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MD4001 Week 3 > 4. Face, scalp, muscles of mastication > Flashcards

4. Face, scalp, muscles of mastication Flashcards

1
Q

Define the margins of the scalp?

A

The scalp consists of skin & subcutaneous tissue
FROM the superior nuchal line of the occipital bone
TO the supraorbital margins of the frontal bone
LATERALLY the scalp extends over the temporal fascia to the zygomatic arch

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2
Q

Margins of the face?

A

The face is the anterior aspect of the head from forehead to chin & from one ear to the other

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3
Q

Layers of the scalp?

SCALP

A

Skin: outermost layer
(Dense) Connective tissue: subcutaneous layer rich in neurovascular structures
epicranial Aponeurosis: suturing required to close gaping wounds
Loose connective tissue: separates scalp proper (1st 3 layers) from underlying pericranium & calvaria
Pericranium: external periosteal layer

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4
Q

In the epicranial aponeurosislayer of the scalp:
Which muscle and tendon is found here?
Issue with gaping wounds?

A

Tendon & muscle of occipitofrontalis (has frontal and occipital belly)
This layer prevents superficial wounds from gaping open; when this layer is compromised (e.g. laceration), gaping wounds result that require sutures to close

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5
Q

Between the aponeurosis & pericranium there are potential spaces for accumulation of fluid (e.g. blood) or spread of infection
Fluid/infection can spread to the eyelids or root of nose. why?

A

Frontal belly of occipitofrontalis inserts into skin & subcutaneous tissue not bone
Note: Fluid/infection do not spread posteriorly to the neck or laterally below the zygomatic arch

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6
Q

How do scalp infections spread to intracranial structures?

A

Via emissary veins

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7
Q

Which nerves innervate the scalp for cutaneious/sensory supply?

A

Cutaneous/sensory innervation is supplied via CN V (V1, V2, V3) & cervical nerves from C2 & C3

CN V1

  • Supraorbital N
  • Supratrochlear N

CN V2
-Zygomaticotemporal N

CN V3
-Auriculotemporal N

C2

  • Greater occipital N
  • Lesser occipital N

C3
-Third occipital N

C2 and C3
-Great auricular N

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8
Q

Skin over angle of mandible is not supplied by CN V, but by the cervical plexus with the ___________

A

Great auricular nerve (C2 and C3)

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9
Q

Innervation fo the auricle and external acoustic meatus?

A

Superficial cutaneous innervation from lesser occipital (C2), great auricular (C2 and C3) and auriculotemproal (CN V3)
Deep cutaneous by CN VII & CN X

Motor innervation of surrounding muscles by CN VII

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10
Q

What is Ramsay Hunt Syndrome?

A 
Varicella zoster virus
reactivation in the
geniculate ganglion (CN VII)
Leads to: 
-Otalgia & acute facial palsy
Erythematous, vesicular
rash in & around the
external auditory canal
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11
Q

What is shingles?

A

Reactivation of varicella zoster virus

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12
Q

Which trigeminal division is involved when there is Reactivation of varicella zoster virus?

A

Shingles CN V1

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13
Q

What is hutchinson’s sign?

Risk?

A

cutaneous involvement of the tip of the nose (external nasal branch of nasociliary nerve) in trigeminal shingles.

Risk: Increases likelihood of ocular complications due to interactions of the nasociliary nerve.
Complications: Conjunctivitis, ketatitis (cornea) and uveitis (anterior chamber of globe)

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14
Q

Describe the blood supply to the scalp

A

Anteriorly: From both internal carotids. Branches are:

  • supraorbital
  • supratrochlear

Posterior and lateral: Both external carotids. Branches are:

  • Superficial temporal
  • Posterior auricular
  • Occipital
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15
Q

Venous drainage of the scalp?

A

Veins run alongside the arteries & have the same names draining to the external jugular vein with the exception of the occipital vein that drains to the internal jugular vein

Note arteries are….
Anteriorly: From both internal carotids. Branches are:
- supraorbital
- supratrochlear

Posterior and lateral: Both external carotids. Branches are:

  • Superficial temporal
  • Posterior auricular
  • Occipital
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16
Q

Posterior and anterior lymph drainage of the scalp?

A

Posterior: Mastoid & occipital nodes —> to deep cervical nodes

Anterior: Pre-auricular & parotid nodes

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17
Q

Muscles of mastication are all derivates of the…

A

1st pharyngeal arch

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18
Q

Muscles of mastication are?

A

Temporalis Masseter Medial pterygoid Lateral pterygoid

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19
Q

All muscles of masticationa re innervated by?

A

All innervated by the motor root of CN V that emerges with CN V3 (anterior trunk except medial pterygoid that comes from the main trunk)

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20
Q

Muscles supplied by CN V3 that AREN’T muscles of mastication?

A
  1. Tensor tympani muscle: In middle ear
  2. Tensor palati (via nerve branch to medial pterygoid)
  3. Mylohyoid
  4. Anterior belly of digastric
    (via inferior alveolar branch)
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21
Q

Attachements and actions of temporalis?

