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Neuro 2019 Exam 2 > Scalp, Face Parotid (Funk) > Flashcards

Scalp, Face Parotid (Funk) Flashcards

1
Q

Scalp

A

A. Skin and connective tissue covering neurocranium; extending from supraorbital margins of frontal bone to superior nuchal line of occipital bone

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2
Q

Layers of scalp

A
  1. S – skin
  2. C – connective tissue (dense) – contains vessels and nerves
  3. A – aponeurosis epicranius (galea aponeurotica)
  4. L – loose connective tissue – allows free movement of scalp; this is normally the plane of cleavage for injury
  5. P – pericranium (periosteum)
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3
Q

Innervation of scalp

A

Spinal nerves

a. Greater occipital n (C2 dorsal ramus)
b. C3 (dorsal ramus)
c. Lesser occipital n
d. Great auricular n

Cranial Nerves (CN V)

a. Auriculotemporal branch of V3
b. Zygomaticotemporal branch of V2
c. Supraorbital branch of V1
d. Supratrochlear branch of V1

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4
Q

Arterial supply of scalp

A

From external carotid a

a. Occipital a
b. Posterior auricular a.
c. Superficial temporal a.

From internal carotid a

a. Supraorbital a
b. Supratrochlear a.

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5
Q

CLINICAL CORRELATION: scalp arteries

A

Scalp is highly vascular and because the vessels are embedded within the dense ct of layer 2 there is limited constriction when lacerated, causing scalp wounds to bleed profusely. Also, due to anastomoses, there is no single vessel to compress to stop bleeding.

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6
Q

Venous drainage of scalp

A
  1. Vena comitantes of arteries
  2. Emissary veins – drain through bones of skull to dural venous sinuses
  3. CLINICAL CORRELATION: Emissary veins (valveless) may spread infections from the scalp to the intracranial cavity.
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7
Q

CLINICAL CORRELATION: veins of scalp

A

Scalp infections/bleeding can spread easily within the loose connective tissue layer (layer 4); can spread within the eyelids and dorsum of the nose and cause ecchymosis (extravasation of blood under skin).

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8
Q

Musculature of the face: general features

A

a. All are derived from pharyngeal arch 2
b. All are innervated by CN VII (SVE component)
c. All are superficial muscles which can move the skin and fascias of the face

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9
Q

Muscles associated with eyes/eyebrows

A

a. Orbicularis oculi
1. Orbital part – surrounds orbit and forcefully closes the eye
2. Palpebral portion – within eyelid; gently closes the eye
3. Lacrimal portion – within medial corner of eye; assists with lacrimal fluid drainage

b. Corrugator supercilli – draws eyebrows down and in (worried look)

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10
Q

Muscles associated with the scalp, forehead

A

Occipitofrontalis

  1. Frontal and occipital bellies attached by epicranial aponeurosis.
  2. Frontal belly – elevates eyebrows; wrinkles skin of forehead
  3. Occipital belly – retracts scalp; assists frontal belly in “surprised” expression
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11
Q

Muscles associated with the mouth

A

a. Orbicularis oris – closes lips/mouth
b. Buccinator – keeps cheeks in contact with the gums so that food does not accumulate in the vestibule of the mouth.
c. Levator labii superioris – elevates upper lip
d. Levator anguli oris – elevates upper lip; widens mouth
e. Zygomaticus major – elevates upper lip; main smile muscle
f. Zygomaticus minor – elevates upper lip
g. Risorius – stretches lips laterally; wide smile
h. Levator labii superioris alaeque nasi – elevates upper lip; flares nostrils
i. Depressor anguli oris – depresses lower lip; frown
j. Depressor labii inferioris – depresses lower lip; frown
k. Mentalis – protrudes lower lip, pout

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12
Q

Muscles associated with the nose

A

a. Procerus – wrinkles skin over dorsum of nose (dislike)

b. Nasalis – flares nostrils

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13
Q

Platysma

A

depresses mandible; tenses skin of lower face and neck

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14
Q

Facial nerve

A

a. SVE component provides innervation to all muscles of facial expression
b. Course
1. Exits brainstem
2. Enters internal acoustic meatus
3. Courses laterally between cochlea and semicircular canals after which it makes a bend (genu) posteriorly and inferiorly to then course along the posterior wall of the middle ear.
4. Exits facial canal via stylomastoid foramen.

