FACECNV&VII

PAROTIDGLAND

JacekBaj,MD,PhDDepartmentofHumanAnatomy

THESCALPThescalpiscomposedoffivelayers:SkinConnecAveAssueAponeurosisLooseconnecAveAssuePericranium

THEFACE

THESCALPThescalpiscomposedoffivelayers:SKIN:thin,exceptintheoccipitalregion,containingmanysweatandsebaceousglandsandhairfollicles.CONNECTIVETISSUE:richlyvascularizedsubcutaneouslayerthatiswellsuppliedwithcutaneousnerves.APONEUROSIS(epicranialaponeurosis):thebroad,strong,tendinoussheetthatcoversthecalvariaandservesastheaJachmentformuscleLOOSEAREOLARTISSUE:asponge-likelayerincludingpotenAalspacesthatmaydistendwithfluidasaresultofinjuryorinfecAon.PERICRANIUM:adenselayerofconnecAveAssuethatformstheexternalperiosteumoftheneurocranium

THEFACE

THEMUSCLESOFFACEANDSCALP•  InnervatedbythefacialnerveCNVII,whichemergesfromthe

stylomastoidforamen•  DerivaAvesofthe2ndpharyngealarch•  Insertintotheskintoprovidemovement•  Mostmusclesoffacialexpressionarelocalizedaroundthefacial

orifices•  Thereisnodeepfasciaalongtheface

FacialnerveCNVIIsupplies

themusclesoffacialexpressionCNVII

THEMUSCLESOFFACEANDSCALP MUSCLESOFSCALP,FOREHEAD,ANDEYEBROWS

OCCIPITOFRONTALIS•  Frontalbelly•  Occipitalbelly

ORIGIN•  Skinofeyebrows•  Lateralpartofsuperior

nuchallineofoccipitalboneandmastoidprocessoftemporalbone

INSERTION•  IntogaleaaponeuroAca•  IntogaleaaponeuroAca

INNERVATIONFacialnerve[CNVII]

•  Frontalbellymovesscalpforwardandraisestheeyebrows

•  OccipitalbellymovesgaleaaponeuroAcabackward

THEMUSCLESOFFACEANDSCALP MUSCLESOFMOUTH,LIPS,ANDCHEEKS

THEORBICULARISORIS•  controllingentryandexitthroughtheoralfissure•  consistsoftwoparts

INNERVATION:FacialnerveCNVII

THEMUSCLESOFFACEANDSCALP MUSCLESOFMOUTH,LIPS,ANDCHEEKS

THEBUCCINATOR•  aJacheslaterallytothealveolarprocessesofthe

maxillaeandmandible,oppositethemolarteeth,andtothepterygomandibularraphe,

•  inserAon-angleofmouth(modiolus);orbicularisoris

INNERVATION:FacialnerveCNVII

THEBUCCINATORTheparoAdductpiercesthebuccinator.

THEBUCCINATOR•  TheparoPdductpiercesthebuccinator.•  InnervaAon– CNVII•  Passingdeeptothemandible•  Occupiesadeeper,moremediallyplacedplanethantheother

facialmuscles•  Ismorecloselyrelatedtothebuccalmucosathantotheskinofthe

face

THEMUSCLESOFFACEANDSCALP MUSCLESOFMOUTH,LIPS,ANDCHEEKS

THEPTERYGOMANDIBULARRAPHEThepterygomandibularraphe,tendinousthickeningofthebuccopharyngealfasciaseparaAngandgivingorigintothesuperiorpharyngealconstrictorposteriorly.Itisconnectedwith:•  buccinators•  middlepharyngealconstrictor•  pterygoidproccess•  pterygoidhamulus

THEMUSCLESOFFACEANDSCALP MUSCLESOFMOUTH,LIPS,ANDCHEEKS

THEPLATYSMAORIGIN:SubcutaneousAssueofinfraclavicularandsupraclavicularregionsINSERTION:Baseofmandible;skinofcheekandlowerlip;angleofmouth(modiolus);orbicularisoris

INNERVATION:FacialnerveCNVII

THEPLATYSMACutaneousmuscleoccupyinganextensiveareaoftheneck.Itextendsfromthelowerpartofthefacetotheupperthorax

