Scalp, Face and Parotid

Question 1

Layers of the SCALP

Answer 1

Skin
Connective tissue (dense) (where vascular structures lie)
Aponeurotic layer (top 3 tighlty attached)
Loose connective tissue (allows movement)
Pericranium/osteum

Question 2

Scalp innervation

Answer 2

Ant: Supraorbital, supratrochlear, zygomaticotemporal

Post: Greater occipital, Third occipital (Posterior rami of C2 and C3)
Antero-posterior: Lesser occipital and greater auricular (cervical plexus)

Question 3

Scalp Blood supply:

lymphatics

Answer 3

External and Internal carotid
IC: Supratrochlear and supraoptic arteries/veins (forhead, anterior scalp)
EC: Superficial temporal and posterior auricular

lymphatics: Certain areas will drain to certain nodes, e.g occipital, mastoid, parotid, submandibular

Question 4

Muscles of facial expression * for ones we need to know as nerves can be damaged
facial nerve

Answer 4

Platysma
Occipitofrontalis
Auricularis
Orbicularis oculi** Loss of inability to shut eye (orbital full, palpebral gently)
Bucinator
Upper (elevates)+lower lip **(depresses) muscles

Question 5

Parotid Gland innervation

Answer 5

Gland: V3 may present with radicular pain over mandible
Parotid fascia (investing layer): C2, radicular pain C2

Question 6

Parotid duct track

Answer 6

Exits anterior part of superfificla parotid
Travels along the masseter
At anterior border of masseter, bends 90 degrees
Perforates buccinator
Opens up next to second molar

Question 7

Parotid duct surface anatomy

Answer 7

Line form inferior tragus to cheilion
Middle third of line, box 1.5cm above and below

93% in this area, (study), 94% were below the contemporary line

Question 8

Faical nerve course

Out of ______ foramen
1st branch is posterior auricular
Then branches to stylohyoid and post belly digastric
Runs in parotid gland
Splits into Temporozygomatic and Cervicofacial
Temporozygomatic: _____ branch
Cervicofacial: ______ _____ branch

Answer 8

Out of stylomastoid foramen
1st branch is posterior auricular
Then branches to stylohyoid and post belly digastric
Runs in parotid gland
Splits into Temporozygomatic and Cervicofacial
Temporozygomatic: Temporal branch (zygomatic)
Cervicofacial: Marginal Mandibular branch (buccal, cervical)

Question 9

Facial Nerve course research paper

Answer 9

• Formally used was Pitanguy’s line. Was found to not track any single nerve ramus, but rather cross several nerve rami.
• Can safely make an incision 12mm form the porion anterior (a line connecting the SOML and IOML) as this encases the most posterior part of the temporal branch
• All functionally important rami lie between the porion line and the zygomatic sutural line

Question 10

Facial nerve an Parotid relations

Answer 10

Facial nerve between styloid and mastoid

Behind facial nerve in parotid is retromandibular vein and EC (deeper)