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ANATOMIC AND TOPOGRAPHIC

REGIONS OF HEAD
Regions of head (cranium)

From topographic point of view, the head presents two parts: cranium and facies.
The limit between cranium and facies – glabella, supraorbitary border of frontal bone,
frontozygomatic suture, posterior border of frontal process of zygomatic, inferior border of
zygomatic arch, base of mandible condyle, inferior part of external acoustic meatus, base
of mastoid process.
Regions of head (cranium)

The limit between head and neck


The limit between cranium and facies

According to International Anatomic Nomenclature, we have the following topographic


regions in the head area:

Regiones capitis

- Median, asymmetrical regions:


- Regio frontalis
- Regio parietalis
- Regio occipitalis
- Lateral symmetrical regions:
- Regio temporalis
- Regio auricularis
- Regio mastoidea
Regions of head (cranium)

Regiones facialis

- Median, asymmetrical regions


- Regio nasalis
- Regio oralis
- Regio mentalis
- Lateral symmetrical regions
- Regio orbitalis
- Regio infraorbitalis
- Regio zygomatica
- Regio bucalis
- Regio parotideomaseterina
- Regio infratemporalis: symmetrical,
deep regions
Regions of head (cranium)
Median regions of head correspond to calvaria
and they resemble from stratigraphic point of
view to fronto-parieto-occipital region.

Limits:
- Anterior – glabella and margo supraorbitalis
- Posterior – external occipital prottruberance an
superior nuchal line – mastoid process
- Lateral – superior temporal line and mastoid
process
Regions of head (cranium)

Fronto-parietal-occipital region

Stratigraphy
Tegument – thick, hairless on forehead except
for the eyebrows and otherwise covered with
hair

Subcutaneous layer – contains less fat;


conjunctive tracts that connect dermis layer to
muscle and aponeurosis plane; blood vessels
and nerves.
Regions of head (cranium)

Fronto-parietal-occipital region

Stratigraphy
Blood vessels
1. Supraorbital artery , branch of ophthalmic
artery, leaves the orbit through supraorbital
foramen and goes to vertex.
2. Supratrochlear artery, superior terminal
branch of ophthalmic artery leaves the orbti
through frontal foramen and goes through
orbit septum
3. Frontal branch of superficial temporal artery
– external carotid artery
4. Parietal branch of superficial temporal
artery
5. Occipital artery
6. Occipital branch of posterior auricular artery
– external carotid artery.
Those arteries create anastomosis between
them and to the others from the opposite side.
Regions of head (cranium)

Fronto-parietal-occipital region

Stratigraphy
Veins form a rich network with many
anastomosis.
Emissary and diploic veins connect the
exocranian venous network to dura mater
sinuses.
Thus, exocranian infections can spread to the
venous sinuses of dura mater
Regions of head (cranium)

Fronto-parietal-occipital region

Stratigraphy
Nerves – sensitive
- Supraorbital nerve – from frontal nerve
of ophthalmic nerve
- Supratrochlear nerve – from frontal
nerve of ophthalmic nerve
- Auriculotemporal nerve
- Greater occipital nerve – dorsal
branches of C2
- Lesser occipital nerve – cervical plexus
– ventral branches C2C3
Regions of head (cranium)

Fronto-parietal-occipital region

Stratigraphy
Nerves
- Temporal branches – facial nerve
- Frontal branches – mimic muscles
- Posterior auricular nerve – occipital
muscle
Regions of head (cranium)

Fronto-parietal-occipital region

Stratigraphy
Muscle and aponeurosis place
Epicranius muscle (mimic, cutaneous
muscle) is made of:
- occipital-frontal muscle
- Temporal-parietal muscle
- Galea aponeurotica – covers the skull
and serve as insertion for occipital-
frontal and temporal-parietal muscles.

Tegument, subcutaneous tissue with


blood vessels and nerves and epicranius
muscle interlocked by conjunctive tracts,
form the scalp.
Regions of head (cranium)

Fronto-parietal-occipital region

Stratigraphy
Sub-aponevrosis plane – between scalp and periosteal there is a lax conjunctive tissue that
allows the scalp to lift during accidents.
Thus hematomas appear – they do not respect the limits of calvaria bones.

