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51 Cards in this Set

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Neurocranium
bony case of the brain or the cranial vault; comprised of 8 bones
Viscerocranium
fascial skeleton provides protection for sensory organs; 15 bones
nasal bones
paired bones which are frequently fractures and repaired y rhinoplasty, these bones form suture lines with frontal and maxillary bones and articulate with nasal cartilages
maxilla bone
paired bones that are small in the infant but enlarge as teeth erupt, thus the maxilla develops an alveolar portion that holds the deciduous and permanent teeth
contributes to the inferior orbital rim and contains an infraorbital foramen and canal
a hollow lightweight bone, helps voice resonate and contains infraorbital (CN V2) nerve
zygomatic bones
paired "cheek" bones which contains an arch that is frequently fractured
forms visible sutures with the maxilla, frontal bones, and temporal bones
contains zygomaticofacial and zygomaticotemporal foramina
Frontal Bone
unpaired bone of the forehead; contains the supraorbital foramen (or notch) which transmits supraorbital (CN V1) nerve; contributes the superior orbital rim
temporal bones
paired bones; bone which frequently shows age of individual, contains a zygomatic process which joins the zygomatic bone to form the zygomatic arch
mandible
paired bones that fuse (one bone); contains a mental foramen where terminal branches of the inferior alveolar nerve, artery, and vein emerge
contains an alveolar portion that is tooth bearing, in infants who have not developed their primary dentation, it is small and underdeveloped
in older edentulous adults, the mandible is reabsorbed and the bone is easily fractured
Cutaneous innervation of the face - primarily innervated by the trigeminal nerve (CN V)
has three divisions:
ophthalmic (CN V1)
maxillary (CN V2)
mandibular (CN V3)
all three divisions are sensory, but the mandibular division is the only divsion with a motor component (innervates muscles of mastication and MATT)
A. pseudounipolar nerve cell bodies reside in an extremely large trigeminal (semilunar) ganlion (collection of cell bodies) ; equivalent to the dorsal root ganglion of the spinal cord
B. all ganglia are derived from neural crest cells
clinical consideration - Herpes Zoster
ganglia can be affected by a viral infection called herpes zoster, or varicella zoster virus, this virus causes chicken pox, but can become latent for years, when a patient becomes immuno compromised, the skin (or dermatomes supplied by the affected ganglia) can develop shingles, a painful skin rash, which blisters, breaks open, crusts over, and then disappears
clinical consideration - trigeminal neuralgia
trigeminal ganglia is also affected (stimulated, irritated) by unknown causes
trigeminal neuralgia is a neuropathic disorder of CN V that causes episodes of intense pain in the eyes, lips, nose, scalp, and forehead.
some research points to a blood vessel, possibly the superior cerebellar artery, compressing the microvascular supply of CN V nears its connection with the pons of the brain
Ophthalmic division of the trigeminal nerve (CN V1)
innervates the skin of the tip and bridge of the nose
innervates the forehead up to the top of the cranial vault
innervates the upper eyelid and medial canthal region (corner of the eye)
innervates the cornea - corneal abrasions from a foreign body are extremely painful5 cutaneous branches
clincal consideration - corneal (blink) reflex
involuntary blinking elicited by the stimulation of the cornea
afferent limb to CN V1
efferent limb to CN VII
cutaneous branches of the Ophthalmic division of the trigeminal nerve (CN V1)
1. supratrochlear nerve - above the trochlea of the superior oblique muscle, innervated by CN IV
2. Supraorbital nerve - supplies the forehead and frontal scalp; administratio of anesthetic enables placement of sutures or extraction of glass/dirt from forehead/scalp skin
3. external nasal nerve - a branch of the anterior ethmoidal nerve; pain from broken nose
4. Infratrochlear nerve - below trochlea of the superior oblique muscle, innervated by CN IV
5. lacrimal nerve - sends a palpebral branch to the lateral portion of the eyelid
Maxillary division of the trigeminal nerve (CN V2)
passes through foramina and canals to enter maxilla where it emerges from various foramina
innervates skin of the upper lip, lateral nose, lower eyelid, lower conjunctival sac, cheek, temporal region of scalp, palate, upper teeth, gingiva, maxillary sinus
3 cutaneous branches
cutaneous branches of the Maxillary division of the trigeminal nerve (CN V2)
1. infraorbital nerve - travels through roof of maxillary sinus to emerge below the eye
2. zygomaticofacial nerve - emerges on the anterior aspect of zygomatic arch
3. zygomaticotemporal nerve - innervates the scalp over the temples
Mandibullar division of the trigeminal nerve (CN V3)
