FASZINATION ANATOMIE, Zusammenfassungen von Anatomie

49-y male. Naitoh et al. 2009. Canalis bifidus. 68. Rouas et al. 2007. 49-y male. Canalis bifidus. 69. Diagnostische Falle. 41-j Mann. 70. Foramen incisivum.

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Thomas von Arx - Universität Bern
FASZINATION ANATOMIE
IM MUND-KIEFERBEREICH
1
www.zmk.unibe.ch
2
Klinik für Oralchirurgie und Stomatologie
3
www.springer.com
4
Unterkiefer-Leitungsanästhesie
5
Unterkiefer-Leitungsanästhesie
Khoury et al. 2010
6
Unterkiefer-Leitungsanästhesie
31.3
10
7
1. injection
(n=495)
2. injection
(n=236)
2. inj. after pos.
first inj. (n=16)
Lustig & Zusman 1999
Positive aspiration (%)
in mandibular block
7
Unterkiefer-Leitungsanästhesie
Arteria meningea media
8
pf3
pf4
pf5
pf8
pf9
pfa

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Thomas von Arx - Universität Bern

FASZINATION ANATOMIE

IM MUND-KIEFERBEREICH

www.zmk.unibe.ch

Klinik für Oralchirurgie und Stomatologie

www.springer.com

Unterkiefer-Leitungsanästhesie

Unterkiefer-Leitungsanästhesie

Khoury et al. 2010 6

Unterkiefer-Leitungsanästhesie

  1. injection (n=495) 2. injection (n=236) 2. inj. after pos. first inj. (n=16) Lustig & Zusman 1999 Positive aspiration (%) in mandibular block

Unterkiefer-Leitungsanästhesie

Arteria meningea media

Unterkiefer-Leitungsanästhesie

Anastomose 9

Unterkiefer-Leitungsanästhesie

Unterkiefer-Leitungsanästhesie

von Arx et al. Swiss Dental Journal 2014;124:1189- 11

Unterkiefer-Leitungsanästhesie

VASOSPASMUS

Mechanische Verletzung einer Arterienwand

Aktivierung

N. sympathicus

Unterkiefer-Leitungsanästhesie

Masseter Glandula parotis Mund- Winkel 13

Unterkiefer-Leitungsanästhesie

Unterkiefer-Leitungsanästhesie

Canalis nasopalatinus

Ductus nasopalatinus 25 von Arx et al. 2018 Surg Radiolog Anat 40:165- Patent nasopalatine ducts: an update of the literature Vol.:(0123456789)1 3^ and a series of new cases Surg Radiol Anat (2018) 40:165–177 DOI 10.1007/s00276-017-1926- REVIEW Patent nasopalatine ducts: an of new cases update of the literature and a series Th. von Arx^1 · M. Schaffner^1 · M. M. Bornstein^2 Received: 11 January 2017 / Accepted: 15 September 2017 / Published online: 19 September 2017 © Springer-Verlag France SAS 2017 epidemiological data are missing with regard to patent NPDs, age and gender predilections are not warranted. Bilat eral occurrence and full patency were prevailing features in- the evaluated case reports of patent NPDs. Keywords Patent nasopalatine duct · Nasopalatine canal · Vomeronasal organ · Case report Introduction Patency of the nasopalatine duct (NPD) in humans is a rarely described anomaly of the anterior maxilla. Niels Stensen (1638–1686), a Danish anatomist and physician, was the first to provide a thorough description of the NPD in 1683 [ 24 ]. The NPD is often mixed up with the nasopalatine (incisive) canal (NPC). The NPC is a prominent structure within the anterior maxilla and represents a passageway originating bilaterally from the anterior nasal floor, subsequently fusing to form a single canal terminating at the incisive foramen in the anterior palate. The NPC conveys the nasopalatine arter- ies and nerves from the lower and anterior portion of the nasal septum to the palatal mucosa posterior to the maxillary incisors. The NPC further contains veins and seromucous glands [ through the NPC as an additional connection from the oral During the fetal period, an epithelialized duct also runs 28 , 49 ]. cavity to the so-called vomeronasal organ (VNO) [ The VNO (also called Jacobson’s organ) is located bilater ally at the bottom of the anterior nasal septum. The pres 23 , 39 ].-- ence of the VNO in humans is still under debate, but has been documented histologically in cadavers [ is general agreement that the NPD degenerates and/or oblite 48 , 56 ]. There- rates completely before birth [ canalicular link between the oral and nasal cavities is usually 23 , 39 ]. As a consequence, the Abstract Purpose update and summary of clinical findings of cases with a The objective of this review is to present an patent nasopalatine duct (NPD) reported in the literature from 1881 to 2016. Methods Previous articles and reviews about patent NPDs were studied and copies of all original publications were obtained for data verification. Furthermore, a litera ture search was conducted. In addition, the study sample- was complemented with four cases recently seen in our institution. Results Ten out of 67 published cases were to be excluded for this analysis due to misinterpretation or misreporting in previous articles. Overall, 57 cases with NPD patency could be analyzed. Males outnumbered females in a ratio of 2:1. The mean age (when this information was available) was 34.1 bilaterally (60%), unilaterally (20%) or centrally (20%). ± 17.6 years (range 6–69 years). NPDs were located Complete or partial patency was reported in 73.9 and 26.1%, respectively. 74.1% of patients presented a variety of clinical signs and symptoms. The ability of the patient to produce a squeaky or whistling sound was the most frequent clinical finding (23.8%). Conclusions Caution must be exercised when read- ing review articles about NPD patency since wrong data have been copied in several subsequent publications. Since