Sub-periosteal plane – periosteum is weakly adherent to calvaria bones but strongly fixed to
their sutures.
Cephalic-hematoma – is a blood collection, under periosteum , limited by sutures.
Regions of head (cranium)

Fronto-parietal-occipital region

Stratigraphy
Osseous plane
- Calvaria – squamos part of frontal, parietal and occipital bones
- Temporal lines
- Sutures – sagittal, coronal, lambdoid
- Parietal foramen
Regions of head (cranium)

Fronto-parietal-occipital region

Stratigraphy

Osseous plane

In new born, at the level of sutures,


there are membranous spaces –
fontanelle
- Anterior fontanelle – rhombic shape
at the junction between coronal,
sagittal and frontal sutures.
- Posterior fontanelle – triangular
shape, at the junction between
sagittal and lambdoid sutures.
Regions of head (cranium)

Fronto-parietal-occipital region

Stratigraphy

Osseous plane

On the inferior face of calvaria:


- Frontal crest
- Groove for superior sagittal sinus
- Grooves for arterial branches
- Granular foveolae – for arachnoid
granulations
Regions of head (cranium)

Fronto-parietal-occipital region

Stratigraphy

Cranial dura mater plane

- Cranial dura mater adheres to sutures


and can be decollated in all the other
areas. Thus, extradural hematomas
can be produced during cranial
traumatisms – branches of meningeal
arteries can be affected, especially
middle meningeal artery.
- Superior sagittal sinus drains to sinus
confluent – internal occipital
protuberance.
Regions of head (cranium)

Temporal region

Symmetrical region located on the lateral


sides of skull.
Limits:
- Superior – superior temporal line
- Inferior – superior border of
zygomatic arch, superior from
external acoustic meatus
- Anterior – zygomatic process of
frontal bone and frontal process of
zygomatic bone.
Regions of head (cranium)

Temporal region

Stratigraphy

Tegument – is thin, mobile, hairless in the


anterior and inferior part and thick,
covered with hair in the posterior and
superior part.
Sub-cutaneous layer – contains mimic
muscles, blood vessels and nerves.
Mimic muscles:
- Anterior auricular muscle
- Temporal-parietal muscle
- Superior auricular muscle
Regions of head (cranium)

Temporal region

Stratigraphy

Sub-cutaneous layer
Blood vessels
- Superficial temporal artery – terminal
branch of external carotid artery,
located anterior from tragus, has an
ascending trajectory. With age, it
becomes visible, prominent under the
skin. It has terminal branches: frontal
and parietal.
- Superficial temporal veins – together
with maxillary veins, they will form
retromandibular vein inside parotid
gland.
Regions of head (cranium)

Temporal region

Stratigraphy

Sub-cutaneous layer
Nerves
- Auriculotemporal nerve – from
mandibular nerve; located posterior
from superficial temporal vessels;
sensitive
- Zygomaticotemporal nerve – from
zygomatic nerve from maxillary nerve;
sensitive
- Temporal branches – motor; from facial
nerve.
Regions of head (cranium)

Temporal region

Stratigraphy

Aponevrosis layer
- the lateral part of galea
aponeurotica that gives insertion
to anterior and superior auricular
muscles and temporal-parietal
muscle.
Regions of head (cranium)
Temporal region

Stratigraphy
Fascial layer
Temporal fascia – superior it inserts to
superior temporal line and inferior
doubles, containing between the
sheaths, adipose tissue.

Muscle plane
Temporal muscle – masticatory muscle

Blood vessels and nerves plane


Between temporal muscle and osseous
plane there are the anterior, middle and
posterior deep vascular and nervous
bundles:
- Anterior and posterior temporal
artery from maxillary artery
- Middle temporal artery from
superficial temporal artery
- Deep temporal nerves – from
mandibular nerve
Regions of head (cranium)

Temporal region

Stratigraphy

Osseous plane

Temporal fossa – frontal, sphenoid,


parietal, squamous part of temporal and
zygomatic bones
The osseous plane is thin and can be
fractured during low energy trauma.
In new born – sphenoidal fontanelle and
mastoid fontanelle ossify immediately
after birth.
Regions of head (cranium)

Temporal region

Stratigraphy

Cranial dura mater

Dura mater is very easily detachable –


Marchand Ferre area.
Between the osseous plane and dura
mater, one can find middle meningeal
vessels, that, if traumatized, can cause an
extradural hematoma.
Regions of head (cranium)

Temporal region

Stratigraphy

Cranial dura mater

The arachnoid and pia mater cover a part


of the lateral face of cerebral hemisphere
with its central and lateral grooves –
important sensitive and motor areas!!
Regions of head (cranium)

