Podcast
Questions and Answers
A patient presents with difficulty wrinkling their forehead and raising their eyebrows. Which muscle is most likely affected?
A patient presents with difficulty wrinkling their forehead and raising their eyebrows. Which muscle is most likely affected?
- Occipitofrontalis (correct)
- Orbicularis oculi
- Levator labii superioris
- Orbicularis oris
Following a blunt force trauma to the face, a patient exhibits significant swelling around the eyes, leading to their complete closure. What anatomical explanation best describes this phenomenon?
Following a blunt force trauma to the face, a patient exhibits significant swelling around the eyes, leading to their complete closure. What anatomical explanation best describes this phenomenon?
- Rupture of the parotid duct causing localized edema.
- Direct damage to the orbital part of the orbicularis oculi muscle
- Compression of the mental foramen obstructing lymphatic drainage.
- The accumulation of fluid within the loose connective tissue due to the looseness of the SMAS fascia. (correct)
A surgeon is performing a procedure near the cheek and needs to avoid damaging the duct associated with the parotid gland. Which anatomical landmark should the surgeon use to locate the duct's entry point into the oral cavity?
A surgeon is performing a procedure near the cheek and needs to avoid damaging the duct associated with the parotid gland. Which anatomical landmark should the surgeon use to locate the duct's entry point into the oral cavity?
- The depressor labii inferioris muscle
- The mental foramen
- Opposite the upper second molar (correct)
- The infraorbital foramen
A patient who has undergone facial surgery is now unable to tightly close their eyelid on one side but can still gently close it. Which part of the orbicularis oculi muscle was most likely affected during the procedure?
A patient who has undergone facial surgery is now unable to tightly close their eyelid on one side but can still gently close it. Which part of the orbicularis oculi muscle was most likely affected during the procedure?
During an examination, a neurologist asks a patient to depress their lower lip to assess nerve function. Which muscle is the neurologist primarily testing?
During an examination, a neurologist asks a patient to depress their lower lip to assess nerve function. Which muscle is the neurologist primarily testing?
A patient presents with a marked reduction in facial expressiveness, often described as a 'mask-like' face. Which of the following conditions is most likely contributing to this clinical presentation?
A patient presents with a marked reduction in facial expressiveness, often described as a 'mask-like' face. Which of the following conditions is most likely contributing to this clinical presentation?
Why is the face relatively small at birth compared to the rest of the head?
Why is the face relatively small at birth compared to the rest of the head?
Damage to which of the following nerve branches would most likely result in the inability to wrinkle the forehead on the affected side?
Damage to which of the following nerve branches would most likely result in the inability to wrinkle the forehead on the affected side?
A surgeon is performing a procedure near the parotid gland and needs to be mindful of the structures within. Damage to which of these structures would most likely result in loss of sensation to the upper lip and cheek?
A surgeon is performing a procedure near the parotid gland and needs to be mindful of the structures within. Damage to which of these structures would most likely result in loss of sensation to the upper lip and cheek?
During a physical exam of a patient who presents with facial asymmetry, you notice drooping of the corner of the mouth and difficulty closing one eye. Which of the following is the most likely location of the lesion causing these symptoms?
During a physical exam of a patient who presents with facial asymmetry, you notice drooping of the corner of the mouth and difficulty closing one eye. Which of the following is the most likely location of the lesion causing these symptoms?
A patient complains of dry eyes and dry mouth following a surgical procedure involving the parotid gland. Which of the following nerves was most likely damaged during the procedure, leading to these symptoms?
A patient complains of dry eyes and dry mouth following a surgical procedure involving the parotid gland. Which of the following nerves was most likely damaged during the procedure, leading to these symptoms?
Following a traumatic injury to the face, a patient reports a loss of sensation in the area of the cheek and upper lip. Which of the following foramina is the most likely location of nerve damage?
Following a traumatic injury to the face, a patient reports a loss of sensation in the area of the cheek and upper lip. Which of the following foramina is the most likely location of nerve damage?
A patient presents with numbness in the cheek and upper lip. Which foramen is most likely associated with nerve damage causing this sensory deficit?
A patient presents with numbness in the cheek and upper lip. Which foramen is most likely associated with nerve damage causing this sensory deficit?
During a surgical procedure near the parotid gland, a surgeon identifies a nerve plexus within the gland. Injury to which nerve is the greatest risk?
During a surgical procedure near the parotid gland, a surgeon identifies a nerve plexus within the gland. Injury to which nerve is the greatest risk?
A young child's face appears rounder due to prominent fat pads. How does facial structure typically change as these fat pads diminish during development?
A young child's face appears rounder due to prominent fat pads. How does facial structure typically change as these fat pads diminish during development?