THEMUSCLESOFFACEANDSCALP MUSCLESOFMOUTH,LIPS,ANDCHEEKS

•  Depressorangulioris•  Depressorlabiiinferioris•  Mentalis•  Risorius•  ZygomaAcusmajor•  ZygomaAcusminor•  Levatorlabiisuperioris•  Levatorlabiisuperiorisalaequenasi •  Levatorangulioris

INNERVATION:FacialnerveCNVII

THEMUSCLESOFFACEANDSCALP MUSCLESOFORBITALOPENING

•  ORBICULARISOCULI•  Palpebralpart•  Orbitalpart

•  CORRUGATORSUPERCILII

INNERVATION:FacialnerveCNVII

isdeeptotheeyebrowsandtheorbicularisoculimuscleandisacAvewhenfrowning.

THEMUSCLESOFFACEANDSCALP MUSCLESOFTHENOSE

•  NASALIS•  PROCERUS•  DEPRESSORSEPTINASI

INNERVATION:FacialnerveCNVII

THENERVESOFFACEANDSCALP

•  AllmotornervesarefromthefacialnerveCNVIIandsupplythemusclesoffacialexpression

•  Sensorynervesofthefacearederivedmainlyfromthe3divisionsofthetrigeminalnerveCNV(V1,V2,V3)

•  Somesensorybranchesarefromthecervicalplexus

Themusclesofthefacialexpression–thefacialnerveCNVIIThesensoryinnervaAon–cutaneousinnervaAonofthefaceisbybranchesofthetrigeminalnerve[CNV]

•  ThefacialnerveCNVIIsuppliesthemusclesoffacialexpression•  Sensorynervesofthefacearederivedmainlyfromthe3

divisionsofthetrigeminalnerveCNV(V1,V2,V3)•  MusclesofmasPcaPonareinnervatedbyCNV3(mandibular

nerve,branchofthetrigemnalnerve)

THENERVESOFFACEANDSCALP Themusclesofthefacialexpression–thefacialnerveCNVII

Thefacialnerve(CNVII)exitsbetweentheponsandoliveandhastwodivisions:themotorrootandtheintermediatenerve,passeswiththevesAbulocochlearnerveintothepetroustemporalbone.

ThefacialnerveCNVIItraverses:•  theposteriorcranialfossa•  internalacousAcmeatus•  facialcanal•  stylomastoidforamenofthetemporalbone•  andparoAdgland

Thelargermotorroot(facialnerveproper)innervatesthemusclesoffacialexpression.Thesmallerintermediatenervecarriestaste,parasympatheAc,andsomaAcsensoryfibers.

THENERVESOFFACEANDSCALP

Themusclesofthefacialexpression–thefacialnerveCNVII

Thefacialnerve[CNVII]exitstheposteriorcranialfossathroughtheinternalacousAcmeatus.

Itpassesthroughthetemporalbone,alongthemedialwallofthetympaniccavity,givingoffseveralbranches,andemergesfromthebaseoftheskullthroughthestylomastoidforamen,locatedbetweenthemastoidandthestyloidprocesses.

Thelargermotorroot(facialnerveproper)innervatesthemusclesoffacialexpression.Thesmallerintermediatenervecarriestaste,parasympatheAc,andsomaAcsensoryfibers.

THENERVESOFFACEANDSCALP

Themusclesofthefacialexpression–thefacialnerveCNVII

Sensory:specialsensory(taste)andsomaAc(general)sensory.Motor:somaAc(branchial)motorandvisceral(parasympatheAc)motor.ItalsocarriespropriocepAvefibersfromthemusclesitinnervates.Nuclei:Themotornucleusofthefacialnerveisabranchiomotornucleusintheventrolateralpartofthepons.Thecellbodiesoftheprimarysensoryneuronsareinthegeniculateganglion.

THEFACIALNERVE

THENERVESOFFACEANDSCALP

Themusclesofthefacialexpression–thefacialnerveCNVII

THEBRANCHESWhiletraversingthetemporalbonewithinthefacialcanal,CNVIIgivesrisetothe:•  Greaterpetrosalnerve:emergingfromtheanteriorwallofthepetrouspartof

thetemporalbone.ItincorporatesparasympatheAcandsensoryfibers,andpenetratesthecoveringplateoftheforamenlacerumlateraltotheinternalcaroAdarterywhereitisjoinedbythedeeppetrosalnerve.

•  Nervetothestapedius:slenderbranchsupplyingthestapediusmuscle.

