Lecture 5 - Continuation Of Cells PDF

“Schisis” means split LECTURE 5 - CONTINUATION OF Most common CONGENITAL OROFACIAL DEFECT Side notes: CELLS...

“Schisis” means split LECTURE 5 - CONTINUATION OF Most common CONGENITAL OROFACIAL DEFECT Side notes: CELLS o “CLEFTS” are common in the LEFT side o “Cleft LIP” is more common in MALES (P) Treatment of CLEFT LIP follows the “RULE OF 10” QUESTION: o 10 weeks In a Right condylar neck fracture, where is the deviation during opening? o 10lbs Answer: Right Side; TOWARDS the side of the fracture o 10g/dL hemoglobin o Unlike o >10,000 WBC Count During tongue protrusion, tongue deviates to the right. What nerve is o RULE OF 10 IS ONLY FOR CLEFT LIP, not damaged? applicable to CLEFT PALATE Answer: R CNXII (Right Cranial Nerve XII) ▪ CLEFT PALATE o CN XII – Motor innervation of the tongue Most common in the LEFT SIDE o CN IX – Sensory innervation to the tongue Most common in FEMALES (P) ▪ Therefore is not involved in tongue deviation Treated between 12-18 months of age o Muscles of the tongue QUESTION: ▪ Genioglossus (CN XII)– Pulls tongue ANTERIORLY to opposite side Cleft of Hard Palate is known as? Has the LEFT and RIGHT genioglossus muscle Answer: Uranoschisis If both muscles are healthy, the tongue is pulled STRAIGHT forward (both muscles Cleft of Soft Palate is known as? counteract their directions) Answer: Staphyloschisis o Sidenote: If the RIGHT Hemisphere of the brain suffers a stroke, which direction does the tongue deviate to? Cleft of Hard and Soft Palate is known as? ▪ Answer: Left side ▪ Brain hemispheres control opposite sides of the body Answer: Uranostaphyloschisis Right hemisphere controls left side of the body Left hemisphere controls right side of the body VERTEBRATE ▪ If the RIGHT side of the brain is affected, the left side of the body (including the tongue) is affected Developed from SOMITES Hence, the LEFT part of the tongue is o Mesodermal embryonic structure paralyzed, and cannot move to the opposite Cervical (7) (missing info here about pairs) direction o C1 (atlas) and Occipital bone - forms atlantooccipital joint ▪ The tongue deviates to the left side ▪ Atlantooccipital Joint = For Saying YES As in nodding UP and DOWN atlantO-Occipital (Oo, as in “yes”) PALATINE BONES o C1 and C2 (axis) – forms atlantoaxial joint ▪ Atlantoaxial Joint = For saying NO L-shaped paired bone As in swinging LEFT and RIGHT HORIZONTAL PLATE forms the part of the ROOF of the oral cavity PERPENDICULAR PLATE forms part of the FLOOR of the orbit o BOARD EXAM: Which of the following bones is not included in forming the FLOOR of the orbit o C7 – has most prominent spinous process ▪ Do not answer: PALATINE BONES ▪ BOARD EXAM: Answer: Ligamentum Nuchae ▪ Cleft Lip (Cheiloschisis) Ligament that is attached from the C7 to the “Cheilio” means lips Occipital Bone  ▪ It is the MOST UNIQUE vertebral vertebrae because it o does NOT have the transverse foramen 2 Pairs of FLOATING RIBS o C1 to C6 has TRANSVERSE FORAMEN – passage for vertebral o 11TH and 12th Pair artery (from subclavian artery) ▪ Textbook 2 ▪ All of them from C1 to C6 has Transverse Foramen 7 Pairs of TRUE RIBS (1-7) ▪ Transverse foramen gives passage for VERTEBRAL 3 Pairs – FALSE RIBS (8-10) ARTERY coming from the SUBCLAVIAN ARTERY 2 Pairs – Floating Ribs (11-12) ▪ C7 does NOT have transverse foramen Lumbar – 5 (Total of 5 whether Child or Adult) o Sidenote: Circulation o Kidney or bean shape ▪ Left and Right Subclavian Artery -> o Largest and strongest UNFUSED vertebra ▪ Left and Right Vertebral Artery -> o Carries MOST OF BODY WEIGHT ▪ Fuse to become a single BASILAR ARTERY -> ▪ Carry is in “lifting most of the body” ▪ Leads to the CIRCLE OF WILLIS Sacrum – 1 in adult (5 pre-adult) o LARGEST and STRONGEST of ALL Vertebrae o 5 in pre-adult fuses into 1 Coccyx – 1 in adult (4 pre-adult) o Also 4 fuses into 1 JOINTS Joints – Structure that connects BONE-TO-BONE Structural Classification of Joints ▪ o Fibrous (FiSS) – Joints formed by Fibers/CT These 5 are the most important arteries in the ▪ Interosseous Membrane (inter- between; osseous – circle of Willis bone) BOARD EXAM: The main source of blood supply Between tibia-fibula of the brain Between radius-ulna o INTERNAL CAROTID ARTERIES (L&R) ▪ Goes to circle of Willis o VERTEBRAL ARTERIES (L&R) ▪ Goes to basilar artery Important: Heart and Head & Neck Arteries and Veins are important in board exam, others are less so o What about stiff neck? Is it related to the Cervical Vertebrae? ▪ No, it is because of MUSCLE SPASM, not due to vertebrae ▪ Sutures ▪ This is also what happens in TMJ dysfunction As in sutures of the skull Thoracic – 12 (Total of 12 whether Child or Adult) Fibers in between two bones o Heart-shape Aging causes transformation of fibers into BONY o Thoracic Vertebrae is where our RIBS are attached tissues ▪ That is why there are 12 PAIRS of RIBS (24 Ribs in total) o Synostosis – transformation of fibers ▪ Board exam: Be careful if asking for PAIR of ribs or RIBS in into a bony joint total o Ribs ▪ Textbook 1 (Doc’s Better Choice) ▪ Syndesmoses 7 pairs of TRUE RIBS Bundles of ligament o 1st pair to 7th pair Gomphosis (PDL) = Dentoalveolar Syndesmoses 5 Pairs of FALSE RIBS Ankylosis - Synostosis of the Gomphosis (PDL)  ▪ Both are due to VITAMIN D/CALCIUM Deficiency Syphilis is caused by TREPONEMA PALLIDUM ▪ Osteomalacia AFTER epiphyseal closure (Adult) ▪ Rickets BEFORE epiphyseal closure (Child) o Acromegaly & Gigantism ▪ Both are due to EXCESSIVE growth hormone Both are associated with a SKELETAL CLASS III MALOCCLUSION o ▪ Acromegaly o Cartilaginous (CaSS) – Joints formed by CARTILAGE AFTER epiphyseal closure (Adult) ▪ Synchondroses - PRIMARY cartilaginous joint Only head is affected Formed by HYALINE cartilage only ▪ Gigantism Such as the Epiphyseal Plate (refer to previous BEFORE epiphyseal closure (Child) notes), ribs, and cranial base All bones are affected ▪ Symphyses – SECONDARY cartilaginous joint o Achondroplastic Dwarfism Formed by BOTH HYALINE CARTILAGE and ▪ Aka. ACHONDROPLASIA FIBROCARTILAGE ▪ Most common type of dwarfism Such as ▪ Etymology o Symphysis Menti “A” – absence o Symphysis Pubis “chondro” – cartilage o Manubriosternal Joint “plasia” – relating to formation or changes in o Invertebral Disc cells BOARD EXAM: Examples of Symphysial Joints / ▪ Due GENETIC MUTATIONS, results to RETARDED cartilage Where they are located growth o Synovial – Joints containing SYNOVIAL FLUID Affects bones that undergo ENDOCHONDRAL ▪ Such as: Elbow Joint, TMJ Ball and Socket formation Types of Joint Movements ▪ Features: