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Neuro > Superficial Face > Flashcards

Superficial Face Flashcards

1
Q

Layers of the SCALP

A

Skin

Connective Tissue - close, subcutaneous layer *has a superficial fatty and fairly vascular portion and a vascular deep portion - laceration can lead to perfuse bleeding

A: Aponeurotic layer –> Galea Aponeurotica, Scalp avulsions

L: Loose subaponeurotic layer (loose CT) - a potential space for the spread of infections, avulsion injuries. Spread of infections via emissary veins into the venous sinus

P: Periosteum -poor osteogenic properties

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2
Q

Scalp avulsions occur in which layer?

A

Aponeurotic layer

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3
Q

Which scalp layer can infections spread from the scalp to the brain?

A

Loose sub-aponeurotic layer (loose CT)

via the emissary veins into the venous sinus

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4
Q

CN: Depressed skull fractures

Which layers does it affect?

A

Over the superior sagittal venous sinus - a fraction of the bone will go into the superior sagittal venous sinus and cause the release of blood into the scalp in the Loose aponeurotic layer* leads to a scalp hematoma. There can be CSF here as well.

Seen above the eyebrows in baseball players - depressed skull fracture
If the baseball player gets hit with a bat or ball

  • Loose aponeurotic layer*
  • Scalp hematoma
  • CSF leakage
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5
Q

Skull fracture with pneumocephalus

*Mount Fuji Sign

A

Frontal fracture - little holes are air sinuses. The large dark area is a pnumocephalus - air that has gotten in. Air comes from the frontal sinus that broke - air goes into the cranial vault and this forms a dark area on an MRI

When air enters it can be a potential route for infection

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6
Q

Scalp Avulsion

A 
Affects the aponeurotic layer. Scalp avulsions occur secondary to an industrial accident. The patient ha long hair which was maintained in a pony tail 
S
C
A ** 
L- loose sub-aponeurotic layer 
P
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7
Q

Name the nerves of the scalp (6)

The posterior head and scalp are spinal nerves

A
  1. Supraorbital (V1)
  2. Supratrochlear (V1)
  3. Auriculotemporal (V3)
  4. Greater Occipital Nerve C2
  5. Lesser Occipital N. C2-C3
  6. Third Occipital N. C3- medial orbit
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8
Q

Companion nerves and arteries of the scalp:

Greater Occipital C2

A

Occipital A. - ECA

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9
Q

Companion nerves and arteries of the scalp:

Lesser Occipital N.

A

Posterior Auricular A. - ECA

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10
Q

Companion nerves and arteries of the scalp:

Auriculotemporal N.

A

Superficial Temporal A. - ECA

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11
Q

Companion nerves and arteries of the scalp:

Supraorbital N.

A

Supraorbital A. - ICA

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12
Q

Companion nerves and arteries of the scalp:

Supratrochlear N.

A

Supratrochlear A. - ICA

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13
Q

What layer of fascia surrounds the parotid gland?

A

Investing layer of deep fascia
splits into the deep layer of parotid fascia (weak) and the superficial layer of parotid fascia (strong)

  • Deep layer of parotid fascia is attached to the stylomandibular ligament
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14
Q

Deep layer of parotid fascia is attached to the

A

stylomandibular ligament

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15
Q

Facial Anatomy Layers

A
  1. Skin
  2. Superficial fat (subcutaneous fat)
  3. SMAS - superficial musculoaponeurotic system - Muscles of facial expression
  4. Retaining ligaments and spaces - run through * plastic surgeons
  5. Deep fat layer - this is absent on the forehead
  6. Deep fascia ** this is the layer that splits and surrounds the parotid gland - the facial nerve runs through this layer.
  7. Bones
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16
Q

The facial nerve runs through which layer of fascia?

A

Facial N. branches in parotid tissue

Deep fascia - splits around and invests the parotid gland

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17
Q

What is SMAS?

A

Superficial musculo-aponeurotic system
This is a layer of tissue deep to the subcutaneous tissue of the face and neck of the muscles of facial expression. Although it is fused with the parotid fascia, it is surgically elevated to perform lower face lifts. The SMAS extends from the platysma muscle to the galea aponeurotica and it is continuous with the temporoparietal fascia and galea. It connects to the dermis via vertical septa.