•  Chordatympaninerve:nervebundlewithparasympatheAcfibersforthesubmandibularglandandsensoryfibersfromthetastebudsoccupyingtheanterior2/3ofthetongue.

THEFACIALNERVE

THENERVESOFFACEANDSCALP

Themusclesofthefacialexpression–thefacialnerveCNVII

THEBRANCHESCNVIIemergesfromthecraniumviathestylomastoidforamen:•  atthispointitgivesofftheposteriorauricularbranch-thisbranchpasses

upward,behindtheear,tosupplytheoccipitalbellyoftheoccipitofrontalismuscleofthescalpandtheposteriorauricularmuscleoftheear

•  themainstemofthefacialnervethengivesoffanotherbranch,whichinnervatestheposteriorbellyofthedigastricmuscleandthestylohyoidmuscle

•  atthispoint,thefacialnerveentersthedeepsurfaceoftheparoPdgland;•  onceintheparoAdgland,themainstemofthefacialnerveusuallydivides

intoupper(temporofacial)andlower(cervicofacial)branches•  theymaybranchfurtherortakepartinananastomoAcnetworkandform

theparoPdplexus,whichgivesrisetothefiveterminalmotorbranches:temporal,zygomaPc,buccal,marginalmandibular,andcervical

THEFACIALNERVE

THENERVESOFFACEANDSCALP

Themusclesofthefacialexpression–thefacialnerveCNVII

TemporalbranchesexitfromthesuperiorborderoftheparoAdglandtosupplymusclesintheareaofthetemple,forehead,andsupra-orbitalarea.ZygomaPcbranchesemergefromtheanterosuperiorborderoftheparoAdglandtosupplymusclesintheinfra-orbitalarea,thelateralnasalarea,andtheupperlip.BuccalbranchesemergefromtheanteriorborderoftheparoAdglandtosupplymusclesinthecheek,theupperlip,andthecornerofthemouth.MarginalmandibularbranchesemergefromtheanteroinferiorborderoftheparoAdglandtosupplymusclesofthelowerlipandchin.CervicalbranchesemergefromtheinferiorborderoftheparoAdglandtosupplytheplatysma.

THEFACIALNERVE

THENERVESOFFACEANDSCALP

Themusclesofthefacialexpression–thefacialnerveCNVII

SOMATIC(BRANCHIAL)MOTORThefacialnervesuppliesmainlythemusclesoffacialexpressionandauricularmuscles.Italsosuppliestheposteriorbelliesofthedigastric,stylohyoid,andstapediusmuscles.VISCERAL(PARASYMPATHETIC)MOTORCNVIIprovidespresynapAcparasympatheAcfibersto:•  thepterygopalaPneganglionviathegreaterpetrosalnerveforinnervaAon

ofthelacrimalglands,andto•  thesubmandibularganglionchordatympaniforinnervaAonofthesublingual

andsubmandibularsalivaryglands.SOMATIC(GENERAL)SENSORYSomefibersfromthegeniculateganglionsupplyasmallareaoftheskinoftheconchaoftheauricle,closetoexternalacousAcmeatus.SPECIALSENSORY(TASTE)FiberscarriedbythechordatympanijointhelingualnervetoconveytastesensaAonfromtheanteriortwothirdsofthetongueandsogpalate.

THEFACIALNERVE

THENERVESOFFACEANDSCALP

Thetrigeminalnerve[CNV]innervatesfacialstructuresderivedfromthefirstarch.Thefacialnerve[CNVII]innervatesfacialstructuresderivedfromthesecondarch.

Duringdevelopmentacranialnervebecomesassociatedwitheachofthepharyngealarches.

THENERVESOFFACEANDSCALP

ThetrigeminalnerveCNV

FUNCTIONS:SomaAc(general)sensoryandsomaAc(branchial)motortoderivaAvesofthe1stpharyngealarch.NUCLEI:Thereare4trigeminalnuclei–onemotor(motornucleusoftrigeminalnerve)andthreesensory(mesencephalic,principalsensoryandspinalnucleioftrigeminalnerve).

Thetrigeminalnerveexitslaterallyfromtheponswithtwogroupsoffibers(largeposteriorsensoryandsmallanteriormotorrootsoftrigeminalnerve),suppliesthemasAcaAonmusclesandprovidessensoryinnervaAontotheface.

