Nerve Supply of Scalp and Face Flashcards
4 plexuses of spinal nerves
cervical
brachial
sacral
lumbar
which spinal nerves supply the back of the scalp?
greater occipital
3rd occipital
which spinal nerve supplies the scalp behind the auricle?
lesser occipital
which spinal nerve supplies skin over the mandibular angle and front of auricle?
great auricular
trigeminal nerve arise from?
pontin portion of brainstem
3 divisions of trigeminal nerve?
V1 (ophthalmic)
V2 (maxillary)
V3 (mandibular)
ophthalmic supplies—
anterior part of scalp forehead upper eyelid dorsum of nose **emerges through superior orbital fissure
maxillary supplies–
lower eyelid upper lip side of nose upper teeth **emerges through foramen rotundum
mandibular supplies–
cheek lower teeth lower lip chin temple **emerges through foramen ovale to supply muscles of mastication
cervical nerves are —- to auricle
posterior
dorsal rami
C2 greater occipital
C3 3rd occipital
ventral rami
(cervical plexus)
C2 lesser occipital
C2-3 great auricular
ophthalmic branches into
supratrochlear
supraorbital
maxillary branches into
zygomaticotemporal
mandibular branches into
auriculotemporal
nerve supply of the scalp
(from anterior to posterior)
- supratrochlear
- supraorbital
- zygomaticotemporal
- auriculotemporal
- great auricular
- lesser occipital
- greater occipital
- 3rd occipital
erb’s point
where branches go from cervical to skin
great auricular nerve (C2-3)
supplies skin over parotid gland and behind the auricle and over the angle of the jaw
lesser occipital nerve (C2)
supplies scalp behind and above the ear
greater occipital nerve (dorsal ramus of C2)
pierces trapezius lateral to the occipital protuberance and supplies scalp of occipital region up to lambdoid suture
3rd occipital nerve (dorsal ramus of C3)
pieces trapezius at midline and supplies scalp of lower occipital and suboccipital region
branches of ophthalmic nerve in scalp and face
- nasociliary
- frontal
- lacrimal
branches of nasociliary and what they supply
a. infratrochlear–skin over the medial angle of the eye and adjacent parts of the eyelids
b. external nasal–terminal branch of anterior ethmoidal. Supplies the skin over the dorsum of the nose
branches of the frontal and what they supply
a. supratrochlear–skin of medial part of upper eye lid
b. supraorbital–skin of middle part of upper eye lid, forehead and scalp up to lambdoid suture
what nerves supply the upper eyelid?
supratrochlear, supraorbital, palpebral branch of lacrimal
lacrimal gland branches and what they supply
palpebral–skin over later part of upper eyelid
lacrimal nerve carries secretomotor fibers to the gland. Where does it come from?
VII
parasympathetic
branches of maxillary nerve in scalp and face
- zygomaticotemporal–> skin over temple
- zygomaticofacial–> skin over zygoma
- infraorbital (palpebral, nasal, labial)
- palpebral–> lower eye lid
- nasal–> side of nose
- labial–> upper lip
- posterior superior alveolar–> upper teeth
- palatine branches–> hard and soft palate
facial nerve goes through—
stylomastoid foramen
greater petrosal nerve conveys what type of fibers to what?
parasympathetic fibers to lacrimal, nasal, and palatine branches
-responsible for allergies or common cold
the pterygoid canal carries–
the vidian nerve
V2 turns into V1 through the —– nerve to get to the —- gland
v2 goes along zygomatic nerve to turn into v1 to transmit secretomotor fibers to lacrimal gland
the pterygoapalatine gland is a part of what nervous system?
parasympathetic nervous system
role of V1 and V2 in transmitting secretomotor fibers to lacrimal gland
facial nerve–> PNS secretion–> nasal, lacrimal, palatine, and trigeminal nerve carrying them–> final glandular destination
branches of mandibular nerve
- long buccal–> cheek and mm over buccinators and gum
- inferior alveolar (mental)–> lower lip, mandibular teeth, mental skin and mm over skin and lower lip
- auriculotemporal–> auricle and posterior temporal region and TMJ and parotid gland
- lingual–> anterior 2/3 of tongue (general sensation)
upper lip innervated by
V2
lower lip innervated by
V3
lower eyelid innervated by
V1
nose innervated by
V1 and V2
what is used for treating wounds of upper lip and maxillary teeth?
infraorbital nerve block
what is used when performing surgery on the mandibular teeth?
inferior alveolar nerve block
herpes zoster on upper eye and forhead
V1 and V2
herpes on upper palate
V2
herpes on chin
V3
herpes on ear
V3
landmarks for occipital nerve block for treatment of cluster headache
lesser occipital N near mastoid process
great occipital N near external protuberance
which nerves should be blocked to extract upper tooth?
V2
which nerves should be blocked to extract lower tooth?
V3
trigeminal neuralgia
stabbing unilateral facial pain triggered by chewing or similar activities
- rarely suffer during sleep
- more women older than 50 yrs
- frequency–comes and goes
- time–few seconds to few minutes
- location–restricted to one side of face. **V2 is mostly involved one then V3 then V1
- bilateral sensory loss or weakness of facial muscles/jaw
idiopathic Trigeminal neuralgia
neurologic examination findings normal
secondary trigeminal neuralgia
- cerebral aneurysms (superior cerebellar artery)
- tumor (acoustic neuromas, trigeminal neuromas, meningiomas)
- MS
* Brain MRI with and without contrast is critical in diagnosing secondary causes of trigeminal neuralgia
treatment of trigeminal neuralgia
- medical–carbamazepine, Gabapentin-Lamotrigine-baclofen
- surgical–gamma knife surgery (GKS), microvascular decompression or percutaneous procedures
* *surgeon introduces trocar or needle into the ipsilateral foramen ovale. The ganglion is lysed at this location
