Orofacial Anatomy and Clinical Examination – Study Guide and Exam Practice Material

pg. 1 Orofacial Exam 2 No ____ and no ___opening in the beginning oral; anal stomodeum The external depression which finally breaks through to establish the oral opening into the foregut the topographical center of the developing facial structures oral plate two layered membrane where the stomodeal depression is deepened, and the ectodermal (outside) floor comes to lie against the entodermal (inside) lining of the foregut head of a young embryo is pressed against its __________ thorax frontal prominence a rounded elevation in the midline, above the stomodeum nasal (olfactory) placodes local thickenings of the ectoderm on either side of the frontal prominence, near the lateral margins of the overhanging frontal prominence destined to form the lining of the nasal pits horse shoe shaped pg. 2 Orofacial Exam 2 During the _____ week all the major structures involved in the formation of the face and jaws become clearly distinguishable fifth The upper jaw is of ______ origin (maxillary process) composite (multiple pieces) the nasal pits bordered by the nasal placodes Later become nares They appear to have sunk below the general surface nasomedial processes The medial limbs of the nasal placode around the nasal pits nasolateral processes lateral limbs of the nasal placode around the nasal pits pg. 3 Orofacial Exam 2 _______ become center part of your upper lip, important feature in the coming together of the upper jaw Nasomedial processes _________ becomes alar cartilage at the side of your nose, looks like gull wing (ala means wing) Nasolateral processes The nasomedial processes play an important part in the formation of the medial portion of the ________, ______, and ________. upper jaw, lip, and palate (Philtrum, Premaxilla, Columella) maxillary processes Grow toward the midline from the upper lateral angles of the oral cavity destined to form the lateral parts of the upper jaw Eventually comes together with nasomedial process nasal fin Juncture between nasomedial process and maxillary process intermaxillary segment all of the upper oral arch, which is of nasomedial origin pg. 4 Orofacial Exam 2 three components of the intermaxillary segment: 1) the labial component- the medial portion of the upper lip or prolabium (philtrum) 2) the gnathogingival (jaw-gum) component within which will develop the portion of the upper jaw carrying the incisor teeth (alveolar process of the premaxilla) 3) the hard palate component or primary medial palatal triangle (process) (the rest of the premaxilla). prolabium philtrum gnathogingival (jaw-gum) component alveolar process of the premaxilla medial palatal triangle (process) the rest of the premaxilla medial palatal primordium is continuous with the most anterior portion of the ________ nasal septum nostrils (external nares) and posterior nares (nasal choanae) the downward extension of the original pits themselves which, during the sixth week, break through into the upper part of the oral cavity the external openings of the nasal pits the formation of the palate elongates the _______ backward nasal chambers _________ as it comes from above, comes from frontal prominence downward and fuses with intermaxillary segment (premaxilla) and also the rest of the hard palate pg. 5 Orofacial Exam 2 Nasal septum the ______ layers of the nasomedial processes and the maxillary processes become adherent to each other to form an epithelial plate known as the nasal fin epithelial All of the features of the face are put together/formed by ___ weeks; Not everything is in the right place though 8 Result of nasal fin epithelium breaking down: removal of the epithelial barrier between the nasomedial and the maxillary processes makes their mesenchymal components continuous and thereby paves the way for their growing together (fusion) Nasal fin is the line of fusion between what two processes nasomedial processes and maxillary processes the nasal fin continues until the ________ incisive foramen If nasal fin doesn't fuse, either front to back or up and down, you will have a category called ______ cleft lip primary palate premaxilla the premaxilla/primary palate portion of the palate is contributed to by the ________ nasomedial processes main part of the _____ is derived from the portion of the upper jaw which arises from the maxillary processes (fusing with each other, behind the incisive foramen) palate secondary palate pg. 6 Orofacial Exam 2 Shelf like outgrowths of the maxillary processes that arise on either side, and grow toward the midline When the palatal shelves first start to develop, the ______ lies between them tongue As development progresses, the position of the tongue is shifted downward and the margins of the palatal shelves are free to swing _______ upward and toward the midline The change in the relations between the ____ and the _________ is crucial for the completion of the palate tongue; palatal shelves If tongue doesn't move away as the palatal shelves come together, _______ will form cleft palate Pierre Robin primary feature is microanathia (tiny lower jaw) Isolated cleft palate because tongue can't get out of the way Treat by distraction- you cut the jaw and start pulling apart micro meter by micro meter it will lay down new bone between the gap and fill it in and make the bone longer maxillary processes are originally pointed ______ with the tongue in between them downward Fusion of the palatal shelves progresses from the ______ toward the ____ front part; uvula (Front to back) Cannot have a cleft of the hard palate without a cleft of the ________ soft palate At the same time that the palate is thus being formed, the ________ grows downward toward it and soon becomes fused to its upper face nasal septum pg. 7 Orofacial Exam 2 separation of right and left ________ from each other is accomplished at the same time that the nasal region as a whole is separated from the oral (inverted T) • First it is fused with premaxilla and then the maxillary shelves nasal chambers Fusion of the lip comes from the fusion of _______ and __________ primordia While fusion of the palate comes from _______ to _________ primordia nasomedial; maxillary; maxillary; maxillary Maxillary processes responsible for: o All the rest of the alveolar process (not incisors) o Palatal processes of maxilla o Palatal processes of palatine bone o Entire soft palate Unilateral only on one side, left or right Bilateral on both sides Complete cleft lip cleft extends into the nose, open communication between oral and nasal cavity (picture: incomplete, unilateral complete, bilateral complete) Incomplete cleft lip cleft does not extend into the nose cleft doesn't extend vertically through the entire floor of the nose Symmetrical cleft Refers to bilateral cleft- it is the same on one side as the other Asymmetrical cleft pg. 8 Orofacial Exam 2 Refers to bilateral cleft- it is not the same on one side as the other (ex. incomplete cleft on one side and complete on the other) Incomplete cleft palate looks like a ditch on the roof of your mouth fused okay up above but not below Bilateral cleft palate if two palatal shells on either side of the vomer do not articulate with the vomer Unilateral cleft palate if one shell articulates with the vomer but the other doesn't Submucous cleft palate where oral epithelium and nasal epithelium have fused but stuff in the middle didn't (bone and muscle didn't fuse in the middle [sandwich with