Head and Neck anatomy EXAM #3

Complication from a greater palatine nerve block.

Gag Reflex

Abscesses & fistulae draining into the Mandibular Vestibule are coming from...

1. Mandibular INCISORS: all surfaces & short roots 2. Mandibular CANINE & PREMOLARS: all surfaces & roots 3. Mandibular 1st & 2nd MOLARS: buccal surfaces & roots

Abscesses & fistulae draining into the Maxillary Vestibule are coming from....

1. Maxillary INCISORS & CANINES: all surfaces and roots 2. Maxillary PREMOLARS & MOLARS: buccal surfaces and roots

Maxillary Teeth: Primary & Secondary Nodes

1° Submandibular 2° Superior deep cervical nodes

Posterior Mandibular Teeth: Primary & Secondary Nodes

1° Submandibular 2°Deep Cervical

Mandibular Incisors: Primary & Secondary Nodes

1° Submental 2°Submandibular

Which of the following areas communicate directly with the retropharyngeal space? A.Parapharyngeal space B.Masticator space C.Submandibular space D.Previsceral space

A. Parapharyngeal space

Which of the following structures allow lymph to flow directly into the surrounding lymph nodes? A. Afferent vessel B. Efferent vessel C. Lymphatic duct D. Capillary E. Venule

A. Afferent vessel

Which of the following disease states may be involved in a dental infection that has an inflammation of the bone marrow? A. Osteomyelitis B. Paresthesia C. Cellulitis D. Meningitis

A. Osteomyelitis Due to invasion of pathogens into bone, MOST COMMON in the MANDIBLE, rare in max

Which of the following nerve blocks uses the intraoral palpation of zygomatic process as a landmark? A. PSA B. Nasopalatine C. Mental D. Greater palatine E. IO

A. PSA

Which of the following fasciae is not included in the layers of the deep fascia of the face and jaws? A. Brachial fascia B. Temporal fascia C. Masseteric-parotid fascia D. Pterygoid fascia

A. Brachial fascia

Which of the following fascial spaces does the canine space communicate with? A. Buccal space B. Temporal space C. Masticator space D. Vestibular space of the mandible

A. Buccal space Canine Space- can lead to Orbital Cellulitis OR Cavernous Sinus Thrombosis

Which of the following is considered the main role of the lymph nodes in relationship to the lymph within lymphatic vessels? A. Filtration B. Liquefaction C. Disassociation D. Oxygenation

A. Filtration

A 25-year-old female complains of soreness in her left jaw. Intraoral examination shows inflammation on the buccal surface around a partially erupted permanent mandibular left third molar and halitosis (bad breath). To extract the involved tooth which nerve would need to be anesthetized? A. IA B. IO C. ASA D. PSA E. Greater palatine

A. IA

Which nerve block would be necessary for a patient undergoing surgery on an edentulous mandibular left alveolar process in the area of extracted molars? A. Left buccal nerve block B. Right buccal nerve block C. Left mental nerve block D. Right ft IO nerve block

A. Left buccal nerve block

The retroauricular lymph nodes are also known by which of the following? A. Mastoid lymph nodes B. Facial lymph nodes C. Deep parotid lymph nodes D. Retropharyngeal lymph nodes

A. Mastoid lymph nodes

Which of the following structures play a role in determine the location of an abscesses secondary to a mandibular tooth infection? A.Mylohyoid line B.Masseter muscle C.Buccinator muscle insertion D.Location of the tooth apex

A. Mylohyoid Line

What nerve can be blocked by injecting anesthesia into the incisive foramen? A. nasopalatine B. greater palatine C. lesser palatine D. posterior superior alveolar E. zygomatic

A. Nasopalatine

Which of the following nerves may be involved with cavernous sinus thrombosis? A.Occulomotor and trochlear B.Vagus and glossopharyngeal C.Hypoglossal and accessory D.Optic and olfactory

A. Occulomotor & trochlear CN III, IV, V1, V2 & VI

Which of the following infections directly involves teeth and associated tissues and thus is a dental infection? A. Odontogenic infection B. Lymphadenitis C. Endophthalmitis D. Otitis media

A. Odontogenic infection Spreads to Vestibular, Canine, Buccal, Submental, Sublingual & Submandibular

Two separate injections are not necessary when anesthetizing the right and left maxillary anterior palatal gingival. Pressure anesthesia before injection is not helpful during the NP nerve block because there is usually no patient discomfort involved with this injection. A. The first statement is true; the second statement is false. B. The first statement is false; the second statement is true. C. Both statements are true. D. Both statements are false.

