Transcript DENTAL GROSS ANATOMY CASE 2.1 History A 36yo woman slept

DENTAL GROSS ANATOMY
CASE 2.1
History
 A 36yo woman slept near an open window on
a cold drafty night.
 Upon awakening she noticed that her face
was distorted.
 She was not able to close her right eye and
she had difficulty speaking, eating (but not
swallowing) and drinking. Additionally, her
sense of taste was impaired.
 She consulted her physician.
Examination
 Examination reveals that the patient’s face is
immobile and without expression on the right
side.
 Right forehead is without wrinkles and right
eyebrow droops.
 Right lower eyelid sags and tears flow down
her face.
 Right corner of her mouth sags, and she cannot
purse her lips.
 Nose and mouth are deviated toward the
unaffected side.
 When attempting to laugh, the facial distortion
becomes more noticeable.
Diagnosis, Therapy and Further Course
 A diagnosis was made.
 Therapy included electrical stimulation,
massage and active exercises of the facial
muscles.
 After five weeks the patient was almost
completely recovered and only traces of the
paralysis could be seen.
1a. What is the diagnosis?
b. What major structure
was affected?
PEOPLE AFFLICTED WITH BELL’S PALSY
(DAMAGE TO FACIAL NERVE)
2. What is (are) the underlying
cause(s) of this condition?
VII. FACIAL N.
VII entering
internal auditory meatus
VII in facial canal
of temporal bone
VII
Posterior auricular a.
( supplies VII)
3a. What is the name of the foramen
by which this major structure
leaves the base of the skull?
b. Name the five terminal branches
of this structure.
Stylomastoid foramen
(exit of VII)
Temporal branches
Zygomatic branches
Posterior
auricular n.
(to occipitalis m.)
Main trunk of VII
TO ZANZIBAR BY MOTOR CAR
Buccal branches
Marginal mandibular branch
Cervical branch
4a. Why were wrinkles absent from
the patient’s forehead and why
did the right eyebrow droop?
b. Why was the patient unable to
purse her lips and why did
liquids run out of the corner of
her mouth when she tried to
drink?
Frontalis m.
Orbicularis oris m.
4c. Paralysis of which muscle
resulted in food collecting in
the vestibule of the patient’s
mouth? What is the anatomical
origin of this muscle? What is
its embryological origin? Is it
a true muscle of mastication?
Buccinator m.
Pterygoid hamulus
Buccinator m.
Pterygomandibular raphe
Superior pharyngeal constrictor m.
Mandible
Buccinator also originates from
alveolar processes of maxilla
and mandible
PHARYNGEAL ARCH MUSCLES
V3
VII
IX
X
X
Muscles of mastication: Arch 1
Muscles of facial expression: Arch 2
(INCLUDING BUCCINATOR)
4d. Why couldn’t the patient close
her right eye? What serious
complication might be the
result?
Orbicularis oculi m.
(palpebral part)
Orbicularis oculi m.
(orbital part)
5. In this patient there was sagging
of the lower eyelid and spilling of
tears down the side of her face.
What is the pathway by which
tears normally drain from the
conjunctival sac?
Superior lacrimal papilla and punctum
Lacrimal gland
(orbital part)
Lacrimal gland
(palpebral part)
Ducts of lacrimal gland
(open into superolateral
part of conjunctival sac)
Lacrimal canaliculi
Lacrimal sac
Nasolacrimal duct
Opening of nasolacrimal
duct (into inferior meatus
of nasal cavity)
Inferior lacrimal papilla and punctum
6a. Why did this patient experience
impairment of taste?
b. Where, precisely, was the loss
of taste sensation?
COURSE OF VII IN FACIAL CANAL
Int. auditory meatus
VII in facial canal
of temporal bone
Nerve to stapedius m.
(paralysis > hyperacusis)
Geniculate ganglion (sensory)
Greater petrosal n. (autonomic to lacrimal gland)
Pterygopalatine ganglion
(autonomic)
Stylomastoid for.
Chorda tympani n. (autonomic to submandibular
& sublingual glands, taste from ant. 2/3 of tongue)
Submandibular ganglion (autonomic)
Branches to muscles
of facial expression
Additional note:
According to Moore & Agur
(Essential Clinical Anatomy),
VII is the most frequently
paralyzed cranial nerve.
END OF CASE 2.1
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