Ans. to Quiz- Enjoy!

Hello,

Dr. Tirman answered class IV vs class V injury of lingual nerve, which is great as this kind of imaging is not done everywhere.

Here’s the complete ans..

Case 1- class V lingual
Case 2- class IV lingual
Case 3- class III long buccal nerve

-all three from molar tooth extractions
-all three nerves injured in isolation with other nerves in the vicinity incl. inferior alv nerve being normal.

The expert surgeon based on the clinical exam and neurosensory testing expected class IV in all three nerves but correctly identified clinically, the particular nerve which was injured.

Two of them have tongue atrophy clinically – case 1 and 2.

Chance of recovery with class 4/5-poor to none without surgery

Class 3- partial recovery but since there is persistent pain- will undergo neurolysis surgery of LBN.

Best!
AC

Avneesh Chhabra, M.D. M.B.A.

Professor Radiology & Orthopedic Surgery

Chief, Division of Musculoskeletal Radiology

UT Southwestern Medical Center, Dallas, Tx

5373 Harry Hines Blvd.

Dallas, Tx-75390-9178

Office: 214-648-2122

avneesh.chhabra@utsouthwestern.edu<mailto:avneesh.chhabra@utsouthwestern.edu>

www.utsouthwestern.edu<www.utsouthwestern.edu/>​

________________________________
From: n-ocad@googlegroups.com <n-ocad@googlegroups.com> on behalf of Avneesh Chhabra <Avneesh.Chhabra@UTSouthwestern.edu>
Sent: Thursday, February 3, 2022 8:05 PM
To: ocad-msk@googlegroups.com <ocad-msk@googlegroups.com>; N-OCAD <n-ocad@googlegroups.com>
Subject: [N-OCAD] Quiz

EXTERNAL MAIL

Hello

It finally snowed in Tx today-1st for the season!!

I read three today- molar tooth extraction related nerve injuries

ps the three snapshots..

Quiz-
which nerve is injured in
1.2.3 pics? and what’s the Sunderland class of Injury?

All three patients badly symptomatic- cant eat- poor QOL

For dental surgery- chose your dentist wisely!

Best!
AC

Best!

AC

Avneesh Chhabra, M.D. M.B.A.

Professor, Radiology & Orthopedic Surgery

Chief, Musculoskeletal Radiology

Department of Radiology

5323 Harry Hines, Blvd. Dallas, Tx-75390-9316

Office: 214-648-2122

www.utsouthwestern.edu/radiology<www.utsouthwestern.edu/education/medical-school/departments/radiology/>

________________________________

UT Southwestern

Medical Center

The future of medicine, today.

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2 thoughts on “Ans. to Quiz- Enjoy!”

  1. OCAD
    Dear all,

    35 years old male, investigating for head ache.

    MRI revealed a small mass lesion in left cingulate gyrusposteriorly.

    Value your expert opinion.

    Thanking you in advance.

    Regards

    Sanjeewa

    #yiv7288845867 P {margin-top:0;margin-bottom:0;}Hello,
    Dr. Tirman answered class IV vs class V injury of lingual nerve, which is great as this kind of imaging is not done everywhere.

    Here’s the complete ans..

    Case 1- class V lingualCase 2- class IV lingualCase 3- class III long buccal nerve
    The expert surgeon based on the clinical exam and neurosensory testing expected class IV in all three nerves but correctly identified clinically, the particular nerve which was injured.
    Two of them have tongue atrophy clinically – case 1 and 2.
    Chance of recovery with class 4/5-poor to none without surgery
    Class 3- partial recovery but since there is persistent pain- will undergo neurolysis surgery of LBN.
    Best!AC

    Avneesh Chhabra, M.D. M.B.A.

    Professor Radiology & Orthopedic Surgery

    Chief, Division of Musculoskeletal Radiology

    UT Southwestern Medical Center, Dallas, Tx
    5373 Harry Hines Blvd.
    Dallas, Tx-75390-9178

    Office: 214-648-2122

    avneesh.chhabra@utsouthwestern.edu


    Sent: Thursday, February 3, 2022 8:05 PM

    EXTERNAL MAIL

    Hello
    It finally snowed in Tx today-1st for the season!!
    I read three today- molar tooth extraction related nerve injuries
    ps the three snapshots..
    Quiz-which nerve is injured in 1.2.3 pics? and what’s the Sunderland class of Injury?
    All three patients badly symptomatic- cant eat- poor QOL
    For dental surgery- chose your dentist wisely!
    Best!AC

    Best!