ThetrigeminalnerveCNVistheprincipalsomaAc(general)sensorynerveforthehead(face,teeth,mouth,nasalcavity,andduramaterofthecranialcavity).

Thesensoryrootleadstothetrigeminalganglion.Themotorrootrunsparalleltothesensoryroot,thenbypassestheganglionandbecomespartofthemandibularnerve(CNV3)

THENERVESOFFACEANDSCALP

ThetrigeminalnerveCNV

TRIGEMINAL(SEMILUNAR,GASSERIAN)GANGLIONSemilunarganglionthatisequivalenttoaspinalganglion.ItislocatedinanoutpockeAngofthesubarachnoidspace(cavumtrigeminale)abovetheforamenlacerumatthemedial,anteriorborderofthepetrouspartofthetemporalbone.

TheophtalmicV1andmaxillaryV2divisionsarewhollySENSORY.ThemandibularV3divisionislargelysensory,butalsoreceivesthemotorfibresthatsupplythemusclesofmasPcaPon.

Thetrigeminalnerveisdividedasfollows:•  ophthalmicV1division:exitstheskullviathesuperiororbitalfissure•  maxillaryV2division:exitstheskullviatheforamenrotundum•  mandibularV3division:exitstheskullviatheforamenovale

THENERVESOFFACEANDSCALP

ThetrigeminalnerveCNV

ThebranchesoftheophthalmicnerveV1thatinnervatethefaceinclude:•  thesupra-orbitalandsupratrochlearnerves(fromfrontalnerve),whichleave

theorbitsuperiorlyandinnervatetheuppereyelid,forehead,andscalp;

•  theinfratrochlearnerve,whichexitstheorbitinthemedialangletoinnervatethemedialhalfoftheuppereyelid,theskinintheareaofthemedialangle,andthesideofthenose;

•  thelacrimalnerve,whichexitstheorbitinthelateralangletoinnervatethelateralhalfoftheuppereyelidandtheskinintheareaofthelateralangle;and

•  theexternalnasalnerve,whichsuppliestheanteriorpartofthenose.

THENERVESOFFACEANDSCALP

ThetrigeminalnerveCNV

Thetrigeminalnerveisdividedasfollows:•  maxillaryV2division:exitstheskullviatheforamenrotundumItpassesthroughtheforamenrotundumtothepterygopalaAnefossaandsubsequentlythroughtheinferiororbitalfissureintotheorbit.

Thetrigeminalnerveisdividedasfollows:•  maxillaryV2division:exitstheskullviatheforamenrotundumItssomaAc(general)sensoryfibersaregenerallydistributedtoskinandmucousmembranesassociatedwiththeupperjaw.

THENERVESOFFACEANDSCALP

ThetrigeminalnerveCNV

ThebranchesoftheMAXILLARYNERVEV2thatinnervatethefaceinclude:•  asmallzygomaPcotemporalbranch,whichexitsthezygomaAcboneand

suppliesasmallareaoftheanteriortempleabovethezygomaAcarch;

•  asmallzygomaPcofacialbranch,whichexitsthezygomaAcboneandsuppliesasmallareaofskinoverthezygomaAcbone;and

•  thelargeinfra-orbitalnerve,whichexitsthemaxillathroughtheinfra-orbitalforamenandimmediatelydividesintomulAplebranchestosupplythelowereyelid,cheek,sideofthenose,andupperlip

THENERVESOFFACEANDSCALP

ThetrigeminalnerveCNV

THEPTERYGOPALATINE(PARASYMPATHETIC)GANGLIONisassociatedwiththisdivisionofCNV,involvedininnervaAngthelacrimalglandandglandsofthenoseandpalate.

OPHTHALMICNERVE(CNV1)-SENSORYONLYMAXILLARYNERVE(CNV2)-SENSORYONLYMANDIBULARNERVE(CNV3)-SENSORYANDMOTOR

THENERVESOFFACEANDSCALP

ThetrigeminalnerveCNV

THESOMATIC(BRANCHIOMOTOR)BRANCHESOFTHETRIGEMINALNERVETHEMANDIBULARNERVEV3ONLY(!):•  masseter•  temporalis•  medialandlateralpterygoids•  mylohyoid•  anteriorbellyofdigastric•  tensortympani

THENERVESOFFACEANDSCALP

BuccalbranchesemergefromtheanteriorborderoftheparoAdglandtosupplymusclesinthecheek,theupperlip,andthecornerofthemouth.

