Aspects of the face

Question 1

What surgery is done on the teeth and jaws?

Answer 1

Orthognathic surgery

Question 2

What is the need to learn about facial proportions and aesthetics?

Answer 2

a. For aesthetic treatments (smile design)

b. Enhanced patient communication – understanding facial aesthetics allow the dentist to communicate effectively with patients about their concerns and expectations. It helps in setting realistic goals for treatments, enhancing patient satisfaction.

Question 3

What is the roof of the cranium called?

Answer 3

Calvarium

Question 4

Where is the menton, subnasale, Glabella, Sellion and Trichion?

Answer 4

Question 5

Describe the face in thirds in scientific language?

Answer 5

a. Upper third – Glabella to Trichion

b. Middle third – Subnasale to the glabella.

c. Lower third – Menton to the subnasale.

Question 6

What is the golden ratio?

Answer 6

1:1.618

Question 7

What other way can you divide the face in?

Answer 7

Into fifths, vertically.

Question 8

What are the different facial zones of the face?

Answer 8

a. Frontal region – forehead zone

b. Ocular region – eye zone

c. Nasal region – nasal zone

d. Oral region – oral zone

e. Buccal region – cheek zone

f. Mandibular region – chin and jaw zone

g. Temporal region – temporal zone

Question 9

What are the scientific terms of the different features on the face?

Answer 9

a. Eyebrow.

b. Superior palpebra – upper eyelid

c. Inferior palpebra – lower eyelid

d. Auricle – the cartilaginous structure that surrounds the outer ear

e. Nasus – external nose, nasus externus

f. Superior labium – upper lip

g. Inferior labium – lower lip
i. On a smiled face:
1. Nasolabial groove.
2. Labiomental groove.

Question 10

How should you observe a patient when you are examining a new patient?

Answer 10

a. First check a patient extra orally, then intraorally.
i. It’s important to do a facial assessment when doing the extra oral exam, check for swollen lymph nodes or any abnormalities.

Question 11

Can you give some examples of some conditions relating to the teeth and jaws?

Answer 11

a. Tooth decay
b. Gum disease
c. Halitosis
d. Malocclusion
e. Bruxism – grinding or clenching of teeth – there is awake bruxism (grinding of teeth when awake) and sleep bruxism (grinding of teeth when asleep)
f. TMJ disorders
g. Oral cancer
h. Dental erosion
i. Tooth sensitivity – often due to exposed dentin, a layer beneath the enamel.

Question 12

How should you record the observations in notes?

Answer 12

Record in notes and referrals, using appropriate landmarks and references.

Question 13

Answer 13

Question 14

Can you list all the landmarks on the anatomy of the lips?

Answer 14

a. Cupid’s bow
b. Vermillion border
c. Oral commissures
d. Tubercles – refer to small, rounded projections or lumps of tissue on the lips; there are tubercles on the upper lips, upper lip’s midline, and lower lips.
e. Philtrum

Question 15

What does the SCALP acronym refer to?

Answer 15

a. Skin
b. Connective tissue
c. Aponeurosis
d. Loose areolar/connective tissue
e. Pericranium

Question 16

Describe the skin in the SCALP acronym.

Answer 16

Skin:
i. epidermis, dermis and hypodermis

ii. Contains hair follicles, sweat glands, sebaceous glands, arteries, and veins.

iii. Normally 3 to 8mm thick.

Question 17

Describe the connective tissue in the SCALP acronym.

Answer 17

i. Fibrofatty layer of dense fibrous connective and adipose tissue.

ii. Contains arteries, veins, lymphatics, and cutaneous nerves.

iii. Skin lacerations extending into this layer bleed profusely because the dense connective tissue does not retract.

Question 18

Describe the Aponeurotica (Galea) in the SCALP acronym.

Answer 18

i. Thin tendinous structure that bridges the paired occipital and frontal bellies of the occipitofrontalis muscle.

ii. Continues laterally towards the temporal fascia.

iii. Normally 1-2mm thick.

Question 19

Explain the loose connective tissue (sub galeal) in the SCALP acronym.

Answer 19

i. Loose fibro areolar tissue

ii. Predominantly avascular

iii. Surgeons use this layer as a guide or pathway when they need to create flaps of the scalp during certain head and brain surgeries.

Question 20

Explain what the danger space is in the SCALP acronym?

