Face, Scalp and Parotid Flashcards by Srishti D

What is the extent of the scalp?

From nuchal line to supraorbital margins

Laterally extends down to zygomatic arches

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What does the nuchal line correspond to?

External posterior protuberance

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What are the five layers of the scalp?

S - skin
C - connective tissue (dense)
A - aponeurosis
L - loose connective tissue
P - pericranium

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What does the skin have associated with it?

Hair follicles

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What is in the dense connective tissue layer?

Fat
Vessels
Nerves

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What muscle is the aponeurosis of the scalp of?

Occipitofrontalis

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What are the two bellies of the occipitofrontalis?

Anterior = frontalis
Posterior = occipitalis

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What does the occipitofrontalis do?

Moves scalp

Frowns forehead

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Why does a scalp wound deep to the aponeurosis gape?

Opposing pull of two bellies of occipitofrontalis

Also contributes to heavy bleeding

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Why can you move the upper part of the scalp?

Because of loose connective tissue layer

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Which layers of the scalp are moved when you “move the scalp”?

Outer three layers that are fused together over bone

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Why can infection localise in the loose connective tissue of the scalp?

Because of consistency

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What is under the periosteum/pericranium?

Skull and meninges

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Which layer of the scalp is the neurovascular layer?

Layer 2

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Which arteries are in the scalp?

Branches of internal and external carotid arteries

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Do the branches of the internal and external carotid arteries communicate in the scalp?

Yes, via free and rich anastomoses

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Why do scalp wounds bleed so heavily?

Because of rich arterial supply

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Why don’t scalp wounds clot easily, and therefore contribute to the heavy bleeding?

Connective tissue septa in layer 2 adhere to margins and hold open cut vessels

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What is the best treatment to stop bleeding in a scalp wound?

Apply tourniquet around head near wound

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What is the difference in the layered organisation between the face and scalp?

No layer 4

No aponeurosis - muscles of facial expression instead

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What is the origin of the muscles of facial expression?

Bone or fascia

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What is the attachment of the muscles of facial expression?

Skin of face

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What are the muscles of facial expression arranged around?

Facial orifices

Eye
Nasal cavity
Mouth

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What is the arrangement of the muscles of facial expression around the orifices?

Surround orifice as sphincter - close

Radiate out linearly from orifice - open

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What are pharyngeal arches?

Embryological structures each supplied by a cranial nerve

Where are the muscles of facial expression derived from?

Second pharyngeal arch

Which nerve supplies the muscles of facial expression?

CN VII - facial nerve

Which nerve/s supply the sensory information from the skin of the face and scalp anterior to the ears?

CN V - trigeminal nerve

What are the three divisions of the trigeminal nerve?

Ophthalmic Maxillary Mandibular

What region does the ophthalmic nerve innervate?

Eye region including forehead and top of nose

What region does the maxillary nerve innervate?

Cheek region - Cheek - Upper lip

What region does the mandibular region innervate?

Jaw region - Lower lip - Jaw

Where does mandibular innervation go laterally?

Turns up to go over ear

What is the cutaneous innervation to the skin behind the ear?

Articular branch of CN X - vagus nerve

What cutaneous innervation does the skin on the back of the head have?

Dorsal rami

What is the cutaneous innervation of the C1 dorsal ramus?

None

What is the cutaneous innervation of the C2 dorsal ramus?

Back of head

What is the cutaneous innervation of the C3 dorsal ramus?

Back of neck - where cervical collar worn

What kind of nerve is the mandibular nerve?

Mixed

What is the motor innervation of the mandibular nerve?

Muscles of mastication

What does the trigeminal ganglion divide into?

Ophthalmic nerve Maxillary nerve Mandibular nerve

Where is he trigeminal ganglion?

Apex of petrous part of temporal bone - in middle of middle cranial fossa

What is the route of the ophthalmic nerve?

Exits skull via superior orbital fissure Enters orbit Up forehead

What is the route of the maxillary nerve?

