rBy: Shatha Khtoum · 2019. 3. 8. · Arterial Supply for Face and Scalp. Blood supply of the face\r1.Facial artery\rThe facial artery arises from the external carotid artery. Having

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Face, Scalp, and Cervical Plexus

Shatha Khtoum

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This file includes the record and some important notes from the book By: Shatha Khtoum

Lecture Objectives

• Review the general anatomical features of the face and scalp.• Describe blood supply, innervation, and lymphatic drainage of the face and scalp.

• Make a list of contributing roots to cervical plexus.• Discuss the general arrangement.• Describe the location of this plexus.• Make a list of the outcoming nerves.• Follow the branches to their target organs.• Make a list of the cutaneous nerves.• Follow the cutaneous branches to their destinations.

Facial Layers• Skin (Layer 1)• Subcutaneous layer (Layer 2)

– Superficial fat compartments• Superficial musculo‐aponeurotic

system (SMAS) (Layer 3)• Retaining ligaments and deep

compartments (Layer 4)– Deep fat compartments

• Deep fascia &/or periosteum (Layer 5)

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the dermis and the epidermis

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hypodermis which is a loose connective tissue

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The reason why we are learning about these layers but not the other regions of the body because the face and scalp are responsible for the facial expressions, and the facial expression muscles are the superfacial structures that located in the skin and the hypodermis. So, the facial expression muscles will pierce of these layers. It will origin deeply in the skull bone (periosteum) or in the deep fascia and it will end in the superfascially together till the subcuteneous layer or to the deep layers of the skin.

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and some loose connective tissue

Layers of the Scalp

• Layers of scalp– Skin– CT (subcutaneous layer)

• Rich in BVs, lymphatics and nerves– Aponeurosis of occipitofrontalismuscle

– Loose CT • Allows movement of above layers

– Periosteum • Muscles of the External Ear

– Auricularis anterior, posterior & superior

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(one of the facial expression muscles)

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(superfacial and lateral) -and there is a lot of muscles deeper to them like the temporalis muscle and other structures like the temporalis fascia deeply.

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the occipitofrontalis has 2 bellies: occipital and frontal and in between them the epicranial aponeurosis that connects them together - frontalis ➡ elevation of the frontal skin ,, at the same time the occipital belly also will contract and elevate the skin posteriorly (because they are one muscle)

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they are mostly from the skull bones and the temporalis fascia toward the skin superfacially and the move the auricle slightly, and we can notice that it's stronger in people more that others.

Muscles of Facial Expression

• Arise from fascia or skull bones & insert onto skin

• Encircle eyes, nose & mouth• Express emotions• Facial Nerve (VII)• Bell’s palsy = facial paralysis

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The muscles of the face are embedded in the superficial fascia, and most arise from the bones of the skull and are inserted into the skin. The function of the facial muscles to serve as sphincters or dilators of the orifices of the face (the orbit, nose, and mouth) A secondary function of the facial muscles is to modify the expression of the face. All the muscles of the face are developed from the second pharyngeal arch and are supplied by the facial nerve.

Facial Muscles

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1 orbicularis oculi m. : surrounds the base of the orbit -origin from the margins of the orbit: external (orbit) part and internal (palpebral) part - Action: closes the palpebral fissure. 2 Procerus m. : a very then muscle, superfacial muscle. - origin: from the nasal bone anteriorly -insertion: Skin between eyebrows (before the frontalis m.)

