Anatomy Of Oral Cavity And Face Flashcards
1
Q
What does the parotid gland secrete?
A
-serous saliva, more watery
2
Q
What do the sublingual glands secrete
A
Mucous saliva, more viscous
3
Q
What do submandibular/maxillary glands secrete?
A
A mixture of serous and mucous saliva
4
Q
What is the frankfort plane and when is this important for radiographs?
A
the horizontal line from the lower margin of the orbit and the upper notch of the tragus of the ear (hole). Important for lining up the horizontal line in OPTs
5
Q
what is Kennedy class 1 tooth loss
A
Bilateral edentulous areas located posterior to natural teeth. Most common
6
Q
what is Kennedy class II tooth loss
A
A unilateral edentulous area located posterior to natural teeth
7
Q
what is Kennedy class III tooth loss
A
A unilateral edentulous area with natural teeth remaining both anterior and posterior to it
8
Q
what is Kennedy class IV tooth loss
A
A single, but bilateral (crossing the midline), edentulous areas located anterior to the remaining natural teeth
9
Q
what is a modification in the Kennedy tooth loss classification (for types 1-3)
A
an extra space of tooth loss e.g. if a patient had Kennedy class II modification II; they would have UL 3-1 and UR1-3 and UR5-7
10
Q
why are palatine injections painful
A
mucosa is tightly bound to the bone so when the fluid is injected into the tissues there is very little space for it to move into, causing a build up of a pressure and pain to the mechanoreceptors
11
Q
why must we be very careful aspirating when doing a maxillary regional block.
A
In the area of pterygoid plexus with high vascularity so ensure we aspirate or adrenaline enters the blood system
12
Q
why should haemophiliacs be very careful with maxillary blocks?
A
pterygoid plexus full of blood vessels that may haemorrhage and cause excessive bleeding
13
Q
why can we not provide mandibular infiltrations?
A
very thick cortical bone with less vasculature than maxilla
14
Q
which nerve and artery pass through the parotid gland
A
facial nerve CNVII
external carotid branch of facial nerve
15
Q
What are the three branches of the trigeminal nerve
A
opthalmic, maxillary and mandibular
16
Q
What are the branches and route of the maxillary V2 and what do they innervate?
A
- posterior superior alveolar nerve branches before entering the infraorbital canal innervates posterior superior teeth
- (in 50% of people there is a middle superior alveolar nerve innervates the middle superior teeth - branches within the infraorbital canal)
- The nerve exits the infra orbital canal s the anterior superior alveolar nerve to innervate the anterior superior teeth
17
Q
What does the lesser palatine nerve inntervate and where does it exit the cranium
A
uvula, soft palate and tonsils
lesser palatine foramen
18
Q
how is the hard palate and nasal septum innervated
A
- V2
- majority innervated by anterior greater palatine nerve from greater palatine foramen
- nasopalatine nerve innervates the most anterior palate through sphenonasal foramen
19
Q
why are palatine injections painful
A
Mucosa is bound very tightly to the underlying bone so very little tissue for anaesthetic to diffuse into, building up pressure and activating pain receptors
20
Q
what nerve passes distal to the third mandibular molar
A
lingual nerve branch of alveolar nerve
21
Q
what joins the lingual nerve to innervate the anterior tongue motor
A
chorda tympani of CNVII facial nerve
22
Q
what does the lingual nerve innervate
A
Lingual gingiva of all mandibular teeth
Mucous membrane of the tongue anterior to the circumvallate papillae (anterior ⅔)
floor of mouth
23
Q
what does the mental nerve innervate
A
buccal mucosa and gingiva anteriorly and chin
24
Q
what branch of the CNV innervates sensory information of the anterior mandibular teeth
A
incisive branch of IAN
25
what does the inferior alveolar nerve branch into
mental nerve
| incisive nerve
26
what artery follows the inferior alveolar nerve
inferior dental artery of maxillary artery
27
what makes the 2 sides of the triangle of which we aim to the centre for an IAN block
anterior ramus of mandible
| pterygomandibular raphe
28
how do we change the angle of injection for a child's IAN block and why
aim down and more lateral as their alveolar foramen is lower and mandible's more flared
29
how do we deal with a flared mandible during IAN block
swing syringe laterally to try hit get closer to bone near the mandibular foramen
use indirect IAN block
30
differentiate direct and indirect IAN block and reason for
direct: normal route of injection from across contralateral premolars
indirect: used for flared mandibles
- hit bone, swing syringe medially and advance further before swinging laterally and advancing further
31
if we can not achieve numbness doing an IAN blcok what do we do
aim much higher towards the mandibular condyle to anaesthetise higher up the nerve
32
why do we not do bilateral IAN blocks
complete numbness of tongue and lips is very uncomfortable for patient
33
what is anaesthetised with an infraorbital nerve block
teeth and buccal gingiva of upper 1-5 and mesiobuccal cusp of 6
34
what does the nasopalatine nerve innervate
palate from 1-3 either side and nasal septum
35
what does the greater palatine nerve innervate
hard palate from 4-8s
36
if a patient has a middle superior alveolar nerve, what does it supply?
