DOCSLIB.ORG

Journalajtcvm(Issue 2)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Journalajtcvm(Issue 2) Neuroanatomic Structure and Function of Acupuncture Points around the Eye Narda G. Robinson, DO, DVM, MS, Jessica Pederson, Ted Burghardt, L. Ray Whalen, DVM PhD ABSTRACT The locations of eight human periocular acupuncture points were transposed to the dog. Canine dissections exposed acupoint-nerve relationships that were compared to those previously identified in the human. Two comparative anatomical differences in periocular points include 1) lack of a complete bony orbit in the dog and absence of cranial nerve foramina, and 2) longer distance between the canine infraorbital foramen and ipsilateral eye than in the human, requiring a different location for ST 2. Traditional Chinese Veterinary Medicine (TCVM) actions assigned to each point were compared to the neurophysiologic results expected after stimulating these nerves. Nerve structure-function relationships of the periocular acupuncture points explain the theoretical TCVM descriptions of point actions. This finding emphasizes the relevance of ensuring that a transpositional point system is based on comparative neuroanatomical precision. Differences exist in periorbital bony anatomy between the dog and the human that call for a re-evaluation of the topographical anatomy of canine periocular acupuncture points. Key Words: Neuroanatomical acupuncture, transpositional points, veterinary acupuncture, Traditional Chinese Veterinary Medicine, TCVM, ophthalmology The effects of acupuncture are associated nervous system and out again through somatic and with “neuromodulation”, which involve the autonomic pathways. Predictable neuromodulation physiologic changes caused by acupuncture that depends upon the accuracy of acupuncture point relate directly to the nerves stimulated.1 Peripheral and nerve stimulation. Obtaining a reliable clinical nerves at acupuncture points impact the body as a outcome with acupuncture requires that the target whole through reflex connections into the central acupuncture point affects the appropriate nerves. Since no comprehensive neuroanatomically accurate acupuncture point atlas yet exists for non- human species, developing such an atlas is a critical From: Narda G. Robinson, DO, DVM, MS first step in upgrading the level of clinical practice 2 Shipley Professorship of Complementary and Alternative and scientific research. Medicine Colorado State University Veterinary Medical Center The head region contains a rich network of 300 West Drake Road cranial nerves and abundance of acupuncture Fort Collins, CO 80523 points. Periocular acupuncture points in particular Jessica Pederson, Professional Veterinary Medicine Student, Colorado State University can serve as a worthwhile first step in creating an Ted Burghardt, Professional Veterinary Medicine Student, anatomically based transpositional canine atlas, Colorado State University given their clinical significance for a variety of L. Ray Whalen, DVM PhD University Distinguished Teaching Scholar conditions. Eight points surrounding the eye in the Department of Biomedical Sciences human selected for study in the dog appear in Table Colorado State University Fort Collins, CO 80523 1. Actions assigned to these eight points focus mainly on eye problems; other actions include Funding Acknowledgement craniofacial pain, sinusitis, and migraine. Made possible by the kind support of the Barry and Savannah French-Poodle Memorial Fund. Examples of periocular and other acupuncture point combinations used for the treatment of some ACUC Approval common conditions in humans are listed in Table 2. Animal Care and Use Committee approval was obtained prior to performing the dissections. The objectives of this study were to (1.) AJTCVM Vol 2, No.1, Summer 2007 33 Table 1: Overview of eight acupuncture points around the eye Acupoint Name