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Neuro Exam 3 > Face, Scalp, Parotid > Flashcards

Face, Scalp, Parotid Flashcards

1
Q

what is the scalp

A

A. Skin and connective tissue covering neurocranium; extending from supraorbital margins of frontal bone to superior nuchal line of occipital bone

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2
Q

what are the 5 layers of the skull

A
  1. S – skin
  2. C – connective tissue (dense) – contains vessels and nerves
  3. A – aponeurosis epicranius (galea aponeurotica)
  4. L – loose connective tissue – allows free movement of scalp; this is normally the plane of cleavage for injury–> great route for spread of infection
  5. P – pericranium (periosteum)
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3
Q

what is the innervation to the scalp?
spinal nerves?
cranial nerves?

A
  1. Spinal nerves
    a. Greater occipital n (C2 dorsal ramus)
    b. C3 (dorsal ramus)
    c. Lesser occipital n
    d. Great auricular n
  2. Cranial Nerves (CN V)
    a. Auriculotemporal branch of V3
    b. Zygomaticotemporal branch of V2- anterior temporal
    c. Supraorbital branch of V1
    d. Supratrochlear branch of V1
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4
Q

what is the arterial supply to the scalp?
from the external carotid? 3
from the internal carotid? 2

A
  1. From external carotid a
    a. Occipital a
    b. Posterior auricular a.
    c. Superficial temporal a.
  2. From internal carotid a
    a. Supraorbital a
    b. Supratrochlear a.
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5
Q

why do scalp wounds bleed profusely

A

Scalp is highly vascular and because the vessels are embedded within the dense ct of layer 2 there is limited constriction when lacerated, causing scalp wounds to bleed profusely. Also, due to anastomoses, there is no single vessel to compress to stop bleeding.

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6
Q

what is the venous drainage of the face?

A
  1. Vena comitantes of arteries
    a. Occipital vein
    b. Superficical temporal vein
    c. Superior ophthalmic vein
  2. Emissary veins – drain through bones of skull to dural venous sinuses
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7
Q

where does an infection go from the emissary veins

A

Emissary veins (valveless) may spread infections from the scalp to the intracranial cavity, face, meninges, etc.

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8
Q

what is the concern for scalp bleeding and spread of infection? where can it spread to

A

Scalp infections/bleeding can spread easily within the loose connective tissue layer (layer 4); can spread within the eyelids and dorsum of the nose and cause ecchymosis (extravasation of blood under skin).

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9
Q

muscles of facial expression origin
innervation
level under the skin?

A

a. All are derived from pharyngeal arch 2
b. All are innervated by CN VII (SVE component)
c. All are superficial muscles which can move the skin and fascias of the face

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10
Q

orbicularis oculi

3 portions ?

A
  1. Orbital part – surrounds orbit and forcefully closes the eye
  2. Palpebral portion – within eyelid; gently closes the eye
  3. Lacrimal portion – within medial corner of eye; assists with lacrimal fluid drainage
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11
Q

corrugator supercilli

A

draws eyebrows down and in (worried look)

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12
Q

occipitofrontalis
frontal belly
occipital belly

A
  1. Frontal and occipital bellies attached by epicranial aponeurosis.
  2. Frontal belly – elevates eyebrows; wrinkles skin of forehead
  3. Occipital belly – retracts scalp; assists frontal belly in “surprised” expression
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13
Q

orbicularis oris

A

closes lips/mouth, palpebral muscle in eyelid

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14
Q

buccinator

A

– keeps cheeks in contact with the gums so that food does not accumulate in the vestibule of the mouth.