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1

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3 Corrugator supercilii m. : deep muscle it will corrugate the eyebrows -origin: medially from the skull bone beneath the frontalis -insertion: Skin of eyebrow 4 nasalis m. : opening and closing of the nostrils 5 orbicularis oris m. : surrounds the mouth opening - origin:Maxilla, mandible, and skin and there is other facial expressions muscle that connected with it. (muscles that are above it will cause elevation of the upper lip and the below it will cause depression and there is some laterally) -insertion: Encircles oral orifice

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منطقة الحاجب

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4

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5

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6

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6 Levator labii superioris alaeque nasi m. : *the most medial m.* -will elevate the superior lip. - the nasi (small) part of it will insert in the lateral side of the nose, so will cause some elevation of nostrils. -originate from the upper part of the maxilla

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7

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7 Levator labii superioris m. -originate from the maxilla just above the infraorbital foramen - inserts on the upper lip, that causes elevation of the upper lip

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8 Levator anguli oris m.(inferior and lateral to the Levator labii superioris m. and also deep to it) -origin: inferior the infraorbtal foramen -insertion: at the angle of the mouth

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9

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the rest of muscles described in the next slide

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10

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6-10 muscles superior to the mouth 11-13 muscles inferior to the mouth

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11

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15

Facial Muscles Action

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9 Zygomaticus minor, Zygomaticus major: -origin from the zygomatic arch -insert in the upper lip and the angle of the mouth -elevation and lateral movement of the angle of mouth 10 Risorius m. (superfacial muscle) -origin: Parotid fascia -insertion: angle of the mouth -cause lateral movement of the angle of the mouth laterally

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11 Depressor anguli oris m. : -origin: from the mandible inferiorly -insertion: angle of the mouth -cause depression of the angle of the mouth. deeper to it 12 Depressor labii inferioris m. originates in the mandible and inserts in the lower lip, causes depression of the lower lip.

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13 mentalis m. : -origin: body of the mandible -insertion: skin of the chin -causes elevation of the skin of the chin

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14. platysma m. wide muscle spinning all over the cervical superfacial structures -origin: deep fascia (shoulder and thoracic wall) -insertion: fascia within the face region causes folding or corrugation of the skin over the cervical region.

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15 Buccinator m. the deepesr muscle -origin posteriorly from the maxilla and the mandible -insertion: anteriorly in the angle of the mouth -Compresses cheeks and lips against teeth

Facial Muscles Innervation

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The facial nerve [VII] exits the posterior cranial fossa through the internal acoustic meatus. It passes through the temporal bone, giving off five branches antriorly, and emerges from the base of the skull through the stylomastoid foramen , at this point it gives off the sixth nerve; 1 the posterior auricular nerve. This branch passes upwards, behind the ear, innervate the occipital belly of the occiptofrontalis m. and the auticularis posterior m.

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As the facial nerve runs forward within the substance of the parotid salivary gland, it divides into its five terminal branches : 2.The temporal branch emerges from the upper border of the gland and supplies the anterior and superior auricular muscles, the frontal belly of the occipitofrontalis, the orbicularis oculi, and the corrugator supercilii. 3. The zygomatic branch emerges from the anterior border of the gland and supplies the orbicularis oculi. 4. The buccal branch emerges from the anterior border of the gland below the parotid duct and supplies the buccinator muscle and the muscles of the upper lip and nostril.

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5. The mandibular branch emerges from the anterior border of the gland and supplies the muscles of the lower lip 6.The cervical branch emerges from the lower border of the gland and passes forward in the neck below the mandible to supply the platysma muscle; it may cross the lower margin of the body of the mandible to supply the depressor anguli oris muscle

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there is overlapping in these nerves, that one muscle may be innervated by more than one branch, or one nerve may innervate more than one muscle


Muscles of Mastication

• Masseter, temporalis & pterygoids• Arise from skull & insert on mandible• Cranial nerve V (trigeminal nerve) –

mandibular division• Protracts, elevates or retracts

mandible

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those are deep muscles.