Comparative (Chinese Name) Regional Anatomy Associated with the Anatomy Indications TCVM Actions English Translation, Acupoint Concerns Human Location All eye No lacrimal part conditions, of the orbicularis Sensory to upper lid, conjunctiva, and including oculi m has been forehead: redness, found in the dog. Supratrochlear n (CN V1) swelling, In humans, the pain, lacrimal part of Sensory to both eyelids, conjunctiva, epiphora, the orbicularis lacrimal sac, and lacrimal caruncle, and BL-1 blurred oculi brings the part of the nose: (Jingming) vision, eye eyelids and the Infratrochlear n (CN V1), a branch of the Clarity of pupils itching, Benefits and lacrimal puncta nasociliary n lacrimation brightens the eyes. toward a medial Location: on wind Expels Wind. direction, Tear drainage Slightly medial and exposure, Clears Heat. pressing the Nasolacrimal duct superior to the inner aversion to puncta into the canthus of the eye. cold with lacrimal lake. Periocular muscles and their nerve supply headache. This allows Orbicularis oculi m, palpebral part (supplied Migraine, lacrimal fluid by palpebral part of auriculopalpebral n, frontal to drain into it (from CN VII) headache, more readily Levator palpebrae superioris m (supplied by rhinitis, through a CN III) frontal capillary action.28 sinusitis. Local pain No supraorbital and swelling, foramen exists in frontal the dog. Instead, headache, the supraorbital lacrimation nerve winds on wind Sensory to upper lid, conjunctiva, frontal BL-2 around the exposure, sinus, and forehead: (Zanzhu) zygomatic blepharospas Supraorbital n (CN V1) Gathered Bamboo process of the m, rhinitis, Dispels Wind. frontal bone. facial pain, Periocular muscles and their nerve supply Location: Clears Heat. Because of this manic Orbicularis oculi m, orbital part (supplied by Directly superior to BL- Benefits the Eyes. transpositional behavior, palpebral part of auriculopalpebral n, from 1, in a tender depression Alleviates Pain. issue, BL- 2 in pain and CN VII) near the medial end of the dog tends to stiffness of the eyebrow, at the have a slightly the neck, Frontalis m (supplied by temporalis and supraorbital notch. more lateral blurred auriculopalpebral branch of CN VII) placement on vision. what would be Hallucination the canine s, nightmares, eyebrow. anxiety. M-HN-6 Redness, Sensory to upper lid, conjunctiva, frontal (Yuyao) pain, swelling sinus, and forehead: As Yuyao resides Fish Waist of the eyes. Supraorbital n (CN V1) lateral to BL 2, Blepharospas there is no bone Relaxes the Location: m. Periocular muscles and their nerve supply beneath this sinews. In the center of the Ptosis, or Orbicularis oculi m, orbital part (supplied by point in the dog, Reduces pain. eyebrow, in the eyelid cannot palpebral part of auriculopalpebral n, from unlike in the Benefits the eyes. depression that lies close. CN VII) human. directly above the pupil Frontal when the eye is looking headache, Frontalis m (supplied by temporalis and forward. migraine. auriculopalpebral br of CN VII) CN V-1 = Trigeminal nerve ophthalmic branch CN V-2 = Trigeminal nerve maxillary branch and CN V-3 = Trigeminal nerve mandibular branch 34 AJTCVM Vol 2, No.1, Summer Sensory to skin of lateral upper lid: Lacrimal n (CN V1, CN V2) Supraorbital n (CN V1) TH- 23 No eyebrows in (Sizhukong) dogs; i.e., there is Sensory to lacrimal gland; carries parasympa- Bamboo Headache. no bony rim to the thetic fibers from CN VII: Thread Pain and red- Resolves Heat. orbit at this loca- Lacrimal n (CN V1, CN V2) ness of the Disperses Wind. tion that contains a Location: eyes. Blepha- Alleviates pain. depression at the In the de- rospasm. Epi- Brightens the eyes. end, which in the Periocular muscles and their nerve supply pression at lepsy. Tooth Frees the channel. human defines Orbicularis oculi m, orbital part (supplied by the lateral pain. palpatory aspects palpebral part of auriculopalpebral