Face and Scalp Flashcards by Allen Daniel

Bones forming the Facial skeleton

(Frontal)
(Ethmoid)
Nasal
Zygomatic
Maxilla

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Only movable facial bone

Mandible

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Trigeminal Nerve - CN V

3 branches:-

Ophthalmic
Maxillary
Mandibular

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Ophthalmic

Vi or V1

Sensory

Passes through the Superior Orbital Fissure

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Maxillary

Vii or V2

Sensory

Passes through the Foramen Rotundum

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Mandibular

Viii or V3

Mixed

Passes through Foramen Ovale

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Cutaneous innervation of the face

Sensory nerves of face enter though a series of foramina: V1 - Supraorbital; Supratrochlear

V2 - Infraorbital

V3 - Mental; Auriculotemporal

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Ophthalmic V1 sensory to:

Skin of forehead (most of)
Conjunctiva
Upper eyelid, bridge of nose
Frontal sinus
Antero-superior nasla cavity (muscosa)

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Maxillary V2 sensory to:

Most of skin of cheek, upper lip and all structures deep to them

upper teeth
gums
oral aspect of hard and soft palate
maxillary sinus
posterior-inferior nasal cavity

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Mandibular V3 sensory to:

Skin of temple
Most of skin over lower jaw

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Mandibular V3 Motor to:

Muscles of Mastication
Tensor tympani (dampens down sound i.e. from talking and chewing)
Tensor palatini (moves hard palate)
Anterior belly of digastric

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Inferior alveolar branch of Mandibular branch of CN V

enters the mandibular bone through the mandibular foramen
Used to deliver a Mandibular block
Branches off to the teeth as the Inferior Dental Plexus

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Surgical management of Trigeminal neuralgia

posterior fossa craniotomy (removing a bone flap from the skull) at the confluence of the sigmoid and transverse sinus

Vascual decompression of CN V

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Facial artery

Branch of the External Carotid Artery

Just above the Linguinal artery, which after a tortuous journey, ends as the Angular Artery at the medial commisure of the eye

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Transverse Facial Artery

Runs just above the Parotid Duct Branch of the Superficial Temporal Artery

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Common carotid artery - splits into 2

ICA : supplies Brain and the Circle of Willis
ECA: supplies the face (external)

Facial Vein (anterior facial vein)

Commences at side of root of the nose as a direct continuation of the angular vein

Lies BEHIND the Facial Artery and follows a less tortuous course

Receives blood from the External Palatine vein before:

joining the ant branch of the Retromandibular vein to form the Common Facial Vein
Draining directly into the Internal Jugular Vein

Clinical importance of Facial Vein

has a direct connection to the Ophthalmic vein and then to a deep venous sinus within the cranial activity, Cavernous Sinus.

Bacteria can enter the facial vein and gain access to internal cranial structures resulting in infection there

Muscles of Facial Expression

Epicranius : Frontalis & Occipitalis
Orbicularis Oculi
Orbicularis Oris
Buccinator
Zygomaticus
Platysma

Epicranius: Frontalis & Occipitalis

Origin to Insertion
Action

Origin/Insertion:

Cranial aponeurosis
Eyebrows

Action:

Raises the eyebrows

Orbicularis Oculi (eye)

Origin to Insertion
Action

Origin to Insertion:

Portions of the frontal and maxilla
to skin around the eyes

Action:

Blinks
Closes eyes

Orbicularis Oris (mouth)

Origin to Insertion
Action

Origin to Insertion:

Skin around mouth

Action:

Closes and protrudes the lips

Buccinator:

Origin to Insertion
Action

Origin to Insertion:

-Mandible/Maxilla to skin around mouth

Action:

Flattens cheek against teeth
Keeps food in mouth whilst you chew

Zygomaticus:

Origin to Insertion
Action

Origin to Insertion:

Zygomatic bone to corner of lips

Action:

Raises corner of mouth

Platysma * Origin to Insertion * Action

Origin to Insertion: * Fascia of chest * To lower border of Mandible Action: * Draws mouth downward

Facial Nerve CN VII Mneumonic: Two Zulus Borrowed My Cat

Motor Branches: * Temporal * Zygomatic * Buccal * Marginal Mandibular * Cervical

Facial Nerve Branchial Motor (special visceral efferent)

Supplies: * THE MUSCLES OF FACIAL EXPRESSION * Posterior belly of Digastric muscle * Stylohyoid * Stapedius

Facial Nerve Visceral Motor (general visceral efferent)

Parasymp innerv of: * lacrimal * submandibular * sublingual glands * mucous membranes of the nasopharynx, hard and soft palate

Facial Nerve Special sensory (Special afferent)

TASTE SENSTATION FROM THE ANT 2/3RDS of tongue hard and soft palates

Facial Nerve General Sensory (General somatic afferent)

General sensation from the skin of the concha of the auricle and from a small area behind the ear

Bell's Palsy

* Paralysis of muscles on one side of face * Due to swelling of facial nerve (CN VII) * Usually develops over 1-3 days * Slowly improves/completely goes away in 1-3 months * Most ppl with Bell's Palsy completely recover; some are left with weakness on side of face * \*Most common in adults in the 40s

Parotid Gland

* Tightly enclosed in fascia; swelling is painful = "mumps" * Contains TERMINAL branches of CN VII * Parotid duct lies on the Masseter and pierces the Buccinator * Duct opens into the oral cavity near the second upper molar tooth * External Carotid divides into its terminal branches in the gland (maxillary art. and superficial temporal)

SCALP N.B. also a useful acronym

Scalp is made up of 5 layers: * Skin * Connective tissue * Aponeurosis - occipito-frontalis * Loose connective tissue * Periosteum

Arterial supply of Scalp

* Superficial Temporal Artery * Supraorbital Artery * Occipital and Posterior Auricular Arteries These are free anastomoses from side to side. Vessels run through the dense connective tissue (in the 2nd layer of the scalp)

Scalp Cutaneous Innervation

* Front - Supraorbital nerve Vi Ophthalmic * Side - Auriculotemporal nerve Viii Mandibular * Back - Greater Occipital nerve CN II (optic) * Side - Lesser Occipital nerve CN II (optic)

Panda's Eyes

Loose connective layer of scalp: * can allow bacteria/fluid to pass freely from the post. aspect of the scalp into the eyelids in front * Trauma in back of head: can result in blood showing up in the eyelids * should make you suspect something going on in the back of the head

What is the skin over the angle of the jaw supplied by?

CN II Optic nerve