Mastoid region

A symmetrical region that


corresponds to the lateral face of
mastoid process; it is located
behind the ear.
By trepanation of mastoid, one
can access the antrum of mastoid
– relation to middle ear.
Regions of head (cranium)

Auricular region

A symmetrical region, located at


the limit between temporal,
mastoid and parotid-masseterin
regions.
It contains the ear pavilion and
external acoustic
meatus=external ear.
Regions of head (cranium)

Auricular region

Ear pavilion
Lateral face:
- Cavity of concha
- Helix – a prominence that starts by
the root of helix, limits the free
border of the pavilion and ends by
tail of helix at the level of lobule. The
root of helix divides the cavity of
concha into cavum concha (inferior)
and cymba concha (superior)
- Antihelix – a prominence parallel to
helix. It starts superiorly by the root
of antihelix (triangular fossa) and
ends inferiorly by antitragus
- Scaphoid fossa – depression
between helix and antihelix
- Tragus – a prominence located
anterior from antitragus

On the medial face one can find


corresponding landmarks.
Regions of head (cranium)

Auricular region

Ear pavilion
Ear pavilion presents fiber-elastic cartilage that takes part to the formation of cartilaginous
external acoustic meatus. One can describe some atrophied muscles in humans.
The pavilion is covered by tegument; it presents hair and ceruminous glands.
Regions of head (cranium)

Auricular region

External acoustic meatus has a cartilaginous part that starts at concha and an osseous part –
tympanic and squamous part of temporal bone.
It has a sinuous trajectory and it is in relation: superior – base of cranium; inferior – parotid
gland; anterior – temporomandibular joint; posterior – mastoid process.
Through external acoustic meatus one can feel the head of mandible.
Regions of head (cranium)
Auricular region

Blood vessels

- Anterior auricular artery (from superficial


temporal artery) and posterior auricular
artery (external carotid artery)
- Veins drain to external jugular vein and
pterygoid plexus.

Innervation:

- Sensitive – auriculotemporal nerve (maxillary


nerve); great auricular nerve (cervical plexus);
Lesser occipital nerve (cervical plexus);
auricular branch of vagus nerve.
- Motor – fibers from vagus nerve for
rudimentary auricular muscles.
Regiones facialis

Regio nasalis

I corresponds to nasal cavity


Regiones facialis

Regio nasalis

Superficial, it corresponds to external nose.


Limits:
- Superior – a skin fold that corresponds to
frontonasal suture
- Inferior – a groove between nose and upper lip
- Lateral – the groove between nose and eyelid
continues to a groove between nose and cheek.
Regiones facialis

Regio nasalis

Nose:
- Radix nasi
- Dorsum nasi
- Apex nasi
- Ala nasi – two orifices called narina, separated
by the membranous part of nasal septum.
Regiones facialis

Regio nasalis

Stratigraphy

Tegumentul – contains sebum and sweat


glands

Muscle plane
Mimic muscles, innervated by facial nerve:
- Procerus muscle
- Depressor septi nasi muscle
- Levator labii superioris alaeque nasi
muscle
- Nasalis muscle – transverse and alar
parts
Regiones facialis

Regio nasalis

Stratigraphy
- Angular artery – from facial artery
- Dorsal nasal artery – from ophthalmic
artery
- Branches of infraorbital artery from
maxillary artery
Veins drain into facial and ophthalmic veins.
Ophthalmic vein drains into cavernous sinus
– thus, an inflammatory process can spread
to cavernous sinus.
Sensitive nerves
- External nasal nerve – from anterior
ethmoidal nerve – nasociliary nerve –
ophthalmic nerve
- Infratrochlear nerve – from nasociliary
nerve – ophthalmic nerve
- Infraorbital nerve – from maxillary nerve
Regiones facialis
Regio nasalis

Stratigraphy
Periosteum and perichondrium plane
Perichondrium continues to periosteum joining the cartilages.
The osseous plane – nasal bone, nasal part of frontal bone, frontal process of maxilla
Cartilage plane – lateral nasal cartilages, septal cartilage, greater alar cartilage, lesser alar
cartilage and accessory alar cartilage.
Regiones facialis
Regio nasalis
At the level of external nose, there are the anterior parts of nasal fossa – nasal vestibule.
Nasal vestibule is covered by tegument that contains sebum glands and hair.
The limit between nasal vestibule and proper nasal cavity - limen nasi.
Regiones facialis
Regio oralis

