L25 - Face and scalp

Question 1

Explain the importance of knowing anatomy of the face and scalp.

Answer 1

• Identity, contact, impression
• Individuality from anatomical variation
• Facial muscles critical to communcation

Question 2

4 anatomical variations that determine the face shape?

Answer 2

 Underlying bones

 Deposition of fatty tissue

 Colour, effects of aging on overlying skin

 Abundance, placement, nature of hair

Question 3

Name of the arch that form the upper border of face?

Answer 3

Supraciliary arch = upper border of face

Question 4

Name of eyelid folds (superior and inferiorly)?

Answer 4

Suprapalpebral sulcus

Infrapalpebral sulcus

Question 5

Name of nose bridge and flairs?

Answer 5

Dorsum of nose = nose bridge

Ala of nose = nose flairs

Apex of nose = tip of nose

Question 6

Name for nostrils and what are they seperated by?

Answer 6

Naris

separated by nasal septum

Question 7

Name of ridge in the centre above the upper lips?

Answer 7

Philtrum

Question 8

Location of labial commissure of the face?

Answer 8

Edge of the oral fisure

Question 9

What forms the inferior border of the face?

Answer 9

Mental protuberance

Question 10

5 layers of the scalp?

Answer 10

Skin
Connective tissue 
Aponeurosis
Loose connective tissue
Pericranium

Question 11

Thickness, content, and blood supply of skin of scalp?

Answer 11

thin, many sweat and sebaceous glands; hair follicles;

Abundant arterial supply; good venous and lymphatic drainage

Question 12

Thickness, content and nerve supply of connective tissue in scalp?

Answer 12

thick, richly vascularised subcutaneous layer;

well supplied with cutaneous nerves

Question 13

Structure of the epicranial aponeurosis?

Answer 13

broad, strong tendinous sheet

covers calvaria

Question 14

Function of the losse connective tissue of scalp?

Answer 14

allows free movement of the above layers over underlying calvaria

Question 15

Damage to the scalp causing pain: Pain signal originates via which layer of the scalp?

Answer 15

Connective tissue layer

Abundant cutaneous nerves

Question 16

Define the borders that separate neurocranium from viscerocranium?

Answer 16

A line between

Anterior: Supraorbital arch

Posterior = mastoid process

Question 17

Function of the facial skeleton?

Answer 17

• To house and protect the sense organs (eye, nose, & mouth)
• To provide a frame on which soft tissues, including muscles of the face can act, and teeth can anchor

Question 18

List the 2 muscles of the scalp?

Answer 18

1) Occipitofrontalis

2) Auricular muscles:
- Anterior auricular
- Superior auricular
- Posterior auricular

Question 19

Function, origin and attachment of the occipitofrontalis muscle?

Answer 19

(2 bellies: occipital and frontal bellies)

Origin = superior nuchal line at occipital protuberance

Attach to skin above upper orbital arch: epicranial aponeurosis

• raises the eyebrows
• wrinkles the forehead

Question 20

Embryonic origin of all the muscles for facial expression? Innervation of all these muscles?

Answer 20

2nd pharyngeal arch

Facial nerve (CNVII)

Question 21

Which layer of tissue are muscles of facial expression located? How are they anchored?

Answer 21

• Small, thin muscle bundles located in the subcutaneous tissue (superficial fascia)
• not covered by own fascia (except buccinators)
• most of them attaches to the bone/fascia and pull the skin, the rest attaches to the other muscles

Question 22

3 functions of muscles of facial expression other than expression?

Answer 22

Sphincters and dilators of the facial orifices
= Protection (e.g. for the eyes)

Support food ingestion
= Closing mouth for swallowing

Involved in sound production

Question 23

2 function of the orbital group of facial muscles?

Answer 23

Main functions of eyelids (L. palpebrae):
- protection of the eyeball from injury and excessive light

• spreading the tears to keep the cornea moist

Question 24

Name the main superficial orbital muscle and it’s functions?