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15
Q

Branches of facial nerve in facial expression (SVE component)

A
  1. Posterior auricular nerve – supplies occipital belly of occipitofrontalis
  2. Digastric n
  3. Stylohyoid n
  4. Temporofacial trunk
    a. Temporal branches
    b. Zygomatic branches
    c. Buccal branches
  5. Cervicofacial trunk
    a. Buccal branches
    b. Marginal mandibular branches
    c. Cervical branches
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16
Q

Facial (Bell’s) Nerve Paralysis

A
  1. Causes: many cases are idiopathic; although linked to herpes virus, trauma or lesion anywhere along course of nerve, otitis media
  2. Paralysis of muscles of facial expression
  3. Facial asymmetry and drooping
  4. Drooping of lower eyelid causes drainage of tears and ulceration of eye.
  5. Paralysis of orbicularis oris causes dribbling of saliva from mouth
  6. Loss of buccinator muscle leads to accumulation of food within the vestibule.
  7. Impaired speech
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17
Q

Cutaneous Innervation of Face - Ophthalmic nerve (V1)

A

a. Supplies embryonic frontonasal prominence
b. Provides skin of forehead, upper eyelid, nose

c. Branches
1. Supratrochlear n.
2. Supraorbital n.
3. Lacrimal n.
4. Infratrochlear n
5. External nasal n.

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18
Q

Cutaneous Innervation of Face- Maxillary nerve (V2)

A

a. Supplies embryonic maxillary prominence
b. Provides skin of temporal region, upper cheek and lip, lower eye lid, ala of nose

c. Branches
1. Zygomaticotemporal n.
2. Zygomaticofacial n.
3. Infraorbital n.

19
Q

Cutaneous innervation of face- Mandibular nerve (V3)

A

a. Provides embryonic mandibular prominence
b. Provides skin of lower cheek, lower lip, and chin
c. Branches
1. Auriculotemporal n.
2. Buccal n.
3. Mental n.

20
Q

Great auricular nerve

A

(C2, C3) provides skin over angle of mandible.

21
Q

Trigeminal Neuralgia

A

(tic douloureux)

a. Sensory disorder of trigeminal nerve which causes sudden, excrutiating facial pain; pain can become so severe that patients can become suicidal and depressed.
b. The cause is believed to be demyelination of axons within the sensory root of CN V; in some cases due to compression by the superior cerebellar a.
c. Division affected: V2 >V3 >V1

22
Q

Nerve blocks for facial/dental surgery

A

a. Infraorbital nerve – anesthetic agent injected around infraorbital foramen; accessed by inserting needle through superior portion of oral vestibule.
b. Mental nerve – anesthetic agent injected around the mental foramen on the chin.
c. Buccal nerve – anesthetic agent injected via the oral vestibule just posterior to the 3rd mandibular molar.

23
Q

Herpes Zoster

A

Herpes Zoster Infection often affects the trigeminal ganglion. It most often affects V1 and can lead to scarring/ulceration of cornea.

24
Q

Arterial supply of the face- Facial artery

A

a. Branch of external carotid .
b. Course
1. Branches from external carotid a within submandibular triangle.
2. Courses through substance of submandibular gland
3. Arches over the mandible just anterior to the masseter to enter face.
4. Takes a tortuous course to allow for movement of the face; courses along angle of the mouth and then along lateral side of nose to medial angle of eye.
c. Branches
1. Inferior labial a.
2. Superior labial a.
3. Lateral nasal a.
4. Angular a.

25
Q

arterial supply of the face: Superficial temporal artery

A

Branch of external carotid Branches

  1. Transverse facial artery
  2. Frontal branches
  3. Parietal branches
26
Q

arterial supply of the face: Maxillary artery

A 
Branch of external carotid 
Branches
1.	Infraorbital a
2.	Buccal a.
3.	Mental a.

“IBM to the Max”

27
Q

Ophthalmic artery

A

a. Branch of internal carotid a
b. Branches
1. Supraorbital a.
2. Supratrochlear a.
3. Lacrimal (lateral palpebral) a.
4. Medial palpebral a
5. Dorsal nasal a.

28
Q

Venous drainage of the face: Retromandibular vein

A

a. Formed from union of superficial temporal and maxillary veins
b. Courses posterior to ramus of mandible within substance of parotid gland.
c. Divides into anterior and posterior division.
d. The anterior division merges with the facial vein.
e. The posterior division merges with the posterior auricular vein to form the external jugular vein.

