L60. GA - Face & Parotid
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Questions and Answers

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?

  • 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?

  • 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?

<p>The orbital part (D)</p> Signup and view all the answers

During an examination, a neurologist asks a patient to depress their lower lip to assess nerve function. Which muscle is the neurologist primarily testing?

<p>Depressor labii inferioris (B)</p> Signup and view all the answers

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?

<p>Parkinson's Disease (B)</p> Signup and view all the answers

Why is the face relatively small at birth compared to the rest of the head?

<p>The mandible and maxilla are not fully developed, and most paranasal sinuses have not yet formed. (C)</p> Signup and view all the answers

Damage to which of the following nerve branches would most likely result in the inability to wrinkle the forehead on the affected side?

<p>Temporal branch of the facial nerve (D)</p> Signup and view all the answers

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?

<p>Auriculotemporal nerve (D)</p> Signup and view all the answers

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?

<p>Facial nerve (CN VII) (B)</p> Signup and view all the answers

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?

<p>Lesser Petrosal Nerve (D)</p> Signup and view all the answers

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?

<p>Infraorbital Foramen (C)</p> Signup and view all the answers

A patient presents with numbness in the cheek and upper lip. Which foramen is most likely associated with nerve damage causing this sensory deficit?

<p>Infraorbital foramen (A)</p> Signup and view all the answers

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?

<p>Facial nerve (D)</p> Signup and view all the answers

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?

<p>The face becomes longer. (B)</p> Signup and view all the answers

A patient reports loss of sensation on the lateral side of the forehead. Which nerve is most likely affected?

<p>Supraorbital nerve (A)</p> Signup and view all the answers

Following trauma to the face, a patient exhibits numbness in the chin region. Which foramen is most likely involved?

<p>Mental foramen (C)</p> Signup and view all the answers

Damage to which nerve exiting from the zygomaticotemporal foramen would result in sensory loss where?

<p>Temporal region (A)</p> Signup and view all the answers

A surgeon is ligating the facial artery to control bleeding. Which of the following structures is at greatest risk?

<p>Facial nerve branches (B)</p> Signup and view all the answers

Which nerve provides sensory innervation to the area immediately surrounding the ala of the nose?

<p>External nasal nerve (D)</p> Signup and view all the answers

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?

<p>Temporal branch of the facial nerve (C)</p> Signup and view all the answers

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?

<p>Supraorbital nerve (A)</p> Signup and view all the answers

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?

<p>External Nasal nerve (C)</p> Signup and view all the answers

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?

<p>Infraorbital nerve (D)</p> Signup and view all the answers

A patient reports experiencing sensory changes on the skin over their zygomatic bone. Which nerve is the most likely source of these symptoms?

<p>Zygomaticofacial nerve (D)</p> Signup and view all the answers

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?

<p>Lacrimal nerve (C)</p> Signup and view all the answers

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?

<p>Infratrochlear nerve (A)</p> Signup and view all the answers

A patient presents with numbness along the anterior temple above the zygomatic arch. Which nerve is the most likely affected?

<p>Zygomaticotemporal nerve (D)</p> Signup and view all the answers

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?

<p>External Nasal nerve (A)</p> Signup and view all the answers

A patient presents with numbness in their lower lip and chin following a mandibular fracture. Which nerve is MOST likely damaged?

<p>Mental nerve (B)</p> Signup and view all the answers

A patient reports numbness in the forehead and scalp, but NOT the upper eyelid. Which nerve is most likely still intact?

<p>Lacrimal nerve (C)</p> Signup and view all the answers

Why do facial lacerations tend to part widely if not sutured properly?

<p>The face lacks a deep fascia to hold the SMAS together. (C)</p> Signup and view all the answers

A dentist is about to anesthetize the upper teeth and lip of a patient. Which nerve should they target?

<p>Infraorbital nerve (D)</p> Signup and view all the answers

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?

<p>Infratrochlear nerve (B)</p> Signup and view all the answers

Which of the following is a key characteristic of facial muscles?

<p>They insert into the skin of the face, moving the skin to create facial expressions. (B)</p> Signup and view all the answers

A patient is experiencing sensory loss in the external ear and temporal area of the scalp. Which nerve is MOST likely affected?

<p>Auriculotemporal nerve (A)</p> Signup and view all the answers

Which of the following nerves exits the mandible via the mental foramen?

<p>Mental (B)</p> Signup and view all the answers

A patient reports a loss of sensation in the cheek's skin and mucous membrane. Which nerve is MOST likely affected?

<p>Buccal nerve (B)</p> Signup and view all the answers

What is the clinical significance of the superficial musculoaponeurotic system (SMAS) in the face?