n, from CN end of the of the eyebrow. VII) eyebrow. Frontalis m (supplied by temporalis and auriculo- palpebral br of CN VII) Dogs lack a com- plete bony orbit; instead, GB-1 oc- curs just dorsal to Sensory to skin of lateral canthus region: the frontal process Lacrimal n (CN V-1, CN V-2) of the zygomatic bone. Supraorbital n (CN V-1) GB-1 Humans lack a (Tongziliao) retractor anguli Zygomaticotemporal n (CN V-2) Pupil Bone oculi lateralis mus- Hole cle. Branches of the Auriculotemporal n (CN V-3) by way of a small Dispels Heat. facial nerve differ Headache, eye communicating branch to the zygomaticotemporal Expels Wind. Location: between humans pain, loss of n or zygomaticofacial n Frees the Qi. Lateral to and dogs; humans visual acuity, Alleviates pain. the lateral lack an auriculo- redness in the Zygomaticofacial n (CN V-2) Brightens the eyes. canthus, in a palpebral nerve; eyes, tearing. Facial n (CN VII) by way of an anastomotic con- depression instead, the pe- nection to the zygomaticofacial n on the lateral riocular muscles of side of the facial expression Periocular muscles and their nerve supply orbit. served by the auri- Orbicularis oculi m, orbital part (supplied by culopalpebral nerve palpebral part of auriculopalpebral n, from CN in the dog receive VII) their motor supply from the zygomatic Retractor anguli oculi lateralis m (supplied by and temporal zygomatic br, auriculopalpebral n, from CN VII) branches of the facial nerve. M-HN-8 (Qiuhou) Sensory to skin of lower orbital region: Behind the Auriculotemporal n (CN V-3) by way of a small Ball communicating branch to the zygomaticotemporal Location: All eye condi- n or zygomaticofacial n Along the tions including Dogs do not have inferior rim short- zygomaticofacial Zygomaticofacial n (CN V-2) of the orbit, sightedness, foramina for local- Facial n (CN VII) by way of an anastomotic
Load more

Recommended publications
  • Palatal Injection Does Not Block the Superior Alveolar Nerve Trunks: Correcting an Error Regarding the Innervation of the Maxillary Teeth
    Open Access Review Article DOI: 10.7759/cureus.2120 Palatal Injection does not Block the Superior Alveolar Nerve Trunks: Correcting an Error Regarding the Innervation of the Maxillary Teeth Joe Iwanaga 1 , R. Shane Tubbs 2 1. Seattle Science Foundation 2. Neurosurgery, Seattle Science Foundation Corresponding author: Joe Iwanaga, [email protected] Abstract The superior alveolar nerves course lateral to the maxillary sinus and the greater palatine nerve travels through the hard palate. This difficult three-dimensional anatomy has led some dentists and oral surgeons to a critical misunderstanding in developing the anterior and middle superior alveolar (AMSA) nerve block and the palatal approach anterior superior alveolar (P-ASA) nerve block. In this review, the anatomy of the posterior, middle and anterior superior alveolar nerves, greater palatine nerve, and nasopalatine nerve are revisited in order to clarify the anatomy of these blocks so that the perpetuated anatomical misunderstanding is rectified. We conclude that the AMSA and P-ASA nerve blockades, as currently described, are not based on accurate anatomy. Categories: Anesthesiology, Medical Education, Other Keywords: anatomy, innervation, local anesthesia, maxillary nerve, nerve block, tooth Introduction And Background Anesthetic blockade of the posterior superior alveolar (PSA) branch of the maxillary nerve has played an important role in the endodontic treatment of irreversible acute pulpitis of the upper molar teeth except for the mesiobuccal root of the first molar tooth [1, 2]. This procedure requires precise anatomical knowledge of the pterygopalatine fossa and related structures in order to avoid unnecessary complications and to make the blockade most effective. The infraorbital nerve gives rise to middle superior alveolar (MSA) and anterior superior alveolar (ASA) branches.