+ Innervation

A

Originates from temporal fossa & fascia (broad)
Inserts at coronoid process of mandible (medial surface) & anterior border of ramus
of mandible near last molar (narrow)

Has distinctive fan shape covering temporal fossa

Its actions are to retract & elevate the mandible (i.e. assists in closing the mouth)

Innervated by deep temporal nerves from anterior trunk of CN V3

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22
Q 
Masseter:
Attachment?
Palpation?
Action?
Innervation?
A

Originates from inferior border of zygomatic arch (deep head) & maxillary process of zygomatic bone (superficial head)
Inserts at the angle & lateral surface of ramus of mandible

Palpable when teeth are clenched

Its action is to elevate the mandible (powerful elevator)

Innervated by masseteric nerve from anterior trunk of CN V3

Note: There is a deep & a superficial head to this muscle

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23
Q 
Medial pterygoid muscle:
Divisions?
Innervation?
Attachment?
Actions?
A

There is a DEEP & a SUPERFICIAL head to this muscle

Innervated by nerve to medial pterygoid from MAIN trunk of CN V3

Originates at medial surface of lateral plate of pterygoid process & pyramidal process of palantine bone (deep head) & tuberosity of pyramidal process of maxilla (superficial head)
Inserts into medial surface of mandible near the angle inferior to mandibular foramen

Its actions are to elevate the mandible & assist with lateral (side-to-side) movements

24
Q 
Lateral pterygoid muscle:
Divisions?
Innervation?
Attachment?
Actions?
A

There is an UPPER & a LOWER head to this muscle

Innervated by nerve to lateral pterygoid from anterior trunk or buccal nerve of CN V3

Originates at roof of infratemporal fossa & crest of wing of sphenoid bone (upper head) & lateral surface of lateral plate of pterygoid process (lower head)
Inserts at condylar process of mandible (pterygoid fovea), capsule of TMJ & articular disc

Its actions are to protrude the mandible, assist medial pterygoid with lateral (side-to-side) movements & depress the mandible

25
Q

Muscles of mastication responsible for depression?

A 
Gravity
Digastric
Geniohyoid
Mylohyoid
Lateral pterygoid
26
Q

Muscles of mastication responsible for elevation?

A

Massater
Temporalis
Medial pterygoid

27
Q

Muscles of mastication responsible for retraction?

A

Posterior fibres of temporalis
Deep part of masseter
Geniohyoid
Digastric

28
Q

Muscles of mastication responsible for protrusion?

A

Lateral pterygoid assisted by medial pterygoid

29
Q

Gliding movements between _____ bone & articular disc (_____ cavity)

A

Gliding movements between temporal bone & articular disc (superior cavity)

30
Q

Hinge & rotational movements between head of mandible & _______ disc (_______ cavity)

A

Hinge & rotational movements between head of mandible & articular disc (inferior cavity)

31
Q

What are the muscles of facial expression?

A 
Buccinator
Orbicularis oris
Orbicular oculi
Occipitofrontalis
Platysma

Note: All 2nd pharyngeal arch derivatives

32
Q

Which nerve innervates all the muscles of facial expression?

A

CN VII

33
Q

Describe the journey of the CN VII from the brainstem to the parotid gland?

A
  1. Enters the skull via the internal acoustic meastus
  2. Exits via the stylomastoid foramen
  3. 2 branches are given off posteriorly: Posterior auricular and digastric nerve
  4. Main nerve enters the parotid gland
  5. 5 terminal branches arise from a plexus within the gland
34
Q

What nerve supplies the occipital belly of occipitofrontalis (occipitalis) & auricular muscles?

A

The posterior auricular which is a branch of the CN VII just after it exits the skull via the stylomastoid foramen

35
Q

What are the 5 terminal branches of the CN VII?

A 
Temporal N (to frontal belly of occipitofrontalis (frontalis) & orbicularis oculi) 
Zygomatic N (to orbicularis oculi & upper lip muscles)
Buccal N (to buccinator (‘cheek muscle’) & orbicularis oris)
Marginal mandibular N (to orbitcularis oris) 
Cervical N (to platysma)
36
Q 
Buccinator:
Muscle of....
Attachments?
Actions?
Innervation?
A

Muscle of facial expression

Originates from posterior part of alveolar processes of maxilla/mandible & from pterygomandibular raphe
Fibres merge with orbicularis oris (insertion)

Its actions are to press the cheeks against the molar teeth & works with the tongue
to keep food between occlusal surfaces of teeth & out of the oral vestibule
It also assists with smiling….

Innervated by buccal branches of CN VII

37
Q

Relationship between buccinator and parotid duct?

A

Note that the parotid duct lies on top of the masseter before reaching the buccinator & piercing it while en route to the oral cavity where it enters near the superior 2nd molar tooth

38
Q

Relationship of buccal fat pad and buccinator? Role in infants?

