11. Eyes and 12. Embryo clinical Flashcards
Describe cleft lips and cleft palates
Form from defects in fusion of either the palatine processes or the maxillary processes to form the palate and the upper lip respectively
Which type of cleft lip/palate is most common and on which side?
Unilateral Left sided cleft lip is the most common
Describe choanal atresia
bony abnormalities of the pterygoid that causes an upper airway obstruction that gets worse with feeding and better with crying Basically the bone blocks the airway and causes issues
What is glossoschissis?
Bifid tongue
What is Ankyloglossia?
Short frenulum, can present with problems breastfeeding and speaking
Define macroglossia
Enlarged tongue; common with Down Syndrome and Beckwith-Wiedemann
Describe an orbital blowout fracture
Caused by indirect trauma; occurs medially and inferiorly in the maxillary bone The fracture is severe enough that a part of the orbital contents may go through the fractured area and protrude into the maxillary sinus
What are the sx of an orbital blowout fracture?
Diplopia, globe ptosis (eye sinking) and protrusion of the eyeball When the patient is asked to look up, they are not able to, and the eyeball is fixed
What is pictured?
Inferior floor fracture of the right orbit that is consistent with a blowout fracture. You can see the orbital contents going down into the maxillary area
What would be consistent with these clinical findings? Bruising, eye sinking, and inability to raise the eye on the affected side?
Orbital blowout fracture
Describe how you would clinically test the function of the superior rectus.
- You want to test elevation only of a rectus muscle, which means in order to do so, you need to abduct the eye via the lateral rectus muscle. (Have the patient abduct their eye)
- Since the superior rectus tests elevation, you can have the patient elevate their eye from this position, as the inferior oblique muscle, the other elevator of the eye is perpendicular to the gaze axis and is trapped in its function
- If the patient is able to elevate their eye then you know that the superior rectus muscle is intact and there is no issue with it or the oculomotor nerve that innervates it
When you are testing the superior rectus muscle with the inferior oblique trapped, what portion of the oculomotor nerve are you testing?
The superior division of the oculomotor nerve is being tested; if they can elevate their eye, then you know that there is not any damage in the upper division of the nerve
How do you clinically test the functionality of the inferior oblique muscle?
- In order to make sure that the oblique muscles are the only ones that are in charge of elevation, the patient must adduct their eye (look medially)
- With the eye adducted, have the patient elevate their eye.
- If they are able to do so, then you know that the oculomotor nerve is intact to that area of the eye
How would you test the functionality of the inferior rectus muscle?
- In order to tell if a rectus muscle is working, you need to have the eye abducted (looking laterally); have the patient look laterally
- In order to test for depression (which is a movement of the inferior rectus), have the patient look down since the superior oblique is now trapped as it is perpendicular to the visual gaze
- If they can, then you know that there is no damage to the muscle, which also means that the inferior divsion of the oculomotor nerve is intact
How would you test the functionality of the superior oblique muscle?
- In order to make sure that the oblique muscles are the only ones being tested, the patient must adduct their eye via the medial rectus (look inwards); so have them do that
- The only muscle that is now able to depress the eyeball would be the superior oblique muscle; so you have the patient look down
When testing the superior oblique from the inferior rectus, describe what is also being tested in regards to the nerves.
This test is discriminating the functionality of the trochlear nerve (which innervates the superior oblique) from the oculomotor nerve (which innervates the inferior rectus and the medial rectus (adduction to trap the inferior rectus)
***so if your patient is able to adequately perform this test, then you know that the oculmotor nerve and the trochlear nerve are intact (at least the portions that innervate the eye muscles)
What are the actions of the inferior oblique muscle?
Elevation, Abduction, Lateral rotation
What are the actions of the superior oblique muscle?
Depression, abduction, and Lateral rotation
What are the actions of the superior rectus muscle?
Elevation, ADduction, Medial rotation
What are the actions of the inferior rectus muscle?
Depresses, Adducts, and laterally rotates the eyeball laterally
Describe trochlear palsy
There is an issue with the superior oblique musle, so the patient is not able to medially rotate the eye as strongly…
- Laterally rotated eye which results in a head tilt away from the affected side to try to get the eye in the appropriate position that the body wants
- With depression of the of the eyeball, there will be increased diplopia because the superior oblique is not there to fully depress the affected eye
Describe abducens palsy
The patient cannot look laterally with the affected eye
What nerve is damaged if a patient has an eye that is looking down and out?
There is not ocular innervation to the LPS, IO, SR, IR, and MR but the SO and the LR are intact.
The SO and the LR are abductors, so the eye will look out and the SO is a depressor, so the eye will be looking down
What nerve would you suspect is affected with complete ptosis of the eye?
Oculomotor because the LPS is not working adequately
