoid tumor
2. Adenoid cystic carcinoma
3. Acinic cell tumor
4. Squamous cel carcinoma
77
Most commonly observed malignant salivary gland tumor:
Mucoepidermoid tumor
78
Pathology reveals that this tumor is benign, what is is your diagnosis:
Pleomorphic adenoma
79
Pathology reveals that this tumor is benign, what is your diagnosis?
Warthins Tumor
80
Pathology reveals that this tumor is benign, what is your diagnosis?
Canalicular adenoma
81
Pathology reveals that this tumor is malignant, and high grade (aggressive), although it could have been low grade or intermediate
Mucoepidermoid Carcinoma
82
Pathology reveals that this tumor is malignant, and characterized by a perineural spread:
Adenoid Cystic carcinoma
83
How to treat sailodenitis?
1. nonsurgical massage, sialagogues, moist heat, increased fluid intake, NSAIDs, antibiotics
2. transoral sialolithotomy with sialodochoplasty (surgical incision of the salivary duct to remove the stone)
3. sialendoscopy
4. surgical removal of salivary gland
84
A mucocele is usually found:
Lower lip (70%) and buccal mucosa
(rarely occur in the upper lip)
85
Usually presents as a translucent blue, dome-shaped, fluctuant swelling of the floor of the mouth:
Ranula
86
What gland is usually involved with a ranula?
Sublingual gland
87
What is the cause of a ranula?
Usually caused by severance of the sublingual gland duct although severance of the submandibular duct may also be the cause
(or blockage could also cause this)
88
Mucocele that occurs on the floor of the mouth
Ranula
89
Treatment of rankles usually involved:
surgical removal of sublingual gland
(or marsupulization)
90
Increased salivary flow:
sialorrhea
91
What may use sialorrhea?
1. psychosis
2. mental retardation
3. certain neurological diseases
4. rabies
5. mercury poisoning
92
What is the most common cause of mandible fracture?
MVA (43%)
93
What is the second most common cause of a mandibular fracture?
Assaults (34%)
94
List the types of mandibular fractures:
1. Greenstick fracture
2. Simple fracture
3. Comminuted fracture
4. Compound fracture
95
Incomplete fracture, periosteum intact (typically in children) :
Greenstick fracture
96
Fracture in which the mucosa or skin or not violated:
Simple fracture
97
Fracture involving multiple fragments of bone which are independently dislocated:
Comminuted fracture
98
Fracture associated with bone exposure through tissue avulsions:
Compound fracture
99
List the 4 most common sites for mandibular fracture:
1. Condylar (29.1%)
2. Mandibular angle (24.5%)
3. Symphysis and Parasymphysis (22%)
4. Mandibular body (16%)
(1354)
100
Intraoral clinical examination of a mandibular fracture patient includes:
1. anesthesia of the lower lip
2. Abnormal mandibular movement
- unable to close
- trismus
3. lacerations, hematomas, ecchymosis
4. loose teeth
5. palpation for step defects
6. bleeding
101
Clinical examination of occlusion while evaluating mandibular fracture patient:
1. anterior open bite
2. posterior open bite
102
An anterior open bite with a mandibular fracture is suggestive of:
Bilateral Condylar Fractures
103
A posterior open bite with a mandibular fracture is suggestive of:
Anterior alveolar process or parasymphseal fracture
104
What is associated with open bite on the opposite side and deviation of chin towards the side of the fx during mouth opening?
Unilateral condylar neck fracture
105
Involves several stages of healing including:
- hematoma/inflamation
- Soft callus
- Hard callus
- Remodeling
Secondary bone healing
106
Method of bone healing that closely resembles endochondral ossification:
Secondary bone healing
107
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
108
Primary bone healing only works when:
the fracture edges are touching exactly
109
Primary bone healing only works for (2):
1. ORIF
2. green-stick fractures
110
What is the main objective of surgical treatment of a mandibular fracture?
Restoration of functional alignment of the bone fragments in anatomically precise position ultilizing the present teeth for guidance
111
What are the key principles of surgical treatment of the mandibular fracture?
