Face-Mon, Sept 25

Front 1

Facial bones

Back 1

1. nasal bones-2 bones form bridge of nose
2. lacrimal-small bone that contributes to medial wall of orbit
3. zygomatic-bony part of cheek
4. vomer-forms part of nasal septum
5. inferior concha-paired bones that project from lateral wall
6. palatine-forms floor of nasal cavity/roof of mouth
7. maxilla
8. mandible

Front 2

facial bone-
Maxilla

Back 2

four sided pyramid lying on its side; four surfaces and four processes
1. base-faces the nasal cavity
2. orbital surface-forms part of floor of orbit
3. facial surface-front
4. infratemporal surface-faces infratemporal fossa
5. frontal process-projects up to articulate with frontal bone
6. zygomatic process-articulates with zygomatic bone
7. alveolar process-tooth socket; maxilla has all sockets of upper teeth
8. palatine process-forms roof of mouth
9. maxillary sinus-large cavity inside of maxilla

Front 3

facial bone-
Mandible

Back 3

largest and strongest bone of face;
1. 2 parts
2. process
3. chin
4. foramina

Front 4

two main parts that meet @ Angle of Mandible

Back 4

1. horizontal body
2. vertical ramus

Front 5

Process of mandible

Back 5

alveolar-contains bottom teeth

Front 6

Chin

Back 6

"mental";
1. mental protuberance-@ midline
2. mental tubercles-on either side of protuberance
3. chin is unique to humans

Front 7

foramina of face

Back 7

1. supraorbital- in frontal bone
2. infraorbital-in maxilla
3. mental-in mandible; transmit cutaneous sensory nerves, branches of trigeminal nerve
4. zygomatic facial-tiny, contains another branch of trigeminal for skin over bony part of the cheek

Front 8

Lateral view of mandible

Back 8

Ramus projects superiorly and ends in 2 processes:
1. coronoid process-attachment of temporalis muscle
2. condyloid process-consists of head and neck; head articulates with temporal bone=TMJ
3. mandibular notch-separates processes

Front 9

Newborn skull

Back 9

1. facial skeleton forms 1/8 of volume of skull compared to 1/3 in adults
2. newborns lack teeth-alveolar processes are underdeveloped
3. paranasal sinues are very small or absent @ birth
4. no mastoid process

Front 10

Adult skull

Back 10

1. paranasal sinuses-all paired
a. maxillary air sinus-largest; fills up much of body of maxilla; facial, infratemporal, and orbital surface
b. sinuses add resonance to voice
c. lighten skull
d. all sinuses open into nasal cavity

Front 11

Muscles of facial expression

Back 11

1. frontalis-raising eyebrows
2. depressor anguli oris-pulling down corner of mouth
3. nasalis-wrinkling of nose

Front 12

Frontalis

Back 12

1. associated with scalp
2. originates from epicranial aponeurosis
3. inserts into eyebrows, therefore raises eyebrows

Front 13

orbicularis oculi

Back 13

1. orbital part- outer portion
a. quite strong and thick
b. surrounds bony margin of orbit, originates from medial margin of orbit and medial palpebral ligament
c. circles part of orbital surface
d. closes eye forcefully
2. palpebral part-inner portion
a. thinner, more delicate than orbital
b. used in blinking, sleeping, light closure of eyes
c. if can't close eye, the cornea will dry out

Front 14

Muscles of neck:
Playsma

Back 14

1. large, very flat, thin
2. easy to remove with skin
3. lies in superficial fascia of neck
4. inserts into corner of mouth and lower vorder of mandible
5. helps draw lower corner of mouth down to express fright

Front 15

Muscles of mouth

Back 15

1. orbicularis oris
2. levator labii superioris-elevates upper lip
3. depressor labii inferioris-depresses lower lip
4. levator anguli oris-deep, elevates corner of mouth
5. depressor anguli oris-depresses corner of mouth
6. zygomaticus major and minor-pull up corner of mouth
7. mentalis-protrudes lower lip
8. buccinator

Front 16

muscle of mouth:
orbicularis oris

Back 16

1. forms sphincter around oral opening
2. purses lip, protrudes lips when sucking or whistling
3. rest of muscles blend into this muscle