o Synarthroses – NON-movable Normal / Close to normal torso ▪ Such as SUTURES Shortened limbs o Amphiarthroses – SLIGHTLY movable BASIC TYPES OF BONE FRACTURES ▪ Such as the VERTREBRAE o Fracture – Separation of bone o Diarthroses – FREELY movable o Types: ▪ Such as the SHOULDER JOINT and TMJ ▪ Close (simple) – no penetration of soft tissue o NOTE: GOMPHOSIS can by Synarthroses or Amphiarthroses ▪ Open (compound) – with penetration of soft tissue ▪ BOARD EXAM: Synarthroses is best option Fractures you see where bone is jutting out of skin ▪ Comminuted – crushed Like due to gunshots or car accidents ▪ Greenstick – Similar to twigs Incomplete fractures, only part of bone is separated Most common in children REMEMBER o BOARD QUESTION: What is the treatment for fractures? ▪ Answer: REDUCTION AND FIXATION EPIPHYSEAL PLATE PATHOLOGIES As in REDUCE the separation o Osteomalacia & Rickets  o Open Reduction – Open surgery ▪ Estrogen & Testosterone ▪ Done when the bone is not seen Promote bone formation or minimal visibility Important in bone maintenance o Close Reduction – No surgery ▪ Menopause (Females) ▪ Done when palpation is enough At or around age of 45, estrogen levels decrease As in FIX/STABILIZE the reduction o Fixation is important because there has to be NO MOBILITY ▪ Healing with mobility disturbs the healing and does not unite (NON-UNION) o ORAL SURGERY BOARD: ▪ (+) mobility during fracture healing Answer: NON-UNION ▪ Most common complication of fracture Due to this, safest ages of pregnancy are 35 and Answer: INFECTION below o Internal Fixation Once they reach 36, risk increases further ▪ Titanium Screws/Plates ▪ Andropause (Male) o External Fixation At or around 45 ▪ Casted arms/legs o BOARD EXAM: FRACTURE REPAIR STEPS Males have GRADUAL REDUCTION in ▪ Hematoma formation testosterone, so effect is not as powerful ▪ Fibrocartilaginous callus formation ▪ Treatment Temporary connection between fractured bones HIGH CALCIUM DIET with VITAMIN D ▪ Bony Callus formation BISPHOSPHONATES – Drug of choice Replaced with bones o Antiresorptive Drug ▪ Bone Remodeling ▪ Results to DENSER bones ▪ 206 bones in body, mixed either New bone is STRONGER than older bone dense or porous o PROSTHO BOARDS SIDENOTE: Border Molding (Greenstick) o Complication: BRONJ ▪ How do you know your border molding is ▪ Bisphosphonate affects both correct/accurate? porous and dense bones Answer: When you test the custom tray on the ▪ Porous bones become dense patient, the tray has RETENTION ▪ Dense bones become DENSER o In doc’s practice, border molding also ▪ This leads to compression of has a vacuum/suction effect blood vessels and cutting off SOME BONE PATHOLOGIES blood supply in specific areas ▪ BRONJ (Bisphosphonate-Related Osteoporosis – excessive porosity of bone due to rapid resorption of bone Osteonecrosis of the Jaw) o Etymology Mandible is mainly ▪ Osteo – bone compact (dense) bone ▪ Por – pores Loss of blood supply in ▪ Osis – accumulation the mandible causes ▪ Accumulation of bone pores BRONJ, necrosis of jaw o MOST COMMON bone disorder bone o More common in females due to: No treatment for ▪ Dramatic LOSS OF ESTROGEN during MENOPAUSE BRONJ, only PALLIATIVE ▪ In males, LOSS OF TESTOSTERONE in ANDROPAUSE  ▪ Dental Clearance must be given ▪ Question: Pathognomonic