1
Q
what are the 5 layers of the scalp from superficial to deep
A
1) skin
2) dense CT
3) aponeurosis
4) loose CT
5) pericranium (periosteum)
2
Q
skin
A
contains all epidermal appendages including hair follicles and sebaceous glands
3
Q
dense connective tissue
A
- highly vascularized and innervated layer, also contains hair follicles
- scalp lacerations that penetrate this layer bleed profusely due to rich blood supply
4
Q
aponeurosis
A
thin, broad, tendon-like sheet that covers the dome of the skull and serves as an intermediate tendon between the occipitalis muscle posteriorly and frontalis muscle anteriorly
5
Q
loose connective tissue
A
- referred to as “danger area of scalp” because infections can spread within it and enter the cranial cavity
- provides an easy plan of separation between the upper 3 layers and pericranium (the external periosteum of the skull)
6
Q
pericranium (periosteum)
A
- very thin layer of connective tissue that covers the bones of the skull
- protects skull and provides nutrients to the bone
7
Q
salivary glands
A
- parotid gland
- sublingual gland
- submandibular gland
8
Q
parotid gland
A
- secretions exit through Stensen’s duct (parotid duct)
- Stensen’s duct passes superficial to masseter muscle, then pierces the buccinator to open into the oral cavity opposite the 2nd upper molar tooth
9
Q
submandibular gland
A
- 2nd largest salivary gland
- can be palpated in neck medial to lower border of mandible
10
Q
muscles of facial expression
A
- specialized group of voluntary muscles that protect orifices of face by acting as sphincter and dilators
- attach to skin therefore can change facial expression
11
Q
buccinator
A
contraction pulls cheeks tightly against teeth, preventing food from collecting between teeth and gums during mastication and working in concert with tongue to keep food between molars
12
Q
what are the branches of the facial nerve
A
- CN VII
- supplies both sensory and motor innervation
- temporal
- zygomatic
- marginal mandibular
- cervical
- buccal
13
Q
trigeminal nerve
A
- CN V
- carries sensory and motor info to face
- each branch supplies sensory info to specific areas of the face
14
Q
what are the 3 branches of the trigeminal nerve
A
- mandibular (V3)
- maxillary (V2)
- ophthalmic (V1)
15
Q
Mandibular branch (V3) of the trigeminal nerve
A
supplies skin of lower lip, lower face, temporal region and upper part of external ear
- only division that carries motor innervation to the muscles of mastication
16
Q
maxillary branch (V2) of the trigeminal nerve
A
- innervates skin of lateral sides of nose, lower eyelid, cheek, temporal region and upper lip
17
Q
ophthalmic branch (V1) of trigeminal nerve
A
carries sensory info from skin of forehead, upper eyelid and midline of nose
18
Q
how many extraocular muscles control the movements of the eyeball and eyelid
A
7
19
Q
movement of eyeball about horizontal axis
A
- elevation of eyeball with pupil in midline by the superior rectus and inferior oblique muscles
- depression facilitated by inferior rectus and superior oblique muscles
20
Q
movement of eyeball about vertical axis
A
- abduction of eyeball facilitated by lateral rectus muscle
- adduction performed by medial rectus muscle
21
Q
arterial supply of orbit
A
- ophthalmic artery = branch of internal carotid artery
- enters orbit with optic nerve (CN II) through the optic canal
- branches of ophthalmic artery supply contents of orbit and eyelids (ex. central retinal artery supplies retina)
22
Q
venous drainage of orbit
A
- superior ophthalmic vein formed by smaller veins that drain orbit
- passes through superior orbital fissure to drain into cavernous sinus
- small inferior ophthalmic vein usually joins superior ophthalmic vein before draining into cavernous sinus
23
Q
ear
A
- contains organs of hearing and balance
- divided into 3 parts: external, middle and inner ear
24
Q
lateral border of middle ear
A
tympanic membrane
25
medial border of middle ear
medial (labyrinthine) wall separates middle and inner ear
26
posterior border of middle ear
thin bone separating tympanic cavity from mastoid air cells in the temporal bone
27
roof of middle ear
tegmen tympani, thin plate of bone which separates the middle ear from the middle cranial fossa
28
floor of middle ear
jugular wall, thin bone which separates middle ear from internal jugular vein
29
anterior border of middle ear
lower anterior wall is thin bone that separates tympanic cavity from internal carotid artery (upper anterior wall incomplete because of opening of eustachian tube)
30
eustachian tube
- channel between middle ear and nasopharynx
- helps equalize pressure on either side of tympanic membrane allowing it to vibrate properly for transmission of sound to inner ear
