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Anatomy > Sensory innervation of the face (A16) > Flashcards

Sensory innervation of the face (A16) Flashcards

1
Q

dermatome

A

-area of skin supplied by the sensory fibres in a given somatic nerve

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2
Q

what is the nipple line supplied by

A

thoracic spinal nerve 4 (T4)

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3
Q

what is the umbilicus (belly button) supplied by

A

thoracic spinal nerve 1 (T1)

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4
Q

which two nerves supply sensory innervation to the face

A
  • great auricular nerve (C2,C3)

- trigeminal nerve (CN V)

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5
Q

great auricular nerve and innervation

A
  • C2, C3
  • spinal nerve branch (connects with the spinal cord)
  • supplies sensory innervation to the angle of the mandible, area underneath the mandible and the earlobe)
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6
Q

3 branches of trigeminal nerve (CN V)

A
  • tri=3, germinal=same genes
  • trigeminal nerve is divided into 3 branches: ophthalmic, maxillary and mandibular (and these branches have subsequent branches)
  • all 3 branches are not identical (some branches of Vc contain motor fibres as well as sensory)
  • supplies sensory innervation to the rest of the face (areas not innervated by the great auricular)
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7
Q

1st branch of trigeminal nerve (CN V)

A
  • ophthalmic division of trigeminal/V1/Va
  • branches are found in the region of the orbit, mid-nose and forehead
  • ophthalmic relates to the eyes
  • supplies sensory innervation
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8
Q

2nd branch of trigeminal nerve (CN V)

A
  • maxillary division of the trigeminal/V2/Vb
  • branches found in region of maxilla and anterior temple
  • supplies sensory innervation
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9
Q

3rd branch of the trigeminal nerve (CN V)

A
  • mandibular division of the trigeminal/V3/Vc
  • branches found in relation to mandible and mid- temple
  • supplies sensory AND motor innervation (motor fibres supply the muscles of mastication/chewing)
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10
Q

why does the mandibular branch of the trigeminal nerve differ to the maxillary and ophthalmic branches

A
  • contains sensory AND motor fibres (whereas the other 2 branches only supply sensory innervation)
  • motor fibres supply the muscles of mastication/chewing
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11
Q

different nomenclature used for the branches of the trigeminal nerve (CN V)

A
  • 1st branch=ophthalmic division of trigeminal/V1/Va
  • 2nd branch=maxillary division of the trigeminal/V2/Vb
  • 3rd branch=mandibular division of the trigeminal/V3/Vc
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12
Q

areas of skin supplied by ophthalmic division of the trigeminal nerve

A

supplies all of forehead region, upper eyelid, medial and lateral corners of the eye, dorsum of the nose and medial ala (wing of nose)

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13
Q

areas of skin supplied by maxillary division of the trigeminal nerve

A

anterior part of temple, lower eyelid, majority of midface including prominence(maxillary prominence/process), maxilla, lateral aspect of ala (wing of nostril), nostrils, upper lip

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14
Q

areas of skin supplied by mandibular division of the trigeminal nerve

A

mid portion of temples, buccal area (where you would expect to find the buccinator muscle), chin

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15
Q

sensory innervation to the angle of the mandible

A
  • not supplied by any branches of the trigeminal

- supplied by greater auricular nerve (C2,C3)

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16
Q

cervical plexus

A

involves spinal nerves C3,C4,C5

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17
Q
  • how is the chicken pox virus able to reactivate to cause ophthalmic herpes zoster (“shingles”)
  • symptoms
  • treatment
A
  • virus doesn’t leave the body, it stays in the trigeminal sensory ganglion in dormant states (within the dorsal root ganglia associated with spinal nerve)
  • reactivates from its latent state
  • chicken pox transmits over face via CNV1 (opthalmic division of trigeminal)
  • causes pain/itch/blisters in the opthalmic dermatome region supplied by CNV1 (all of forehead, upper eyelid, medial/lateral corners of the eye, dorsum of the nose, medial aspect of ala/wing of nose/nostril)
  • can involve the eye
  • treated with antiviral
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18
Q

trigeminal ganglia

A
  • CNV
  • chicken pox virus can remain dormant in trigeminal ganglia (within the dorsal root ganglia associated with the spinal nerve)
  • distal part of trigeminal nerve, before nerve splits into its 3 primary divisions
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19
Q

5 named branches of the ophthalmic division of the trigeminal nerve

A 
1-lacrimal nerve
2-supraorbital nerve
3-supratrochlear nerve 
4-infratrochlear nerve 
5-external nasal nerve
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20
Q

lacrimal nerve

A
  • 1st branch of ophthalmic division of trigeminal
  • lacrimal gland supply
  • secretomotor supply (to produce tears)
  • supplies lateral aspect of skin on eyelid
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21
Q

supraorbital nerve

A
  • 2nd branch of ophthalmic division of trigeminal
  • supplies skin of majority of forehead, scalp (wide extensive)
  • exits via supraorbital foramen/notch
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22
Q

supratrochlear nerve

A
  • 3rd branch of ophthalmic division of trigeminal
  • supplies skin on medial aspect of forehead, conjunctiva (lines inside of eyelids and covers sclera) and skin of upper eyelid
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23
Q

infratrochlear nerve

A
  • 4th branch of ophthalmic division of trigeminal

- supplies skin on medial aspect of the eyelid

24
Q

external nasal nerve

A
  • 5th branch of ophthalmic division of trigeminal

- supplies skin of dorsum of nose and medial ala (wing of nostril)

