BDS2 Anatomy (Trigeminal Nerve, etc) Flashcards
what are the 2 divisions of the trigeminal nerve?
sensory
motor
why is the sensory route of the trigeminal nerve important
aiming for with LA
supples the skin of face; nasal and sinus mucosa and teeth
what does the motor route of the trigeminal nerve supply
muscles of mastication and 4 other muscles
aware of so know side effects
trigeminal nerve is CN
V
special feature of trigeminal nerve
largest CN nerve
3 divisions of trigeminal nerve
Ophthalmic V1
Maxillary V2
Mandibular V3
what branches of the CNV are targeted in local anaesthesia
CNV2 and 3 (maxillary and mandibular)
CNV1 ophthalmic can show symptoms
what is a foramen
hole
what is a notch
semi-circular opening
ligament disintegrates - get notch form
where does CNV1 exit
supra orbital notch/formamen
above the human orbit
where does CNV2 exit
infraorbital foramen
below orbit
2nd branch of CNV2
where does CNV3 exit
metal foramen
below the mandibular teeth
what is the frontal process of hard palate called
palatine process of maxilla
what is the dorsal section of hard palate called
horizontal plate of palatine bone (not maxilla)
what are the 3 openings on the hard palate
from front to back
- incisive foramen
- greater palatine foramen
- lesser palatine foramen
what are the functional purposes of the osteology of the mandible
condylar process, ramus, angle, body
- Site of muscle attachments
- Foramina for passage of neurovascular structures
- Lower teeth in alveolar process
condylar process
part of mandible (dorsal head)
part of TMJ - feel on opening and closing
coronoid process
part of mandible (anterior head)
site of attachment of temporalis
mandibular foramen
where the inferior alveolar nerve passes on the ramus of mandible
lingula
on the internal mesial side of the ramus of mandible
- can feel not easy to see
where does the CNV exit through on the base of the skull
through the mid-level of human brainstem pons
what are the 2 components of the CNV
special visceral efferent
general somatic afferent
special visceral efferent functions of the CNV
Motor from motor nucleus in the pons
Predominantly to muscles of mastication
general somatic afferent functions of CNV
To the mesencephalic (midbrain), chief (pons) and spinal nuclei (medulla)
Sensory is vital for clinical practice
- More complex – 3 brainstem nuclei
- Different sensory information processed at different parts of the brain
Fibres come together and exit brainstem at pons level
where is the motor nucleus of CNV
level of pons
predominately to muscles of mastication
what are the 3 sensory nuclei for the CNV
mesencephalic (midbrain)
chief sensory
spinal nucleus
what is the purpose of the mesencephalic sensory nucleus of CNV
proprioception
what is the purpose of the chief sensory nucleus of CNV
discriminating touch
what is the purpose of the spinal nucleus of the CNV
pain and temperature for structures supples by CNV as well as general conscious sensation for the viscera supplies by CN IX and X
where do the 3 sensory nuclei of CNV exit
come together and exit midway through the pons
exit point for CNV1
supraorbital notch/foramen
exit point for CNV2
infraorbital foramen
exit point for CNV3
mental foramen
carries motor fibres for muscles of mastication
basic key role of CNV3
carries motor fibres for muscles of mastication
trigeminal ganglion
lies in a cave of dura mater (Meckel’s cave)
role of Meckel’s cave
Practical
Protective cave that holds the trigeminal ganglion