Exits skull via foramen rotundum | Onto cheek

What is the route of the mandibular nerve?

Exits skull via foramen ovale | Onto jaw

What area of the scalp does the ophthalmic branch of the internal carotid supply?

Central forehead via branches winding out of orbit

What are the two major branches of the internal carotid on the central forehead?

``` Medial = supratrochlear arteries Lateral = supraorbital arteries ```

What is the main artery of the face?

Facial artery

What artery is the facial artery a branch of?

External carotid artery

What is the route of the facial artery?

Winds around inferior border of mandible and onto face Heads to inferior border of eye Tortuous course across cheek to inner corner of eye Branches to - Lower lip - Upper lip - Cheek - Nose Anastomoses with internal carotid branches at eye

What is the route of the superficial temporal artery?

Passes up and over zygomatic arch | Supplies anterior and lateral part of scalp

What are the branches of the external carotid artery supplying the face and scalp?

Facial artery Superficial temporal artery External auricular artery Occipital artery

What areas do the external auricular and occipital arteries supply?

Behind ear

Which branches of the external carotid artery are accompanied by veins?

All

What is the main venous drainage of the face?

Facial vein

Where is the facial vein, and what is its shape?

Behind facial artery | Straighter than facial artery

How do the tissues of the face drain into the cavernous sinus?

Via emissary veins | Directly through facial bones

Can infections from the face spread into the brain and meninges and cause encephalitis and meningitis?

Yes, because facial tissues drain into cavernous sinus

Which lymph nodes drain the face and scalp?

``` Those in ring around base of scalp - Submental anteriorly - Submandibular more posteriorly and laterally - Pre-auricular and parotid near ear - Mastoid - Occipital Move into deep cervical nodes ```

What is the parotid gland?

Salivary gland

Where is the parotid gland?

``` Below zygomatic arch Above angle of mandible In front of ear Behind massoter muscle Superficial to styloid process ```

What is the parotid gland wrapped in?

Parotid fascia

What happens when the parotid gland is infected, as happens on mumps, for example?

Gland swells Fascia doesn't Causes intense pain

How does the parotid gland deliver saliva to the mouth?

Via duct - Comes forward from anterior border of gland - Across massoter muscle - Reaches anterior border and pierces buccinator muscles - Enters oral cavity near second molar

What are the structures inside the parotid gland, from superficial to deep?

Facial nerve Retromandibular vein External carotid artery

How does the facial nerve exit the skull?

Via stylomastoid foramen, in between styloid and mastoid processes at base of skull

Which motor nerve innervates the occipitalis bell of the occipitofrontalis muscle?

Facial nerve branch

What else does the facial nerve innervate, that isn't a muscle of facial expression?

Posterior belly of digastric and stylohyoid muscles

Where does the facial nerve enter the parotid gland?

Posteromedial surface

What does the facial nerve do inside the parotid gland?

Creates plexus within substance of gland

What is the name of the plexiform arrangement of the facial nerve within the parotid gland?

Pes anserinus

What are the five branches of the facial nerve, from superior to inferior?

``` Tall - temporal Zulus - zygomatic Bear - buccal Many - mandibular Children - cervical ```

What do the branches of the facial nerve innervate?

Muscles of facial expression

Where does the retro mandibular vein run?

Behind mandible

What forms the retromandibular nerve?

Union of superficial temporal and maxillary veins

What does the external carotid artery divide into after entering the parotid gland?

Superficial temporal artery Maxillary artery Given off within substance of gland

What is a very important branch of the maxillary artery?

Medial meningeal artery

What is the risk of performing surgery near the parotid gland?

Damaging facial nerve | Damage supply of muscles of facial expression in that side

What is Bell's palsy?

``` Affects branches of facial nerve Unknown aetiology - possible previous viral infection Happens overnight Characteristics - Drooping eyelid - Flattening of nasolabial fold - A little drooling Treatment - High dose steroids - Can recover in weeks-months-years, but sometimes never ```