no meat]) Median cleft two nasomedial processes not joining eachother, absent part of the middle upper lip and premaxilla What happens to levator muscle with cleft palate they can't meet their neighbor from the other side (contralateral half), so both sides turn and insert into back edge of hard palate Identifying features of submucous cleft -Absent posterior nasal spine, instead there is a notch that points anteriorly which you can feel -Looking in roof of mouth and shine a light, right in the middle there's going to be a blueish color because light is penetrating through- zona pellucida (no muscle to make it solid) -A-shaped appearance of levator when you say ah, attached to the back of the hard palate, contracts and bulges out -Bifid uvula- but that doesn't necessarily mean they have a cleft Occult sub mucous cleft No cleft, no bifid uvula, nasal spine is there, no zona pellucida But when you ask them to say ah you get the A shape of the levator Causes of Cleft lip/palate 1. Multifactoral inheritance 2. Chromosome Abnormalities pg. 9 Orofacial Exam 2 3. Genetic Mutation 4. Environmental Teratogens Multifactorial inheritance Cleft tends to be inherited but there are a lot of factors within the inheritance umbrella because there are a number of factors it does not follow the simple (mendel/genetics) laws that we learned in biology environmental teratogens agent that causes master like deformities in the developing embryo (Rubella, thalidomide) Velocardiofacial syndrome/DiGeorge syndrome Chromosome 22 deletion Velo- somethings wrong with the velum (cleft) Cardio- heart problems Facial- muscle weakness of the face and oral structures (Infraorbital hypoplasia- under eyes, cheek bones really flat, appear to have down turned appearance) Cruzan syndrome cranial stenosis; mid third of face is deformed, eye orbits are shallow (frog-like appearance), normal intelligence Has cleft associated with it Genetic mutation 14% syndrome related in ____ 17% syndrome related in isolated ____ CL/P; CP Increased incidence in siblings of _____ patients but not in ______ alone CL/P; CP Monozygotic twins Identical- came from one egg If one of the twins has a cleft, the other one will also have a cleft 42% of the time Dizygotic twins If one of them has a cleft the other will have a cleft 7% of the time Twice as likely to have a cleft on the _____ side over the ___ side left; right pg. 10 Orofacial Exam 2 (CL/P) Cleft lip with or without palate occurs twice as often in ____ males Isolated CP Twice as often in ______ females with a cleft lip what happens to the alar cartilage flattened alar cartilage on the cleft side incidence rate of clefting in US 1 in 750 live births (.1% of the population) Highest incidence and lowest incidence in what populations highest- Asians and Native Americans (1:500) lowest- African Americans (1:2000) Rule of "over 10's" Over 10 pounds Over 10 gms hemoglobin (red blood cells) Over 10 weeks old WBC less than 10,000 (white blood cell count) [About 2.5-3 months] Goals of Cleft Lip Repair Approximation of cleft edges Maintenance of natural landmarks Cupids bow Philtral dimple Muscle approximation Alar base balance and symmetry Scar in natural lines Palate Repair Considerations Feeding and swallowing Speech development vs. maxillary growth -closure too early can result in maxillary growth arrest Closure in this country is generally between 9 months and 18 months with the average being around 12 months pg. 11 Orofacial Exam 2 Von Langenbeck Process (1859) A. Injecting epinephrine into the site that they are going to close to control the bleeding B. Take a scalpel and freshen the edges of the cleft (aka cut away edge and expose raw under surface) C. Relaxing incisions- Incision starts at about where canine would be, so canine to molar incision (cut through mucous membrane layer and tissue and then periosteum of the bone to get to the bone properly) C. Dotted lines by premaxilla and posterior edge of hard palate- take a blunt instrument and lift periosteum off the bone D. Then you sew nasal mucosa to nasal mucosa, then muscle to muscle and then oral mucosa to oral mucosa. Pulls the part you lifted off to the midline so that when you are done, the hole is still there you just closed it (kind of like submucous cleft). Mucoperiostial flaps- the flaps you sewed together. As you pull them together it gaps open those original relaxing incisions you made. There was a lot of tension on that middle tissue and it would pull apart but these relaxing incisions prevent that from happening. Fill in with scar tissue. Wardill-Kilner-Peet Procedure (1937) Making incisions that still involve lifting mucoperiostial flaps Makes palate a little but longer Bigger relaxing incisions Furlow Procedure (1980) effective for after initial closure, if you want to lengthen the palate then its good NOT a primary closure technique "The mark of Zorro" Reanastamosis of the levator muscle Velopharyngeal Insufficiency (VPI) Management Management takes place after full evaluation of the velopharyngeal mechanism and deficiencies are seen Videofluoroscopy/Nasal Endoscopy Speech Evaluation Videofluoroscopy x ray when saying speech sounds, sounds that require greatest amount of velopharyngeal closure and continuant sounds (plosives are too fast) high vowels (i, NOT a) (high pressure continuant sound because high pressure would require complete velopharyngeal closure[need pressure to build up]- fricative /s, sh/ Ohm's law: pg. 12 Orofacial Exam 2 Pressure=flow*resistance more pressure = more flow Multi-view x-rays Basal - lie down on stomach on x ray table and assume position of sphinx (stick neck out), illuminates entire velopharyngeal port *Lateral- front to back movement of VP port *Submental/towne's view- shoot x ray just under the mandible so it goes through soft tissues and they can get the whole velopharyngeal port like that Face-on- can see lateral walls and can measure the extent of lateral wall movement Fiber optic nasopharyngoscopy (nasal endoscopy) go through the nose with a very flexible tube that is made out of fiber optic filaments, on the end it has a lens (computer camera); light travels down the fiber optic filaments; you plug a cord into a computer that has a lightbulb in it, so all the heat is dissipated and only the light travels down the filament and illuminates what the lens is pointed at Taub oral panendoscope rigid stainless steel scope that has a lightbulb in it, stick it in someone's mouth and it acts like a parascope on a submarine; can look at VP closure from oral side Also one that you can look through the nose Velopharyngeal Closure Patterns Sagittal closure- where side walls come together so that when you're looking at VP port the closure line goes front up and down Coronal closure- more front to back closure; posterior movement of velum towards back of pharynx Circular closure- side wall and front to back kind of equal in a circular pattern Circular with passavant's pad- a lot of forward bulging of the posterior pharyngeal wall Cleft Palate Management Techniques/Speech Surgeries Palatal lengthening Pharyngeal flaps Posterior pharyngeal wall augmentation Palatal lifts Palatal lengthening Furlow (side wall closure is really good though) (3RD BIGGEST PROBLEM) Pharyngeal flap pg. 13 Orofacial Exam 2 there is side wall closure but the gap is bigger, so lengthening the palate still wont make it long enough (2ND BIGGEST PROBLEM) Posterior pharyngeal wall augmentation for tiny gaps, so petty good movement all