Surface – labial region


Deep – oral cavity
Regiones facialis
Regio oralis
Surface – labial region – corresponds to soft tissues that form the lips – superior and inferior
lip.
Each lip presents:
- A superficial face – cutaneous; superior lip – a large median groove=philtrum; inferior lip –
a small depression
- Deep face – mucous – labial salivary glands; frenulum of upper lip; frenulum of inferior lip.
- A free border – red lips=transition area between tegument and mucosae. The epithelium is
keratin type, very thin and basal layer does not contain any pigment (transparent)
- An adherent border
Regiones facialis
Regio oralis

When mouth is closed, the lips form


the anterior wall of oral vestibule.
When mouth is open, the lips form
the oral orifice – rima oris.
Lips are united at their extremities
and form the angle of oral cavity –
inside, one can find the
commissures of mouth.
Regiones facialis
Regio oralis

Limits:

- Superior – nasal-labial groove (nasal region)


- Inferior – chin-labial groove (regio mentalis)
- Lateral – a curve line that passes at 1 cm
lateral from the angle of mouth, between the
posterior extremity of nostril and chin-labial
groove.
Regiones facialis
Regio oralis (at the surface)
Layers:
1. The tegument: - adherent, containing hair follicles on the
anterior surface
- thin, transparent at the free margin level; it
is usually the location of lip cancer
2. Muscular layer: - orbicularis oris muscle: - labial part
- marginal part
- levator labii superioris muscle
- levator labii superioris
- zygomaticus major and minor muscles
- risorius muscle
- depressor anguli oris muscle
- depressor labii inferioris muscle
- levator anguli oris muscle
- buccinator muscles, located in a deeper
plane
At the level of the commissures, these muscles fibers cross
and form the commissural notch.
They are innervated by facial nerve (buccal branch, marginal
branch of mandible)
Regiones facialis

Regio oralis (at the surface):


3. Mucous layer: superior lip frenulum and inferior lip frenulum, between labial
mucosa and the gum.
Regiones facialis
Regio oralis (at the surface)
Blood vessels are located between
muscular and mucous layers
At the level of superior lip, the
anastomosis of superior labial
arteries (branches of facial
arteries), forms an arterial arch. At
this arch, also participate:
branches of buccal artery
(maxillary artery), infraorbital
artery (maxillary artery) and
transverse facial artery (superficial
temporal artery).
At the level of inferior lip: the
anastomosis of inferior labial
arteries (branches of facial
arteries), forms an arterial arch. At
this arch, also participate:
branches of mental artery (inferior
alveolar artery- maxillary artery)
Regiones facialis

Regio oralis (at the surface)


Superior and inferior labial veins
drain into facial vein
Lesions of the lips lead to
important bleeding and
hemostasis is difficult to
achieve (block suture)
Regiones facialis

Regio oralis (at the surface)


Lymphatic vessels drain into
submandibular,
submental and deep
cervical lymph nodes
Regiones facialis

Regio oralis
Innervation - sensitive:
- infraorbital nerve (maxillary
nerve) for the superior lip
- - submental nerve (inferior
alveolar nerve- mandibular
nerve) for the inferior lip
Regiones facialis

Regio mentalis
Contains the soft parts which, together with the mandible body, form “the chin”
Regiones facialis

Regio mentalis
Delimitation:
- superior: mentolabial ditch
(oral region)
- inferior: mandibular inferior
margin (neck)
- lateral: the vertical line that
passes at 1 cm lateral to the
mouth’s angle (anguli oris), to
the inferior margin of
mandible
Regiones facialis

Regio mentalis
Layers:
1. Tegument: thick, adherent, containing hair follicles
2. Subcutaneous layer: poorly developed, containing
fibers of platysma muscle
3. Muscular layer: - depressor labii inferioris muscle
- depressor anguli oris muscle

The innervation is achieved by mandibular marginal


branch (facial nerve)
Regiones facialis

Regio mentalis
Muscular and subcutaneous layers contain vascular-nervous structures:
- mental arteries (inferior alveolar artery- maxillary artery)
- submental arteries (facial artery)
- Inferior labial arteries (facial artery)
Veins drain into facial veins
Regiones facialis

