問題一覧
1
which nerves exits/holes are in the anterior cranial fossa
cribriform plate (of ethmoid bone), optic canal
2
which nerves exits/holes are in the middle cranial fossa
superior orbital fissure , foramen rotundum , foramen ovale
3
which nerves exits/holes are in the posterior cranial fossa
internal acoustic meatus , jugular foramen , hypoglossal canal
4
what nerve exits through the cribriform plate
olfactory nerve (1)
5
what nerve exits though the optic canal
optic nerve (2)
6
which nerves exit through the superior orbital fissure
oculomotor nerve (3) , trochoear nerve (4) , opthalmic nerve CN5 (1), abducens nerve (6)
7
which never extis through foramen rotundum
maxillary nerve CN5 (2)
8
what nerve exits through foramen ovale
Mandibular never CN5 (3)
9
what nerves exit through the internal acoustic meatus
facial nerve (7), vesticulocochlear (8)
10
what nerves exit through the jugular foramen
glosopharyngeal nerve (9), vagus nerve (10) , accessory nerve (11)
11
what nerve exits through the hypoglossal canal
hypoglossal nerve (12)
12
what are the cranial nerves in order
olfactory , optic, oculomotor , trochlear , trigeminal , abducens , facial , vestibulocochlear , glosopharyngeal , vagus , accessory , hypoglossal
13
which cranial nerves are only sensory (3)
olfactory , optic , vestibulocochlear
14
what cranial nerves are only motor (5)
oculomotor , trochlear , abducens , accessory , hypoglossal
15
what cranial nerves ar both sensory and motor (4)
trigeminal , facial , glosopharyngeal , vagus
16
what is a sensory (afferent) neuron
carry signals to the brain to help taste, touch, smell and see
17
what is a motor (efferent) neuron
carry signals to muscles and glands to help you move and function
18
what does the olfactory nerve supply and what’s its function
olfactory bulb, sense of smell
19
damage to the olfactory nerve can cause
total loss, distorted sense of smell and abnormal taste
20
origin and function of optic nerve
retinae of eye (both nerves join at optic chiasma), vision
21
origin and function of oculomotor nerve
oculomotor nucleus in midbrain, eye movement
22
damage to oculomotor nerve can cause
oculomotor nerve palsy- dropping eyelids, impaired medial and upward movement, dilated pupils, infection, diabetes
23
origin and function of trochlear nerve
origin nerve junction of midbrain of pons, supply and helps function of eyes superior oblique muscle
24
damage to trochlear muscle can cause
upwards eyeball deviation, double vision, head tilt caused by diabetes, hypersensitive disease
25
origin and supply of abducens muscle
origin- abducens nuclear in pons (of midbrain), supply- lateral rectus muscle of eye (which moves eye laterally)
26
damage to abducens nerve can cause
medial deviation of eye, lateral gaze deficit, double vision (Diplopia) caused by diabetic neuropathy
27
what’s the vestibulocochlear nerve aka and what is it’s origin do function
aka auditory nerve , origin-both vestibular & cochlear nerve come from different nuclei in brain, function- balance (vestibular) and special hearing (cochlear)
28
what can damage to the vestibular and cochlear branch cause
vestibular branch- vestibular neuritis- inflammation of the branch causing vertigo (false sense of surrounding) & nystagmus (vibration of eye) , damage to both branches due to inflammation of membranous labyrinth (labrynthitis) causing tinnitus
29
origin and supply of glosopharyngeal nerve
medulla oblangata , posterior 1/3 tongue, soft palate, palatine tonsils, fauces, pharynx
30
what can damage the glosopharyngeal nerve and what can it cause
glosopharyngeal neuralgia- sharp stabbing in back of throat, tongue, tonsils and middle of ear, loss of taste, gag reflex and impaired swelling , dry mouth (impairment of parotid gland) , caused by neurovascular compression of nerve trauma, surgery, tumour, infection
31
origin, function and supply of vagus nerve
motor function: gastatory (rate buds around epiglottis), visercal (smooth muscles and glands) , origin- medulla (oblongata), sensory function: supply skin of back of eye & external acoustic meatus, epiglottis mucous mem, palate lower pharynx and larynx
32
origin and supply of accessory muscle
origin- 5-6 craninal segments of spinal cord, supply- trapezius (back) & sternocleidomastoid muscle, muscle of soft palate (motor)
