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FACE & SCALP > ALL THE THINGS > Flashcards

ALL THE THINGS Flashcards

1
Q

How many territories is the face divided into?

A

8

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2
Q

What are the territories of the face?

A 
mental (chin)
oral (mouth)
buccal (cheek)
temporal
zygomatic
orbital
infraorbital
supraorbital
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3
Q

How many facial muscles are there and what do they allow us to express?

A

43 muscles that express universal emotions

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4
Q

What are the two trochlear regions of the face?

A

Supra and Infratrochlear regions

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5
Q

What is the function of the trochlear region of the face?

A

Supra/infratrochlear regions act as a pulley system for the superior oblique muscle. Important area for rhino surgeries

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6
Q

What are the important facial muscles?

A 
Platysma
Orbicularis oculi
Orbicularis oris
Zygomaticus major
Buccinator
Occipital Frontalis
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7
Q

What are the 3 parts of the orbicularis oculi?

A

Orbital part
Palpebral part
Lacrimal part

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8
Q

What is the orbital part of the orbicularis oculi responsible for?

A

for winking

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9
Q

What is the palpebral part of the orbicularis oculi responsible for?

A

responsible for blinking and wetting the cornea

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10
Q

What is the lacrimal part of the orbicularis oculi responsible for?

A

compresses lacrimal sac to release tears

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11
Q

What is the orbicularis oris responsible for?

A

purses lips, manipulates food

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12
Q

Why is the Zygomaticus major muscle important?

A

landmark for vessels running underneath

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13
Q

What is the buccinator muscle responsible for?

A

important for swallowing

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14
Q

How are the fibers of the buccinator muscle oriented?

A

at right angles to the plane of the face

important area for face lifts

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15
Q

What is the occipital frontalis associated with?

A

the galea aponeurotica

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16
Q

What is the galea aponeurotica?

A

a broad aponeurosis that extends over the head to the occipitalis major

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17
Q

What does the galea aponeurotica form?

A

one of the layers of the scalp

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18
Q

Motor functions of the facial nerve involve what?

A

UMNs and LMNs

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19
Q

What controls the muscles of mastication?

A

motor branch of CN V3

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20
Q

UMNs of the CN VII are located in what region of the motor homunculus?

A

facial region

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21
Q

LMNs are in the facial motor nucleus in the brainstem on what side?

A

in the brainstem on the opposite side

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22
Q

The facial motor nucleus activates LMNs to input what muscles?

A

muscles of facial expression

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23
Q

The muscles of mastication rare regulated by what nucleus?

A

the motor nucleus of V

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24
Q

Which specific muscles are innervated by the facial motor nucleus axons?

A

Stylohyoid muscle
Posterior belly digastric
muscles of facial expression
Stapedius muscle

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25
Q

Which specific muscles are innervated by the motor nucleus of V axons?

A

masseter

medial/lateral pterygoid muscles

temporalis anterior belly of digastric

tensor tympani

tensor palati

mylohyoid

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26
Q

Which muscle is involved in smiling?

A

Risorius

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27
Q

How many peripheral branches of CN VII are there?

A

5

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28
Q

What are the peripheral branches of CN VII on the face?

A 
temporal
zygomatic
buccal
mandibular
cervical
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29
Q

What do the peripheral branches of CN VII innervate?

A

facial muscles

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30
Q

Where do ALL the peripheral branches of CN VII pass through?

A

the parotid gland

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31
Q

Bell’s palsy is a paralysis of what?

A

of the peripheral branches of the facial nerve

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32
Q

What is typically implicated as a cause of Bell’s Palsy?

A

Lyme disease

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33
Q

What causes the paralysis seen in Bell’s Palsy?

A

LMN lesion

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34
Q

What muscles are affected in a person with Bell’s Palsy? What are the symptoms associated?

A

orbicularis oris - drooling

buccinator - disrupted swallowing, speech

orbicularis oculi - tears cannot wet eyeball leading to ulceration

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35
Q

What can sometimes remedy Bell’s Palsy?

A

an end to end nerve anastomosis can remedy the symptoms

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36
Q

How does CN VII get to the stapedius in order to innervate it?

A

passes through the facial canal

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37
Q

What does the stapedius muscle do?

A

dampens sound

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38
Q

Where do the axons of the facial motor nucleus exit to innervate the stylohyoid and posterior belly of the digastric muscle?

A

exit the skull at the stylomastoid foramen

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39
Q

What are the locations of possible lesions of the facial nerve?