THEFACIALNERVE

ThebranchesofthemandibularnerveV3innervaAngthefaceinclude:•  thebuccalnerve,whichisonthe

surfaceofthebuccinatormusclesupplyingthecheek;

THEMANDIBULARNERVEVS.

BRANCHES NERVE

THENERVESOFFACEANDSCALP

ThetrigeminalnerveCNV

ThebranchesofthemandibularnerveV3innervaAngthefaceinclude:•  theauriculotemporalnerve,whichentersthefacejustposteriortothe

temporomandibularjoint,passesthroughtheparoAdgland,andascendsjustanteriortotheeartosupplytheexternalacousAcmeatus,thesurfaceofthetympanicmembrane(eardrum),andalargeareaofthetemple;

•  thebuccalnerve,whichisonthesurfaceofthebuccinatormusclesupplyingthecheek;and

•  thementalnerve,whichexitsthemandiblethroughthementalforamenandimmediatelydividesintomulAplebranchestosupplytheskinandmucousmembraneofthelowerlipandskinofthechin.

THENERVESOFFACEANDSCALP ThetrigeminalnerveCNV

OPHTHALMICNERVE(CNV1)-SENSORYONLYMAXILLARYNERVE(CNV2)-SENSORYONLYMANDIBULARNERVE(CNV3)-SENSORYANDMOTOR

THENERVESOFFACEANDSCALP

ThetrigeminalnerveCNV

THESOMATIC(BRANCHIOMOTOR)BRANCHESOFTHETRIGEMINALNERVETHEMANDIBULARNERVEV3ONLY(!):•  masseter•  temporalis•  medialandlateralpterygoids•  mylohyoid•  anteriorbellyofdigastric•  tensortympani

THETRIGEMINALNERVECNVissensoryto:•  theduraoftheanteriorandmiddlecranialfossae•  skinoftheface•  teeth•  gingiva•  mucousmembraneofthenasalcavity•  paranasalsinuses•  andmouth

THENERVESOFFACEANDSCALP

ThetrigeminalnerveCNV

TwoparasympatheAcganglia,theoPcandsubmandibular,areassociatedwiththemandibulardivisionV3;bothareconcernedwiththeinnervaAonofsalivaryglands.

THENERVESOFFACEANDSCALP

Thespinalcutaneousnerves

Posteriortotheear,thescalpreceivescutaneousinnervaAonfromthespinalcutaneousnervesthatoriginateintheneck(C2,C3):•  greateroccipitalnerve(C2)•  lesseroccipitalnerve(C2,C3)•  thirdoccipitalnerve(C3)

THEVASCULATUREOFFACIALANDSCALP

THESUPERFICIALARTERIESOFFACE

THESUPERFICIALARTERIESOFFACEANDSCALP:•  Facial•  Inferiorlabial•  Superiorlabial•  Lateralnasal•  Angular•  Occipital•  Posteriorauricular•  Superficialtemporal•  Transversefacial•  Mental•  Supra-orbital•  Supratrochlear

MostsuperficialarteriesofthefacearebranchesorderivaAvesofbranchesoftheexternalcaroAd

artery

THEVASCULATUREOFFACIALANDSCALP

THESUPERFICIALARTERIESOFFACE

THEFACIALARTERYThirdanteriorbranchofexternalcaroAdartery.Itrunsbelowthestylohyoidmuscle,firstupward,thenlateral,andcrossesthemandibleattheanteriormarginofthemasseter.

THEFACIALARTERYcrossesthemandibleattheanteriormarginofthemasseter.

THEFACIALARTERYThefacialarterycrossesthemandible,buccinator,andmaxillaasitcoursesoverthefacetothemedialangle(canthus)oftheeye,wherethesuperiorandinferioreyelidsmeet.

THEFACIALARTERYThefacialarteryprovidesthemajorarterialsupplytotheface.

THEVASCULATUREOFFACIALANDSCALP

THESUPERFICIALARTERIESOFFACE

THEFACIALARTERYThefacialarterypassesapproximatelyafinger’sbreadthlateraltotheangleofthemouth

THEFACIALARTERYsendsbranchestotheupperandlowerlips(thesuperiorandinferiorlabialarteries),ascendsalongthesideofthenose.Theterminalpartofthefacialarteryiscalledtheangularartery,itanastomoseswiththeophthalmicartery.

