A Question...

[ItsGavinC]

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A question, because I'm ill-informed when it comes to this, for all PRACTICING dentists and for students with clinical (DS3/4) experience:

How much of your Head & Neck anatomy do you remember, and how much do you utilize on a daily basis? I'm thinking that after a year or two on the job, you remember the important anatomy associated with each procedure, but have probably forgotten the minutia that was once required in school.

Am I correct in this? For those who are currently practicing, do you still remember the pathways of cranial nerves? Do you remember where their ganglion are? What about the Trigeminal? Do you remember all the divisions of the Facial nerve, as well as what it innervates? How about the muscles of the neck?

Thanks for the responses. I'm wondering because I'm REALLY fascinated by all of this, but I find myself wondering how much I'll forget in the next couple of years, and how (or if?) that will impact my clinical skills and patient care.

 

[JTLUK001]

Undoubtedly there will be some of us who can remember most of their head and neck...but for the rest of us we buy references so that we can refer to them! After studying for Part I you'll have to review a little again for Part 2. So the refreshers will reinforce some of the minutia.
Learn the anatomy well. It'll make it easier to look things up or recall from the relations that you will learn. The acronyms will always help too. Those tend to stick to your head!

 

[ItsGavinC]

Thanks James.

Rob, Tom, Griffin, Dr. Jeff, Thisisit...I'm waiting to hear from each of you.

 

[UBTom]

Hey Gavin,

The few instances where I found myself reviewing some of the anatomy during 3rd and 4th years:

1 - Landmarks for cephalometric analysis (for ortho).

2 - Oral surgery. My rotation group gets quizzed sometimes on head and neck anatomy. I get quizzed daily when I was on my OMS externship though, along with all the other OMS residents. It's frightening how much I have forgotten.. 😛

3 - Bony Landmarks and muscles for removable prosthodontics, but those are pretty easy.

4 - Oral Path/Oral Medicine/Oral Diagnostics. That's because certain diseases with oral manifestations also presents with anomalies in other areas of the head and neck... Like Paget's disease for example which may overcalcify and constrict some of the foramena in the skull.

5 - Clinic. We get quizzed a lot on the cranial nerves since CN function is supposed to be a part of the comprehensive exam one gives a patient on the first visit... Though I admit I don't see it done very often in a practicing dentist's office! 😀

 

[thisisit]

I'm embarrassed of saying that, after a few years of practicing, I only remember what I use and see. If you threw me a cadaver, I'm sure I'd fail an exam without some refresher course. I'm just being honest. It would be great if I could answer you as if I'd remembered everything, but I don't. I wish I did, but I don't. I refer to books if I need to, but I hardly even do that.

 

[DrRob]

Don't even remember the cranial nerves- I'm in the same boat as Thisisit

 

[no2thdk999]

When the talk around here turns to all the "useless" stuff we have to learn to be a dentist I admit I felt the same way when I was having to study it.

Now I can't think of a single thing I learned in dental school that I'm glad I subsequently forgot. I wish I could retain it all. No matter how unrelated to clinical dentistry it seemed at the time, knowing something never made anybody a lesser practicioner (small exception maybe for the Kreb's cycle 🙂 )

As to head and neck anatomy the use it or lose it holds here as well, but I think we use it more than DrRob & Thisisit let on and I'm sure after seeing a diagram or two for less than a minute they would say "yeah I guess I did know that". You'll remember (or should) all the muscles of the head and neck, their insertions, and innervations, what nerves provides sensory and motor for different structures, you probably won't remember what a ganglion is (but it won't hurt if you do), you'll need a good working knowledge of the TMJ. You'll see a lot of the bony structures on your radiographs everyday so that will keep it fresh in your mind. I for sure don't remember all the minutia but I wish I did.

Most of the head and neck stuff you'll remember because it ends up being clincally relevant. When you can't get #18 numb enough to work on it'll be handy to know that many 2nd molars have accessory innervation from the mylohyoid and cervical branches and a little anesthetic on the lingual will knock it out.

Short answer: you'll never regret knowing some piece of information but the opposite might not hold true.

JMHO
Rob

 

[gryffindor]

I haven't forgotten the functions of the cranial nerves b/c I still do the CN exam on my new patients. However, I had an Oral Diagnostics professor ask me the other day why I was still doing the CN exam on my patient- surprised me, maybe my other senior classmates don't do it anymore. But I'd be hard pressed to give you the correct names of all of the CN.

Gavin, you prompted me to go get my Head & Neck notes to see what I did learn when we went through that block. All the minute details of the ears, eyes and neck/throat, I no longer remember. Functions of the muscles, also don't remember too many of those (like jaw openers vs. jaw closers, etc.) Names & locations of bones & muscles I do remember. A bunch of the bones & landmarks are important for removable & ortho, so I get refreshed on those everytime I get grilled on border molding in removable or tracing an ortho ceph (like Tom said). Glancing through our H & N notes, I'd say I remember about 50% of the stuff (mostly names & locations) and use it directly or indirectly in clinic.

For those who are currently practicing, do you still remember the pathways of cranial nerves? - No. I remember what some of the nerves innervate, but not too much about which foramina they came from in the skull - although this was on the Part II boards, but that was in early Dec. so I've forgotten it by now.

Do you remember where their ganglion are? Heck no, but I could refresh my brain if I had to.

What about the Trigeminal? Basically I remember the bits of it that have to do with numbing up the patient before a procedure.

Do you remember all the divisions of the Facial nerve, as well as what it innervates? Is this the "Ten Zebras Ate My Chickens" (or something like that) nerve? Guess I don't remember this one either. The facial nerve makes you smile, frown and wrinkle your forehead, that's the extent of my knowledge on CN 7. And it innervates the platysma, but that's just one useless random fact that is stuck in my brain.

How about the muscles of the neck? If you said "Where is the omohyoid?" I'd point to my neck. That should make it clear how much of the neck I retained.

I think a lot of the details of H & N anatomy are probably very important if you are an Oral Surgeon doing a neck dissection or putting a face back together, but if you are a restorative dentist doing operative, fixed, endo & perio, it's probably not critical to remember all of it. If you want to know & remember by heart all of H & N anatomy and actually use it, be an Oral Surgeon with hospital privileges or be an attending/program director in a trauma 1 center GPR if you don't want to go the OMS route.

 

[ItsGavinC]

Guys, thanks for all your responses! VERY impressive!!

In any event, I'm really enjoying our H&N module--I simply LOVE this stuff. Your answers, though, fell right where I anticipated them to. I'm not trying to skip out on learning stuff, I'm simply wondering if I should feel like a putz for forgetting this stuff in a couple of years.

Once again, thanks for the prompt responses!

 

[dientesfuertes]

Gavin,
Last year when our class was stressing about Gross/Head & Neck Anatomy, a professor of ours gave me one of my favorite quotations relevant to dentistry:

As a dentist, if you get to anything you can name from anatomy, you've gone too far.

Of course that mainly applies to restorative dentistry, but I thought it was helpful to keep things in perspective. And this year I need all the perspective I can get because school ain't exactly fun right now.

 

[dinonuggets]

Hey strongteeth,

great quote!

Hey GavinC,

great question, and thanks to all who opined. It's nice to get a little perspective on things...

 

[ItsGavinC]

DN,

Glad I could be of service to you.