Questions

Group 4

In 3 dierent resources this week, we found there were dierent

descriptions of the actions of the medial and lateral pterygoids, so
we just wanted to clarify what the action was of each muscle?
The pre-lecture, anatomy practical and several textbooks were
completely dierent.
We also found this was the case with several of the muscles of
facial expression and are unsure of what resource to use as the
most reliable. What should we be using?

Muscles of Mastication

Lateral pterygoid

Arises:

upper head from infra temporal surface of

sphenoid bone,

lower head from lateral surface of lateral

pterygoid plate

Inserts: pterygoid fovea below condoler process of

mandible & intra-articular disc & capsule of TMJ

Action: protrudes mandible & opens mouth by

pulling condyle & disc forwards

Nerve: Nerve to lateral pterygoid (anterior division

of trigeminal nerve)

Muscles of Mastication

Medial pterygoid:

Arises:

deep head - medial side of lateral pterygoid plate

& fossa between medial & lateral plates

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pyramidal process of palatine bone

Inserts: medial aspect of angle of mandible

Action: elevates, protracts & laterally displaces

mandible to opposite side for chewing

Nerve: nerve to medial pterygoid (main trunk of

mandibular nerve)

Muscles

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Group 7
How do you assess when it is necessary to insert an ICP monitor?
How high does ICP have to be raised in order to see pupillary signs?
Is it likely that the patient in our weekly case (Justin) would have had plates put in
place to secure/ repair the facial fractures? (The case did not discuss this)

Normal ICP 5-15mmHg

>30mmHg pupil signs

Indications:

trauma

052J/A8@
@;
9;:5@;>

Intracranial haemorrhage

post-op

tumours

JM
23#year#old#male#

PMHx:#
Re2ni2s#pigmentosa#(blind)#

History#
Fall#o#tandem#bicycle##

Examina2on#
LeA#malar#aCening,#leA#
enopthalmos,#trismus#

Injuries:#
LeA#zygoma2comaxillary#
complex#fracture#

Surgery:#
ORIF#leA#ZMC#fracture#(plate#to#
infraorbital#rim,#lateral#orbital#
wall,#lateral#buCress),#Medpor#
to#orbital#oor#

JM

JM

JM

Day 1 post re-do ORIF left ZMC fracture

Group 8

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2) If a patient sustained an injury to the orbital plate of the ethmoid bone, would this
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with?

50 year old male

History

D-95:-@5;:

Crushed between tractor & crate of apples

3mm enopthalmos

Injuries:

Left medial orbital wall fracture

Right-sided rib fractures (3-6), undisplaced

Surgery:

Reconstruction of left medial orbital wall Biopore

Intraop: transcaruncular
-<<>;-/4

D
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0121/@
Biopore Ultrathin to

reconstruct

Postop CT scans:

LDW

18 year old male

History

D-95:-@5;:

Diplopia on medial & lateral gaze, ION numbness,

normal 1D@>-;/A8-> movements, normal visual acuity

Injuries:

Shoulder vs right side of face during footy match, LOC

immediately after impact

Fractured right zygoma

Surgery:

ORIF right zygomatic body fracture (ZF plate, infraorbital

rim plate, L-plate to ZM buttress)

LDW

ST

46 year old male />-EJ?41> from Racecourse Bay

History

D-95:-@5;:

Trismus
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Injuries:

Hit to the face by lifter while at work

Right zygomatic arch fracture

Surgery:

Right Gillies lift

ST - Postop

20 year old male

History

D-95:-@5;:

Malocclusion, open fracture

Injuries:

Alleged assault, punched to the face multiple times by multiple

assailants

Left parasymphyseal & right mandibular angle fractures

Surgery:

ORIF mandibular fractures, IMF screws & elastics. Removal of

48 tooth

GB - Postop


20#year#old#male#

History#

Alleged#assault,#
punched#to#the#face#

Examina2on#

Malocclusion,#open#
fracture#

Injuries:#

Right#
parasymphyseal#&#
leA#coronoid#fracture#

Surgery:#

ORIF#right#

Postop

# #
# #

#
#

Group 9
How does a fracture result in CSF leakage from the ears--> would this require damage
to the arachnoid membrane so that the subarachnoid space is exposed.
Does the mental nerve!innervate lower teeth ? Some confusion in textbooks saying it
only innervates the lower lips, chin and gums, and others saying it also
innervates anterior lower teeth.
If there is damage to the facial nerve, what is the likelihood that taste and secretion
from the lacrimal gland and submandibular and sublingual glands are
eected?
What bones of the skull derive from neural ectoderm? Can you explain how cartilage
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Facial Nerve

