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OMFS exam 5 - L1-3

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oeshnoeugo123's version from 2018-02-26 04:10

Tx of cleft

Question Answer
 Bilateral cleft palatecan look through into center of the nasal septum & vomer, communication w/ nasal cavity
cleft palate onlyonly type of cleft problem that has a female predilection
4th wk-paired mandibular processes fuse
 Tongue develops from 1st branchial arch (anterior 1/3) & 3rd branchial arch (posterior 1/3) – mandible formed from the mandibular processes
5th wkmedial & lateral nasal processes arise from the nasal placode & the nasal pits (nostrils) – lateral nasal processes & maxillary processes fuse (epithelial remnant becomes the nasolacrimal duct), eyes develop
6-7th wkpaired medial nasal processes fuse to form the intermaxillary segment (philtrum, primary palate, alveolus, & incisor teeth)
 Medial nasal processes fuses w/ the maxillary process to form the upper lip
 Lateral nasal process moves superiorly & becomes alar of the nose
 Cleft lip → when there is no fusion between median nasal process & maxillary process – can go further & become cleft alveolus
6th wkmaxillary & mandibular processes fuse to form corners of the mouth – lateral palatine processes develop from maxillary process
• The face broadens by 2/3 – ears develop
7th wkexternal face acquires a more normal appearance – lateral palatine processes grow medially & then down along the tongue
• Tongue is high & narrow in the midline
8-12wksmaxilla formed from
-frontal prominence
-median nasal processes
-lateral nasal processes
-maxillary processes
secondary palate fuses 1st
then primary palate
what fuses first?
-primary palate?
-secondary palate?
2ndary palatemass of tissue that forms from the fusion of the bilateral lateral palatine shelves
primary palatemass of tissue arising from the medial nasal process, contains the 4 incisor teeth
cleft lip &/or alveoluswhat cleft forms at junction of:
-median nasal process (primary palate)
-maxillary process
push back palatoplastymost frequently used technique for cleft PALATE
pharyngeal flapmost popular method for VPI (velopharyngeal incompetence
<2yrs oldprimary bone grafting - @ what yr age?
2-5yrs oldearly 2ndary grafting - @ what yr age?
6-12yrs old (prior canine eruption) - supernumerary teeth extracted at least 6-8wks prior2ndary grafting - @ what yr age?
adult agelate 2ndary grafting - @ what yr age?
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Section

Question Answer
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aabb
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Neuropathology

Question Answer
trigeminal neuralgiasevere pain followed by
-DULL ache
trigeminal neuralgiao Light touching stimulates the problem (specific trigger zone) – patients will pull away/withdraw from you when you try to touch them, avoids stimulating the pain
trigeminal neuralgia Severe, sharp, electric-like, excruciating pain
 Duration  a few seconds – may be followed by a dull ache
 Specific trigger zone which may be stimulated by touching, shaving, talking, etc. – Patient often withdraws from the examiner’s hand to avoid stimulating the pain
 Usually unilateral; mandibular or maxillary branch of trigeminal nerve more frequently involved than ophthalmic branch
 Older age  older than 50
 The pain can be temporarily blocked by a local anesthetic block of the involved area
 There are no sensory or motor nerve deficits in the involved area
 Patients w/ multiple sclerosis are more likely to develop tic douloureaux
trigeminal neuralgiaa neurologic exam & MRI of the brain & brainstem are done to rule out a central (brain) lesion
• Dilantin (Phenytoin)  works very well but does not stop pain 100% (100 mg 4x/day)
• Tegretol (Carbamazepine)  stronger drug than Dilantin w/ more problems, used more frequently when problem is minor & not life-threatening – also shows side effects of aplastic anemia, agranulocytosis, thrombocytopenia (decrease in platelets)
• Baclofen
• Clonazepam (same category as Midazolam)
• Neurontin  used for Supra-tentorial pain (pain of your brain)
Tx - Drug therapy for trigeminal neuralgia
Jannetta Procedure for Trigeminal NeuralgiaMRI leads to diagnosis – rather major & delicate operation where neurosurgeon goes into base of skull & if MRI has showed an area where a vascular anomaly exists (ex. aneurysm or bulging/pushing of internal carotid a. onto CN V at base of skull), then artery & nerve are separated & foreign body placed between (so artery does not push on brain)
o Material placed between Epineurium of Trigeminal n. & vascular anomaly over it pulsating (usually a branch of internal carotid a. or aberrant branch of another a.)
o Only sx that offers complete pain relief w/o sensory loss (only surgical procedure that does this)
o CN V-VIII come off the brainstem at the Pons or Medulla
Glossopharyngeal Neuralgia Duration  a few seconds
 Older age patients
 Trigger zone may be difficult to locate, often is in the pharynx (way back)
 In an attempt to avoid triggering the pain, the patient may not eat, or not swallow his saliva & therefore drool
 Patients communicate awkwardly due to avoidance of pain
Glossopharyngeal Neuralgia Anatomically the tic-like pain emanates from the area. posterior 1/3 of the tongue & pharynx
• Severe electric-like pain
Glossopharyngeal NeuralgiaTx for what Neuralgia?
-Dilantin
-Tegretol
-alcohol injection
-peripheral neurectomy of CN IX
Sphenopalatine Neuralgiaaka pterygopalatine Neuralgia
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