Padalecki 4 Flashcards
The face is richly supplied with vasculature. The ends of these arteries ______ freely.
anastomose
Origin of facial artery
external carotid artery
Course of facial artery
a. Usually runs _____ to the submandibular gland
b. Crosses mandible _____ to masseter m. and enters the face
b. Follows tortuous course toward _______.
c. _____ to superficial facial muscles
a. deep
b. anterior
c. medial canthus of eye
d. Deep
Facial artery branches (neck) - do not reach the face; named according to main areas of termination
a. Ascending palatine a.
b. Tonsillar a.
c. Submandibular a.
d. Submental a.
Facial artery branches (face)
a. Inferior labial a.
b. Superior labial a.
c. Lateral nasal a.
d. Angular artery
runs medially in and supplies the lower lip
Inferior labial a.
runs medially in and supplies the upper lip, nasal ala and septum
Superior labial a.
passes medially to the ala of the nose to supply the skin on the ala and dorsum of nose
Lateral nasal a.
terminal branch of the facial artery passing to the medial canthus of the eye to supply to superior part of the cheek and the inferior eyelid (end artery after the lateral nasal branch )
Angular artery
Connections of facial artery
a. Buccal branch of maxillary a.
b. Transverse facial a.
c. Infraorbital branch of maxillary a.
d. Dorsal nasal branch of opthalmic a.
e. Mental branch of maxillary a.
artery near buccinator muscle
Buccal branch of maxillary a.
branch of the superficial temporal artery within parotid gland; crosses face superficial to the masseter and inferior to the zygomatic arch; supplies parotid gland and duct; tissues of face
Transverse facial a.
terminal branch of the inferior alveolar artery; emerges from mental foramen to supply skin and tissues of the chin
Mental branch of maxillary a.
Other arteries of the face
- Supraorbital branch of ophthalmic a.
- Supratrochlear branch of ophthalmic a.
- Superficial temporal a.
a. Smaller terminal branch of the external carotid a.
b. Divides into frontal and parietal branches
Superficial temporal a.
Origin of facial vein
formed by the supraorbital and supratrochlear veins
a. Posterolateral to facial a.
b. Straighter than facial a.
c. More superficial than facial a. in submandibular triangle
Course of facial vein
The facial vein communicates with the ophthalmic veins and thus, the _______ or Danger Area of the Face.
cavernous sinus
roughly triangular area from upper lip to bridge of nose where the facial vein and its tributaries have direct connections to intracranial venous structures allowing for the possible spread of infection
Danger Area of the Face
a. Fever and disorientation (general infection)
b. loss of papillary reflex (CNIII)
c. diplopia (CNIII, IV, VI (extraocular muscles)
d. pain in orbit and forehead (CN V)
e. edema of eyes/orbit (blockage of venous blood flow)
Cavernous sinus thrombosis
important during inferior alveolar n. block because it is vulnerable to penetration by needle (resulting in intravascular injection of anesthesia or hematoma formation
Pterygoid plexus
Termination of facial vein
a. Joined by anterior branch of retromandibular vein
b. Ends in internal jugular vein (may be direct or indirect connection)
Other facial veins
- Supraorbital vein
- Supratrochlear vein
- Deep facial vein
- Superficial temporal vein
near (long) buccal nerve; terminates by entering the posterior aspect of the facial vein; drains infratemporal fossa
Deep facial vein
joined by the maxillary vein to form the retromandibular vein; drains scalp, forehead and part of temple and face
Superficial temporal vein
Parotid nodes receive lymph from:
a. Forehead
b. Lateral scalp
c. Lateral eyelids
d. Preauricular nodes
Submandibular nodes receive lymph from:
a. Medial eyelids
b. Nose
c. Cheek
d. Upper lip
e. Lateral part of lower lip
f. Buccal nodes
g. Mandibular nodes
Submental nodes receive lymph from:
a. Central part of lower lip
b. Central mandibular incisors
c. Tip of tongue
d. *Drain to submandibular or deep cervical nodes
All nodes drain to deep cervical nodes to _______ to thoracic duct.
jugular lymphatic trunk
- Usually involves the lower lip
- Can be caused by sun overexposure or chronic irritation from pipe smoking
- Cancer cells from lower lip, floor of mouth or apex of tongue
- Drain to the submental/submandibular nodes
Squamous Cell Carcinoma of the Lip
Divisions of Trigeminal Nerve (nerve cell bodies in the trigeminal ganglion)
- Ophthalmic Division (V1) afferent
- Maxillary Division (V2) afferent
- Mandibular Division (V3) afferent
Nerves of Ophthalmic Division (V1)
- Supraorbital n.
- Supratrochlear n.
- Infratrochlear n.
- External nasal n.
- Lacrimal n.
Nerves of Maxillary Division (V2)
- Zygomaticotemporal n.
- Zygomaticofacial n.
- Infraorbital n.
Nerves of Mandibular Division (V3)
- Auriculotemporal n.
- (Long) buccal n.
- Mental n.
(1) emerges through the supraorbital foramen/notch
(2) supplies: mucous membrane of frontal sinus; *skin and subcutaneous tissue of upper eyelid, and forehead and scalp as far back as the vertex
Supraorbital n.
*middle of forehead to hairline
Supratrochlear n.
