Face And Scalp Flashcards
Bony framework of the face
. Frontal bone
. Viscerocranium (vomer, lacrimals, nasals, maxillae, inf. Nasal conchae, zygomatics, palatines)
. Mandible
Forehead
. Extends from the hair margin to the eyebrows
Glabella
. Area btw the eyebrows
. Characterized by vertical creases
Orbital region
. Bounded by the bony rim of the orbit
. Supraorbital region: upper edge, contains notches/foramina for transmission of supraorbital and supratrochlear nn. And vessels
. Eyelids: sup. And inf. Palpebrae that protect eyeball
. Sup. Lid larger and more mobile
. Palpebral fissur: slit btw eyelids
. Med. and lat. canthi: med. and lat. angles of the eyelids
Cheek
Anterolat. Aspect of face inf. To orbits and zygomatic arches
External nose
. Dorsum of nose: runs btw root and apex
. External nares: openings to nasal cavities, separated by septum
. Alae: flared nostril margins
. Composed of nasal bones and nasal cartilages (septal, lat. and alar)
Oral region
. Vermillion: red zone surrounding mouth
. Philtrum: shallow vertical groove running form nasal septum to upper lip
. Lips: competent if lightly closed at rest
Temporal region
. Lat. aspect of face
. Posterolateral to orbits and sup. To zygomatic arch
. Superficial temporal vessels may be visible under skin
Innervation of muscles of fascial expression
. Parotid plexus branches of facial n. Proper (CN VII)
Insertion of facial expression mm.
Skin
Orbicularis oculi orbital part OA
O: orbital margin and med. palpebral ligament
A: forceful closure of eyes
Orbicularis oculi palpebral part OA
O: med. palpebral ligament through both lids to insert on lat. palpebral raphe
A: gentle closure of eyelids (winking, blinking)
Orbicularis oculi lacrimal part OA
O: post. To med. palpebral ligament and lacrimal sac
A: draws eyelids and lacrimal sac med. to aid in tear collection
Levator labii superioris OIA
O: maxilla near inf. Margin of orbit, deep to orbicularis oculi
I: courses inf. To insert on the lat. half of upper lip
A: elevates upper lip
Zygomaticus minor OIA
O: zygomatic bone med. and ant. To zygomaticus major
I: courses obliquely to insert onto lat. part of the upper lip
A: elevates upper lip
Zygomaticus major OIA
O: zygomatic bone
I: courses obliquely to insert on the corner of mouth
A: pulls the mouth upwards and outwards (smiling and laughing)
Levator anguli oris OIA
O: maxilla deep to levator labii superioris
I: corner of mouth
A: elevates the corner of mouth
Risorius OIA
O: parotid fascia and buccal skin
I: corner of mouth
A: widens mouth
Depressor anguli oris OIA
O: ant. Mandible
I: upward to insert on angle of mouth
A: depresses corner of mouth (frowning)
Depressor labii inferioris
O: Ant. Mandible
I: passes med. to insert onto the lower lip, most med. fibers may cross over one another at midline
A: depresses lower lip and draws it lat.
Mentalis OIA
O: incisive fossa on the mandible
I: onto skin of chin
A: raises and protrudes Lowe lip
Orbicularis oris
. Circular muscle w/in upper and lower lips
. Formed from interlacing fibers of oral group mm. Plus buccinator m. And fibers w/in lips
. Oral sphincter
. Closes mouth and contributes to pursing and protrusion of lips
Buccinator OIA
O: pterygomandibular raphe, maxilla, and mandible
I: pass ant. To mouth, some cross cross and form substance on cheek
A: mastication by compressing cheek to keep food in molars, involved in cheek expansion (whistling)
Buccal fat pad
. Pierced by parotid duct
. Lies sup., to muscle
. Prominent in infants to aid in suckling
Auricular muscles
. Radiate around the ears
. Mostly rudimentary, moves auricles in some
Platysma OIA
O: superficial fascia of skin of thorax
I: courses upwards through neck to insert onto lower part of face
A: wrinkles skin over neck and face, may also be active in deep inspiration
Occipitofrontalis
Frontalis m. And occipitalis m. Bellies are united by epicranial
Frontalis portion of occipitofrontalis OIA
O: epicranial aponeurosis
I: skin of forehead
A: wrinkles skin of forehead, raises the eyebrows
Occipitalis portion of occipitalis OIA
O: occipital bone
I: epicranial aponeurosis
A: pulls scalp post., wrinkles skin over post. Aspect of cranium
Muscles of mastication motor innervation
. Branches of mandibular division of trigeminal n (CNV3)
Masseter OIA
O: zygomatic arch
I: angle and lat. surface of mandibular ramus
A: elevates mandible, superficial head also assists in protraction of mandible
Temporalis OIA
O: floor temporal fossa and inf. Temporal line on lat. surface of temporal fascia
I: muscle fibers converge inf. To form tendon inserting on corn oil process of mandible
A: vertically oriented fibers elevate mandible
. Horizontally oriented fibers retract the mandible
Medial pterygoid OIA
O: 2-heads arise from med. surface of lat. pterygoid plate and tuberosity of maxilla
I: med. surface of mandibular ramus
A: acts w/ masseter to elevate mandible, aids in protrusion, alternate unilateral activity produces small grinding movements
Lateral pterygoid OIA
O: 2 heads arise from infratemporal surface, crest of gr. Wing, and lat. surface of lat. pterygoid plate
I: joint capsule and articular disc ofTMJ and condylar neck of mandible
A: bilaterally protracts mandible and depresses chin, unilaterally swings jaw to opposite side, alternate unilateral contraction produce larger lat. chewing movements
Facial n.
