Face and Scalp

Question 1

What are the 4 main bones that make up the facial skeleton?

Answer 1

Frontal
Nasal
Zygomatic
Maxilla

Question 2

What is the only moveable facial bone?

Answer 2

Mandible

Question 3

What are the important parts of the mandible to remember?

Answer 3

Coronoid process
Condylar 
TMJ
Ramus
Angle
Body 
Mental foramen
Mandibular foramen

Question 4

Trigeminal branches, motor or sensory?

Answer 4

Opthalmic: sensory
Maxillary: sensory
Mandibular: mixed

Question 5

What nerve innervates the tongue?

Answer 5

Lingual nerve, branch off the mandibular nerve from the trigeminal

Question 6

What does V1 sensory go to?

Answer 6

• Skin of forehead
• Conjunctiva
• Upper eyelid, bridge of nose
• Frontal sinus
• Antero-superiour nasal cavity

Question 7

What does V2 sensory go to?

Answer 7

• Most of skin to upper cheek, upper lip and all structures deep to them
• Maxillary sinus
• Hard and soft palate

Question 8

Where does V3 sensory go to?

Answer 8

To skin of temple and most of skin over lower jaw, except skin over angle of jaw
(that comes from C2)

Question 9

Where does V3 motor go to?

Answer 9

Goes to muscles of mastication
And:
Tensor tympani (muscle that reduces the sound when chewing)
Tensor palatini (supporting the soft palate)
Anterior belly of digastric (under the mandible for speaking, breathing and swallowing)

Question 10

What is the difference between the maxillary nerve and the mandibular nerve innervation?

Answer 10

Maxillary nerve branching out onto the superior dental plexus. (one nerve innervating many teeth)

Mandibular bone has one branch going into each tooth.

Question 11

What is trigeminal neuralgia?

Answer 11

Pain coming from the trigeminal nerve.

Comes as sudden bursts of pain from one or more branches of the trigeminal nerve.

Usually the maxillary and mandibular branches causing it.

Usually affects one side of the face.

Mainly due to blood vessels pressing on the nerve at the foramen.

Question 12

What are the two ways of treating trigeminal neuralgia?

Answer 12

Anticonvulsants

Surgery

Question 13

Explain the blood supply to the head and face

Answer 13

The blood supply to the head and face is via the external carotid artery, which branches off to form the internal maxillary artery.

Further branching forms the infraorbital artery to the skin of the orbital area and the greater palatine artery to the roof of the mouth.

The middle meningeal artery branches off the internal maxillary artery and forms branches that anastomose with the ophthalmic and lacrimal arteries.

The inferior alveolar artery branches off the internal maxillary artery and descends to the mandibular foramen.

Question 14

Where does the facial artery come from?

Answer 14

Facial artery is a branch of the external carotid artery.

Question 15

Explain the innervation of the facial vein and why it is important clinically

Answer 15

The facial vein commences at the side of the root fo the nose as a direct continuation of the angular vein.

It lies behind the facial artery.

It receives blood from the external palatine vein to form the common facial veiner directly drains into the internal jugular vein.

Clinically = it has a direct connection to the ophthalmic vein and then to a deep venous sinus within the cranial cavity. Bacteria can enter the facial vein and gain access to internal cranial structures.

Question 16

What do the muscles of facial expression attach to?

Answer 16

In the face, the muscles have 1 bony attachment but the other attachment is into the skin, this allows us to do all the facial expressions.

Question 17

Name the muscles of facial expression and their origin and action

Answer 17

Epicranius (frontalis and occipitalis) - origin is the cranial aponeurosis to eyebrows and the action is to raise the eyebrows.

Orbicularis oculi - origin is portions of the frontal and maxilla to the skin around eyes and the action is blinking and closing eyes

Orbicularis oris - origin is skin around the mouth and this closes and protrudes lips

Buccinator - origin is mandible/maxilla to skin around mouth and the action is to flatten cheeks against teeth

Zygomaticus - origin is the zygomatic bone to corner of lips and action is to raise corner of mouth

Platysma - origin is the fascia of chest to lower border of mandible and action is to draw mouth downwards

Question 18

What are the 5 parts of the facial nerve?

Answer 18

Temporal
Zygomatic 
Buccal
Mandibular 
Cervical

Question 19

Explain the different roles of each of these from the trigeminal

1. Branchial motor
2. Visceral motor
3. Special sensory
4. General sensory

Answer 19

1. Supplies the muscles of facial expression
2. Parasympathetic innervation of the lacrimal, submandibular and sublingual nerves
3. Taste sensation from the anterior 2/3 of tongue
4. General sensation from the skin of the concha of the auricle and from a small area behind the ear

Question 20

What control do we have for the upper and lower muscles of facial expression from the cortex?

Answer 20

Upper = bilateral control

Lower = contralateral control

Question 21

What details on the parotid gland are in this lecture?

Answer 21

• Tightly enclosed in fascia
• Contains terminal branches of facial nerve
• Parotid lies on masseter and pierces buccinator
• External carotid divides into its terminal branches in the gland

Question 22

What is the acronym for the layers of the scalp?

Answer 22

S = skin
C = connective tissue 
A = aponeurosis 
L = loose connective tissue 
P = periosteum

Question 23

What innervates the scalp?

Answer 23

Supraorbital nerve (V1)
Auriculotemporal nerve (V3)
Greater occipital nerve (C2)
Lesser occipital nerve (C2)

Question 24

What arteries supply the scalp?

Answer 24

Superficial temporal artery
Supraorbital artery
Occipital and posterior auricular arteries

Question 25

How does the blood get to your eye?

Answer 25

The loose connective layer of the scalp will allow bacteria or fluid to pass freely from the posterior aspect of the scalp into the eyelids in front.