L25 - Face and scalp Flashcards
Explain the importance of knowing anatomy of the face and scalp.
- Identity, contact, impression
- Individuality from anatomical variation
- Facial muscles critical to communcation
4 anatomical variations that determine the face shape?
Underlying bones
Deposition of fatty tissue
Colour, effects of aging on overlying skin
Abundance, placement, nature of hair
Name of the arch that form the upper border of face?
Supraciliary arch = upper border of face
Name of eyelid folds (superior and inferiorly)?
Suprapalpebral sulcus
Infrapalpebral sulcus
Name of nose bridge and flairs?
Dorsum of nose = nose bridge
Ala of nose = nose flairs
Apex of nose = tip of nose
Name for nostrils and what are they seperated by?
Naris
separated by nasal septum
Name of ridge in the centre above the upper lips?
Philtrum
Location of labial commissure of the face?
Edge of the oral fisure
What forms the inferior border of the face?
Mental protuberance
5 layers of the scalp?
Skin Connective tissue Aponeurosis Loose connective tissue Pericranium
Thickness, content, and blood supply of skin of scalp?
thin, many sweat and sebaceous glands; hair follicles;
Abundant arterial supply; good venous and lymphatic drainage
Thickness, content and nerve supply of connective tissue in scalp?
thick, richly vascularised subcutaneous layer;
well supplied with cutaneous nerves
Structure of the epicranial aponeurosis?
broad, strong tendinous sheet
covers calvaria
Function of the losse connective tissue of scalp?
allows free movement of the above layers over underlying calvaria
Damage to the scalp causing pain: Pain signal originates via which layer of the scalp?
Connective tissue layer
Abundant cutaneous nerves
Define the borders that separate neurocranium from viscerocranium?
A line between
Anterior: Supraorbital arch
Posterior = mastoid process
Function of the facial skeleton?
- To house and protect the sense organs (eye, nose, & mouth)
- To provide a frame on which soft tissues, including muscles of the face can act, and teeth can anchor
List the 2 muscles of the scalp?
1) Occipitofrontalis
2) Auricular muscles:
- Anterior auricular
- Superior auricular
- Posterior auricular
Function, origin and attachment of the occipitofrontalis muscle?
(2 bellies: occipital and frontal bellies)
Origin = superior nuchal line at occipital protuberance
Attach to skin above upper orbital arch: epicranial aponeurosis
- raises the eyebrows
- wrinkles the forehead
Embryonic origin of all the muscles for facial expression? Innervation of all these muscles?
2nd pharyngeal arch
Facial nerve (CNVII)
Which layer of tissue are muscles of facial expression located? How are they anchored?
- Small, thin muscle bundles located in the subcutaneous tissue (superficial fascia)
- not covered by own fascia (except buccinators)
- most of them attaches to the bone/fascia and pull the skin, the rest attaches to the other muscles
3 functions of muscles of facial expression other than expression?
Sphincters and dilators of the facial orifices
= Protection (e.g. for the eyes)
Support food ingestion
= Closing mouth for swallowing
Involved in sound production
2 function of the orbital group of facial muscles?
Main functions of eyelids (L. palpebrae):
- protection of the eyeball from injury and excessive light
- spreading the tears to keep the cornea moist
Name the main superficial orbital muscle and it’s functions?
Orbicularis oculi = sphincter of the eye:
1) Palpebral part: closes eyelid gently
2) Orbital part: closes eyelid forcefully
3) Lacrimal part
Name the deep orbital muscles and their functions?
- Corrugator supercilii : draw eyebrows together (frown)
- Depressor supercilii : depress eyebrows
List the nasal group muscles and their functions/ facial expression?
-Procerus [1]:
pulls eyebrows downward to produce transverse wrinkles over the nose
- Nasalis [2]:
a) Transverse part: compresses nostrils and wrinkle nose
b) Alar part: opens nostrils laterally
-Depressor septi nasi [3]: pulls nose down
Name the muscle that acts as the sphincter of the mouth?
Orbicularis oris [1] = sphincter of the mouth (most important): kiss
Name the main muscle of the cheeks?
buccinator [5] (= muscle of the cheek, beneath fat): blow up cheeks
List the 4 sets of muscles of the upper lip?
1) Zygomaticus major + zygomaticus minor: smiling / meh (elevate, draw angle of mouth)
2) Levator anguli oris
3) Levator labii superioris: bare teeth
4) Levator labii superioris alaeque nasi: moves nose up
List 2 sets of muscles for the lower lip + the facial expression made?
1) Mentalis: pout
2) Depressor labii inferioris (medial) + depressor anguli oris (superficial): bare teeth
Name the muscle for widening the mouth opening?
Risorius
widens mouth opening = fake smile (draws back angle of mouth)
Function of the Platysma?
Tenses the skin over lower face and anterior neck
Depresses mandible (against resistance)
Describe the sensory innervation of the head and neck dermatomes.
refer to lecture notes for visualization
Dermatome supplied by?