A. The first statement is true; the second statement is false.

What does the Mylohyoid Line divide?

ABOVE LINE: Sublingual [incisors, premolars & 1st molar] BELOW LINE: Submandibular [2nd 3rd molar]

As a result of a bicycle accident, a patient has suffered trauma to the upper lip and maxillary central incisors. Which of the following nerve blocks may be used when treating the injured tissues? A. ASA, IO, and incisive nerve blocks B. ASA, IO, and NP nerve blocks C. ASA, MSA, and GP nerve blocks D. IO, GP, and Gow-Gates nerve blocks

B. ASA, IO, and NP nerve blocks

Which of the following terms is an infection with suppuration resulting from the entrapment of pathogens in a contained space? A. Cellulitis B. Abscess C. Fistula D. Embolus

B. Abscess Specifically, Periapical Abscess (pulp)

Which of the following lymph nodes can be effectively palpated during the extraoral examination by having the patient turn his or her head to the side? A. Superficial cervical lymph nodes B. Anterior jugular lymph nodes C. Inferior cervical lymph nodes D. Occipital lymph nodes

B. Anterior jugular lymph nodes

An 83-year-old male complains of achy jaws and a dark front tooth. Intraoral examination shows a darkened permanent maxillary right central incisor. The site of injection to numb the darkened tooth is directed to which all the following? A. Apex of the mandibular second premolar B. Apex of the maxillary first premolar C. Apex of the maxillary second molar D. Lateral to the incisive papilla E. Pterygomandibular space

B. Apex of the maxillary first premolar

Which of the following disease states can cause the spread of dental infections by way of the vascular system? A. Fistula B. Bacteremia C. Pustule D. Abscess

B. Bacteremia

Which of the following nerve blocks can be involved in the spread of infection to the cavernous venous sinus? A. ASA nerve block B. IA nerve block C. PSA nerve block D. IO nerve block

C. PSA nerve block

Significance of Pterygomandibular Space for local anesthesia

BEST injection site for IA Lateral to the pterygomandibular raphe

Which of the following complication can result from a GP nerve block? A. Cheek bite B. Anesthesia of the upper lip C. Stimulation of the gag reflex D. Hematoma in the infratemporal fossa

C. Stimulation of the gag reflex

A 25-year-old female complains of soreness in her left jaw. Intraoral examination shows inflammation on the buccal surface around a partially erupted permanent mandibular left third molar and halitosis (bad breath). Which nerve is involved in the discomfort at the site of the inflammation? A. Incisive B. PSA C. Lingual D. (Long) Buccal E. Mental

D. (Long) Buccal

Which of the following nerve blocks uses the apex of the maxillary first premolar for a landmark during administration? A. IO nerve block B. ASA nerve block C. MSA nerve block D. PSA nerve block

B. ASA nerve block

Which of the following signs or symptoms cannot be used to describe cellulitis of the face and neck? A. Pain B. Tenderness C. Redness D. Systemic infection

D. Systemic infection

Which one of the following is an important landmark to palpate before performing an inferior alveolar block? A. Tongue B. Coronoid notch C. Mental depression D. Pupil E. 2nd maxillary molar

B. Coronoid Notch

Which of the following nerve blocks is usually NOT used bilaterally due to possible complications associated with swallowing and speech? A. Incisive nerve block B. IA nerve block C. PSA nerve block D. GP nerve block

B. IA nerve block

Which of the following nerve blocks uses an extraoral landmark on the face when locating the injection site? A. IA nerve block B. IO nerve block C. PSA nerve block D. Mental nerve block

B. IO nerve block also ASA

Which of the following locations is the injection site for the IA nerve block? A. Medial to the pterygomandibular fold B. Lateral to the pterygomandibular fold C. Superior to the pterygomandibular fold D. Inferior to the pterygomandibular fold

B. Lateral to the pterygomandibular fold

A patient is missing the mandibular right molars, and surgery is to be performed on the remaining teeth. Which combination of nerve blocks would most likely be administered? A. Right mental and left IA nerve blocks B. Left IA and right incisive nerve blocks C. Right PSA and left IA nerve blocks D. Right mental and left incisive nerve blocks