    [Show full text]
  • Nerves of the Orbit Optic Nerve the Optic Nerve Enters the Orbit from the Middle Cranial Fossa by Passing Through the Optic Canal
    human anatomy 2016 lecture fourteen Dr meethak ali ahmed neurosurgeon Nerves of the Orbit Optic Nerve The optic nerve enters the orbit from the middle cranial fossa by passing through the optic canal . It is accompanied by the ophthalmic artery, which lies on its lower lateral side. The nerve is surrounded by sheath of pia mater, arachnoid mater, and dura mater. It runs forward and laterally within the cone of the recti muscles and pierces the sclera at a point medial to the posterior pole of the eyeball. Here, the meninges fuse with the sclera so that the subarachnoid space with its contained cerebrospinal fluid extends forward from the middle cranial fossa, around the optic nerve, and through the optic canal, as far as the eyeball. A rise in pressure of the cerebrospinal fluid within the cranial cavity therefore is transmitted to theback of the eyeball. Lacrimal Nerve The lacrimal nerve arises from the ophthalmic division of the trigeminal nerve. It enters the orbit through the upper part of the superior orbital fissure and passes forward along the upper border of the lateral rectus muscle . It is joined by a branch of the zygomaticotemporal nerve, whi(parasympathetic secretomotor fibers). The lacrimal nerve ends by supplying the skin of the lateral part of the upper lid. Frontal Nerve The frontal nerve arises from the ophthalmic division of the trigeminal nerve. It enters the orbit through the upper part of the superior orbital fissure and passes forward on the upper surface of the levator palpebrae superioris beneath the roof of the orbit .
    [Show full text]
  • Regional Anesthesia in Head and Neck Surgery
    TITLE: Regional Anesthesia in Head and Neck Surger SOURCE: Grand Rounds Presentation, UTMB, Dept. of Otolaryngology DATE: May 24, 2006 RESIDENT PHYSICIAN: Jacques Peltier, MD FACULTY PHYSICIAN: Francis B. Quinn, MD SERIES EDITORS: Francis B. Quinn, Jr., MD and Matthew W. Ryan, MD "This material was prepared by resident physicians in partial fulfillment of educational requirements established for the Postgraduate Training Program of the UTMB Department of Otolaryngology/Head and Neck Surgery and was not intended for clinical use in its present form. It was prepared for the purpose of stimulating group discussion in a conference setting. No warranties, either express or implied, are made with respect to its accuracy, completeness, or timeliness. The material does not necessarily reflect the current or past opinions of members of the UTMB faculty and should not be used for purposes of diagnosis or treatment without consulting appropriate literature sources and informed professional opinion." Introduction Local anesthetic techniques were popularized early in the history of surgery with the advent of injectable nerve blocking agents. Until their discovery, patients were either held down or knocked unconscious to perform procedures. In the early days of general anesthesia, local anesthesia was preferred in all cases that it was applicable due to the significant risks associated with general anesthesia. Many procedures performed today under general anesthesia, such as tonsillectomy, rhinoplasty, and even bronchoscopy, were performed under local anesthesia to avoid the perils of general anesthetics. With the introduction of pulse oximetry, safer inhaled anesthetics, and combined intravenous and inhaled general anesthesia techniques, general anesthesia has become much safer, resulting in many surgeons being unfamiliar with regional nerve blocks to perform surgery.
    [Show full text]
  • Vocabulario De Morfoloxía, Anatomía E Citoloxía Veterinaria
    Vocabulario de Morfoloxía, anatomía e citoloxía veterinaria (galego-español-inglés) Servizo de Normalización Lingüística Universidade de Santiago de Compostela COLECCIÓN VOCABULARIOS TEMÁTICOS N.º 4 SERVIZO DE NORMALIZACIÓN LINGÜÍSTICA Vocabulario de Morfoloxía, anatomía e citoloxía veterinaria (galego-español-inglés) 2008 UNIVERSIDADE DE SANTIAGO DE COMPOSTELA VOCABULARIO de morfoloxía, anatomía e citoloxía veterinaria : (galego-español- inglés) / coordinador Xusto A. Rodríguez Río, Servizo de Normalización Lingüística ; autores Matilde Lombardero Fernández ... [et al.]. – Santiago de Compostela : Universidade de Santiago de Compostela, Servizo de Publicacións e Intercambio Científico, 2008. – 369 p. ; 21 cm. – (Vocabularios temáticos ; 4). - D.L. C 2458-2008. – ISBN 978-84-9887-018-3 1.Medicina �������������������������������������������������������������������������veterinaria-Diccionarios�������������������������������������������������. 2.Galego (Lingua)-Glosarios, vocabularios, etc. políglotas. I.Lombardero Fernández, Matilde. II.Rodríguez Rio, Xusto A. coord. III. Universidade de Santiago de Compostela. Servizo de Normalización Lingüística, coord. IV.Universidade de Santiago de Compostela. Servizo de Publicacións e Intercambio Científico, ed. V.Serie. 591.4(038)=699=60=20 Coordinador Xusto A. Rodríguez Río (Área de Terminoloxía. Servizo de Normalización Lingüística. Universidade de Santiago de Compostela) Autoras/res Matilde Lombardero Fernández (doutora en Veterinaria e profesora do Departamento de Anatomía e Produción Animal.