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15
Q

levator labii superioris

A

elevates upper lip

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16
Q

levator anguli oris

A

elevates upper lip

widens mouth

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17
Q

zygomaticus major

A

elevates upper lip

main smile muscle

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18
Q

zygomaticus minor

A

elevates upper lip

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19
Q

risorius

A

stretches lips laterally

wide smile

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20
Q

levator labii superioris alaeque nasi

A

elevates upper lip

flares nostrils

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21
Q

depressor anguli oris

A

depresses lower lip

frown

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22
Q

depressor labii inferioris

A

depresses lower lip
frown
pout

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23
Q

mentalis

A

protrudes lower lip

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24
Q

procerus

A

wrinkles skin over dorsum of nose (disklike)

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25
Q

nasalis

A

flares nostrils

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26
Q

platysma

A

depresses mandible

tenses skin of lower face and neck

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27
Q

what is the course of the facial nerve

A

exits brainstem
enters internal acoustic meatus

  1. Courses laterally between cochlea and semicircular canals after which it makes a bend (genu) posteriorly and inferiorly to then course along the posterior wall of the middle ear.

exits facial canal via stylomastoid foramen

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28
Q

what are the 8 main branches off the facial nerve as it exits the stylomastoid foramen

A
  1. Posterior auricular nerve – supplies occipital belly of occipitofrontalis
  2. Digastric n
  3. Stylohyoid n
  4. Temporofacial trunk
    a. Temporal branches
    b. Zygomatic branches
    c. Buccal branches
  5. Cervicofacial trunk
    a. Buccal branches
    b. Marginal mandibular branches
    c. Cervical branches
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29
Q

what does facial (Bell’sY nerve paralysis look like

what is it caused by

A
  1. Causes: many cases are idiopathic; although linked to herpes virus, trauma or lesion anywhere along course of nerve, otitis media
  2. Paralysis of muscles of facial expression
  3. Facial asymmetry and drooping
  4. Drooping of LOWER eyelid causes drainage of tears and ulceration of eye. (loss of orbicularis oculi)
  5. Paralysis of orbicularis oris causes dribbling of saliva from mouth
  6. Loss of buccinator muscle leads to accumulation of food within the vestibule (b/w cheek and teeth)
  7. Impaired speech
30
Q

what are the 4 main branches which supply cutaneous innervation to the face?

A

ophthalmic
maxillary
mandibular
great auricular nerve

31
Q

ophthalmic nerve (V1)
supplies what?
branches? (5)

A

a. Supplies embryonic frontonasal prominence
b. Provides skin of forehead, upper eyelid, nose
c. Branches
1. Supratrochlear n.- wedge on forehead
2. Supraorbital n.- exits supraorbital foramen, most of forehead
3. Lacrimal n. –lateral part of upper eyelid
4. Infratrochlear n- dorsum of nose
5. External nasal n. –dorsum of nose to apex

32
Q

what does the maxillary nerve V2 supply and what are its branches (3)

A

a. Supplies embryonic maxillary prominence
b. Provides skin of temporal region, upper cheek and lip, lower eye lid, ala of nose

c. Branches
1. Zygomaticotemporal n.- anterior temporal region
2. Zygomaticofacial n.- through zygomatic bone
3. Infraorbital n. –lateral nose, upper lip, cheek, lower eyelid

33
Q

what does the mandibular nerve supply and what are its branches (3)

A

a. Provides embryonic mandibular prominence
b. Provides skin of lower cheek, lower lip, and chin

c. Branches
1. Auriculotemporal n.- auricle and most of temporal region
2. Buccal n.- cheek
3. Mental n. – lower lip and chin

34
Q

what does the greater auricular nerve supply? and what are its levels

A

(C2 and C3)

provides skin over angle of the mandible

35
Q

what is trigeminal neuralgia
what is the cause (any artery involvement?)
what divisions of nerve are affected and in what order

A

a. Sensory disorder of trigeminal nerve which causes sudden, excrutiating facial pain; pain can become so severe that patients can become suicidal and depressed.
b. The cause is believed to be demyelination of axons within the sensory root of CN V; in some cases due to compression by the superior cerebellar a.
c. Division affected: V2 >V3 >V1

36
Q

where do you inject anesthetic for infraorbital nerve

A

infraorbital foramen which is accessed by inserting needle through superior portion of oral vestibule

37
Q

where do you insert anesthetic agent for mental nerve/

A

around mental formane on the chin

38
Q

where do you insert anesthetic for buccal nerve

A

anesthetic agent injected via the oral vestibule just posterior to the 3rd mandibular molar.