Answer 20

i. The frontalis muscle inserts into the skin, connective tissue, and the aponeurosis layer.

ii. Any lacerations/infections in this area facilitates the spread of disease (blood, tumour, and infection) from this layer into the upper, and occasionally the lower, eye lid.

iii. Emissary veins traverse this layer and pass through skull foramina, allowing for spread of infection and tumour into the intracranial compartment.

Question 21

What is the periostium?

Answer 21

i. Continuous with the endosteum at the suture lines.

ii. Potential space where fluid may loculate.

iii. Plastic surgeons use the subperiosteal plane (space just underneath the periosteum) during procedures to prevent injury to the supraorbital nerve (which is in the connective tissue layer) that serves the forehead’s sensation.

Question 22

Where is the blood supply in the scalp?

Answer 22

**Blood supply come from external (superficial temporal, posterior auricular, and occipital artery) and internal carotid arteries (supratrochlear and supraorbital arteries).
* Below the skin, there is a subcutaneous tissue layer.
* In this layer, there are fibrous structure called septa and arteries.
* the walls of these arteries are firmly anchored to these septa.
* When lacerations may cut this wall, the arteries struggle to close up/contract/retract making it harder to stop the bleeding leading to profuse bleeding.

Question 23

Which layer of the scalp is the “danger area” for spread of infection?

Answer 23

The danger area is the loose areolar/connective tissue.

Loose Structure:
The tissue’s configuration has more space between fibers, enabling fluids, including pus from infections, to spread easily.

Emissary Veins:
These veins connect the veins of the scalp to intracranial venous sinuses. Infections in this layer can potentially spread intracranially via these veins, leading to severe complications.

Connection to Eyelids:
The anterior part of this layer is continuous with the eyelids, allowing infections to spread between the scalp and the eyelids.

Potential Space for Fluid Accumulation:
Due to its lax nature (not tight), it can accumulate pus or other fluids, making it conducive for bacterial growth and spread.

iii. Causing osteomyelitis or may travel farther into venous sinuses and produce venous sinus thrombosis.

Question 24

What are epidermal appendages?

Answer 24

Epidermal appendages are specialised structures that extend/are in between the epidermis and hypodermis

For example, hair follicles, sebacceous glands, sweat glands, nails, apocrine glands, ceruminous glands etc.

Question 25

What is the superficial musculoaponeurotic system (SMAS)?

Answer 25

• SMAS divides the superficial adipose tissue and the deep adipose tissue.
• It surrounds and connects the muscles responsible for facial expressions in the deep adipose tissue.
• It is a fibrous network of connective tissue.

Question 26

Anatomically where is the SMAS located?

Answer 26

a. SMAS lies inferior to the zygomatic arch and superior to the muscular belly of the platysma.

b. In other words, the SMAS is primarily located in the mid-to-lower face and neck. It extends from the forehead, covering the cheeks, and down to the neck.

Question 27

Where is the platysma located?

Answer 27

a. It is located in the superficial layers of the neck.

b. It is a large flat muscle that stretches from the upper chest and shoulder areas to the lower part of the face, covering the front of the neck.

Question 28

What is the Pterygomandibular Raphae?

Answer 28

The pterygomandibular raphe is located on the inner side of the mouth, near the rear end of the mandible, specifically in the retromolar fossa.

Question 29

What is the retromolar fossa?

Answer 29

The retromolar fossa is a small, concave depression located behind the last molar tooth in the lower jaw (mandible).

Question 30

What are Fordyce spots?

Answer 30

Sebaceous glands found on the buccal/labial mucosa

Question 31

What are the key groups of lymph nodes in the face and neck?

Answer 31

a. Submental nodes – located under the chin.

b. Submandibular nodes – located along the jawline.

c. Parotid nodes – near the parotid salivary gland.

d. Preauricular nodes – in front of the ear.

e. Postauricular nodes – behind the ear.

f. Occipital nodes – at the base of the skull.

Question 32

Tell me about the different lymph drainage pathways in the face.

Answer 32

a. The forehead and eyes – lymph from the forehead and the area around the eyes typically drains into the preauricular and parotid nodes.

b. Nose and cheeks – lymph from the nose and cheeks usually drains into the submandibular nodes.

c. Mouth, lips, and tongue – lymph from the mouth, lips, and tongue drains into both submandibular and submental nodes.

d. Chin and lower lip – Lymph from the chin and lower lip drains into the submental nodes.

e. Ears and Scalp – Lymph from ears and the scalp often drains into the postauricular and occipital nodes.

Question 33

What is the preauricular, Parotid, Submental and Submandibular?

Answer 33

Question 34

Answer 34

Question 35

Answer 35

Question 36

Answer 36