Anatomy of the Face Flashcards
Front part of head that in humans extends from forehead to chin and includes mouth, nose, cheeks, and eyes defines what?
The face
*ears are not part of the face, it is part of the neck
What are the contents of the face?
- Bones (facial aspect neuro- & viscerocranium)
- Nerves (branches of trigeminal and facial nerve)
- Muscles of facial expression
- Blood supply (veins, arteries)
- Other structures (buccal fat pad, pterygomandibular raphe, parotid gland)
- Sinuses
What are the three part of the cranium?
Neurocranium: bony case of the brane
Viscerocranium: facial skeleton
The neurocranium includes which part of the skull?
Frontal bone
What are the muscles around the mouth?
A.Levator labii superioris alaeque nasi
B.Levator labii superioris
C.Zygomaticus minor
D.Zygomaticus major
E.Risorius
F.Depressor anguli oris
G.Depressor labii inferioris
H.Orbicularis oris
Levator anguli oris
What are the 3 muscles of the mouth that originate from the maxilla?
A.Levator labii superioris alaeque nasi
B.Levator labii superioris
I.Levator anguli oris
What are the 2 muscles of the mouth that originate from the zygomatic bone?
A.Zygomaticus minor
B.Zygomaticus major
What are the muscles of the mouth that originate from the fascia/skin?
Fascia
Risorius
Obicularis Oris
Skin
Orbicularis oris
What are the two muscles of the mouth that orignate from the mandible?
Depressor anguli oris
depressor labi inferioris
What are the 4 muscles of the mouth that insert into the angle of the mouth?
A.Zygomaticus major
B.Risorius
C.Depressor anguli oris
Levator anguli oris
What are the three muscles of the mouth that insert onto the upper lip?
A.Levator labii superioris alaeque nasi
B.Levator labii superioris
C.Zygomaticus minor
Where does the depressor labii inferioris inserts where?
Lower lip
The orbicularis oris inserts where?
surround mouth opening
Levator labii superioris alaeque nasi and levator labii superioris share a function. What is it?
Lift upper lip
Additional function of Levator labii superioris alaeque nasi is wing of nose
The Viscerocranium includes what part of the skull?
Zygomatic bone
Mandible
Nasal Bone
Maxilla
Which nerve supplies the face?
Trigeminal Nerve - CN V
Sensory: face
Facial Nerve - CN VII
Motor: mm of facial expression
The branches of the trigeminal nerve provide sensory innervation on the face. What are the zones and how do they enter the face?
Opthalmic Zone - Opthalmic division (V1) and it enters through supraorbital foramen
Maxillary Zone - Maxillary division (V2) and it enters through the infraorbital foramen
Mandibular zone - Madibular branch (V3) and it enter throught he mental foramen
What are the divisions of the CN V1?
Supraorbital n.
Supratrochlear n.
Infratrochlear n.
External nasal n.
Lacrimal n.
What are the branches of CN V2?
Zygomatico-temporal n.
Sygomaticofacial n.
Infra-orbital n.
What are the branches of CN V3?
Auriculotemporal n.
Buccal n. (long buccal n.)
Mental n.
The branches of the trigeminal nerve all originate from one common are. This structure is located in the middle cranial fossa. What is it?
Trigeminal Ganglion
V1 then goes through supraorbital fissure
V3 goes through foramen ovale
V2 goes through foramen rotundum
Trigeminal neuralgia is also known as ______.
Describe the cause of this disorder.
Tic douloureux
- Disorder of the sensory root of CNV àDemyelination of axons in the sensory root
- Caused by pressure of a small aberrant artery (too close) or by pathological process which affects neurons (neuron shed myelin)
- Most often in middle-aged and elderly persons
- Frequency of involved branches from trigeminal divisions: V2 > V3 > V1
What are the characteristics of tic douloureux?
- Characterized by sudden attacks of excruciating, lightening like japs of facial pain (can be 15+ min)
- Pain can be so intense that person winces àhence the common term tic(twitch)
- Can be initiated by touching face, brushing teeth, shaving, drinking, or chewing
How is tic douloureux treated?