Regio mentalis
- Lymphatics drain into submandibular and submental lymph nodes
- Sensitive innervation: mental nerve (inferior alveolar nerve- mandibular nerve)
Regiones facialis

Regio mentalis
Osseous layer: anterior face of mandible body:
- mental protuberance
- mental tubercles
- mental foramen (mental vascular-nervous bundle- for anesthesia)
Regiones facialis

Regio orbitalis
- At the surface, it corresponds to all
the soft parts located anterior to
the aditus orbitalis: palpebral
region
- Corresponds to the orbit (in the
depth), where the eye ball is
located
Regiones facialis

Regio orbitalis (at the surface)

• Is delineated by the margins of aditus


orbitalis
• Contains the two eyelids:
- superior eyelid
- inferior eyelid
• Each eyelid consists of:
- anterior face
- posterior face
- adherent margin- at the level of aditus
orbitalis
- free margin
• Free margins delineate rima
palpebrarum (palpebral opening)
Regiones facialis

Regio orbitalis (at the surface)


The free margin consists of two parts, separated by lacrimal papilla:
- medial part- contains the lacrimal duct
- lateral part: - an anterior ciliary lip with sebaceous glands (of Zeiss) and Moll ciliary
glands (modified sudoripar glands)
- interstitium: punctiform orifices of tarsal glands
- a posterior lip- delineates together with the anterior face of the eye
ball, a space called “lacrimal river”
Regiones facialis

Regio orbitalis
• Eyelids unite themselves laterally and medially, and form:
- lateral palpebral commissure
- medial palpebral commissure
The medial angle of the eye consists of lacrimal caruncle and the semilunar fold. It
delineates the lacrimal sac.
The lateral angle of the eye is sharper
Regiones facialis
Regio orbitalis (at the surface)
The stratigraphic structure of eyelids:
- Tegument: thin, pigmented skin
- Subcutaneous layer: connective
tissue which allows edema
formation
- Muscular layer: orbicularis muscle
(palpebral part)
- Conjunctive submuscular layer:
contains blood vessels, nerves
- Fibrous layer = the skeleton of the
eyelid- orbital septum (in the
periphery) and the tarsi (superior
and inferior)
- Smooth muscle layer: superior
tarsal muscle and inferior tarsal
muscle
- Mucous layer: palpebral
conjunctiva
Regiones facialis

Regio orbitalis
- Orbital septum continues with the periorbital septum and attaches to the tarsal
margins
- Superior and inferior tarsi form the central part
- They attach to the margins of aditus orbitalis through lateral and medial palpebral
ligaments
Regiones facialis

Regio orbitalis
- Palpebral conjunctiva covers the posterior face of tarsi and tarsal muscles and
continues with the bulbar conjunctiva, which covers the sclera.
- The superior conjunctiva fornix and the inferior conjunctiva fornix form
Regiones facialis
Regio orbitalis - Vascularization:
- Lateral palpebral arteries (superior and inferior) from the lacrimal artery (ophthalmic
artery)
- Medial palpebral arteries (superior and inferior) from the ophthalmic artery
- Branches from the infraorbital artery (maxillary artery), transverse facial artery,
supraorbital artery

Veins drain into facial vein, superficial temporal artery and orbital veins
Regiones facialis

Regio orbitalis - Sensitive innervation:


- Infratrochlear nerve (nasociliary nerve from ophthalmic nerve)
- Lacrimal nerve (ophthalmic nerve)
- Zygomaticofacial nerve (maxillary nerve)
- Infraorbital nerve (maxillary nerve)
Regiones facialis

Infraorbital, zygomatic, buccal regions form together the “genian” region


Regiones facialis

Genian region
Limits:
- anterior: nasogenian groove, prolonged by the line that descends at 1 cm lateral to the
oral commissure, to the inferior margin of mandible
- posterior: anterior margin of masseter muscle
- superior: infraorbital margin
- inferior: inferior margin of mandible
Stratigraphy:
1. Tegument: skin containing sebaceous and sweat glands, hair follicles (in males)
Regiones facialis

Genian region

2. Muscular layer: mimic muscles situated in two layers:


• levator labii superioris alaeque nasi muscle
• levator labii superioris muscle
• zygomaticus minor muscle
• zygomaticus major muscle
• risorius muscle
• levator anguli oris muscle
• depressor oris muscle
• platysma muscle
Buccinator muscle
Regiones facialis

