Face Flashcards

1
Q

What is the intracranial course of the facial nerve?

A

Originates between the pons and medulla > Internal acoustic meatus >Facial canal (petrous part of the temporal bone) >exists through the stylomastoid foramen

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2
Q

Branches of the facial nerve

A

Divides into 5 branches within the parotid gland
- Temporal
- Zygomatic
- Buccal
- Marginal mandibular
- Cervical

Branches before entering the parotid gland
- Digastric
- Posterior auricular
- Cervicofacial
- Temporofacial

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3
Q

Which cranial nerves transmit parasympathetic fibres?

A

Oculomotor, glossopharyngeal, vagus and facial

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4
Q

What is the surface anatomy of the parotid duct?

A

The middle third of a line drawn between the intertragic notch and the middle of the philtrum

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5
Q

Where does the parotid duct open?

A

Crosses the masseter, pierces the buccinator and opens adjacent to the upper 2nd molar (stensen’s duct)

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6
Q

Which structures pass through the parotid gland?

A

Facial nerve (most superficial structure)
External carotid artery
Retormandibular vein
Auriculotemporal nerve
Deep parotid lymph nodes

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7
Q

What are the relations of the parotid gland?

A

Anterior - masseter, medial pterygoid, superficial temporal and maxillary arteries, facial nerve and stylomandibular ligament

Posterior - posterior belly of digastric muscles, SCM, Stylohyoid, internal carotid artery, mastoid process and styloid process

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8
Q

What is the arterial supply of the parotid gland?

A

Branches of the external carotid artery

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9
Q

What is the venous drainage of the parotid gland?

A

Retromandibular vein (union of the superficial temporal and maxillary veins)

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10
Q

What is the lymphatic drainage of the parotid gland?

A

Deep and superficial parotid LN > upper and lower deep cervical lymph nodes

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11
Q

What is the innervation of the parotid gland?

A

Parasympathetic - secretomotor from the otic ganglion
Sympathetic - superior cervical ganglion
Sensory - greater auricular nerve

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12
Q

What is the surface anatomy of the parotid gland

A

Upper end - curved line from the tragus to the centre of the mastoid bone
Anterior border - a line from the tragus to the centre of the posterior border of the masseter then to the point 2cm below and behind the angle of the mandible

Posterior - straight line from the mastoid process to a point 2cm below and behind the angle of the mandible

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13
Q

What type of secretions does the parotid gland produce?

A

Serous

parasympathetic stimulation produces watery serous saliva
Sympathetic stimulation produces low volume, enzyme rich saliva

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14
Q

Name some differential diagnoses of a parotid swelling

A

Infection - parotitis, mumps
Obstructed duct - calculi, external compression
Neoplasm- pleomorphic adenoma, warthin’s tumour
Deep parotid lymph node

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15
Q

What is Frey syndrome?

A

Damage to the parasympathetic fibres from the auriculotemporal nerve results in excessive gustatory sweating in response to saliva production

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16
Q

Where can the facial artery be palpated

A

Where it crosses the inferior border of the mandible adjacent to the anterior border of the masseter

17
Q

Where is the submandibular duct opening located?

A

Opens in the floor of the mouth on either side of the lingual frenulum

18
Q

What type of secretions does the submandibular gland produce?

A

Mucous and serous

19
Q

Which nerves are at risk on submandibular gland excision?

A

Lingual nerve
Hypoglossal nerve > leads to deviation of the tongue towards the affected side on protrusion
Marginal mandibular branch of the facial nerve

20
Q

What is the difference between and UMN and LMN facial palsy?

A

UMN lesions spare the upper part of the face
LMN - all parts of the face are involved

21
Q

Which regions are drained by the pre-aurciular LNs

A

Upper half of the face
Temporal region
Auricle and EAM
Gums

22
Q

What is the nerve supply of the tongue?

A

Motor
- Hypoglossal nerve
- except for palatoglossus which is innervated by the vagus nerve

Sensory
- Posterior root of the tongue > vagus
- anterior 2/3 - mandibular nerve via the lingual
- posterior1/3 - glossopharyngeal

Taste
- posterior root of the tongue - vagus
- anterior 2/3 of the tongue - glossopharyngeal
- posterior 1/3 of the tongue - Facial nerve via chorda tympani

23
Q

Name the extrinsic muscles of the tongue

A

Styloglossus
hyloglossus
genioglossus
palatoglossus

24
Q

Which muscle retracts the tongue?

A

Styloglossus

25
Which is the nerve supply to the tongue
All extrinsic muscles are innervated by hypoglossal nerve except for palatoglossus which is innervated by the vagus nerve
26
What forms the roof of the middle ear?
Tegmen tympani
27
How do middle ear infections cross the skull?
By direct erosion of the tegmen tympani which allows spread to the mastoid air cells causing mastoiditis
28
Describe the clinical picture of meningism
Photophobia Stiff neck Fever
29
Which structures pass through the IAM?
Facial nerve Vesticubulocochlear nerve
30
What disease process can lead to irreversible damage of the CN VIII?
Acoustic neuroma
31
Why do patients with acoustic neuromas hear sounds loudly on the affected side?
They often have involvement of the facial nerve with paralysis of stapedius
32
What are the relations of the middle ear?
Roof - Tegmen tympani- separates the tympanic cavity from the MCF Floor - thin bone separates the tympanic cavity from the superior bulb of the IJV Anterior wall - Thin bone, separates the tympanic cavity from the ICA. At upper part there are openings into two canals - auditory tube and canal for tensor tympani Posterior - Aditus to the mastoid antrum superiorly and pyramid inferiorly Lateral wall - tympanic membrane and lateral wall of epitympanic recess Medial wall - lateral wall of the inner ear