A patient reports loss of sensation on the lateral side of the forehead. Which nerve is most likely affected?
A patient reports loss of sensation on the lateral side of the forehead. Which nerve is most likely affected?
Following trauma to the face, a patient exhibits numbness in the chin region. Which foramen is most likely involved?
Following trauma to the face, a patient exhibits numbness in the chin region. Which foramen is most likely involved?
Damage to which nerve exiting from the zygomaticotemporal foramen would result in sensory loss where?
Damage to which nerve exiting from the zygomaticotemporal foramen would result in sensory loss where?
A surgeon is ligating the facial artery to control bleeding. Which of the following structures is at greatest risk?
A surgeon is ligating the facial artery to control bleeding. Which of the following structures is at greatest risk?
Which nerve provides sensory innervation to the area immediately surrounding the ala of the nose?
Which nerve provides sensory innervation to the area immediately surrounding the ala of the nose?
During a facelift procedure, a surgeon must be cautious to avoid damaging specific nerves. Injury to which nerve would most likely result in the inability to wrinkle the forehead on the affected side?
During a facelift procedure, a surgeon must be cautious to avoid damaging specific nerves. Injury to which nerve would most likely result in the inability to wrinkle the forehead on the affected side?
A patient reports loss of sensation in their forehead and upper eyelid following a traumatic injury. If the injury is located near the exit point of the nerve, which nerve is most likely affected?
A patient reports loss of sensation in their forehead and upper eyelid following a traumatic injury. If the injury is located near the exit point of the nerve, which nerve is most likely affected?
Following a surgical procedure, a patient exhibits numbness in the skin of the nose. Which nerve is the most likely source of this sensory deficit?
Following a surgical procedure, a patient exhibits numbness in the skin of the nose. Which nerve is the most likely source of this sensory deficit?
A patient presents with sensory loss of the lower eyelid, cheek and upper lip region after a motor vehicle accident. Which nerve is most likely damaged?
A patient presents with sensory loss of the lower eyelid, cheek and upper lip region after a motor vehicle accident. Which nerve is most likely damaged?
A patient reports experiencing sensory changes on the skin over their zygomatic bone. Which nerve is the most likely source of these symptoms?
A patient reports experiencing sensory changes on the skin over their zygomatic bone. Which nerve is the most likely source of these symptoms?
A patient is diagnosed with trigeminal neuralgia affecting the ophthalmic division. Which nerve branch, if affected, would cause them to experience pain in the lateral aspect of their upper eyelid?
A patient is diagnosed with trigeminal neuralgia affecting the ophthalmic division. Which nerve branch, if affected, would cause them to experience pain in the lateral aspect of their upper eyelid?
Which nerve's proximity to the medial supraorbital margin makes it vulnerable to injury during surgical procedures in that area, potentially leading to sensory deficits?
Which nerve's proximity to the medial supraorbital margin makes it vulnerable to injury during surgical procedures in that area, potentially leading to sensory deficits?
A patient presents with numbness along the anterior temple above the zygomatic arch. Which nerve is the most likely affected?
A patient presents with numbness along the anterior temple above the zygomatic arch. Which nerve is the most likely affected?
A surgeon is performing a rhinoplasty and needs to be mindful of the sensory innervation to avoid causing nerve damage. Which nerve must be carefully considered during the procedure?
A surgeon is performing a rhinoplasty and needs to be mindful of the sensory innervation to avoid causing nerve damage. Which nerve must be carefully considered during the procedure?
A patient presents with numbness in their lower lip and chin following a mandibular fracture. Which nerve is MOST likely damaged?
A patient presents with numbness in their lower lip and chin following a mandibular fracture. Which nerve is MOST likely damaged?
A patient reports numbness in the forehead and scalp, but NOT the upper eyelid. Which nerve is most likely still intact?
A patient reports numbness in the forehead and scalp, but NOT the upper eyelid. Which nerve is most likely still intact?
Why do facial lacerations tend to part widely if not sutured properly?
Why do facial lacerations tend to part widely if not sutured properly?
A dentist is about to anesthetize the upper teeth and lip of a patient. Which nerve should they target?
A dentist is about to anesthetize the upper teeth and lip of a patient. Which nerve should they target?
A patient experiencing sensory loss in the medial upper eyelid, the adjacent skin of the nose, and the lacrimal sac most likely has damage to which nerve?
A patient experiencing sensory loss in the medial upper eyelid, the adjacent skin of the nose, and the lacrimal sac most likely has damage to which nerve?
Which of the following is a key characteristic of facial muscles?
Which of the following is a key characteristic of facial muscles?
A patient is experiencing sensory loss in the external ear and temporal area of the scalp. Which nerve is MOST likely affected?
A patient is experiencing sensory loss in the external ear and temporal area of the scalp. Which nerve is MOST likely affected?