Answer 24

Orbicularis oculi = sphincter of the eye:

1) Palpebral part: closes eyelid gently
2) Orbital part: closes eyelid forcefully
3) Lacrimal part

Question 25

Name the deep orbital muscles and their functions?

Answer 25

- Corrugator supercilii : draw eyebrows together (frown) | - Depressor supercilii : depress eyebrows

Question 26

List the nasal group muscles and their functions/ facial expression?

Answer 26

-Procerus [1]: pulls eyebrows downward to produce transverse wrinkles over the nose - Nasalis [2]: a) Transverse part: compresses nostrils and wrinkle nose b) Alar part: opens nostrils laterally -Depressor septi nasi [3]: pulls nose down

Question 27

Name the muscle that acts as the sphincter of the mouth?

Answer 27

Orbicularis oris [1] = sphincter of the mouth (most important): kiss

Question 28

Name the main muscle of the cheeks?

Answer 28

buccinator [5] (= muscle of the cheek, beneath fat): blow up cheeks

Question 29

List the 4 sets of muscles of the upper lip?

Answer 29

1) Zygomaticus major + zygomaticus minor: smiling / meh (elevate, draw angle of mouth) 2) Levator anguli oris 3) Levator labii superioris: bare teeth 4) Levator labii superioris alaeque nasi: moves nose up

Question 30

List 2 sets of muscles for the lower lip + the facial expression made?

Answer 30

1) Mentalis: pout | 2) Depressor labii inferioris (medial) + depressor anguli oris (superficial): bare teeth

Question 31

Name the muscle for widening the mouth opening?

Answer 31

Risorius widens mouth opening = fake smile (draws back angle of mouth)

Question 32

Function of the Platysma?

Answer 32

Tenses the skin over lower face and anterior neck Depresses mandible (against resistance)

Question 33

Describe the sensory innervation of the head and neck dermatomes.

Answer 33

*refer to lecture notes for visualization* Dermatome supplied by? Anterior/ face = Trigeminal nerve (CN V): - Ophthalmic nerve [CN V1] - Maxillary nerve [CN V2] - Mandibular nerve [V3] Posterior = Spinal nerves: C2, C3, C4

Question 34

List the spinal nerves that forms the cutaneous distribution of nerves of the posterior head + neck?

Answer 34

*refer to lecture notes for visualization* Anterior rami: - Greater auricular nerve (C2, C3) - Lesser occipital nerve (C2, C3) Posterior rami: - Greater occipital nerve (C2) - 3rd occipital nerve (C3)

Question 35

List all the branches of opthalmic nerve that forms the cutaneous distribution of nerve on the face. (5)