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18
Q

What fascia layer is used for lower face lifts?

A

SMAS

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19
Q

What are the contents embedded in parotid fascia?

A

Facial Nerve
Retromandibular Vein - medial to the facial nerve
External Carotid Artery

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20
Q

When is the parotid gland grossly inflamed?

A

Epidemic parotitis (mumps), and hypertrophied in patients with chronic bulimia.

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21
Q

What fascia forms the stylomandibular ligament?

What lies deep to that fascia?

A

Parotid fascia
The internal jugular
vein, cranial nerves IX, X, XI, and XII, the internal carotid artery lie deep to this fascia, in that order.

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22
Q

Superficial and deep parotid lymph nodes drain into the

A

Deep cervical lymph nodes

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23
Q

Sympathetic innervation of the parotid gland

A

After arising from the superior cervical ganglion, postganglionic sympathetic fibers to the parotid gland travel through the internal carotid plexus, carotico-tympanic nerve, tympanic plexus, lesser petrosal nerve, otic ganglion (no synapse), and auriculotemporal nerve before finally terminating in the parenchyma of the gland.

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24
Q

Parasympathetic innervation of the parotid gland

A

Preganglionic Parasympathetic fibers originate in the inferior salivatory nucleus, course in the glossopharyngeal nerve, tympanic nerve, tympanic plexus, and lesser petrosal nerve before synapsing in the otic ganglion. Postganglionic fibers reach the gland via the auriculotemporal nerve.

25
Q

The parotid duct has a relationship with what nerve?

A

Buccal Branches of the facial nerve
Pierces the buccinator muscle
enters the mouth opposite the crown of the second molar

26
Q

What facial expression muscle will be affected if the Marginal Mandibular N. is lacerated?

A

Depressor angel orgs m.

- you won’t be able to frown

27
Q

What nerve if lacerated will not allow you to raise you eyebrows?

A

Temporal branch of the facial nerve

28
Q

In the parotid gland, the facial nerve courses lateral to the

A

Retromandibular vein

29
Q

In a viral infection such as mumps - why does it hurt to open the mouth?

A

The parotid gland is wrapped around the ramus of the mandible - a viral inflammation of the parotid gland (MUMPS) - it hurts to open the mouth because the mandible will come back and squeeze the inflamed gland

30
Q

What nerve supplies sensory fibers to the middle ear?

General Visceral Afferent fibers

A

Glossopharyngeal N. IX –> Tympanic N. [Parotid gland]
Otitis Media - if a child is crying
General visceral afferent fibers are irritated

31
Q

In order to reach the Otic Ganglion [Parotid gland] the lesser petrosal nerve must travel through

A

the foramen oval

32
Q

The motor nucleus are CN VII (SVE) innervate

A

The muscles of facial expression, stylohyoid, and the posterior belly of the digastric m.

The anterior belly of the digastric muscle is innervated by the nerve to mylohyoid - comes from V3 –> inferior alveolar n –> nerve to mylohyoid

33
Q

Describe the course of the facial n.

A

The facial nerve exits the brainstem, passes through the internal auditory meatus and enters the facial canal. The facial canal is a sigmoid-shaped tunnel embedded in the petrous temporal bone, and intimately associated with internal ear. The facial nerve exits the facial canal at the stylomastoid foramen. There are three branches of the facial nerve during its course through the facial canal

34
Q

What nerves branch off the facial nerve in the facial canal?

A
  1. Nerve to stapeidus M –> lesion results in hyperacusis
  2. Greater petrosal N. –> goes to the lacrimal gland, a lesion to this nerve would result in a decrease in lacrimation
  3. Chodra Tympani Nerve –> submandibular and sublingual glands. A lesion to this nerve will result in the loss of taste sensation to the anterior 2/3 of the tongue, decrease in salivation from the submaxillary glands
35
Q

What muscle of facial expression allows you to raise your eyebrows? What branch of the facial nerve innervates this muscle?