Genian region
• Bichat fat pad is located at the
cheeks level, between
buccinator and masseter
muscles
• The parotid duct penetrates the
buccinator muscle

3. Mucous layer = mucosa of oral


cavity vestibule which covers the
buccinator muscle
Superior and inferior to the
buccinator muscle, the mucous
layer is missing, being replaced
by an osseous layer: the anterior
face of maxillar body
(infraorbital foramen), zygomatic
bone (zygomaticofacial foramen)
and the body of mandible
Regiones facialis

Genian region

• Facial artery and vein: the artery has a


sinuous trajectory, anterior to the vein
• Infraorbital artery and vein (maxillary
artery)
• Buccal artery and vein (maxillary
artery)
• Transverse facial artery and vein
(superficial temporal artery)
• Lymphatics drain into parotid and
submandibular nodes
Regiones facialis

Genian region

• Sensitive nerves:
- infraorbital nerve (maxillary nerve)
- zygomaticofacial nerve (zygomatic
nerve of maxillary nerve)
- buccal nerve (mandibular nerve)
Branches of facial nerve parotid plexus
innervate mimic muscles
Regiones facialis

Parotideomasseteric region
At the surface, it has a quadrilateral
shape
Delimitation:
• anterior: anterior margin of masseter
muscle
• posterior: anterior margin of
sternocleidomastoid muscle
• inferior: inferior margin of mandible,
prolonged till the anterior margin of
sternocleidomastoid muscle
• superior: inferior margin of zygomatic
bone, till the anterior margin of
sternocleidomastoid muscle
It contains two regions:
• masseteric region
• parotid region
Regiones facialis

Masseteric region

- Corresponds to the masseter muscle


(which covers the mandible
ramus)
- Stratigraphy:
1. Tegument
2. Subcutaneous layer: platysma
muscle and risorius muscle
Regiones facialis

Masseteric region

3. Superficial part of parotid gland: covered by parotid fascia


• Transverse facial vessels (artery from superficial temporal artery)
• Parotid duct
• Buccal and zygomatic branches of facial nerve parotid plexus
Regiones facialis

Masseteric region

4. Masseteric fascia
5. Masseter muscle
• The masseteric vascular-nervous bundle pass through incisura mandibulae
(comunication with infratemporal fossa, masseteric artery from maxillary artery,
masseteric nerve from mandibular nerve)
Regiones facialis

Masseteric region

Osseous region (plane):


- Ramus of madible
- Masseteric vascular-nervous bundle is located between masseter muscle and ramus of
mandible
Regiones facialis

Parotid region

• Corresponds to retromandibular
fossa, where the profound
portion of parotid gland is found
=parotid lodge
• Delimitation (at the surface):
- anterior: posterior margin of
ramus of mandible
- posterior: mastoid process and the
anterior margin of
sternocleidomastoid muscle
- superior: external acoustic pore
- inferior: the horizontal from the
angle of the mandible to the
anterior margin of mandible
Regiones facialis

Parotid lodge

• Lateral wall: located between


sternocleidomastoid muscle and
ramus of mandible, has the shape of
a groove (which allows surgical
direct access)
• Tegument
• Subcutaneous layer: poorly
represented, contains fibers of
platysma muscle, the great auricular
nerve and superficial parotid lymph
nodes
• Parotid fascia
Regiones facialis

Parotid lodge
• Walls- delimitation:
- anterior: posterior margin of mandible
- posterior and medial: muscle-facial layer
and the ligament from the anterior
margin of sternocleidomastoid muscle
and styloid process to the posterior
margin of mandible; posterior belly of
digastric muscle, stylohyoidian muscle,
stylohyoidian and stylomandibular
ligament (styloid process- angle of
mandible)
- superior: external acoustic pore and
incisura mandibulae (communicates
with infratemporal region)
- inferior: fibrous structure from the
anterior margin of sternocleidomastoid
muscle to the angle of mandible, that
separates parotid lodge and
submandibular lodge
Regiones facialis

Parotid lodge

• Within parotid lodge, are located: the profound portion of parotid gland and
vascular-nervous elements that cross the gland, forming vascular-nervous pedicles
(the majority must be known and ligatured in total parotidectomy)
Regiones facialis

