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HNNS > HNS25 Face And Scalp > Flashcards

HNS25 Face And Scalp Flashcards

1
Q

Face borders

A

Upper:
Supraciliary arches / upper aspect of eyebrows —> Forehead belongs to Scalp

Lower:
Lower edge of mandible

Posterior:
Front of ear (face does not include ear)

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2
Q

Scalp border

A

Rest of head and neck (except face)

Auricle / ear not included

Inferior:
Occipital protuberance / Superior nuchal line (margin between head and neck)

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3
Q

Importance of face

A
  1. Identity
  2. Individuality (difference between people)
    - shape
    - skin colour etc.
  3. Communication
    - non-verbal (facial expression)
    - verbal (production of speech)
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4
Q

Face shape determination factor

A
  1. Underlying bones and cartilages
  2. Deposition of fatty tissue (children with more buccal fat to suck milk)
  3. Colour and effects of aging on overlying skin
  4. Abundance, placement, nature of hair
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5
Q

Features of face: 3 mains areas of face

A
  1. Eyes
    - Suprapalpebral sulcus
    - Infrapalpebral sulcus
    - Eyelids
    - Palpebral sulcus (眼窿)
    - Eyebrows (on Supraciliary arch)
    - Epicanthal / Palpebronasal folds
  2. Nose
    - Glabella
    - Dorsum
    - Apex
    - Ala
    - Naris (opening)
    - Nasal septum
  3. Mouth
    - Philtrum (人中)
    - Lips (upper + lower)
    - Labial commissure (嘴角)
    - Oral fissure (口窿)
    - Vermillion border (嘴唇同皮膚border)
    - Mentolabial sulcus
    - Mental protuberance (下巴尖)
    - Chin

Rest of face: Cheek

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6
Q

Skin of face

A
  • Thick, Elastic, Vascular

- Normally Lax (except nose (securely attached to cartilage))

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7
Q

Structure of scalp

A

5 layers:

  1. Skin
    - thin
    - many sebaceous gland, sweat gland
    - hair follicles
    - abundant arterial supply
    - good venous and lymphatic drainage
  2. Connective tissue
    - thick
    - richly vascularised ***SC layer
    - cutaneous nerves
  3. Aponeurosis
    - Epicranial aponeurosis
    - broad, strong
    - tendinous sheet that covers calvaria

Skin + Connective tissue + Aponeurosis —> Proper scalp

  1. Loose connective tissue
    - allow free movement of layers above
  2. Pericranium
    - external periosteum of calvaria
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8
Q

Skeletons of face and scalp

A

Division: Neurocranium + Viscerocranium

Function:

  • House and protect sense organs (eye, nose, mouth)
  • Provide a frame on which soft tissues (including muscles of face) can act, teeth can anchor
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9
Q

Classification of muscles of head and neck

A

Based on anatomical location:

  1. Face and scalp
  2. Eye and orbit
  3. Middle ear
  4. Soft palate
  5. Tongue
  6. Neck
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10
Q

Muscles of face and scalp

A

Muscles of scalp:

  1. Epicranial muscles
    - Occipitofrontalis (CN7)
  2. Auricular muscles

Muscles of facial expression:

  1. Orbital group
    - Orbicularis oculi (Palpebral part, Orbital part)
  2. Nasal group (relatively unimportant in human)
  3. Oral group
    - Orbicularis oris
    - Muscles of upper lip (Levator labii superioris, Levator anguli oris, Zygomaticus minor, Zygomaticus major)
    - Muscles of lower lip (Depressor labii inferioris, Depressor anguli oris, Mentalis)
    - Risorius
    - Buccinator
    - Platysma
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11
Q

Epicranial muscles

A
  1. Occipitofrontalis (2 bellies: frontal + occipital belly)
    - connection: Epicranial aponeurosis
    - origin: Superior nuchal line (occipital belly), ***Skin above upper orbital margin (frontal belly) (attach to skin rather than bone —> for facial expression)
    - Elevation of eyebrows, Wrinkles the forehead
    - Innervated by CN7
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12
Q

Muscles of facial expression

A
  • Small, thin muscle bundles located in SC tissue / Superficial fascia
  • NOT covered by own fascia (except buccinators)
  • Most attaches to bone / fascia / skin (pull the skin), rest attaches to other muscles
  • ALL from 2nd pharyngeal arch
  • ALL innervated by CN7 Facial nerve

Functions:

  1. Sphincters and dilators of facial orifices —> Protection (Primary function) (e.g. eyes)
  2. Facial expression (Secondary function) —> expression of emotions
  3. Support food ingestion —> close mouth for swallowing
  4. Sound production involvement
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13
Q

Orbital group muscles (3 groups)

A

Main functions of eyelids:
1. Protection of eyeballs from injury / excessive light
2. Spreading tears to keep cornea moist
—> by closing Palpebral fissure (眼窿)

