HEAD AND NECK

Skull, Scalp, Superficial Face

>Before studying the detailed anatomy of the Head and Neck, examine the following bones of the skull:

Major Bones of the Skull

Frontal Bone (1) Parietal bone (2) Occipital bone (1) Temporal bone (2) Mastoid process Sphenoid bone (1) Ethmoid bone (not seen in these views (1) Inferior nasal concha (2) Lacrimal bone (2) Vomer (1) Nasal bone (2) Maxilla (2) Palatine bone (2) Zygomatic bone (2) Mandible (1)

Lateral aspect of the mandible:

body ramus inferior border posterior border coronoid process head of condyle neck of condyle mandibular notch

Other items of lateral skull:

temporomandibular joint external auditory meatus zygomatic arch coronal suture

Air Sinuses of the Skull

Several of the bones of the skull have developed air spaces that are lined with mucous membrane. It is this mucous membrane that becomes infected in sever cases of sinusitis. It is also irritation of the mucous membrane that results in excessive fluid production that can fill the air spaces and give you a stuffed nose feeling. Since these sinuses are embedded in bone, they cannot be seen easily on regular skull preparations and usually require sawing into the bone to see them. Some believe that the function of the sinuses are twofold: 1) makes the skull lighter to carry around and 2) serve as resonating chambers during speech. The figures below were taken from a specially prepared skull.

Air Sinuses Frontal Maxillary Sphenoid Ethmoid Mastoid

Once you have learned some of the bones of the skull, you should then try to visualize some areas as they project to the skin. In the following diagrams, you can see some areas of the skull as they project onto the skin of the face.

FACIAL SKULL

The sensory nerves of the face enter the face through a series of foramina:
1

supraorbital (supraorbital nerve & vessels) Deep to frontalis m. 2 infraorbital (infraorbital nerve & vessels) Deep to levator labii superioris m. 3 mental (mental nerve & vessels) deep to the platysma m. 4 zygomaticofacial (zygomaticofacial nerve) Identify the following on the anterior skull and face

glabella superciliary arch canine fossa alveolar processes anterior nasal spin

In cadaver dissections, the skin is removed carefully and the muscles of facial expression are identified. This is no easy task since the skin is very thin and with very little fatty tissue beneath it. The motor nerves to the muscles of facial expression and the muscles themselves are just beneath the skin. Up until now you have studied muscles that have had 2 bony attachments. The muscles of the face may have a bony attachment but the insertion is into the skin. This is how we can make facial expressions of happiness, sadness, anger or disapproving. Most of us understand these expressions well. Once the skin is removed and the muscles cleaned, you can start to name them. In the following images, the muscles are identified.

MUSCLES OF THE FACE

Muscles of facial expression (image 1): 1. frontalis 2. orbicularis oculi

orbital portion palpebral portion

3. zygomaticus major 4. levator labii superioris alequae nasii 5. levator anguli oris 6. orbicularis oris 7. risorius 8. depressor anguli oris 9. depressor labii inferioris 10. mentalis 11. platysma Image 2 displays the buccinator and the masseter muscles. The masseter is a muscle of mastication, not facial expression but it is superficial in the face. You might notice that the muscles of facial expression are arranged around the orifices of the face: orbit, nasal cavity, mouth and ear (although you wont examine these). Muscles around the mouth include:

1 2

zygomaticus major (3) levator labii superior alequae nasii (4) levator anguli oris (5) orbicularis oris (6) risorius (7) depressor anguli oris (8) depressor labii inferioris (9) buccinator

Muscles around the orbit are:

frontalis (1) orbicularis oculi (2)

MOTOR INNERVATION TO THE FACE

The motor innervation to the muscles of facial expression is Cranial Nerve VII (Facial) (yellow in the diagram) It leaves the skull through the stylomastoid foramen on the base of the skull and immediately turns forward to enter the substance of the parotid gland (pink in the image). While within the gland, it divides into 5 major divisions:

T -- temporal Z -- zygomatic B -- buccal M -- mandibular C -- cervical

Another nerve enters deep in the buccal area where the buccal branches of the facial nerve are found but it is a purely sensory branch of the mandibular branch of Cranial Nerve V (Trigeminal). It supplies the mucous membrane inside the cheek and to the skin in this area. The parotid duct (white) can be seen crossing the masseter muscle on it way to penetrate the buccinator muscle. It opens into the mouth opposite the upper 2nd molar tooth. It forms a small swelling (papilla) inside the oral cavity that can be easily seen. The partotid gland is one of three salivary glands in the head and neck. The transverse facial artery (red) runs just above the parotid duct and is a branch of the superficial temporal artery.

The arterial and venous supply to the face is seen in the diagram. They are the:

Facial artery o inferior labial o superior labial o angular Facial vein Superficial temporal artery Superficial temporal vein

The facial vein is important clinically because it has a direct connection to the ophthalmic vein and then to a deep venous sinus within the cranial cavity, the cavernous sinus. Bacteria can enter the facial vein and gain access to internal cranial structures resulting in infection there. This is probably the reason our mothers always said not to squeeze our pimples.