31
nasal septum
- forms common medial wall that separates the left and right nasal cavities
- important supporting structure of nasal cavity, formed by cartilage and bone
32
what are the components of the nasal septum
- perpendicular (vertical) plate of ethmoid bone superiorly
- vomer bone inferiorly
- septal cartilage anteriorly
33
arterial supply of nasal septum
- anterior portion of nasal septum contains rich anastomosis of arteries
- irritation caused by allergens, bacteria or foreign objects may cause swelling/inflammation of these arteries which can restrict breathing
- carotid arteries
- ophthalmic and maxillary arteries
- Kiesselbach's plexus
34
carotid arteries
- internal and external carotid arteries ascend towards the nasal septum
35
ophthalmic and maxillary arteries
- ophthalmic artery branches off the internal carotid artery
| - maxillary artery branches off the external carotid artery
36
Kiesselbach's plexus
- branches of ophthalmic and maxillary arteries anastomose to form Kiesselbach's plexus, a richly vascularized area in the anterior portion of the nasal septum
37
which nerve supplies sensory info from nasal septum
branches of trigeminal nerve (CN V)
- anterosuperior part of nasal septum innervated by ophthalmic branch (V1) and the rest of the nasal septum is innervated by the maxillary branch (V2)
38
which nerve supplies special sensory info from nasal septum
olfactory nerve (CN I)
39
oral cavity
bounded by roof of composed palate and floor formed by mucous membrane covering mylohyoid muscle
40
sensory innervation of the tongue
- glossopharyngeal nerve (CN IX)
- trigeminal nerve (CN V)
- facial nerve (CN VII)
41
glossopharyngeal nerve
- CN IX
| - has lingual branches that supply both general and special sensory innervation to the posterior 1/3 of the tongue
42
trigeminal nerve
- CN V
- 3 major general sensory branches
- mandibular division gives rise to lingual nerve which supplies general sensory innervation to the anterior 2/3 of the tongue
43
facial nerve
- CN VII
- special sensory (taste) from the anterior 2/3 of the tongue carried by lingual nerve to the chorda tympani, branch of facial nerve
44
lingual artery
- the external carotid artery ascends in the neck and gives rise to several branches including the maxillary and lingual artery which supply the tongue, sublingual gland and the floor of the mouth
- maxillary artery supplies upper jaw and nose
45
masticatory apparatus
4 paired muscles that attach to the mandible, responsible for movements of jaw
46
lateral (external) pterygoid muscle
fibres run horizontally to insert into neck of mandible as well as capsule and articular disc of temporomandibular joint (TMJ)
47
medial (internal) pterygoid muscle
- fibres run obliquely downward and backwards to insert on to medial surface of mandible near its angle
48
muscles of mastication involved in elevation
temporalis, masseter, medial pterygoid
49
muscles of mastication involved in depression
primarily gravity and relaxation of muscles
50
muscles of mastication involved in lateral (side to side) movement
medial and lateral pterygoid
51
muscles of mastication involved in protraction (protrusion)
lateral pterygoid
52
muscles of mastication involved in retraction
temporalis
53
innervation of the muscles of mastication
trigeminal nerve provides sensory innervation to face and motor innervation to muscles of mastication from the mandibular nerve (V3) branch
54
the temporomandibular joint
- synovial, modified hinge joint
- between head (condyle) of the mandible, the mandibular fossa and the articular tubercle of the temporal bone
- between the articular surfaces is a fibrocartilaginous articular disc
55
movements of temporomandibular joint
- during normal chewing, acts like a hinge between head of mandible and articular disc
- during wide opening of mouth, mandible is depressed and pulled forward (protracted) by lateral pterygoid muscles
- head of mandible and articular disc slide anteriorly on articular tubercles
- allows for wider opening of mouth but also prevents angle of mandible from moving too far posteriorly
- elevation achieved by temporalis and masseter muscles
- retraction achieved achieved by temporalis muscles
56
vasculature of masticatory apparatus
- maxillary artery supplies the muscles of mastication
- maxillary artery is a branch of the external carotid artery
- middle meningeal artery = important branch of the maxillary artery, enters cranial cavity and supplies much of the dura mater
57
cranial nerve
- 12 pairs that emerge from brain and brainstem
- some carry strictly sensory or motor info whereas others carry both
