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Human Systems > Clinical anatomy of face > Flashcards

Clinical anatomy of face Flashcards

1
Q

What is the cranium

A

Skeleton of the head

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2
Q

What are the two parts of the cranium

A

Neurocranium (bony covering of brain and meninges)​
- Roof called the calvaria​
- Floor called the cranial base​
- Eight bones (frontal (1), ethmoid (1), sphenoid (1), occipital (1), temporal (2), parietal (2))​

​Viscerocranium (facial skeleton)​
- 14 bones​, Frontal, temporal, sphenoid, ethmoid and maxillary bones are pneumatised

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3
Q

What does pneumatised bones mean

A

Air within the bones. For the frontal, sphenoid, ethmoid and maxillary bones, these are in the form of paranasal sinuses

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4
Q

What percentage of non-verbal communication does our face provide

A

80-90%

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5
Q

What are the two main nerves which innervate the face

A

Trigeminal nerve supplies sensory innervation to the face (ophthalmic, maxillary and mandibular divisions) as well as motor innervation to the muscles of mastication (masseter, temporalis, and the two pterygoid muscles – lateral and medial).​

Facial nerve from a clinical perspective supplies the muscles of facial expression (branchial motor fibres/special visceral efferent), special sensory fibres (special visceral afferent; taste), general sensory fibres (general somatic afferent; ear), parasympathetic fibres (general visceral efferent – innervating the sublingual and submandibular salivary glands)​

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6
Q

What parts of the face does each division of the trigeminal nerve supply

A

Ophthalmic nerve​

-Forehead and scalp​
-Frontal and ethmoidal sinus​
-Upper eyelid and its conjunctiva​
-Cornea (see clinical relevance)​
-Dorsum of the nose​

​

Maxillary nerve​

-Lower eyelid and its conjunctiva​
-Cheeks and maxillary sinus​
-Nasal cavity and lateral nose​
-Upper lip​
-Upper molar, incisor and canine teeth and the associated gingiva​
-Superior palate​

​

Mandibular nerve​
(Sensory supply)

-Mucous membranes and floor of the oral cavity​
-External ear​
-Lower lip​
-Chin​
-Anterior 2/3 of the tongue (only general sensation; special taste sensation supplied by the chorda tympani, a branch of the facial nerve)​
-Lower molar, incisor and canine teeth and the associated gingiva​

(Motor Supply)

-Muscles of mastication; medial pterygoid, lateral pterygoid, masseter, temporalis​
-Anterior belly of the digastric muscle and the mylohyoid muscle (these are suprahyoid muscles)​
-Tensor veli palatini​
-Tensor tympani”

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7
Q

What is herpes simplex

A

Virus caused by herpes simplex virus. There are 2 types, Type 1 and Type 2 and around the mouth, Type 1 is more common the mouth and Type 2 around the genitalia.
It could cause a cold sore around the corners of the mouth, affecting the maxillary or mandibular territories.

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8
Q

What is VZV

A

Varicella zoster virus (VZV): Primary varicella zoster infection results in CHICKENPOX and can cause lung and airway disease like bronchitis or pneumonia. When it resolves the virus lays dormant in the ganglia (collection of cell bodies) and can reactivate in 10-20% of people resulting in shingles or herpes zoster

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9
Q

What are the muscles of mastication

A

Masseter (zygomatic arch-mandible)​

Temporalis (frontal/parietal bones – coronoid process of mandible)​

Pterygoids (lateral and medial)​

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10
Q

What is the function of the lateral pterygoid

A

Both left and right acting at the same time will result in protraction of the mandible. When one acts on its own it results in deviation of the mandible to the opposite side

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11
Q

What does the masseter do

A

Elevates the mandible and closes the mouth​

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12
Q

What is the function of the temporalis

A

Elevates the mandible and closes the mouth, retraction of the mandible

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13
Q

What does the medial pterygoid control

A

Elevation of the mandible, closure of the mouth

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14
Q

How many muscles are in the face

A

43 - arranged around orifices
supplied by facial nerve

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15
Q

What is the orbicularis oris

A

Originates from the maxilla and cheek muscles inserting into the lips – skin and mucous membrane of the lips. This is involved in pursing of the lips – think of the selfie pout

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16
Q

What supplies the orbicularis oris

A

Buccal branch of facial nerve

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17
Q

What is the buccinator

A

Originates from the maxilla and the mandible and extends down to blend with the orbicularis oris and the skin of the lips

Pulls cheeks inwards resulting in pushing food and fluid into the centre of the oral cavity

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18
Q

What supplies the buccinator

A

Buccal branch of facial nerve

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19
Q

What does the orbital part of the obicularis oculi muscle do

A

Strong closure of the eyes, thicker part of this muscle

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20
Q

What does the palpebral part of the orbicularis oculi muscle do

A

In the eyelids, can do soft closure of the eyes including blinking

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21
Q

What are the auricular muscles

A

Auricularis superior/ anterior/posterior muscles

Very small and vestigial in humans and few of us are able to easily move our ears voluntarily

