| Identifier |
teeth_and_neuro_ophthalmology_lee |
| Title |
Teeth and Neuro-Ophthalmology |
| Creator |
Andrew G. Lee, MD; Hannah Wang |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (HW) Class of 2023, Baylor College of Medicine, Houston, Texas |
| Subject |
Teeth; Dental Health; Sinus; Dry Eye; Trigeminal Nerve |
| Description |
Summary: • Teeth/ ophthalmology anatomical relationship o Teeth are close to maxillary sinus, maxillary sinus is close to the orbit o Pterygomaxillary fissure: entry site behind maxillary sinus o Pterygopalatine fossa: inside maxillary sinus, "subway station" where lines converge; paths lead to: > Inferior orbital fissure for direct access to orbit • Vidian nerve: carries tearing nerve through inferior orbital fissure to lacrimal gland o Unilateral dry eye could be sign of pterygopalatine fossa disease > Maxillary division of trigeminal V2 through foramen rotundum into the cavernous sinus > Entry and exit into the nasal cavity o Sphenopalatine foramen: connects pterygopalatine fossa and nasal cavity o Lower teeth and mandible: jaw far away from orbit o Upper and back molars: most associated with neuro-ophth problems > Infection in tooth root forms dental abscess -> access to infratemporal fossa -> travels to pterygomandibular space or pterygopalatine space • ENT effects on pterygopalatine fossa o Cancer types: can spread perineurally > Adenoid cystic carcinoma > Squamous cell carcinoma of head and neck > Lymphoma > Cutaneous: basal cell carcinoma or squamous cell carcinoma in V2 distribution of cheek • Presentation of teeth and neuro-ophthalmology interactions (upper molar dental abscesses) o Ophthalmoplegia o Cavernous sinus syndromes o Orbital apex syndromes |
| Transcript |
Okay so today we're just going to be talking about something super weird, which is the teeth in neuro-ophthalmology. And so there are some things that are odontogenic, and the reason you need to know about it is because the teeth are very close to the maxillary sinus, and the maxillary sinus is very close to the orbit, and some of the nerves that are running to the teeth can send the signal back or carry with them tumor or infection perineurally back to the pterygopalatine fossa, which is kind of a subway station where all the lines converge and then head right upstairs into the inferior orbital fissure or on the maxillary division of the trigeminal V2 through foramen rotundum into the cavernous sinus. So you need to know a little bit about the teeth, and so when we have teeth problems, the ones that come to us in neuro-ophth is the gonna be the upper teeth because the lower teeth and the mandible, those don't really come to me because the jaw is so far away from the orbit, so usually it's the upper teeth. When it's not really these front teeth (the central incisors, or the lateral incisors, or the canines), those aren't the teeth that come to me. The teeth problems that come to me are the upper and back molars. So the back teeth in the upper jaw is the type of problem, usually infection. So they have a root, and the infection gets up in to the tooth root and forms of dental abscess, and so once it's a dental abscess, it has access to the infratemporal fossa. So once you're in the infratemporal fossa, we can have the infection travel to the pterygomandibular space or the pterygopalatine space. The pterygopalatine fossa is sometimes very difficult to visualize. I like to kind of think of it as a like a cone: it has an entry and an exit into the nasal cavity is the sphenopalatine foramen, and the fossa is the pterygopalatine fossa, so it's a combination of the pterygomaxillary. Pterygomaxillary is the entry site behind the maxillary sinus. The pterygopalatine fossa is inside there, and then the sphenopalatine, which means things that can come from your teeth or your maxilla or your mid-face or from your palate can end up in the pterygopalatine fossa, and because that's like a subway station that has different routes that can travel to different parts. So you can go to the nasal cavity, you can go upstairs through the inferior orbital fissure and you have direct access to the orbit, you can affect the trigeminal V2 and that can carry perineural on the maxillary nerve right into the brain and the cavernous sinus via the foramen rotundum. The reason that's important to know about this pterygopalatine fossa is it can come down from ophthalmology, so the nerve that's carrying the tearing, the greater superficial petrosal nerve, to the Vidian nerve through the inferior orbital fissure, to the lacrimal gland, is passing past this pterygopalatine fossa, and that means you can have a unilateral dry eye. So a unilateral, markedly asymmetric or frankly unilateral dry eye could be Vidian nerve, and Vidian nerve could be a sign of pterygopalatine fossa disease. So we need to need know a little bit about the ENT cancers that can affect the pterygopalatine fossa; that's adenoid cystic carcinoma and squamous cell carcinomas of the head and neck. Once it gets access to the parent pterygopalatine fossa, it has access both into to the intracranial cavity and to the intraorbital through the fissures, the internal fissure or the foramen rotundum. That perineural spread can happen with all different types of cancers. There's not just adenoid cystic carcinoma but lymphoma and also cutaneous cancers like basal cell carcinoma or squamous cell carcinoma in the V2 distribution on the cheek. So those are very dangerous cancers if you have ipsilateral cavernous sinus syndrome or ipsilateral ophthalmoplegia on the same side of either a dental abscess or a cancer on the skin or ENT. So in summary we're talking basically about the teeth, but you've got a little free preview about the pterygopalatine fossa. The odontogenic ways that teeth abscess come to me is if it's in the upper and posterior part of the jaw, the back molar teeth in the upper jaw. If they have an abscess that abscess can diffuse into the infratemporal space, and what we're worried about is access to the pterygopalatine fossa, and once you're in the pterygopalatine fossa that has direct access to the orbit which could produce orbital signs or to the cavernous sinus through foramen rotundum carried as a perineural spread of infection or tumor on maxillary V2. So we're going to be worried about ophthalmoplegia, cavernous sinus syndromes, and orbital apex syndromes in patients who have upper molar dental abscess. |
| Date |
2021-04 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890 |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6mw8drx |
| Setname |
ehsl_novel_lee |
| ID |
1680630 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6mw8drx |
