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Neuro Exam II > FACE, SCALP, PAROTID GLAND - SRS > Flashcards

FACE, SCALP, PAROTID GLAND - SRS Flashcards

1
Q

The scalp is skin and connective tissue covering neurocranium; extending from supraorbital margins of the frontal bone to?

A

The superior nuchal line of the occipital bone

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2
Q

What are the layers of the scalp?

A
  1. S – skin
  2. C – connective tissue (dense) – contains vessels and nerves
  3. A – aponeurosis epicranius (galea aponeurotica)
  4. L – loose connective tissue – allows free movement of scalp; normally the
  5. P – pericranium (periosteum)

Awesome, a built in mnenonic

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3
Q

By what nerves is the scalp innervated?

A

Spinal and cranial nerves

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4
Q

What spinal nerves innervate the scalp?

A

a. Greater occipital n (C2 dorsal ramus)
b. C3 (dorsal ramus)
c. Lesser occipital n
d. Great auricular n

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5
Q

What cranial nerves innervate the scalp?

A

a. Auriculotemporal branch of V3
b. Zygomaticotemporal branch of V2
c. Supraorbital branch of V1
d. Supratrochlear branch of V1

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6
Q

What main arteries supply the scalp?

A

External carotid

Internal carotid

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7
Q

What branches of the external carotid supply the scalp?

A

a. Occipital a
b. Posterior auricular a.
c. Superficial temporal a.

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8
Q

What branches of the internal carotid supply the scalp?

A

a. Supraorbital a
b. Supratrochlear a.

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9
Q

Why do scalp wounds bleed so much?

A

Scalp is highly vascular and because the vessels are embedded within the dense ct of layer 2 there is limited constriction when lacerated, causing scalp wounds to bleed profusely. Also, due to anastomoses, there is no single vessel to compress to stop bleeding.

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10
Q

What veins drain the scalp?

A
  1. Vena comitantes of arteries
  2. Emissary veins – drain through bones of skull to dural venous sinuses
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11
Q

Emissary veins are valveless, why do we care about this apart from test q’s?

A

May spread infection from scalp to the intracranial cavity

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12
Q

Scalp infections/bleeding can spread easily within the loose connective tisse layer (layer 4) and spread to what structures?

A

can spread within the eyelids and dorsum of the nose and cause ecchymosis (extravasation of blood under skin).

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13
Q

What muscles are associated with the eyebrows?

A

Orbicularis oculi

Corrugator superilli

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14
Q

What does the corrugator supercilli do?

A

draws eyebrows down and in (worried look)

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15
Q

What are the three functions of the orbicularis oculi?

A
  1. Orbital part – surrounds orbit and forcefully closes the eye
  2. Palpebral portion – within eyelid; gently closes the eye
  3. Lacrimal portion – within medial corner of eye; assists with lacrimal fluid drainage
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16
Q

What is the muscle associated with the scalp?

A

Occipito frontalis

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17
Q

What is the action of occipitofrontalis?

A
  1. Frontal belly – elevates eyebrows; wrinkles skin of forehead
  2. Occipital belly – retracts scalp; assists frontal belly in “surprised” expression
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18
Q

What are the eleven muscles associated with the mouth?

A

a. Orbicularis oris – closes lips/mouth
b. Buccinator – keeps cheeks in contact with the gums so that food does not accumulate in the vestibule of the mouth.
c. Levator labii superioris – elevates upper lip
d. Levator anguli oris – elevates upper lip; widens mouth
e. Zygomaticus major – elevates upper lip; main smile muscle
f. Zygomaticus minor – elevates upper lip; elevates upper lip
g. Risorius – stretches lips laterally; wide smile
h. Levator labii superioris alaeque nasi – elevates upper lip; flares nostrils
i. Depressor anguli oris – depresses lower lip; frown
j. Depressor labii inferioris – depresses lower lip; frown, pout
k. Mentalis – protrudes lower lip

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19
Q

What is the function of orbicularis oris?

