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The nervous system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Lesions of the whole trigeminal nerve lead to loss of sensation in the skin and mucous membrane of the face and nasopharynx, and a reduction in salivary, buccal and lacrimal secretions. Taste is spared, but lack of oral secretions may result in subjective changes. A characteristic feature is weakness of the muscles of mastication. Pain in the distribution of the ophthalmic division of the trigeminal nerve may be caused by herpes zoster infection.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
There are four muscles of mastication: temporalis, masseter, medial pterygoid, and lateral pterygoid. They are all 1st branchial arch derivatives and are therefore all innervated by the same nerve (mandibular division of trigeminal, or Vc).
Physiology of Swallowing
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Joanne M. Patterson, Stephen McHanwell
Most of our knowledge of the role of these regions in swallowing control comes from experimental studies in animals. The results of these studies clearly have limitations when one attempts to apply them to humans.35 Within the medulla there are a number of neuron groups involved in the control of swallowing.36 Swallowing is initiated by touch sensation or pressure from the liquid or food within the posterior part of the oral cavity, epiglottis or oropharynx. Thus, the nuclei receiving afferent input from these regions, which include the nucleus tractus solitarius and the spinal trigeminal nucleus, are very important. Afferent input from the jaw, muscles of mastication, lips and tongue is also essential to the control of swallowing, not just during the pharyngeal phase as outlined above but also during the oral phase. The oral cavity contains an unusually high concentration of mechanoreceptors. These protect delicate tissues from the high forces generated during mastication, to trigger the reflex and to sense the size and consistency of the bolus, also as part of the trigger mechanism.
Cross cheek dumbbell-shaped radial forearm free flap for bilateral trismus release
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Touqeer Hussain, Hasan Tahir, Obaid U. R. Rahman, Mirza Shehab Afzal Beg
Trismus is known to complicate post-operative outcomes in oral cancer surgery. Most often the cause is found to be oral submucosal fibrosis and fibrosis of muscles of mastication. Wei et al. [16] used two separate RFFF for bilateral buccal mucosa reconstruction. This technique demands both upper limbs to be worked on for flap harvest, causes scars on both upper limbs, needs double vascular anastomosis (both flaps anastomosed separately) leading to longer operating time burdening both surgeon and patient, in contrast, our technicians use only a single forearm and single anastomosis. The utilization of two independent RFFF from the single radial artery was presented by Tsao et al. [17] splitting fascio-cutaneous flap into two, based on perforators. He marked distal flap in the standard fashion and the proximal skin paddle is designed in the middle third of the forearm, based on septo-cutaneous branches of the radial artery. He elevates the two flaps and subsequently divides them into two independent free flaps, like bilateral RFFF this demands two separate micro-vascular anastomoses. Jiang et al. [18] presented a tri-paddled anterolateral thigh flap with three independent sets of perforators to cover the trismus defect.
Biomarkers in temporomandibular disorder and trigeminal neuralgia: A conceptual framework for understanding chronic pain
Published in Canadian Journal of Pain, 2020
Tina L. Doshi, Donald R. Nixdorf, Claudia M. Campbell, Srinivasa N. Raja
The simplistic perspective that TMD is a problem of inflammation and sensitization, whereas TN is a problem of nerve dysfunction, would suggest very different areas of biomarker research for the two conditions. However, chronic pain is never that simple, and some evidence suggests that inflammation could contribute to TN pain,58,59 and nerve dysfunction may play a role in TMD.60,61 Moreover, the same nerves can be involved in both conditions. Sensory innervation of the temporomandibular joint is supplied by the V3 branch of the trigeminal nerve, so in cases of TMD involving facial or joint pain, the trigeminal nerve is necessarily involved in pain transmission. The branches of the trigeminal also supply motor innervation to the muscles of mastication (masseter, temporalis, medial, and lateral pterygoids and anterior digastric); therefore, dysfunction of the trigeminal nerve may also lead to dysfunction of musculoskeletal structures involved in TMD. Identifying areas of overlap and dissimilarity in biomarkers for the two conditions has important implications for understanding which molecules may better serve as screening or diagnostic biomarkers and which are better suited as predictive biomarkers.
Vesalius criticism on Galen’s musculoskeletal anatomy
Published in Acta Chirurgica Belgica, 2019
Konstantinos Markatos, Dimitrios Chytas, Georgios Tsakotos, Marianna Karamanou, Maria Piagkou, Elizabeth Johnson
In terms of the structure of muscles, Vesalius also expressed a different opinion from Galen’s. According to the latter, the muscle contained a mixture of ligaments and nerves, which are divided into fibers, creating an extended course with interstices that are covered with flesh [7,8]. In contrast, Vesalius argued that this flesh is the organ of motion and not simply the support of the aforementioned fibers. Moreover, concerning the muscles of mastication, Vesalius described separately temporalis and masseter, which were considered as a single muscle by Galen. Besides, lateral and medial pterygoid muscles were mentioned, as well as the digastric [1,8]. Vesalius also criticized Galen in terms of the description of the lateral flexion of the head, which, according to Galen, could be performed without the participation of the neck muscles [8].