A

near the stylomastoid foramen

in the facial canal

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40
Q

What is the result of a lesion near the stylomastoid foramen?

A

Bell’s Palsy

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41
Q

What is the result of a lesion in the facial canal?

A

Bell’s palsy and hyperacusis

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42
Q

What is hyperacusis?

A

exaggerated sound

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43
Q

A lesion or neuroman at the internal acoustic (auditory) meatus will result in what?

A

Bell’s palsy, hyperacusis, and problems with hearing and balance

44
Q

What group of glands is the Parotid gland apart of?

A

one of the 3 salivary glands

45
Q

What is another name for the parotid duct?

A

Stensen’s duct

46
Q

Describe how the parotid duct is positioned

A

crosses the face, wraps medial to the masseter muscle, pierces the buccinator muscle, and enters the mouth adjacent to 2nd maxillary molar tooth

47
Q

What are some common problems associated with the parotid gland?

A

Parotitis (mumps)

Pleomorphic (mixed) adenomas

48
Q

Parotitis is the result of what?

A

highly contagious viral infection of the parotid gland that is now controlled by vaccine

49
Q

What does a parotitis affected individual present with commonly?

A

swelling and pain

50
Q

Parotitis is common in _____ without complications, but is serious in ____ .

A

common in young without complications

serious in adults

51
Q

In adults, what can the virus associated with parotitis cause?

A

orchitis (swelling of the testicles)

infertility (rarely)

increased chances for abortion

52
Q

What are Pleomorphic adenomas?

A

mixed, benign tumors

53
Q

What is clinically significant about the fact that the branches of CN VII go through the parotid gland in ONE plane?

A

the gland above and below can be surgically removed without damaging the nerve

54
Q

Where are the pre-ganglionic parasympathetic neurons of the parotid gland located?

A

in the inferior salivatory nucleus

55
Q

Where do the pre-ganglionic parasympathetic neurons of the parotid gland exit and where do they go after that?

A

exit in CN IX

take a circuitous route to the otic ganglion where they synapse on post ganglionic neurons

56
Q

After synapsing, where do the postganglionic parasympathetic axons of the parotid go?

A

they enter the auriculo-temporal branch of V3 to the gland

57
Q

What would happen to the parasympathetic axons if I removed the parotid gland?

A

the axons will be severed, but they will regenerate and innervate sweat glands

58
Q

What is the result of the parasympathetic axons regenerating to innervate sweat glands upon removal of the parotid gland?

A

Frey’s Syndrome

59
Q

What is Frey’s syndrome?

A

when the paraysmpathetic system is activated by eating, the sweat glands are activated

60
Q

How is the parotid gland innvervated sympathetically?

A

Preganglionic ganglionic sympathetic neurons from Lamina 7, T1-2, travel up synapse in the superior cervical ganglion, post ganglionic neurons follow blood vessels to the gland

61
Q

What is the result of sympathetic innervation of the parotid gland?

A

saliva is NOT released, but it’s viscosity is regulated

62
Q

Are the muscles of mastication activated individually?

A

Nope

63
Q

Mastication results from the activation of what?

A

a dedicated UMN circuit

64
Q

When the UMN circuit is activated, what happens?

A

the axons at the circuit descend the cortico-bulbar tract

65
Q

After the axons descend the cortico-bulbar tract, what is the next step to activate the muscles of mastication?

A

as they descend the tract, the axons synapse on group of LMNs in the motor nucleus of V

66
Q

Once the group of LMNs in the motor nucleus of V are synapsed on, what happens?

A

the axons of the LMNs produce a coordinated activation of the muscles resulting in mastication

67
Q

Afferent innervation of the orofacial region involve the 3 division of which nerve? Name the divisions as well.

A

CN V - Trigeminal nerve

V1 - Opthalmic
V2 - Maxillary
V3 - Mandibular

68
Q

What is the Tragal Line?

A

Dividing line between the cranial system and the spinal system.

V3 branch sensation stops at the Tragal Line

69
Q

Each branch of CN V occupies what?

A

a specific territory anterior to the tragal line

70
Q

Each branch of CN V innervates its territory —

A

Exclusively!

THERE IS NO DERMATOME OVERLAP AS IN SPINAL NERVES!

71
Q

The terminal cutaneous branches of CN V include what?

A

V1 - supraorbital, supratrochlear, infratrochlear, lacrimal

V2 - infraorbital, small zygomaticofacial, zygomaticotemporal

V3 - mental, buccal, auriculo-temporal

72
Q

CN V conveys sensations from where else?