Answer 35

``` Ophthalmic nerve [CN V1]:  Supraorbital  Supratrochlear  Infratrochlear  External nasal  Lacrimal ```

Question 36

List all the branches of Maxillary nerve that forms the cutaneous distribution of nerve on the face. (3)

Answer 36

Maxillary nerve [CN V2]:  Infraorbital  Zygomaticotemporal  Zygomaticofacial

Question 37

List all the branches of Mandibular nerve that forms the cutaneous distribution of nerve on the face. (3)

Answer 37

 Mental  Auriculotemporal  Buccal

Question 38

Which 3 areas of the face can be tapped to check the intactness of the the facial nerve? Nerves that supply these area?

Answer 38

* refer to lecture notes for visuals* 1. Tap supraciliary arch = test supraorbital nerve from V1 2. Tap zygomatic bone area/ medial cheek = test infraorbital nerve from V2 3. Tap jaw lateral to chin = test mental nerve from V3

Question 39

Define the cause of trigeminal neuralgia "suicide disease"?

Answer 39

Severe pain in facial area served by one or more of the 3 branches of trigeminal nerve Caused by compression of blood vessels / tumour at the base of skull Occurs in people >50 (affects women more)

Question 40

Which nerve is responsible for the motor function of facial expression muscles?

Answer 40

Facial nerve (CN VII)

Question 41

Outline the course and branches of the motor division of the facial nerve supplying the facial muscles?

Answer 41

Exits skull at stylomastoid foramen Divides in parotid gland into 6 major branches in the face: 1. Temporal 2. Zygomatic 3. Buccal 4. Mandibular (marginal) 5. Cervical 6. Posterior auricular: occipital belly of occipitofrontalis + auricularis inferior) Also supplies stapedius, posterior belly of digastric, stylohyoid

Question 42

What is the cause of Bell's palsy?

Answer 42

Facial nerve injury

Question 43

2 major symptoms of Bell's palsy?

Answer 43

Incomplete closure of the eye (orbicularis oculi) Drooling

Question 44

List some complications that arise from incomplete closure of the eyes in Bell's palsy?

Answer 44

Incomplete closure of the eye (orbicularis oculi) – cause cornea to dry out [exposure keratitis] – drooping of lower eyelid [ectropion]

Question 45

List some complications that arise from Bell's palsy?

Answer 45

Dribbling saliva and drinks, difficult in chewing & speaking (orbicularis oris) Decrease sense of taste (chorda tympani) Sensitive to loud noise [hyperacusis] (stapedius)

Question 46

Explain why lacerations of the scalp leads to profuse bleeding?

Answer 46

rich blood supply from ECA and ICA Bleeding is mainly arterial: - Venous pressure is extremely low in the erect position - Connective tissue around vessels prevents retraction

Question 47

List the 5 MAJOR arteries of the face and scalp?

Answer 47

- Superficial temporal (branches) - Posterior auricular - Occipital - Maxillary (branches) - Facial (branches)

Question 48

Origin and branches of facial artery that supply the face?

Answer 48

Origin = ECA ``` (torturous) – branches into:  Angular artery (nose)  Lateral nasal artery (nose)  Superior, inferior labial arteries (upper and lower lips) (+ submental a.) ```

Question 49

Origin and branches of the superficial temporal artery?

Answer 49

Origin = ECA Branches: - Parietal branch - Frontal branch - Transverse facial artery - Zygomaticoorbital artery

Question 50

Origin and branches of the Maxillary artery that supply the face?

Answer 50

Origin = ECA Branches: - Mental branch (through mental foramen) - Buccal artery - Infraorbital artery (through infraorbital foramen)

Question 51

Origin and branches of the Opthalmic artery that Supply the face?

Answer 51

Origin = ICA (NOT ECA) Branches:  Supratrochlear artery  Supra-orbital artery + Dorsal nasal artery)

Question 52

4 palpable locations for arterial pulse in the head?

Answer 52

1. Temporal pulse @ pre-auricular region = superificial temporal artery 2. Temporal pulse @ superior to pre-auricular region = Anterior branch of superficial temporal artery 3. Facial pulse @ later to chin = facial artery 4. Carotid pulse @ upper border of thyroid cartilage at neck = common carotid artery

Question 53

Compare the drainage of the 2 divisions of retromandibular vein?

Answer 53

 Anterior division drains into internal jugular vein  Posterior division drains into external jugular vein

Question 54

Drainage of superficial temporal vein?

Answer 54

internal jugular vein

Question 55

Define the danger area of the face?

Answer 55

Triangle area drained by valveless facial vein, deep facial vein, infraorbital vein, ophthalmic veins >> leads directly / indirectly (via pterygoid plexus) to cavernous sinus >> route for infectious spread (e.g. Cavernous sinus thrombosis)

Question 56

Overview of the lymph drainage of the face and scalp?

Answer 56

Submental, submandibular, parotid nodes >> superficial cervical lymph nodes >> superior deep cervical lymph nodes

Question 57

List the lymph nodes located anterior and posterior to vertex?

Answer 57

Anterior to the vertex:  Preauricular nodes  Parotid nodes Posterior to the vertex:  Mastoid nodes  Occipital nodes