the way around but the palate doesn't quite touch the posterior pharyngeal wall, in rapid conversational speech its not making it all the way back. Insert material to plump posterior pharyngeal wall forward (hydroxyapatite) (4TH BIGGEST PROBLEM) Sphincter palato-plasty For really serious problems, almost no sidewall movement, they will dissect the posterior pillar (palatapharyngus) and make a sphincter out of it (BIGGEST PROBLEMS) Add or remove terms You can also click the terms or definitions to blur or reveal them Hide definitions Review with an activity Orofacial Ch 28 Notes 1 Origin Generally the end of the muscle attached to the least movable structure. (more fixed) Insertion The end of the muscle attached to the more movable structure. (more movable) Action Work that is accomplished when the muscle fibers contract. Orofacial Ch 28 Notes 2 In general, the _________ moves toward the _________ when a muscle is contracted. Insertion; origin What are the muscles of mastication? (List them) Masseter Temporal / temporalis Medial pterygoid Lateral pterygoid The muscles of mastication primarily are responsible for what movements? Elevating the mandible, protruding & retruding the mandible, and moving the mandible laterally Orofacial Ch 28 Notes 3 Which muscle of mastication is probably the most powerful? Masseter What is the origin of the Masseter muscle? Two areas if the Zygomatic arch What is the insertion of the Masseter? The angle of the mandible. Orofacial Ch 28 Notes 4 What is the action of the Masseter? Elevated the mandible (closes the mandible) What is the origin of the temporal or temporalis muscle? The temporal fossa What is the insertion of the temporal muscle? Coronoid process of the mandible What is the action of he temporal muscle? Orofacial Ch 28 Notes 5 Entire muscle contraction elevates the mandible; if only the posterior fibers contract it retrudes the mandible. What is the origin of the medial pterygoid muscle? medial side of the lateral pterygoid plate and pterygoid fossa plus small area of palatine bone What is the insertion of the medial pterygoid muscle? Angle of the mandible on the medial side (medial side of the mandible) What is the action of the medial pterygoid muscle? Orofacial Ch 28 Notes 6 Elevation of the mandible What is the origin of the lateral pterygoid muscle? Superior head originates at the infratemporal (infra=below) fossa; Inferior head originates at the lateral side of the lateral pterygoid plate What is the insertion of the lateral pterygoid muscle? anterior border of the TMJ and disc capsule plus the neck of the condyle What is the action of the lateral pterygoid muscle? Orofacial Ch 28 Notes 7 if both the right and left sides of the inferior heads contract the mandible moves forward (protrusion) and is depressed; if only one side contracts there will be lateral excursion to the opposite side. What are suprahyoid muscles? Muscles above the hyoid What are infrahyoid muscles? Muscles below the hyoid. Which muscles are part of the suprahyoid group? Orofacial Ch 28 Notes 8 Digastric muscle Mylohyoid muscle Geniohyoid muscle Stylohyoid muscle Which suprahyoid muscle has a collagenous tendon in the middle? the digastric muscle (this collagenous tendon separates the anterior and posterior bellies) (resembles a slingshot) Where is the origin & insertion of the digastric muscle? origin: the digastric notch just medial to the mastoid process behind the ear Insertion: digastric fossa Orofacial Ch 28 Notes 9 *Which muscle forms the floor of the mouth? Mylohyoid muscle What is the insertion and origin of the mylohyoid bone? origin: mylohyoid line insertion: hyoid bone What is the action of the mylohyoid bone? depression of the mandible Orofacial Ch 28 Notes 10 What is the origin of the geniohyoid muscle? the inferior genial tubercle or mental spine on the lingual surface of the mandible at the midline (deep to mylohyoid muscle) Where is the insertion of the geniohyoid muscle? hyloid bone at the midline What is the motion of the geniohyoid muscle? depression of the mandible Orofacial Ch 28 Notes 11 Where does the stylohyoid muscle originate? the styloid process at the base of the skull Where does the stylohyoid muscle insert? posterior part of the hyoid bone What is the action of the stylohyiod muscle? pulls the hyoid bone back and up Which muscles are part of the infrahyoid group? (list them) omohyoid Orofacial Ch 28 Notes 12 sternohyoid sternothyroid thyrohyoid Add or remove terms You can also click the terms or definitions to blur or reveal them Review with an activity Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 1 Exam 2 Orofacial Anatomy, orofacial II midterm, Orofacial II test 1, Orofacial Test #2, Orofacial Exam 2, Orofacial 2 final exam, Orofacial 2 Final, Orofacial Anatomy II Final Exam Review, Dental Decks - Part I  Exam 2 Orofacial Anatomy Answered  Orofacial II midterm Answered  Orofacial II test 1 Answered  Orofacial Test #2 Answered  Orofacial Exam 2 Answered  Orofacial 2 final exam Answered  Orofacial 2 Final Answered  Orofacial Anatomy II Final Exam Review Answered  Dental Decks - Part I Answered (1940 Questions and Answers) Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 2 Original QUESTION: Orbicularis Oris ANSWER: Functions: 1. puckers & seals the lips Location Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 3 QUESTION: Zygomaticus Minor ANSWER: Functions: smiling Location QUESTION: Zygotmaticus Major ANSWER: Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 4 Functions: smiling Location QUESTION: Buccinator ANSWER: Functions: 1. swallowing 2. preventing the pocketing of food Location Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 5 QUESTION: Risorius ANSWER: Functions: 1. pulls corner of the mouth to produce smiling Location Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 6 QUESTION: Depressor Labii Inferioris ANSWER: Functions: 1. brings the lower lip downward & laterally Location Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 7 QUESTION: Depressor Anguli Oris ANSWER: Functions: 1. brings down the edges of the lips Location Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 8 QUESTION: Levator Labii Superioris ANSWER: Functions: 1. lifts upper lip 2. everts upper lip Location Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 9 levator anguli oris Function: 1. Lifts the angle of the mouth 2. Assists in closing of the mouth Mentalis Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 10 Functions: 1. elevates and protrudes lower lip; aka pouting 2. wrinkles skin of cheek All facial nerves are innervated by cranial nerve vii (7) What's the deepest facial muscle? Buccinator Orgin where the muscle begins; unmoveable portion Insertion where the muscle ends; moveable structure Orgin & insertion of buccinator Orgin: mandible, maxilla Insertion: angle of the mouth Orgin & insertion of risorius Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 11 Orgin: fascia over the massester Insertion: corner of the mouth Orgin & insertion of levator labii superioris Orgin: maxilla & infraorbital region Insertion: skin of upper lip & alar cartilage of nose Orgin & insertion of zygomaticus Orgin: zygomatic bone Insertion: angle of mouth Orgin & insertion of depressor labii inferiorus Orgin: Mandible Insertion: lower lip Orgin & insertion of mentalis Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 12 Orgin: Mandible Insertion: orbicularis oris & skin of chin Orgin & insertion of depressor anguli oris Orgin: mandible Insertion: angle of mouth Orgin & insertion of levator anguli oris Orgin: maxilla Insertion: angle of mouth Which zygomaticus muscle is located more medially? Laterally? Zygomaticus minor is located more medially. Zygomaticus major is located more laterally. hyoid bone Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 13 suspended by muscle in the neck; above larynx function of hyoid bone supports the larynx & the tongue Mandible lower jaw bone What's the only moveable bone in craniofacial skeleton? Mandible Temporomandibular joint between the condyle of the mandible and the temporal bone Locate Condyle, Coronoid Process, Ramus, Angle, Mental Protuberance, Mylohyoid Line, & Diagastric Fossa Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 14 Locate Cristi Galli, Cribriform Plate, Middle Nasal Concha, Perpendicular Plate, & Superior Nasal Concha Frontal Bone (single) Name this bone Parietal Bone (paired) Name this bone Temporal Bone (paired) Name this bone. Occipital Bone (single) Name this bone. Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 15 sphenoid bone (single) Name this bone. 1.Sinusitis (Inflammation of the frontal and max sinuses, filled with fluid from)? mucus comes from nasal cavity The only movable bone of the skull is the mandible The process that resorbs and causes tooth mobility? alveolar process On lateral view of skull, there is a suture, its fan shaped? squasmosal The curled structure that increase the surface area in nose conchae Inferior to greater wing of sphenoid bone( muscles of mastication attaches to it) pterygoid process 2 pairs of sinuses that are palpable frontal and maxillary this landmar is where the olfactory nerves run through? Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 16 cribiform plate this depression in the temporal bone is where the condyle articulates? articulate fossa The notch lies between the coronoid process and mandibular condyle? mandibular notch The sternocleoidmastoid muscle (SCM) and trapezeus belong to? cervical muscles The platysma belongs to what group? facial expression The masseter muscle is a muscle of mastication, where does it originate from? zygomatic arch If I clench and grind, this muscle can protrude/enlarge over time masseter muscle Of the hyoid muscles, the suprahyoid muscle, which of these muscles elevates the tongue in floor of the mouth? Mylohyoid muscle The muscle omomyoid muscle what group of muscle? Infrahyoid muscle 17. Which is the biggest muscle that makes you smile? zygomatic major What is fossa underneath the mandible? submandibular fossa What foramen on the mandible cannot be seen on the medial side? mental foramen What suture articulates with parietal and occipital bone? Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 17 lamboidal The maxillary process of the zygomatic bone form which side of the infraorbital bone? medial side Which muscle group that attaches to the Pterygoid process? muscles of mastication Whats the landmark on the posterior portion of the maxillary 8? maxillar tuberosity This bony projection attaches the tongue and larynx? styloid process 25. The band or muscle that helps contract the frontalis and occipitalis? epicranial neurosis muscles that closes the eye? orbicularis ocular This muscle raises the lower lip and makes chin wrinkle? mentalis Extraction surface of maxillary teeth which is thinner? facial Gliding on what and rotation on the other? lateral excursion An aging the joint disc of the TMJ menicus becomes what and what? thinner and profurated Lower synovial concavity and condyle disc form what movement? forms? rotational movement Fibrous tissue that wraps around articular eminences, mandibular fossa and condyle? Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 18 joint capsule Dislocation of tmj is called? subluxation Limited opening of tmj? trismus Forward movement of the mandible? protrusion When the mandible is in rest position, what is the amount of freeway space? 2-4 mm freeway space What do we Palpating for on the stm? cervical lymph nodes muscles contract from? insertion to origin what pointy boney process atteches the tonge to larynk styloid process What muscle closes the eye? orbicularis oculi origin is inferior mandible, and inserts in chin skin tissue? mentalis This muscle mastication that inserts at coronoid process? temporalis The 3 pharyngeal constricting muscles helps us do what with food? Swallowing This muscle helps push our food posterior on the occlusal surface? Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 19 Buccinator/ Trumpet muscle aka During swallowing the supra hyoid muscles elevate which bone? hyoid bone This facial expression muscle originates at the inferior border of the mandible and inserts at the labial commissure? Depressor anguli oris this tongue muscle makes you stick your tonge out genialglossal this muscle contracts and dilatates the nasal mucles? Levator Labii Superioris Alaeque Nasi Muscles This muscle raises the tongue and depresses the soft palate during swallowing? palatoglossal Extrinsic tongue muscle that retracts the tongue? styloglossus Risorius and zygomatic major muscle, one does not raise the upper lip, which muscle? risorius This is associated with tmj, prevents mandible from retraction or moving too far back? Temporal mand joint ligament skull is composed of __ bones 22 general QUESTION: for any prominence = process articulation = area of the skeleton where the bones are joined to each other what are the 2 categories of skull bones? Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 20 neurocranium, and viscerocranium how many neurocranium bones ? 8 how many viscerocranium bones? 14 foramen ovale - large anterior oval opening of the sphenoid bone for the fifth cranial nerve AKA _______ ? trigeminal nerve foramen spinosum = smaller and more posterior opening which carries the middle meningeal artery into the cranial cavity foramen lacerum = large irregularly shaped which is filled with cartilage coronal suture = articulation between frontal and parietal bones lambdoidal suture = articulation between parietal and occipital bones squamosal suture = articulation between temporal and parietal bones supraorbital ridges = curved bony elevations superior to orbits and right below the eyebrows supraorbital notch = located on the medial portion of the ridge and is where the supraorbital artery and nerve travel from the orbit to the forehead glabella = Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 21 smooth elevated area between the eyebrows frontal eminence = prominence of the forehead typically more pronounced in childen and adult females zygomatic process of the frontal bone = projection lateral to the orbital surface lacrimal fossa = smooth, more deep concave depression on the lacrimal bone, forms the medial wall of the orbital cavity Parietal bones = paired cranial bones parietal bones articulate with each other at the sagittal suture temporal bones = serves as an attachment for the strongest chewing muscles 3 portions of temporal bones = squamous, tympanic, petrous squamous = large fan-shaped, flat tympanic = small irregularly shaped, forms most of the external acoustic meatus petrous = inferiorly located and helps form the cranial floor* not visible mastoid process = serves as the site for attachment of the large muscles of the neck such as the sternocleidomastoid muscle Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 22 styloid process = serves for the attachment of the tongue and