A

the teeth, gums, meninges, cerebral blood vessels, and the cornea all via the internal branches of CN V

73
Q

The majority of the sensory innervation of the face is carried out via which terminal cutaneous branches of CN V?

A

V1 - Supraorbital nerve
V2 - Infraorbital nerve
V3 - Mental nerve

74
Q

A unique feature of CN V is that there is no overlap in its peripheral branches. What does this allow us to do?

A

each branch can be tested and anesthetized separately

procedures can then be performed under local anesthesia

75
Q

What pathology is associated specifically with CN V?

A

Trigeminal neuralgia (Tic Doloroux)

76
Q

What is trigeminal neuralgia?

A

horrendous, debilitating pain that usually involves the infraorbital nerve

77
Q

How is the pharmacology of CN V unique?

A

drugs effective in alleviating nervous disorders in other regions of the body are not as effective in dealing with CN V disorders

78
Q

How does CN V refer pain to skin to skin areas of the forehead and eye?

A

afferents of V1 from cerebral blood vessels refer the pain to skin areas that are a branch of the same nerve

79
Q

All of the blood to the head region comes from what?

A

the external carotid

80
Q

What provides blood to the brain?

A

the internal carotid artery

81
Q

What are the two divisions of the carotid artery?

A

internal and external

82
Q

Does the internal carotid artery have external branches?

A

Nope

83
Q

What is the primary artery of the face?

A

the facial branch of the external carotid artery

84
Q

What is unique about the facial branch of the external carotid artery?

A

it takes a tortuous course near the mouth to avoid stretching when the mouth is opened

85
Q

What supplies circulation to the scalp?

A

the superior temporal artery and its branches

86
Q

Why do the branches of the superior temporal artery bleed copiously?

A

they are not end arteries, so blood will emerge from both cut ends

87
Q

What does the facial vein begin as and where does it course?

A

begins as the angular vein and courses to the lower border of the mandible

88
Q

Where does the facial vein receive tributaries from?

A

lips (labial)
palpebral (eyelids)
external nasal areas

89
Q

Below the mandible, angular vein becomes what?

A

the common facial vein

90
Q

The common facial vein joins what vein and terminates at what vein?

A

joins the retromandibular vein and terminates in the internal jugular vein

91
Q

Since the facial vein doesn’t have valves, what makes it a potential danger area?

A

its connections to opthalmic veins can convey an embolism to the cavernous sinuses

92
Q

Since the facial vein has no valves, what determines flow?

A

posture

93
Q

The facial skull consists of how many bones?

A

14

94
Q

Where are the most common fractures of the facial skull seen?

A

Nasal bone - readily repaired

Mandible

95
Q

More serious facial skull fractures are classified according to what?

A

Le Fort classification

96
Q

Describe a Le Fort type I fracture

A

horizontal across maxillae

97
Q

Describe a Le Fort type II fracture

A

through maxillary sinuses, infraorbital foramina, bones of medial orbit and then across the bridge of the nose

Entire central part of the face becomes separated from the skull

98
Q

Describe a Le Fort type III fracture

A

horizontal through superior orbital fissure of the orbit

Causes separation from the skull

99
Q

Why are Le Fort types II and III the most serious?

A

they involve the orbit and its contents

100
Q

What is the clinical benefit of the Le Fort fracture lines?

A

the skull can be disarticulated along the lines to correct facial anomalies

applicable to Crouzon’s Syndrome

101
Q

What does the scalp offer the skull?

A

considerable protection from injury

102
Q

How many layers make up the SCALP?

A

5 layers

103
Q

What are the layers of the SCALP?

A

Skin

Connective tissue

Aponeurosis (galea aponeurotica)

Loos connective tissue

Periosteum

104
Q

Describe the connective tissue layer of the SCALP and what it contains

A

dense and contains the extensive network of superficial blood vessels and nerves

105
Q

What does the aponeurosis layer of the SCALP cover?

A

the temporalis, frontalis, occipitalis muscles.

is firm and difficult to penetrate

106
Q

Describe the loose connective tissue layer of the SCALP and why it is considered a danger area

A

forms a potential space under the galea aponeurotica that is easily filled with blood

blood can extravasate into the peri orbital region resulting in ecchymosis (Raccoon Eyes)

Infections can move through the same way and gain access to the meninges and brain via emissary veins

107
Q

What are the blood vessels and arteries of the scalp called?

A

the Superficial Temporal Arteries

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