33
damage to accessory muscle can cause
shoulder pain, weakness, limited upper arm movement- caused by neck/head trauma, tumour/carotid or internal jugular vein surgery + penetrating (knife) and blunt (pressure) trauma
34
origin and Function of hypoglossal nerve
origin- medulla oblangata, motor to intrinsic and extrinsic tongue muscles, speaking and swallowing
35
damage to hypoglossal nerve can cause
wasting and deviation of tongue on affected side- difficulty in eating, speaking. caused by neck/head injury
36
what does the opthalmic branch of the the trigeminal nerve supply
conjunctiva, cornea , eyeball and orbit, forehead , ethmoid sinuses , frontal sinuses , portions of Dura mata
37
what is the opthalmic branch divided into (select 3)
frontal branch , nasociliary branch , lacrimal branch
38
what does the maxillary branch pass through after exiting through foramen retundom
pterygopalatine fossa
39
what nerves does the maxillary branch divide into
zygomatic nerve , infraorbital nerve , posterior superior alveolar nerve , pterygopalatine nerves- greater, lesser palatine and nasopalatine
40
what does the zygomatic nerve go through and what does it innervate
through zygomaticofacial foramen and innovates the skin of check
41
what does the infraorbital fissure go through to leave the orbital
infraorbital foramen
42
what does the infra orbital nerve spilt into
posterior superior alveolar nerve- buccal gingiva and pulp of molars , middle superior alveolar nerve- premolars and mesiobuccal root of 1st molar , anterior superior alveolar nerve- incisors and canine
43
what does the posterior superior alveolar nerve leave through and what does it supply
leaves throygh pterygopalatine fossa through pterygomaxillary fissure , supplies buccal gingiva and pulp of molars (not the mesiobuccal root of 1st molar)
44
what does the grater palatine nerve pass through and supply
passes though greater palatine canal and foramen, supplies most of mucosa, hard palate and palatal gingiva except near the incisive papilla (4-8 only)
45
what does the lesser palatine nerve pass through and what does it supply
passes through greater palatine canal and lesser palatine foramen, supplies soft palate
46
what does the nasopalatine nerve pass though and what does it supply
through sphenopalatine foramen to enter nasal cavity and incisive canal on hard palate, supplies nasal septum, mucosa around anterior teeth
47
what are the branches of he Mandibular nerve before it leaves skull (2)
meningeal branch- supplies dura mater, medial pterygoid nerve
48
what are the nerves of the larger posterior trunk of Mandibular nerve
auriculotemporal nerve- above & in front of ear , lingual nerve- 2/3 dorsum of tongue, FOM, lingual gingiva of Mandibular teeth, inferior alveolar dental nerve- pulp of Mandibular teeth, mylohyoid nerve- mylohyoid muscle & anterior belly of digastric muscle
49
what are the nerves of the smaller anterior trunk of Mandibular nerve
long buccal nerve- skin of cheek, gingiva of Mandibular posterior teeth , lateral pterygoid nerve- lateral pterygoid muscle, deep temporal nerve- temporalis muscle , masseteric nerve- masseter muscle
50
where does the facial nerve originate from
from the pons of the brainstem
51
the facial nerve has 2 roots- one large motor root and one small sensory root
true
52
what does the facial nerve go through to exit the facial canal
sylomastoid foramen
53
what does the facial nerve enter through to enter the facial canal
internal acoustic meatus
54
what 3 branches does the facial nerve have before leaving the facial canal
greater petrosal nerve- mucous glands of nouse, paranasal sinuses, palate, lacrimal glands (tear), nerve to staledius- stapedius muscles (middle of the ear to dampen nosies), chords tympani- travels with lingual nerve for taste sensations to anterior 2/3 of tongue and fibres of submandibular & sublingual glands
55
what are the extracranial branches of the facial nerve (when it’s left the cranium and now in the facial canal)
posterior auricular nerve- intrinsic & extrinsic muscles of outer ear and occipitalis part of occipitofrontalis muscle , posterior belly of digastric muscle , stylohyoid muscle
56
the facial nerve (when outside of the cranium) passes through the parotid gland and terminates into what 5 branches in order