- All the fibres of CNV are still together
- Before divide into the 3 divisions
what happens to the CNV nerve roots after they emerge from the mid pons
they pass forward to the apex on the petrous temporal bone where the trigeminal ganglion lies in a cave of dura mater (Meckel’s cave)
how does the CNV1 reach the superior orbital fissure
pass anteriorly in the lateral wall of the cavernous sinus to reach the superior orbital fissure
how does CNV2 pass through the foramen rotundum
pass anteriorly in the lateral wall of the cavernous sinus to pass through the foramen rotundum
what does CNV3 pass through
passes through the foramen ovale
what important structures are the foramina (superior orbital fissure, rotundum and ovale) close to
neurovascular structures - cavernous sinus
- close proximity to the internal carotid artery and sympathetic plexus
where must the lesion be if all 3 divisions of the CNV are affected
If all 3 CNV divisions are affected the lesion must be in the pons (i.e. stroke) or at the cranial base (i.e. trauma or tumour)
what can occur in the cavernous sinus which has a negative effect on the CNV
clot can develop in the internal carotid artery
- compression on CNV (esp V1 and V2 - maxillary and mandibular symptoms)
what else is seen if the CNV is affected in the cavernous sinus
usually evidence of effect on other nerves too
CNIII and CNIV sometimes CNVI. Eye issues
course of ophthalmic division
Will pass inside the human orbit
- Lateral to cavernous sinus, pass anteriorly to reach the superior orbital fissure
Once inside the orbit divide into different branches
branches of ophthalmic division
predominatly sensory
- never going to block sensory nerve
sensory to scalp, eyes, upper facial sinuses
- carries parasympathetic via cillary ganglion to eye for accommodation and pupal constriction (10 short ciliary nerves), via pterygopalatine ganglion for lacrimal gland
sympathetics via cavernous sinus to pupil for dilation (2 long cilary nerves)
main braches
- frontal
- lacrimal
- nasocillary
2 separate nerves provide sensation and innervation to different parts of head
- frontal nerve
- lacrimal nerve
- nasocilary nerve (complex)
3 main branches of opthalmaic division
main braches
- frontal
- lacrimal
- nasocillary
divisions of frontal division of CNV1
dividing into supraobiral and supratrochlear to skin of vertex and upper eyelid
divisions of lacrimal division of CNV1
to lacrimal gland and skin of lateral upper eyelid and forehead (crying and sensation to lateral side of eyelid)
division and course of nasocillary division for CNV1
gives off long ciliary nerve(s), anterior and posterior to ethmoidal nerves before continuing as the infratrochlear nerve to skin of medial upper eyelid and root of nose
anterior ethmoidal nerve divides into external nasal nerve to top of nose sensation
sensory distribution of CNV1
the supratrochlear, supraorbirtal and lacrimal nerves supply the vertex, forehead and upper eyelids
the anterior ethmoidal nerve continues as the external nasal nerve to the skin at the tip of the nose
the infratrochlear nerve supplies the skin at the medial angle of the eye and adjacent root of nose
the infratrochlear nerve supplies
supplies the skin at the medial angle of the eye and adjacent root of nose
course of the anterior ethmoidal nerve
continues as the external nasal nerve to the skin at the tip of the nose
what do the supratrochlear, supraorbirtal and lacrimal nerves supply?