39
Q

what is herpes zoster infection presentation

A

affects trigeminal ganglion

most often affects V1 and can lead to scarring and ulceration of the cornea

rash follows a specific dermatome

40
Q

does the buccal nerve come from 1 or 2 nerves?

A

2! facial and trigeminal branches

41
Q

what are the 4 MAIN arteries supplying the face

A

facial
superficial temporal
maxillary
ophthalmic

42
Q

facial artery course
branch off of what?
branches (4)

A

a. Branch of external carotid
b. Course
1. Branches from external carotid a within submandibular triangle.
2. Courses through substance of submandibular gland
3. Arches over the mandible just anterior to the masseter to enter face.
4. Takes a tortuous course to allow for movement of the face; courses along angle of the mouth and then along lateral side of nose to medial angle of eye.

c. Branches
1. Inferior labial a.
2. Superior labial a.
3. Lateral nasal a.
4. Angular a. (becomes this at nose area)

43
Q

what are the branches off the superfical temporal (3)

A

a. Branch of external carotid a.
b. Branches
1. Transverse facial artery
2. Frontal branches
3. Parietal branches

44
Q

what are the branches off the maxillary artery

A

a. Branch of external carotid a.
b. Branches supplying face
1. Infraorbital a- upper cheek
2. Buccal a.- cheek
3. Mental a.- chin

45
Q

what are the branches off the opthalmic

A

a. Branch of internal carotid a.
b. Branches
1. Supraorbital a.
2. Supratrochlear a.
3. Lacrimal (lateral palpebral) a.
4. Medial palpebral a- medial eyelids
5. Dorsal nasal a. – to nose

46
Q

what are the two main veins draining the face?

A

retromandibular

facial vein

47
Q

retromandibular vein

formed form what?
courses where?
what does it turn into?

A

a. Formed from union of superficial temporal and maxillary veins
b. Courses posterior to ramus of mandible within substance of parotid gland.
c. Divides into anterior and posterior division.
d. The anterior division merges with the facial vein.
e. The posterior division merges with the posterior auricular vein to form the external jugular vein.

48
Q

where does the facial vein begin and as what vein? where does it course from there

A

a. Begins at medial corner of eye as angular vein; descends face receiving venae comitantes of artery.

49
Q

what does the common facial vein from from

A

facial vein and anterior division of retromandibular

then drains into the internal jugular vein

50
Q

via what does the facial vein communicate to reach pterygoid plexus

A

deep facial vein

51
Q

via what does the facial vein communicate with to reach the cavernous sinus

A

via ophthalmic veins

52
Q

what is the danger area

A

the central face is an area where infection can travel into the skull or into the deep face

53
Q

what is the lymphatic drainage of the face

A
  1. Lymphatic vessels of the face drain to submental, submandibular, and parotid lymph nodes.
  2. Ultimately lymph flow is to deep cervical lymph nodes along internal jugular vein.
54
Q

what are the borders of the parotid bed?

A
  1. Superior boundary – zygomatic arch
  2. Medial boundary – ramus of mandible, styloid process and associated musculature
  3. Posterior boundary – external ear
  4. Inferior boundary – inferior border of mandible and posterior belly of digastric
  5. Anterior boundary – posterior border of masseter
55
Q

what invests the parotid gland

A

parotid fascia

derived from the investing lyaer of deep cervical fascia

56
Q

where does the parotid duct leave the parotid gland ?
over what muscles does it cross

what muscle does it pierce

where does it enter the oral cavity

what is clinically significant about the oral cavity entrance of the parotid duct

A

E. The parotid duct leaves the anterior border of the gland,

crosses the masseter muscle, turns around the anterior border of the muscle and

pierces the buccinator muscle and mucosa of cheek to

enter the oral cavity opposite the 2nd upper molar tooth.