temporal branch , zygomatic branch , buccal branch, marginal Mandibular branches, cervical branches
57
damage to the facial nerve due to intracranial lesions (that occur proximal to sylomastoid foramen) can cause
infection to external/ middle of of the ear , stroke , paralysis of facial expressions , damage to chords tympani causes taste loss and dry mouth, reduced lacrimal fluid due to greater petrosal never causes dry eye
58
damage to the facial nerve due to extracranial lesions (that only affect motor function as facial nerve has exited stylomastoid foramen) can cause and is caused by
caused by- tumour, paratosis, surgery, caused by- infection to nerve (herpes virus) , caused by- idiopathic (no definitive cause) called Bell’s palsy , caused by- LA , causes paralysis of facial expression
59
what does the infraorbital nerve anaesthetise
pulp of maxillary 1-5 , mesiobuccal root of the 6 in 72% , overlying buccal peridontium and bone , lower eyelid, lateral aspect of the nose and upper lip in the side it’s injected
60
what does the posterior superior alveolar nerve block anaesthetise
pulp of maximally molars , mesiobuccal root of the 6 is no anaesthetised , buccal periodontium and bone overlying these theeth
61
what does the middle superior alveolar nerve block anaesthetise
pulp of maxillary premolars , mesiobuccal root of the 6 , buccal periodontium and bone of these teeth
62
what does the greater palatine nerve block anaesthetise
posterior hard palate and underlying soft tissue , palatal gingiva from 4-8 , palate from midline to the palatal gingiva of posterior teeth
63
where should you aim for a greater palatine nerve block
at the greater palatine foramen (adjacent to the maxillary 3rd molar)
64
what does the nasopalatine nerve block anaesthetise
soft tissues of the anterior position of hard palate (palatal gingiva of anterior teeth) , bilateral from 3-3
65
what does the anterior middle superior alveolar nerve block anaesthetise
pulp of the maxillary incisors, canines and premolars of the side of injection (1-5), buccal gingival of 1-5 , palatal gingiva and palatal soft tissues to the midline of the palate
66
what does the maxillary nerve block anaesthetise
pulp of all maximally teeth on the side of injection, buccal periodontium and bone overlying all the teeth on side of injection , soft tissues and bone of hard palate and part of soft palate to the midline , skin of lower eyeline, side of nose, check and upper lip on side of injection
67
to anaesthetise the upper 6 what blocks do we give
posterior superior alveolar NB , greater palatine NB, middle superior alveolar NB (to get the mesiobuccal root of 6)
68
to anaesthetise the canine what blocks do we give
nasopalatine NB , infraorbital nerve block
69
what does the inferior alveolar nerve block anaesthetise
the pulp of all the Mandibular teeth on side of injection, buccal gingiva from 1-5 , lip (of the incisal area) , the tongue
70
what blocks do you need to give for anaesthetising the 6
Inferior alveolar never block, buccal block
71
what does the incisive block anaesthetise
pulp of 1-5 , buccal gingiva of 1-5 , lip from 1-5
72
what is the pulpal and soft tissue anaesthesia for lidocaine and epinephrine
pulpal- 45 min, soft tissue- 3+ hours
73
what is the pulpal and soft tissue anaesthesia for prilocaine + felypressin
pulpal- 30-45 min, soft tissue- 2 hours
74
what is the pulpal and soft tissue anaesthesia for articaine and epinephrine
soft tissue- 3-4+ hours , pulpal- 75 mins
75
what is the pulpal and soft tissue anaesthesia for mepivacaine
pulpal- 20 mins, soft tisse- 1 hour
76
what is the pulpal and soft tissue anaesthesia for bupivacaine
pulpal- 4 hours , soft tissue- 6-8 hours
77
max dose, max number of 2.2ml cartridges for adult and child for lidocaine
max dose- 4.4 , max no. for adult- 6.8, max no. for child- 2.0
78
max dose, max number of 2.2ml cartridges for adult and child for prilocaine
max dose- 5.0, max no. for adult- 6.0, max no. for child- 1.8
79
max dose, max number of 2.2ml cartridges for adult and child for mepivacaine
max dose- 4.4, max no. for adult- 4.5, max no. for child- 1.3
80
max dose, max number of 2.2ml cartridges for adult and child for articaine
