Last OSCE Study Guide Set

Articular disk of TMJ

Temporomandibular joint

a joint one each side of the head that allows for movement of the mandible for mastication, speech, and respiratory movements

TMJ is innervated by

Innervated by cranial nerve V (Trigeminal)

articular eminence

Raised portion of the temporal bone just anterior to the glenoid fossa.

What is this?

Articulating disc or meniscus is comprised of

dense fibrous connective tissue

articular fossa

depression on the inferior aspect of the temporal bone

what is this?

Completely closes the TMJ

joint capsule

Movements of the TMJ:

depression, elevation, protraction, retraction, lateral deviation

Temporomandibular disorder (TMD)

a group of conditions affecting the (TMJ) and the muscles controlling jaw movement.

Patients with TMD may experience

chronic joint tenderness, swelling, difficulties in moving the joint, and painful muscle pains.

TMJ pain comes from

originates from one of the surrounding soft tissues, pain causes a reflex to limit the mandible's movement

TMD Acute Episode

can occur when a patient opens too wide which causes subluxation

Subluxation of TMJ

partial dislocation of both joints, occurs when the head of each condyle moves too far anteriorly past the articular eminence

Crepitus of TMJ

joint noise, generally indicates joint damage (disc tear, and/or bone to bone contact)

cranial nerve I

Olfactory, sense of smell, sensory

Cranial nerve II

Optic - vision, sensory

Cranial nerve III

oculomotor, moves eye muscles, motor

Cranial nerve IV

Trochlear - motor: eye movement

Cranial nerve V

Trigeminal, mixed, facial/teeth sensation and muscles of mastication

Cranial nerve VI

Abducens, Motor, Lateral movement of the eye

Cranial nerve VII

Facial, mixed, facial expressions and taste

Cranial nerve VIII

Vestibulocochlear, sensory, hearing and balance

Cranial nerve IX

Glossopharyngeal, mixed, controls pharynx muscles, taste

Cranial nerve X

the vagus nerve, both, muscles of the soft palate and abdominal organs

Cranial nerve XI

accessory, motor, moves neck muscles

Cranial nerve XII

Hypoglossal, motor, tongue movement

trigeminal neuralgia

inflammation of the 5th cranial nerve characterized by sudden, intense, brief attacks of sharp pain on one side of the face

NO KNOWN ETIOLOGY

Bell's Palsy

Unilateral facial paralysis with no known cause.• A loss of excitability of the facial nerve, is idiopathic

local infiltration anesthesia

anesthetizes a small area

nerve block anesthesia

affects a larger area than local infiltration

Area does anesthesia tend to be more successful in

maxilla due to it being less dense and having less variation

PSA Maxillary Block

posterior superior alveolar block

completed to anesthetize the maxillary molars on one side of the mouth, but the mesial buccal cusp of first molar may need a MSA block

MSA Maxillary Block

Middle superior alveolar block

anesthetizes the pre-molars on one side and buccal side of the mesial cusp of the first molar

NP Maxillary block

Nasal Palatine Block

anesthetize the anterior hard palate from canine to canine

GP Maxillary block

Greater Palatine Block

anesthetize the posterior portion of the hard palate from the premolar through the molars on one side

PSA injection site

muccobuccal fold at the apex of MX 2nd Molar

MSA injection site

height of mesiobuccal fold at the apex of the maxillary second pre-molar

ASA Maxillary Block

anterior superior alveolar block

anesthetizes anterior teeth on one side

ASA Maxillary injection site

apex of the canine, parallel with the canine emine

GP Maxillary injection site

palatal tissue anterior to the greater palatine foramen, use pressure anesthesia to cause blanching.