Anterior/ face = Trigeminal nerve (CN V):
- Ophthalmic nerve [CN V1]
- Maxillary nerve [CN V2]
- Mandibular nerve [V3]
Posterior = Spinal nerves: C2, C3, C4
List the spinal nerves that forms the cutaneous distribution of nerves of the posterior head + neck?
refer to lecture notes for visualization
Anterior rami:
- Greater auricular nerve (C2, C3)
- Lesser occipital nerve (C2, C3)
Posterior rami:
- Greater occipital nerve (C2)
- 3rd occipital nerve (C3)
List all the branches of opthalmic nerve that forms the cutaneous distribution of nerve on the face. (5)
Ophthalmic nerve [CN V1]: Supraorbital Supratrochlear Infratrochlear External nasal Lacrimal
List all the branches of Maxillary nerve that forms the cutaneous distribution of nerve on the face. (3)
Maxillary nerve [CN V2]:
Infraorbital
Zygomaticotemporal
Zygomaticofacial
List all the branches of Mandibular nerve that forms the cutaneous distribution of nerve on the face. (3)
Mental
Auriculotemporal
Buccal
Which 3 areas of the face can be tapped to check the intactness of the the facial nerve? Nerves that supply these area?
- refer to lecture notes for visuals*
1. Tap supraciliary arch = test supraorbital nerve from V1
2. Tap zygomatic bone area/ medial cheek = test infraorbital nerve from V2
3. Tap jaw lateral to chin = test mental nerve from V3
Define the cause of trigeminal neuralgia “suicide disease”?
Severe pain in facial area served by one or more of the 3 branches of trigeminal nerve
Caused by compression of blood vessels / tumour at the base of skull
Occurs in people >50 (affects women more)
Which nerve is responsible for the motor function of facial expression muscles?
Facial nerve (CN VII)
Outline the course and branches of the motor division of the facial nerve supplying the facial muscles?
Exits skull at stylomastoid foramen
Divides in parotid gland into 6 major branches in the face:
- Temporal
- Zygomatic
- Buccal
- Mandibular (marginal)
- Cervical
- Posterior auricular: occipital belly of occipitofrontalis + auricularis inferior)
Also supplies stapedius, posterior belly of digastric, stylohyoid
What is the cause of Bell’s palsy?
Facial nerve injury
2 major symptoms of Bell’s palsy?
Incomplete closure of the eye (orbicularis oculi)
Drooling
List some complications that arise from incomplete closure of the eyes in Bell’s palsy?
Incomplete closure of the eye (orbicularis oculi)
– cause cornea to dry out [exposure keratitis]
– drooping of lower eyelid [ectropion]
List some complications that arise from Bell’s palsy?
Dribbling saliva and drinks, difficult in chewing & speaking (orbicularis oris)
Decrease sense of taste (chorda tympani)
Sensitive to loud noise [hyperacusis] (stapedius)
Explain why lacerations of the scalp leads to profuse bleeding?
rich blood supply from ECA and ICA
Bleeding is mainly arterial:
- Venous pressure is extremely low in the erect position
- Connective tissue around vessels prevents retraction
List the 5 MAJOR arteries of the face and scalp?
- Superficial temporal (branches)
- Posterior auricular
- Occipital
- Maxillary (branches)
- Facial (branches)
Origin and branches of facial artery that supply the face?
Origin = ECA
(torturous) – branches into: Angular artery (nose) Lateral nasal artery (nose) Superior, inferior labial arteries (upper and lower lips) (+ submental a.)
Origin and branches of the superficial temporal artery?
Origin = ECA
Branches:
- Parietal branch
- Frontal branch
- Transverse facial artery
- Zygomaticoorbital artery
Origin and branches of the Maxillary artery that supply the face?
Origin = ECA
Branches:
- Mental branch (through mental foramen)
- Buccal artery
- Infraorbital artery (through infraorbital foramen)
Origin and branches of the Opthalmic artery that Supply the face?
Origin = ICA (NOT ECA)
Branches:
Supratrochlear artery
Supra-orbital artery
+ Dorsal nasal artery)
4 palpable locations for arterial pulse in the head?
- Temporal pulse @ pre-auricular region = superificial temporal artery
- Temporal pulse @ superior to pre-auricular region = Anterior branch of superficial temporal artery
- Facial pulse @ later to chin = facial artery
- Carotid pulse @ upper border of thyroid cartilage at neck = common carotid artery
Compare the drainage of the 2 divisions of retromandibular vein?
Anterior division drains into internal jugular vein
Posterior division drains into external jugular vein
Drainage of superficial temporal vein?
internal jugular vein
Define the danger area of the face?
Triangle area drained by valveless facial vein, deep facial vein, infraorbital vein, ophthalmic veins
> > leads directly / indirectly (via pterygoid plexus) to cavernous sinus
> > route for infectious spread (e.g. Cavernous sinus thrombosis)
Overview of the lymph drainage of the face and scalp?
Submental, submandibular, parotid nodes
> > superficial cervical lymph nodes
> > superior deep cervical lymph nodes
List the lymph nodes located anterior and posterior to vertex?
Anterior to the vertex:
Preauricular nodes
Parotid nodes
Posterior to the vertex:
Mastoid nodes
Occipital nodes