A

The buccal fat pad lies superficially to the buccinator & is also pierced by the parotid duct
This is much larger in infants to reinforce cheeks & inhibit cheek collapse during feeding

39
Q

Orbicularis oris:
Innervation?
Attachment?
Actions?

A

Innervated by buccal & marginal mandibular branches of CN VII

Inserts into mucous membrane of lips

Its actions are to close &/or protrude the lips
Together with the buccinator & tongue, keeps food between occlusal surfaces of teeth
Also assists in whistling…

40
Q

Platysma:
Attachment?
Innervations?
Actions?

A

Originates from subcutaneous tissue of the infra & supraclavicular regions
Inserts at base of mandible to merge with orbicularis oris, skin of cheek & lower lip,
angle of mouth & lower lip

Innervation by cervical branch of CN VII

Action: tense the skin of inf face/neck and depress the mandible

41
Q

Occipitofrontalis:
Innervation?
Attachments?
Actions?

A

Innervation:

  • Temporal branch of CN VII to frontal belly
  • Posterior auricular branch of CN VII to the occipital belly

Attachment:
Frontal belly originates from epicranial aponeurosis & inserts into the skin/ subcutaneous tissue of eyebrows & forehead
Occipital belly originates from the lateral 2/3 of superior nuchal line & inserts into the epicranial aponeurosis

Actions:

  • Retract the scalp ( by occipital belly)
  • Wrinke the forehead and elevate the eyebrows (by frontal belly)
42
Q

Orbicularis oculi:
Innervation?
Parts of muscle and role?
Origins?

A

Innervated by temporal & zygomatic branches of CN VII

Palpebral part:

  • Originates from the medial palpebral ligament and inserts into the lateral palpebral raphe at the ligament
  • Role is to gently closing eyes in involuntary/blinking reflex

Orbital part:

  • Originates from the nasal part of the frontal bone, frontal process of maxilla and medial palplebral ligament and inserts into skin around margin of orbit
  • Role is to tightly close the eyelids which is a voluntery movement
43
Q

Which muscles of facial expression are ‘dilators’?

A 
Via insertion to angle of mouth:
Levator anguli oris
Depressor anguli oris
Risorius
Zygomaticus major

Via insertion into upper and lower lips:
Levator labii superioris
Depressor labii inferioris
Zygomaticus minor

44
Q

Which muscles wrinkle skin over dorsum of nose?

A

Depressor depti

Nasalis

45
Q 
Muscles of facial expression that relate to the ear:
Innervation?
Which muscles?
Arterial supply + venous drainage?
Lymph drainage?
A

Innervate by CN VII

Muscles: Superior auricular, anterior auricular, posterior auricular

Arterial supply is via external carotid artery & venous drainage to external jugular vein as shown for scalp

Lymphatic drainage (like scalp) is via parotid, mastoid & deep cervical nodes

46
Q

Layers of the eyelid?

A 
Skin
Connective tissue
Muscle (orbicularis oculi)
Orbital septum
Tarsus: Superior and inferior muscles give eyelid support
Conjunctiva
47
Q

What is preseptal cellulitis?

A

Infection of the skin/subcutaneous tissue
(superficial layers) anterior to the orbital septum
Important to differentiate from orbital cellulitis

48
Q

What is orbital cellulitis?

A

Infection posterior to the orbital septum
Pain on movements of the eye that are restricted
along with proptosis (bulging of the eye)
Threatens vision & there is risk of infection spread to cavernous sinus or meninges/brain

49
Q

What is conjunctivitis?

A

Conjunctivitis (i.e. pink eye)

= Inflammation of the membrane covering the posterior surface of the eyelid & eyeball

50
Q

Innervation of eyelid?

A

CN V1 and V2

51
Q

Arterial supply and venous drainage of eyelid?

A

Arterial supply is via the external carotid (facial, transverse facial, superficial temporal) & internal carotid (supratrochlear, supraorbital, lacrimal) arteries

Venous drainage is via veins following arteries

52
Q

Lymphatic drainage of eyelid?

A

Via parotid nodes

53
Q

Branches of internal and external carotid that supply the face?

A

Internal carotid, branches of ophthalamic:

  • Zygomatiofacial
  • Zygomaticotemporal
  • **External carotid:
  • Facial
  • BUccal, mental, infraorbital (branches of the maxillary)
  • Transverse facial (branch of the sup temporal_
54
Q

Venous drainage of face?

A

Facial vein drains most of the face to internal jugular vein Transverse facial vein drains some of the upper face

55
Q

What is the danger triangle of the face?

A 
No valves in the external facial veins
  Blood flows in both directions
  Veins deep to danger triangle
drain to cavernous sinus
  Skin infections in this area may
spread as intracranial infections
56
Q

Lymph drainage of the face?

A
  1. Pre-auricular & Parotid: Near ear, from eyelids,
    lateral cheek, external nose
  2. Submandibular: Follows facial artery, from medial orbit, external nose, medial cheek, upper lip, lateral lower lip
  3. Submental: Inferior chin, from medial lower lip & chin

MD4001 Week 3 (12 decks)

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