Chapter 7 Blue Pages Flashcards
Headaches and facial pain are usually benign and frequently associated with? (3)
Tension, fatigue or mild fever
Headaches can indicate serious intracranial problems such as? (3)
Brain tumor, subarachnoid hemorrhage or meningitis.
Neuralgias are characterized by?
Severe throbbing or stabbing pain
Neuralgias are caused by?
demylenating lesion to a nerve
A blow to the superciliary arches can cause?
Laceration - bleeding
Bruising/Black Eye - fluid and blood accumulate in the surrounding connective tissue which gravitates into the superior eyelid.
What is a malar flush and what is it associated with?
Redness of the skin covering the zygomatic process. It is associated with a rise in temperature.
Malar flush only occurs with certain diseases; what are they?
TB and systemic lupus erythematous disease.
Describe a Le Fort I fracture
wide variety of horizontal fractures of the maxillae, passing superior to the maxillary alveolar process, crossing the bony nasal septum and possible the pterygoid plates of the sphenoid.
Describe a Le Fort II fracture
passes from the poster lateral parts of the maxillary sinus, superomedially though the infra-orbital foramina, lacrimals or ethmoids to the bridge of the nose.
Describe a Le Fort III fracture
horizontal fracture that passes through the superior orbital fissures and the ethmoid and nasal bones and extends laterally through the greater wings of the sphenoid and the frontozygomatic arches, causing the zygomatic and maxillae bones to separate from the rest of the cranium.
A broken mandible usually involves how many fractures?
2
If you observe 1 mandible fracture what should you look for?
A second fracture on the opposite side.
Fractures to the coronoid process of the mandible are typically?
single and uncommon
Fractures to the neck of the mandible are often ______ and associated w/__________?
transverse and associated with dislocation of TMJ (on the same side)
Fractures to the angle of the mandible are usually _____ and may involve the______ or _______.
oblique and involve the bony socket or alveolus of the 3rd molar tooth.
Where do fractures of the body of the mandible frequently pass through?
Socket of a canine tooth
What often happens to the alveolar bone when after teeth extraction?
The alveolar bone will resorb in the affected area.
With a maxillary tooth extraction, what process resorbs?
Alveolar
With mandibular tooth extraction, what process can resorbs?
Mental foramina
Resorption of the mental foramina leads to?
damage to the mental nerves.
We most often see depressed fractures in what area of the calvaria?
Thin areas
What is the most common type of calvaria fractures?
Linear
What is common to see with linear calvaria fractures?
Fracture line at the point of impact but also radiating lines in 2 or more directions.
Describe a comminuted fracture.
The bone is broken into several different pieces.
What is a countercoup fracture?
A fracture that does not occur at the site/side of impact but occurs on the opposite side of the calvaria.
What is a craniotomy?
When a section of the neurocranium (bone flap) is removed for surgery but is replaced after surgery.
What is a craniectomy?
When a bone flap is not replaced after surgery, instead a permanent plastic or metal plate replaces the flap.
What are the 2 important fontanelles?
Anterior and posterior
What is the shape of the anterior fontanelle?
Diamond or star shaped
What is the shape of the posterior fontanelle?
Triangular
At what age is the anterior fontanelle no longer palpable?
18 months
At what age is the posterior fontanelle no longer palpable?
By the end of the 1st year
Obliteration of the cranial sutures of the calvaria begins between what ages?
30-40 years (internal) - 10 yrs later (external)
What is primary craniosynostosis and what does it result in?
Premature closing of the cranial sutures causing cranial malformations.
What is Scaphocephaly?
A long narrow wedge-shaped cranium as a result of premature closure of the sagittal suture in which the anterior fontanelle is small or absent.
What is Plagiocephaly?
The cranium is twisted or asymmetrical due to the premature closure of the coronal or lambdoid suture occurring only on one side.
What is Oxycephaly?
A high, tower-like cranium due to the premature closing of the coronal suture.
Why don’t superficial scalp wounds gape?
Due to the strength of the epicranial aponeurosis
Deep scalp wounds that gape occur when?
The epicranial aponeurosis is lacerated in the coronal plane. Gaping is due to the pull of the frontal and occipital bellies of the occipitofrontalis muscle in opposite directions.
What is considered the dangerous area of the scalp and why?
Layer 4 of the scalp, the loose connective tissue layer.
Dangerous because pus and blood spreads easily in it.
Infection to the 4th layer of the scalp can spread as far as?
The Meninges.
How does infection to the 4th layer of the scalp get into the meninges?
Infection in this layer can pass into the cranial cavity via the emissary veins, which pass through the foramina in the calvaira and reach intracranial structures such as the meninges.
A scalp infection cannot spread in what 2 directions?
Posterior - can’t go past the neck.
Laterally - can’t go past the zygomatic arches
What is it called when there is obstruction of the sebaceous glands which cause a retention of secretions?
Sebaceous cyst
What is a cephalhematoma?
Blood trapped between the pericranium (5th layer of scalp) and the calvaria, usually over the parietal bone.
When is is common to see a cephalhematoma?
After a difficult birth
What diagnostic value does the flaring of nostrils show?
nasal breathers from mouth breathers. Nasal breathers can flare their nostrils distinctively Mouth breathers may have a chronic nasal obstruction which diminishes or eliminates their ability to flare their nostrils
Bells Palsy occurs due to injury to which CN?
CN 7 - Facial Nerve
Injury to CN 7 that weakens or paralyzes the buccinator and orbicularis oris causes?
Food to accumulation in the oral vestibule during chewing - usually requiring continual removal of food with a finger.
The loss of tonus of the orbicularis oculi causes the inferior eyelid to evert (falling away from the surface of the eyeball). This results in?