A

closes lips/mouth

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20
Q

What is the function of the buccinator muscle?

A

Keeps cheeks in contact with the gums so that food does not accumulate in the vestibule of the mouth

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21
Q

What is the function of the levator labii superioris?

A

Elevates the upper lip

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22
Q

Function of levator anguli oris?

A

elevates upper lip and widens mouth

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23
Q

Function of zygomaticus major?

A

Elevates upper lip, main smile muscle

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24
Q

Function of zygomaticus minor?

A

elevates upper lip

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25
Q

Function of risorius?

A

Stretches lips laterally, wide smile

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26
Q

What is the function of levator labii superioris alaeque nasi?

A

Elevates upper lip, flares nostrils

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27
Q

Depressor anguli oris does what?

A

depresses lower lip; frown

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28
Q

What does depressor labii inferioris do?

A

Depresses lower lip, frown, and pout

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29
Q

What does the mentalis do?

A

Protrudes lower lip

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30
Q

What muscles are associated with the nose?

A

Procerus

nasalis

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31
Q

Function of procerus?

A

Wrinkles skin over dorsum of nose (dislike)

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32
Q

what is the function of nasalis?

A

flares nostrils

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33
Q

What is the action of platysma?

A

a.depresses mandible; tenses skin of lower face and neck.

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34
Q

What is the course of the facial nerve?

A
  1. Exits brainstem
  2. Enters internal acoustic meatus
  3. Courses laterally between cochlea and semicircular canals after which it makes a bend (genu) posteriorly and inferiorly to then course along the posterior wall of the middle ear.
  4. Exits facial canal via stylomastoid foramen.
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35
Q

What are the branches of the facial nerve?

A
  1. Posterior auricular nerve – supplies occipital belly of occipitofrontalis
  2. Digastric n
  3. Stylohyoid n
  4. Temporofacial trunk
  5. Cervicofacial trunk
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36
Q

What are the branches of the temporofacial trunk?

A

a. Temporal branches
b. Zygomatic branches
c. Buccal branches

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37
Q

What are the branches of the cervicofacial trunk?

A

a. Buccal branches
b. Marginal mandibular branches
c. Cervical branches

38
Q

What is the cause of Facial (Bell’s) nerve paralysis?

A

1.Causes: many cases are idiopathic; although linked to herpes virus, trauma or lesion anywhere along course of nerve, otitis media

39
Q

What are the consequences of Bell’s palsy?

A
  1. Paralysis of muscles of facial expression
  2. Facial asymmetry and drooping
  3. Drooping of lower eyelid causes drainage of tears and ulceration of eye.
  4. Paralysis of orbicularis oris causes dribbling of saliva from mouth
  5. Loss of buccinator muscle leads to accumulation of food within the vestibule.
  6. Impaired speech
40
Q

What nerves supply cutaneous innervation to the face?

A
  1. Ophthalmic nerve (V1)
  2. Maxillary nerve (V2)
  3. Mandibular nerve (V3)
  4. Great auricular nerve (C2, C3)
41
Q

What are the branches of the opthalmic n. (V1)?

A
  1. Supratrochlear n.
  2. Supraorbital n.
  3. Lacrimal n.
  4. Infratrochlear n
  5. External nasal n.
42
Q

What areas of innervation is the opthalmic nerve responsible for?

A

skin of forehead, upper eyelid, nose

43
Q

What embryonic structure does the opthalmic nerve supply?

A

embryonic frontonasal prominence

44
Q

What are the branches of the maxillary nerve (V2)?

A
  1. Zygomaticotemporal n.
  2. Zygomaticofacial n.
  3. Infraorbital n.
45
Q

What does the maxillary nerve provide innervation to?

A

a.Provides skin of temporal region, upper cheek and lip, lower eye lid, ala of nose

46
Q

What embryonic structure is supplied by the maxillary nerve?

A

Embryonic maxillary prominence

47
Q

What does the mandibular nerve supply in utero?