pharyngeal muscles and ligaments carotid canal = large circular aperture which ascends at first vertically and then making a bend, runs horizontally forward and medial ward, transmits into the cranium the internal carotid artery and carotid plexus of nerves sphenoid bone = helps connect the cranial skeleton to the facial skeleton body of sphenoid contains paired paranasal sinuses, aka sphenoidal sinuses 3 paired processes of the sphenoid = lesser wing, greater wing, pterygoid process ethmoid bone = 2 unpaired plates (midline vertical perpendicular plate, the horizontal cribriform plate) vomer = forms the posterior of the nasal septum, has no muscle attachments lacrimal bones = irregular, thin plates of bone that form the small portion of the anterior medial wall of the orbit nasolacrimal duct = formed at the junction of the lacrimal and maxillary bones, where lacrimal fluid of drained zygomatic bones = paired facial bones that form the cheekbones what r the 3 processes of zygomatic bones? frontal process(anterior wall), temporal process(zygomatic arch), maxillary process (portion of lateral orbital wall) Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 23 median palatine suture = midline articulation between two palatine processes of the maxillae anteriorly and the two horizontal plates of the palatine bones posteriorly transverse palatine suture = articulation between the two palatine processes of the maxillae and the two horizontal plates of the palatine bones greater and lesser palatine foramina = transmits nerves and blood vessels greater palatine foramina = landmark for administration of the greater palatine local anesthetic block lesser palatine foramina = transmits nerve and blood vessels to the soft palate and tonsils, smaller opening each maxilla includes .... a body and 4 processes what r the 4 processes of the maxilla ? frontal, zygomatic, palatine, alveolar infraorbital sulcus = groove in the floor of the orbital surface canina fossa = just posterio-superior to the roots of the maxillary teeth canine eminence = ridge over the maxillary canine landmark for the administration of the anterior superior alveolar local anesthetic block = canine eminence incisive foramen = Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 24 anterior portion of the palatine process, just posterior to the max central incisors landmark for the administration of the nasopalatine local anesthetic block ? incisive foramen maxillary tuberosity = rounded, roughened elevation just posterior to the most distal molar of max dentition landmark for posterior superior alveolar local block = max tuberosity mandible = movable mental protuberance = bony prominence of the chin is located deep to the roots of the mand incisors, more pronounced in males symphysis = faint ridge at midline mental foramen = an opening typically between the apices of the first and second PM 3 parts of mandible = horizontal body, the alveolar process, ramus mandibular foramen = where the nerves and blood vessels of the lower teeth and lip enter the mandible mylohyoid line = attachment site for the mylohyoid muscle mylohyoid groove = for the passage of the mylohyoid nerve and vessels to the mylohyoid and anterior diagastric muscles Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 25 sublingual and submandibular fossae = the sublingual and submandibular salivary glands lie in there depressions retromolar triangle = lateral margin of this is the external obliquee line, and the medial margin is the internal oblique line (area posterior to third molar) superior and inferior genial tubercles/mental spines = serve as attachments for the muscles that help in tongue movement and swallowing nasal bones = paired, facial bones inferior to the nation, a bony structure forms the ... bridge of the nose tip of nose is ... "apex", flexible when palpated, made of cartilage naris aka ? nostril, inferior to the apex on each side of the nose ala of nose = winglike structure, made of cartilage postnasal drip = when excess mucous flows backward from the nose to the throat during sleep olfactory epithelium = found in the roof of the nasal cavity, contain nerve fibers that perceive odours 4 pairs of paranasal sinuses = ethmoid, frontals, maxillaries, sphenoids subdivided into numerous small compartments (anterior, middle, posterior) = ethmoid Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 26 sinuses that can't be palpated = ethmoid, sphenoid largest sinus = maxillary drainage of maxillary sinus may promote prolonged chronic sinusitis sinusitis = inflammation or swelling of the tissue lining the sinuses usually following a cold function of paranasal sinuses = lighten overall weight of the skull bones origin of a muscle = end of muscle that is attached to the least movable structure insertion of a muscle = the other end of the muscle attached to the more movable structure action = work that is accomplished when the muscle fibers contract 4 pairs of muscles of mastication = masseter, temporalis, medial pterygoid, lateral pterygoid all muscles of mastication are innervated by the ..... mandibular nerve of the fifth cranial or "trigeminal nerve" - nerve responsible for chewing action of masseter muscle = elevates mand, closing mouth most powerful muscle of mastication and most superficial = masseter Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 27 temporalis muscle origin = very wide action of temporal muscle = elevation of mandible and retraction of mandible action of medial pterygoid muscle = elevate the mandible during jaw closing action of lateral pterygoid muscle = depression of mandible occurs during jaw opening accessory muscles of mastication = assist in actions of mastication & swallowing muscles attached to the hyoid bone = accessory muscles of mastication what are the 2 groups of accessory muscles of mastication? suprahyoid, infrahyoid suprahyoid = muscles above the hyoid bone infrahyoid = muscles below the hyoid bone, can be referred to as "strap mucsles" because of their belt like shape what are the suprahyoid muscles? diagastic, mylohyoid, stylohyoid, geniohyoid what are the infrahyoid muscles? sternothyroid, sternohyoid, omohyoid, thyrohyoid action of diagastric muscle = Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 28 by contracting it can create a backward pull on the mandible (retrusion), if jaw is clenched, contraction of the muscle elevates the hyoid bone and lifts up on the larynx or voice box what muscle forms the floor of the mouth? mylohyoid muscle action of mylohyoid + geniohyoid muscle = depress the mandible or elevate the hyoid bone action of stylohyoid muscle = pull the hyoid bone back and up action of omohyoid + sternohyoid muscles = when it contracts, it pulls the hyoid bone down action of sternothyroid muscle = with contraction, it pulls the larynx down action of thyrohyoid muscle = depress hyoid bone, and raises the thyroid cartilage and larynx deglutition = action or process of swallowing cervical muscles = sternocleidomastoid muscle, trapezuis muscle tilting and rotating head = sternocleidomastoid muscle referred pain = pain felt in a part of the body other than its actual source muscle spasms of cervical muscles = involuntarily contract under tension or in conjunction with migraines Muscle responsible for smiling Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 29 Zygomaticus major Muscle responsible for "surprise" Epicranial The _______ muscles are four pairs of hyoid muscles inferior to the hyoid bone