Which of the following nerves exits the mandible via the mental foramen?
Which of the following nerves exits the mandible via the mental foramen?
A patient reports a loss of sensation in the cheek's skin and mucous membrane. Which nerve is MOST likely affected?
A patient reports a loss of sensation in the cheek's skin and mucous membrane. Which nerve is MOST likely affected?
What is the clinical significance of the superficial musculoaponeurotic system (SMAS) in the face?
What is the clinical significance of the superficial musculoaponeurotic system (SMAS) in the face?
Shingles of the face (Herpes zoster ophthalmicus) can affect regions supplied by which nerve?
Shingles of the face (Herpes zoster ophthalmicus) can affect regions supplied by which nerve?
Through which opening does the mental nerve exit the mandible?
Through which opening does the mental nerve exit the mandible?
Flashcards
The Face
The Face
The visible part of the head in frontal and lateral views, including eyes, ears, nose, and mouth.
Parotid Region
Parotid Region
A region containing the parotid gland, located superficially in the face.
Facial Communication
Facial Communication
The face communicates verbal and emotional information.
Expressionless Face
Expressionless Face
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Face as a Diagnostic Tool
Face as a Diagnostic Tool
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Infant Facial Development
Infant Facial Development
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Verbal and emotional Communication
Verbal and emotional Communication
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Facial Region Structures
Facial Region Structures
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Parotid Region Structures
Parotid Region Structures
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Supraorbital Foramen
Supraorbital Foramen
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Zygomatic Foramina
Zygomatic Foramina
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Infraorbital Foramen
Infraorbital Foramen
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Mental Foramen
Mental Foramen
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Trigeminal Nerve Branches
Trigeminal Nerve Branches
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Ophthalmic Nerve (V1)
Ophthalmic Nerve (V1)
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Maxillary Nerve (V2)
Maxillary Nerve (V2)
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Supraorbital Nerve
Supraorbital Nerve
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Supratrochlear Nerve
Supratrochlear Nerve
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Infratrochlear Nerve
Infratrochlear Nerve
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Lacrimal Nerve
Lacrimal Nerve
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External Nasal Nerve
External Nasal Nerve
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Infraorbital Nerve
Infraorbital Nerve
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Zygomaticofacial Nerve
Zygomaticofacial Nerve
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Zygomaticotemporal Nerve
Zygomaticotemporal Nerve
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Frontal Nerve
Frontal Nerve
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Maxillary Nerve
Maxillary Nerve
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Occipitofrontalis Action
Occipitofrontalis Action
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Orbicularis Oculi Action
Orbicularis Oculi Action
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Levator Labii Superioris Action
Levator Labii Superioris Action
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Depressor Labii Inferioris Action
Depressor Labii Inferioris Action
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Buccinator Action
Buccinator Action
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Mental Nerve
Mental Nerve
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Buccal Nerve (Sensory)
Buccal Nerve (Sensory)
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Auriculotemporal Nerve
Auriculotemporal Nerve
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Shingles of the Face
Shingles of the Face
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Mental Nerve Damage
Mental Nerve Damage
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Facial Muscles: Origin & Insertion
Facial Muscles: Origin & Insertion
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Facial Muscles: Function
Facial Muscles: Function
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Facial Nerve (CN VII)
Facial Nerve (CN VII)
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Superficial Musculoaponeurotic System (SMAS)
Superficial Musculoaponeurotic System (SMAS)
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Study Notes
- The face is the part of the head visible in frontal and lateral views, including eyes, ears, nose, and mouth; it is an instrument of communication, both verbal and emotional.
- Diseases like Parkinson's or Bell's palsy can produce an expressionless face, while pain or depression alter facial expressions.
- Physicians can gain information about a patient's health by observing their face.
- At birth, the face is small compared to the head due to undeveloped maxilla, mandible, and paranasal sinuses but develops during infancy and childhood.
Facial and Parotid Regions
- The facial region contains muscles of facial expression, sensory branches of the trigeminal nerve (V1, V2, V3), and the facial artery/vein with branches.
- The parotid region contains the parotid gland and duct, parotid plexus of the facial nerve, and superficial temporal artery/vein and branches.
Facial Skeleton
- Frontal bone contains the supraorbital foramen.
- Zygomatic bone contains zygomaticofacial and zygomaticotemporal foramina.
- Maxilla contains the infraorbital foramen.
- Mandible contains the mental foramen.
Sensory Nerves of the Face
- Sensory cutaneous nerves of the face are derived from the three divisions of the trigeminal nerve (CN V).
- V1 Ophthalmic nerve branches include: supraorbital, supratrochlear, infratrochlear, lacrimal, and external nasal nerves.