<p>It is a continuation of the superficial layer of cervical fascia and contributes to facial structure; its absence of deep fascia causes lacerations to spread. (C)</p> Signup and view all the answers

Shingles of the face (Herpes zoster ophthalmicus) can affect regions supplied by which nerve?

<p>Ophthalmic nerve (V1) (B)</p> Signup and view all the answers

Through which opening does the mental nerve exit the mandible?

<p>Mental foramen (D)</p> Signup and view all the answers

Flashcards

The Face

The visible part of the head in frontal and lateral views, including eyes, ears, nose, and mouth.

Parotid Region

A region containing the parotid gland, located superficially in the face.

Facial Communication

The face communicates verbal and emotional information.

Expressionless Face

Some diseases can reduce facial expression, impacting communication.

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Face as a Diagnostic Tool

Physicians use facial observations to assess patient health.

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Infant Facial Development

At birth, the face is relatively small because the maxilla, mandible, and paranasal sinuses are not fully developed.

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Verbal and emotional Communication

The face is an instrument of communication- both verbal and emotional.

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Facial Region Structures

Facial region structures include muscles of facial expression, sensory branches of the trigeminal nerve, branches of the facial nerve, and the facial artery and vein.

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Parotid Region Structures

The parotid region contains the parotid gland & duct, parotid plexus of the facial nerve, and the superficial temporal artery and vein.

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Supraorbital Foramen

Openings in the frontal bone above the eye socket; transmits nerves and vessels.

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Zygomatic Foramina

Small openings located on the zygomatic bone; transmits nerves and vessels.

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Infraorbital Foramen

An opening in the maxilla bone below the eye socket; transmits nerves and vessels.

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Mental Foramen

An opening on the anterior mandible; transmits nerves and vessels.

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Trigeminal Nerve Branches

The three main divisions that provide sensory innervation to the face.

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Ophthalmic Nerve (V1)

Sensory cutaneous nerves of the face, including supraorbital, supratrochlear, infratrochlear, lacrimal, external nasal.

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Maxillary Nerve (V2)

Sensory cutaneous nerves of the face, including infraorbital, zygomaticofacial, zygomaticotemporal.

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Supraorbital Nerve

Branch of V1; exits via the supraorbital foramen/notch.

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Supratrochlear Nerve

Branch of V1; exits at the medial supraorbital margin.

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Infratrochlear Nerve

Branch of V1 (from Nasociliary); exits at the medial infraorbital margin.

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Lacrimal Nerve

Branch of V1; exits at the lateral orbital margin.

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External Nasal Nerve

Branch of V1 (from Anterior Ethmoid); exits between nasal bone and cartilage.

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Infraorbital Nerve

Branch of V2; exits via the infraorbital foramen.

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Zygomaticofacial Nerve

Branch of V2 (from Zygomatic nerve); exits via the zygomaticofacial foramen.

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Zygomaticotemporal Nerve

Branch of V2 (from Zygomatic nerve); exits via the zygomaticotemporal foramen.

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Frontal Nerve

Origin of Supraorbital and Supratrochlear nerves.

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Maxillary Nerve

Origin of the Infraorbital nerve.

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Occipitofrontalis Action

Muscle consisting of occipital and frontalis bellies connected by the galea aponeurotica; raises eyebrows and wrinkles forehead.

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Orbicularis Oculi Action

Flat, elliptical muscle around the eye's rim; orbital part tightly closes the eye, while the palpebral part gently closes it.

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Levator Labii Superioris Action

Muscle that covers the infraorbital foramen and elevates the upper lip.

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Depressor Labii Inferioris Action

Muscle that covers the mental foramen and depresses the lower lip.

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Buccinator Action

Principle cheek muscle that presses the cheek against the teeth.

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Mental Nerve

A branch of the mandibular nerve (V3) that exits through the mental foramen.

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Buccal Nerve (Sensory)

A branch of the mandibular nerve (V3) that provides sensory innervation to the cheek.

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Auriculotemporal Nerve

A branch of the mandibular nerve (V3) that provides sensory innervation to the external ear and temporal scalp.

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Shingles of the Face

A viral infection affecting sensory nerves, such as ophthalmic nerve (V1).

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Mental Nerve Damage

Damage can cause loss of sensation in lower teeth, chin, and lower lip.

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Facial Muscles: Origin & Insertion

Originate from the facial skeleton or superficial fascia and insert into the skin of the face.

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Facial Muscles: Function

They move the skin of the face to create expressions.

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Facial Nerve (CN VII)

All facial muscles are innervated by this nerve.

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Superficial Musculoaponeurotic System (SMAS)

A continuation of the superficial layer of cervical fascia, enclosing the platysma.

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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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