Clinical Anatomy of the Face

Question 1

What is the ‘cranium’?

Answer 1

Skeleton of the head i.e. the skull

Question 2

What are the 2 parts of the skull?

Answer 2

Neurocranium (bony covering of brain and meninges) and viscerocranium (facial skeleton)

Question 3

What is the neurocranium?

Answer 3

• Bony covering of the brain and meninges
• Roof called calvaria
• Floor called the cranial base
• 8 bones: frontal, ethmoidal, sphenoidal, occipital, temporal, parietal

Question 4

What is the viscerocranium?

Answer 4

• Facial skeleton

- 14 bones

Question 5

Which bones of the neurocranium are pneumatised?

Answer 5

Frontal, temporal, sphenoidal, ethmoidal

contain air filled cavities

Question 6

What percentage of communication is non-verbal?

Answer 6

80-90%

Question 7

How many muscles are in the face?

Answer 7

43

Question 8

What are the boundaries of the face?

Answer 8

Extends from forehead to chin, and from ear to ear

Question 9

Cranial nerves come off our brain. What are the 12 cranial nerves?

Answer 9

1. Olfactory
2. Optic
3. Oculomotor
4. Trochlear
5. Trigeminal
6. Abducens
7. Facial
8. Vestibulocochlear
9. Glossopharyngeal
10. Vagas
11. Accessory
12. Hypoglossal

Question 10

What are the 3 branches of the trigeminal nerve (V)?

Answer 10

V1: Ophthalmic branch (sensory)
V2: Maxillary branch (sensory)
V3: Mandibular branch (sensory and motor)

Question 11

Name the muscles of mastication

Answer 11

Masseter (zygomatic arch -> mandible)
Temporalis (frontal/parietal bones -> coronoid process of mandible)
Lateral pterygoid
Medial pterygoid

Question 12

If a patient has a problem with muscles on one side of the face, what is typically observed clinically?

Answer 12

Overcompensation on the opposite side

Question 13

Which nerve supplies the 43 muscles of the face?

Answer 13

Facial Nerve (CN VII)

Question 14

What is the muscle in lips termed?

Answer 14

Orbicularis oris

Question 15

Which muscle forms the cheeks?

Answer 15

Buccinator

Question 16

Which cranial nerve does puffing out the cheeks test?

Answer 16

Tests the integrity of the facial nerve (CN VII)

Question 17

If the buccinator muscles don’t work, what will a patient be unable to do?

Answer 17

Patient will not be able to push food into centre of mouth

Question 18

What are the 2 components of the orbital oculi muscle?

Answer 18

Orbital part: responsible for scrunching up the eye

Palpebral part: tiny part of the eyelid - makes sure the eyes are closed when you sleep

Question 19

Which major salivary gland does the facial nerve pass through?

Answer 19

Parotid

Question 20

The facial nerve, retromandibular vein and external carotid artery all pass through which gland?

Answer 20

Parotid gland

Question 21

Which virus causes mumps and which region does it affect?

Answer 21

Paramyxovirus

Parotid gland - swelling (hamster appearance)

Question 22

What is Bell’s palsy?

Answer 22

The most common cranial neuropathy
Complete facial paralysis on one side of the face
Diagnosed only if no specific cause can be identified

Question 23

What is the most common cranial neuropathy?

Answer 23

Bell’s Palsy

Question 24

Which treatments may help relieve symptoms of Bell’s Palsy?

Answer 24

Prednisolone - steroid medication

Acyclovir - antiviral medication typically used to treat herpes simplex infections

Question 25

Which virus is a potential risk factor for Bell's Palsy?

Answer 25

Herpes simplex/zoster virus | Controversial

Question 26

What percentage of all head and neck tumours are in the salivary glands?

Answer 26

3%

Question 27

What percentage of tumours of the salivary glands are of the parotid gland?

Answer 27

75-85%

Question 28

What percentage of tumours in the parotid gland are benign?

Answer 28

75-80%

Question 29

Which 2 factors does facial reanimation following paralysis depend on?

Answer 29

1. Level of injury | 2. Duration of paralysis

Question 30

How is Bell's Palsy usually treated?

Answer 30

Usually resolves spontaneously for most patients

Question 31

What are the options for treatment if someone's face has been paralysed?

Answer 31

1. Immediate/early reconstruction (dynamic) 2. Intermediate reconstruction (dynamic) 3. Late reconstruction (static)

Question 32

Why is facial reconstruction after 12 months of paralysis not possible?

Answer 32

After 12 months, nerve and motor end plates die

Question 33

What is the hypoglossal-facial anastomosis approach to facial reconstruction?

Answer 33

- The hypoglossal nerve is joined to the facial nerve to reinnervate patient's face following facial paralysis - Used for patients with intermediate duration length facial paralysis - Side-to-end anastomosis most popular

Question 34

Where is the fascia lata located?

Answer 34

On the thigh

Question 35

How can the fascia lata from the thigh be used to treat patients with long-standing facial paralysis?

Answer 35

Use fascia lata to tunnel through hairline and under the skin, used to pull up side of the face to regain facial symmetry

Question 36

What is the benefit of keyhole surgery?

Answer 36

Minimal scarring