    [Show full text]
  • Simple Ways to Dissect Ciliary Ganglion for Orbital Anatomical Education
    OkajimasDetection Folia Anat. of ciliary Jpn., ganglion94(3): 119–124, for orbit November, anatomy 2017119 Simple ways to dissect ciliary ganglion for orbital anatomical education By Ming ZHOU, Ryoji SUZUKI, Hideo AKASHI, Akimitsu ISHIZAWA, Yoshinori KANATSU, Kodai FUNAKOSHI, Hiroshi ABE Department of Anatomy, Akita University Graduate School of Medicine, Akita, 010-8543 Japan –Received for Publication, September 21, 2017– Key Words: ciliary ganglion, orbit, human anatomy, anatomical education Summary: In the case of anatomical dissection as part of medical education, it is difficult for medical students to find the ciliary ganglion (CG) since it is small and located deeply in the orbit between the optic nerve and the lateral rectus muscle and embedded in the orbital fat. Here, we would like to introduce simple ways to find the CG by 1): tracing the sensory and parasympathetic roots to find the CG from the superior direction above the orbit, 2): transecting and retracting the lateral rectus muscle to visualize the CG from the lateral direction of the orbit, and 3): taking out whole orbital structures first and dissecting to observe the CG. The advantages and disadvantages of these methods are discussed from the standpoint of decreased laboratory time and students as beginners at orbital anatomy. Introduction dissection course for the first time and with limited time. In addition, there are few clear pictures in anatomical The ciliary ganglion (CG) is one of the four para- textbooks showing the morphology of the CG. There are sympathetic ganglia in the head and neck region located some scientific articles concerning how to visualize the behind the eyeball between the optic nerve and the lateral CG, but they are mostly based on the clinical approaches rectus muscle in the apex of the orbit (Siessere et al., rather than based on the anatomical procedure for medical 2008).
    [Show full text]
  • Anatomical Study of the Zygomaticotemporal Branch Inside the Orbit
    Open Access Original Article DOI: 10.7759/cureus.1727 Anatomical Study of the Zygomaticotemporal Branch Inside the Orbit Joe Iwanaga 1 , Charlotte Wilson 1 , Koichi Watanabe 2 , Rod J. Oskouian 3 , R. Shane Tubbs 4 1. Seattle Science Foundation 2. Department of Anatomy, Kurume University School of Medicine 3. Neurosurgery, Complex Spine, Swedish Neuroscience Institute 4. Neurosurgery, Seattle Science Foundation Corresponding author: Charlotte Wilson, [email protected] Abstract The location of the opening of the zygomaticotemporal branch (ZTb) of the zygomatic nerve inside the orbit (ZTFIN) has significant surgical implications. This study was conducted to locate the ZTFIN and investigate the variations of the ZTb inside the orbit. A total of 20 sides from 10 fresh frozen cadaveric Caucasian heads were used in this study. The vertical distance between the inferior margin of the orbit and ZTFIN (V-ZTFIN), the horizontal distance between the lateral margin of the orbit and ZTFIN (H-ZTFIN), and the diameter of the ZTFIN (D-ZTFIN) were measured. The patterns of the ZTb inside the orbit were classified into five different groups: both ZTb and LN innervating the lacrimal gland independently (Group A), both ZTb and LN innervating the lacrimal gland with a communicating branch (Group B), ZTb joining the LN without a branch to the lacrimal gland (Group C), the ZTb going outside the orbit through ZTFIN without a branch to the lacrimal gland nor LN (Group D), and absence of the ZTb (Group E). The D-ZTFIN V-ZTFIN H-ZTFIN ranged from 0.2 to 1.1 mm, 6.6 to 21.5 mm, 2.0 to 11.3 mm, respectively.