•Medical or surgical treatment to reduce pain (e.g., avulsion or cutting of nerve branches at foramina) – minimal invasive procedure.
Widespread anesthesia involving the
- Corresponding anterior half of scalp
- Face,except area around angle of mandible (this is the cranial auricular nerve that comes from the cervicalplexus), cornea, and conjunctiva
- Mucous membranes of mouth, nose, and anterior part of tongue
Is caused by what?
Lesion of the entire trigeminal nerve
Lesion to the motor part of the trigeminal nerve affects which part of the head?
Paralysis of muscles of mastication and tensor veli palatini
Clinical Herpes Zoster is caused by what?
Describe it’s characteristics.
Also known as Shingles!
it is caused by infection of trigeminal ganglion (infection may produce a lesion in the cranial ganglia)
Characteristics
•eruption of groups of vesicles following the course of the affected nerve
Ganglion infection occurs in 20% of cases
Which branch of the trigeminal nerve is often affected by Herpes Zoster (Shingles)?
Opthalmic n. (V1)
Often affects the cornea -> painful corneal ulceration and subsequent scarring of cornea
The facial nerve exits the skull through the stylomastoid foramen and gives off two initial branches. What are they?
Posterior: Posterior auricular nerve (VII) - not part of the face
Anterior - transveres parotid gland and divides into 5 main branches (deep to skin) - this is know as the parotid plexus
What are the branches of the facial nerve?
- T–Temporal
- Z– Zygomatic
- B– Buccal
- M– Marginal mandibular
- C– Cervical (innervates platysma muscle)
“Two Zebras Bit My Cat”
Condition in which muscles of facial expression on one side of the face becomes weak or paralyzed is known as?
Facial Palsy - Bell’s Palsy
What is the characteristic of Bell’s Palsy?
•It affects only one side of the face at a time, causing it to droop or become stiff on that side
How does Bell’s Palsy occur?
- It’s caused by some kind of trauma to the facial nerve (CNVII)
- Seems to occur more often in people who have diabetes or are recovering from viral infections (e.g., herpes simplex 1 virus).
- Most of the time, symptoms are only temporary.
Infection with Borreliaburgdorferi via tick bites can cause ______?
Lyme Disease
Of pts affected with Lyme diseas, 10% develop ______ _______, with 25% of the patients presenting with _______ _________.
Facial paralysis (paralysis of muscles of facial expression)
Bilateral Palsy
In this image the muscles that are X’ed out are what?
Not muscle of facial expression
This muscle originates from the fascia overlying pectoralis major and deltoid muscles and inserts into the inferior border of mandible and skin over lower face. What is it?
Platysma
ONLY muscle of facial expression over the neck region
What are the actions and innervation of the Platysma?
Action:
- depresses corners of mouth
- depression of mandible
- tenses skin of neck (shaving)
- expands neck during heavy breathing
Innervation: cervical branch of facial nerve
The frontalis and occipitalis together create the?
Epicranius
Fronatalis
Origin
Insertion
Innervation
Origin: galeaaponeurotica/ epicranialaponeurosis
Insertion: skin of eyebrows
Innervation: temporal branches of
Occipitalis
Origin
Inseriton
Innervation
Origin: superior nuchal line
Insertion: galeaaponeurotica
Innervation: posterior auricular branch/nerve
What is the function of the Epicranius?
Elevates eyebrows and wrinkles forehead. Pulls scalp back and forth
Orbicularis Oculi
Origin
Insertion
Action
Innervation
Origin: medial palpebral ligament
Insertion
- orbital part: skin of lateral cheek (part that runs over bone)
- palpebral part: lateral palpebral ligament (runs on eyelid, no bone)
Action: closes the eyelids; protects eye
Innervation: temporal (above fissure) & zygomatic branches (below fissure)
Procerus
Origin
Insertion
Action
Innervation
Origin: nasal bone
Insertion:skin between the eyebrows
Action: depresses the medial corners of the eyebrows
Innervation: temporal branch
What is the common function of the Zygomatic major and zygomatic minor?
Smile (Zmile)
Zygomatic major lift the lips at the angle of the mouth and the zygomatic minor lifts the upper lip
What is the common function of the Depressor anguli oris and depressor labii inferioris?