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causing movement of TMJ

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1. Masseter m. -origin: Zygomatic arch -insertion: Lateral surface angle of mandible -Elevates mandible to occlude teeth 2. Temporalis m. (wide muscle has superior and posterior fibers; together they cross the TMJ just deep to zygomatic arch) -origin: Floor of temporal fossa -insertion: Coronoid process of mandible -Anterior and superior fibers elevate mandible; posterior fibers retract mandible 3. Lateral pterygoid m. -origin: lateral pterygoid plate (posteriorly) -insertion: Neck of mandible and disc of TMJ (anteriorly) -Pulls the mandible forward (protrusion)

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4. Medial pterygoid m. -origin: lateral pterygoid plate and Tuberosity of maxilla -insertion: Medial surface of angle of mandible -Elevates mandible

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the angle or ramus of mandible will be like a sandwich between the masseter and medial pterygoid muscles

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All innervated by the mandibular division of the Trigeminal nerve

Muscles of Mastication

Lateral Pterygoid

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Slide 14: Sensory Nerve Supply of the Scalp The main trunks of the sensory nerves lie in the superficial fascia. Moving laterally from the midline anteriorly, the following nerves are present: -The supratrochlear nerve, a branch of the ophthalmic division of the trigeminal nerve, winds around the superior orbital margin and supplies the scalp . It passes backward closeto the median plane and reaches nearly as far as the vertex of the skull.

Cutaneous Nerves of Face and Scalp

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-The supraorbital nerve, a branch of the ophthalmic division of the trigeminal nerve, winds around the superior orbital margin and ascends over the forehead . It supplies the scalp as far backward as the vertex. -The zygomaticotemporal nerve, a branch of the maxillary division of the trigeminal nerve, supplies the scalp over the temple.

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-The auriculotemporal nerve, a branch of the mandibular division of the trigeminal nerve, ascends over the side of the head from in front of the auricle . Its terminal branches supply the skin over the temporal region. -The lesser occipital nerve, a branch of the cervical plexus (C2), supplies the scalp over the lateral part of the occipital region and the skin over the medial surface of the auricle. -The greater occipital nerve, a branch of the posterior ramus of the 2nd cervical nerve, ascends over the back of the scalp and supplies the skin as far forward as the vertex of the skull

Arterial Supply for Face and Scalp

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Blood supply of the face 1.Facial artery The facial artery arises from the external carotid artery. Having arched upward and over the submandibular salivary gland, it curves around the inferior margin of the body of the mandible at the anterior border of the masseter muscle. It is here that the pulse can be easily felt. The doctor said it deep to the submandibular gland but the book said it's over it. then it goes obliquely in the face (it's superfacial to many facial expression muscles), then It runs toward the angle of the mouth and gives the branches : -Inf. Labial branch supplies the lower lip -Superior labial branch supplies the upper lip, and also provides a branch to the nose from the lateral nasal artery and continues as angular artery 2.Maxillary artery it's a deep artery supply the internal structures. gives the inferior alveolar that ends in the chin as mental artery that supply the superfacial structures

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3. Ophthalmic artery From the internal carotid artery also contribute to the arterial supply of the face. -Branches: supra-orbital & supratrochlear arteries

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-and there is the posterior auricular and the occipital artery supply the posterior region of the scalp. -and the superficial temporal artery will cross the zygomatic arch, and here you can feel the pulse. above the scalp there will be a lot of anastomosis

Arterial Supply for Face and Scalp


Venous Supply for Face and Scalp

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-The posterior auricular vein unites with the posterior division of the retromandibular vein, just below the parotid gland, to form the external jugular vein -The superficial temporal vein unites with the maxillary vein in the substance of the parotid gland to form the retromandibular vein -The external jugular vein mostly goes in the subclavian and it may also goes in the internal jugular vein. -Anteriorly in the face; The angular vein is formed at the medial angle of the eye by the union of the supraorbital and supratrochlear veins. And the angular vein unites with the maxillary vein in the deep fascia and give the facial vein. -The facial vein ends by draining into the internal jugular vein.