    AC

    Avneesh Chhabra, M.D. M.B.A.

    Professor, Radiology & Orthopedic Surgery

    Chief, Musculoskeletal Radiology

    Department of Radiology

    5323 Harry Hines, Blvd. Dallas, Tx-75390-9316

    Office: 214-648-2122

    http://www.utsouthwestern.edu/radiology

    |
    UT Southwestern
    |
    |
    Medical Center
    |
    | |
    |
    The future of medicine, today.
    |

    [gallery]

  2. Thanks.I have already told him to get a CT scan done. Will let you know the findings.RegardsSanjeewa 

    Sent from Yahoo Mail for iPad


    I don’t favor DNET

    Ganglioglioma good for d/dx.  Is CT avail?  Ca++ or hem.

    If it is a glioma, not a typical low grade astrocytoma.  Doesn’t quite look like a (rare) supratentorial JPA, and he’s 35….So anaplastic astrocytoma (grade II-III) considerations

    Any demographics that might warrant non-neoplastic considerations?

     

    Blake A. Johnson, MD, FACR

    Medical Director, MSCPA

    5775 Wayzata Blvd. Suite 190

    St. Louis Park, MN  55416

    P: 952.738.4623

     

    Sent: Sunday, February 20, 2022 9:16 AM

     

    CAUTION: This email originated from outside of the RAYUS Radiology network. Please follow RAYUS Radiology’s phishing training and guidance. Do not click links, open attachments, or follow demands/requests that appear suspicious. If you would like to report or if you have any questions about an email’s validity, please forward it to Phishing-Report or contact Enterprise Support.

     

    Dear all,

    35 years old male, investigating for head ache.

    MRI revealed a small mass lesion in left cingulate gyrus posteriorly.

    Value your expert opinion.

    Thanking you in advance.

    Regards

    Sanjeewa

     

     

     

    Hello,

     

    Dr. Tirman answered class IV vs class V injury of lingual nerve, which is great as this kind of imaging is not done everywhere.

     

    Here’s the complete ans..

     

    Case 1- class V lingual

    Case 2- class IV lingual

    Case 3- class III long buccal nerve

     

    -all three nerves injured in isolation with other nerves in the vicinity incl. inferior alv nerve being normal.

     

    The expert surgeon based on the clinical exam and neurosensory testing expected class IV in all three nerves but correctly identified clinically, the particular nerve which was injured.

     

    Two of them have tongue atrophy clinically – case 1 and 2.

     

    Chance of recovery with class 4/5-poor to none without surgery

     

    Class 3- partial recovery but since there is persistent pain- will undergo neurolysis surgery of LBN.

     

    Best!

    AC

     

     

    Avneesh Chhabra, M.D. M.B.A.

    Professor Radiology & Orthopedic Surgery

    Chief, Division of Musculoskeletal Radiology

    UT Southwestern Medical Center, Dallas, Tx

    5373 Harry Hines Blvd.

    Dallas, Tx-75390-9178

    Office: 214-648-2122

    avneesh.chhabra@utsouthwestern.edu

    Sent: Thursday, February 3, 2022 8:05 PM

     

    EXTERNAL MAIL

    Hello

     

    It finally snowed in Tx today-1st for the season!!

     

    I read three today- molar tooth extraction related nerve injuries

     

    ps the three snapshots..

     

    Quiz-

    which nerve is injured in 

    1.2.3 pics? and what’s the Sunderland class of Injury?

     

    All three patients badly symptomatic- cant eat- poor QOL

     

    For dental surgery- chose your dentist wisely!

     

    Best!

    AC

     

    Best!

    AC

    Avneesh Chhabra, M.D. M.B.A.

    Professor, Radiology & Orthopedic Surgery

    Chief, Musculoskeletal Radiology

    Department of Radiology

    5323 Harry Hines, Blvd. Dallas, Tx-75390-9316

    Office: 214-648-2122

    http://www.utsouthwestern.edu/radiology

     

    |
    UT Southwestern
    |
    |
    Medical Center
    |
    | |
    |
    The future of medicine, today.
    |

    [gallery]

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