sign of Gout? before prescription of Answer: Tophi Bodies Bisphosphonates o Enlargement of the joints ▪ Necrotic or Infected teeth o Kyphosis, Lordosis, and Scoliosis – ABNORMAL VERTEBRAL increases chances of BRONJ CURVES Must be treated or ▪ Kyphosis – Thoracic Curvature extracted before HUNCHBACK – excessive thoracic curvature prescribing ▪ Lordosis – Lumbar Curvature ▪ Radiology rule “If in doubt, HOLLOWBACK/SWAYBACK – Excessive lumbar extract” curvature Because radiology also ▪ Scoliosis – Lateral Curvature of Spine causes Necrosis of Jaw S-Shaped Spine o Osteoarthritis MOST COMMON of the abnormal curves ▪ aka. WEAR AND TEAR ARTHRITIS o Ankylosing Spondylitis Due to aging ▪ Aka. Marie-Strumpell Disease ▪ MOST COMMON form of Arthritis ▪ Arthritis of the Spine ▪ Articular cartilage degeneration causing contact between “Spondy” – Spine bones ▪ No treatment Recall that cartilage does not have blood supply, o Paget’s Disease of Bone therefore it does not heal/regenerate ▪ Aka. Osteitis Deformans ▪ Contact between bones causes pain and inflammation, ▪ BOARD EXAM: Usual complaint: Denture/Hat doesn’t fit as well as damage to bone anymore. Answer: Paget’s Disease of Bone Athletes and weightlifters are also prone to this ▪ Presents with SPONTANEOUS (random) BONE ▪ In TMJ, structures remain but no cartilage anymore and FORMATION pain is present ▪ Diagnosis: o Rheumatoid Arthritis Radiograph: Cotton-Wool Appearance ▪ Autoimmune disorder, not related to age and affects all ▪ Immune cells attack Articular Cartilage, which also causes contact between bones ▪ In TMJ, since it occurs very early, the TMJ structures are flat and are constantly in pain ▪ Corticosteroids may help because they are ANTI- INFLAMMATORY and IMMUNOSUPPRESSANT o Gouty Arthritis ▪ Due to EXCESSIVE URIC ACID building up in blood ▪ Uric Acid + Sodium = Crystallization Histology: Jigsaw Puzzle or Mosaic Pattern Crystallization usually accumulates in joints ▪ Question: What nitrogenous bases are involved in uric acid formation? Answer: PURINES (Adenine and Guanine) o Any food that is high in PURINES will results in high blood uric acid ▪ Purines when broken down will produce URIC ACID o Example: BEER and RED MEAT Doc sidenote: Many children now have high o Pink structures are freshly calcified bone chance of cancer o Light pink structures are osteoid o Colon Cancer: 10% in 50 years old below o Now, 20% in 50 years old below  Blood Chem: Increased SERUM ALKALINE PHOSPHATASE o Not a pathognomonic feature o Increased serum alkaline phosphatase is common in bone and liver diseases o In Paget’s Disease, it can be used in differential diagnosis o Sidenote: Multiple Myeloma ▪ Plasma Cell Malignancy ▪ Also has increased serum alkaline phosphatase ▪ Differentiate by radiograph: Punched-Out Radiolucencies ▪ ▪ Differentiate by Histology ▪ BOARD EXAM: Which involves BENCE-JONES PROTEINS? Answer: Multiple Myeloma Presence of BONE DEFORMITY o Known as “Lion Face” o Osteomyelitis ▪ Bone infection affecting BONE MARROW ▪ Due to STAPHYLOCOCCUS AUREUS Part of natural flora in SKIN and ORAL CAVITY If it invades the BONE MARROW, it causes Osteomyelitis ▪ Presents with: Radiograph: MOTH-EATEN appearance Sidenote: MOTH-EATEN RADIOGRAPHS: o Osteomyelitis o Ewing’s Sarcoma o External Root Resorption