the vertex, forehead and upper eyelids
what nerve supplies the tip of the nose
the external nasal branch of the anterior ethmoidal branch of the nasociliary branch of CNV1
nasocillary nerve also supplies sensation to the cornea of eye
- shingles at the tip of the nose may be a warning that the disease will also develop on the cornea
shingles can affect any of the 3 divisions of CNV
corneal reflex involves
nasocillary (sensory) and facial (motor)
trigger for conrneal reflex
Stimulate cornea with cotton wool
First part is mediated via nasocillary nerve (first limb)
Closing of eye (blink) via facial nerve CNVII
what do the ethmoidal nerves supply
Supply the ethmoidal sinuses, lateral wall of nasal cavity and nasal septum
course of CNV2
CNV2 passes anteriorly in the lateral wall of the cavernous sinus and reaches the pterygopalatine fossa via the foramen rotundum
Never actively block but be aware of
Provide substantial sensory function to maxilla and upper teeth and gingiva
- Remove the anterior and posterior fossa from cranial base and look at middle fossa
exit point for CNV2
foramen rotundum (middle cranial fossa) - CNV2 enters and goes to the pterygopalatine fossa
where does the pterygopalatine fossa lie
Lies just lateral to the upper aspect of the nasal cavity and nasopharynx behind the orbit and above the hard/soft palate
Hidden – can only ID on inner aspect (not if turn upside down)
what is the pterygomaxillary fissure
Opening leading to the pterygopalatine fossa and sphenopalatine foramen medial to this fossa
Below zygomatic bone and superior to hard palate
what is the sphenopalatine foramen
medial wall of the pterygopalatine fossa
what is the main role of the pterygopalatine fossa
houses a few things - including nerves of CNV
what does CNV2 supply
Sensory to middle face, hard & soft palate, sinuses, nasopharynx, nose
Carries parasympathetic via pterygopalatine ganglion to lacrimal gland, mucous gland of nose, palate and nasopharynx
Taste via hard and soft palate
parasympathetic role of CNV2
Carries parasympathetic via pterygopalatine ganglion to lacrimal gland, mucous gland of nose, palate and nasopharynx
sensory role of CNV2
Sensory to middle face, hard & soft palate, sinuses, nasopharynx, nose
- taste to hard and soft palate
2 main branches of CNV2
zygomatic
- splits into temporal and facial
infra-orbital
all the branches of CNV2 (6, 2 key)
zygomatic
infra-orbital
nasopalatine
greater and lesser palatine to palate
pharyngeal to nasopharynx
alveolar to upper teeth
course of nasal nerves
disappear through pterygoid fossa posteriorly sphenopalatine
course of palatine nerves
through palatine canal into greater and lesser branches
what does the infra-orbital branch of CNV2 supply
eye and upper lip
the 3 superior alveolar nerves
anterior superior alveolar nerve
middle superior alveolar nerve
posterior superior alveolar nerve
posterior superior comes from its on branch of CNV2
anterior and middle superior are from infra-orbital (a branch of CNV2)
what areas does CNV2 innervate
skin , nasal cavity, nasopharynx, maxillary sinus, hard and soft palate, upper teeth and gums
where does the infraorbital nerve exit
infraorbital foramen to supply the lower eyelid, cheek, nose and upper lip
what does the zygomatic branch of CNV2 supply
anterior temple (zygomaticotemporal)
zygoma (zygomaticofacial)
where is the sphenopalatine foramen
Opens inside the nasal cavity
- Lateral wall of Pterygoid fossa has this opening into the nasal cavity
what enters the sphenopalatine foramen
nasopalatine nerve
- reaches the nasal cavity septum
- goes inferiorly downwards into incisive foramen to reach anterior hard palate
what are the 3 alveolar branches
Anterior superior alveolar
Middle superior alveolar
Posterior superior alveolar
post - separate branch on its own
ant and middle - from infraorbital
what teeth do the 3 superior alveolar branches supply
maxillary teeth
what do the 3 superior alveolar branches enter
the pterygoid fossa
2 branches of palatine nerve
greater and lesser
what structure do the palatine nerves pass through
the palatine canal
- lateral wall of the nasal cavity
- roof of oral cavity
where do the 2 palatine nerves exit
through their corresponding foramen in the hard palate
where are the upper teeth and gum sensory supply processed
processed in brainstem
- gathered by different branches of maxillary CNV3
what are the 3 sensory detections of upper teeth and gums
General sensation
Proprioception
Discrimination
what nerve supplies upper anterior teeth (3 to 3)
anterior superior alveolar nerve
what nerve supplies upper premolars (14, 15, 24, 25)?
middle superior alveolar nerve
what nerve supplies the upper molars (16, 17, 18, 26, 27, 28)
posterior superior alveolar nerve
what nerve supplies the palatine and labial gums of maxillary anterior teeth
nasopalatine nerve
what nerve supplies the buccal and palatine gums from the maxillary premolars distally
greater palatine nerve
what is an important role for the lesser palatine nerve
soft palate and uvula
interesting anatomical feature for the nasopalatine, greater and lesser palatine nerves
they overlap
What are the 3 dermatomes of the head?