A

Embryonic mandibular prominence

48
Q

What does the mandibular nerve innervate? (cutaneously)

A

a.Provides skin of lower cheek, lower lip, and chin

49
Q

What are the branches of the mandibular nerve?

A
  1. Auriculotemporal n.
  2. Buccal n.
  3. Mental n.
50
Q

Where does the great auricular nerve (C2, C3) provide innervation to?

A

Skin over the angle of the mandible

51
Q

What is trigeminal neuralgia?

A

Neurological condition characterized by episodes of brief, intense facial pain over one of the three areas of distribution of CN V. The pain is so intense that the patient winces, which produces a facial muscle tic.

52
Q

What is the most common infection of the peripheral nervous system?

A

Herpes Zoster (Shingles)

53
Q

What is the proposed cause of trigeminal neuralgia?

A

The cause is believed to be demyelination of axons within the sensory root of CN V; in some cases due to compression by the superior cerebellar a

54
Q

In what order, from most to least common are the branches of the trigeminal nerve affected by trigeminal neuralgia?

A

V2 >V3 >V1

55
Q

What are the three common nerve block sites for facial/dental surgery?

A

Infraorbital nerve

mental nerve

buccal nerve

56
Q

Where is the injected performed for an infraorbital nerve block?

A

around infraorbital foramen; accessed by inserting needle through superior portion of oral vestibule.

57
Q

Where is the site of injection for the mental nerve block?

A

a.anesthetic agent injected around the mental foramen on the chin.

58
Q

Where is the site of injection for the buccal nerve?

A

a.anesthetic agent injected via the oral vestibule just posterior to the 3rd mandibular molar.

59
Q

Herpes zoster most often affects the trigeminal ganglion, specifically V1. What can this lead to?

A

Scarring and ulceration of the cornea

60
Q

What four main arteries provide blood to the face?

A

Facial artery

Superficial temporal artery

maxillary artery

opthalmic artery

61
Q

What are the branches of the facial artery?

A
  1. Inferior labial a.
  2. Superior labial a.
  3. Lateral nasal a.
  4. Angular a.
62
Q

What is the course of the facial artery?

A
  1. Branches from external carotid a within submandibular triangle.
  2. Courses through substance of submandibular gland
  3. Arches over the mandible just anterior to the masseter to enter face.
  4. Takes; courses alongalong lateral
63
Q

What is the superficial temporal artery a branch of?

A

External carotid artery

64
Q

What are the branches of the superficial temporal artery?

A
  1. Transverse facial artery
  2. Frontal branches
  3. Parietal branches
65
Q

What are the branches of the maxillary artery?

What is it a branch of?

A

a. Branch of external carotid a.
b. Branches
1. Infraorbital a
2. Buccal a.
3. Mental a.

66
Q

What is the opthalmic artery a branch of?

A

Internal carotid

67
Q

What are the branches of the opthalmic artery?

A
  1. Supraorbital a.
  2. Supratrochlear a.
  3. Lacrimal (lateral palpebral) a.
  4. Medial palpebral a
  5. Dorsal nasal a.
68
Q

What are the two main veins that drain the face?

A
  1. retromandibular vein
  2. Facial vein
69
Q

What is the course of the retromandibular vein?

A

a. Formed from union of superficial temporal and maxillary veins
b. Courses posterior to ramus of mandible within substance of parotid gland.
c. Divides into anterior and posterior division.
d. The anterior division merges with the facial vein.
e. The posterior division merges with the posterior auricular vein to form the external jugular vein.

70
Q

What is the course of the facial vein?

A

a. Begins at medial corner of eye as angular vein; descends face receiving venae comitantes of artery.
b. Joins anterior division of retromandibular vein to form the common facial vein which then drains to the internal jugular vein.

71
Q

The facial vein communicates with deeper plexuses, with what plexuses and via what veins does it accomplish this?

A
  1. With pterygoid plexus via deep facial vein
  2. With cavernous sinus via ophthalmic veins
72
Q

What is the clinical association regarding the facial vein communication with the deeper plexuses?