CLINICAL CORRELATION - Abscesses or infections of dental origin may spread to the parotid gland via the parotid duct. (parotiditis)

57
Q

what are the 3 structures embedded in the parotid gland (superficial to deep?)

why is this clinically significant

A
  1. Facial nerve
  2. Retromandibular vein
  3. External carotid artery
  4. CLINICAL CORRELATION: During parotidectomy (surgery to removed parotid tissue) these structures must be isolated and protected in order to prevent damage.
58
Q

what is the preganglionic parasympathetic innervation of the parotid gland?

cell bodies?
foramen traveled through?

A

a. Preganglionic (glossopharyngeal nerve)
1 Location of cell bodies – salivatory nucleus within brainstem
2 Preganglionic fibers travel with the glossopharyngeal nerve (CN IX).
3 CN IX exits at the jugular foramen and immediately gives a tympanic branch.
4 The tympanic nerve then enters the middle ear via the tympanic canaliculus.
5 Travels through the middle ear and then reforms as the lesser petrosal nerve.
6 Lesser petrosal nerve exits middle ear via hiatus for the lesser petrosal nerve; nerve is now in the middle cranial fossa and exits via the foramen ovale.
7 Lesser petrosal n is now in infratemporal fossa and synapses in otic ganglion.

59
Q

what is the post ganglionic parasympathetic innervation to the parotid gland?

A

b. Postganglionic (distribute with V3)
1. Location of cell bodies – otic ganglion
2. Postganglionic fibers travel with the auriculotemporal branch of V3.

60
Q

what is the function of parasympathetics to the parotid gland?

A

secretomotor; stimulates gland secretion

61
Q

what is the sympathetic innervation to the parotid gland
what is the function of sympathetics

dysfunction?

A

vasomotor

sympathetic innervation to the parotid gland will make the secretions more watery

negligible effects

62
Q

what is parotiditis

is it painful? if yes where?

A

Parotiditis refers to inflammation of the parotid gland. This can be very painful because of stretching of the parotid sheath. Pain from the parotid region is carried via the auriculotemporal branch of V3 and the great auricular nerve. Often, pain will “refer” to the auricle, TMJ, and external acoustic meatus.

63
Q

what is sialolith?

A

A sialolith (calculus) is a calcified concretion that can sometimes form in the parotid gland. If it passes into the parotid duct, the duct can become blocked. This can be quite painful.

64
Q

parasympathetic innervation to the parotid gland is via what?

A

via tympanic/lesser petrosal branch of CN IX

65
Q

sympathetic innervation to the parotid gland is via what

A

external carotid n.

66
Q

what are the 4 CN’s that carry preganglionic sympathetic fibers?

A

CN III
CN VII
CN IX
CN X

67
Q

via what nerve will postganglionic fibers of the parasympathitic nervous system travel with

A

CN V

68
Q

what are 4 questions you must ask when discussing autonomics?

A

Where is the preganglionic neuron’s cell body located (will always be in CNS)?
Which nerve carries the preganglionic fibers and what is the course?
Where are the postganglionic cell bodies located (will always be in the PNS)?
Which nerve distributes postganglionic fibers to the structure and what is the course?

69
Q

via what is the otic ganglion suspended from?

A

V3

70
Q

what occurs with dysfunction of the parasympathetic innervation to the parotid gland

A

dry mouth (xerostomia)

or can develop cavities more often

trouble chewing and speaking

71
Q

where does every single sympathetic to the head originate? and where do they synapse?

A

T1-T4

synapse in the superior cervical ganglion

Neuro Exam 3 (12 decks)

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