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EDRA > 5.6 Head & Neck > Flashcards

5.6 Head & Neck Flashcards

1
Q

Facial nerve block is performed

to

aid to which eye block

Where is it blocked

A

attain akinesia of
orbicularis oculi along
with retrobulbar block
not needed with peribulbar block

proximally along its course
(causing lower facial hemiparesis
and
anaesthesia)

or

distally (preferable).

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2
Q

Various approaches of facial nerve block for ocular surgery

Approach Landmark Needle direction Side effects

Classic
Van Lint

A

Classic
Van Lint

Lateral orbital rim

Subcutaneously
superlaterally and
inferolaterally

Lid oedema and
periorbital
ecchymosis

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3
Q

Classic Atkinson

Various approaches of facial nerve block for ocular surgery

A

Classic Atkinson

Zygomatic arch

.Superiorly and posteriorly along zygoma

nil

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4
Q

Various approaches of facial nerve
block for ocular surgery

Modified Atkinson

A

Modified Atkinson

2 cm away from lateral orbital rim

Subcutaneously superlaterally and
inferolaterally

Less periorbital
ecchymosis

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5
Q

Various approaches of facial nerve
block for ocular surgery

O’Brien

A

O’Brien

Mandibular condyle

Injection over condyle and
then redirected inferiorly
along posterior edge of ramus

Total facial paralysis

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6
Q

Various approaches of facial nerve
block for ocular surgery

Nadbath– Rehman

A

Nadbath–Rehman

Stylomastoid foramen

Between mastoid process
and mandibular ramus,
directed toward top of the opposite ear

Total facial paralysis

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7
Q

Various approaches of facial nerve
block for ocular surgery

Nadbath– Rehman
other s/e

A

Nadbath–Rehman block may also result in paralysis of
glossopharyngeal, vagus and spinal accessory nerves, as they exit via jugular
foramen 1 cm medial to the stylomastoid foramen.

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8
Q

Scalp is supplied by the following nerves.

A

Cervical nerve (C2):

Trigeminal nerve:

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9
Q

Scalp is supplied by the following nerves.

Cervical nerve (C2):

A

Cervical nerve (C2):

greater occipital nerve (C2)
posteriorly up to the vertex

lesser occipital nerve (C2)
behind the ear.

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10
Q

Trigeminal nerve:

A

Trigeminal nerve:

ophthalmic division –
supratrochlear and supraorbital nerve

maxillary division:
zygomaticotemporal nerve

mandibular division:
auriculotemporal nerve

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11
Q

Blockade of nerves supplying the scalp

used for

A

Blockade of nerves supplying the scalp

(scalp block)

is used for awake craniotomy.

The landmarks for blocking these are
outlined in Table
5.26.

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12
Q

scalp block) nerves blocked x 7

A

1.
Greater occipital

2.
Greater and lesser occipital

3.
Lesser occipital

4.
Auriculotemporal

5.
Zygomaticotemporal

6.
Supraorbital

7.
Supratrochlear

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13
Q

Greater occipital

A

2–3 cm lateral to occipital protuberance

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14
Q

Greater and lesser

occipital

A

Along line joining occipital protuberance and mastoid process

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15
Q

Lesser occipital

A

Superficial cervical plexus block along posterior border of sternocleidomastoid,
on its middle third; or posterior to the auricle, above mastoid

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16
Q

Auriculotemporal

A

At the temporal fossa (in front of auricle)

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17
Q

Zygomaticotemporal

A

Against the zygomatic arch

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18
Q

Supraorbital

A

Above the supraorbital notch

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19
Q

Supratrochlear

A

Between the eyebrows (blocks both sides)

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20
Q

Scalp block using

A 
Scalp block using (image page 230/363 pdf)
0.5% bupivacaine has been 
shown to be successful in
blunting the haemodynamic 
response to head pinning.
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21
Q

Nerve supply of face is by

A

Nerve supply of face is by
trigeminal nerve
and C2 spinal nerve is
outlined in Table 5.27

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22
Q

Nerve supply of face - various portions

A

Ophthalmic division (V1) Forehead, nose, upper eyelid

Maxillary division (V2) Cheeks, lower eyelid, upper lip

Mandibular division (V3) Lower lip, chin, most of jaw

Cervical nerve (C2) Angle of jaw

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23
Q

What gives motor supply to face

A

facial nerve gives motor but

not sensory supply to face.

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24
Q

Largest CN

A

Largest CN Trigeminal

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25
Q

Longest CN

A

Longest CN Vagus

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26
Q

CN with longest intracranial course

A

CN with longest intracranial course Abducens

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27
Q

CN emerging from posterior surface of brainstem

A

CN emerging from posterior surface of brainstem Trochlear

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28
Q

Trigeminal nerve (CNV)

A 
Trigeminal nerve (CNV) is the 
largest cranial nerve.
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29
Q

Trigeminal nerve (CNV)

Supply

sensory or motor or both?

A 
It supplies 
sensory, 
proprioceptive 
and 
pain nerve fibres to the head
and face,

and the motor supply to the muscles of mastication.