  1. Orbicularis oculi (sphincter of eye)
    - Palpebral part —> closes eyelid gently
    - Orbital part —> closes eyelid forcefully
    - Lacrimal part (deep)
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14
Q

***Oral group muscles (6 groups)

A
  1. Orbicularis oris (sphincter of mouth)
    - opening of mouth
  2. Muscles of upper lip
    - Levator labii superioris (labii: lip)
    - Levator anguli oris (anguli: angle of lip)
    - Zygomaticus minor
    - Zygomaticus major
  3. Muscles of lower lip
    - Depressor labii inferioris
    - Depressor anguli oris
    - Mentalis (directly attach to skin)
  4. Risorius
    - widens mouth opening
  5. Buccinator
    - cheek muscles
  6. Platysma (大塊) (also from 2nd pharyngeal arch, also innervated by CN7)
    - muscles of neck interwoven with oral group muscles
    - **tenses skin over lower face + anterior neck
    - **    depresses mandible (against resistance)
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15
Q

Receptor on face

A
  1. Touch
  2. Pain
  3. Temperature
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16
Q

***Dermatomes of head and neck

A

Face + Anterior scalp: CN5 Trigeminal nerve

  • CNV1 Ophthalmic division: Scalp + nose
  • CNV2 Maxillary division: Cheek
  • CNV3 Mandibular division: Chin + side of face

Posterior scalp + Neck: Spinal nerve

Anterior-Posterior division:

  • Anterior ramus (anterior head and neck, including ear)
  • Posterior ramus (posterior head and neck)

OR

Superior-Inferior division:

  • C2 (posterior head)
  • C3 (neck)
  • C4 (just above pectoral girdle)

No C1 dermatome (∵ no cutaneous nerve from C1)

17
Q

***Cutaneous distribution of nerves in head and neck

A

Anterior:

Ophthalmic nerve (CNV1)

  • ***Supraorbital nerve (middle upper lid, forehead, anterior scalp) —> Supraorbital foramen
  • Supratrochlear nerve (glabella)
  • Infratrochlear nerve (nose dorsum, small part of glabella)
  • External nasal nerve (lateral dorsum, apex)
  • Lacrimal nerve (lateral upper lid)

Maxillary nerve (CNV2)

  • ***Infraorbital nerve (face, upper lip) —> Infraorbital foramen
  • Zygomaticotemporal nerve (lateral forehead)
  • Zygomaticofacial nerve (lateral face)

Mandibular nerve (CNV3)

  • Auriculotemporal nerve (ear, lateral scalp)
  • Buccal nerve (cheek)
  • Mental nerve (lower lip, chin) —> Mental foramen

Posterior:

Posterior rami of spinal nerve

  • Greater occipital nerve (C2) (posterior scalp)
  • Third occipital nerve (C3) (posterior neck)

Anterior rami of spinal nerve

  • Lesser occipital nerve (C2, C3 —> cervical plexus) (lateral scalp)
  • Greater auricular nerve (C2, C3 —> cervical plexus) (anterior neck, angle of mandible, ear)

Posterior rami of spinal nerve —> never form plexuses
Anterior rami of spinal nerve (cervical, lumbar, sacral) —> form plexuses

***Maps can overlap

18
Q

Region for testing

A 
NOT overlap with other nerves
—> Major nerve tested:
1. CNV1 —> Supraorbital nerve
2. CNV2 —> Infraorbital nerve
3. CNV3 —> Mental nerve
19
Q

Trigeminal neuralgia

A
  • Severe pain in facial area served by >=1 of 3 branches of CN5
  • Electric-shock like
  • Suicide disease
  • Caused by compression of CN5 and at the base of skull (root / entry zone) (e.g tumour)
20
Q

Original of ALL 3 sensory divisions of CN5

A

Trigeminal ganglion (Sensory ganglion) (cell bodies of pseudo-unipolar neurons located)
—> Sensory root
—> Brainstem
—> Information about touch
—> Principal Trigeminal sensory nucleus of Trigeminal nerve

21
Q

***Motor pathway of face: CN7 and effectors (muscles of facial expression)

A

CN7: Emerge from Stylomastoid foramen

Divides in parotid gland into major branches in face:

  1. Temporal (auricular muscles, frontal belly of occipitofrontalis)
  2. Zygomatic
  3. Buccal
  4. Marginal mandibular
  5. Cervical
  6. Posterior auricular (posterior auricular muscle, occipital belly of occipitofrontalis)

Facial nerve also supples Stapedius, Posterior belly of digastric, Stylohyoid which are NOT muscles of facial expression

22
Q

Bell’s palsy

A

Symptoms (temporary):