Front 17

muscle of mouth:
buccinator

Back 17

1. deeply placed
2. forms soft part of cheek
3. bony origin from alveolar process of maxilla and mandible
4. fibrous origin from pterygomandibular raphe
5. fibers run horizontally forward to insert into lips, blending with fibers of orbicularis oris
6. parotid duct pierces buccinator so that secretions empty into vestibule of mouth
7. compresses the cheek, used in blowing, whistling, and smiling
8. used in eating-tone keeps bolus of food between occlusal surfaces of teeth

Front 18

Nerves of face:
Facial Nerve (CN VII)

Back 18

1. motor nerve of face
2. innervates all facial muscles
3. leaves brain from posterior cranial fossa and enters the opening in the temporal bone called the Internal Auditory Meatus; then emerges on base of skull in stylomastoid foramen

Front 19

branches of Facial Nerve
(CN VII)

Back 19

gives off 2 small branches as it emerges:
1. posterior auricular-innervates occipitalis and auricular muscles
2. nerve to stylohyoid and digastric muscles-muscles of neck
3. facial nerve sinks into parotid and divides into 5 branches
a. temporal-innervates frontalis and superior part of orbicularis oculi
b. zygomatic-cross zygomatic arch, innervates lower part of o. oculi and zygomatic muscles
c. buccal-run superficial to masseter, go to oral area and innervate buccinator and o. oris
d. marginal mandibular-run along margin of mandible, innervate muscles of lower lip and chin
e. cervical-innervate playsma

Front 20

Bell's Palsy

Back 20

1. facial muscles on one side are paralyzed
2. sudden onset
3. corner droops, levator anguli oris and zygomatic major paralyzed
4. buccinator cannot keep food out of vestibule
5. can't chew properly
6. constantly drooling
7. can't close eyes
8. tears spill out on face
9. might be caused by inflammation as the nerve transverses the temporal bone

Front 21

branches of Facial Nerve (CN VII) within the facial canal

Back 21

1. greater petrosal-presynaptic parasympathetic fibers that supply lacrimal gland, in the orbit
2. nerve to stapedius-tiny muscle in inner ear; functions to keep stapes from moving too much and protects from sudden loud sounds (reflex); paralysis leads to hyperacousis
3. chorda tympani-comes off just proximal to stylomastoid foramen; carries taste fibers from anterior 2/3 of tongue

Front 22

Trigeminal Nerve (CN V)

Back 22

chief sensory nerve of face and head; 3 major branches:
1. ophthalmic-V1
2. maxillary-V2
3. mandibular-V3
All have sensory fibers (GSA), fibers which supply skin and certain mucus membranes of nasal and oral cavity
**Only mandibular has efferent fibers (SVE)-supply muscles of mastication

Front 23

ganglion of trigeminal nerve

Back 23

1. swelling that lies in middle cranial fossa and is much like a dorsal root ganglia of spinal nerve-contains cell bodies of psedounipolar neurons and strictly a sensory ganglion
2. peripheral processes pass out of V1-V3
3. All return signals to brain

Front 24

Trigeminal nerve (CN V): V1

Back 24

skin of forehead, upper eyelid and dorsum, some of sides and tip of nose

Front 25

CN V: V2

Back 25

lower eyelid, upper lip, side of nose and area in from of temple

Front 26

CN V: V3

Back 26

reverse L-shaped region, lower lip, chin, lower part of cheek, part of ear, auricle, and temple
**only area of facial skin trigeminal nerve doesn't get is over Angle of Mandible

Front 27

Facial artery

Back 27

terminal branch of ECA;
1. only branch that gives off branches of its own
2. appear on face first at lower border of mandible
3. tortuous course to angle of eye
4. branches:
a. inferior and superior labial
b. lateral nasal
c. angular-near medial angle of eye, terminal branch

Front 28

Ophthalmic artery

Back 28

off the ICA, branches into:
1. supraorbital
2. supratrochlear
3. dorsal nasal

Front 29

venous drainage:
facial vein

Back 29

parallels facial artery, but posterior; usually unites with retromandibular vein; jnctn of anterior division of retromandibular and facial veins is common facial vein, which drains into IJV

Front 30

communications of facial vein between deeper veins

Back 30

superior and inferior ophthalmic veins which connect the upper part of facial vein, angular vein, with the cavernous venous sinus inside skull

Front 31

clinical correlations of venous infection spread

Back 31

1. valveless veins; should infection get into facial vein in area near the angular vein, it could travel posteriorly into sinus, inside skull
2. deep facial vein, lies in soft part of cheek that connects facial vein to pterygoid plexus of veins, which is connected to caverous sinus by little veins at base of skull