- V2 Maxillary nerve branches include: infraorbital, zygomaticofacial, and zygomaticotemporal nerves.
- V3 Mandibular nerve branches include: mental, buccal, and auriculotemporal nerves.
Functional Anatomy of CN V
- V1 (Ophthalmic division)
Nerve Branch | Origin | Exit | Sensory Area |
---|---|---|---|
Supraorbital | Frontal | Supraorbital foramen of frontal bone | Forehead, scalp, upper eyelid |
Supratrochlear | Frontal | Medial supraorbital margin of frontal bone | Forehead, scalp, upper eyelid |
Infratrochlear | Nasociliary | Medial infraorbital margin of frontal bone | Medial upper eyelid, skin of nose |
Lacrimal | Ophthalmic | Lateral orbital margin of frontal bone | Lateral eyelid |
External Nasal | Anterior Ethmoid | Between nasal bone and part of the nose | Skin of the nose |
- V2 (Maxillary division)
Nerve Branch | Origin | Exit | Sensory Area |
---|---|---|---|
Infraorbital | Maxillary nerve | Infraorbital foramen of maxilla | Lower eyelid, cheek, side of nose |
Zygomaticofacial | Zygomatic nerve | Zygomaticofacial foramen | Skin of face over zygomatic bone |
Zygomaticotemporal | Zygomatic nerve | Zygomaticotemporal foramen on posterior surface | Skin of anterior temple above zygomatic arch |
- V3 (Mandibular division)
Nerve Branch | Origin | Exit | Sensory Area |
---|---|---|---|
Mental | Inferior alveolar | Mental foramen of mandible | Skin/mucous membrane of lower lip and chin |
Buccal | Mandibular nerve | IT Fossa | Skin/mucous membrane of cheek |
Auriculotemporal | Mandibular nerve | IT Fossa | External ear, temporal area of scalp |
Clinical Correlations
- Shingles (Herpes zoster ophthalmicus) can affect regions supplied by ophthalmic (V1) branches.
- Infraorbital Nerve injury is common in maxillary fractures and is a target for dental anesthetization.
- Mental Nerve damage can occur from mandibular fractures, causing loss of sensation in lower teeth and chin/lower lip skin.
Muscles of the Face
- Facial muscles originate from the facial skeleton or superficial fascia and insert into the skin of the face.
- Facial muscles are innervated by the facial nerve (CN VII).
- Superficial fascia of the face is a continuation of the superficial layer of cervical fascia called the Superficial Musculoaponeurotic System (SMAS).
- Facial lacerations tend to part widely due to lack of deep fascia.
Actions of Selected Muscles
- Occipitofrontalis: raises eyebrows and wrinkles the forehead
- Orbicularis oculi: closes the eye
- Orbicularis oris: closes oral fissure, puckers the lips, and changes shape of the oral fissure.
- Buccinator: presses the cheek against the teeth.
- Levator labii superioris: raises the upper lip.
- Depressor labii inferioris: depresses the lower lip.
Facial Nerve
- The facial nerve has five branches: Temporal, Zygomatic, Buccal, Marginal Mandibular, and Cervical.
- CN VII injury causes paralysis of the facial muscles (Bell's palsy) often due to inflammation of the facial nerve near the stylomastoid foramen.
Vasculature of the Face
- The facial artery is a branch of the external carotid artery that crosses the mandible and terminates as the angular artery.
- The superficial temporal artery is a terminal branch of the external carotid.
- The angular vein anastomoses with ophthalmic veins which connects to the cavernous sinus, providing a route for infection to spread to the brain.
Parotid Region
- The parotid is the largest of the three salivary glands.
- It is pyramidal in shape with its base running along the zygomatic arch and its apex downwards towards the mandible.
- The parotid duct exits anteriorly, crosses superficial to masseter, runs along the transverse facial artery and then pierces the buccinator muscle.
Structures Traveling Through the Parotid Gland
- Parotid plexus of CN VII: the facial nerve enters the gland and divides into temporofacial and cervicofacial divisions forming a plexus.
- External carotid artery: passes through the parotid and terminates into the superficial temporal and maxillary arteries.
- Retromandibular vein: located within the gland.
Innervation of the Parotid Gland
- Salivation is stimulated by the parasympathetic autonomic nervous system (PANS).
- Preganglionic PANS fibers originate from the lesser petrosal nerve (branch of CN IX) and synapse in the otic ganglion.
- Postganglionic PANS fibers travel with the auriculotemporal nerve (V3) to the parotid gland.
Clinical Problems of the Parotid Region
- Mumps: viral inflammation of the parotid gland and duct, causing pain when chewing.
- Facial nerve palsy (Bell's Palsy): can be caused by chilling of the face, viral infection, or a tumor/fracture.
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