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D3 Oral Surgery Ex4 > Trigeminal Nerve Injury (Lui) > Flashcards

Trigeminal Nerve Injury (Lui) Flashcards

1
Q

What are initial questions to ask if patient present complaining of neuropathy?

A
  1. When was the procedure
  2. When did symptoms start
  3. Are symptoms the same, improving, getting worse
  4. Are you in pain?
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2
Q

What is the layman’s term for distorted sensation?

A

Numbness

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3
Q

What are 3 primary things that could cause a patient to seek treatment in a nerve injury?

A
  1. Distorted sensation
  2. Impaired function
  3. Pain (dysethesia)
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4
Q

Which nerves has a LOWER rate of spontaneous regeneration: those in soft tissue or those in bony canal?

A

Soft Tissue

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5
Q

Which nerve has better chance of spontaneous recovery: lingual or IAN and why?

A

IAN, inside a bony canal

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6
Q

What provides the best opportunity for sensory recover if an observed or known injury occurs?

A

Prompt microsurgery

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7
Q

Full recovery in 1 month indicates what?

A

Neurapraxia (bruised nerve)

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8
Q

Is recovery anticipated if neurosensory dysfunction lasts for >1 month and what does that indicate?

A

It indicates a higher grade injury with uncertain spontaneous recovery

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9
Q

If have a patient has nerve injury symptoms for more than 1 month, what diagnosis should you consider?

A

Microsurgical consult

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10
Q

Most injuries resolve in ____ months, but only if improvement begins before ___ months?

A

3-9 months 3 months

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11
Q

What is prognosis for patient that is anesthetic at 3 months?

A

Poor

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12
Q

Will surgery improve function and objective testing or will it reduce pt’s pain and their subjective feeling of numbness?

A

Improve function and objective results only

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13
Q

Numbness is subjective or objective feeling?

A

Subjective

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14
Q

What is the only objective way to know the extent and what the nerve problem is?

A

Quantitative Sensory Testing (QST)

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15
Q

Myelination increases what?

A

Conduction velocity

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16
Q

Do nerves have blood vessels?

A

Yes

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17
Q

What are 3 types of neural fascicular patterns?

A
  1. Monofascicular
  2. Oligofascicular
  3. Polyfascicular
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18
Q

Which fascicular pattern is severly damaged easier?

A

Monofascicular

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19
Q

What is the big picture with the QST with respect to conduction velocities?

A

Different fibers have different velocities

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20
Q

The pseudo unipolar neurons of CN V region in which ganglion and head where?

A

Trigeminal ganglia and go to the trigeminal nucleus

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21
Q

What tract does the trigeminal nerve impulse travel to get to the primary somatosensory cortex?

A

Trigeminothalamic

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22
Q

What are 7 common causes of nerve injury?

A
  1. Local anesthesia
  2. Implant placement
  3. Endodontic therapy
  4. Mucoperiosteal flap
  5. Chemical
  6. Infection (Vincent’s syndrome)
  7. Third molar surgery
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23
Q

What are 7 chemicals that can cause neurotrauma?

A
  1. Tetracycline power
  2. Surgical
  3. Canoy’s solution
  4. Eugenol
  5. Intracanal endodontic medicaments
  6. Calcium hydroxide
  7. Local anesthetics
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24
Q

What should you do if you know that an implant has approximated the IAN?

A

Remove and replace immediately

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25
Q

What degree is a nerve injury that reaches to the endoneurium?

A

1st degree

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26
Q

What degree is the nerve injury that goes through the endoneurium?

A

2nd degree

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27
Q

What degree is a nerve injury going to the perineurium?

A

3rd degree

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28
Q

What degree is a nerve injury through the perineruium?

A

4th degree

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29
Q

What degree is a nerve injury through the epineurium?

A

5th degree

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30
Q

What can form at the end of a nerve injury and prevent healing or transmission?

A

Neuroma (Wallerian degeneration)

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31
Q

What is the difference between Sunderland and Seddon nerve injury classifications?

A

Sunderland is 5 degrees, Sneddon is 3

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32
Q

Seddon Neurapraxia is what degree in Sunderland?

A

1st degree

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33
Q

Seddon Axontomesis is what degree in Sunderland?

A

2nd degree

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34
Q

Seddon Neurotomesis is what degree in Sunderland?

A

5th degree

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35
Q

Neurapraxia (Seddon) / Sunderland 1st degree takes how long to heal?

36
Q

Axonotomesis (Seddon) / Sunderland 2nd Degree takes how long to heal?

A

Recovery in 1-3 months

37
Q

Neurotomesis (Seddon) / Sunderland 5th degree is what type of disruption?

A

Complete transaction

38
Q

What is the proximal axon tying to do to heal the distal nerve that is severed from it?

A

Increase metabolism to grow axons out and recanniculate with distal nerve

39
Q

Which respond better to healing, myelinated or unmyelinated?

A

Myelinated

40
Q

What are 4 neuroma formations?

A
  1. Amputation neuroma
  2. Neuroma in continuity
  3. Lateral exophytic neuroma
  4. Lateral adhesive neuroma
41
Q

Why is operator unable to draw a straight line when marking cutaneous feelings of a QST?

A

Due to recruitment / collateralization of other nerves

42
Q

What are 3 theories of local anesthetic nerve injury?