  • 1 Th. von Arx [email protected] of Oral Surgery and Stomatology, School 2 of^3010 Applied Oral Sciences, Faculty of^ Dental Medicine, University of^ Bern, Switzerland^ Bern, Freiburgstrasse 7,Dentistry, Prince Philip Dental Hospital, The University of Road, Sai Ying Pun, Hong Kong SAR, China Hong Kong, 34 Hospital Ductus nasopalatinus 26 33-j Frau Ductus nasopalatinus 27 Ductus nasopalatinus 28 Moss et al. 2000 Endodontic considerations of the nasopalatine duct region. JOE 26:107- Ductus nasopalatinus 29

DNP Ductus nasopalatinus-Zyste

Ductus nasopalatinus 30 Kieferhöhle Kieferhöhle

Kieferhöhle

MAXILLARY SINUSKieferhöhle

Septum 34

MAXILLARY SINUSKieferhöhle

Recessus Recessus 35

MAXILLARY SINUSKieferhöhle

MAXILLARY SINUSKieferhöhle

Brooks & Kleinman JOE 2013 Retrieval of extensive gutta-percha extruded into the maxillary sinus

Kieferhöhle

Kieferhöhle

Kieferhöhle

47-j Frau

Mandibularkanal 49 Mandibularkanal 21-j Mann 50 Mandibularkanal 51 Wilbrand et al. J Endod 2011

  • Wurzelbehandlung 37
  • Starke Blutung aus distalem Wurzelkanal
  • Einpressung von CaOH 2 zur Blustillung Mandibularkanal 52 Wilbrand et al. J Endod 2011
  • Farbveränderung Wange
  • Hypästhesie
  • N. infraorbitalis links
  • N. mentalis links Mandibularkanal 53 Wilbrand et al. J Endod 2011
  • Hautnekrose
  • Hospitalisierung für 5 Tage
  • Kortikosteroide, Heparin und Clindamycin 2 Wochen Mandibularkanal 54 Wilbrand et al. J Endod 2011 2 Wochen 3 Jahre Mandibularkanal Lindgren et al. 2002 48-j Mann Wurzelbehandlung 47 Starke Blutung aus distalem Kanal Applikation CaOH 2 -Paste
  • (^) nach 2 min rechte Gesichtshälfte bleich
  • (^) danach Hautzyanose
  • heftigste Schmerzen
  • Parese N. facialis
  • Parästhesie N. trigeminus Mandibularkanal

Lindgren et al. 2002 Angiographie: Fehlender Blutfluss in Arteria maxillaris Laser Doppler: Ischämie der rechten Gesichtshälfte (dunkelblau = Perfusion < 16%) Mandibularkanal 57 Lindgren et al. 2002

  • (^) Totalausfall Unterkiefernerv
  • (^) Fazialisparese für 4 Monate
  • (^) Ohrnekrose → Hauttransplantat
  • (^) Patient entwickelt Depression Mandibularkanal 58
  1. Kanal zu Milchinzisiven
  2. Kanal zu Milchmolaren
  3. Kanal zu Molaren verschmelzen zum Mandibularkanal Chavez-Lomeli et al. 1996 1 2 3 Entwicklung Mandibularkanal 59 Mandibularkanal 21-j Mann Naitoh et al. 2009 60 Retromolarkanal 21-j Mann 61 Canalis bifidus 26-j Frau Naitoh et al. 2009 62 Rouas et al. 2007 Canalis bifidus Rouas et al. 2007 Canalis bifidus

vor 12 Jahren Diagnostische Falle 73

*Leere Bucht der Kieferhöhle

Recessus alveolaris 74 Gefässkanal 75 Gefässkanal 76 Gefässkanal 77 47-j Mann Diagnostische Falle Bornstein et al. 2009 78 Bornstein et al. 2009 Fossa sublingualis [email protected] Mahalo