max dose- 7.0, max no. for adult- 5.0, max no. for child- 1.5
81
what are the main cautions/ contraindications/ precautions for the LA drugs
myocardial infarction (heart attack, stroke) , heart failure (or have had a stroke in the past) , irregular heartbeat , blood vessel problems e.g valvular heart disease, blood pressure problems or on medications for it e.g, beta blockers , epilepsy , kidney or liver problems
82
anaemia/ blood disorders is a caution/contraindication for what LA drugs (2)
prilocaine , mepivocaine
83
breathing problems is a caution/contraindication for what LA drug
prilocaine
84
uncontrolled diabetes is a caution/contraindication for what LA drugs (2)
lidocaine , articaine
85
what do you need to check on the cartridge
right prescribing according to pt MH , expiration date , cloudy of white- means it’s been exposed to sunlight , air bubbles , scratches or cracks- due to transportation or bad handling , recheck these after assembling it
86
what injections do you need to give for sub PMPR on UL 67
posterior superior alveolar NB, middle superior alveolar NB, greater palatine NB between the 6 and 7
87
what injections would give for sub PMPR of LL6
ID block , long buccal infiltration
88
what injections would you give for sub PMPR on UL 123
buccal infiltrations on the 1 and 3 , nasoplatien NB
89
what injections can you give to anaesthetise the lower anterior teeth
incisive block, ID block
90
what are contents of LA cartridge
analgesic agent/ LA drug, vasoconstrictor- epinephrine or felypressin, reducing agent- sodium metabisulphate , vehicle- sterile saline
91
what are cautions for when patient can’t be given Adrenaline/epinephrine
contraindication- cocaine in last 24 hrs, tricyclic antidepressants, beta blockers , calcium channel blockers , diuretics , cardiac conditions, hypertension , circulatory issues (including previous strokes)
92
after giving LA what do we need to document on pt records on EPIC
type of LA agent and vasoconstrictor , amount of solution administered , site of injection, any usual effects, post operative instructions given verbally (POIV)
93
what are the complications of LA
failure to get numb, pain during the injection, bleeding, lip/soft tissue trauma , visual disturbances, skin blanching , intravascular injection and local haemotoma (blood clot), prolonged impairments of sensation, infection, trismus, facial paralysis (IDB), needle breakage
94
what are complications of general anaesthesia
fainting, toxicitysensitivity reaction, drug interaction, cardio-respiratory emergencies
95
when giving a buccal and palatal infiltration how much do you need to insert, and for a palatal infiltration at what angle do we insert at
palatal- 90 degree with the tip facing more diagonally towards the back of the mouth and about less than 2mm, buccal- 2mm
96
technique for IDB in order
pt supine/upright, lighting, 35mm, 27 Gauge needle, use 3 fingers to hold the ot head in place (positioning of fingers will be different depending on which side you’re injecting) , place thumb on the external oblique ridge to retract , use thumb to locate retromolar fossa (the bony curved area), look for the crease between the the pterygomandibular raphe and the external oblique ridge , to inject go 1mm above the middline of the thumb and 1cm above the occlusal plane to inject into the crease (pterygomandibular space), position syringe on the controlateral premolars, insert needle smoothly and slowly keeping syringe bevel to bone and parallel to upper arch, insert about 2-2.5cm until bone is contacted (never insert the full needle 5mm-10mm should always be visible) , withdraw 1mm and aspirate , inject the solution (usually the full cartridge) then withdraw quickly and smoothly, make needle safe. when exiting make sure to keep pushing plunger to get the lingual nerve
97
label 1-10 in the pterygomandibular space
1- pterygomandibular raphe, 2- masseter muscle , 3- internal oblique ridge , 4- medial surface of ramus of mandible, 5- inferior alveolar nerve , 6- facial nerve , 7- parotid gland , 8- medial pterygoid muscle, 9- sphenomandibular ligament , 10- lingual nerve
98
label 1 and 2
1- pterygomandibular raphe, 2- external oblique ridge
99
label 1-3
1- mandibualr foremen and canal, 2- external oblique ridge , 4- internal oblique ridge