Bone Formation

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Cranium

Neurocranium: portion of skull encasing & protecting the brain

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crest origin, includes paired frontal, squamosal, and parietal bones, and
upper occipital bone

Cartilaginous neurocranium (basicranium) - forms via endochondral

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mastoid & petrous temporal bone, and the base of the occipital bone

Viscerocranium: bones of the facial skeleton:

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condyles)

Membranous Neurocranium

Forms the cranial vault

Comprised of seven bones

Derived from cranial neural crest

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mesenchymal cells condense & directly differentiate into
osteoblasts without cartilaginous intermediate

Occipital bone - both endochondral & intramembranous

ossication

Membranous Neurocranium

Histologically - arises from skeletogenic mesenchyme located

between surface ectoderm & underlying cerebral hemispheres

Bone formation initiated - neural crest derived mesenchymal

cells
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Primary cranial sutures: frontal, sagittal, coronal, lambdoid

Fontanelles (anterior & posterior)

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fusion

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frontal suture (between 6th & 8th months)

Development of Sutures

Skull bones ossify during fetal period

Continue growing well into young adulthood - stimulated by

expansion of the brain, & achieved by continuous differentiation of
cells at the margins of individual bones

Subset of mesenchymal cells between the osteogenic fronts

maintained in an undifferentiated state

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tissue become sutures

Sutures remain open while postnatal brain continues to grow

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Essential process during formation of long bones, growth

of the length of long bones and the natural healing of
fractures

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middle of the diaphysis (shaft)

Formation of periosteum the perichondrium becomes periosteum. The periosteum

contains a layer of undifferentiated cells which later become osteoblasts

Formation of bone collate the osteoblasts secrete osteoid against the shaft of the
cartilage model (appositional growth). The serves as support for the new bone

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grow (hypertrophy). They stop secreting collagen & other proteoglycans & begin
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Group 13
What level of knowledge is required for Skull CT and Xray interpretation?

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OPG

DC

42 year old male from Alice Springs

Alleged assault

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of mandible fractures

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ORIF mandibular fractures

DC

DC

Group 14

 



 





 
  




1
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Le Fort I

Le Fort II

Le Fort III

39 year old male

Pushbike accident
traveling at speed
downhill, came off
bicycle face vs.
guard rail

# left ZF suture, left

zygomatic arch, left
ZM buttress, left
infraorbital rim, nasal
bone fractures

Group 15
1. !At presentations to ED, "the middle third of his facial skeleton seems mobile".
!How is this
determined? !Is this limited to observation or has physical examination of the facial
skeleton
been performed in ED prior to imaging?

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!Why is it
there?

AE

17 year old male transferred

from Alice Springs Hospital

History

D-95:-@5;:

High speed MVA, head

on collision, restrained,
driver, fatality in other
car

Intubated & ventilated in

ICU

Injuries:

Femoral fracture

Closed head injury

Manubrium fracture

Left LeFort II

Bilateral Z-F suture

Bilateral infraorbital rim

Right
FE3;9-@5/;9-D588->E

Left mandibular angle

Right parasymphyseal

AE

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9-D588->E
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JD-@5;:
9-:05.81
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Upper & lower arch bars

Access:

Upper & lower vestibular incisions

Bilateral transconjunctival incisions

Bilateral eyebrow incisions

Left cheek stab incision

D-95:-@5;:
;2
2-/5-8
@>-A9-

Burr hole

Group 16

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of
hearing tests? (i.e. Rinnes and Webbers Tests)
2. In the case, what caused the bleeding from the ear?

Facial Fracture Post-ops

jensen 11349507

searle 07484327

lewis 11309759

beaumont 67733381

king 03686263

gjeta 1480706

downs 1414512

wignall 1286617

campbell 1312956

mitchell 1482602

koulioubas 928508

1483048 muscher

jaensch 975706

lancaster 01473507

frasca 1473511

lawry 247818

angelo 1408064

mandible 1480702

1480900