B. Left IA and right incisive nerve blocks

27-year-old female, complains of a sore tongue with whitish material around tongue piercing stud and bad taste in mouth. She has regular dental care until recently. Supplemental History: Intraoral examination shows suppuration around tongue piercing jewelry due to a localized infection. Which of the following infections could occur secondarily in this patient due to the present situation with her tongue? A.Gingival abscess B.Ludwig's angina C.Maxillary sinus infection D.Pericoronitis

B. Ludwig's angina

A restoration will be placed on the distal surface of the maxillary first premolar. Which of the following nerve blocks needs to be administered? A. ASA nerve block B. MSA nerve block C. NP nerve block D. IA nerve block

B. MSA nerve block

Which fascial space contains the mandible and a portion of the inferior alveolar nerve and vessels? A. Retropharyngeal space B. Masticator space C. Submental space D. Submandibular space

B. Masticator space

The parapharyngeal space is located between the superior pharyngeal constrictor muscle and the _____ muscle. A.Lateral pterygoid B.Medial pterygoid C.Mylohyoid D.Masseter E.Buccinator

B. Medial pterygoid

Which of the following nerve blocks is NOT related to any area of the maxillary nerve? A. Nasopalatine B. Mental C. Greater palatine D. PSA E. IO

B. Mental

Which one of this blocks a mandibular nerve territory?

B. Mental

What is the term used to denote the spread of cancer from the original or primary site of the tumor to another secondary site? A. Miosis B. Metastasis C. Mitosis D. Mydriasis

B. Metastasis

Which of the following lymph nodes are NOT considered to be superficial lymph nodes located in the head? A. Occipital lymph nodes B. Retropharyngeal lymph nodes C. Retroauricular lymph nodes D. Facial lymph nodes

B. Retropharyngeal lymph nodes

Which of the following fasciae surrounds the trachea, esophagus, and thyroid gland? A. Vertebral fascia B. Visceral fascia C. Buccopharyngeal fascia D. Prevertebral fascia

B. Visceral fascia

An 83-year-old male complains of achy jaws and a dark front tooth. Intraoral examination shows a darkened permanent maxillary right central incisor. To performed further treatment on the darkened tooth, which nerve must be anesthetized? A. Inferior alveolar B. Posterior superior alveolar C. Anterior superior alveolar D. Mental E. Greater palatine

C. Anterior superior alveolar

Which of the following nerves is NOT anesthetized during an inferior alveolar block? A. Lingual B. Mental C. Buccal D. Incisive

C. Buccal

The loss of which of the following noted during an examination of a patient is related to abducens nerve paralysis? A. Hearing B. Smelling sensation C. Eyeball movement D. Tongue movement

C. Eyeball movement

Which of the following nerves is located in the pterygomandibular space? A. Infraorbital nerve B. Posterior superior alveolar nerve C. Inferior alveolar nerve D. Anterior superior alveolar nerve

C. Inferior Alveolar Nerve

Which of the following nerve blocks would provide the greatest area of anesthesia to a maxillary quadrant? A. PSA, and GP nerve blocks B. MSA and GP nerve blocks C. MSA, PSA, and GP nerve blocks D. ASA, MSA and PSA nerve blocks

C. MSA, PSA, and GP nerve blocks

When administering a local anesthetic agent to teeth and their related dental structures, which three bones of the head and neck contain the landmarks/foramina essential for proper injection technique? A. Maxilla, mandible, and temporal bones B. Maxilla, mandible, and zygomatic bones C. Maxilla, mandible, and palatine bones D. Maxilla, mandible, and sphenoid bones

C. Maxilla, mandible, and palatine bones

An 83-year-old male complains of achy jaws and a dark front tooth. Intraoral examination shows a darkened permanent maxillary right central incisor. What nerves may be involved in the ache he feels in her jaw? A. Lingual B. Chorda tympani C. Maxillary (V2) D. Mandibular (V3) E. Facial

C. Maxillary (V2)

27-year-old female, complains of a sore tongue with whitish material around tongue piercing stud and bad taste in mouth. She has regular dental care until recently. Supplemental History: Intraoral examination shows suppuration around tongue piercing jewelry due to a localized infection. Which of the following spaces can be involved in the localized tongue infection? A.Buccal space B.Canine space C.Submandibular space D.Submasseteric space