A

Frontalis M.

Temporal Branch

36
Q

What muscle of facial expression allows you to blink? What nerve innervates this muscle?

A

Orbicularis Oculi
Temporal branch of VII
Zygomatic branch of VII

37
Q

What muscle allows you to smile? What nerve innervates this muscle?

A

Zygomatic Major M.

Zygomatic branch of VII

38
Q

What muscle allows you to pucker your lips? What nerve?

A

Orbicularis oris

Buccal Branch of VII

39
Q

What muscle allows you to flare your neck?

A

Platysma M.

Cervical Branch of VII

40
Q

Inability to elevate the eyebrows

What muscle? What nerve?

A

Frontalis M.

Temporal Branch of VII

41
Q

Drooping of the lower eyelid, spilling of tears (ectropion),spilling of tears (epiphora), and corneal drying.

What muscle? What nerve?

A

Orbicularis Oculi

Temporal Branch of VII
Zygomatic Branch of VII

42
Q

Drooling of saliva from the corner of the mouth, food falling out of the corner of the mouth
What muscle? What nerve?

A

Orbicularis Oris

Buccal Branch of VII

43
Q

Inability to elevate and retract the angle of the mouth

What muscle? What nerve?

A

Zygomatic Major - smiling

zygomatic branch of VII

44
Q

What muscle allows you to frown?

A

Depressor anguli oris

Zygomatic branch of VII

45
Q

What are the clinical presentations of Belly’s Palsy?

A
  • FACIAL N.
  • Drooping of the lower lid (ectropion)
  • Spilling of tears from the eyes (epiphora)
  • Drying of cornea
  • Inability to wink or raise the eyebrow’s
  • Unequal smile
  • Drooling from the corner of the mouth
  • Hyperacusis

*you need to protect the eye because the patient can’t close the eye - they have to close the eye lids.

Mass on the parotid gland - squamous cell carcinoma can be a cause of Bell’s palsy

46
Q

What muscle is used to suck on a straw? Manipulation of food and sucking/ blowing action
This is a muscle of facial expression, what nerve innervates this muscle?

A

Buccinator

- Buccal branch of VII

47
Q

Which artery supplies the medial aspect of orbit terminal branch of facial; anastomoses with branches of the ophthalmic artery (ICA)?

A

Angular A.

48
Q

Infraorbital A. is a terminal artery of the

A

Maxillary A.

49
Q

Angular V is formed at the junction of the

A

Supra-trochlear V. and Supra-orbital V. –> drain into the cavernous sinus

50
Q

What drains the cheek?

A

deep facial vein –> facial vein drains into the internal jugular vein - at the level of the hyoid

51
Q

Where is the retromandibular vein located?

A

It is located deep to the mandible, parotid gland and facial N. (VII)

Drains the temporal/ cheek region

52
Q

The retromandibular vein joins the ____ to make the external jugular vein.

A

Posterior auricular vein

53
Q

The infra-orbital and mental veins drain into the ____ plexus

A

pterygoid plexus

54
Q

What nerve supplies the skin of the lateral aspect of

the forehead and scalp?

A

V1
Suborbital N.

All GSA fibers will terminate in the trigeminal sensory complex

55
Q

What nerve supplies the skin of the medial aspect of the forehead and scalp?

A

V1
Subtrochlear N.

All GSA fibers will terminate in the trigeminal sensory complex

56
Q

What nerve supplies the skin of the antero-superior cheek region?

A

V2
Infraorbital nerve

All GSA fibers will terminate in the trigeminal sensory complex

57
Q

What nerve supplies the skin of the malar prominence.

A

V2
Zygomaticofacial nerve

All GSA fibers will terminate in the trigeminal sensory complex

58
Q

What nerve supplies the skin of the temporal region?

A

V3
Auriculotemporal N.

All GSA fibers will terminate in the trigeminal sensory complex

59
Q

What nerve supplies mucous membrane and skin of the inner and outer cheek, respectively.

A

V3 Long buccal nerve

All GSA fibers will terminate in the trigeminal sensory complex

Neuro (6 decks)

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