Depresses angle of mouth (anguli oris) and lower lip (Labii inferioris)
What is the function of the Risorius m.?
subtle retraction of angle of mouth
What is the function of the Orbicularis oris?
Constictor!
Closes mouth (kissing and eating)
What is the function of the levator anguli oris?
lift angles of mouth
Out of all the muscles of the mouth how many are used for laughing and how many for frowning?
22 for a full laugh
6 for frowning
Most the muscle (except one) surrounding the mouth are innervated by the buccal branch of the facial nerve. What are they?
Levator labii superioris alaeque nasi
Levator labii superioris
Zygomaticus minor
Risorius
Orbicularis oris
Levator anguli oris
Depressor anguli oris
Zygomatic major
(As you can see the only muscle not included is the depressor labi inferioris)
Of the muscle surrounding the mouth, three muscles recieve innervation outside of the bucal branch of the facial n? What are they?
Zygomatic and buccal branches supply the Zygomatic major
Marginal mandibular and buccal branches supply the depressor angular oris
The marginal mandibular branch supplies the depressor labii inferioris
Mentalis
Origin
Insertion
Nerve
Actions
- Origin: anterior mandible
- Insertion: skin of chin
- Nerve: mandibular branch of facial nerve
- Actions: elevates and wrinkles skin of chin, protrudes lower lip
Buccinator
Origin
Insertion
Action
Innervation
Origin
- pterygomandibularraphe
- maxilla lateral to molar teeth
- mandible
Insertion:
- angle of mouth
- lateral portion of both lips
Action:
- pulls the corner of mouth laterally
- presses the cheek against the teeth
Innervation:buccal branches of facial n.
IMPORTANT IN MASTICATION (but not innervated by the buccal nerve from V3)
Image shows the vessels of the head
Slide 31????
Listen again
What is the cavernosus sinus?
Communicates with veins of the face through 2 routes
- Veins that pass through superior orbial fissue
- Veins that pass through foramen ovale/foramen of Vesalius
T/F
The flow of the veins can be reversed?
True
Pterygoid plexus has valves and can act as a suction pump (this occurs during yawning)
What is the flow of veins in the faces?
Opthalmic veins darin into the Cavernous Sinus
inferior opthalmic v. also drains into pterygpid plexus
infraorbital vein drains into pterygoid plexus
Deep facial vein drains into facial vein which then heads toward jugular vein
What is the danger zone?
Possible infection between angular and deep facial veins
- Dangerous area is triangle bounded by lines from root of nose to angle of mouth
- Venous drainage from this area (face and orbit) communicate with cavernous sinus via superior & inferior ophthalmic veins and deep facial vein (via pterygoid plexus)
- Risk of spread of infection -> can lead to sinus thrombosis
What is the content of the cavernous sinus?
TOM of CAT
T: Trochlear nerve
O: Opthalmic nerve
M: Maxillary nerve
O: Occulomotor nerve
C: Cavernous Part ofo Internal Carotid artery
A: Abducens Nerve
T: Trigeminal nerve
INFECTION TO THIS AREA IS DANGEROUS
An infection leading to a blood clot caused by the complication of an infection in the paranasal or central face sinuses can lead to what?
Thrombosis of the Cavernosus SInus
What are the symptoms of Thromboss of the Cavernous Sinus?
Fatigue
Seizure
Vomiting
Impaired vision
Boil on the face
Drooping eyelid
high temp
Sinusitis - an infection in the skull
Severe pain or numbness in the face
Infection in eyes - redness, swellin or irritation around the eyes
What are the branches of the extenal carotid artery?
Some Anatomists Like Freaking Out Poor Medical Students (inferior to superior)
- S: superior thyroid artery
- A: ascending pharyngeal artery
- L: lingual artery
•F: facial artery
- O: occipital artery
- P: posterior auricular artery
•M: maxillary artery - behind the angle of the mandible
•S: superficial temporal artery - behind the angle of the mandible
What are the branches of the facial artery?