*medial part of upper eyelid, side of nose, lacrimal sac and bridge of nose
Infratrochlear n.
*tip of nose
External nasal n.
skin over and conjunctiva deep to lateral upper eyelid
Lacrimal n.
(1) branch of zygomatic n. ; through zygomaticotemporal foramen
(2) *anterior part of temple
Zygomaticotemporal n.
(1) branch of zygomatic n.; through zygomaticofacial foramen
(2) *zygomatic prominence
Zygomaticofacial n.
(1) Exits infraorbital foramen
(2) *upper cheek, inferior eyelid; mucosa of maxillary sinus, maxillary incisors, canines and premolar teeth and adjacent gingival; part of nose, upper lip
Infraorbital n.
(1) through the parotid gland
(2) *part of auricle; external surface of tympanic membrance and skin/subcutaneous tissue superior to auricle
Auriculotemporal n.
(1) emerges from DEEP to mandibular ramus and pierces the buccinators
(2) *cheek; mucosa lining cheek, posterior part of buccal surface of gingiva
(Long) buccal n.
(1) Branch of inferior alveolar n.
(2) *chin, lower lip, inferior labial gingiva
Mental n.
- Primary sensory nerve of the head
- Does NOT innervate muscles of facial expression
- Innervates muscles of mastication - masseter, temporalis, medial pterygoid, lateral pterygoid
Trigeminal Nerve
Other cutaneous nerves of face and scalp
- Greater occipital n. (dorsal ramus C2)
- Third occipital n. (dorsal ramus C3)
- Lesser occipital n. (ventral rami C2-C3)
- Great auricular n. (ventral rami C2-C3)
- Transverse cervical n. (ventral ramus C2)
(the last three nerves in the above list are derived from cervical plexus)
a. lesion in spinal or cranial ganglia
b. eruption of vesicles following the course of the affected nerve
c. 20% of cases involve trigeminal ganglion; ophthalmic division is most commonly affected
- can lead to ulceration of cornea
- subsequent scarring can lead to blindness
Herpes Zoster
-recurrence can occur anywhere along the course of the affected nerve; historically important in dental practice
Herpes Labialis
an infection of the fingers acquired by dentists, nurses and other health practioners as a result of contamination of the hands by virus-laced saliva or other secretions
Herpetic whitlow
a. sudden attacks of excruciating facial pain
b. maxillary nerve most commonly involved
c. common in middle aged to elderly patients
d. often initiated by touch e. cause unknown
Trigeminal Neuralgia
Layers of the scalp
- Skin
- Connective tissue (tela)
- Aponeurotic layer (galea aponeurotica)
- Loose connective tissue
- Pericranium
Scalp proper (connected)
- Skin
- Connective tissue (tela)
- Aponeurotic layer (galea aponeurotica)
dense connective tissue, contains neurovascular
components
Connective tissue (tela)
strong, tendinous sheet covering calvaria between occipitalis m., superior auricular m. and frontalis m.
Aponeurotic layer (galea aponeurotica)
a. allows movement of the scalp proper over the skull
b. infections may spread via this layer
Loose connective tissue
a. periosteum of the external side of the calvaria
b. loosely attached to calvaria except at sutures
c. limited osteogenic capacity
Pericranium
The supraorbital and supratrochlear arteries are branches of the______. The superficial temporal, posterior auricular, and occipital arteries are branches of the ______. The names and distribution of the veins corresponds to the arteries.
- internal carotid artery
2. external carotid artery
Arteries of the scalp
- Supraorbital a.
- Supratrochlear a.
- Superficial temporal a.
- Posterior auricular a.
- Occipital a.
Nerves of the scalp
(Note: From anterior to posterior, the nerves of the scalp include all divisions of the trigeminal nerve, ventral rami (C2-C3), dorsal ramus of C2, and dorsal ramus of C3.)
- Supraorbital n. (V1)
- Supratrochlear n. (V1)
- Zygomaticotemporal n. (V2)
- Auriculotemporal n. (V3)
- Lesser occipital n. (ventral rami C2-C3)
- Greater occipital n. (dorsal ramus C2)
- Third occipital n. (dorsal ramus C3)
Scalp wound: no gaping; epicranial aponeurosis may help hold margins together
Superficial wound
Scalp wound: gape widely especially if lacerated in the coronal plane because frontalis and occipitalis will pull in opposite directions
Deep wound
- loose connective tissue layer is the danger area of the scalp
- infections can pass to cranial cavity via emissary veins
- limited by the epicranial aponeurosis
Scalp infection
A. Due to facial nerve impairment.
B. Some major characteristics/symptoms:
1. Facial asymmetry.
2. Sagging corner of the mouth, which can lead to food and saliva collection.
a. difficulty in chewing and drinking
3. Inability to whistle; inability to produce labial sounds
4. Cannot completely close the eye on the affected side; lower lid droops.
a. can result in corneal injury
5. Difficulty in raising the eyebrow on the affected side.
6. Cannot wrinkle the forehead on the affected side.
Bell’s Palsy- a type of facial nerve palsy
Tend to gape because there is no deep fascia and only loose connective tissue
Facial Lacerations
Lines and wrinkles—appear w/ age
- _____-run perpendicular to muscles
- Incisions along these lines heal w/ less scarring
Langer lines