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30
Q

Trigeminal nerve (CNV)

A

It emerges from the side of the pons,
near its upper border,

by a small motor and a large sensory root

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31
Q

CNV Passage

to where

what happens then

A

It passes laterally to join the
Gasserian (semilunar) ganglion
in Meckel’s cave.

The Gasserian ganglion gives three branches:

ophthalmic (V1),
maxillary (V2)
mandibular (V3).

32
Q

Which branches of CNV are sensory and motor

A

The ophthalmic and maxillary branches
comprise sensory fibres exclusively,

while the mandibular branch
carries motor fibres as well.

33
Q

Any parasympathetic suppy from CNV

A

Four small parasympathetic ganglia
are associated with the three
divisions of the trigeminal nerve:

1.
ciliary ganglion – ophthalmic nerve

2
sphenopalatine ganglion (pterygopalatine) – maxillary nerve
3.
otic &
4. 
submaxillary ganglia – 
mandibular nerve.
34
Q

Trigeminal nerve branches and foramen

cranium exit
assoc foramen

Ophthalmic nerve

A

Ophthalmic

Superior orbital fissure

Supraorbital notch
(supraorbital nerve)

35
Q

Trigeminal nerve branches and foramen

cranium exit
assoc foramen

Maxillary nerve

A

Maxillary nerve

Foramen rotundum

Inferior orbital fissure
Infraorbital foramen (infraorbital nerve)
36
Q

Trigeminal nerve branches and foramen

cranium exit
assoc foramen

Mandibular nerve

A

Mandibular nerve

Foramen ovale

Mental foramen (mental nerve)

37
Q

Ophthalmic nerve

Path

A

ophthalmic nerve
is the first and
smallest branch of the
trigeminal nerve.

It traverses along the
lateral wall of the
cavernous venous sinus

38
Q

Ophthalmic nerve

Skull exit
what happens then

A

and exits the skull

through the superior orbital fissure,

dividing into
three branches:

frontal,
lacrimal
and
nasociliary.

39
Q

Frontal nerve:

divides

A

branch of Ophthalmic nerve

Frontal nerve: (largest branch of the V1):

supraorbital nerve

supratrochlear nerve

40
Q

supraorbital nerve –

exit

supply

blocked @

A

Branch of Frontal nerve

exits skull through the supraorbital notch.

It supplies
upper lid and
the scalp up to the lambdoid suture.

It is blocked at the supraorbital notch
in the middle of the upper margin of orbit.

41
Q

supratrochlear nerve

emerges

supply

blocked @

A

Branch of Frontal nerve

Emerges from the
upper medial quadrant
of the orbit.

It supplies medial eyelid
and medial forehead.

A single injection in the
midline between the eyebrows
blocks this nerve from both sides.

42
Q

Lacrimal nerve:

passage

supply

A

branch of Frontal Nerve (branch itself of ophthalmic)

Lacrimal nerve:

passes in the lateral part of the
superior orbital fissure.

It supplies the lacrimal gland,
conjunctiva and upper lid.

43
Q

Nasociliary nerve:

passagee

A

Nasociliary nerve:

branch of Frontal Nerve (branch itself of ophthalmic)

passes in the central part of

the superior orbital fissure.

44
Q

Nasociliary nerve:

branches

A

Its branches include the

anterior ethmoid nerve, 
posterior ethmoid nerve, 
internal nasal branch, 
external nasal branches 
and two to three long ciliary nerves.
45
Q

Nasociliary nerve: branches blocked where?

A

The nasal branches are blocked by placing

nasal pellets soaked with local anaesthetic.

46
Q

Can all of V1 be blocked??

A

only the extracranial part of V1 can be blocked.

47
Q

The maxillary nerve (V2)

type

A

The maxillary nerve (V2)

is a purely sensory nerve.

48
Q

The maxillary nerve (V2)

passage

exits skull

fossa

orbit entry

A

passes at the
lateral wall of the cavernous sinus,

leaves the skull through the
foramen rotundum,

then crosses the pterygopalatine fossa
and enters the

orbit through the inferior orbital fissure

49
Q

The maxillary nerve (V2)

face appears…

A

It traverses the infraorbital groove
and canal in the floor of the orbit,

and appears upon the

face at the infraorbital foramen
as the infraorbital nerve.

50
Q

The maxillary nerve

Its main branches are as follows.

A

Zygomatic:

Sphenopalatine

Posterior alveolar nerve

51
Q

Zygomatic

A

zygomaticofacial (cheek)
and
zygomaticotemporal (temple).

The latter is blocked at the zygomatic arch
for scalp block.

52
Q

Sphenopalatine

branches to

whats blocked for palatal surgery

A

supplies nerves to the

orbit, 
nasal branches,
nasopalatine nerve, 
greater palatine nerve, 
lesser palatine nerve 
and
pharyngeal branches.

The nasopalatine and greater palatine branches
are blocked for palatal surgery.

53
Q

Posterior alveolar nerve

A

Posterior alveolar nerve:

supplies posterior upper alveolus.

It is blocked for molar tooth extraction.