- Submental a.: arises at lower body of mandible; supplies skin of chin and lower lip
- Inferior labial a.: arises near angle of mouth, runs medially in lower lip, anastomosis with fellow of opposite site
- Superior labial a.: runs medially in upper lip and gives branches of to septum and ala of nose
- Angular a.: termination of facial artery, supplies area around eye
The superficial temporal artery is the terminal of the carotid artery?
What is the path of the artery?
- Ascends in front of ear (palpable) to supply temporal and anterior portion of scalp
- Transverse facial artery runs above parotid duct to supply the cheek region
The maxillary artery give of many branches. What are thr three branches we need to know currently?
- Infra-orbital: enters the face through the infra-orbital foramen and suplies the lower eyelid, upper lip and the area between these structures
- Buccal artery: enters the face on the superficial surface of the buccinator muscle and supplies structures in this area
- Mental artery: enters the face through the mental foramen and supplie the chin
What is the origin of the supra orbital a?
Arises from the opthalmic a. which arises from the internal carotid a.
What is the origin of the infra-orbital a.?
Arises from the maxillary a. (3rd part) which ariss from external carotid artery
What is the buccal fat pad?
•One of many encapsulated fat pads in the cheek (above buccinator and can extend to temporal region)
What is a common cosmetic facial surgery uprocedure that is performed to slim the cheeks or face?
Buccal fat pad reduction
Why is the buccal fat pad used in surgery for cingenital and aquired defects that occur in the maxillofacial area
The buccal fat pad flap is a simple and reliable flap for the treatment of many of these defects because of its rich blood supply and location, which is close to the location of various intraoral defects.
What is the Pterygomandibular raphe?
From mouth to oropharynx: orbicularis oris, buccinator, superior pharyngeal constrictor
•Sphincter to oropharynx (keep food between teeth
* this is piered during a inferior alveolar nerve block to reach the linguak n. (V3) and inferior alveolar n. (V3)
Whhich gland is the largest of the 3 paired salivary glands?
Parotid gland
- Irregular shaped àparotid bed: anterio-inferior of external acoustic meatus
- Wedged between ramus of mandible and mastoid process
- Fatty tissue between lobes: flexibility of gland to accommodate motion of mandible
What are the structures that are embedded in parotid gland?
Facial nerve plexus, retromandibular vein, and external carotid artery
Structures are encolsed within tough facial capsule, know as the Parotid Sheet
Lymph nodes are located on the sheet and within gland
What is the path of the parotid duct?
- Parotid duct passes horizontally from anterior edge of gland
- At anterior border of masseter, the duct runs medially, pierces the buccinator, and enters oral cavity through small orifice opposite of 2nd maxillary tooth
What is a Parotidectomy?
Sugical Excision of the parotid gland
80% of Salivary gland tumors in the parotid gland, most the time they are benign.
Procedure is done to preserve the facial plexus
Small air-filled spaces located within bones surrounding the nose
This is known as?
Paranasal sinused
How do the paranasal sinuses develop?
develop from invaginations of nasal cavity that extend into bones: 2 during fetal development, 2 postnatally
In an adult, what are 4 paired paranasal sinuses?
Maxillary sinuses
Ethmoid sinuses
Frontal sinuses
Sphenoid sinuses
Why is the paranasal sinuses so important?
- Sinuses shape/reshape face through enlargement of air filled space
- Keep weight of head low while growing
Describe the Maxillary sinus?
It develops in the 3rd fetal month
Invagination of nasal sac that expands within the maxillary bone
Describe the Ethmoid sinuses?
Develop in the 5th fetal month
Invagination of middle meatus of nasal passages (spaces underlying middle nasal concha) grow into ethmoid bone
Describe the Sphenoid sinuses?
Developes in the 5 postnatal month
extensions of ethmoid sinuses into sphenoid sinuses
Describe the frontal sinuses?
Develops in the 5-6th postnatal year
Each frontal sinus consist of two independent spaces that develop from different sources.
- 1 forms by expansion of ethmoid sinus into frontal bone
- 1 develops from independent invagination of middle meatus of nasal passages
What is sinusitis?
- Inflammation of membranes lining the paranasal sinuses
- Can be caused by infection or other health problem
- Symptoms include facial pain and nasal discharge