innervates the skin of the lower lip, the skin over the lower mandible, temporal region, lower teeth and gingiva, external auditory meatus, outer eardrum
3 cutaneous division
cutaneous divisions of the Mandibullar division of the trigeminal nerve (CN V3)
1. Auriculotemporal nerve - travels with the superficial temporal artery to vertex of the scalp
2. (long) Buccal nerve - should not be confused with buccal branch of the facial nerve; provides sensory innervation to the lining of cheek; look for accompanying buccal artery
3. mental nerve - terminal branch of the inferior alveolar nerve; look for mental artery
Muscles of facial expression: General Characteristics
1. located in the subcutaneous tissue of the anterior and posterior scalp, face, and neck
2. move the skin and change facial expressions to convey mood
3. originate on bone or fascia and insert into skin to produce their affects
4. all of these muscles are derived from mesoderm in the second pharyngeal (branchial) arch
5. facial nerve (CN VII) provides motor innervation to all muscles of facial expression
6. work as sphincters and dilators of the openings on the face (eyes, mouth, nose)
clinical consideration - wrinkles
these muscles are responsible for the wrinkles that inevitable develop along the tension lines (of Langer) as a person ages and the skin experiences a lifetime of pull in a certain direction
surgeons deliberately orient their incisions in these lines of tension whenever possible, in order to reduce the development and visability of scars
1st pharyngeal arch
CN V3, innervates muscles of mastication and MATT muscles
5 main branches of the fascial nerve (CN VII)
1. temporal
2. zygomatic
3. buccal
4. mandibular
5. cervical
Muscle of the orbit:
Orbicularis oculi muscle
muscle surrounding the eye that acts as sphincter of the orbit
a. orbital portion - closes eye forcefully (as in winking or squinting) to protect eyeballs against dust or glare
b. palpebral portion - closes eye gently as in blinking or sleeping; helps keep cornea from drying out by distributing tears
oral muscles
forming the sphincters and openings to the oral cavity; controlling the degree of opening of the oral fissure
orbicularis oris
encircles mouth to act as the all important sphincter of the oral fissure
1. attaches to the modiolus, a convergence of several muscles of facial expression at the corners of the mouth
2. originates from the (incisive fossae of) mandible and maxilla
3. functions to close the oral fissure, protrude lips (kissing, whistling, sucking), resists distension (when blowing)
levator labii superioris
dilator of oral fissure by retracting (elevating) the upper lip
1. originates on the infraorbital margin of the maxilla (above the infraorbital foramina)
2. covers the infraorbital foramina
3. functions to dilate the oral fissure, retract (elevate) or evert the upper lip to show the upper teeth; deepens nasolabial sulcus (showing sadness)
zygomaticus major
dilator of the oral fissure by elevates corners of the mouth (smiling)
1. originates on the lateral aspect of the zygomatic bone
2. dilate oral fissure; elevate labial commissure bilaterally to smile or unilaterally to sneer (shows disdain)
depressor anguli oris
dilator of the oral fissure; depresses labial commissure (frowning)
1. originates on the oblique line of the body of the mandible; inferior to the mental foramina
2. functions to dilate the oral fissure; depresses labial commissure bilaterally to frowning
3. functions to elevate and protrude lower lip; elevates skin off chin (showing doubt)
platysma
muscle of neck and lower face; depresses mandible and wrinkles skin of the neck
1. originates in subcutaneous tissue near clavicle; inserts into modiolus
2. functions to depress mandible (against resistance); tenses skin of the inferior face and neck (conveying tension and stress)
muscle of the cheek: Buccinator (L. trumpeter)
givens tension to the cheeks to keep food between teeth
1. originates in the alveolar ridges of the maxillary and mandibular molar teeth
2. inserts in the orbicularis oris; the tonus of both muscles compresses the cheeks and lips against the teeth and gums, provides resistance to keep teeth from tilting laterally, and keeps food between the occlusal surfaces of the teeth during mastication; prevents ppl from looking like hamsters when they chew
Facial Nerve (CN VII)
innervates the muscles of facial expression
1. it emerges from the base of the cranium at the stylomastiod foramen
2. it emerges on the face as 5 main branches: temporal, zygomatic, buccal, marginal mandibular, cervical [Two Zebras Bit My Cheek]
3. it passes through the parotid gland
clinical consideration - Facial (Bell's) Palsy
unilateral facial paralysis can be caused by a brain tumor, stroke, or Lyme's disease, when there is no specific cause it is called Bell's palsy which is unilateral facial paralysis which presents on affected side with
1. the eye can't be tightly closed - lower lid droops, tears overflow [epiphora]
