Face and Parotid Gland

Question 1

Other muscles of the mouth:

Answer 1

1. Orbicularis oris: kissing, puckering, talking, eating 2. Buccinator: PRINCIPAL MUSCLE OF CHEEK, b/t maxilla and mandible, helps with mastication but NOT a m. of mastication, covered by buccopharyngeal fascia and fat pad and the parotid duct pierces this m. at the upper 2nd molar*** 3. Platysma: from superficial fascia covering deltoid and pectoralis m., ascends to mandible, can depress lower lip laterally and inferiorly

Question 1

The ______ v. anastomoses with the ______ v. and drains into the cavernous sinus.

Answer 1

Angular v.; ophthalmic v. **This could be a route for infection of the face to spread into the brain b/c facial veins have no valves, thus blood from the face can enter the cavernous sinus.

Question 1

Posterior to parotid:

Answer 1

Styloid and mastoid process, external acoustic meatus, SCM, occipital v., posterior auricular a.

Question 2

Parotid: Relationships with other facial structures: Superior:

Answer 2

Zygomatic arch, superficial temporal a., auriculotemporal n., temporal branch of VII

Question 3

Zygomaticotemporal n. is a branch of the _____. It exits through the z-temporal foramen and supplies:

Answer 3

Zygomatic n.; supplies the temporal part of the head

Question 3

Relationships within the PAROTID gland:

Answer 3

1. Parotid plexus (most superficial structure) - VII enters the parotid gland and divides into the tempro-facial and cervico-facial divisions, these divisions branch repeatedly and form an anterior plexus in the parotid gland, the 5 branches of this plexus supply all the facial muscles
2. Retromandibular v (middle)
3. External carotid a (deepest structure): passes thru the parotid and terminates into superficial temporal and maxillary a.

Question 4

Medial to parotid:

Answer 4

Masseter m., internal carotid a.

Question 5

In the parotid, parasympathetic fibers come through the:

Answer 5

Glossopharyngeal n. IX arising from the otic ganglion

Question 6

Auriculotemporal n. is a _____ division of the mandibular n., it arises through 2 roots that encircle the ________. It is closely related to the parotid gland and superficial temporal a. It supplies:

Answer 6

Posterior; encircles the middle meningeal a.; supplies skin of the external ear and temporal area of the scalp

Question 6

Nerves of the face? what does injury result in? why are children more susceptible to injury from the facial nerve?

Answer 6

The facial n. supplies all the facial m. through it’s branches: TZBMC

1. Temporal 2. Zygomatic 3. Buccal 4. Marginal mandibular 5. Cervical branches I

Injury to the facial n. will cause paralysis of the facial m. - common cause of this is due to inflammation of facial nerve near the stylomastoid foramen.

Also, facial n. is vulnerable to injury in children bc the stylomastoid foramen opens up beneath the skin bc mastoid process of temporal bone is not formed yet

Question 6

The parotid gland is supplied by the _______ artery and drained by the __________.

Answer 6

External carotid a.; retromandibular v.

Question 7

Bones of the face and their foramina:

Answer 7

Frontal - supraorbital foramina and notch, supratrochlear Zygomatic - zygomaticofacial and temporal Nasal Maxilla - infraorbital Mandible - mental Temporal

Question 8

Supratrochlear is a branch of the _______, exits the orbit at the medial end of the supraorbital margin and supplies:

Answer 8

FRONTAL N.; forehead and upper eyelids

Question 9

Mumps:

Answer 9

Inflammation of the parotid gland, mumps virus also causes inflammation of the parotid duct, causing pain during swallowing

Question 10

Corrugator supercilii:

Answer 10

Run from frontal bone and insert into the skin of the medial half of the eyebrow –> draws eyebrows medially and downward

Question 10

Superficial temporal a. is a terminal branch of the external carotid a. which forms in the _____ and one of its branches, _______, accompanies the parotid duct and also anastomoses with the facial a.

Answer 10

Parotid gland; transverse facial a. Branches of the superficial temporal a. also anastomose with the supraorbital a. and supratrochlear branches of the ophthalmic a

Question 11

Orbicularis oculi consists of 3 parts. what are they and what are their function?

Answer 11

1. Orbital - Attached to medial margin of the orbit - at the medial palpebral ligament –> winking and tightly closing the eye
2. Palpebral - Contained in eyelids, arises from medial palpebral ligament - fibers run thru upper and lower eyelid and join laterally to form the common tendon - lateral palpebral ligament (which inserts to the orbital tubercle of the zygomatic bone) –> gentle closure of eye
3. Lacrimal: lies behind the medial palpebral ligament and lacrimal sac - arises from the crest of the lacrimal bone and inserts lateral into the superior and inferior tarsal plate –> maybe helps to compress the lacrimal sac to drain tears thru the nasolacrimal duct

Question 12

Lymphatics of the face: what are the three main nodes? where do they drain lymph from?

