Anaesthetics: Anatomy - Face and scalp

Question 1

Describe the arterial supply of the face

Answer 1

From external carotid:
1. Facial artery -> inferior labial, superior labial, lateral nasal, angular branches
2. Occipital
3. Posterior auricular
4. Superficial temporal -> transverse facial
5. Maxillary -> inferior alveolar, deep auricular -> mental (through mental foramen)

From internal carotid:
1. Supra-orbital
2. Supratrochlear

Question 2

What parts of the face is supplied by the facial artery?

Answer 2

Muscles of facial expression, face

Question 3

What parts of the face are supplied by the inferior and superior labial arteries?

Answer 3

Along lip beneath red margin
Anastomose with artery from other side
Superior gives off branch to nasal septum

Question 4

What parts of the face are supplied by the occipital artery?

Answer 4

Scalp of back of head as far as vertex

Question 5

What parts of the face are supplied by the posterior auricular artery?

Answer 5

Auricle of ear
Scalp posterior to auricle

Question 6

What parts of the face are supplied by the superficial temporal artery?

Answer 6

Facial muscles
Skin of temporofrontal and frontal regions

Question 7

What parts of the face are supplied by the transverse facial artery?

Answer 7

Parotid gland and duct
Muscles of skin and face

Question 8

What parts of the face are supplied by the maxillary artery?

Answer 8

Deep temporal branches anastomose with middle temporal (branch of superficial temporal)

Question 9

What parts of the face are supplied by the mental artery?

Answer 9

Facial muscles and skin of chin

Question 10

What parts of the face are supplied by the supra-orbital and supratrochlear artery?

Answer 10

Muscles and skin of forehead and scalp
Superior conjunctiva
Anastomose with superficial temporal

Question 11

Do facial veins have valveless?

Answer 11

No

Question 12

Describe the course of the veins in the face

Answer 12

Generally accompanying arteries
Also anastomose with pterygoid venous plexus and dural venous sinuses via emmisary veins

Question 13

What is the clinical significance of the pattern of the venous drainage of the face?

Answer 13

Connects with dural venous sinuses via emissary veins
Provides route for spread of infection or cavernous sinus thrombosis

Question 14

Describe the venous drainage of the face

Answer 14

Supratrochlear and supraorbital drain to angular vein (at root of nose)
Angular and deep facial drain to facial vein (at inferior margin of orbit)
Superficial temporal and maxillary drain to retromandibular vein -> anterior branch joins facial vein and drains into IJV (at level of hyoid or just inferior), posterior branch joins posterior auricular vein to form EJV
Occipital vein (may receive mastoid emissary vein from sigmoid sinus)
Deep temporal vein connects with tributaries of pterygoid venous plexus (drains deep parts of scalp in temporal region)

Question 15

Describe the lymphatic drainage of the face

Answer 15

Apart from parotid/buccal region, there are no lymph nodes in the face or scalp
Lymph drains into superficial ring (pericervical collar):
- Submental, submandibular, parotid, mastoid and occipital lymph nodes
- All drain directly or indirectly into deep cervical lymph nodes

Question 16

Which five arteries supply the nose and what areas does each supply?

Answer 16

1. Anterior ethmoidal (from ophthalmic): lateral and medial/septal branches*
2. Posterior ethmoidal (from ophthalmic): lateral and medial/septal branches*
3. Sphenopalatine (main artery, from maxillary): lateral and medial/septal branches, enters via sphenopalatine foramen, supplies mucosa over conchae and meatuses, much of septum
4. Greater palatine (from maxillary): via incisive canal on anterior hard palate
5. Septal branch of superior labial (from facial)

• supply roof and upper parts of lateral wall and septum

Question 17

What four arteries supply the external nose?

Answer 17

1. Anterior ethmoidal
2. Septal branch of superior labial
3. Nasal branches of infra-orbital
4. Lateral nasal branches of facial

Question 18

What is Kiesselbach’s area?

Answer 18

Anastomotic plexus at anterior septum involving all five arteries supplying the internal nose:
1. Anterior ethmoidal
2. Posterior ethmoidal
3. Sphenopalatine
4. Greater palatine
5. Septal branch of superior labial

Question 19

Describe the venous drainage of the nose

Answer 19

Submucosal venous plexus via sphenopalatine, facial and ophthalmic veins

Question 20

Describe the layers of the scalp

Answer 20

Skin: with sweat and sebaceous gland, hair follicles, arterial/venous/lymphatic supply/drainage
Connective tissue: richly vascularised and supplied with cutaneous nervces
Aponeurosis with muscle at front, back and sides (“epicranius”): occipitofrontalis, temperoparietalis, superior auricular
Loose areolar tissue: sponge-like layer with potential spaces, also free movement of scalp on bone
Periosteum: dense connective tissue layer

Question 21

Describe the nerve supply of the scalp and face

Answer 21

1. Ophthalmic nerve (CN V!) and branches:
   - Supra-orbital: frontal sinus, scalp to vertex, anterolateral forehead
   - Supratrochlear: anteromedial forehead
   - Lacrimal: lacrimal gland (secretomotor fibres)
   - Infratrochlear: bridge of nose
   - External nasal: ala, vestibule and dorsum of nose (including apex)
2. Maxillary nerve (CN V2) and branches:
   - Infra-orbital: maxillary sinus, maxillary teeth, inferior eyelid, cheek, laterla nose, superior lip
   - Zygomaticofacial: prominence of cheek
   - Zygomaticotemporal: anterior (hairless) part of temporal fossa
3. Mandibular nerve (CN V3) and branches:
   - Auriculotemporal: skin anterior to auricle, posterior temporal fossa, superior external acoustic meatus and tympanic membrane, tragus, helix and adjacent auricle
4. Anterior rami of cervical spine nerves:
   - Great auricular (C2, C3): angle of mandible, inferior earlobe, parotid sheath
   - Lesser occipital (C2, C3): scalp posterior to auricle
5. Posterior rami of cervical spine nerves:
   - Greater occipital (C2): scalp of occipital region
   - Third occipital (C3): scalp of lower occipital and suboccipital regions

Question 22

What nerves supply the ear?

Answer 22

Auriculotemporal supplies tragus, helix and adjacent auricle, superior external acoustic meatus and tympanic membrane
Vagus and facial nerve (via chorda tympani) contribute to supply of tympanic membrane, and small area of posterior ear and external acoustic meatus