Front 32

External nose

Back 32

Bony and cartilaginous:
1. nasal bones on frontal process of maxilla and frontal bone contribute to bony framework
2. lower part of nose has cartilaginous framework, including septal cartilage in midline and lateral expansions on either side called lateral nasal cartilages or processes of septal cartilages
3. U-shaped cartilage, which bonds the external nostril called greater alar cartilage

Front 33

5 layers of eyelid

Back 33

1. skin
2. subcutaneous
3. palpebral part of orbicularis oculi-part that gently closes eye
4. tarsal fascia layer
5. conjunctiva

Front 34

More:
Tarsal fascia layer

Back 34

2 parts:
1. dense thickening of connective tissue in both upper and lower eyelids know as tarsal plates which stiffen the lid
2. fascia-orbital septum or palpebral fascia
3. together form sheet of tissue from bony margin of orbit to margin of lid

Front 35

More:
Conjunctiva

Back 35

**mucus membrane which lines the inner surface of eyelid
1.palpebral part
2. bulbar part-at upper part of eyelid, conjunctiva is reflected onto upper part of eyeball (same for lower lid)
3. points of reflection where palpebral and bulbar conjunctiva are continuous are called fornices
4. conjunctiva sac is space between the two
5. tears are secreted into superior fornix of sac
6. tarsal glands embedded in the tarsal plates-have oily secretion; glands open on margins of lid an dkeep lids from sticking together and waterproof the lids
8. tarsal plates bound to orbital margins by medial and lateral palpebral ligaments
9. lacrimal sac lies just posterior to medial palpebral lig

Front 36

Lacrimal apparatus

Back 36

1. gland lies in upper lateral corner of orbit
2. ducts are tiny and open to superior fornix; about 12 ducts secrete into sac and blinking draws lids medially and spreads fluid
3. lacrimal papilla
4. lacrimal punctum-tiny opening on summit of papilla
5. lacrimal canaliculis-tube
**excess lacrimal fluid is suctioned into punctum with capillary action into canaliculi which drain into sac, which lies in medial margin of orbit; sac drains inferiorly into nasal cavity via nasolacrimal duct (sniffing when cry)

Front 37

autonomic innervation

Back 37

1. lacrimal gland- secretomotor fibers are parasympathetic
2. CN VII (facial nerve) controls lacrimation and so presynaptic fibers leave brain with this nerve (via temporal bone, Greater Petrosal nerve)
3. greater petrosal nerve joins the deep petrosal nerve (postsynaptic sympathetic-cell bodies lie in neck and cervical ganglion)
4. the joining of these 2 nerves makes the nerve of the pterygoid canal (bony canal in sphenoid bone)

Front 38

AI: pterygoid canal

Back 38

**canal leads to space in skull called pterygopalatine fossa where pterygopalatine ganglion lies
1. synapse occurs for parasympathetic fibers
2. pterygopalatine ganglia lies in wedge-shaped space on side of skull (fossa)
2. postsynaptic fibers run up and connect with maxillary nerve and travel in now what is the zygomatic nerve to enter orbit
3. run up to lacrimal nerve, which is branch of V1, and leads to lacrimal gland

Front 39

5 layers:
SCALP

Back 39

1. Skin
2. dense Connective tissue-contains vessels and nerve to scalp
3. Aponeurosis-epicranial aponeurosis where frontalis originates
**first 3 layers are very closely bound together, move together as unit on fourth layer
4. Loose connective tissue-danger layer b/c infections can spread quite rapidly; emissary veins-little valveless veins that connect veins outside to inside skull; infection can spread into intradural venous sinuses
5. Pericranium-outer connective tissue of skull

Front 40

Blood and Nerve supply to SCALP

Back 40

Nerves:
1. All 3 divisions of trigeminal nerve have cutaneous brs
2. more posteriorly, cervial nerves, Greater and Lesser occipital nerves
Blood:
* 3 direct branches of ECA:
1. Superficial temporal
2. posterior auricular
3. occipital
**all anastomose
* 2 indirect branches off ICA:
1. supraorbital
2. supratrochlear
**these anastomose

Front 41

CC: laceration to head

Back 41

1. most common head injury requiring surgical intervention
2. heavy bleeding due to anastomoses
3. arteries are in dense Connective tissue, therefore remain open