A

The central face area is thus a “danger area” for an infection to travel into the skull or into the deep face.

73
Q

Where do the lymphatic vessels of the face drain?

A
  1. submental
  2. submandibular
  3. parotid

These nodes ultimately drain to deep cervical nodes along the internal jugular vein

74
Q

Which salivary gland is largest?

A

Parotid gland

75
Q

Where is the parotid located?

A

A.Lies on posterolateral side of face; overlying ramus of mandible.

76
Q

What five structures form the parotid bed? What borders do they contribute?

A
  1. Superior boundary – zygomatic arch
  2. Medial boundary – ramus of mandible, styloid process and associated musculature
  3. Posterior boundary – external ear
  4. Inferior boundary – inferior border of mandible and posterior belly of digastric
  5. Anterior boundary – posterior border of masseter
77
Q

In what fascia is the parotid invested? What is this fascia derived from?

A

A.Invested in parotid fascia – derived from investing layer of deep cervical fascia.

78
Q

The parotid duct leaves the anterior border of the gland, crosses the masseter muscle, turns around the anterior border of the muscle and pierces the buccinator muscle and mucosa of cheek to enter the oral cavity opposite the 2nd upper molar tooth.

What is the corresponding clinical correlation?

A

Abscesses or infections of dental origin may spread to the parotid gland via the parotid duct.

79
Q

What are the important structures embedded within the parotid duct?

A

Superficial to deep…

  1. Facial nerve
  2. Retromandibular vein
  3. External carotid artery
80
Q

During parotidectomy, what structures must be isolated and protected in order to prevent damage?

A
  1. Facial nerve
  2. Retromandibular vein
  3. External carotid artery
81
Q

What autonomic components innervate the parotid gland?

A

Both parasympathetic nervous system and sympathetic

82
Q

What is the course of the glossopharyngeal nerve to the parotid?

A

1Location of cell bodies – salivatory nucleus within brainstem

2Preganglionic fibers travel with the glossopharyngeal nerve (CN IX).

3CN IX exits at the jugular foramen and immediately gives a tympanic branch.

4The tympanic nerve then enters the middle ear via the tympanic canaliculus.

5Travels through the middle ear and then reforms as the lesser petrosal nerve.

6Lesser petrosal nerve exits middle ear via hiatus for the lesser petrosal nerve; nerve is now in the middle cranial fossa and exits via the foramen ovale.

7Lesser petrosal n is now in infratemporal fossa and synapses in otic ganglion.

a. Postganglionic (distribute with V3)
1. Location of cell bodies – otic ganglion
2. Postganglionic fibers travel with the auriculotemporal branch of V3.
b. Function: secretomotor; stimulates gland secretion

I think this is where Bucks drawings will be handy…

83
Q

Where does the lesser petrosal nerve synapse?

A

Otic ganglion

84
Q

Where are the preganglionic cell bodies that innervate the parotid gland located?

A

T1-4

85
Q

Where are the post ganglionic cell bodies that innervate the parotid located?

A

superior cervical sympathetic ganglion.

86
Q

What do the postganglionic sympathetic fibers travel with to reach the parotid gland?

A

External carotid nerve

87
Q

What is the function of the parasympathetic innervation to the parotid?

A

secretomotor; stimulates gland secretion

88
Q

What is the function of the sympathetic innervation to the parotid gland?

A

vasomotor

89
Q

Parotiditis refers to inflammation of the parotid gland. This can be very painful because of stretching of the parotid sheath. Where can this pain from refer?

A

Pain from the parotid region is carried via the auriculotemporal branch of V3 and the great auricular nerve. Often, pain will “refer” to the auricle, TMJ, and external acoustic meatus.

90
Q

What is a sialolith?

A

(calculus) is a calcified concretion that can sometimes form in the parotid gland. If it passes into the parotid duct, the duct can become blocked. This can be quite painful.

Neuro Exam II (13 decks)

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