2. the eye can't be blinked increasing the risk for corneal infection or drying (the efferent limb of the blink reflex is deficient)
3. the corner (commissure) of the mouth droops, saliva drools, the patient cant whistle, has trouble producing labial sounds, has a croked smile from contralateral muscles that do work and are not oposed by the opposite side
4. affected cheek accumulates food in vestibule due to lack of muscular tone in the cheek
clinical consideration - exclusion of herpes zoster
clinicians need to exclude herpes zoster infection of CN VII from their facial palsy diagnosis by looking for small vesicles, or blisters, in the external ear
clinical consideration - re-animation of face
re-animation of the muscles of fascial expression is possible following traumatic damage to CN VII
surgeons place myocutaneous gracilis flaps into the affected side and reanastomose the neurovascular pedicle into nearby nerves (CNs V or XII)
muscles of mastication
produce movements of the temporomandibular joint (TMJ); derived from the 1st pharyngeal arch; innervated by the mandibular divsion of the trigeminal nerve (CN V3)
temporalis muscle
arises off the temporal bone
1. origin - floor of the temporal fossa and deep surface of the temporal fascia
2. insertion - tip of the coronoid process and anterior border of ramus of mandible
3. actoins: elevates the mandible, middle , oblique, and posterior fibers retract the mandible
masseter muscle
1.origin - inferior border and medial surface of zygomatic arch
2. insertion - lateral surface of ramus and angle of the mandible
3. actions - elevates and protrudes mandible (closing jaw), deep fibers retrude the chin
venous drainage of face/scalp
A. Angular V. to Facial V. to Retromandibular V. to Internal jugular V.

B. Superficial Temporal V, to Retromandibular V. to Internal Jugular V.

IMPORTANT: veins on the face may have deep connections into the skull (spread of infection)
deep triangle of the face
Angular V. to Ophthalmic Venous Plexus to Cavernous Sinus
clinical consideration - face infections
infections of the face are rather rare and respond well to therapeutic levels of antibiotics. However, infections from the face can spread into the brain/meninges through their venous channels and become life-threatening
Clinical consideration - vein valves
there are no valves in the veins of the face or scalp or inside the skull; thus blood can flow in either direction in response to pressures from build up of pus
Superficial temporal artery
terminal branch of the ECA supplying the temporal region
1. runs anterior to the tragus of ear where pulse can be palpated
2. Transverse Facial a. - branch that courses near the parotid duct
facial artery
direct branch of the ECA
1. this artery emerges onto the face superficial to the mandibular and winds upward
2. as it runs over the mandible it offers a convient site to measure pulse
branches of the facial artery
1. submental a. - comes off the facial artery before it courses superficial to the body of the mandible; supplies blood to the floor of the mouth in the submental regoin
2. inferior labial a. - supplies blood to the lower lip
3. superior labial a. - supplies blood to the upper lip
4. lateral nasal a. - supplies the skin of the ala of the nose
5. angular a. - supplies the medial canthus (angle of the eye)
arteries that travel with the trigeminal nerve
supraorbital, infraorbital, buccal and mental
clinical consideration - facial blood supply
the face and scalp are exceedingly well supplied with a rich series of blood vessels
lacerations or deliberate excisions by surgeons bleed profusely and typically require suturing
the rich blood supply make infections and wound healing problems rare and enables surgeons to use skin flaps to cover tissue defects made after excising a tumor
parotid gland
the largest of the salivary glands, embryological outgrowth of the oral cavity, it is encased in an unyeilding fibrous capsule that contains deep cervical fascia in the neck
clinical consideration - parotid gland
the gland is sometimes infected with viral pathogens (mumps)
swelling of the gland is esp. painful (auriculotemporal nerve [CN V3] = sensory innervation) during movements of the mandible or triggering of salvation b/c the facial covering is fibrous and unyeilding
parotid duct
stensen's duct
outflow tract for parotid secretions that passes from the horizontal anterior edge of the gland to pierce the buccinator muscle; opening of the duct empties into the vestibule of the mouth near the upper 2nd maxillary molar tooth
clinical considerations - parotid duct
it can be palpated one finger breadth beneath the zygomatic arch
it can be severed in facial laterations (dog bites, car wrecks, and knifing wounds)
it can be blocked by calculi (stones)
structures with in the parotid gland
branches of ECA (superficial temporal and its transverse facial branch)
facial nerve (CN VII)
retromandibular vein
auriculotemporal nerve (CN V3)