THEVASCULATUREOFFACIALANDSCALP

THESUPERFICIALARTERIESOFFACE

THEOCCIPITALARTERYSeconddorsalbranchofexternalcaroAdartery.Itpassesmedialtothemastoidprocessattheocciputandanastomoseswiththesuperficialtemporal,vertebral,deepcervicalandposteriorauriculararteries.

THEPOSTERIORAURICULARARTERYThirddorsalbranchofexternalcaroAdartery.ItliesundertheparoAdglandonthestyloidprocessbetweenthemastoidprocessandtheear.

THESUPERFICIALTEMPORALARTERYOneoftwoterminalbranchesoftheexternalcaroAdartery.Itpassesupwardinfrontoftheauricle(pinna)accompaniedbytheauriculotemporalnerve.

THETRANSVERSEFACIALARTERYBranchofthesuperficialtemporalartery,thatiscoveredbytheparoAdglandandpassesbelowthezygomaAcarchtothecheek.Approximatelyafinger’sbreadthinferiortothezygomaAcarch.

THEVASCULATUREOFFACIALANDSCALP

THESUPERFICIALARTERIESOFFACE

THEMENTALARTERYTerminalbranchofinferioralveolarartery.Theonlysuperficialbranchderivedfromthemaxillaryartery,accompaniesthenerveofthesamenameinthechin.

*

THESUPRAORBITALandSUPRATROCHLEARARTERIESThebranchesoftheophthalmicartery,accompanynervesofthesamenameacrosstheeyebrowsandforehead.

THEVASCULATUREOFFACIALANDSCALP

THEARTERIESOFSCALP

THEARTERIESOFSCALPThearterialsupplyisfromtheexternalcaroAdarteriesthrough:•  theoccipital•  posteriorauricular•  andsuperficialtemporalarteriesAndfromtheinternalcaroAdarteriesthrough:•  thesupratrochlear•  andsupra-orbitalarteries

THEEXTERNALVEINSOFFACE•  Supratrochlear•  Supra-orbital•  Angular•  Facial•  Deepfacial•  Superficialtemporal•  Retromandibular

THEVASCULATUREOFFACIALANDSCALP

THEFACIALVEINSThefacialveins,coursingwithorparalleltothefacialarteries,arevalvelessveinsthatprovidetheprimarysuperficialdrainageoftheface.Itcoursesfromthemedialangleoftheeye,behindthefacialartery.Thefacialveindrainsdirectlyorindirectlyintotheinternaljugularvein.

THEEXTERNALVEINSOFFACEOFSCALP

THEFACIALVEINSAtthemedialangleoftheeye,thefacialveincommunicateswiththesuperiorophthalmicvein,whichdrainsintothecavernoussinus.

THEANGULARVEINFormedbytheunionofthesupratrochlearandsupraorbitalveins;itbecomesconAnuouswiththefacialveinatthemedialangleoftheeyeandanastomoseswiththeophthalmicvein.

THEVASCULATUREOFFACIALANDSCALP

THEDEEEPFACIALVEINArisesfromthepterygoidplexus(drainsthepterygoidvenousplexusoftheinfratemporalfossa)andpassesanteriorlyonthemaxilla.

THEEXTERNALVEINSOFFACEOFSCALP

THERETROMANDIBULARVEINItdrainsintothefacialveinagerreceivingtheconfluenceofmanybranchesinfrontoftheear.TheretromandibularveindividesintoananteriorbranchthatuniteswiththefacialveinandaposteriorbranchthatjoinstheposteriorauricularveininferiortotheparoAdglandtoformtheexternaljugularvein.Thisveinpassesinferiorlyandsuperficiallyinthenecktoemptyintothesubclavianvein.

THEVASCULATUREOFFACIALANDSCALP

THEVEINSOFSCALP

THEVEINSOFSCALPThesupra-orbitalandsupratrochlearveinsuniteatthemedialcanthusoftheeyetoformthefacialvein.Thesuperficialtemporalveinjoinsthemaxillaryveintocreatetheretromandibularveinjustposteriortotheneckofthemandible.Theposteriorauricularveinoriginatesbehindtheearandchannelsvenousbloodfromtheposteriorofthescalptowardtheexternaljugularvein.