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22
Q

Where does the parotid gland enter the mouth

A

Opposite the second upper molar

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23
Q

What major structures pass through the parotid gland

A

External carotid artery (and terminal branches – maxillary and superficial temporal arteries)​

Retromandibular vein (superficial temporal and maxillary veins unite)​

Facial nerve​

24
Q

What is Mumps

A

Mumps is caused by a paramyxovirus and the relevance here is that it can cause swelling of the parotid gland, and lymph nodes, including those inside the parotid gland. These swellings are painful and give a hamster appearance, and are sore as they stretch the fascia (connective tissue) which surrounds the parotid gland.​

25
Q

Why are mumps so dangerous

A

It causes a number of problems like deafness, infertility and meningitis. It is usually a self limiting condition and clears itself, and analgesia and bed rest are the only supportive treatments available

26
Q

What is the most common condition of the face

A

Bell’s Palsy

Named after Sir Charles Bell​

Facial paralysis on 1 side​

Most common cranial neuropathy​

Diagnosed only if no specific cause can be identified

27
Q

Where does the facial nerve leave the skull

A

Stylomastoid foramen

28
Q

What are the treatments for bell’s palsy

A

Prednisolone​

Acyclovir​

29
Q

What are the five main branches of the facial nerve supply the muscles of facial expression

A

Temporal branch – Innervates the frontalis, orbicularis oculi and corrugator supercilii​

Zygomatic branch – Innervates the orbicularis oculi.​

Buccal branch – Innervates the orbicularis oris, buccinator and zygomaticus muscles.​

Marginal Mandibular branch – Innervates the mentalis muscle.​

Cervical branch – Innervates the platysma

30
Q

Why is a nerve stimulator used in surgery to remove parotid gland

A

Buzz any area which looks like the facial nerve and this will result in the electrodes picking up the impulses​ allowing surgeon to avoid these areas and maintain full nervous stimulation in face

31
Q

What are the different types of reanimation

A

Immediate/early reconstruction (dynamic)- full movement

Intermediate reconstruction (dynamic)​ - full movement

Late reconstruction (static) - cosmetic/aesthetic

32
Q

How can facial reanimation be achieved

A

Hypoglossal - Facial anastomosis

used for intermediate duration length facial paralysis

Causes contraction of the face every time the patient eats or drinks but this can be diminished with intense craniofacial physiotherapy and botox type B injections

33
Q

What is the fascia lata

A

The thickened aspect of this called the iliotibial tract, is a fibrous avascular band running down the lateral aspect of the thigh, with a very minor role in hip movement and knee stabilization​

34
Q

What does the use of the fascia lata allow for

A

The main purpose of this was to provide symmetry to the face and stop sagging and improve the patient’s confidence

The piece of the patient’s own fascia lata was taken out and transferred to the face for those patient’s with a longstanding facial paralysis which could not be otherwise operated or treated

It was placed in and around the zygomatic bone and anchored to the modiolus – the corner of the mouth. Placing here prevents the joker smile

Allows for facial reanimation

35
Q

Who was the most famous contributor to anatomic andfunctional knowledge of the face

A

Sir Charles Bell

36
Q

What is the basis of Bell’s palsy

A

Idiopathic, generally related to inflammation of the stylomastoid foramen

37
Q

What is the nerve supply of the tempoarlis

A

Mandibular division of the trigeminal nerve

38
Q

How can you clinically test the nerve supply of the temporalis

A

Ask patient to clench teeth while feeling the muscle

39
Q

What condition commonly affects the buccinator

A

Stroke - affects ability to keep food in the middle of the mouth

40
Q

What is the nerve supply of the buccinator

A

Buccal branch ofthe facial nerve

41
Q

How cna you test the integrity or the buccinator and its nerve supply

A

Ask patient to puff out cheeks

42
Q

What additional gland can be found anterior to the main parotid gland

A

Accessory Parotid gland

43
Q

Name three structures that pass throughthe parotid gland

A

Facial nerve, retromandicular vein, external carotid artery

44
Q

What are the two components of the orbicularis oculi

A

Palpebral and oribital parts

45
Q

What is the function of the palpebral obicularis oculi

A

Soft closure of eyelids

46
Q

What part of the obicularis occuli controls strong closure

A

Orbital

47
Q

What is the nerve supply ofthe orbicularis oculi

A

Temporal and zygomatic branches of the facial nerve

48
Q

What are consequences of paralisation of the orbicularis oculi

A

Corneal dryng, iritation, corneal ulceration

49
Q

What are the attachments of the masseter

A

zygomatic arch and mandible

50
Q

What nerve supplies the masseter

A

Mandibular division of the trigeminal nerve

51
Q

How would you test the integrity of the masseter

A

Ask patient to clench teeth

52
Q

What are the main branches arising from the anterior border of the paroid gland called

A

Temporal, Zygomatic, Buccal, Marginal Mandibular and cervical

53
Q

What broad sets of muscles does the temporal branch of the parotid gland supply

A

Frontalis and upper eye muscles

54
Q

What bone in the base of the skull does the facial nerve pass through

A

Petrous temporal bone

55
Q

Where does the facial nerve exit the skull from

A

Stylomastoid foramen

Human Systems (34 decks)

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