Opthalmic
Maxillary
Mandibular
The skin on the back of the head is supplies by which Nerves
Upper Cervical Spinal nerves C2 and C3
The skin on the front of the head is supplies by which main nerve
Trigeminal Nerve CNV
Which anatomical landmark distinguishes the anterior and posterior part of the head
angle of the mandible
What areas of the skin are supplies by the ophthalmic dermatome
Front of eye, upper eyelid, forehead and front of scalp
What areas of the skin are supplied by the maxillary dermatome
Upper lip, over zygoma, lower eye and front of cheek
What areas of the skin are supplies by the mandibular dermatome
Chin, lower lip, mucosa inside lower lip, sideburn area, posterior cheek, buccal gingivae of posterior teeth
What is the vertex
the highest point of the head
What nerve supplies the upper eyelid, frontal sinus and from the forehead to the mid scalp
supraorbital nerve
What does the external nasal nerve supply
Lower half of the nose and nasal septum
Where does the zygomaticofacial nerve supply
Skin on the prominence of the cheek
Where does the zygomaticotemporal nerve supply
Skin on the side of the forehead
When does the maxillary nerve change its name to the infraorbital nerve
When it passes through eh infraorbital canal
What nerve supplies the lower eyelid, upper lip and nasal vestibule
Infraorbital nerve
What 3 nerves make up the mandibular dermatome of the face
Buccal, mental and auricotemporal
What does the mental nerve supply
Front of the chin, lower lip, and buccal gingivae of the mandibular anterior teeth
The mental nerve is a branch of which nerve and passes through which foramen
Inferior alveolar nerve
Mental foramen
What area of the skin does the buccal nerve supply
cheek
The auricotemporal nerve supplies where and runs with which artery and vein
Side of the head
Runs with the superficial temporal artery and vein
What are the 5 branches of the facial nerve which pass through the parotid gland
Temporal
Zygomatic
Buccal
Mandibular
Cervical
The maxillary branch of the trigeminal nerve CNV passes through what
foramen rotundum
What nerve supplies the mucosa of the upper lip
infraorbital nerve
What nerve supplies the skin of the cheek
buccal nerve
What nerve supplies the mucosa of the posterior part of the cheek
buccal nerve
What nerve supplies the posterior part of the gingiva on the buccal side
buccal nerve
What nerve supplies the mucosa of the floor of the mouth
lingual nerve
What nerve supplies the mucosa of the lower lip
mental nerve
What nerve supplies the mucosa of the anterior tongue
lingual nerve
What nerve supplies the mucosa of the upper soft palate
lesser palatine nerve
What nerve supplies the posterior 2/3 of the hard palate
greater palatine nerve
What nerve supplies the anterior 1/3 of the hard palate
nasopalatine nerve
What division of the trigeminal nerve is the largest
mandibular
what branch of the trigeminal nerve do dentists target
third branch
- ID blocks (lower teeth LA)
why is targeting the Trigeminal nerve comple
several branches
what are the components of the mandibualr division of trigeminal
sensory distribution
- focussed on oral cavity
motor components
- to muscles of mastication
unlike other 2 branches just pure sensory
course of mandibular division course
passes through the foramen ovale and into the infratemporal fossa where it gives several branches
- Comes out at pons level (see all CNV nerve roots)
- Hides in Meckel’ cave
- Trigeminal ganglion formed
(Dura met excised can see trigeminal ganglion)
where does 3rd division exit
through the foramen ovale
- More lateral and inferior
- Not in close proximity to cavernous sinus
- Branch out from trigeminal ganglion
what 2 openings cannot see when turn skull upside down/on base of external skull
- superior orbital fissure
- foramen rotundum
what is the only opening you can see on base of skull
foramen ovale
what fossa is foramen ovale
middle cranial fossa
Third division exits into less protected structure than CNV1 and CNV2
- CNV1 – superior orbital fissure
- CNV2 – ptertygoid fossa
CNV3 into infratemporal fossa
- No bone
- 2 boundaries
Nerve and branches can be vulnerable to injuries
how is the CNV3 more vulnerable than the CNV1 and 2?