THEVASCULATUREOFFACIALANDSCALP THEVEINSOFSCALP

THEVEINSOFFACIALANDSCALPSomesmallveinsalsocommunicatewiththecavernoussinuswithintheskull.ThisconnecAonoffacialvenousdrainagewithintracranialvenousdrainageaccountsforthespreadofsomeinfecPonsfromthefacetothebrain.

ThethrombophlebiPsofthecavernoussinusmaybecausedbyaninflammaAonlimitedtothe:•  medialangleoftheeye•  upperlip

THEVASCULATUREOFFACIALANDSCALP THECAVERNOUS SINUS

Cranial nerves: oculomotor CN III, trochlear IV and abducent VI and the ophthalmic V1 and maxillary V2 divisions of CN V, as well as the internal carotid artery and its periarterial plexus of postganglionic sympathetic fibers traverse the CAVERNOUS SINUS.

AllofthesecranialnervescourseinthelateralwallofthesinusexceptforabducentCNVI,whichcoursesthroughthemiddleofthesinus.Asaresult,CNVIistypicallyaffectedfirstinacavernoussinusthrombosisorbyananeurysmoftheinternalcaroAdartery,withtheothernervesbeingaffectedlater.

THEVASCULATUREOFFACIALANDSCALP

THELYMPHATICDRAINAGEOFFACEANDSCALP

LYMPHATICDRAINAGEOFFACEANDSCALP•  Lymphfromthelateralpartofthefaceandscalp,includingtheeyelids,drainsto

thesuperficialparoAdlymphnodes.

•  LymphfromthedeepparoAdnodesdrainstothedeepcervicallymphnodes.

•  Lymphfromtheupperlipandlateralpartsofthelowerlipdrainstothesubmandibularlymphnodes.

•  Lymphfromthechinandcentralpartofthelowerlipdrainstothesubmentallymphnodes.

LYMPHATICDRAINAGEOFFACEANDSCALPTherearenolymphnodesinthescalp,andexceptfortheparoAd/buccalregion,therearenolymphnodesintheface.

THEVASCULATUREOFFACIALANDSCALP

THELYMPHATICDRAINAGEOFFACEANDSCALP

LYMPHATICDRAINAGEOFFACEANDSCALPThesuperficialring(pericervicalcollar)oflymphnodes:•  submental•  submandibular•  paroAd•  mastoid•  andoccipitalLymphfromthescalp,face,andneckdrainsintothesuperficialringoflymphnodes

LYMPHATICDRAINAGEOFFACEANDSCALPAlllymphaAcvesselsfromtheheadandneckdraindirectlyorindirectlyintothedeepcervicallymphnodes

THEPAROTIDGLAND

THEPAROTIDREGION

THEPAROTIDREGIONTheparoAdregionistheposterolateralpartofthefacialregion,boundedbythe:•  ZygomaAcarchsuperiorly•  Externalearandanteriorborderofthesternocleidomastoidposteriorly•  Ramusofthemandiblemedially•  Anteriorborderofthemassetermuscleanteriorly•  Angleandinferiorborderofthemandibleinferiorly

THEPAROTIDREGIONTheparoAdregionincludes:•  theparoAdglandandduct•  theparoAdplexusofthefacialnerve(CNVII)•  theretromandibularvein•  theexternalcaroAdartery•  andthemassetermuscle

THEPAROTIDGLAND

THEPAROTIDGLANDTheparoAdglandisenclosedwithinatough,unyielding,theparoPdsheath(capsule)

THEPAROTIDGLANDTheapexoftheparoAdglandisposteriortotheangleofthemandible,anditsbaseisrelatedtothezygomaAcarch.

THEPAROTIDDUCTTheparoAdductpasseshorizontallyfromtheanterioredgeofthegland•  theductturnsmedially•  piercesthebuccinator•  andenterstheoralcavitythroughasmallorificeoppositethe

2ndmaxillarymolartooth

THEPAROTIDGLAND

THEPAROTIDGLANDFromsuperficialtodeepthereare:•  theparoAdplexusofthefacialnerve(CNVII)anditsbranches•  theretromandibularvein•  theexternalcaroAdartery

TheparoAdectomymaydamagethefacialnerveCNVII(theparoAdplexus)

THEPAROTIDGLANDOntheparoAdsheathandwithintheglandareparoAdlymphnodes.