- cranial nerve disorders can affect smell, taste, vision, sensation of the face, facial expression, hearing, balance, speech, swallowing and muscles of the neck
58
eye drifts
- lateral rectus and medial rectus must be activated to maintain a forward gaze, an imbalance would cause eye to drift to one side
- dysfunctional lateral rectus muscle results in eye drifting towards midline (adducting)
- lateral rectus receives motor innervation from CN VI the abducens nerve
59
tooth sensation
- trigeminal nerve carries general sensory info from upper and lower jaw
- the lower jaw is specifically innervated by the terminal branch of the trigeminal nerve, the mandibular nerve
- if mandibular nerve is damaged, sensation of lower jaw impaired
60
smiling
- facial nerve provides motor innervation to the muscles of facial expression
- inability to move muscles of face to produce smile implicates this nerve
61
tongue deviations
- hypoglossal nerve controls the muscles of the tongue
- if damaged, moving tongue in and out of mouth and using it to speak and swallow impaired
- unilateral tongue weakness, tongue deviates towards weak side
62
hearing and equilibrium
- vestibulocochlear nerve transmits info regarding sound and equilibrium
- if damaged, hearing and balance impaired
63
what are the 4 parasympathetic ganglia located in the head
- ciliary
- pterygopalatine
- submandibular
- otic
64
where do the preganglionic fibres of these ganglia originate
receive parasympathetic fibres from the oculomotor, facial and glossopharyngeal nerves
65
the otic ganglion
- preganglionic fibres leave the medulla oblongata of the brainstem as the glossopharyngeal nerve
- post ganglionic nerve to innervate parotid gland (auriculotemporal nerve = branch of the mandibular division of the trigeminal nerve)
66
arterial supply of the face
- ophthalmic artery is a branch of the internal carotid artery that supplies the eyes
- superficial temporal artery and facial artery are 2 branches of the external carotid artery that supply several structures of the face
67
the ophthalmic artery
- branch of the internal carotid artery
- branches supply eyes and forehead
- terminal branches of ophthalmic artery form extensive anastomoses with branches of facial, maxillary and superficial temporal arteries (all of which arise from the external carotid artery)
68
the superficial temporal artery
- arises from external carotid artery in parotid gland
- ascends side of face and crosses over the zygomatic arch to supply the skin and muscles of the temple and scalp, in addition to the parotid gland
- the pulse of the superficial temporal artery can be felt where it crosses the zygomatic arch, anterior to the ear
69
the facial artery
- enters the face by passing over the lower border of the mandible, running in a tortuous course towards the medial angle of the eye
- has this course to accommodate movements of the fave, namely regions of the eyes, mandible and lips
- the facial artery supplies superficial structures of the skin and face, such as some muscles of facial expression and mastication
- because the facial artery runs superficially, the pulse of the facial artery can be felt where it crosses the mandible
70
venous drainage of the face
- mainly drained by facial vein which travels alongside the facial artery and empties into the internal jugular vein
- facial vein (through deep communication veins ex. ophthalmic vein) drains into cavernous sinus
71
cavernous sinus
- one of the dural venous sinuses
| - functions to drain blood from brain
72
what is unique about the veins of the face
they do not contain valves, allowing blood to flow in either direction
- facial vein can be a conduit for infections to spread from face intracranially, to the cavernous sinuses
73
the danger triangle
- trochlear nerve (CV IV), abducens nerve (CV VI) and the ophthalmic nerve (CN V1) are cranial nerves that would likely be affected by an infection of the cavernous sinus
74
lymphatics of the head and neck
3 groups of lymph nodes: superficial ring of nodes (collar nodes), superficial cervical nodes and deep cervical nodes
75
collar nodes
name originates from location of traditional collar at junction of head and neck
76
superficial cervical nodes
found on surface of sternocleidomastoid muscle and are associated with external jugular vein
77
deep cervical nodes
found deep to sternocleidomastoid and are closely related to the internal jugular vein
- all lymphatic drainage of head and neck empties into deep cervical nodes
- deep cervical nodes drain into right lymphatic duct and thoracic duct, draining the right and left sides respectively
ANAT380
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