  1. Incomplete closure of eye (Orbicularis oculi)
    - cause cornea to dry out (exposure keratitis)
    - drooping of lower eyelid (ectropion) (vs ptosis: drooping of upper lid)
  2. Drooling
    - dribbling saliva and drinks, difficulty in chewing / speaking (Orbicularis oris)
  3. Decrease sense of taste (anterior 2/3 tongue) (Chorda tympani)
  4. Sensitive to loud noise (hyperacusis) (Stapedius)
23
Q

Origin of blood supply to face and scalp

A

Internal carotid artery (NO branch in neck, 1st branch within skull):
—> Orbit, Medial forehead, Dorsum

External carotid artery:
—> Rest of face and scalp (Majority)

24
Q

***External carotid artery branches (only superficial —> Lingual, Superior thyroid, Ascending pharyngeal not counted)

A
  1. Facial artery (main artery of face, hook around inferior mandible, go through face to medial eye)
    - ***Angular artery (medial eye) —> Anastomoses with Dorsal nasal artery
    - Inferior labial artery
    - Superior labial artery
    - Lateral nasal branch
    - Submental artery
  2. Maxillary artery
    - Infraorbital artery (Infraorbital foramen)
    - Mental artery
  3. Superficial temporal artery
    - Frontal branch
    - Parietal branch
    - Zygomaticoorbital artery
    - Transverse facial artery (on zygomatic arch)
  4. Occipital artery
  5. Posterior auricular artery
25
Q

***Internal carotid artery (Anterior and Middle cerebral arteries not counted)

A
  1. Ophthalmic artery (go through orbit)
    - Supratrochlear (forehead, dorsum)
    - ***Dorsal nasal artery (rest of dorsum) —> Anastomoses with Angular artery
    - Supraorbital artery (forehead)
    - Lacrimal artery
26
Q

Supraorbital artery vs Infraorbital artery

A

Supraorbital artery:
- Internal carotid —> Ophthalmic —> Supraorbital artery

Infraorbital artery:
- External carotid —> Maxillary —> Infraorbital artery

(Supraorbital nerve: CNV1
Infraorbital nerve: CNV2)

27
Q

Scalp anastomoses (Anterior to Posterior) (External + Internal)

A

Occurs between L/R branches, different branches of same / different origin

External carotid (Posterior)

  1. Superficial temporal
  2. Occipital
  3. Posterior auricular
Internal carotid (Anterior)
4. Upper branches of Opthalmic artery
—> Supratrochlear
—> Supraorbital
—> Zygomatico-temporal branches
28
Q

Arterial anastomoses in the face

A

Significant anastomoses may develop between 2 arterial territories: External + Internal carotid arteries
—> provide alternative route for blood flow

e.g. Blockage of internal carotid artery
—> External carotid artery
—> Facial artery
—> ***Angular artery
—> ***Dorsal nasal artery
—> Ophthalmic artery
—> Internal carotid artery (bypass blocked site)
29
Q

Arterial pulse

A
  1. Carotid pulse
  2. Facial pulse (Facial artery at mandible)
  3. Temporal pulse (Superficial temporal artery, anterior to auricle as artery crosses zygomatic arch)
30
Q

Veins of face and scalp

A

Internal jugular vein (Majority)

External jugular vein (Minor)

31
Q

***Venous drainage

A 
Face:
1. Facial vein (Main)
- Angular vein
- External nasal vein
- Superior labial vein
- Inferior labial vein
- Submental vein (also can go anterior cervical vein —> Brachiocephalic)
2. Retromandibular vein
3. Others
—> Internal / External jugular vein
Scalp:
1. Occipital (Main)
2. Superficial temporal vein
3. Supraorbital vein
4. Others
—> Internal / External jugular vein
32
Q

***Pterygoid plexus and Cavernous sinus

A
  1. Facial vein —> Can go into Deep facial vein —> Pterygoid plexus of veins
  2. Infraorbital vein —> Pterygoid plexus of veins
  3. Ophthalmic vein —> Can go into Cavernous sinus (intracranial)
  4. Angular vein
  5. Others

Pterygoid plexus connected with Cavernous sinus via Emissary veins

***These veins are valveless
—> can drain into Pterygoid plexus
—> Emissary veins
—> Cavernous sinus
—> into Brain

“Danger area of face”
—> bacterial dissemination from mouth / face
—> Cavernous sinus
—> Thrombosis / Cerebral edema / Meningitis

Plastic surgery injecting toxins during plastic surgery: beware of vessel damage

33
Q

3 major group of Lymph nodes of head and neck

A
  1. Submental nodes
  2. Submandibular nodes
  3. Parotid nodes
34
Q

Lymphatic drainage pathway

A

Submental, Submandibular, Parotid LN
—> Superficial cervical LN
—> Superior deep cervical LN
—> blood supply

Anterior to vertex: Parotid nodes
Posterior to vertex: Mastoid nodes, Occipital nodes

HNNS (58 decks)

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