Scalp and Superficial Face

Question 1

What are the layers of the scalp? What are their roles?

Answer 1

Skin
dense Connective Tissue= hold vasculature and nerves
Aponeurosis= area of potential spread of infection from back of skull to eyelids and tip of nose
Loose connective tissue= connects occipital frontalis muscle –> move skin over head wrinkle forehead
Pericranium= periosteum outside of bone, highly vascularized, innervated

Question 2

Where can you find emissary vein?

Answer 2

In the loose connective layer connecting outside the cranium to inside

Infections can get into dural sinus (superior saggittal sinus) causing meningitis

Question 3

What layers compose the scalp proper? How is this clinically significant in terms of detached scalp injuries?

Answer 3

Skin
Dense connective tissue
Aponeurosis

If you tear of scalp proper you still have most of the bloody supply/vasculature intact since runs inferior to superior so can easily reattach

Question 4

What is the difference between a gaping and non-gaping scalp wound?

Answer 4

Gaping= normally coronal lesion, penetrates aponeurosis
Non-gaping= only through the first 2 layers

Question 5

How do scalp infections occur?

Answer 5

If you have a wound that goes into the loose connective tissue layer then infiltrate emissary vein causing spread of infection in dural sinuses

Question 6

Where do you find the parotid gland?

Answer 6

Zygomatic arch to the inferior arch of the mandible
Extends a little into submandibular triangle
Surrounded by investing layer of deep cervical fascia

Question 7

Where do you find the parotid duct?

Answer 7

On the masseter m.

Question 8

What could possibly be effected by a tumor on the parotid gland?

Answer 8

Fascial N. (runs through the gland but does not innervate)
External carotid A.
Retromandibular N.

Question 9

What nerve closes the eye?

Answer 9

Facial N.

Question 10

What does the frontal belly of the Occipitofrontalis M. do?

Answer 10

Wrinkle the forehead

Question 11

What does the ocibularis oculi m. do?

Answer 11

Close eye
Orbital= close tightly
Palpebral= gently

Question 12

What does the levator labii superioris m. do?

Answer 12

Elevate the upper lip

Question 13

What does the zygomaticus major and minor m. do?

Answer 13

Rises corners of the lip when a person smiles

Question 14

What does the risorius m. do?

Answer 14

Retracts the angle of the mouch

Question 15

What does the Oribcularis Oris m. do?

Answer 15

Purse lips and closes mouth

Question 16

What does the Platysma M. do?

Answer 16

Wrinkles the neck

Question 17

What does the Buccinator M. do?

Answer 17

Aid in smiling

Question 18

What innervates the muscles of facial expression? Where are these muscles derived from?

Answer 18

CN VII= facial nerve

PA2 mesoderm

Question 19

What connects the frontal and occipital body of the occipitofrontalis?

Answer 19

Epicranial aponeurosis

Question 20

What foes the facial nerve go through to get into face? What does it pass through before branching?

Answer 20

Styloid mastoid foramen

Parotid and then branch into motor branches

Question 21

What are the motor branches of the facial nerve?

Answer 21

“To Zanzibar By Motor Car”

Temporal
Zygomatic
Buccal
Mandibular
Cervical

Question 22

What does the sensory root of the facial nerve supply?

Answer 22

Taste to the anterior 2/3 of the tongue via the Chorda tympani (also used by submandibular and sublingual glands)

Parasympathetic fibers to the lacrimal gland, submandibular, and sublingual glands

Question 23

What carries the preganglionic parasympathetic fibers of the facial n.?

Answer 23

CN 3,7,9,10

Question 24

What carries the postganglionic parasympathetic fibers of the facial n.

Answer 24

trigeminal n.

Question 25

What nerve contributes to tears from the lacrimal gland?

Answer 25

Greater pretorsal n.

Question 26

What is Bell's Palsy?

Answer 26

Epsilateral paralysis of muscles of facial expression

Question 27

What are the three main cutaneous branches of the trigeminal n? What do they split into?