infratemporal fossa
- no bone
- 2 boundaries
nerve and branches can be vulnerable to injuries
what is the difference between infratemporal fossa
very different to Pterygopalatine fossa
- not bone bound/rigid box
what forms the boundaries of the infratemporal fossa
not bone/rigid box
- small bone congregations
- muscles
how to trace the infratemporal fossa
Take skull lateral
Transverse temporalis muscle on temporalis fossa
Below zygomatic arch
Find empty space (infratemporal fossa)
- Masseter and mandible anterior
- Posterior bone
lateral boundary of infratemporal fossa boundary
ramus of manible
medial boundary of infratemporal fossa
lateral pterygoid plate of sphenoid bone
anterior boundary of infratemporal fossa
posterior aspect of maxilla
posterior boundary of infratemporal fossa
tympanic plate
mastoid (most posterior) and styloid process
superior boundary of infratemporal fossa
infratemporal crest of sphenoid bone
inferior boundary of infratemporal fossa
angle of mandible
why is the boundaries of infratemporal fossa not being connected/continuous significant
means can target CNV3 from different angles
what does dislocation of the TMJ joint lead to potentially
- branches of CNV3 can be affected as affect space (infraorbital fossa)
anterior dislocation most common
2 components of the mandibular division of CNV3`
sensory and motor
what is the sensory function of CNV3`
Predominately in temple, jaw and part of chin (lower face), anterior 2/3 of tongue
what nerve supplies the skin over the angle of the mandible
Skin over angle of mandible is not supplies by CNV, but by the cervical plexus with the great auricular nerve (C2, 3)
what is the motor components of CNV3
muscles of mastication, tensors tympani and palati
what are the 6 branches of CNV3
auriculotemporal
buccal
mental
lingual
muscular (not encounter often)
inferior alveolar
how does the CNV3 divide
into 3 main branches and then more smaller ones
how to get direct surgical access of infratemporal fossa
to cut mandible
what are the 3 main branches of CNV3
branches from main trunk
then anterior
then posterior
what are the 4 branches of the main branch of CNV3
meningeal
branch to tensor tympani
branch to tensor veli palatini
nerve to medial pterygoid
what is the role of the meningeal branch of CNV3 main trunk
goes to supply sensory of dura mater
what is the role of the branch to tensor Tympani of CNV3 main trunk
in the middle ear they are 3 small bones help with conducting vibrations
2 muscles attach to little bones control vibration of ear bones speed – innervated by CNV3 main branch
what are 3 consequences of severe fracture to side of mandible
Lack of ability to clench teeth
Sensitive to loud noises
- defect in branch to tensor tympani of CNV3 main trunk
Sensory loss in temple, jaw and chin
what is the role of the branch to tensor veli palatini on CNV3 main trunk
small muscle on soft palate
- elevates soft palate
what is the role of the nerve to medial pterygoid of CNV3 main trunk
muscle of mastication motor innervation
are the branches of CNV3 main trunk sensory or motor or combination
all motor bar meningeal branch (sensory supply of dura mater)
are the branches of anterior trunk of CNV3 sensory or motor or combination
all motor bar buccal nerve (sensory)
- to skeletal muscles
4 branches of CNV3 anterior trunk
deep temporal nerves
- to temporalis MOM
Nerve to lateral pterygoid
- to lateral pterygoid MOM
buccal nerve
- sensory
masseteric nerve
- to masseter MOM
what are the 3 nerves of the CNV3 posterior trunk
Auriculotemporal
Inferior alveolar
- Disappears inside the mandible
Lingual
what is the position of the lingual nerve in relation to the inferior alveolar nerve
anterior to
are the nerves of the posterior trunk of CNV3 sensory, motor or combination
auricolotemporal and lingual are sensory
inferior alveolar
- mixed motor and sensory
when does the inferior alveolar nerve become putely sensory