upper 4,5 and mesiobuccally cusp of 6
37
what is the aim of a mental block
for anaesthetic to diffuse back along the nerve to supress action potentials in the incisve and mental nerve, anaesthetising the lower anterior 4, 3,2,1
38
what nerve provides sensory innervation of the pharynx
mostly glossopharyngeal nerve CNIX
| anterior nasopharynx innervated by pharyngeal branch of V2
39
what provides motor innervation to the pahrynx
vagus nerve CNX
| apart from stylopharyngeus innervated by glossopharyngeal
40
what does the infra-oribtal nerve innervate
lower eyelid, the side of the nose, and the upper lip (buccal mucosa of upper 1-5)
41
what is the pathway of the CNV2
maxillary branch of trigeminal
zygomatic branch comes off before entering canal
enters the infra-orbital canal
within canal branches superior posterior, middle superior and anterior superior alveolar nerves branch off to innervate teeth
exits infraorbital canal becoming infraorbital nerve
innervates buccal mucosa, lower eyelid and upper lip
42
how does an infraorbital nerve block work
```
anaesthetic diffuses into the infraorbital canal
affecting anterior (and middle) superior alveolar nerve and infraorbital nerve
numbs upper 1-5 and mesiobuccally cusp of 6 and lips, lower eyelid and buccal mucosa of 1-5
```
43
where is there overlap between soft tissue innervation in the oral cavity
between 5-6 long buccal and mental nerve
| across any midline tongue/gingiva/lips
44
what is the pterygomandibular space bound by and why is this important
```
medially by medial pterygoid
anteriorly by buccinator
laterally by ramus of mandible
superiorly by lateral pterygoid
where we find mandibular foramen for IAN block
```
45
where does the lingual nerve run in relation to the IAN
anterior and medially
46
what muscle does the pterygomandibular raphe come from
superior constrictor muscle
47
why is the lingua of important and what attachments occur here
is just above the mandibular foramen
| site of attachment for sphenomandibular ligament
48
what muscle attaches to the roughened mesial angle of the mandible
medial pterygoid
49
what muscle attachment is formed on the anterior aspect of the mandibular condyle
lateral pterygoid
50
what is and where do we find the temporal crest
anterior of the ramus of the mandible
| splits the external and internal oblique ridge
51
roughly how far above the occlusal plane o we find the mandibular foramen
1cm
52
what is the internal part of the angle of the mandible
coranoid notch
53
what is the lining material of the MAS called
schneiderian membrane
54
what is pneumatization
movement of air sinus epithelium into a space e.g. when a maxillary molar is removed and the MAS moves into its root space
55
what is trismus and what can cause it
reduced mobility of the mouth
LA into muscles of mastication
haemorrhage build up against nerve after XLA
oropharyngeal cancer enters masseter
56
what and where is the lingual foramen
small midline opening on the posterior aspect of the symphysis of the mandible, just above the mental spine below central incisors
Passage of lingual artery, nerve and vein
57
how and where does the parotid duct secrete its products into the mouth
stensons duct
| buccal mucosa of upper 7s
58
what are the 2 small indentations at the margin of hard and soft palate and why are they important for prosthesis
fovea palatini
| upper denture should extend 1-2mm in front of this
59
what is the hamular notch
junction between most posteiro part of maxilla and the hamular process of sphenoid bone
60
what is the tissue between lip and gingiva called
gingival frenae
61
what are the incisive papillae
2 small mucosal prominences on the hard palate just posterior to the incisors
62
what is the average distance between the distal border of the incisive papilla and the labial surface of incisors?
12mm
63
what is the retromolar pad
mass of soft tissue located at the posterior end of the mandibular alveolar ridge
64
what's another name for the mylohyoid ridge
internal oblique ridge
65
what mucosa lie in the mouth above the ramus of mandible
internal and external oblique ridge
66
what is the lingual gingival remnant LGR
remnant line on newly edentulous patients where teeth used to be
67
what is the lingual frenum
mucosa attaching tongue to floor of mouth/lower ridge
68
where are the two bony projections at the lingual surface of the midline mandible and what are their attachments
genial tubercles that attach to geniohyoid inferiorly & genioglossus superiorly
69
explain the strength of the cortical plates of the mandible
anteriorly the labial plate is weaker (lingual stronger)
| posteriorly the buccal plate is stronger and lingual is weaker
70
in a edentulous patient, how will the lower residual ridge change shape
will resorb over time becoming lower (sulci shallower)
anteriorly the labial cortical plate resorbs more
posteriorly the buccal cortical plate is stronger and lingually weaker
resorbs labially anteriorly and lingually posteriorly
residual ridge becomes wider at the back and shorter at front
71
how does the maxillary arch resorb
slower than mandible
all maxilla has weaker buccal/labial plate so resorbs here
leaving a more palatal, smaller residual ridge
72
what helps reduce resorption after XLA
implant retained tooth
retained roots
little evidence showing dentures reduce resorption
73
what increases risk of bone resorption
lack of teeth XLA
| systemic disease e.g. osteoperosis
74
where is the buccal shelf located
the widening bone buccal to lower 7/8
75
what is the interpapillary line
