The Face And Scalp Flashcards
What is Frey’s syndrome?
Uncontrolled sweating upon eating. Caused by promiscuous parasympathetic/sympathetic axons innervating sweat glands
(From when the parotid gland is lost)
What does V3 innervate for motor?
Masseter Temporalis Medial pterygoid Lateral pterygoid Tensor Tympani Tensor palati
What does sensation behind the tragal line?
C2 (greater occipital nerve)
What s tic doloroux (trigeminal neuralgia)?
Horrendous pain with no known counterpart in spinal nerves
What are the 5 layers of the head?
- Skin
- Connective tissue-dense
- Aponeurotica (galea)
- Loose ct (danger area)
- Periosteum of skull
- SCALP
What are the 3 parts of the orbicularis oculi and their function?
- Orbital part - winking
- Palpebral part - blinking (attached to medial and lateral check)
- Lacrimal part - compresses the lacrimal sac to release tears
What is blinking important for?
Wetting the cornea
What does the orbicularis oris do?
Purses the lips and manipulates food
What does the Buccinator muscle do?
(Important for swallowing)- attaches to the pterygoid-mandíbula Raphae in common with the superior pharyngeal constrictor. It’s fibers are at a right angle to the plane of the face
What is the galea aponeurotica?
A broad aponeurosis that extends over the head from the frontalis belly to the occipitalis muscle.
Forms a layer of a scalp.
Where are the LMNs cell body located for the facial nerve?
Facial motor nucleus in the brainstem on the opposite side of the muscle.
What are the 5 branches of the facial nerve and where do most of them pass through?
Temporal Zygomatic Bucal Marginal mandíbulas Cervical
They pass through the parotid gland
What is Bell’s palsy?
A paralysis of the peripheral branches of the facial nerve.
Cause is usually indeterminate, although Lyme disease is now implicated.
What are the effects of Bell’s palsy?
Paralysis due to LMN lesion (last 3-5 days)
- Orbicularis oris- drooling
- Buccinator- disrupted swallowing and speech
- Orbicularis oculi -tears cannot wet eyeball leading to ulceration
Note: severe cases produce major distortions of the face with psychological problems (can be remedied with nerve anostomosis)
What CN’s form a genu (knee bend) around the nucleus of CN VI to exit from the cranial cavity?
CN VII and VIII go around 6 and exit from the cranial cavity through the internal auditory meatus
What is the pathway of CN VII before the branches of the face?
- Goes around CN VI with VIII and goes into internal auditory meatus
- Passes through the facial canal where it innervates the Stapedius muscle (dampens sound)
- Exits the skull at the stylomastoid foramen where the nerve innervates the stylohoid and the posterior belly of the digastric muscle
- Forms branches of the face.
What are the symptoms that can occur with lesions to the facial nerve?
- Near stylomastoid foramen: Bell’s palsy
- In the facial canal: Bell’s Palsy and hyperacusis (exaggerated sound)
- At the internal auditory meatus: Bell’s palsy, hyperacusis, and problems with hearing and balance (happens with neuroma too)
What parasympathetic symptoms will occur with lesions to CN VII?
Reduced tearing and salivation
Note: the parasympathetic axons that activate the lacrimal, sublingual and submandibular glands are affected.
What is the path of the parotid (stensen’s) duct?
Crosses the face, wraps medial to the masseter muscle, pierces the Buccinator m, and enters the mouth adjacent to 2nd maxillary molar tooth
Note: occasionally there is an accessory gland along the duct
What pierces the Buccinator muscle?
Stensen’s duct (parotid)
What are some common problems with the parotid gland?
Parotitis
Pleomorphic (mixed) adenomas- benign tumors
What is parotitis? (Mumps)
Highly contagious virus that is characterized by swelling and pain.
Common in young without complications, but seriously in adults where the virus can cause:
- orchitis and rarely infertility
- increase chances for abortion
What is orchitis?
Swelling of the testicles
Why can the parotid gland be removed without damaging the surrounding nerves?
The branches of VII go through the parotid in one plane so that the gland above and below can be surgically removed without damaging the nerve.
What branch of V3 innervate the parotid gland (para)?
Aurículo-temporal
What happens to the parasympathetic axons when the parotid gland is removed?
They innervate sweat glands and can cause Frey’s syndrome when eating
What are the branches of V1?
LIESS
L: Lacrimal N. I: Infratrochlear N. E: Ethmoidal N. S: Supratrochlear N. S: Supraorbital N.
What are the cutaneous branches of V2?
ZIZ
Z: zygomaticofacial (small)
I: infraorbital
Z: zygomaticotemporal
What are the cutaneous branches of V3?
BAM
B: Buccal N.
A: Auricotemporal N.
M: Mental N.
Why can procedures be done under local anesthesia in the face?
The absence of overlap in peripheral branches means that each can be tested and anesthetize separately.
What is tic Doloroux (Trigeminal neuralgia)?
A horrendous, debilitating pain that usually involves the infraorbital nerve.
Where do afferents of V1 from cerebral blood vessels refer pain to?
Skin areas of the forehead and eye that are from a branch of the same nerve
What does the facial nerve do to avoid stretching when the mouth is opened? (Branch of external carotid)
Takes a tortuous corse near the mouth to avoid stretching when the mouth is opened.
What arteries can be used to support skin pedirles for facial reconstruction?
The superior temporal a and it’s branches that supply the scalp
Why do the superior temporal artery and its branches bleed a lot?
They are not end arteries, i.e. Blood will emerge from both cut ends.
Where can you get a pulse on the head region?
The superficial temporal and facial arteries
What path does the facial vein take and what drains into it?
The facial vein begins as angular vein and it courses to the lower border of the mandible.
It receives tributaries from the lip (labial), palpebral (eyelids) and the external nasal areas.
What does the facial vein become below the mandible?
It becomes the common facial vein, usually joining the retromandibular vein and terminating in the internal jugular vein
What are the most common fractures of the face?
Nasal bone (readily repaired)
Mandible
Where is the mandible usually fractured?
Across the foramina and can be accompanied by a fracture on the contralateral side. Repair is technically challenging to avoid malocclusions.
What are the serious Le fort fracture of the facial skull?
Type 1: horizontal across maxillae
Type II: through maxillary sinuses, infraorbital foramina, bones of medial orbit and then across the bridge of nose. The entire central part of the face becomes separated from the skull
Type III: horizontal through superior orbital fissure of the orbit. This causes separation from the skull
Why are type II and III le fort fractures extremely serious?
They involve the orbit and its contents
When are Le Fort fractures useful?
In cases of Crouzon’s syndrome (aka brachial arch syndrome, craniofacial dysostosis) in which a premature closure of facial sutures results in a desarticulación following the type 2 LeFort fracture lines.
Skin is provided by transposition from the scalp
What is the danger area of the scalp?
The loose connective tissue forms a potential space under the galea aponeurotica that is easily filled with blood. The blood can extravasated into the peri-orbital region resulting in echymosis (raccoo eyes).
Infections can take a similar path and can also gain access to the meninges and brain via emissary veins.
How can infections gain access to the brain?
Through the emissary veins from the loose connective tissue of the scalp