Answer 27

Opthalmic (V1): - suprathrochlear and supraorbital - plapebral branch of lacrimal - infratrochlear - external nasl branch of anterior ethmoidal Maxillary (V2): - infraorbital - zygomaticofacial - zygomaticotemporal Mandibular (V3): - mental (inferior alveolar) - buccal - auriculotemporal

Question 28

What nerves are involved in sensation to the scalp?

Answer 28

CN V1: supratrochlear and supra-orbital CN V2: zygomaticotemporal CN V3: auriculotemporal Anterior rami of greater auricular and lesser occipital (C2 and C3) Postrior rami of greater occipital (C2) and third occipital (C3)

Question 29

What nerve provides motor innervation to the muscles of mastication?

Answer 29

Trigeminal, V3, Mandibular branch

Question 30

How is the trigeminal nerve related to herpes zoster/shingles?

Answer 30

latent virus in dorsal root of the trigeminal Shingles cause reactivation of virus so then the distribution of the virus is based on if its V1 V2 or V3 Can also have shingles in sensory ganglion and get pattern that follows dermatomes on arm and torso

Question 31

What does the angular a. anastomose with?

Answer 31

Super trochlear a.

Question 32

What does the supra orbital a. anastomose with?

Answer 32

superficial temporal a.

Question 33

Where doe the supraorbital and supratrochlear a. come from? Which one is more medial?

Answer 33

The ophthalmic artery which is a branch of the internal carotid supraorbital a.

Question 34

What is the origin, course, and distribution of the facial artery?

Answer 34

External Carotid a. Ascends deep to submandibular gland winds around inferior border of mandible and enters face Muscles of facial expression and face

Question 35

What is the origin, course, and distribution of the superior and inferior labial a.?

Answer 35

Facial a. near angle of the mouth Run medially in upper and lower lip ``` Inferior= lower lip Superior= upper lip, ala, and spetum of nose ```

Question 36

What is the origin, course, and distribution of the anuglar a.?

Answer 36

terminal branch of facial a. Passes to medial angle of eye superior part of cheek and inferior eyelid

Question 37

What is the origin, course, and distribution of the lateral nasal a.?

Answer 37

Facial artery as it ascends alongside nose Passes to ala of nose skin to ala and dorsum of nose

Question 38

What is the origin, course, and distribution of the occipital a.?

Answer 38

External carotid a. Passes medial to posterior belly of digastric and mastoid process, accompanies occipital nerve in occipital region Scalp of back of head as far as vertex

Question 39

What is the origin, course, and distribution of the posterior auricular a.?

Answer 39

External carotid a. Passes posteriorly, deep to parotid gland along styloid process between mastoid process and ear Auricle of ear and scalp posterior to auricle

Question 40

What is the origin, course, and distribution of the superficial temporal a?

Answer 40

Small terminal branch of external carotid Ascends anterior to ear to region and ends in scalp Facial muscles and skin of temporal frontal and temporal regions

Question 41

What is the origin, course, and distribution of the transverse facial a?

Answer 41

Superficial temporal a. within parotid Crosses superficial to masseter and inferior to zygomatic arch Parotid gland and duct, muscles and skin of face

Question 42

What is the origin, course, and distribution of the mental a.?

Answer 42

Terminal branch of inferior alveolar a. Emerges from mental foramen and passes to chin Facial muscles of skin and chin

Question 43

What is the origin, course, and distribution of the supra-orbital a.?

Answer 43

Terminal branch of ophthalmic a. Passes superiorly from supra-orbital foramen Muscles and skin of forehead and scalp and superior conjunctiva

Question 44

What is the origin, course, and distribution of the supratrochlear a.?

Answer 44

Terminal branch of ophthalmic a. Passes superiorly from supratrochlear notch Muscles and skin of forehead and scalp and superior conjunctiva

Question 45

What important veins of the face drain into the cavernous sinus?

Answer 45

Superior and inferior opthalmic veins: from eye also connect with angular Angular vein Deep facial vein: connect to pterygoid venous plexus --> cavernous sinus