C. Submandibular space & sublingual

Intraoral examination shows bone damage of mandibular alveolar process with hemorrhagic and parethesia of entire lower lip. Why does bone damage of this kind happen mainly in the mandible? A.Thicker cortical plates and increase vascularization B.Thinner cortical plates and reduced vascularization C.Thicker cortical plates and reduced vascularization D.Thinner cortical plates and increased vascularization

C. Thicker cortical plates and reduced vascularization

32-year-old Male, complains of bad breath and soreness in lower left jaw area. He smokes 1 pack of cigarettes per day. The last dental visit was 5 years ago. Intraoral examination shows pericoronal inflammation around a partially erupted permanent mandibular left third molar, and the patient presents with halitosis and coated tongue . If the spaces associated with the involved tooth were to undergo cellulitis, into which location could the infection travel? A.Unilateral zygomatic region B.Cavernous sinus C.Retropharyngeal space D.Maxillary sinus

C.Retropharyngeal space ** note: Cellulitis can extend to Infraorbital, Zygomatic & Buccal Regions

Which of the following structures are not included in the masticator space? A. Temporal and infratemporal space B. Masseter muscle and ramus C. Body of the mandible D. Buccinator muscle

D. Buccinator muscle

Which one of the following nerve blocks may be complicated with transient facial paralysis? A. PSA B. IO C. ASA D. IA E. Mental

D. IA

An 83-year-old male complains of achy jaws and a dark front tooth. Intraoral examination shows a darkened permanent maxillary right central incisor. Which landmark is used to perform the nerve block to the darkened tooth? A. Maxillary tuberosity B. Zygomatic process C. Anterior border of ramus of the mandible D. Infraorbital rim E. Coronoid notch

D. Infraorbital rim

Where is the buccal space of the mandible located? A. Envelopes the parotid gland B. Superior to the upper lip C. Between the buccinator muscle and the oral mucosa D. Lateral to the buccinator muscle

D. Lateral to the buccinator muscle

Which of the following terms describes the process in lymph nodes when a patient has a disease process active in a region, such as cancer or infection, by increasing in size and changing the consistency of the lymphoid tissue? A. Lymphosarcoma B. Lymphangitis C. Lymphedema D. Lymphadenopathy

D. Lymphadenopathy

32-year-old Male, complains of bad breath and soreness in lower left jaw area. He smokes 1 pack of cigarettes per day. The last dental visit was 5 years ago. Intraoral examination shows pericoronal inflammation around a partially erupted permanent mandibular left third molar, and the patient presents with halitosis and coated tongue. If the involved tooth is extracted, from which bone and its process would the extraction take place? A.Maxillary bone and zygomatic process B.Mandible and coronoid process C.Zygomatic bone and maxillary process D.Mandible and alveolar process

D. Mandible and alveolar process

Which of the teeth listed below, when infected, do NOT initially drain into the submandibular lymph nodes but into another group of lymph nodes? A. Maxillary anterior teeth B. Maxillary first and second molars C. Maxillary premolars D. Maxillary third molars

D. Maxillary third molars

Which of the following complications can occur during the administration of the IA nerve block, resulting in inability to close the eyelid? A. Motor function of the abducens nerve B. Motor function of the oculomotor nerve C. Sensory function of the facial nerve D. Motor function of the facial nerve

D. Motor function of the facial nerve

To which cranial nerve, besides the eleventh and twelfth, is the parapharyngeal space adjacent? A. Third cranial nerve B. Sixth cranial nerve C. Seventh cranial nerve D. Ninth cranial nerve

D. Ninth cranial nerve (Glossopharyngeal)

Which of the following nerve blocks anesthetizes the buccal gingiva of the maxillary first molar? A. IO nerve block B. ASA nerve block C. Buccal nerve block D. PSA nerve block

D. PSA nerve block & MSA

To drill a mandibular tooth without causing undue pain, a dentist has injected an anesthetic into the space located between the medial pterygoid muscle and the mandible near the lingual. Given the nerves passing through the immediate vicinity of the injection site, where would one expect anesthesia in addition to the mandibular teeth? A. back of tongue B. external ear C. maxillary incisor teeth D. skin of chin E. upper lip

D. skin of chin

In which of the following spaces is the pterygoid plexus of veins located? A.Parotid space B.Buccal space C.Parapharyngeal space D.Masticatory space E.Carotid space