Neck

Hyoid Bone

• Position – C3– Between mandible & thyroid cartilage

• Shape – U • Stylohyoid ligament• Parts

– Body– Lesser horn– Greater horn

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its location makes connection between the floor of the mouth and the larynx division between the supra and infra-hyoid muscles in the neck

Neck Muscles• Superficial mm. of the side

of the neck– Platysma ‐ VII– SCM ‐ XI

• Suprahyoid mm.– Stylohyoid ‐ VII– Digastric

• Posterior belly ‐ VII• Anterior belly ‐ V

– Mylohyoid ‐ V– Geniohyoid – C1

• Infrahyoid mm.– Omohyoid ‐ AC– Sternohyoid ‐ AC– Sternothyroid ‐ AC– Thyrohyoid – C1

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it's important and we will use it in the description of relation with other muscles later.

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the deepest one of the suprahyoid muscles\ support the floor of the mouth

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orientation= toward the sapula

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most superfacialy of the infrahyoid muscle

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deeper to the sternohyoid muscle

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# All the infrahyoid muscles innervated by Ansa cervicalis from the cervical plexus except the thyrohyoid which innervated by first cervical nerve like the genihyoid


Neck Muscles• Anterior and lateral vertebral mm.– Scalenus anterior

• Relations

– Scalenus medius– Scalenus posterior

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insert in the 1st rip

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inserts in the 2nd rip

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-all originate from the transverse processes of the vertebrae

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they have relations with the cervical and and the brachial plexus (very important)


Cervical Plexus

• Ventral rami of spinal nerves (C1 to C5)

• Supplies parts of head, neck & shoulders

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-The cervical plexus is formed by the anterior rami of the first five cervical nerves. -The rami are joined by connecting branches, which form loops that lie in front of the origins of the levator scapulae and the scalenus medius muscles. -The plexus is covered in front by the prevertebral layer of deep cervical fascia and is related to the internal jugular vein within the carotid sheath. -it supplies the skin and the muscles of the head, the neck, and the shoulders. and motor supply for some of the infrahyoid muscles by ansa cervicalis -The phrenic nerve, which arises from the anterior rami of the 3rd, 4th and 5th cervical nerves, gives supply to the muscle of the diaphragm.

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anterior to the middle scalene and the lavator scapule, and anterior to them there will be the sternocliedomastoid muscle, so the cervical plexus will form posterior to the sternocliedomastoid muscle

Cervical Plexus• Relations

– Anterior to levator scapulae m. and middle scalene m.

– Posterior to the sternocleidomastoid m.

– Subcutaneous branches emerge behind the lateral border of the sternocleidomastoid m.

Cervical Plexus: Relations

Cervical Plexus: Branches

• Cutaneous branches– Lesser occipital n. (C2)– Greater auricular n. (C2‐C3)– Transverse cervical n. (C2‐C3)– Supraclavicular nn. (C3‐C4)

• Muscular branches – Ansa cervicalis (Infrahyoid mm.)

• Descending branch from hypoglossal n. (C1)

• Descending cervical n. (C2‐C3)– Phrenic n. (C1‐C3)

• Diaphragm

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Branches ■■ Cutaneous branches -The lesser occipital nerve (C2), which supplies the back of the scalp and the auricle -The greater auricular nerve (C2 and 3), which supplies the skin over the angle of the mandible -The transverse cervical nerve (C2 and 3), which supplies the skin over the front of the neck -The supraclavicular nerves (C3 and 4) supply the skin over the shoulder region.

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**These nerves are important clinically, because pain may be referred along them from the phrenic nerve (gallbladder disease).

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Some of these C1 fibers later leave the hypoglossal as the descending branch, which unites with the descending cervical nerve (C2 and 3), to form the ansa cervicalis. The first, second, and third cervical nerve fibers within the ansa cervicalis supply the omohyoid, sternohyoid, and sternothyroid muscles. Other C1 fibers within the hypoglossal nerve leave it as the nerve to the thyrohyoid and geniohyoid.

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(C3-C5)

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not only mascular also sensory part


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Sensations

rBy: Shatha Khtoum · 2019. 3. 8. · Arterial Supply for Face and Scalp. Blood supply of the face\r1.Facial artery\rThe facial artery arises from the external carotid artery. Having

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