Final Flashcards
There are different types of nerve fibers. Which of the myelinated nerve is responsible for Proprioception and which one is for Fine touch… Know your Myelinated nerve on Table 41-2
- Proprioception: a-beta
- Fine touch: a-alpha
When patient has nerve injury, what are the Level A, B, C testing? Example, what’s tests are included in Level A, B, C?
* A:
o Level A test: used to determine the response of the slowly adapting larger myelinated fibers (A-alpha)
o Two point discrimination test: patient’s eyes closed with 2 points of the caliper essential touching so that the patient is able to discriminate only one point. The distance between the 2 points are increased in 2 mm increments until the patient is able to discriminate between two distinct points at 6 mm – which is then considered normal
o Brush stroke directional discrimination: the test is used to determine the response of the slowly adapting larger myelinated fibers (A-alpha) and A-beta myelinated axons. The sensory modalities for these receptors are vibration, touch, and flutter. The brush is stroked gently across the area of involvement at a constant rate, and the patient is asked to indicate the direction of the movement and the correct number of patient statements out of 10 is recorded.
- B:
o Contact detection
o Von Frey filaments
- C:
o Thermal discrimination
o Pinprick nociception
Surgical Nerve Repair.. How you do it? How you put the segmented nerve back together?
- Surgical exploration of the nerve, identification and removal of pathology is present, and identification and repair of severed nerve endings in a tension free manner (epineural neurorrhaphy)
- Nerve repair is completed under general anesthesia in an OR setting, magnification using 3.5x loupes or operating microscope with fiberoptic lighting, and repair using 8-0 nylon suture in epineural fashion
When perform nerve graft, which nerve(s) in our body provides the best answer?
- Sural nerve: preferred since it most appropriately matches the nerve diameter and the fascicular number and pattern of the trigeminal nerve
- Greater auricular nerve
Nerve injury classification. Know Sunderland and Seddon and how they correlate and which nerve injury is more severe. Yes, there is a blue table in your slide under “Sunderland’s Classification”
* Most severe:
Neurotmesis
What’s in the incident of Inferior alveolar nerve injury vs Lingual nerve injury (Know the average?)
* Inferior alveolar never injury:
* Lingual nerve injury:
1.2%
0.9%
How do you injury inferior alveolar nerve and Lingual nerve? In another word, what procedure or movement you have to do to CUT and mess it up? Dude, you are the one with the 15 blade so don’t tell me “I don’t know what happened”.
* Inferior alveolar nerve:
o During extraction of lower third molars, during administration of LA injection, during placement of endosseous dental implants/plates/screws, during RCT, due to pathology, due to infections.
How do you injury inferior alveolar nerve and Lingual nerve? In another word, what procedure or movement you have to do to CUT and mess it up? Dude, you are the one with the 15 blade so don’t tell me “I don’t know what happened”.
* Lingual nerve:
o Third molar extraction is most common etiology for iatrogenic trauma to the lingual nerve.
o Extraction of lower third molars, placement of dental implants through lingual cortex, pathology, LA injection
There are several criteria need to meet before performing Secondary Alveolar Bone grafting. (Slide 89/93) Example: Done before eruption of the permanent canine, usually when the root of the canine is 1/3 to 2/3 formed…… yes, that slide
* Secondary alveolar bone grafting:
o Done before eruption of the permanent canine
o Usually when the root of the canine is 1/3-2/3 formed
o Usually between the ages of 9-11 years
o In CLP dental age is usually behind chronological age
o 3 layered closure (nasal layer, bone graft, oral layer)
o Provide bone for the eruption and/or orthodontic repositioning of teeth
o Closure of oro-nasal fistulas
o Support and elevation of the alar base
o Stabilization of the pre-maxilla in bilateral cases
o Provide continuity of the alveolar ridge
VPI Velopharyngeal Incompetence. What is it? Why do you need to do Pharyngoplasty procedure? (Slide 83/93)
* Velopharyngeal incompetence (VPI)
o The velopharyngeal mechanism is incapable of separating the oral and nasal cavities during swallowing and speech. In this situation, a pharyngoplasty procedure is necessary.
- Indications for Pharyngoplasty:
o Pharyngeal flap surgery may be recommended to resolve velopharyngeal incompetence after patients prove unable to achieve significant speech improvements through speech therapy alone.
o Other requirements to qualify for the surgery include a short wand immobile or easily fatigued palate
What’s special about Palatoplasty? There are layered closure. What are the layers?
(3)
- Nasal layer
- Muscle
- Oral layer
There is a General question that you need to think about CLP patient. CLP patient usually have restricted grow of which part of the maxillofacial region? What does not mean to the patient in term of esthetic? What you may like to do to take care of that? (That’s All I can tell you… I want you to think about it and understand what the overall picture of the CLP patient is)
Slide 53/93. It should be about “Management of Cleft Lip and Palate, Sequence of Interventions”
What is the most commonly used surgical technique to close a cleft lip….
Millar’s Rotation Advancement Flap (unilateral cleft lip and palate)
Cleft lip develops when there is a failure of fusion of what fetal structures?
- Maxillary processes with the lateral and medial nasal prominences (4-7 weeks of gestation)
Anatomical classification of the CLP is based on?
(3)
- Location
- Completeness (incomplete/complete)
- Extent
Incidence of CLP in USA according to different ethnic groups are?
- Native north Americans have the highest incidence rates followed by Asians, Caucasians, Africans
What are the 3 major glands and what do they secrete?
(3)
- Parotid (largest): serous
- Submandibular: serious>mucous
- Sublingual: mucous
Faial nerve is associated with what gland?
- Parotid
o The facial nerve is embedded within the superficial and deep lobes of the parotid gland
Wharton’s duct and Stenson’s duct, what are they and who do they work for?
* Wharton’s duct
o SUBMANDIBULAR
o Excretory duct, exits on the sides of the lingual frenum
o Adjacent to the lingual nerve and drains into punctum within the sublingual caruncles on either side of the lingual frenum. Punctum prevents retrograde flow of fluid