25
Q

where does the supraorbital nerve exit the skull

A

via supraorbital foramen from cranial cavity (neurovascular bundle comes through here)

26
Q

3 branches of maxillary division of trigeminal

A

1-zygomaticotemporal nerve
2-zygomaticofacial nerve
3-infraorbital nerve

27
Q

zygomaticotemporal nerve

A
  • branch of maxillary division of trigeminal
  • supplies skin on anterior region of temple,
  • passes through zygomaticotemporal foramen
28
Q

zygomaticofacial nerve

A
  • branch of maxillary division of trigeminal
  • supplies skin on prominence of cheek
  • exits via zygomaticofacial foramen
29
Q

infraorbital nerve

A
  • branch of maxillary division of trigeminal
  • supplies (extensively) to majority of mid face, lower lip/eyelid, lateral aspect of ala/nostril
  • travels through the infraorbital foramen
  • sits below levator labii superioris muscle
30
Q

3 branches of mandibular division of trigeminal

A

1-auriculotemporal nerve
2-long buccal nerve
3-mental nerve

31
Q

auriculotemporal nerve

A
  • branch of mandibular division of trigeminal

- supplies mid temple region

32
Q

long buccal nerve

A
  • branch of mandibular division of trigeminal

- supplies buccinator muscle

33
Q

mental nerve

A
  • branch of mandibular division of trigeminal
  • supplies skin on chin and lower lip
  • travels through mental foramen
  • lies below levator labii inferioris
34
Q

supraorbital and infraorbital foramen

A
  • supraorbital may be a notch (as they sit just above superior orbital rim)
  • infraorbital is always a foraminae (where the infraorbital nerve exits)
35
Q

other foraminae of the face

A
  • mental

- zygomaticofacial

36
Q

why does the chicken pox virus cause itchiness

A

-chicken pox virus infects the sensory nerve endings in the skin stimulating action potentials that travel centrally causing an itch

37
Q

why is ophthalmic herpes zoster painful

A
  • can cause post herpetic neuralgia/ trigeminal neuralgia

- neuralgia= intense, typically intermittent pain along the course of a nerve, especially in the head or face

38
Q

route of ophthalmic division of trigeminal nerve

A
  • exits cranial cavity through superior ophthalmic fissure

- passes through superior aspect of orbit

39
Q

route of maxillary division of trigeminal nerve

A
  • exits cranial cavity initially via foramen rotundum
  • travels in inferior aspect/part of orbit
  • and through infraorbital foramen
40
Q

route of mandibular division of trigeminal nerve

A

-exits base of skull via foramen ovale
-and through mandibular foramen inside
-mental nerve
?

41
Q

clinical testing of the sensory component of CNV (trigeminal nerve/sensory nerve supply to the face)

A
  • ask patient to close eyes
  • gently brush the skin in each dermatome with a fine tip of cotton wool
  • ask the patient to tell you when they feel their skin being touched
  • test both sides (bilaterally)
42
Q

layers of scalp

A
  • Skin
  • Connective tissue (vascular layer-arterial blood supply to scalp contained within)
  • Aponeurosis (epicranial connects frontalis to occipitalis)
  • Loose connective tissue
  • Pericranial periosteum (PERICRANIUM specifically)
43
Q

infiltration of connective tissue layer of the scalp

A
  • supratrochlear and supraorbital branches of internal carotid artery
  • superficial temporal, occipital and posterior auricular branches of external carotid artery
44
Q

external layer of scalp

A

skin

45
Q

arteries contributing to arterial supply in connective tissue of scalp

A
  • 3 branches of external carotid: occipital artery, posterior auricular artery and superficial temporal artery
  • 2 terminal branches of internal carotid artery (which has no branches in neck): ophthalmic which then branches into supraorbital and supratrochlear
46
Q

branches of internal carotid artery within the neck

A
  • DOES NOT give branches in the neck

- only branches once inside the skull

47
Q

mental artery

A

-branch of maxillary artery

48
Q

infra-orbital artery

A

-branch of maxillary artery

49
Q

facial artery

A
  • branch of external carotid

- passes posterior to angle of mandible, travels up face and branches to lips and lateral to nose

50
Q

maxillary artery

A

-contributes to supply of face
-branch of external carotid artery
further branches- infraorbital artery, mental artery

51
Q

blood supply to upper face

A

internal carotid (rest of face supplied by external carotid)

52
Q

anastomosis

A

-network of multiple arteries

53
Q

why is it a problem if the connective tissue layer of the scalp is cut

A
  • due to the anastomosis (network of multiple arteries), the blood can travel in both directions of network therefore will bleed profusely/ to a great degree
  • dense connective tissue surrounding arteries also holds them open when cut and prevents them contracting in an attempt to close over and stop bleeding like they usually would
54
Q

epicranial aponeurosis

A
  • 3rd layer of scalp
  • flat tendon connecting two muscles (frontalis and occipitalis)
  • connects anteriorly to frontalis and posteriorly to occipitalis
55
Q

loose connective tissue layer of scalp

A

allows mobility of aponeurosis sitting above it

56
Q

frontal occipital complex

A

joining of occipitalis to frontal bone (?)

57
Q

pericranium

A
  • pericranial periosteum (say PERICRANIUM)
  • very thin tissue on top of bones of skull
  • responsible/allows initial bone formation/has relation to ossification

Anatomy (21 decks)

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