Infrahyoid The infrahyoid muscles include: (4) -Omohyoid -Sternohyoid -Sternothyroid -Thyrohoid Orgin and Insterion of the masseter muscle: Both heads of the muscle originate the ____ ____ but from differing locations. Zygomatic arch The _____ muscle passes inferiorly to insert onto the medial surface, apex and border of the coronoid process of the mandible at the anteromedial border of the mandibular ramus. Temporalis If only the posterior part of the temporalis muscle contracts, the muscle moves the lower jaw backward, which occurs with ____ of the mandible. Retraction The _____ muscle raises the eyebrows and scalp to show surprise Epicranial The ______ muscle is a thin quadrilateral muscle of facial expression that forms the anterior part of the cheek or the lateral wall within the buccal region of the oral cavity Buccinator Muscles of facial expression include: -Epicranial -Orbicularis oculi Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 30 -Orbicularis oris -Buccinator -Risorius -Levator labii superioris -Levator labii superioris alaeque nasi -Zygomaticus major -Zygomaticus minor -Levator anguli oris -Depressor anguli oris -Depressor labii inferioris -Mentalis -Platysma The sternocleidomastoid muscle is a thick muscle of the neck, it serves as a primary muscular landmark of the neck during an extraoral exam of a patient since it divides the neck region into anterior and posterior ______ ________ Cervical triangles The extrinsic tongue muscles include: -Styloglossus -Hypglossus -Genioglossus All extrinsic tongue muscles are innervated by the ___ ___ or _____ nerve -Twelfth cranial -Hypoglossal Intrinsic tongue muscles are found entirely _____ ____ ___ Inside the tongue The muscles of _____ or pharyngeal muscles are involved in speaking, swallowing, and middle ear function. Pharynx The Styloglossus ____ the tongue Retracts Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 31 The genioglossus _____ the tongue and _____ parts -Protrudes -Depresses The hyoglossus _____ the tongue Depresses Deviation occurs because of the ____ muscle Lateral pterygoid Unlike the other three muscles of mastification, the _____ _______ is the only muscle of mastification that assists in depressing the mandible, lowering the mandible, as it moves forward or protrudes. Lateral pterygoid There are ____ cervical muscles 2 The two cervical muscles include: the _______ muscle and the _____ muscle. -Sternocleidomastoid -Trapezius The muscle that elevates the upper lip and ala of the nose, thus also dilating each naris, as in a sneering expression Levator labii superioris alaeque nasi muscle The ______ muscle originates on the inferior border of the mandible. It then passes superiorly to insert into the skin at the ipsilateral labial commissure. Depressor Anguli Oris The Depressor anguli oris muscle is responsible for what action? Frowning The depressor labbi inferioris muscle depresses the ____ lip, exposing the _____ _____ teeth. -Lower -Mandibular incisor Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 32 Which muscle originates on the mandible near the midline, then inserts into the skin of the chin. Mentalis muscle The mentalis muscle raises the _____, wrinkling its skin. Chin Since the ____ muscles change the way in which a patient's head and neck are positioned, a muscle malfunction in this region may cause the head to move to one side or the other, and the patient may not be able to raise the chin as requested during treatment Cervical Which muscle is responsible for producing a "grimace" Risorius Muscle -Digastric -Mylohyoid -Stylohyoid -Geniohyoid Are all part of what muscle group Suprahyoid Muscles -Sternothyroid -Sternohyoid -Omohyoid -Thyrohyoid Are all part of what muscle group Infrahyoid Muscles One action of both the anterior and posterior suprahyiod muscles is to cause elevation of the ____ ____and ____ if the mandible is stabilized by contraction of the muscles of mastification. This action also occurs during swallowing. hyoid bone Larynx What are the 4 muscles of mastification? Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 33 -Masseter -Temporalis -Medial pterygoid -Lateral pterygoid Movement accomplished by a muscle when muscle fibers contract Action End of the muscle attached to more movable structure Insertion End of muscle attached to least movable structure Origin An inability to form facial expressions on one side of the face may be the first sign of damage to the _____ cranial or facial nerve that innervates the muscles of facial expression. The nerve damage results in ___ _____ Seventh Facial paralysis Facial paralysis can occur with a ____, ______ or possibly with parotid salivary gland cancer b/c the seventh cranial or facial nerve travels through the gland. Stroke Bell palsy True or false: Twitching, spasms, and weakness can also be evident along with excessive drooling and altered taste sensations. These causes of facial paralysis may resolve over time or with specific treatment True What muscle elevates and arches tongue to soft palate, depressing soft palate toward tongue, forms sphincter, separating oral cavity from pharynx? Palatoglossus Which muscle moves palate posteroinferiorly and posterior pharyngeal wall anterosuperiorly to help close off nasopharynx: elevates pharynx? Palatopharyngeus Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 34 The ______ muscle forms the posterior faucial pillar in the oral cavity, a vertical fold posterior to each palatine tonsil. Palatopharyngeus The ____ ligament is a variable ligament found from thickened cervical fascia in the area. Stylomandibular A fibrous ____ ____ completely encloses the TMJ Joint capsule The fibrous joint disc is located between the ____ bone and the ____ ____ on each side allowing articulation between the two bones. Temporal Mandibular condyle True or false: The shape of the joint disc conforms to the shape of both the adjacent articulating bones of the TMJ and is related to joint movements. True True or false: The disc is attached to the lateral and medial poles of the mandibular condyle. True True or false: The disc is not attached to the temporal bone anteriorly, except indirectly through the capsule. True With aging or trauma to the area, the joint disc can become ____ or even _____ Thinner Perforated Recent studies suggest this disc degeneration may also cause ______ within the disc, changes that may lead to impaired movements of the joint. calcifications At ____ age the disc may become dislocated by injury to its attachments. Any Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 35 Both perforation and displacement can lead to _____ problems noted during dental treatment. Clinical What are the three paired ligaments associated with the TMJ? Temporomandibular Stylomandibular Sphenomandibular The temporomandibular ligament is located on the ____ side of each joint forming a reinforcement of the lateral part of the joint capsule of the TMJ. Lateral The base of this triangular ligament is attached to the _____ ____ of the temporal bone lateral to the articular eminence; its apex is fixed to the lateral side of the neck of the mandible. Zygomatic process The temproromandibular ligament prevents the excessive ____ or moving backward of the mandible. Retraction Opening the jaws involves both ____ and _____ of the mandible. -Depression -Protrusion Closing the jaws involves both _____ and _____ of the mandible. Elevation Retraction The disc plus the condyle glide on the articular fossa in the _____ synovial cavity, moving forward or backward on the articular eminence. Roughly at the same time, the mandibular condyle rotates on the disc in the ____ synovial cavity. -Upper -Lower Lateral deviation involves both the ____and _____ movements of the contralateral TMJs in their respective joint cavities. Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 36 Gliding Rotational _____ of the contralateral lateral pterygoid muscles, the one on the protruding side, is involved during lateral deviation. Contraction The resting position of the TMJ ____ with the teeth biting together. Instead, the muscular balance and proprioceptive feedback allow a physiologic rest for the mandible, an interocclusal clearance or freeway space, which is approx. ___-____mm between the opposing teeth of each dental arch. IS NOT 2-4mm The Temporomandibular joint, aka TMJ, is a joint on each side of the head that allows movement of the mandible for _____, ______ and _____ -Mastication -Speech -Respiration's A _____ is a site of junction or union between two or more bones Joint The ____ is classified as a ginglymoarthrodial joint. (Or hinge and sliding joints) TMJ The TMJ has its sensory innervation by the auriculotemporal and massetric branches of the mandibular nerve of the ___ cranial or trigeminal nerve; motor function is by the muscles of mastification. Fifth The blood supply to the joint is from branches of the external carotid artery, predominantly the superficial _____ branch. Temporal True or False: The dental practitioner plays an important role in the recognition, treatment, and maintenance of patients with the TMJ disorder. Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 37 True True or false: An acute episode o TMD can occur when a patient opens the mouth too wide, causing maximal depression and protrusion of the mandible, as when yawning or receiving prolonged dental care. True Located between the coronoid process and the condyle is a deep concavity the ____ ___or the sigmoid notch Mandibular notch True or False: The sphenomandibular ligament is close in location to the inferior alveolar nerve True The TMJ is palpated laterally at a depression inferior to the zygomatic arch and approx. ___- ____cm anterior to the tragus 1-2 The articular fossa, which is also known as the ____ ___ , is posterior to the articular eminence. Mandibular fossa No ____ and no ___opening in the beginning oral; anal stomodeum The external depression which finally breaks through to establish the oral opening into the foregut the topographical center of the developing facial structures oral plate Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 38 two layered membrane where the stomodeal depression is deepened, and the ectodermal (outside) floor comes to lie against the entodermal (inside) lining of the foregut head of a young embryo is pressed against its __________ thorax frontal prominence a rounded elevation in the midline, above the stomodeum nasal (olfactory) placodes local thickenings of the ectoderm on either side of the frontal prominence, near the lateral margins of the overhanging frontal prominence destined to form the lining of the nasal pits horse shoe shaped During the _____ week all the major structures involved in the formation of the face and jaws become clearly distinguishable fifth The upper jaw is of ______ origin (maxillary process) composite (multiple pieces) the nasal pits bordered by the nasal placodes Later become nares They appear to have sunk below the general surface Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 39 nasomedial processes The medial limbs of the nasal placode around the nasal pits nasolateral processes lateral limbs of the nasal placode around the nasal pits _______ become center part of your upper lip, important feature in the coming together of the upper jaw Nasomedial processes _________ becomes alar cartilage at the side of your nose, looks like gull wing (ala means wing) Nasolateral processes The nasomedial processes play an important part in the formation of the medial portion of the ________, ______, and ________. Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 40 upper jaw, lip, and palate (Philtrum, Premaxilla, Columella) maxillary processes Grow toward the midline from the upper lateral angles of the oral cavity destined to form the lateral parts of the upper jaw Eventually comes together with nasomedial process nasal fin Juncture between nasomedial process and maxillary process inQUESTION:axillary segment all of the upper oral arch, which is of nasomedial origin three components of the inQUESTION:axillary segment: 1) the labial component- the medial portion of the upper lip or prolabium (philtrum) 2) the gnathogingival (jaw-gum) component within which will develop the portion of the upper jaw carrying the incisor teeth (alveolar process of the premaxilla) 3) the hard palate component or primary medial palatal triangle (process) (the rest of the premaxilla). prolabium Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 41 philtrum gnathogingival (jaw-gum) component alveolar process of the premaxilla medial palatal triangle (process) the rest of the premaxilla medial palatal primordium is continuous with the most anterior portion of the ________ nasal septum nostrils (external nares) and posterior nares (nasal choanae) the downward extension of the original pits themselves which, during the sixth week, break through into the upper part of the oral cavity the external openings of the nasal pits the formation of the palate elongates the _______ backward nasal chambers _________ as it comes from above, comes from frontal prominence downward and fuses with inQUESTION:axillary segment (premaxilla) and also the rest of the hard palate Nasal septum the ______ layers of the nasomedial processes and the maxillary processes become adherent to each other to form an epithelial plate known as the nasal fin epithelial All of the features of the face are put together/formed by ___ weeks; Not everything is in the right place though 8 Result of nasal fin epithelium breaking down: Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 42 removal of the epithelial barrier between the nasomedial and the maxillary processes makes their mesenchymal components continuous and thereby paves the way for their growing together (fusion) Nasal fin is the line of fusion between what two processes nasomedial processes and maxillary processes the nasal fin continues until the ________ incisive foramen If nasal fin doesn't fuse, either front to back or up and down, you will have a category called ______ cleft lip primary palate premaxilla the premaxilla/primary palate portion of the palate is contributed to by the ________ nasomedial processes main part of the _____ is derived from the portion of the upper jaw which arises from the maxillary processes (fusing with each other, behind the incisive foramen) palate secondary palate Shelf like outgrowths of the maxillary processes that arise on either side, and grow toward the midline Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 43 When the palatal shelves first start to develop, the ______ lies between them tongue As development progresses, the position of the tongue is shifted downward and the margins of the palatal shelves are free to swing _______ upward and toward the midline The change in the relations between the ____ and the _________ is crucial for the completion of the palate tongue; palatal shelves If tongue doesn't move away