1 - Zill - Face

Question 1

What is unique about the fascia of the face?

Answer 1

No deep fascia, all loose (except nose)

Question 2

What is the innervation of muscles of facial expression?

Answer 2

Cranial Nerve 7 - Facial Nerve

Question 3

What is the insertion of facial muscles?

Answer 3

Skin

Question 4

What control are facial muscles under?

How are contractions detected?

Answer 4

Voluntary and involuntary (emotional) control

Contractions detected by stretching of skin–no or very few muscle spindles

Question 5

Bell’s Palsy

Answer 5

Lower Motor Neuron Disorder of of Facial Nerve (Cranial Nerve 7)

Can be associated with viral infection (herpes simplex)

Sudden onset, paralysis of all facial muscles on one side

Symptoms: Drooping, inability to close eye, loss of taste to anterior tongue, pain in or begind ear, hyperacousia

1/2 Face - Drooping eyebrow, drooping upper lip

Question 6

Upper Motor Neuron Disorder of Cranial Nerve 7

Answer 6

Sparing of upper face

After cortical strokes, only muscles of lower face are paralyzed

Question 7

Lower Motor Neuron vs Upper Motor Neuron Lesion in the face?

Answer 7

Upper - Only 1/2 lower face

Lower - All 1/2 face

Question 8

Blood source for face/head?

Answer 8

Left Common Carotid - off Arch of Aorta

Right Common Carotid - off Brachiocephalic Trunk

Vertebral Artery

Question 9

Division and path of common carotid?

Answer 9

Common Carotid divides ito external and internal carotid arteries

Internal Carotid / Vertebral Artery: Supply Brain

External Carotid: Supply Face and Head

Question 10

Carotid Pulse

Answer 10

At Upper Border of Thyroid Cartilage

Vertebral Level C4

Question 11

Facial Artery

Answer 11

Very winding and tortuous as skin moves

Arises from ant. side of External Carotid

Courses medial to mandible, and anterior

Site of Facial Pulse

Question 12

Facial Artery Branches

Answer 12

1. Superior and Inferial Labial (lip) Arteries

*Anastomoses with opposite side, cut lip can bleep profusely

- - -

2. Angular Artery

Nose, corner of eye (Angle)

Question 13

Superficial Temport Artery

Answer 13

Terminal brance of carotid

Anterior to opening of ear (auditory meatus)

Can take facial pulse here

Small branches to face – Transverse Facial Artery

Question 14

Vertebral Artery pathway?

Answer 14

Courses through Foramina Tranversaria, C1-C6

Supplies Brain Stem / Spinal Cord

Question 15

Internal Carotid

Answer 15

Enters skull without branching

Compression causes blackout

Branches in skull to Brain, Ophthalmic Artery

Question 16

Ophthalmic Artery

Answer 16

Major blood supply to eye (orbit)

Branches leave orbit to supply Face, Forehead, Nasal Cavity

Question 17

Major route for nerves and blood vessels to reach face and nasal cavity?

Answer 17

Orbit (eye socket)

Question 18

Venous drainage in face?

Answer 18

Veins of face have no valves, drain to neck and into skull

Extensive anastomoses between Facial and Ophthalmic Veins

Question 19

Risk of Spread of Infection from Face to Brain?

Clinical sign?

Answer 19

Prolonged Infections can spread via valveless veins through orbit to Cavernous Sinus

- - -

Clinical Sign: Blurred Vision (Diplopia)

Cranial Nerves to eye muscles pass through Cavernous Sinus

Infections lateral to nose dangerous

Question 20

Clinical Test of Cranial Nerve 5?

Answer 20

Supraorbital Nerve - “Trigeminal Cranial Nerve V1”

Paperclip drag the forehead

Question 21

Answer 21

Question 22

Orbicularis Oculi

2 parts

Answer 22

1. Palpebral Part - Close eyelids
2. Orbital Part - Buries eyelines (ex. sandstorm)

Question 23

Paralysis of Orbicular Oculi?

Answer 23

Patient unable to close eye

Can damage cornea of eye

Often goes with mouth drop

Question 24

Orbicularis Oris

Answer 24

Surrounds/Closes mouth

Controlled by Facial Nerve

Clinical Test: Purse your lips

Question 25

Muscles of Nose: Compressor Nares Dilator Nares Procerus

Answer 25

Compressor Nares: Lateral to bridge of nose, compresses nasal cartilage Dilator Nares: Lateral to nostriles, dilates Procerus: Wrinkles skin of nose

Question 26

Muscles of Upper Lip: Levator Labii Superioris Zygomaticus Major and Minor

Answer 26

Levator Labii Superioris - Lifts upper lip Zyg. Major / Minor - Raise and pull upper lip laterally

Question 27

Muscles at Angle of Mouth: Levator Anguli Oris Risorius Depressor Anguili Oris

Answer 27

Levator Anguli Oris - Raise corner of mouth Risorius - Smiling Depressor Anguli Oris - Frown (tragedy)

Question 28

Muscles of Lower Lip and Chin: Depressor Labii Inferioris Mentalis

Answer 28

Depressor labii Inferioris: Depresses lower lip Mentalis: Wrinkles skin of chin

Question 29

Buccinator Clinical issues?

Answer 29

Compresses mouth, **keeps food between teeth when chewing** **- - -** Facial Paralysis can lead to paralysis of buccinator; **patient complains of not being able to hold food in mouth while chewing**

Question 30

Frontalis Clinical?

Answer 30

Muscle in scalp attached to Epicranial Aponeurosis; **raises eyebrows** Clinical Test for **Facial Nerve**

Question 31

Platysma

Answer 31

Extends from mandible to fascia over Pextoralis Major Tenses, moves skin of neck

Question 32

Clinical Tests for Facial Nerve Function?

Answer 32

Eyebrow Raise - Frontalis Smile - Risorius Purse Lips - Orbicularis Oris Show Teeth - Levator Labii Superioris, Zygo. Maj/Min

Question 33

5 Terminal Branches of Facial Nerve (CN 7)

Answer 33

1. Temporal 2. Zygomatic 3. Buccal 4. Mandibular 5. Cervical

Question 34

Development of Face

Answer 34

1. Nasal Placodes (Thickenings) form on side of **FrontoNasal Process** 2. **Medial and Lateral Nasal Processes** form at margins of nasal placodes 3. **Medial Nasal Process and Maxillary Process** fuse to form upper lip (Philtrum)

Question 35

Cleft Lip (Cheiloschisis)

Answer 35

Failure of fusion of **Medial Nasal Process** and **Maxillar Process** 1/1000 births, can be unilateral or bilateral at **philtrum of lip**

Question 36

Development of Nasolacrimal Duct Clinical?

Answer 36

Develops as solid cord from medial angle of eye to nasal cavity, **becomes canalized** **- - -** **Obstructed Nasolacrimal Duct -** Failure of duct to canalize; opened surgically for tears to drain to nasal cavity