FEATURES OF THE ORBITAL REGION

Inspect and palpate the living eye. To the right are a few items Under the lacrimal that can easily be caruncle (4) is located seen: the medial palpebral ligament to which the orbicularis oculi palpebral commissures muscle attaches and beneath which is the medial & lateral angles lacrimal sac (7) which empties into the (7,8) lacrimal duct (8) that cornea enters the nose. sclera (3) iris (2) pupil (1) Tarsal cartilages are lacrimal found in each eye lid caruncle (4) and add rigidity to the lacrimal lids. These can be punctum (5) seen if the eyelid is openings of inverted so that the tarsal glands conjuntival side is (6) exposed. eyelashes eyebrows

Structures of the External Ear

On yourself or a lab partner, identify the following parts of the external ear:

1 concha 2 crus of helix 3 helix 4 scaphoid fossa 5 antihelix 6 antitragus 7 tragus

Sensory Nerves of the Face

The sensory nerves of the face are terminal branches of the three divisions of the trigeminal nerve (cranial nerve V) Opthalmic division (V1)

lacrimal supraorbital supratrochlear infratrochlear external nasal

Maxillary division (V2)

infraorbital zygomaticofacial

Mandibular division (V3)

buccal mental

The Scalp
The skin of the scalp continues from t he front and lateral side of the face into the occipital region of the skull posteriorly. The makeup of the scalp is important clinically because trauma to the scalp is frequent and it is up to the clinician to determine by palpation and observation just how serious the trauma is.

The scalp is made of 5 layers and they spell scalp:

S -- skin C -- dense Connective tissue A -- aponeurosis L -- loose connective tissue P -- periosteum

The blood vessels travel through the dense connective. The connective tissue has a special relationship with the arteries in this area. When an artery is severed, the connective tissue fibers around the vessel contract and pull the artery open. This results is more hemorrhage than in other places. With scalp hemorrhage, compression must be used to stop the bleeding. Blood vessels and nerves come into the scalp from three different regions: 1) anterior (supraorbital), 2) lateral (superficial temporal), 3) posterior (occipital). There is free anastomoses from side to side. With all of this blood supply, lacerations of the scalp are usually profuse and because of the nerve supply, very sensitive. The loose connective layer of the scalp will allow bacteria or fluid to pass freely from the posterior aspect of the scalp into the eyelids in front. Trauma in the back of the head can result in blood showing up in the eyelids and should make you suspect

something going on in the back of the head.

Major Sutures and Anthropological Landmarks of the Skull

The major sutures to identify are the:

coronal lambdoid sagittal

Major anthropological points:

bregma lambda

Finally, take a look at some of the skull structures you have identified thus far but through a radiographic image.

1. 2. 3. 4. 5. 6. 7. 8.

coronal suture frontal sinus orbit ethmoid sinus nasal cavity inferior concha maxillary sinus ramus of mandible 9. body of mandible 10. nasal septum 11. mastoid air cells 12. sphenoid sinus 13. hypophyseal fossa

Summary of items in this lesson

Bones Maxillary division (V2) Frontal Bone (1) infraorbital Parietal bone (2) zygomaticofacial Occipital bone (1)

Temporal bone (2) Sphenoid bone (1) Ethmoid gone (1)

Mandibular division (V3) buccal mental Arteries

Inferior nasal concha (2) Lacrimal bone (2) Vomer (1) inferior labial Nasal bone (2) superior labial Maxilla (2) angular Palatine bone (2) Zygomatic bone (2) Mandible (1) body ramus inferior border posterior border coronoid process head of condyle neck of condyle mandibular notch temporomandibular joint external auditory meatus zygomatic arch coronal suture anterior nasal spin Foramina openings of tarsal glands supraorbital eyelashes infraorbital mental eyebrows External ear features sclera iris pupil lacrimal caruncle lacrimal punctum medial lateral angles cornea Superficial temporal vein Eye features palpebral commissures External carotid Superficial temporal artery Veins Facial vein Facial

zygomaticofacial glabella superciliary arch canine fossa alveolar processes Sutures and anthropological landmarks Sutures coronal

concha crus of helix helix scaphoid fossa antihelix antitragus tragus Scalp S -- skin

lambdoid C -- dense Connective tissue sagittal Anthropological landmarks A -- aponeurosis bregma lambda Muscles zygomaticus major levator labii superioris alequae nasii ethmoid levator anguli oris sphenoid orbicularis oris Radiographs risorius depressor anguli oris depressor labii inferioris buccinator frontalis orbicularis oculi orbital portion palpebral portion Nerves coronal suture frontal sinus ethmoid sinus maxillary sinus sphenoid sinus nasal septum inferior concha body of mandible ramus of mandible L -- loose connective tissue P -- periosteum Air sinuses frontal maxillary

Facial mastoid sinus T -- temporal Z -- zygomatic B -- buccal M -- mandibular C -- cervical Trigeminal Opthalmic division (V1) lacrimal supraorbital supratrochlear infratrochlear external nasal hypophyseal fossa