1. normal occlusion
2. anatomical reduction of fragments in good position
3. Immobilization until bony union occurs
4. soft tissue repair
112
What muscles are involved with mandibular fracture?
1. Temporalis
2. Medial & Lateral pterygoid
3. Masseter
4. Digastric
113
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. obstructive sleep apnea
114
Corrective jaw surgery used to correct both jaw and facial deformities:
Orthographic surgery
115
Goals of orthognathic surgery:
1. normalize relationship of the jaws to each other and to the rest of the craniofacial complex
2. correct dental malocclusion
3. improve overall facial harmony
116
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
117
The main goal of orthognathic surgery is to restore:
form and function
118
Correction of dent-facial deformities using ______ _____ and _____ treatment can provide dramatic changes in both cosmetic and functional aspects of the face
COMBINED orthodontic and surgical treatment
119
With orthognathic surgery, the key to a successful outcome is correct diagnosis of both:
dental and skeletal abnormalites
120
_____ can often mask an underlying skeletal deformities
dental compensation
121
The MB cusp of the upper first permanent molar occludes in the buccal groove of the lower first percent molar
Class I
122
The MB cusp of the upper first permanent molar occludes ANTERIOR to the buccal groove of the lower first permanent molar:
Class II
123
The MB cusp of the upper first permanent molar occludes posterior to the buccal groove of the lower first permanent molar:
Class III
124
Mesial slope of upper canine coincides with the distal slope of the lower canine:
Class I
125
Distal slop of the upper canine coincided with mesial slope of the lower canine:
Class II
126
Le Fort 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 repositional maxilla
127
What hard tissue is cut in lefort 1?
maxilla only (maxilla moves)
128
Most commonly performed MANDIBULAR osteotomy:
Bilateral Sagital Split Osteotomy
129
The most commonly performed MAXILLARY osteotomy:
Lefort 1
130
Indications for a bilateral sagittal split osteotomy:
1. Mandibular advancement
2. Mandibular set-back
3. Mandibular rotation
131
Components of the nasal complex:
1. perpindicualr plate of the ethmoid
2. vomer
3. septal cartilage
4. maxilla
5. palatine bones
132
Bones forming the orbit:
1. Frontal
2. Zygomatic
3. Ethmoid
4. Lacrimal
5. Maxilla
6. Palatal
7. Sphenoid
133
Epidemiology of mid face fracture:
- Males to females 4:1
- 20s-30s
- MVA > Altercation > Fall
- Nasal > Zygoma
134
In altercations, the ____ is the most common fracture
left zygoma
135
Common clinical findings when examining a mid face fracture:
1. Facial asymmetry
2. Peri-orbital ecchymosis
3. Subchonjunctival hemorrhage and chemises
4. Widened intercanthal distance
5. Crepitation and step-deformity
6. Maxillary mobility and malocclusion
7. Battle's Sign
136
With a physical exam for a possible mid face fracture, what needs to be ruled out and what is this?
Battle's Sign; mastoid ecchymosis- skull base fracture)
137
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
138
Horizontal fracture through the maxilla above the level of the nasal floor and alveolar process:
Lefort 1
139
What bones are involved in Le fort 1 fracture?
1. Piriform rims
2. Anterior maxilla
3. Zygomatic Buttresses
4. Pterygoid plates
140
With Le Fort 1 fracture, we will commonly see disturbed:
Occlusion
141
What bone is in common for all le fort fractures?
Pterygoid plates
142
This Le Fort fracture is the most severe extending through the nasal bridge, medial orbital wall, and lateral orbital wall, resulting in the complete separation of the mid face from the base of the skull:
Le Fort 3
143
This Le Fort fracture involves the posterolateral maxillary sinus wall and extends through the inferior orbital rim and to the orbital floor:
Le Fort 2
144
What are the 3 types of NOE fractures?
1. Single, non-comminuted central fragment
2. Comminution of the central fragment
3. Severe central fragment communities with medial cantonal tendon avulsion
145
