Scalp and Superficial Face

Question 1

5 layers of the scalp

Answer 1

Skin
Connective tissue (dense) - neurovascular
Aponeurosis - connects facial muscles to skin
Loose connective tissue - susceptible to infection that can spread through the facial muscles
Pericranium - periosteum of the cranium, neurovascula

Question 2

Scalp proper includes

Answer 2

Skin, dense connective tissue and aponeurosis

Question 3

Emissary vein and infection

Answer 3

Infection in the loose connective layer can erode into emissary vein, spread to the dural sinuses and result in meningitis

Question 4

Scalp injuries/detached scalp

Answer 4

Neurovascular supply goes from inferior to superior from the dense connective tissue layer. Can be reattached since there is still neurovasculature coming from below supplying the scalp (flow is still there despite the ends being cut)
-U shaped scalp flap during surgery helps preserve the neurovasculature

Question 5

Gaping wounds on scalp

Answer 5

Usually due to cutting the aponeurosis layer (connected to the muscles, so gaping occurs), especially in the coronal plane. If the wound does not gape, it only cut through the first 2 layers

Question 6

Course of the parotid gland and parotid duct

Answer 6

• Goes from the superior zygomatic arch to the inferior border of the mandible, may extend into the submandibular triangle
• Duct dives into the buccinator muscle

Question 7

Clinical significance of the parotid gland

Answer 7

Neurovasculature passes through the parotid gland. Facial N. branches, retromandibular v. and the external carotid a.
Tumors compressing the parotid gland can also affect these vessels
-Also mumps clinical correlation from the triangles lecture

Question 8

What foramen does Facial N. (CN VII) exit to get into the face?

Answer 8

Stylomastoid foramen, between the styloid process and mastoid process

Question 9

Course of the facial N.

Answer 9

Exits the stylomastoid foramen into the face > Dives into the parotid gland and branches into 5 branches

Question 10

What are the five branches of the facial N.?

Answer 10

Tiny Zebra Bit My Cheek

Temporal N. 
Zygomatic N. 
Buccal N. 
Mandibular N. 
Cervical N.

Question 11

Clinical significance of facial N. branching (in relation to muscle innervation)

Answer 11

No specific innervations to specific muscles. There are communicating branches between each of the nerve branches. Nerves innervate different muscles in different individuals

Question 12

Which cranial nerve carry parasympathetic fibers (preganglionic)?

Answer 12

CN III, VII, IX, X

Question 13

Which cranial nerve carries majority of the postganglionic parasympathetics?

Answer 13

CN V

Question 14

Tears are produced via

Answer 14

Lacrimal gland, via the Greater Petrosal N.

Question 15

Innervation of the Facial N.

Answer 15

Sensory: taste to the anterior 2/3 of the tongue via the chorda tympani, upper EAM
Motor: Muscles of facial expression, stapedius, P. belly of the digastric
Parasympathetic: Lacrimal gland, submandibular and sublingual salivary glands (also via chroda tympani)

Question 16

Bell’s palsy:

Answer 16

Facial N. lesion causing ipsilateral paralysis of the muscles of facial expression
Cannot close eyes (drying out the cornea), cannot close mouth etc.

Question 17

Draw the pathway of the Facial N.

Answer 17

Refer to drawings

Question 18

Draw the cutaneous innervations of the scalp and face

Answer 18

Refer to drawings

Question 19

Draw the course of the Trigeminal N.

Answer 19

Refer to drawings

Question 20

Cutaneous facial innervations:

A. Ophthalmic N. (via Supraorbital and Supratrochlear branches) 
		     (via External nasal n.)

B. Infraorbital N. (via Nasal and Palprebal branches) 

C. Mandibular N. (via Auriculotemporal)
		     (via Buccal branch)
		     (via Mental N.)

Answer 20

A.

1) skin of eyelids, forehead
2. ) skin of nose

B
1.) skin of nose and lower eyelids respectively

C.

1. ) skin of external ear
2. ) skin of cheek
3. ) skin of mental region

Question 21

Which type of muscles does trigeminal nerve innervate?

Answer 21

Muscles of mastication via the mandibular nerve branch

Question 22

Herpes zoster (shingles):

Answer 22

Chicken pox and shingles virus can linger latent in the sensory ganglion. Reactivation of the virus in older age follows the nerve distribution of the ganglion. So if it lies dormant in the trigeminal ganglion, the shingles will occur in the areas cutaneously innvervated by the trigeminal nerve
So in this patient it appears in areas innervated by the V1 branch

Question 23

Draw the superficial arteries of the face

Answer 23

Refer to drawings

Question 24

Superficial temporal a. runs with what nerve?

Answer 24

Auriculotemporal n.

Question 25

Which facial arteries form anastomosis?

Answer 25

Right and left labial arteries
Angular and Supratrochlear arteries
Supraorbital and superficial temporal arteries

So branches from ECA and ICA anastomose with each other

Question 26

Which facial arteries originate from the internal carotid a?

Answer 26

Supraorbital a. and Supratrochlear a.

Question 27

Draw the veins of the superficial face

Answer 27

Refer to drawings

Question 28

Facial infections and veins/venous sinuses

Answer 28

Superior and Inferior ophthalmic veins + Angular veins + Deep facial veins (via the pterygoid venous plexus) all connect with the cavernous sinus. Infections in the face can drain back to the cavernous sinus due to these connections and cause meningitis and other issues

Question 29

What nodes make up the Superficial ring/Pericervical collar?

Answer 29

Submental
Submandibular
Parotid/preauricular
Mastoid
Occipital

Question 30

What do these superficial ring nodes drain? 
Occipital 
Mastoid
Parotid
Submandibular
Submental

Answer 30

-Posterior scalp and neck
Posterior lateral half of the scalp
-anterior ear and upper half of face and scalp
-where the facial artery goes
-bottom part of the chin, lower lip, tip of tongue

Question 31

Submental, Submandibular and Parotid nodes drain to which nodes?
How about Occipital and mastoid?

Answer 31

Deep cervical nodes

Superficial cervical nodes, but eventually will drain to the deep cervical nodes

Question 32

Superficial cervical nodes travel with which vessel?

Deep cervical nodes travel with which vessel?

Answer 32

• External jugular v.

- Internal jugular v.

Question 33

What nodes make up the deep cervical nodes?

Answer 33

Jugulo-digastric

Jugulo omohyoid