    [Show full text]
  • Orbital Malignant Peripheral Nerve Sheath Tumours
    Br J Ophthalmol: first published as 10.1136/bjo.73.9.731 on 1 September 1989. Downloaded from British Journal of Ophthalmology, 1989, 73, 731-738 Orbital malignant peripheral nerve sheath tumours CHRISTOPHER J LYONS,' ALAN A McNAB,l ALEC GARNER,2 AND JOHN E WRIGHT' From the I Orbital clinic, Moorfields Eye Hospital, City Road, London EC] V 2PD, and the 2Department of Pathology, Institute ofOphthalmology, London EC] V 9A T SUMMARY We describe three patients with malignant peripheral nerve tumours in the orbit and review the existing literature on these rare lesions. Malignant peripheral nerve sheath tumours are Sensation was diminished over the distribution of the unusual in any part of the body and very rare in the second division of the right trigeminal nerve. The left orbit, where only 13 cases have previously been globe was normal. Plain anteroposterior skull x-rays described. These tumours can spread rapidly along showed a normal appearance, but undertilted the involved nerve to the middle cranial fossa. They occipitomental tomographic views revealed enlarge- are radioresistant, and total surgical excision offers ment of the right infraorbital canal (Fig. 1). copyright. the only hope of cure. Our experience with three An inferior orbital margin incision revealed patients may help clinicians to recognise these lesions tumour protruding from the infraorbital foramen and and excise them at an early stage. extending beneath the soft tissues of the cheek. The tumour had a firm consistency and a pale grey cut Case reports surface. The orbital periosteum on the floor of the orbit was elevated and a mass over 18 mm in diameter PATIENT 1 was found within an expanded infraorbital canal Four years prior to presentation a man which extended posteriorly into the superior orbital 55-year-old http://bjo.bmj.com/ noted a small lump at the medial end of his right fissure.
    [Show full text]
  • Comparison of Greater Palatine Nerve Block with Intravenous Fentanyl for Postoperative Analgesia Following Palatoplasty in Children
    Jemds.com Original Research Article Comparison of Greater Palatine Nerve Block with Intravenous Fentanyl for Postoperative Analgesia Following Palatoplasty in Children Amol Singam1, Saranya Rallabhandi2, Tapan Dhumey3 1Department of Anaesthesiology, JNMC, DMIMS, Sawangi Meghe, Wardha Maharashtra, India. 2Department of Anaesthesiology, JNMC, DMIMS, Sawangi Meghe, Wardha, Maharashtra, India. 3Department of Anaesthesiology, JNMC, DMIMS, Sawangi Meghe, Wardha, Maharashtra, India. ABSTRACT BACKGROUND Good pain relief after palatoplasty is important as inadequate analgesia with vigorous Corresponding Author: cry leads to wound dehiscence, removal of sutures and extra nursing care. Decrease Dr. Saranya Rallabhandi, in oxygen requirement and cardio-respiratory demand occur with good pain relief Assisstant Professor, and also promotes early recovery. Preoperative opioids have concerns like sedation, Department of Anesthesiology, AVBRH, DMIMS (DU), Sawangi Meghe, respiratory depression and airway compromise. Greater palatine nerve block with Wardha- 442001, Maharashtra, India. bupivacaine is safe and effective without the risk of respiratory depression. The study E-mail: [email protected] was done to compare pain relief postoperatively with intravenous fentanyl and greater palatine nerve block in children following palatoplasty. DOI: 10.14260/jemds/2020/549 METHODS How to Cite This Article: 80 children of ASA I & II, between 1 to 7 years were included and allocated into two Singam A, Rallabhandi S, Dhumey T. Comparison of greater palatine nerve block groups of 40 each. Analgesic medication was given preoperatively after induction of with intravenous fentanyl for postoperative general anaesthesia, children in Group B received greater palatine nerve block with analgesia following palatoplasty in -1 2 mL 0.25% inj. Bupivacaine (1 mL on each side) and Group F received 2 μg Kg I.V.