A
  1. Needle to nerve
  2. Hematoma, inside nerve
  3. Neurotoxicity
43
Q

Did a cadaver study show that a needle would pierce fascicles to cause direct trauma?

A

No, showed it passed between fascicles

44
Q

Of the 3 local anesthesia theories, what is the one that does not require direct contact of the needle with the nerve?

A

Neurotoxicity

45
Q

What is the fascicular pattern of the lingual and IANs near the lingula?

A

Lingual, monofascicular

IAN, multifascicular

46
Q

What are the percentages of lingual and IAN nerve damages when hit?

A

Lingual 70%

IAN 30%

47
Q

What are 3 levels of the QST?

A
  1. Directional discrimination (moving stimulus and 2 point)
  2. Contact detection
  3. Pain (noxious stimulant)
48
Q

What is the term for pain to normal touch?

49
Q

Level A brush stroke measures what fiber responses?

A

A-alpha

A-beta

50
Q

Level A 2 point detection tests what fiber response?

51
Q

Level B von Frey (contact) detection tests what fiber response?

52
Q

Level C noxious pinch test what fiber response?

A

A-delta, C

53
Q

What is the term for elicitation of electric shock like paresthesisas and distal radiating pain in response to tapping or compressing an injured nerve trunk hot spot or demyelinated zone?

A

Tinel’s sign

54
Q

Tinel’s sign usually indicated what formation?

A

Neuroma formation, Wallerian degeneration

55
Q

What type of response is Tinel’s sign to stimulus?

A

Hyperpathia

56
Q

What uses imagery to visualize and compare stimulation of the normal and affected sides for behavioral?

A

Sensory re-education stimulation

57
Q

What are 2 pharmalogical treatments for trigeminal nerve injury?

A
  1. Anticonvulsant (gabapentin)

2. Antidepressant and anxiolytic

58
Q

What is a compound prescription for trigeminal nerve injury?

A 
CGKL
Clondine 0.2
Gabapentin 8
Ketamine 10
Lidocaine 5%
59
Q

The lingual nerve is best treated in what time frame?

A

1-3 months

60
Q

IAN is best treated in what time frame?

A

3-6 months

61
Q

What should a patient be told prior to nerve repair?

A

May not restore to pre-injury function. If lingual, do not expect return of taste sensation.

62
Q

Is surgery indicated if a patient’s symptoms are improving?

63
Q

Why might delayed repair be indicated after BSSO?

A

Amount of inflammation and increased vascularity will make a difficult surgical field

64
Q

If placing an implant and you make direct contact with the IAN, what should you do?

A

Reposition immediately to 2mm separation from canal. If the implant is not stable, remove.

65
Q

What has better results: end to end anastamosis or nerve grafting?

A

End to end anastomosis

66
Q

What is the term for removal of surrounding bony, soft tissue structure and / or foreign material around the nerve?

A

External decompression

67
Q

Where is the opening of the epineurium to inspect and decompress the nerve fascicles?

A

Internal neurolysis

68
Q

What is the term for the removal of neuroma associate with a nerve?

A

Excision of neuroma

69
Q

What is the term for microsurgical anastamosis of a transected nerve?

A

Neururrhaphy

70
Q

What is the placement of a nerve graft (allogenic or autogenous) for nerve reconstruction?

A

nerve graft

71
Q

What is the microsurgical anastamosis of a distal nerve to a different proximal nerve via an interposed nerve graft? (what does this even mean?)

A

Nerve sharing

72
Q

What is the term for the placement of a conduit to guide axonal sprouting and regeneration across a nerve gap from proximal to distal portions of a nerve?

A

Guided nerve regeneration

73
Q

What is the term for the microsurgical transaction and removal of a segment of a peripheral nerve?

A

Neurectomy

74
Q

What is the term for covering of the proximal stump of a transected nerve with its epineurium to prevent neuroma formation?

A

Nerve capping

75
Q

What is the term for redirection of a nerve’s sensory innervations to a different anatomic location (usually adjacent muscle), usually done to prevent or minimize deafferentation?

A

Nerve redirection

76
Q

OMFS uses what nerve graft materials?

A

Bovine, don’t risk donor site complications

77
Q

What is the pain response called if the patient has pain in level A of QST with a brushstroke?

78
Q

What is the pain response called if pt has pain in level B of QST with repetitive stimulus evoked pain?

A

Hyperpathia

79
Q

What is the pain response called if pt has pain in Level C of QST with noxious mechanical stimulus?

A

Hyperalgesia

80
Q

What is the key to everything done when evaluating and planning for Nerve injury and therapy?

81
Q

Which heal better: trigeminal nerve injuries involving distal segments or those involving proximal segments?

82
Q

Does spontaneous sensory recovery occur in all patients?

A

No. Only most patients.

83
Q

What are three important aspects of early recovery prediction?

A
  1. It is difficult
  2. It may not be complete
  3. It may not be to the patient’s satisfaction
84
Q

When should a referral for nerve injury care be considered?

A
  1. Based on individual patient needs
  2. Criteria and indications for surgery are met (usually within 3 months of injury)
  3. Patient acceptance of surgery
  4. Outcome expectations need to be realistic
85
Q

What percentage of patients with a permanent nerve injury reported that it felt like a perfectly normal injection?

D3 Oral Surgery Ex4 (5 decks)

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