29
Q

venous drainage of the face: Facial vein

A

a. Begins at medial corner of eye as angular vein; descends face receiving venae comitantes of artery.
b. Joins anterior division of retromandibular vein to form the common facial vein which then drains to the internal jugular vein.

c. Communicates with deeper plexuses
1. With pterygoid plexus via deep facial vein
2. With cavernous sinus via ophthalmic veins

30
Q

Clinical correlation: venous drainage of the face

A

the facial vein communicates with deeper plexuses

  1. With pterygoid plexus via deep facial vein
  2. With cavernous sinus via ophthalmic veins

The central face area is thus a “danger area” for an infection to travel into the skull or into the deep face.

31
Q

Lymphatic drainage of the face

A
  1. Lymphatic vessels of the face drain to submental, submandibular, and parotid lymph nodes.
  2. Ultimately lymph flow is to deep cervical lymph nodes along internal jugular vein.
32
Q

Parotid gland

A

A. Largest of the salivary glands.

B. Lies on posterolateral side of face; overlying ramus of mandible.

C. On Parotid bed

D. Invested in parotid fascia – derived from investing layer of deep cervical fascia.

33
Q

Parotid bed

A
  1. Superior boundary – zygomatic arch
  2. Medial boundary – ramus of mandible, styloid process and associated musculature
  3. Posterior boundary – external ear
  4. Inferior boundary – inferior border of mandible and posterior belly of digastric
  5. Anterior boundary – posterior border of masseter
34
Q

Parotid duct

A

leaves the anterior border of the gland, crosses the masseter muscle, turns around the anterior border of the muscle and pierces the buccinator muscle and mucosa of cheek to enter the oral cavity opposite the 2nd upper molar tooth.

35
Q

Clinical correlation- parotid duct

A

Abscesses or infections of dental origin may spread to the parotid gland via the parotid duct.

36
Q

Important structures embedded within the parotid duct/ gland (superficial to deep)

A
  1. Facial nerve
  2. Retromandibular vein
  3. External carotid artery
37
Q

clinical correlation: parotidectomy

A

During parotidectomy (surgery to removed parotid tissue) these structures must be isolated and protected in order to prevent damage:

  1. Facial nerve
  2. Retromandibular vein
  3. External carotid artery
38
Q

Parasympathetic innervation of parotid gland- preganglionic

A

1 Location of cell bodies – salivatory nucleus within brainstem

2 Preganglionic fibers travel with the glossopharyngeal nerve (CN IX).
3 CN IX exits at the jugular foramen and immediately gives a tympanic branch.
4 The tympanic nerve then enters the middle ear via the tympanic canaliculus.
5 Travels through the middle ear and then reforms as the lesser petrosal nerve.
6 Lesser petrosal nerve exits middle ear via hiatus for the lesser petrosal nerve; nerve is now in the middle cranial fossa and exits via the foramen ovale.
7 Lesser petrosal n is now in infratemporal fossa and synapses in otic ganglion.

39
Q

Parasympathetic innervation of the parotid gland- postganglionic

A

b. Postganglionic (distribute with V3)
1. Location of cell bodies – otic ganglion
2. Postganglionic fibers travel with the auriculotemporal branch of V3.

40
Q

function of parasympathetic innervation of parotid

A

secretomotor; stimulates gland secretion

41
Q

Sympathetic innervation of parotid gland

A

a. Preganglionic cell bodies located in the spinal cord at levels T1-T4.
b. Postganglionic cell bodies located in superior cervical sympathetic ganglion.
c. Postganglionic fibers travel with external carotid nerve to parotid tissue.
d. Function: vasomotor

42
Q

Parotiditis

A

refers to inflammation of the parotid gland. This can be very painful because of stretching of the parotid sheath. Pain from the parotid region is carried via the auriculotemporal branch of V3 and the great auricular nerve. Often, pain will “refer” to the auricle, TMJ, and external acoustic meatus.

43
Q

sialolith

A

A sialolith (calculus) is a calcified concretion that can sometimes form in the parotid gland. If it passes into the parotid duct, the duct can become blocked. This can be quite painful.

Neuro 2019 Exam 2 (14 decks)

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