Face & Scalp

Question 1

why do facial lacerations tend to gape?

Answer 1

no deep fascia in face

Question 2

what’s important about an attached craniotomy?

Answer 2

scalp arteries anastomose freely and as long as at least one of these arteries remains intact, the scalp has a good chance at recovering

Question 3

which arteries supply the calvaria?

Answer 3

LITTLE from scalp arteries, mostly from middle meningeal

Question 4

why don’t superficial scalp wounds gape?

Answer 4

strength of epicranial aponeurosis

Question 5

why do deep scalp wounds that cut through the epicranial aponeurosis in the coronal plane gape widely?

Answer 5

pull of frontal and occipital bellies of occipitofrontalis in opposite directions

Question 6

which layer is the danger area of the scalp?

Answer 6

loose connective tissue layer because pus and blood spread easily on it

Question 7

how can infection pass into cranial cavity through the loose CT layer of the scalp?

Answer 7

emissary veins which pass through parietal foramina in calvaria and reach intracranial structures such as meninges

Question 8

what stops loose CT infections from going into the neck?

Answer 8

occipital belly attachment to occipital bone and mastoid processes

Question 9

what stops a scalp infection from spreading more laterally than the zygomatic arches?

Answer 9

epicranial aponeurosis is continuous with temporal fascia that attaches to the zygomatic arches

Question 10

why can a scalp infection enter the eyelids and root of the nose?

Answer 10

frontal belly inserts into skin and subQ tissue instead of bone

Question 11

what is ecchymosis?

Answer 11

black eye from blows to periorbital region (soft tissue damage)

Question 12

what is a sebaceous cyst?

Answer 12

obstruction of sebaceous glands & retention of their fluids

Question 13

what is a cephalhematoma?

Answer 13

blood pooling between pericranium and calvaria over one parietal bone from a difficult birth

Question 14

the action of nasalis muscle can tell?

Answer 14

whether a person is a nasal or chronic mouth breather

Question 15

habitual mouth breathing is caused by?

Answer 15

nasal obstruction

Question 16

chronic mouth breathers usually develop?

Answer 16

dental malocclusion (improper bite)

Question 17

injury to the facial nerve (CN VII) causes?

Answer 17

bell palsy

Question 18

loss of tonus of orbicularis oculi causes?

Answer 18

inferior eyelid sags, which prevents lacrimal fluid spreading to cornea

Question 19

if the cornea can’t receive lacrimal fluid?

Answer 19

cornea becomes vulnerable to ulceration and scarring can impair vision

Question 20

paralysis to buccinator and orbicularis oris causes?

Answer 20

food to accumulate in oral vestibule during chewing

Question 21

what nerve block is used to repair the maixllary incisor teeth?

Answer 21

infraorbital nerve block

Question 22

where is an infraorbital nerve block given?

Answer 22

infraorbital foramen by elevating upper lip and passing the needle through the junction of the oral mucosa and gingiva

Question 23

how do you anesthetize the skin of the lower lip and chin?

Answer 23

injection into mental foramen to mental nerve

Question 24

how do you anesthetize the skin and the cheek?

Answer 24

injection into mucosa covering the retromolar fossa

Question 25

where is the retromolar fossa?

Answer 25

triangular depression posterior to 3rd mandibular molar tooth between anterior border of ramus and temporal crest

Question 26

trigeminal neuralgia can cause?

Answer 26

paroxysm and tics; psychological changes such as depression and suicide

Question 27

which CN is mostly involved in trigeminal neuralgia?

Answer 27

CN V2

Question 28

what causes trigeminal neuralgia?

Answer 28

demyelination of axons in sensory root; pressure of small aberrant artery

Question 29

what is a simple surgical treatment for trigeminal neuralgia?

Answer 29

avulsion of branches of nerve at infraorbital foramen

Question 30

what surgical technique is used to prevent regeneration of nerve fibers in treatment of trigeminal neuralgia?