D.Masticatory space Between medial pterygoid & masseter

Extends down to the diaphragm along the posterior mediastinum

Danger Space

If a maxillary central incisor needs to be extracted, which of the following nerves or their terminal branches would have to be anesthetized? A. Anterior superior alveolar and greater palatine B. Greater palatine and nasopalatine C. Nasopalatine and Buccal D. Middle superior alveolar and nasopalatine E. Anterior superior alveolar and nasopalatine

E. Anterior superior alveolar and nasopalatine

Which of the following spaces communicate most directly with the submandibular space? A.Temporal B.Parotid C.Buccal D.Canine E.Sublingual

E.Sublingual

32-year-old Male, complains of bad breath and soreness in lower left jaw area. He smokes 1 pack of cigarettes per day. The last dental visit was 5 years ago. Intraoral examination shows pericoronal inflammation around a partially erupted permanent mandibular left third molar, and the patient presents with halitosis and coated tongue. If the infection progresses, which of the following locations of an abscess presentation would be most likely? A.Palate B.Buccal space C.Submental space D.Sublingual space E.Submandibular space

E.Submandibular space

Complications can occur during an incorrect administration of the inferior alveolar local anesthetic nerve block, resulting in inability to close the eyelid?

Facial Nerve the MOST commonly used during dental procedures

If an infection involves the lingual surface of the mandibular 2nd molar, where is a swelling most likely to be observed?

In the Submandibular Region

Ultimately, ALL lymph vessels of Head and Neck pass through which group of lymph nodes?

Inferior Deep Cervical Nodes

Abscesses & fistulae draining into the Nasolabial Skin Region are coming from...

MAX Canine- All surfaces

Abscesses & fistulae draining into the Maxillary Sinus are coming from...

MAX Molars: buccal surfaces & roots

Which teeth DO NOT drain into the submandibular lymph nodes?

Max 3rd Molars & Man Incisors

Which one of the following may be a direct complication from a periapical abscess of a maxillary 2nd molar?

Maxillary Sinusitis

Which term is used in infections that initially and DIRECTLY involves teeth and associated tissue?

Odontogenic

Anatomical landmark to divide the lymph nodes along the internal jugular vein into superior and inferior deep cervical nodes.

Omohyoid Muscle

Nerve Block for the MAXILLARY BUCCAL GINGIVA

PSA

Nerve block that uses the intraoral palpation of zygomatic process as a landmark

PSA

Extends down along the vertebral column

Prevertebral Space

For some authors, the "danger space" is considered part of which of the following spaces?

Prevertebral space Orbital Region, Nasal Region & Paranasal Sinuses

Life threatening complication with untreated Ludwig's angina?

Respiratory Obstruction

Extends up to the bifurcation of the trachea/ Sup. mediastinum

Retropharyngeal Space

Abscesses & fistulae draining into the Nasal Floor are coming from...

Root of MAX central incisors

The lymph vessels from the mandibular premolars pass directly to which lymph nodes?

Submandibular

Which of the superficial group of lymph nodes initially receives the major portion of the lymphatic drainage of the maxilla?

Submandibular

Intraoral examination shows inflammation on the buccal surface around a partially erupted permanent mandibular left third molar and halitosis (bad breath). Which lymph nodes drain primarily the site of infection?

Submandibular Nodes

Lymphatics from an apical infection in the permanent maxillary right central incisor will drain into which lymph nodes?

Submandibular Nodes

In a pericoronal inflammation around a partially erupted permanent mandibular left 3rd molar if the infection progresses, which of the following locations of an abscess presentation would be most likely?

Submandibular Space

A suppuration from the body of the tongue, around a piercing jewelry can spread to the next space, which is what?

Submandibular space

Lymph nodes receiving drainage from the tip of the tongue, lower central incisors and the middle portion of the lower lip.

Submental

What group of lymph nodes is the first to receive the drainage from the tip of the tongue, lower central incisors and the middle portion of the lower lip?

Submental

Which of the following nodes are primary involved in infection of maxillary third molar?

Superior Deep Cervical

What recent procedure performed in the community has increased the cases of Ludwig angina?

Tongue Piercing

5 spaces involved with Ludwig Angina

•Submental •Submandibular •Sublingual •Parapharyngeal •Retropharyngeal