    [Show full text]
  • Original Article Anatomic Study of the Lacrimal Fossa and Lacrimal Pathway
    Original Article Anatomic study of the lacrimal fossa and lacrimal pathway for bypass surgery with autogenous tissue grafting Hai Tao, Zhi‑zhong Ma1, Hai‑Yang Wu, Peng Wang, Cui Han Purpose: To study the microsurgical anatomy of the lacrimal drainage system and to provide anatomical Access this article online evidence for transnasal endoscopic lacrimal drainage system bypass surgery by autogenous tissue grafting. Website: Materials and Methods: A total of 20 Chinese adult cadaveric heads in 10% formaldehyde, comprising www.ijo.in 40 lacrimal ducts were used. The middle third section of the specimens were examined for the following DOI: features: the thickness of the lacrimal fossa at the anterior lacrimal crest, vertical middle line, and posterior 10.4103/0301-4738.121137 lacrimal crest; the cross section of the upper opening, middle part, and lower opening of the nasolacrimal PMID: canal; the horizontal, 30° oblique, and 45° oblique distances from the lacrimal caruncle to the nasal cavity; ***** the distance from the lacrimal caruncle to the upper opening of the nasolacrimal duct; and the included Quick Response Code: angle between the lacrimal caruncle–nasolacrimal duct upper opening junction and Aeby’s plane. Results: The middle third of the anterior lacrimal crest was significantly thicker than the vertical middle line and the posterior lacrimal crest (P > 0.05). The horizontal distance, 30° oblique distance, and 45° oblique distance from the lacrimal caruncle to the nasal cavity exhibited no significant differences (P > 0.05). The included angle between the lacrimal caruncle and the lateral wall middle point of the superior opening line of the nasolacrimal duct and Aeby’s plane was average (49.9° ± 1.8°).
    [Show full text]
  • Oculoplastics/Orbit 2017-2019
    Academy MOC Essentials® Practicing Ophthalmologists Curriculum 2017–2019 Oculoplastics and Orbit *** Oculoplastics/Orbit 2 © AAO 2017-2019 Practicing Ophthalmologists Curriculum Disclaimer and Limitation of Liability As a service to its members and American Board of Ophthalmology (ABO) diplomates, the American Academy of Ophthalmology has developed the Practicing Ophthalmologists Curriculum (POC) as a tool for members to prepare for the Maintenance of Certification (MOC) -related examinations. The Academy provides this material for educational purposes only. The POC should not be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the best results. The physician must make the ultimate judgment about the propriety of the care of a particular patient in light of all the circumstances presented by that patient. The Academy specifically disclaims any and all liability for injury or other damages of any kind, from negligence or otherwise, for any and all claims that may arise out of the use of any information contained herein. References to certain drugs, instruments, and other products in the POC are made for illustrative purposes only and are not intended to constitute an endorsement of such. Such material may include information on applications that are not considered community standard, that reflect indications not included in approved FDA labeling, or that are approved for use only in restricted research settings. The FDA has stated that it is the responsibility of the physician to determine the FDA status of each drug or device he or she wishes to use, and to use them with appropriate patient consent in compliance with applicable law.
