H&N - Face and Scalp Flashcards
Surface marking for parotid gland
Starts around tragus
Follows inferior to zygomatic arch
Drops down to angle of mandible and wraps around it
Climbs to inferior part of lobule
Parotid duct aka
Stensen’s duct
Surface marking of Stenson duct
Middle third of a line between intertragic line (between tragus and anti tragus) and philtrum
How does parotid duct get into mouth
After masseter muscle, dives into buccal fat and pierces buccinator muscle
End point of parotid duct
Near the second upper molar tooth
Structures through the parotid gland
Facial nerve
External carotid artery (and its branches; the maxillary and superficial temporal)
Retromandibular vein
Auriculotemporal nerve
Branches of facial nerve in facial canal
- greater petrosal nerve
- nerve to stapedius
- chorda tympani
Facial nerve branches through the stylomastoid foramen
Posterior auricular
Digastric
Stylohyoid
Facial nerve branches after entering parotid gland
The Zebra Buggered My Cat
Temporal branch
Zygomatic branch
Buccal branch
Marginal mandibular branch
Cervical branch
Functions of facial nerve
Face, ear, taste, tear
Taste: anterior 2/3
Tear: PSN to lacrimal and salivary glands
Facial nerve end branches motor test
Temporal: raise eyebrow
Zygomatic: close eyes tightly
Buccal : blow cheeks
mandibular: show lower teeth
cervical: tense skin under your chin
External carotid artery branches
Some attendings like freaking out potential medical students
Sup thyroid
Ascending Pharyngeal
Lingual
Facial
Occipital
Post auricular
Maxillary
Sup temporal
Tribuaries of retromandibular vein
superficial temporal and maxillary veins
Arterial supply of parotid
External carotid artery
Venous supply of parotid
Retromandibular vein
Lymphatic drainage of parotid
deep cervical
Innervation of parotid gland
Glossopharyngeal -> otic ganglion -> Auriculotemporal
Branches of opthalmic nerve
Supra-orbital
Supratrochlear
Infratrochlear
Lacrimal
External nasal
Branches of maxillary nerve
Zygomaticotemporal
zygomaticofacial
Infra-orbital
Branches of mandibular nerve
Auriculotemporal
Lingual
Inferior alveolar
Nerve to the mylohyoid
Mental
Layers of scalp
Skin
Connective tissue (dense)
Aponeurotic layer of occipito frontalis (Galear layer)
Loose connective tissue
Pericranium (ie periosteum)
Innervation of scalp
Anterior to vertex: trigeminal
Posterior to vertex: C2 and C3 (great auricular, lesser and greater occipital, third occipital)
In which layer of scalp do blood vessels and nerves lay
In dense connective tissue
Scalp blood supply
Opthalmic artery (internal carotid): supratrochlear and supraorbital
External carotid: Post auricular, superficial temporal, occipital
Why scalp lacerations bleed so profusely
Arterial wall firmly attached to fibrous tissue, cant vasospasm/contract so continues to bleed.
How to rx scalp laceration and bleed
apply pressure
primary closure by suturing
Which muscles close the jaw
Medial pterygoid
Masseter
Temporalis
Submandibular gland duct
Whartons duct
Which muscle divides the submnadibular gland into two parts
mylohyoid muscle
Nerve around whartons duct
lingual
What is the acini composition of the three salivary glands
Parotid: mainly serous
Sublingual: mainly mucous
Submandiblar: mixture of mucous and serous
Where do majority of salivary gland stones form
Submandibular:
Slow movement of saliva
- up ward against gravity
- mucous composition
- alkaline (deposits calcium crystals)
Muscles of mastication
Masseter
Temporalis
Medial /lateral pterygoid
Which muscle opens the jaw
lateral pterygoid muscle
Position of lacrimal gland
Superior and lateral to the orbit
Angle of the jaw innervation
C2-C3 (greater auricular nerve)
Which muscles does mandibular nerve innervate
Muscles of mastication
Tensor veli oalatine
Mylohyoid
Anterior belly of digastric
Tensor tympani
Blood supply of lacrimal apparatus
Ophthalmic artery
Which nerve runs close to parotid duct
Buccal nerve of facial
Mx of facial nerve laceration
Lateral to lateral canthus: surgical repair
Medial to lateral canthus line: surgery =conservative
Always check parotid duct (look for blood at papilla or put a cannula in)
Where are scalp flaps taken from
Subgaleal layer (loose areolar connective tissue), fewer vessels
More superficial is very vascular and firmly attached
Deeper also done sometime but more vascular/attached to suture lines
Branches of the maxillary artery
Terminal 6:
- Posterior superior alveolar
- Pterygoid canal
- Palatine (greater- > hard palate, lesser → soft palate)
- Sphenopalatine/nasopalatine
- Pharyngeal
- Infraorbital
Muscles of soft palate
Tensor veli palatini
Levator veli palatini
Palatoglossus
Palatopharyngeus
Muscularis uvulae
Action of tensor veli palatini
Pulls laterally flattening and tensing palate
Action of levator veli palatini
Elevates soft palate, stopping food entering nasopharyinx during eating
Also helps tensor veli palatini to open the cartilagenous auditory tube to equalise middle ear pressure
Action of palatopharyngeus
Elevates larynx and pharynx
Depresses soft palate
Action of palatoglossus
inserts into lateral portion of tongue
Depresses soft palate
Nerve supply to soft palate muscles
All vagus (pharyngeal plexus from CN10 and CN11)
Except tensor veli palatini → CN5V3
Facial muscles
Frontalis
Procerus
Orbicularis oculi
Nasalis
Levator labi superioris alaeque nasi
Levator labi superioris
Zygomaticofacial major and minor
Orbicularis oris
Risorius
Depressor labii inferioris
Depressor anguli oris
Mentalis
Muscles deep to facial nerve
Mentalis
Buccinator
levator anguli oris
Where are facial muscles cause horizontal and vertical wrinkles in glabella region?
Vertical: Corrugator causes
Horizontal: procerus
