Clinical Applications of COMM - Treffer

Question 1

Ear

Frequency of this in infants is due to?

Answer 1

OM

Shorter eustacian tibe and more A/P

Question 2

What bone(s) are most likely to cause constriction/blockage of eustacian tube?
Where does the tube lie?

Answer 2

Sphenoid and temporal

It lies in the GROOVE BETWEEN THE PETROUS TEMPORAL BONE AND GREATER WING OF SPHENOID

Question 3

Pain in the cranium may be due to?

Examples (2)

Answer 3

Distention, traction or dilation of intracranial or extracranial arteries.
Examples - MMA, superficial temporal arteries

Question 4

Arteries within the dura

What nerve is associated with them?

Answer 4

Especially proximal parts of ACA and MCA and intracranial portion of ICA.

Trigeminal nerve

Question 5

Cranial Veins within dural envelop

Answer 5

Superior and inferior sagittal sinus
Straight sinus
Transverse sinuses

Question 6

Relationship between superior cervical ganglion (symp to head and face) with what vertebra?
Relationship of inferior ganglion of the vagus to what vertebrae?

Answer 6

C2

C1

Question 7

Patient complains of frequent HA, stressful current job. Palapatory exam reveals hypertonic cervical muscles. You do suboccipital release.
What is the name of this HA and what nerves?

Answer 7

Subocciptial HEadache

Cervical Nerves - C1,2,3! (these innervate teh upper neck musculature)

Question 8

Pateint has paralysis of right side of face, sudden onset, no trauma, Bells Palsy (ipsilateral dry eye and loss of taste to ant 2/3 of tongue). What nerves?

Answer 8

CN7

Question 9

What bones does CN7 pass through?

Answer 9

Temporal!

Question 10

Distribution of chorda tympani
What part goes to tongue/mouth?
What part goes to lacrimal gland?

Answer 10

Tongue - chorda tympany - lingual nerves and submandibular ganglion
Lacrimal gland -

Question 11

Compression of CN& that results in Bell’s Palsy results in what symptoms?

Answer 11

change in taste to ant 2/3 of tongue (chorda tympani)
Unable to control affected side face muscles.
Drying of cornea - lack of lacrimation.

Question 12

Correction of what for Bell’s Palsy?

Answer 12

marked external rotation of temporal with Sphenobasilar flexion an dSB rotation. Paralysis solved quickly.

Question 13

What nerve conveys supratentorial sensory info?
What nerves convey infratentorial sensory info referred to vertex and post head and neck
What nerves refer pain to nasoprbital area, ear, throat?

Answer 13

Trigeminal nerve

Cervical nerves 1-3

CN7, 9, 10

Question 14

Patient has lancinating pain in face. Pain is incapacitating and lasts seconds to 2 mintues. Stimulus is chewing. What is this called and what nerve?

Answer 14

Trigeminal Nerualgia.

V1 and V2

Question 15

What does the trigeminal nerve transmit?

Answer 15

sensory impulses from forehead, orbit, anterror and middle fossae of the skull, and the upper surface of the tentorium

Question 16

V1, V2, V3 pass through what spaces?

Answer 16

Standing Room Only
V1 - Superor orbital fissure (and CN3,4,6)
V2 - foramen Rotundum
V3 - foramen Ovale

Question 17

FO and FR are in what bone?

Answer 17

Sphenoid

Question 18

What bone has the trigeminal gangion? And what part of the bone?

Answer 18

Temporal

Meckel’s cave - superior surface of petrosal ridge of temporal bone.

Question 19

What is tightly attached to the petrosal ridge of Meckel’s Cave?

If temporal bone is ER, what would this put pressure on?

Answer 19

Tentorium cerebri.

Pressure on structures deep to the tentories (dura mater) cerebri.

Question 20

OM implicated by what bone turned in what direction?

Answer 20

Temporal Bone in IR

Question 21

OM suture associated with drainage of what and what CN’s affected?

Answer 21

venous drainage, CN9, 10, 11q

Question 22

Bell’s Palsy - what CN and what bone and what exit?

Answer 22

CN7, temporal bone dysfunction, exits stylomastoid foramen