Blanching in the tissue in a GP site

helps a little bit with the discomfort of the palatal injection and to feel the depression of the greater Palatine foramen

NP Maxillary injection site

palatal tissue lateral to the incisive papilla

IA Mandibular Block

used to anesthetize almost all of the tissue and teeth on one side of the mandible. Except for the buccal mucosa of the mandibular molars

IA injection site

3 quarters of the way between the coronoid notch and the pterygomandibular fold, and you're going to be coming across from the opposite premolar

Buccal Block

Mandibular Molars buccal

buccal block injection site

the buccal fat pad, just distal and buckle to the terminal molar

mental block

anesthetize the mandibular premolars and anterior teeth and associated buccal tissue

Mental Block Injection Site

anterior to mental foramen at depth of mandibular mucobuccal fold

lympatic vessels

A network of vessels that carry lymph throughout the body

Lymph

colorless fluid that is part of the body's immune system

lymph nodes

Small, bean-shaped structures distributed throughout the body that filter lymph and house immune cells (like lymphocytes) to fight infection

Afferent Lymphatic Vessel

Lymphatic vessels that carry lymph to a lymph node

efferent lymphatic vessels

Lymphatic vessels that carry filtered lymph away from the lymph node

palatine tonsils

tonsils that are located on either side of the throat

lingual tonsils

located at the base of the tongue

Pharyngeal Tonsil (Adenoids)

Located in the upper part of the throat, behind the nose

Odontogenic Infection

infection that originates in the teeth or jawbone

abscess

localized collection of pus caused by infection

Fistula

abnormal passage

stoma

an opening

Cellulitis

diffuse inflammation of soft tissue spaces

supperation

pus

Odontogenic infection can spread to

to the paranasal sinuses or can be spread by the vascular system, lymphatic system, or spaces in the head and neck

bacteremia

Bacteria traveling in the vascular system

Ludwig angina

is cellulitis of the submandibular space, with a risk of spreading to the parapharyngeal space and then onto the retropharyngeal space of the neck

"Danger space" of the neck

the retropharyngeal space, becomes involved with edema of the larynx there can be complete respiratory obstruction,asphyxiation, and death

Thus, Ludwig angina is ____ medical emergency

acute

Piercing causing possible infection

tongue piercing

hilus of lymph nodes

depression where vessels and nerves enter an organ

lymphatic ducts

drain tissues of body and move lymph into major veins

5 groups of paired superficial lymph nodes in the head:

the occipital, retroauricular, anteriorauricular, superficial parotid, and facial

occipital lymph node location

posterior base of the head

retroarticular lymph node location

located posterior to each auricle

anterior auricular lymph node location

in front of the ear

superficial parotid lymph node location

located just superficial to each parotid salivary gland

facial lymph node location

located along the length of the facial vein

four facial node subgroups

malar, nasolabial, buccal, and mandibular

Deep parotid lymph node location

located deep within the parotid salivary gland

retropharyngeal lymph node location

posterior to the pharynx, palate,paranasal sinuses, and nasal cavity

4 groups of superficial cervical lymph nodes include:

submental, submandibular, external jugular, and anterior jugular.

AKA Adenoids

The pharyngeal tonsil

pustule

elevation of skin containing pus

perforation

an abnormal hole in the wall of the sinus

Muscle that pulls the condyle of the mandible forward for opening

lateral pterygoid muscle

3 branches of the cranial nerve

Opthalmic (V1), Maxillary (V2), and Mandibular (V3)

Lymphadenopathy

Swelling of the lymph nodes, which can indicate infection

Management of Odontogenic Infections

Antibiotics, Incision and Drainage, and Surgical Intervention

inferior synovial cavity

under the articular disk

superior synovial cavity

above the articular disk

considered the tonsillar node

the jugulodigastric lymph node

Palpatable nodes

superficial ones

Unpalpatable nodes

deep ones

Acute symptoms

abscess plus draining, pain

chronic symptoms

no drainage, an abscess but no fistula

Health Implications of Bacteremia from Oral Sources

sepsis risk, infective endocarditis, Systemic Inflammation, and Chronic Conditions

Hinging motion of mandible provides

elevation and depression

Gliding motion of mandible provides

protrusion and restrusion