. CN VII
. Emerges from stylomastoid foramen inf. To external auditory meats, pierces the parotid gland, and emerges as 5 branches (parotid plexus of facial n.)
Motor innervation to muscles of facial expression
. Facial n. . Temporal . Zygomatic . Buccal . Mandibular . Cervical
Branches of mandibular division of trigeminal n. (CN V3)
. Deep temporal nn.
. Masseteric n.
. Nn. To lat. pterygoid
. N. To med. pterygoid
Bell’s palsy
Unilateral paralysis of mm. Of facial expression
. Sagging/drooping of lower eyelid, angle of mouth, drooling, and inability to smile, whistle, eat properly, and blink
. Causes idiopathic, may be viral infection
. Can be brought about temporarily (neck block at dentist)
Cutaneous sensation to the face
. Branches of the 3 divisions of trigeminal n. (CN V)
. Arise from face along vertical line from supraorbital notch to the mental foramen
Ophthalmic division of CN V
. CN V1
. Sensation to forehead, upper eyelid, and nose
. Supraorbital n. Emerges through supraorbital foramen to supply gelid, forehead, and ant. Scalp
. Supratrochlear n. Emerges from upper med. angle of eye to supply med. aspect of eye and forehead
Maxillary division of CN V
. CN V2
. Provides sensation to the lower eyelid, upper cheek, ala of nose, temple, and upper lip
. Infraorbital n. Emerges through the infraorbital foramen
Mandibular division of CN V
. CN V3
. Sensation to skin over mandible, lower lip, fleshy part of cheek, auricle, and temple
. Mental n. Emerges through mental foramen and supplies skin over mandible and lower lip
. Buccal n.: emerges on face external to buccinator m. But does not innervate it
. Provides sensory to the skin and mucosa of the cheek
Auriculotemporal n.
Courses w/ superficial temporal vessels
. Provides sensation to the face and scalp in temporal region
Greater occipital n.
C2
. Sensory post. Scalp
Lesser occipital n.
. C2
. Sensory to skin post. To ear and auricle of the ear
Greater auricular n.
. C2/3
. Sensory to angle of mandible, post. To parotid gland, and auricle of the ear
Trigeminal neuralgia
. Disorder of sensory root of trigeminal n. That results in excruciating facial pain
. Pain has sudden, unexplained onset
. Triggered by touching sensitive region of face
. Usually occurs unilaterally and most assoc. w/ CN V2 and V3
. Etiology unknown
. pulsations of anomalous blood vessel lying close to sensory root of CN V may be involved in certain regions of face sensitivity
Arterial blood supply of face and scalp is primarily from branches of ____
. External carotid a.
. Some contribution of internal carotid a. Supplying forehead and ant. Scalp
Facial a.
. Branch of ECA
. Tortuous course crossing ant. Border of mandible ant. To masseter m. Where it is covered only by skin and platysma m. So pulse is palpable
. Crosses obliquely upwards onward bridge of nose supplying branches to the lips and nose
Occipital a.
. Branch of ECA
. Passes post. To auricle of ear onward post. Scalp
Superficial temporal a.
. Terminal branch of ECA
. Passes sup. Toward the scalp ant. To auricle
. Divides into ant. And post. Branches in temporal region
Infraorbital a.
. Branch of maxillary a.
. Runs w/in maxilla and emerges on ant. Face via infraorbital foramen
Mental a.
. Terminal branch of inf. Alveolar a. (ECA)
. Emerges on ant. Face via mental foramen
Supraorbital and supratrochlear aa.
. Terminal branches of ophthalmic a. (ICA)
. Merge on ant. Forehead via supraorbital foramen/notch and med. angle of orbit
. Course sup. To supply forehead and ant. Scalp
Superficial temporal v. Joins the ____ to form retro mandibular v.
. Joins maxillary v.
Retromandibular v. Drains via branches into ____
. Internal and external jugular vv.