54
Q

Cleft palate surgery

A

Infraorbital block can be used for analgesia in cleft palate surgery

55
Q

Infraorbital nerve

is a branch of

exits through

A

Infraorbital nerve is the

terminal branch of maxillary nerve

and exits
through the infraorbital foramen.

56
Q

Infraorbital nerve

A

It divides into
inferior palpebral,
lateral nasal and
superior labial branches.

It is blocked at the infraorbital foramen
(intramucosal or extramucosal approach)
for cleft lip surgery

(analgesia to upper lip)

and upper-incisor dental surgery.

57
Q

The mandibular nerve (V3)

type

A

The mandibular nerve (V3)

is the largest branch of the trigeminal nerve.

It is made up of a large sensory root
and a small motor root
(supplies the muscles of mastication).

58
Q

The mandibular nerve (V3)

exit

Main trunk division

A

They exit through the foramen ovale
and unite to form the main trunk of V3.

The main trunk gives two branches
before it divides into

anterior and posterior divisions,
which give more branches again.

59
Q

The mandibular nerve (V3)

Of interest are its three branches of posterior division

A

Auriculotemporal nerve:

Lingual nerve:

Inferior alveolar nerve:

60
Q

Auriculotemporal nerve:

path

innervates

blocked @

A 
ascends upwards behind the
temporomandibular joint (TMJ)

innervating the auricle,
external auditory meatus,
tympanic membrane
and TMJ.

It is blocked at
temporal fossa for scalp block.

61
Q

Lingual nerve:

A

supplies sensory innervation to
the anterior two-thirds of the tongue,
floor of mouth
and gingival mucosa.

62
Q

Inferior alveolar nerve:

A

traverses the mandibular canal to
emerge as the mental nerve
at the mental foramen.

It supplies the chin and lower lip.

63
Q

Blockade of terminal branches of trigeminal nerve

nerve

where

A

Supraorbital

Supratrochlear

Infraorbital nerve

Mental nerve Mental foramen
FIGURE

64
Q

Supraorbital

A

Supraorbital

Supraorbital notch

65
Q

Supratrochlear

A

Supratrochlear

Just above the medial end of eyebrows or between eyebrows to block bilaterally

66
Q

Infraorbital nerve

A

Infraorbital nerve

Infraorbital foramen

67
Q

Mental nerve

A

Mental nerve Mental foramen

68
Q

terminal branches of the trigeminal nerve (CNV)

can be blocked in a vertical line except

A

Supratrochlear nerve

69
Q

maxillary nerve can be blocked

where

A

after it exits the foramen rotundum.

For this, a lateral approach
through the infratemporal fossa

70
Q

maxillary nerve block

describe

A

An 8-cm 22-G needle is
passed below the midpoint of zygomatic arch,
overlying the coronoid notch of mandible.

As it is advanced deeper, it
contacts the lateral pterygoid plate
at a depth of 5 cm.

It is then redirected
anteriorly to walk off the edge of the lateral pterygoid plate, to enter the
pterygopalatine fossa.

Paraesthesias/radiological confirmation can be used
to access placement. Local anaesthetic (5 mL) is injected here.

71
Q

Indications for the maxillary block

A

Indications for the maxillary block:

1.
surgery – 
lower eyelid, 
the nose (with the nasal nerve), 
the cheek, the
zygomatic area, 
the upper lip, 
superior dental surgery, 
palate and
maxillary bone surgery

2.
trigeminal neuralgias

3.
refractory headaches (sphenopalatine ganglion origin).
72
Q

maxillary block

quirky side effect

does this change approach for other blocks
how are they done

A

Spread of local anaesthetic here may
cause transient blindness.

For the same reason,

neurolytic blocks are avoided
through this approach; rather,
they are performed at the Gasserian ganglion.

73
Q

The mandibular nerve can be blocked where

what approach

A

The mandibular nerve can be blocked
after it exits the foramen ovale.

For this, a lateral approach through the infratemporal fossa is used

74
Q

The mandibular nerve block

describe (detail)

process

endpoint

A

An 8-cm 22-G needle is
passed below the
midpoint of zygomatic arch,
overlying the coronoid notch of mandible.

As it is advanced deeper, it
contacts the lateral pterygoid
plate at a depth of 5 cm.

It is then redirected
posteriorly to walk off 
the edge of the lateral pterygoid 
plate to stimulate V3
near the foramen ovale.

Paraesthesias, motor stimulation or radiological
confirmation can be used to access placement.

Local anaesthetic (5 mL) is
injected here.
75
Q

Indications for the mandibular block:

A

Indications for the mandibular block:

1.
surgery –
lower lip, mandible, temple surgery, inferior dental surgery
and wound of the anterior two thirds of the tongue

2
pain syndromes

3
TMJ pain.

76
Q

Risk with mandibular block

side effects

best performed @

A

Deeper placement of the needle can
result in piercing the pharynx.

Neurolytic blocks can affect the
otic ganglion, resulting in xerostomia.

They are best performed at the Gasserian ganglion

EDRA (26 decks)

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