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D3 Oral Surgery Ex4 > Trigeminal Nerve Injury (Lui) > Flashcards

Trigeminal Nerve Injury (Lui) Flashcards

(85 cards)

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1
Q

What are initial questions to ask if patient present complaining of neuropathy?

A
  1. When was the procedure
  2. When did symptoms start
  3. Are symptoms the same, improving, getting worse
  4. Are you in pain?
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2
Q

What is the layman’s term for distorted sensation?

A

Numbness

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3
Q

What are 3 primary things that could cause a patient to seek treatment in a nerve injury?

A
  1. Distorted sensation
  2. Impaired function
  3. Pain (dysethesia)
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4
Q

Which nerves has a LOWER rate of spontaneous regeneration: those in soft tissue or those in bony canal?

A

Soft Tissue

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5
Q

Which nerve has better chance of spontaneous recovery: lingual or IAN and why?

A

IAN, inside a bony canal

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6
Q

What provides the best opportunity for sensory recover if an observed or known injury occurs?

A

Prompt microsurgery

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7
Q

Full recovery in 1 month indicates what?

A

Neurapraxia (bruised nerve)

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8
Q

Is recovery anticipated if neurosensory dysfunction lasts for >1 month and what does that indicate?

A

It indicates a higher grade injury with uncertain spontaneous recovery

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9
Q

If have a patient has nerve injury symptoms for more than 1 month, what diagnosis should you consider?

A

Microsurgical consult

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10
Q

Most injuries resolve in ____ months, but only if improvement begins before ___ months?

A

3-9 months 3 months

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11
Q

What is prognosis for patient that is anesthetic at 3 months?

A

Poor

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12
Q

Will surgery improve function and objective testing or will it reduce pt’s pain and their subjective feeling of numbness?

A

Improve function and objective results only

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13
Q

Numbness is subjective or objective feeling?

A

Subjective

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14
Q

What is the only objective way to know the extent and what the nerve problem is?

A

Quantitative Sensory Testing (QST)

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15
Q

Myelination increases what?

A

Conduction velocity

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16
Q

Do nerves have blood vessels?

A

Yes

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17
Q

What are 3 types of neural fascicular patterns?

A
  1. Monofascicular
  2. Oligofascicular
  3. Polyfascicular
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18
Q

Which fascicular pattern is severly damaged easier?

A

Monofascicular

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19
Q

What is the big picture with the QST with respect to conduction velocities?

A

Different fibers have different velocities

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20
Q

The pseudo unipolar neurons of CN V region in which ganglion and head where?

A

Trigeminal ganglia and go to the trigeminal nucleus

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21
Q

What tract does the trigeminal nerve impulse travel to get to the primary somatosensory cortex?

A

Trigeminothalamic

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22
Q

What are 7 common causes of nerve injury?

A
  1. Local anesthesia
  2. Implant placement
  3. Endodontic therapy
  4. Mucoperiosteal flap
  5. Chemical
  6. Infection (Vincent’s syndrome)
  7. Third molar surgery
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23
Q

What are 7 chemicals that can cause neurotrauma?

A
  1. Tetracycline power
  2. Surgical
  3. Canoy’s solution
  4. Eugenol
  5. Intracanal endodontic medicaments
  6. Calcium hydroxide
  7. Local anesthetics
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24
Q

What should you do if you know that an implant has approximated the IAN?