horizontal line parralell to the line made in-between the two pupils of our eyes
76
what is the alatragar line
line between the inferior border of alar of nose and upper border tragus of ear
77
what is the alar
side of nose
78
what is the tragus
small point of cartilage protruding backwards covering the entrance to the ear
79
what is foxes plane
parallel to the alatragar line
| line at which the upper maxillary teeth follow posteriorly
80
What are some features of the ideal occlusion
```
ICP = RCP
Canine lateral guidence
Anterior guidence
Forces down long axis of tooth
Mutual protection
```
81
What is mutual protection
Anterior teeth protect posterior teeth whilst in eccentric positions (protrusion and lateral excursions)
Posterior teeth protect anterior teeth during mastication and intercuspation
82
what muscle is the labial sulcus determined by
obicularis oris
83
what is the buccal sulcus determined by
masseter posterior
| buccinator anterior
84
what is the average mandible angle and how do we find this
~30 dgerees
| difference in angle between CR and protruded jaw
85
what is bonwills triangle
equilateral triangle from tips of mandibular condyle and tips of lower incisors
86
what is balanced occlusion
refers to posterior contact points being balanced in ICP when in CR
87
what is balanced articulation
balanced contact points when in eccentric positions
88
what is an eccentric position
relation of mandible to maxilla when the jaws are not in centric relation
89
what is the mandibular symphysis
inferior point of the mandible at midline
90
what is the MMPA on a ceph and how do we find it and what should it be
mandibular maxillary plane angle
find intersection between ANS-PNS line and lower border of mandible
27 degrees
91
what should the angle between maxillary plane and upper incisors be (on a ceph)
109 degrees +/- 2 degrees
92
what should the mandibular plane form with the lower incisors
92 degrees +/- 2
93
what 3 types of mucosa are found in the mouth and where
masticatory mucosa covers the gingiva and hard palate - keratinized stratified squamous epithelium tightly bound to underlying bone
lining mucosa covers lips, sucli, cheeks - non-keratinized stratified sqaumous pithelium with high adiose tissue loosely bound to underlying bone
special mucosa covers upper surfae of tongue with squamous tratified non-keratinized with papillae
94
what type of epithelium lines the nose
ciliated pseudostratified columnar cells
95
what is the name for the phenomenon that occurs posteriorly in protrusion
Christensen’s phenomenon.
| disocclusion of posterior teeth
96
give 4 reasons why the canines are ideal for lateral excursion guidance
Morphology – very strong tooth with long roots
Favourable crown:root ratio
Distant from the hinge of the mandible
Distant from the powerful muscles of mastication
97
why are anterior teeth ideal for protrusive excursion
furthest away from masseter so less force
| furthest away from hinge so less force due to moments
98
why is it ideal to have RCP = ICP
condyles and muscles are working in their most physiologically stable position whilst the teeth are occluding which spreads load across most teeth rather than single or small groups of teeth
99
why is a cusp-fossa relationship important
increase longevity and long term stability as it
| prevents horizontal forces on the tooth and its root
100
what checks must we make when placing a restoraiton
BEFORE AND AFTER
restoration not too high
Contact in ICP
Maintaining contacts on all other teeth - we are not changing the occlusal schemes.
Fitting our restoration with the existing scheme.
Contact in protrusion or laterotrusion? In most cases no, unless the tooth we are restoring previously had these contacts
Skeletal/Incisor/Angle classifications
Signs of occlusion issues? Wear facets, craze or fracture lines, fremitus.
Occlusal vertical dimension – can often be decreased due to tooth wear
101
what is prognathsim
positional relationship of the mandible or maxilla to the skeletal base where either of the jaws protrudes beyond a predetermined imaginary line in the coronal plane of the skull
102
what innervates trapezius and sternocleidomastoid
accessory nerve XI
103
what does the facial nerve supply
motor innervation to facial msucle expressions
| sensory taste receptors of anteiror 2/3 via chorda tympani
104
what involvement does the vagus nerve have with the oral cavity
motor to pharynx and larynx
| sensory to larynx
105
which muscles innervates muscles of the tongue
hyoglossus XII
106
what are the functions of glossopharyngeal nerve
sensory to pharynx
gag reflex
taste posterior 1/3 tongue
swallowing
107
what are the functions of CNV
trigeminal
sensory to facial tissue
motor to muscles of mastication - lead to trismus
108
how is the tongue innervated
glossopharyngeal IX - posterior 1/3 taste of tongue
hypoglossus XII - motor control of muscles of tongue
facial nerve VII- anterior 2/3 taste of tongue
trigeminal nerve V- senosry to tongue
109
what forms the TMJ
mandibular condylar head
fitting into the glenoid fossa of the sphenoid bone
with anterior articular eminence of the sphenoid bone
110
explain the drainage of the lymphatics of the teeth
maxillary and posterior mandibular teeth drain to submandibular
lower incisors drain to submental
111
where does the ear's lymphatics drain to
mastoid lymph node
112
what anatomy is important for ID blocks
pterygomandibular raphe of superior constrictor muscle
Coronoid notch deepest concavity of the mandible
occlusal plane 1cm above