Lacrimal fluid is not spread over the cornea.
Improper lubrication of the cornea makes the cornea vulnerable to?
Ulceration - corneal scarring can impair vision.
Weakness to lip muscles because of CN 7 damage leads to?
affected speech/impaired ability to produce B, M, P or W sounds.
To achieve local anesthesia to the inferior portion of the face, one would infiltrate which nerve?
Infra-orbital nerve
To suture something such as a severe laceration to the of the lower lip, a block would be placed where?
Mental foramen to block the mental nerve.
To suture something such as a knife wound to the cheek, an anesthetic injection should be made where?
The mucosa covering the retromolar fossa - a triangular depression post. to 3rd mandibular molar between he ant. border of the ramus and temporal crest. *Buccal Nerve Block
What is trigeminal neuralgia or Tic doulourex characterized by?
sudden attacks of excruciating, lightening-like jabs of facial pain.
Tic doulourex is a sensory disorder of which nerve root?
CN 5 - Trigeminal Nerve
V2 most frequently involved and then V3 and least frequently, V1
Tic doulourex often affects what age groups?
Middle-aged and elderly
The pain of tic doulourex can get so severe that the patient can suffer from?
psychological changes - leading to depression and sometimes suicide.
The paroxysms of tic doulourex are often set off by?
touching the face - in the “trigger zone” (frequently located around the tip of the nose or cheek)
What are some of the treatments for tic doulourex?
- blocking infra-orbital nerve
- avulsion
- radiofrequency selective ablation of parts of the trigeminal ganglion
- tractotomy
Lesions of the entire trigeminal nerve cause widespread anesthesia to?
- ant. half of the scalp
- face (except for angle of mandible, cornea and conjunctiva)
- mucous membranes of the nose, mouth and ant. tongue
- paralysis of mastication muscles
When the herpes zoster infection produces a lesion on CN 5 ganglion, the cornea is involved and can result in?
painful corneal ulceration and subsequent scarring of the cornea.
How is the sensory portion of CN V tested?
lightly dragging a piece of gauze to across the forehead, cheek and lower jaw
What is the most common non traumatic cause of facial paralysis?
inflammation of the facial nerve near the stylomastoid foramen often from a viral infection - the edema compresses the nerve in the facial canal
Facial nerve palsy may be idiopathic,but it often follows exposure to?
cold
In lacerations to the lip involving the facial artery, pressure must be applied where?
to both sides of the cut - only compressing one side of the facial artery will not stop all of the bleeding
w/advanced aging, the internal carotid can become stenotic. Because of the arterial anastomosis, intracranial structures such as the brain will begin to receive blood from?
the connection of the facial artery to the dorsal nasal branch of the ophthalmic artery
What is the most common type of head injury requiring surgery?
scalp lacerations
The arteries involved in scalp lacerations do not retract because?
they are being held open by the dense connective tissue in layer 2 of the scalp - if the bleeding isn’t controlled, scalp lacerations can be fatal
Squamous cell carcinoma of the is often caused by?
- overexposure to sunshine for many years.
- chronic irritation from pipe smoking
In squamous cell carcinoma, cancer cells from the CENTRAL part of the lower lip, floor of the mouth and apex of the tongue spread to the?
submental lymph nodes
In squamous cell carcinoma, cancer cells from the LATERAL parts of the lower lip drain to?
submandibular lymph nodes
What vessels does the pterion overly?
the frontal branches of the middle meningeal vessels
A hard blow to the side of there head can cause?
a fracture to the thin bones that make up the pterion, producing a rupture of the frontal middle meningeal artery or vein resulting in a hematoma.
An untreated middle meningeal vessel hemorrhage causes?
b/c of an increase in pressure on the underlying cerebral cortex resulting in death w/in a few hours
The facial vein makes clinically important connections w/the cavernous sinus through what veins?
superior ophthalmic vein, pterygoid venous plexus through the inferior ophthalmic and deep facial veins.
Individuals w/thrombophlebitis of the facial vein can develop thrombophelitis of the cavernous sinus because of?
the facial vein has no valves, blood may pass through in the opposite direction. Therefore, venous blood from the face can reach the cavernous sinus.
What is thrombophlebitis of the facial vein?
inflammation of the facial vein w/secondary thrombus (clot) formation
Lacerations to the nose and pimple popping on the side of the nose and upper lip can cause?
infection of the facial veins spreading to the dural venous sinuses
What is considered the danger area of the face?
triangular area from the upper lip to the bridge of the nose
A fracture to the cranial base typically results in?
tearing of the dura that leads to the leakage of CSF.
True or False: A blow to the head can detach the periosteal layer of the dura from the calvaria w/out fracturing the cranial bones.
True
What occurs during a tentorial herniation?
the temporal bone can become lacerated by the tough tentorium cerebella and the oculomotor nerve may be stretched, compressed or both.
What is the cause of a tentorial herniation?
space occupying lesions (tumors) in the supratentorial compartment produces increased intracranial pressured may cause part of the temporal lobe to of the brain to herniate through the tentorial notch.
What is the result of pituitary tumors through the aperture in the diaphragm sellae?
bulging of the diaphragm sellae
Bulging of the diaphragm sell can lead to?
visual symptoms - b/c of pressure on the optic chiasm
Occlusions of the cerebral veins and dural venous sinuses may result from?
- Thrombi (clots)
- Thrombophlebitis (venous inflammation)
- Tumors
Which of the dural venous sinuses are most frequently thrombosed?
- Transverse
- Cavernous
- Superior Sagittal
Cavernous sinus thrombosis usually results from infections in which structures?
orbit and nasal sinuses and superior part of the face (danger zone)
Septic thrombosis of the cavernous sinus often results in the development of what disease?
acute meningitis