as the palatal shelves come together, _______ will form cleft palate Pierre Robin primary feature is microanathia (tiny lower jaw) Isolated cleft palate because tongue can't get out of the way Treat by distraction- you cut the jaw and start pulling apart micro meter by micro meter it will lay down new bone between the gap and fill it in and make the bone longer maxillary processes are originally pointed ______ with the tongue in between them downward Fusion of the palatal shelves progresses from the ______ toward the ____ front part; uvula (Front to back) Cannot have a cleft of the hard palate without a cleft of the ________ soft palate At the same time that the palate is thus being formed, the ________ grows downward toward it and soon becomes fused to its upper face Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 44 nasal septum separation of right and left ________ from each other is accomplished at the same time that the nasal region as a whole is separated from the oral (inverted T) • First it is fused with premaxilla and then the maxillary shelves nasal chambers Fusion of the lip comes from the fusion of _______ and __________ primordia While fusion of the palate comes from _______ to _________ primordia nasomedial; maxillary; maxillary; maxillary Maxillary processes responsible for: o All the rest of the alveolar process (not incisors) o Palatal processes of maxilla o Palatal processes of palatine bone o Entire soft palate Unilateral only on one side, left or right Bilateral on both sides Complete cleft lip cleft extends into the nose, open communication between oral and nasal cavity (picture: incomplete, unilateral complete, bilateral complete) Incomplete cleft lip cleft does not extend into the nose cleft doesn't extend vertically through the entire floor of the nose Symmetrical cleft Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 45 Refers to bilateral cleft- it is the same on one side as the other Asymmetrical cleft Refers to bilateral cleft- it is not the same on one side as the other (ex. incomplete cleft on one side and complete on the other) Incomplete cleft palate looks like a ditch on the roof of your mouth fused okay up above but not below Bilateral cleft palate if two palatal shells on either side of the vomer do not articulate with the vomer Unilateral cleft palate if one shell articulates with the vomer but the other doesn't Submucous cleft palate where oral epithelium and nasal epithelium have fused but stuff in the middle didn't (bone and muscle didn't fuse in the middle [sandwich with no meat]) Median cleft two nasomedial processes not joining eachother, absent part of the middle upper lip and premaxilla What happens to levator muscle with cleft palate they can't meet their neighbor from the other side (contralateral half), so both sides turn and insert into back edge of hard palate Identifying features of submucous cleft -Absent posterior nasal spine, instead there is a notch that points anteriorly which you can feel -Looking in roof of mouth and shine a light, right in the middle there's going to be a blueish color because light is penetrating through- zona pellucida (no muscle to make it solid) -A-shaped appearance of levator when you say ah, attached to the back of the hard palate, contracts and bulges out -Bifid uvula- but that doesn't necessarily mean they have a cleft Occult sub mucous cleft Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 46 No cleft, no bifid uvula, nasal spine is there, no zona pellucida But when you ask them to say ah you get the A shape of the levator Causes of Cleft lip/palate 1. Multifactoral inheritance 2. Chromosome Abnormalities 3. Genetic Mutation 4. Environmental Teratogens Multifactorial inheritance Cleft tends to be inherited but there are a lot of factors within the inheritance umbrella because there are a number of factors it does not follow the simple (mendel/genetics) laws that we learned in biology environmental teratogens agent that causes master like deformities in the developing embryo (Rubella, thalidomide) Velocardiofacial syndrome/DiGeorge syndrome Chromosome 22 deletion Velo- somethings wrong with the velum (cleft) Cardio- heart problems Facial- muscle weakness of the face and oral structures (Infraorbital hypoplasia- under eyes, cheek bones really flat, appear to have down turned appearance) Cruzan syndrome cranial stenosis; mid third of face is deformed, eye orbits are shallow (frog-like appearance), normal intelligence Has cleft associated with it Genetic mutation 14% syndrome related in ____ 17% syndrome related in isolated ____ CL/P; CP Increased incidence in siblings of _____ patients but not in ______ alone CL/P; CP Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 47 Monozygotic twins Identical- came from one egg If one of the twins has a cleft, the other one will also have a cleft 42% of the time Dizygotic twins If one of them has a cleft the other will have a cleft 7% of the time Twice as likely to have a cleft on the _____ side over the ___ side left; right (CL/P) Cleft lip with or without palate occurs twice as often in ____ males Isolated CP Twice as often in ______ females with a cleft lip what happens to the alar cartilage flattened alar cartilage on the cleft side incidence rate of clefting in US 1 in 750 live births (.1% of the population) Highest incidence and lowest incidence in what populations highest- Asians and Native Americans (1:500) lowest- African Americans (1:2000) Rule of "over 10's" Over 10 pounds Over 10 gms hemoglobin (red blood cells) Over 10 weeks old WBC less than 10,000 (white blood cell count) [About 2.5-3 months] Goals of Cleft Lip Repair Orofacial Anatomy II test 1& 2, II midterm, Exam 2, Orofacial 2 final exam, Orofacial Anatomy II Final Exam Review Quiz Bank 48 Approximation of cleft edges Maintenance of natural landmarks Cupids bow Philtral dimple Muscle approximation Alar base balance and symmetry Scar in natural lines Palate Repair Considerations Feeding and swallowing Speech development vs. maxillary growth -closure too early can result in maxillary growth arrest Closure in this country is generally between 9 months and 18 months with the average being around 12 months Von Langenbeck Process (1859) A. Injecting epinephrine into the site that they are going to close to control the bleeding B. Take a scalpel and freshen the edges of the cleft (aka cut away edge and expose raw under surface) C. Relaxing incisions- Incision starts at about where canine would be, so canine to molar incision (cut through mucous membrane layer and tissue and then periosteum of the bone to get to the bone properly) C. Dotted lines by premaxilla and posterior edge of hard palate- take a blunt instrument and lift periosteum off the bone D. Then you sew nasal mucosa to nasal mucosa, then muscle to muscle and then oral mucosa to oral mucosa. Pulls the part you lifted off to the midline so that when you are done, the hole is still there you just closed it (kind of like submucous cleft). Mucoperiostial flaps- the flaps you sewed together. As you pull them together it gaps open those original relaxing incisions you made. There was a lot of tension on that middle tissue and it would pull apart but these relaxing incisions prevent that from happening. Fill in with scar tissue. Wardill-Kilner-Peet Procedure (1937) Making incisions that still involve lifting mucoperiostial flaps Makes palate a little but longer Bigger relaxing incisions Furlow Procedure (1980) Orofacial Anatomy II test 1& 2