Retromandibular v. Branches
. Ant. Division: joins facial v. And drains into internal jugular v.
. Post. Division: joins post. Auricular v. To form external jugular v.
Facial v.
. Joins ant. Branch of the retromandibular v. And drains into internal jugular v.
Facial vv.
. Have connections w/ ophthalmic vv. (Both valveless)
Ophthalmic vv. Drain into ___
Cavernous sinuses (intracranial dural sinuses) . Infections may pass intracranial into the cavernous sinuses and put several important structures at risk
Lymph from face drains to ___
. Superficial rings of lymph nodes (parotid, occipital, sumandibular, submental)
. Deep cervical lymph nodes located along internal jugular v. Receive lymph from superficial nodes
. Lymph then passes to jugular lymphatic trunk which joins thoracic duct (L side) or brachiocephalic v. (R side)
Scalp
. Skin, CT, and mm. Covering neurocranium
. Extends from supraorbital margins of the frontal bone to sup. Nuchal lines of Occitan bone and laterally to zygomatic arches
Scalp consists of 5 layers
. Skin
. CT: superficial fascia, thick layer dense subQ CT and fat w/ abundant aa., vv., nn
. Aponeurosis: epicranial aponeurosis (membranous tendon of occipitofrontalis m., attaches ant. To frontalis m. And post. To occipitalis m., innervated by parotid plexus of facial n. )
. Loose CT: subaponeurotic space, areolar CT permits movement of the more superficial layers, potential space for fluid accumulation continuous w/ eyelids and nose so fluid can flow into those regions
. Pericranium: loosely attached to bone except near sutures
Why do wounds of scalp bleed profusely?
. Pull of occipitofrontalis m. Retracts the cut ends of vessels keeping them open
Blood supply of scalp
. Branches of ECA via superficial temporal, post. Auricular, and occipital aa.
. Branches of ICA via supratrochlear and supraorbital aa.
. Aa. Anastomoses extensively
. Venous distribution follows aa.
. Blood may drain into dural venous sinuses via emissary vv. That pass through skull
Cutaneous innervation of scalp
. Trigeminal n. Branches ant. To ear
. Greater occipital n. (Dorsal ramus of C2 spinal n.) and third occipital n. (Dorsal ramus Ca spinal n.)
. Lesser occipital n. (Ventral rami C2/3 spinal nn. Via cervical plexus)
Parotid region
. Region of face located ant. And inf. To external eat
. Extends from angle of mandible to zygomatic arch and post. To starnocleidomastoid m.
. Contains parotid salivary gland
Parotid gland
. Largest salivary gland
. Has superficial and deep parts separated by facial n. And its branches
. Superficial part of gland lies on surface of masseter m.
. Deep part lies post, and med. to the ramus of the mandible
. Drained by parotid salivary duct which pierces buccinator m. To open into oral cavity opposite the upper second molar tooth
. Encased by parotid fascia: dense fascial capsule derived from investing fascia of the neck
Sympathetic innervation of parotid gland
. Preganglionic fibers from sympathetic trunk
. Synapse in sup. Cervical ganglion and the post-ganglionic sympathetic fibers travel w/ external carotid a. And its branches to the parotid gland
Parasympathetic innervation of parotid gland
. Secretomotor
. Preganglionic fibers that travel w/ lesser petrosal n.
. Synapse in the optic ganglion and the postganglionic parasympathetic fibers are course to the parotid in auriculotemporal n. (CN V3)
Sensory innervation to parotid
. To gland, sheath, and overlying skin
. Auriculotemporal n. And great auricular n. (C2/3)
Structures passing through parotid gland from superficial to deep
. Facial n.
. Retromandibular v.
. External carotid a. And its branches
Facial n. In the parotid gland
. Exits stylomastoid foramen and divides into 5 major branches that innervate the mm. Of facial expression
. Divides gland into superficial and deep parts
Retromandibular v. In parotid gland
. Located in deep part of the gland and formed by superficial temporal and maxillary vv.
. Divides inf. Into ant. And post. Divisions
External carotid a. And its branches in parotid gland
. 3 sup. Directed branches that originate w/in deep part of the parotid gland
. Post. Auricular a.: from post. Side of ECA near inf. Limit of the gland and courses to scalp behind the ear
. Superficial temporal a.: terminal branch of ECA courses sup. Toward scalp ant. To ear btw TMJ and auricle
. Maxillary a.: terminal branch of ECA, courses med. deep to mandibular ramus, has many branches arising in infratemporal fossa
Mumps
. Viral infection of the salivary glands
. Inflammation of parotid gland (parotitis) causes swelling that puts pressure on parotid fascia
. Causes pain
. Complications of mumps: inflammation of testis, ovaries, and/or breasts, brain, meningitis
. Permanent or temporary deafness