Parotid lodge
• External carotid artery crosses
parotid gland (arterial plane has a
medial disposition). It has a
trajectory until it reaches the
mandible neck; superficial
temporal artery, maxillary artery
(terminal branches)
• Sometimes, posterior auricular
artery detach inside the parotid
gland
• Branches of external carotid artery
will form, outside the gland, the
following pedicles:
- condylian pedicle:
- maxillary artery- passes through
infratemporal region
- maxillary vein- enters the parotid
gland
- auriculotemporal nerve (mandibular
nerve)- enters the parotid gland
Regiones facialis

Parotid lodge
- Superior pedicle:
- superficial temporal artery (passes into temporal region)
- superficial temporal veins (enter the parotid gland)
- auriculotemporal nerve (exits the gland)
Regiones facialis

Parotid lodge
- posterior pedicle:
- posterior auricular artery
- posterior auricular veins
Regiones facialis
Parotid lodge
• Facial nerve enters the parotid
gland and forms another posterior
pedicle.
• A lateral located nervous plane
crosses the parotid gland and
forms the parotid plexus, from
which branches for mimic muscles
innervation detach:
- temporal branches
- zygomatic branches
- buccal branches
- marginal branch of mandible
- cervical branch (r.coli)
Facial nerve and its branches (mostly
temporal branches) will be
protected (lagophthalmie with
corneal lesions because orbicularis
oculi muscle does not contract.)
Regiones facialis

Parotid lodge

• Parotid gland is also crossed by


veins= venous plane (middle plane):
- external jugular vein
- Retromandibular vein
In the inferior part, they will form two
cervical venous pedicles
Regiones facialis

Infratemporal region
• Is located deeply, at the border between cranial basis, calvaria and face.
Regiones facialis

Infratemporal region

• One of the access ways is by sectioning the zygomatic arcade and the removal of
temporal muscle tendon
Regiones facialis

Infratemporal region - walls:


• superior: - inferior face of great wing of sphenoid bone (oval and spinosus orifices)
- orifice delineated by zygomatic arcade and infratemporal crest (communicates
with the temporal region)
• inferior: angle of mandible
• anterior: maxillary tuberosity (alveolar orifices)
• lateral: medial face of ramus of mandible
• medial: lateral pterygoid plate (pterygomaxillary fissure- entering into pterygopalatine
fossa)
• posterior: muscle-fascial wall
Regiones facialis

Infratemporal region communicates with:


• temporal region
• the orbit- inferior orbital fissure \
• parotideomasseteric region, through incisura mandibulae
• middle cranial fossa (oval and spinosus orifices)
Regiones facialis

Infratemporal region contains:


1. lateral pterygoid muscle
2. medial pterygoid muscle
3. sphenomandibular ligament
Regiones facialis

Infratemporal region
4. mandibular nerve- comes from middle cranial fossa, through oval orifice and divides into
its branches:
- auriculotemporal nerve (enters the parotid region)
- lingual nerve
- inferior alveolar nerve (towards mandible orifice
Medial from this nerve, there is the otic ganglion vegetative ganglion which functionally
belongs to glossopharyngeal nerve)
Regiones facialis
Infratemporal region
- masseteric nerve
- profound temporal nerves (anterior, middle, posterior)
- lateral pterygoid nerve
- medial pterygoid nerve
- buccal nerve
Regiones facialis

Infratemporal region

5. maxillary artery- reaches the parotid


region through the space between
mandible neck and sphenomandibular
ligament (retrocondylar space described
by Juvara) and enters the pterygopalatine
fossa (terminal branch: sphenopalatine
artery)

Branches: masseteric artery, anterior and


posterior deep temporal arteries, lateral
and medial pterygoid arteries, buccal
artery, inferior alveolar artery, middle
meningeal artery (spinosus orifice),
infraorbital artery
Regiones facialis

Infratemporal region

6. pterygoid venous plane -


maxillary veins
Regiones facialis

Infratemporal region
Pterygomaxillary fissure is the entering place into pterygopalatine fossa:
- posterior wall: anterior face of pterygoid process
- medial wall: perpendicular plate of palatine bone
- anterior wall: maxillary tuberosity inferior orbital fissure)
- superior wall: - sphenopalatine orifice (nasal cavity)
- round orifice (middle cranial fossa
- orifice of pterygoid canal
Regiones facialis

Infratemporal region
Pterygopalatine fossa contains:
- terminal portion of maxillary artery with its terminal branch: sphenopalatine
artery (passes through sphenopalatine orifice, into/and nasal cavity)
- maxillary nerve- passes through the round orifice
- Pterygomaxillary ganglion