Answer 12

The lymphatic vessels in the forehead and anterior part of the face drain mainly through 3 groups of lymph nodes.

1. Submental nodes - collect lymphatics from the medial part of the lower lip and chin
2. Submandibular nodes - located superficial to the submandibular glands and inferior to mandible –> collects lymphatics from the medial cornea of orbit, most of external nose, medial cheek, and upper and lateral part of the lower lip
3. Pre-auricular and parotid nodes: located anterior to the ear and collect lymphatics from most of the eyelids, parotid and temporal regions

Question 14

Why is the face small at birth compared to the rest of the head?

Answer 14

Maxilla and mandible are not yet fully developed and most of the paranasal sinuses in the facial bones have not started to form, still have fat pad

Question 16

Sensory innervation of the face:

Answer 16

All sensory cutaneous innervation of the face is derived from the 3 divisions of the trigeminal n. The face is derived from the first and second pharyngeal arches, thus V innervates facial structures derived from the 1st arch and VII innvervates facial structures from the 2nd arch

Question 16

External nasal n. is a branch of the ________ and emerges between the bony and cartilaginous part of the nose and supplies:

Answer 16

Anterior ethmoidal n; supplies skin of nose

Question 17

Procerus:

Answer 17

Superficial to the nasal bone and attaches to the roof of the nose (inferior extension of the occipitofrontalis m) –> draws down medial angle of eyebrows and wrinkles superior part of the nose

Question 18

Muscles of the face lies in the subcutaneous layer and are attached to the skin of the face (muscles of facial expression) and they do not move the facial skeleton. The face has no deep fascia and the looseness of the superficial fascia enables fluid and blood to accumulate in loose CT. All facial m. innervated by:

Answer 18

Facial n. (VII). VII passes thru the parotid gland but does NOT innervated it.

Question 19

Inferior alveolar n. supplies:

Answer 19

Sensation to the lower teeth and skin of chin and lower lip. Goes with the inferior alveolar a. through the mandibular foramen

Question 19

Inferior to Parotid:

Answer 19

Angle of mandible, external carotid a., retromandibular v. which joins the posterior auricular v. –> external jugular v., cervical branches of the facial n., platysma m., great auricular n.

Question 21

Clinical Aspects of V: Inferior Alveolar N:

Answer 21

May be damaged by a fracture of the ramus of the mandible –> loss of sensation of lower teeth and skin of chin and lower lip. A lesion of the ENTIRE trigeminal n. could cause these sxs and is called Trigeminal neuralgia: - loss of sensation in anterior 1/2 of skull (skin, supraorbital, supratrochlear) - loss of sensation of face - loss of sensation of cornea and conjunctiva - loss of sensation of mucous membrane of nose, mouth, and anterior 2/3 of tongue - atrophy of muscles of mastication (b/c these are innervated by V)

Question 23

Supraoribtal n is the direct continuation of _______, leaves orbit thru the _________ and is distributed to:

Answer 23

FRONTAL N.; supraorbital foramen; distributed to forehead, scalp, upper eyelid, and frontal sinus

Question 24

Blood supply of the face:

Answer 24

1. Facial a. 2. Superficial temporal a. 3. Facial v.

Question 25

Anterior to Parotid:

Answer 25

Parotid duct, transverse facial a., zygomatic/buccal/marginal mandibular branches of facial n.,

Question 26

Muscles around the orbit:

Answer 26

Orbit OCP 1. Orbicularis oculi 2. Corrugator supercilii 3. Procerus

Question 27

Infraorbital n. is the continuation of the ______. It enters the face through the _______ and then branches. It supplies:

Answer 27

Maxillary n.; infraorbital foramen; supplies conjunctiva and skin of lower eye lid, skin of nose, skin of lip and mucous membrane of mouth. **Infraorbital nerve block - for local anethesia of maxillary part of the face, the infraorbital n. is infiltrated with the anesthetic agent for treatment of upper lip, cheek, and upper teeth. Infraorbital n. is commonly injuered in fracture of maxilla

Question 29

Muscles of the mouth - upper lip (medial to lateral):