A

Remove and replace immediately

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25
What degree is a nerve injury that reaches to the endoneurium?
1st degree
26
What degree is the nerve injury that goes through the endoneurium?
2nd degree
27
What degree is a nerve injury going to the perineurium?
3rd degree
28
What degree is a nerve injury through the perineruium?
4th degree
29
What degree is a nerve injury through the epineurium?
5th degree
30
What can form at the end of a nerve injury and prevent healing or transmission?
Neuroma (Wallerian degeneration)
31
What is the difference between Sunderland and Seddon nerve injury classifications?
Sunderland is 5 degrees, Sneddon is 3
32
Seddon Neurapraxia is what degree in Sunderland?
1st degree
33
Seddon Axontomesis is what degree in Sunderland?
2nd degree
34
Seddon Neurotomesis is what degree in Sunderland?
5th degree
35
Neurapraxia (Seddon) / Sunderland 1st degree takes how long to heal?
4 weeks
36
Axonotomesis (Seddon) / Sunderland 2nd Degree takes how long to heal?
Recovery in 1-3 months
37
Neurotomesis (Seddon) / Sunderland 5th degree is what type of disruption?
Complete transaction
38
What is the proximal axon tying to do to heal the distal nerve that is severed from it?
Increase metabolism to grow axons out and recanniculate with distal nerve
39
Which respond better to healing, myelinated or unmyelinated?
Myelinated
40
What are 4 neuroma formations?
1. Amputation neuroma 2. Neuroma in continuity 3. Lateral exophytic neuroma 4. Lateral adhesive neuroma
41
Why is operator unable to draw a straight line when marking cutaneous feelings of a QST?
Due to recruitment / collateralization of other nerves
42
What are 3 theories of local anesthetic nerve injury?
1. Needle to nerve 2. Hematoma, inside nerve 3. Neurotoxicity
43
Did a cadaver study show that a needle would pierce fascicles to cause direct trauma?
No, showed it passed between fascicles
44
Of the 3 local anesthesia theories, what is the one that does not require direct contact of the needle with the nerve?
Neurotoxicity
45
What is the fascicular pattern of the lingual and IANs near the lingula?
Lingual, monofascicular | IAN, multifascicular
46
What are the percentages of lingual and IAN nerve damages when hit?
Lingual 70% | IAN 30%
47
What are 3 levels of the QST?
1. Directional discrimination (moving stimulus and 2 point) 2. Contact detection 3. Pain (noxious stimulant)
48
What is the term for pain to normal touch?
Allydonia
49
Level A brush stroke measures what fiber responses?
A-alpha | A-beta
50
Level A 2 point detection tests what fiber response?
A-beta
51
Level B von Frey (contact) detection tests what fiber response?
A-gamma
52
Level C noxious pinch test what fiber response?
A-delta, C
53
What is the term for elicitation of electric shock like paresthesisas and distal radiating pain in response to tapping or compressing an injured nerve trunk hot spot or demyelinated zone?
Tinel's sign
54
Tinel's sign usually indicated what formation?
Neuroma formation, Wallerian degeneration
55
What type of response is Tinel's sign to stimulus?
Hyperpathia
56
What uses imagery to visualize and compare stimulation of the normal and affected sides for behavioral?
Sensory re-education stimulation
57
What are 2 pharmalogical treatments for trigeminal nerve injury?
1. Anticonvulsant (gabapentin) | 2. Antidepressant and anxiolytic
58
What is a compound prescription for trigeminal nerve injury?
``` CGKL Clondine 0.2 Gabapentin 8 Ketamine 10 Lidocaine 5% ```
59
The lingual nerve is best treated in what time frame?
1-3 months
60
IAN is best treated in what time frame?
3-6 months
61
What should a patient be told prior to nerve repair?
May not restore to pre-injury function. If lingual, do not expect return of taste sensation.
62
Is surgery indicated if a patient's symptoms are improving?
No
63
Why might delayed repair be indicated after BSSO?
Amount of inflammation and increased vascularity will make a difficult surgical field
64
If placing an implant and you make direct contact with the IAN, what should you do?
Reposition immediately to 2mm separation from canal. If the implant is not stable, remove.
65
What has better results: end to end anastamosis or nerve grafting?
End to end anastomosis
66
What is the term for removal of surrounding bony, soft tissue structure and / or foreign material around the nerve?
External decompression
67
Where is the opening of the epineurium to inspect and decompress the nerve fascicles?
Internal neurolysis
68
What is the term for the removal of neuroma associate with a nerve?
Excision of neuroma
69
What is the term for microsurgical anastamosis of a transected nerve?
Neururrhaphy
70
What is the placement of a nerve graft (allogenic or autogenous) for nerve reconstruction?
nerve graft
71
What is the microsurgical anastamosis of a distal nerve to a different proximal nerve via an interposed nerve graft? (what does this even mean?)
Nerve sharing
72
What is the term for the placement of a conduit to guide axonal sprouting and regeneration across a nerve gap from proximal to distal portions of a nerve?
Guided nerve regeneration
73
What is the term for the microsurgical transaction and removal of a segment of a peripheral nerve?
Neurectomy
74
What is the term for covering of the proximal stump of a transected nerve with its epineurium to prevent neuroma formation?
Nerve capping
75
What is the term for redirection of a nerve’s sensory innervations to a different anatomic location (usually adjacent muscle), usually done to prevent or minimize deafferentation?
Nerve redirection
76
OMFS uses what nerve graft materials?
Bovine, don't risk donor site complications
77
What is the pain response called if the patient has pain in level A of QST with a brushstroke?
Allydonia
78
What is the pain response called if pt has pain in level B of QST with repetitive stimulus evoked pain?
Hyperpathia
79
What is the pain response called if pt has pain in Level C of QST with noxious mechanical stimulus?
Hyperalgesia
80
What is the key to everything done when evaluating and planning for Nerve injury and therapy?
Document
81
Which heal better: trigeminal nerve injuries involving distal segments or those involving proximal segments?
Distal
82
Does spontaneous sensory recovery occur in all patients?
No. Only most patients.
83
What are three important aspects of early recovery prediction?
1. It is difficult 2. It may not be complete 3. It may not be to the patient's satisfaction
84
When should a referral for nerve injury care be considered?
1. Based on individual patient needs 2. Criteria and indications for surgery are met (usually within 3 months of injury) 3. Patient acceptance of surgery 4. Outcome expectations need to be realistic
85
What percentage of patients with a permanent nerve injury reported that it felt like a perfectly normal injection?
40

D3 Oral Surgery Ex4 (5 decks)

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