Face, scalp and parotid

Question 1

What are the margins of the scalp?

Answer 1

From external occipital protuberance posteriorly to supraorbital margins anteriorly

Extends to the level of the zygomatic arches laterally

Question 2

What are the layers of the scalp, from external to internal?

Answer 2

Skin

Dense connective tissue

Aponeurotic layer (of occipitofrontalis)

Loose connective tissue

Pericranium

Question 3

Which layer of the scalp allows it to move?

Answer 3

Loose connective tissue

Question 4

Which two muscles form the aponeurotic layer of the scalp?

Answer 4

Occipitalis and frontalis

Question 5

What are the actions of occipitalis and frontalis?

Answer 5

Move the scalp and raise the eyebrows

Question 6

What happens when a laceration to the scalp divides the aponeurosis?

Answer 6

Wound will gape, as occipitalis and frontalis will pull in opposite directions

Question 7

In which layer of the scalp is the neurovascular plane found?

Answer 7

Dense connective tissue

Question 8

Why does a scalp laceration bleed so profusely?

Answer 8

1: There is a rich vascular arrangement within the scalp, with many anastamoses between branches of the internal and external carotid arteries
2: The dense connective tissue has fibrous septa, that adhere to vessels and prevent constriction

Question 9

What are the layers of the face?

Answer 9

Skin

Dense connective tissue

Muscles of facial expression

Pericranium

Question 10

Whta do the facial muscles attach to?

Answer 10

Arise from bone or fascia and attach to skin of face

Question 11

How are the facial muscles organised?

Answer 11

Organised to surround the facial orifices; either act as sphincters or dilators

Question 12

Describe the general properties of sphincter and dilator facial muscles?

Answer 12

Sphincters: circular, name ‘ocularis’

Dilators: span out from corners, name ‘depressor’ or ‘levator’

Question 13

Which cranial nerve supplies the facial muscles?

Answer 13

CN VII

Facial nerve

Question 14

What is the embryological origin of the facial muscles?

Answer 14

Second pharyngeal arch

Question 15

Describe the dermatomes of the head and neck?

Answer 15

Question 16

Which nerves supply the dermatomes of the head and neck posterior to the ears?

Answer 16

Dorsal rami or cervical spinal nerves (C2 and C3)

Question 17

Where is the ganglion of the trigeminal nerve found?

Answer 17

Petrous part of temporal bone

Question 18

Which cranial nerve is responsible for sensation of the face?

Answer 18

CN V

Trigeminal nerve (V1, V2 & V3)

Question 19

Which two major arteries give branches that supply the face?

Answer 19

Internal carotid

External carotid

Question 20

List the arterial branches to the face that arise from the internal carotid artery? What do the supply?

Answer 20

Supraorbital branches

Supratrochlear branches

Both supply the centre of the forehead

Question 21

Which gives off a greater blood supply to the face: the internal carotid or the external carotid?

Answer 21

External carotid

Question 22

List the branches of the external carotid artery that supply the face?

Answer 22

Facial artery

Superficial temporal artery

Occipital artery

Posterior auricular artery

Question 23

Which branch of the external carotid artery gives the most extensive blood supply to the face?

Answer 23

Facial artery

Question 24

Describe the course of the facial artery?

Answer 24

Winds over inferior angle of mandible

Has tortuous course over the face to the medial angle of the eye

Sends branches off to nose, cheeks, etc.

Question 25

Describe the course of the superficial temporal artery?

Answer 25

Runs over zygomatic arch

Question 26

What does the superficial temporal artery supply?

Answer 26

Side of scalp

Question 27

What is the major venous drainage of the face?

Answer 27

Facial vein

Question 28

How can the facial vein be distinguished from the facial artery?

Answer 28

The facial vein is much less tortuous

Question 29

Describe the venous drainage of the face?

Answer 29

Veins accompany the arteries and mirror them

Question 30

In which area of the face may communication between the venous drainage of the face and cavernous sinus occur?

Answer 30

Question 31

Describe the lymph drainage of the face and scalp?

Answer 31

Lymph drains into a ring of lymph nodes which surround the base of the skull Submental nodes, submandibular nodes, pre-auricular and parotid nodes, mastoid nodes and occipital nodes All drain into deep cervical nodes

Question 32

What is the parotid gland?

Answer 32

A serous salivary gland

Question 33

Where does the parotid gland sit?

Answer 33

Below zygomatic arch In front of mastoid process and ear Above angle of mandible Behind masseter Overlies styloid process of temporal bone

Question 34

What encloses the parotid gland?

Answer 34

Thick parotid fascia

Question 35

How does saliva travel from the parotid gland to the oral cavity?

Answer 35

Parotid duct

Question 36

Describe the course of tje parotid duct?

Answer 36

Emerges from anterior border of gland onto masseter Then turns inwards and pierces buccinator to enter the oral cavity near the second molar

Question 37

List the structures that lie within the parotid, superficial to deep?

Answer 37

1. CN VII 2. Retromandibular vein 3. External carotid artery Parotid lymph nodes are scattered throughout

Question 38

Describe the pathway of the facial nerve?

Answer 38

Exits skull via stylomastoid foramen \> goes through auditory meatus, and has a short course through the temporal bone \> gives off posterior auricular arch (to occipitalis) \> enters substance of parotid gland \> creates plexiform arrangement - pes anserinus \> gives off five terminal branches

Question 39

What are the five terminal branches of the facial nerve?

Answer 39

Temporal Zygomatic Buccal Mandibular Cervical (Tall Zulus Bear Many Children)

Question 40

How is the retromandibular vein formed?

Answer 40

By superficial temporal and maxillary veins

Question 41

What happens to the external carotid artery once it enters the parotid gland?

Answer 41

Divides into maxillary and superifical temporal arteries

Question 42

Describe the risks associated with surgery in the parotid area?

Answer 42

Facial nerve lesion \> partial or complete paralysis of facial muscles ipsilaterally, flattening of nasolabial folds, no movement of eyes

Question 43

What is the most common cause of facial nerve palsy?

Answer 43

Bell's palsy (unknown cause, maybe post-viral)