    [Show full text]
  • Cranial Neuralgias
    CRANIAL NEURALGIAS Presented by: Neha Sharma M.D. Date: September 27th, 2019 TYPES OF NEURALGIAS ❖ TRIGEMINAL NEURALGIA ❖ GLOSSOPHARYNGEAL NEURALGIA ❖ NASOCILIARY NEURALGIA ❖ SUPERIOR LARYNGEAL NEURALGIA ❖ SUPRAORBITAL NEURALGIA ❖ OCCIPITAL NEURALGIA ❖ SPHENOPALATINE NEURALGIA ❖ GREAT AURICULAR NEURALGIA ❖ NERVUS INTERMEDIUS NEURALGIA ❖ TROCHLEAR NEURALGIA WHAT IS CRANIAL NEURALGIA? ❖ Paroxysmal pain of head, face and/or neck ❖ Unilateral sensory nerve distribution ❖ Pain is described as sharp, shooting, lancinating ❖ Primary or Secondary causes ❖ Multiple triggers TRIGEMINAL (CN V) NEURALGIA TRIGEMINAL NEURALGIA ❖ Also called Tic Douloureux ❖ Sudden, unilateral, electrical, shock-like, shooting, sharp pain. Presents affecting Cranial Nerve V; primarily V2 and V3 branches ❖ F>M; 3:1 TRIGEMINAL NEURALGIA ❖ Anatomy of Trigeminal Nerve ❖ Cranial Nerve V ❖ Three Branches: Ophthalmic, Maxillary and Mandibular ❖ Sensory supply to forehead/supraorbital, cheeks and jaw https://www.nf2is.org/cn5.php TRIGEMINAL NEURALGIA – TRIGGERS ❖ Mastication (73%) ❖ Eating (59%) ❖ Touch (69%) ❖ Talking (58%) ❖ Brushing Teeth (66%) ❖ Cold wind (50%) TYPES OF TRIGEMINAL NEURALGIA ❖ Primary/Classic/Idiopathic ❖ Vascular compression of the nerve – superior cerebellar artery ❖ Secondary/Symptomatic ❖ Caused by intracranial lesions ❖ Tumors, Strokes, Multiple Sclerosis (4%) ❖ Typical vs. Atypical ❖ Paroxysmal (79%) vs. Continuous (21%) IASP/IHS & CLASSIFICATIONS OF TRIGEMINAL NEURALGIA ❖ IASP – International Association ❖ Classifications for the Study of Pain ❖ I
    [Show full text]
  • Clinical Anatomy of the Trigeminal Nerve
    Clinical Anatomy of Trigeminal through the superior orbital fissure Nerve and courses within the lateral wall of the cavernous sinus on its way The trigeminal nerve is the fifth of to the trigeminal ganglion. the twelve cranial nerves. Often Ophthalmic Nerve is formed by the referred to as "the great sensory union of the frontal nerve, nerve of the head and neck", it is nasociliary nerve, and lacrimal named for its three major sensory nerve. Branches of the ophthalmic branches. The ophthalmic nerve nerve convey sensory information (V1), maxillary nerve (V2), and from the skin of the forehead, mandibular nerve (V3) are literally upper eyelids, and lateral aspects "three twins" carrying information of the nose. about light touch, temperature, • The maxillary nerve (V2) pain, and proprioception from the enters the middle cranial fossa face and scalp to the brainstem. through foramen rotundum and may or may not pass through the • The three branches converge on cavernous sinus en route to the the trigeminal ganglion (also called trigeminal ganglion. Branches of the semilunar ganglion or the maxillary nerve convey sensory gasserian ganglion), which contains information from the lower eyelids, the cell bodies of incoming sensory zygomae, and upper lip. It is nerve fibers. The trigeminal formed by the union of the ganglion is analogous to the dorsal zygomatic nerve and infraorbital root ganglia of the spinal cord, nerve. which contain the cell bodies of • The mandibular nerve (V3) incoming sensory fibers from the enters the middle cranial fossa rest of the body. through foramen ovale, coursing • From the trigeminal ganglion, a directly into the trigeminal single large sensory root enters the ganglion.
    [Show full text]