Answer 29

M-L: LAN L LAO MIN, MAJ R (Lan Loved Laos as a Minor, but as a Major, she Resents it) 1. Levator labii superioris alaeque nasi: 2 parts - 1 to the nose, 1 to upper lip 2. Levator labii superioris: runs from infraorbital ridge on the maxilla to the upper lip (covers the infraorbital foramen) 3. Levator anguli oris: deeper, runs at an angle from frontal part of maxilla to corner of mouth, mostly covered by levator labii superioris, **arises below infraorbital foramen 4. Zygomaticus minor: from zygomatic bone and inserts to the upper lip b/t superioris and major 5. Zygomaticus major: runs from zygomatic bone to corner of lip 6. Risorius: comes from parotid region and inserts on corner of mouth (squiggly)

Question 30

Mandibular division (V3) branches:

Answer 30

IMBA - I Make Bagels A lot (and then eat them w/ my mandible) Inferior alveolar n. Mental n. Buccal n. Auriculotemporal n.

Question 31

Maxillary division (V2) branches:

Answer 31

ZIZ 1. Zygomaticofacial 2. Infraorbital 3. Zygomaticotemporal

Question 32

Bell’s palsy:

Answer 32

Facial n. damage, paralysis can be caused by the following: chilling of the face, middle ear infection, tumor or fracture near the middle ear or stylomastoid foramen, or tumor near the internal acoustic meatus

Question 34

Muscles of mouth - lower lip (lateral to medial):

Answer 34

DA DL DM: 1. Depressor anguli oris: well developed, from body of mandible, inserts at corner of lower lip 2. Depressor labii inferioris: **Covers mental foramen, arises from mandible, inserts into lower lip –> depresses lower lips 4. Mentalis: arises from incisive fossa of mandible and inserts on chin, the POUTING MUSCLE

Question 35

Buccal n. is an ________ division of the mandibular n. and supplies:

Answer 35

Anterior division.; supplies the skin and mucous membrane of the cheek

Question 36

Facial a. is a branch of the external carotid a., it crosses the mandible, crosses the anterior border of ______ m. and terminates at the medial angle of the eye by anastomosing with branches of the _______ a. What are the facial a. branches?

Answer 36

Masseter m.; anastomoses with ophthalmic a.; Branches: LISA Lateral nasal Inferior labial Superior labial Angular

Question 38

Infratrochlear is a branch of the ________, exits the orbit at the medial side of the infraorbital margin and supplies:

Answer 38

NASOCILIARY N.; supplies the medial side of the upper and lower eyelid, skin of nose, and lacrimal sac

Question 39

Lateral to parotid:

Answer 39

Investing layer of fascia; lymph nodes

Question 40

Facial v. drains into the:

Answer 40

Internal jugular v

Question 41

Muscles of the forehead:

Answer 41

Occipitofrontalis m. - 4 thin broad muscular bellies - 2 occipital, 2 frontalis that are connected by an aponeurosis - galea aponeurotica –> raise eyebrows and wrinkle forehead

Question 42

Muscles of the Nose:

Answer 42

Nose - NDD: 1. Nasalis: best developed nasal m., from the 2 sides form aponeurosis on the dorsum of nose –> widening of nostril 2. Dilator nares: flaring of nostrils 3. Depressor septi: attaches to nasal septum under the cover of the skin flap (between nostrils, called columnellae) –> lowers nasal septum during allergies

Question 44

Clinical Aspects of V: Shingles (Herpes zoster ophthalmicus):

Answer 44

Viral infection of the face that involves regions supplied by V1, this infection can affect corneal nerve supply and could cause partial paralysis of ocular muscles, indicating involvement of III, IV, and VI

Question 45

Mental n. is the termination of the ______, emerges through the mental foramen and supplies:

Answer 45

Inferior alveolar n.; supplies skin of lower lip and chin

Question 46

Parotid gland: largest of the 3 salivary glands

Answer 46

Lateral surface is covered by investing layer of fascia while the medial surface of the gland is covered by fascia of the masseter m. Has both sympathetic (superior cervical ganglia) and parasympathetic (glossopharyngeal n.) innervation Parotid duct - exits anteriorly, crossing the cheek superficial to the masseter m. and running along with TRANSVERSE FACIAL A, pierces buccinator m. and opens into the mouth

Question 47

In the ophthalmic division (V1) - area around the orbit:

Answer 47

SSIE - “see” 1. Supraorbital 2. Supratrochlear 3. Infratrochlear 4. External nasal

Question 48

In the parotid, sympathetic fibers come from:

Answer 48

Superior cervical ganglion

Question 49

Zygomaticofacial n. is a branch of the _______, exits through the z-facial foramen and supplies:

Answer 49

Zygomatic n.; supplies skin of face

Question 50

Diseases that produce expressionless faces:

Answer 50

Bell’s palsy and Parkinson’s disease