Head and Neck Practical 2 Flashcards
How many terminal branches does the facial nerve have?
5 that innervate the muscles of facial expression
How does the facial nerve enters/leave the skull?
Enters - internal acoustic canal in temporal bone
Exits - stylomastoid foramen
Motor branches of facial nerve
Ten Zebras Bit My Clavicle
How many bellies does the occipitofrontalis have?
2 - one in frontal region and one in occipital region
Action of 2 bellies of occipitofrontalis?
- Frontal part: pulls scalp forward, wrinkles forehead and elevates eyebrows
- Occipital part: retracts scalp
What circular muscle is being pointed to? Function?
Orbicularis oculi - closes eyelids (sphincter)
What muscle is this? Function?
Orbicularis oris - sphincter of mouth (closing lips - ‘kissing muscle’)
What is the action of orbicularis oris opposed by?
A number of muscles that dilate the mouth –> dilators of mouth
Function of buccinator? Location?
- Lateral to corner of mouth and anterior to masseter
- Contracts and keeps cheeks taut when whistling, talking etc and presses cheek against teeth when eating
What duct is buccinator pierced by?
The parotid duct
What gland is being pointed to?
Paired parotid gland (anterior to ear)
Where does parotid gland enter into mouth?
At level of upper 2nd molar tooth
What muscle is being pointed to? Function?
Platysma (flat and thin) - tenses skin of neck
What nerve is this?
Temporal branches of facial nerve
What nerve is this? What does it innervate?
- Zygomatic branch of facial nerve
- Innervates the orbicularis oculi
What nerve is this?
Buccal branch(es) of facial nerve
What nerve is this?
Marginal mandibular branch of facial nerve
What nerve is this? What does it innervate?
- Cervical branch of facial nerve
- Innervates platysma
Within the parotid gland, the facial nerve terminates by splitting into five branches. Does it innervate the parotid gland?
No - only provides motor innervation to the muscles of facial expression.
Clinical case 1:
Judy is a 29-year-old secretary who has had diabetes since childhood, went to the ER as it looked like she was having a stroke.
She presents with her left face drooping and inability to close her left eye which also felt dry.
Physical examination reveals facial weakness:
- Left eye would not close completely and appeared to droop slightly
- Only the right side of her mouth was elevated when she was asked to smile
- Only the right eyebrow was elevated when she was asked to wiggle her eyebrows
1) What is your preliminary diagnosis?
- Injury to left facial nerve (unilateral) –> muscles of facial nerve not working
- Obicularis oculi not working
- Dilators of mouth not working
- Occipitofrontalis not working
What level does common carotid artery bifurcate?
Between C3 and C4
Describe course of internal carotid artery
Travels more posterioly - gives off no branches in neck/face but goes straight to supply brain
Describe course of external carotid
More anterior to internal, gives off branches to supply face
What is the 1st branch of the external carotid?
Superior thyroid artery - goes to supply thyroid gland
What is the 2nd branch of the external carotid? What does it supply?
Lingual branch - goes to supply floor of mouth
What is the 3rd branch of the external carotid?
Facial artery (very tortuous)
What are the 2 terminal branches of the external carotid?
- Superficial temporal artery
- Maxillary artery
What artery is this? What does it supply?
Superficial temporal artery - generally supply superficial areas of the face.
What artery is this? What does it supply?
Maxillary artery - supplies the deep structures of the face
What pulse is being felt here? How can it be found?
Carotid pulse - identify laryngeal prominence and make your way laterally
What pulse is being felt here?
Facial pulse (near angle of mandible)
What pulse is being felt here?
Temporal pulse (superfical temporal artery)
What nerve is this? Course?
Hypoglossal nerve CN VII - Descends down neck then makes a 90 degree turn around the external and internal carotid arteries to make its way towards area of tongue (motor)