Answer 30

cutting of sensory root of CN V between the ganglion and brainstem (rhizotomy)

Question 31

what other technique can be used to treat trigeminal neuralgia?

Answer 31

tractotomy which causes loss of sensation of pain, temperature, and light touch over the skin supplied by cut nerve of CN V

Question 32

lesions of the entire CN V cause?

Answer 32

anesthesia to: -ipsilateral anterior half of scalp -face except for angle of mandible, cornea, and conjunctive -mucous membranes of nose, mouth, and anterior tongue -paralysis of facial muscles of mastication

Question 33

where can a herpes zoster infection produce a lesion?

Answer 33

cranial ganglion, mostly trigeminal ganglia

Question 34

which division of CN V is mostly affected by herpes zoster?

Answer 34

V1 (ophthalmic)

Question 35

what are symptoms of herpes zoster infection of CN V1?

Answer 35

corneal ulceration and scarring

Question 36

how is the sensory function of CN V tested?

Answer 36

person closes eyes and Dr strokes person's face with different objects on both sides

Question 37

lesions of CN VII near pons and before greater petrosal nerve (geniculate ganglion) cause?

Answer 37

loss of motor, taste, and autonomic functions

Question 38

lesions of CN VII distal to geniculate ganglion but proximal to chorda tympani cause?

Answer 38

same dysfuction except lacrimal secretion is unaffected

Question 39

lesions of CN VII near stylomastoid foramen result in?

Answer 39

loss of motor function only (facial paralysis)

Question 40

what the most common nontraumatic cause of facial nerve palsy?

Answer 40

inflammation of facial nerve near stylomastoid foramen from a viral infection

Question 41

traumatic cause of facial nerve palsy?

Answer 41

fracture of temporal bone

Question 42

identification of the facial nerve is important in which surgery?

Answer 42

parotidectomy

Question 43

what is associated with facial nerve palsy?

Answer 43

- dental manipulation - vaccination - pregnancy - HIV - Lyme disease - middle ear infections (otitis media)

Question 44

a lesion of zygomatic branch of CN VII?

Answer 44

paralysis of orbicularis oculi in inferior eyelid

Question 45

lesion of buccal branch of CN VII?

Answer 45

paralysis of buccinator and superior portion of orbicularis oculi and upper lip muscles

Question 46

lesion of marginal mandibular branch of CN VII?

Answer 46

paralysis of inferior portion of orbicularis oris and lower lip muscles

Question 47

where can the facial artery be occluded?

Answer 47

pressure against mandible where vessel crosses it

Question 48

does compression of facial artery stop all bleeding of the face?

Answer 48

no. large amount of anastomoses that must be considered when a branch of the facial is ligated

Question 49

where is a temporal pulse taken?

Answer 49

where the superficial temporal artery crosses the zygomatic process just anterior to auricle

Question 50

where is the temporal pulse relevant clinically?

Answer 50

anesthesiologists use it during surgery

Question 51

how can you palpate a facial pulse?

Answer 51

clench teeth and palate facial pulse where the facial artery crosses inferior border of mandible anterior to massester

Question 52

if the internal carotid artery is occluded, how can the brain receive anastomotic blood?

Answer 52

through facial artery (from external carotid artery) and its connection with dorsal nasal branch of ophthalmic artery

Question 53

why do scalp lacerations blood profusely?

Answer 53

because the arteries entering the periphery of scalp bleed from both ends of anastomoses and the arteries are held open by dense CT in layer two of scalp

Question 54

what can increase bleeding from scalp?

Answer 54

spasms of occipitofrontalis

Question 55

what is the most common cause of squamous cell carcinoma of the lip?

Answer 55

not using sunscreen and chronic irritation from pipe smoking

Question 56

cancer from central lower lip, floor of mouth, and apex of tongue spread to?

Answer 56

submental lymph nodes

Question 57

where do cancer cells of lateral lower lip drain to?

Answer 57

submandibular lymph nodes