when it enters the manidibular foramen of the jaw
mylohyoid branch of to support muscles of the oral cavity floor of mouth
what is CNV3 facial distribution like
General sensation to the floor of the mouth along with the lower teeth and gums
General sensation to the anterior 2/3rd of the tongue (general somatic afferent)
- Via the lingual nerve
- —The lingual nerve carries the chorda tympani nerve (Branch of CNVII)
where does CNV3 carry general sensation to
floor of mouth
lower teeth and gum
anterior 2/3 of tongue
what is the key vital role of CNV3
large important motor components
- easy target
- vulnerable to injurt
where does the auricotemporal branch of posterior trunk innervate
sensory innervation to the temple and anterior ear
- do not need to LA
where does the buccal branch of the posterior trunk innervate
sensory innervation to the cheek
where does the mental branch of the posterior trunk innervate
sensory innervation to the chin
what is trigeminal neuralgia
excessive, extreme pain that is felt in one of the distributions of CNV
different medications to help with pain
let it settle before commencing treatment
what branch of CNV is most commonly affected by trigeminal neuralgia
CNV3 most common
Occasionally CNV2
what is the general sensory supply of oral cavity
Buccal nerve to cheek and lateral gum
Inferior alveolar nerve and its branch – incisive nerve – to lower teeth
Inferior alveolar nerve to skin of chin and lower lip (skin and mucous membranes) as the mental nerve
what is the general sensory supply of the cheek and lateral gum
buccal nerve (CNV anterior, 3)
what is the general sensory supply of the lower teeth
inferior alveolar nerve and its branch the incisive nerve (CNV3 posterior, 2)
what is the general sensory supply to chin and skin and mucous of lower lip
inferior alveolar nerve as the mental nerve
CNV3, posterior 2
where does the buccal nerve orginate
comes from the anterior trunk to the cheek and lacrimal glands
course of inferior alveolar nerve
After enters the mandibular foramen, Nerve goes from inferior alveolar nerve to incisive nerve (innervates lower anterior teeth)
- On the medial aspect of mandible
Branch from mental foramen to supply general sensation to chin and mucous membranes is the mental nerve
The inferior alveolar nerve also supplies the mylohyoid and anterior belly of digastric before entering the mandibular foramen to supply general sensation to the lower teeth
what is the role of the incisive nerve
sensory innervation of lower teeth on medial aspect of mandible
(inferior alveolar, CNV3, posterior 2)
what is the role of the mental nerve
sensory innervation supply to chin, skin and mucous membranes
(inferior alveolar, CNV3, posterior 2)
what is the sensory supply of lower teeth and gums
incisive nerve branch of inferior alveolar nerve (target)
what is the sensory supply of the gingivae of the lingual side
lingual nerve (CNV3, posterior 3)
what is the sensory supply of the gingival on the lateral/buccal side
buccal nerve (CNV3, anterior 2)
what is the general sensory supply of the gingivae on the anterior section of gingivae
mental nerve
upper teeth general sensory supply
from CNV2
infraorbital
- anterior superior alveolar nerve
- middle superior alveolar nerve
Posterior superior alveolar (own branch)
lower teeth general sensory supply
from CNV3
inferior alveolar nerve and divisons
what is the anterior 1/3 of tongue area referred to
oral part
what supplies the general sensory supply of anterior part of the tongue
via mandibular division of trigeminal nerve CNV3
- branch on lingual (posterior trunk)
what is the significance of the tongue have general sensory and special sensory supply
numb tongue but can still have taste
what supplies the special sensory supply of the anterior 2/3 of tongue
taste via facial nerve CNVII
- the chorda tympani
what is the branch of the facial nerve that supplies taste sensation to anterior 2/3 of tongue
the chorda tympani
- CNVII
what is encompassed in general sensation of the mouth
pressure, temperature, pain etc
what is special sensation of the tongue
taste
what is the anatomical relation of the lingual nerve and inferior alveolar nerve
close to each other
block both
- pt will present with numbness on tongue tip
- need to warn not to bite
what are the 4 muscles of mastication
temporalis
masseter
lateral pterygoid
medial pterygoid
role of temporalis
elevator (close)
role of masseter
elevator (close
anatomical location of medial and lateral pterygoid
posterior to mandible in infra-temporal fossa
role of lateral pterygoid
horizontal
depressor (open)
- only MOM that will, others are assisting muscles
role of medial pterygoid
vertical
elevator (close)
what is the key role of motor root of CNV3
supplies all muscles of mastication
the motor root of CNV3 supplies
all muscles of mastication
tensor tympani muscle in middle ear
tensor palati (the latter via the branch to medial pterygoid)
mylohyoid and anterior belly of digastric (via inferior alveolar branch)
jaw jerk reflex and CNV
Tap chin
Proprioception stimulate
- Position of chin changes
Goes to mesencephalic nucleus
Goes to CNV and closes the jaw
Mediated by afferent (sensory) and Efferent (motor)
- Same nerve CNV - Unlike corneal - CNV1 and CNVII
where can you test sensory innervation of CNV1 (opthalmic)
temples
where can you test sensory innervation of CNV2 (maxillary)
cheeks
can you test sensory innervation of CNV3 (mandibular)
chin
what is the sensory supply for the skin over the angle of the mandible
not supplied by CNV, but by the cervical plexus with the great auricular nerve (C2 and C3)
what is shingles
Reactivation of varicella zoster virus in the trigeminal ganglion
Cutaneous involvement in the distribution of CN V1
Erythematous, vesicular, crusting rash & burning sensation
- PC painful blistery rash on nose
Hutchinson’s sign: cutaneous involvement of the tip of the nose (external nasal branch of nasociliary nerve)
- Progress posterior to rest of CNV1
- To involve eye
A positive Hutchinson’s sign increases the likelihood of ocular complications (nasociliary nerve)
what is Hutchinson’s sign in shingles
cutaneous involvement of the tip of the nose (external nasal branch of nasociliary nerve)
- Progress posterior to rest of CNV1
- To involve eye
what does a positive Hutchinson’s sign in shingles indicate
increased likelihood of ocular complicatoins
- Conjunctivitis, keratitis (cornea) & uveitis (anterior chamber of globe)
—-Same nerve that supplies sensation to tip of nose and eye
——Can lose eyesight if left untreated
Catch early can treat - improve quality
eye complications due to shingles
- Conjunctivitis, keratitis (cornea) & uveitis (anterior chamber of globe)
—-Same nerve that supplies sensation to tip of nose and eye
——Can lose eyesight if left untreated
Catch early can treat - improve quality
2 methods of avoiding iatrogenic damage when administering dental anaesthesia
aspirate
not hit vein or artery
potential vein that can be iatrogenically damaged in dental anaesthesia
pterygoid plexus
potential arteries that can be iatrogenically damaged in dental anaesthesia
many - external carotid
potential muscles that can be iatrogenically damaged in dental anaesthesia
if go deep then the medial pterygoid
- trismus: ability to open mouth gone as muscles anaesthetised
- — more common than CNVII palsy
trismus
ability to open mouth gone as muscles anaesthetised
—- more common than CNVII palsy
potential gland that can be iatrogenically damaged in dental anaesthesia
parotid gland
consequence of damaging of parotid gland on LA injection
LA going into gland may hit CNVII
Ipsilateral (same side) half face paralysis
- All facial nerve fibres is affected
Will resolve after a day or 2
- Not permanent
- Reassure pt
