Head Lu Xiaoli Regional Anatomy & Operative Surgery China Medical University Boundaries Inf. Border of Mandible Angle of Mandible Mastoid Process Sup. Nuchal Line Ext. Occipital Protuberance Divisions Supraorbital margin Sup. Border of Zygomatic arch Sup. Border of external acoustic meatuses Mastoid process Surface Anatomy 1 Superciliary arch Supraorbital notch 2 3 Infraorbital foramen Mental foramen 4 Pterion 1 Zygomatic arch Mastoid process 2 3 5 Condylar process Angle of mandible 4 Tragus Anterosuperiorly: superficial temporal a. Anteriorly: Temporomandibular joint Bregma 1 Lambda Superior nuchal line 3 2 External occipital protuberance Cen. sulcus Sagittal Mid. meningeal a. Sup. Horizontal Lat. sulcus Inf. Horizontal Ant. Middle Pos. Vertical Face Superficial layers Lateral compartment parotideomasseteric region Deep lateral region Skin & Superficial Fascia Thin Full of sebaceous gland, sweat gland & hair follicle – sebaceous cyst & furuncle (Boil ) Loose connective tissue in Palpebral area – edema Full of blood vessels – good heal, anti-infection, but heavy bleeding furuncle (Boil ) Sebaceous cyst Facial Muscles Orbicularis oculi Nostrils Rima oculi Nasalis Rima oris Superficial Middle Orbicularis oris Levator labii superioris Zygomaticus Risorius Depressor anguli oris Levator anguli oris Depressor labii inferioris Deep Buccinator Mentalis Orbicularis oculi Nasalis Orbicularis oris Levator labii superioris Zygomaticus Risorius Depressor anguli oris Levator anguli oris Depressor labii inferioris Buccinator Mentalis Facial a. Angular a. Lateral nasal a. Superior labial a. Inferior labial a. External carotid a. Facial v. From Angular v. to Internal jugular v. Anastomosis with cavernous sinus No valves Innervations Trigeminal n. Supraorbital n. Infraorbital n. Mental n. Facial n. Temporal branches Zygomatic branches Buccal branches Marginal mandibular branch Cervical branch Supraorbital n. Infraorbital n. Mental n. Ophthalmic n. Maxillary n. Mandibular n. parotideomasseteric region Parotid gland Masseter Blood vessels Innervations Parotid Gland masseter Ramus of mandible Medial pterygoid Mastoid process • Zygomatic arch • Ext. acoustic meatus • Temporomandibular joint • Angle of mandible • Mastoid process • Sternocleidomastoid superficial temporal posterior auricular maxillary retromandibular facial external jugular temporal Pos. auricular zygomatic motor branch to pos. belly of digastric buccal mandibular cervical transverse facial a. maxillary a. superficial temporal a. occipital a. external carotid a. Parotid Bed styloid process stylohyoid m. stylopharyngeus m. posterior belly of digastric m. Parotid Fascia a derivative of superficial layer of deep cervical fascia fixed above to zygomatic arch Superficial layer is thick, deep layer is thin Parotid Duct Parotid papilla vestibule of mouth opposite upper 2nd molar tooth Sialogram Muscle of Mastication Temporalis Masseter Lat. Pterygoid Medial pterygoid Temporomandibular Joint Temporomandibular Joint Reduction Deep lateral region Roof Bottom Greater wing of sphenoid bone Inferior margin of mandible Ant. Post. Surface of body of maxilla Walls Post. Deep parotid gland Lat. Ramus of mandible Lat. pterygoid plate Med. Lat. pharyngeal wall Greater wing of sphenoid bone Lat. pterygoid plate maxilla Pterygoid Plexus Cavernous sinus Inf. Ophthalmic v. Pterygoid Plexus Pterygoid Plexus Deep facial v. mandibular nerve deep temporal auriculotemporal inferior alveolar Lingual Buccal Masseter Space Skull Epicranial Aponeurosis diploic veins Emissary vein venous sinus of dura mater Communications between intracranial & extracranial veins Sigmoid sinus Internal jugular v. Cavernous sinus Sup. ophthalmic v. Inf. Ophthalmic v. Venous Plexus of foramen ovale Deep facial v. Pterygoid plexus Angular v. Facial v. Internal jugular v. Emissary v. of foramen lacerum Superficial temporal v. Parietal emissary v. Occipital v. Mastoid emissary v. Supoccipital v. Condylar emissary v. Frontal sinus v. of nasal cavity Frontal emissary v. Sup. Sagittal simus Sigmoid sinus Sup. Saggittal sinus Sup. Orbital v. Frontal diploic v. Sup. Sagittal sinus Ant. Deep temporal v. Ant. Temporal diploic v. Sphenoparietal sinus Superficial extracranial v. Post. Temporal diploic v. Transverse sinus Occipital v. Occipital diploic v. Transverse sinus When trying to locate the parotid duct, a physician would consider each of the following relationships EXCEPT: A. B. C. D. E. its opening can be seen in the vestibule of the mouth opposite the upper 2nd premolar tooth it extends from the anterior border of the parotid gland it can be palpated as it crosses the face, superficial to the masseter muscle it is inferior to the zygomatic arch it is superior to the zygomatic arch Which of the following statements best describes the facial vein? : A. B. C. D. E. it is located within the substance of the parotid gland it communicates superiorly with the ophthalmic vein it is more tortuous than the facial artery it lies anterior to the facial artery as it passes through the face it usually empties into the external jugular vein The coronoid process belongs to which bone in the head? A. B. C. D. E. maxillary mandible sphenoid occipital temporal The muscles of mastication, their nerves and their vessels are located primarily in which part of the head? A. B. C. D. E. pterygopalatine fossa jugular fossa incisive fossa infratemporal fossa temporal fossa The facial artery gives rise to branches that supply each of the regions listed below EXCEPT for the: A. B. C. D. E. medial angle of the orbit lateral nose region of the eyebrow upper lip lower lip The superior sagittal sinus: A. B. C. D. E. drains into the straight sinus is attached to the petrous temporal bone receives emissary veins from the scalp communicates with the cavernous sinus receives the superior petrosal sinus Pulsations felt just above the zygomatic arch and in front of the ear are from which vessel? A. B. C. D. E. facial internal jugular vein superficial temporal artery retromandibular vein maxillary artery The "danger zone" of the scalp is recognized as which of the following layers? A. B. C. D. E. Galea aponeurotica Loose connective tissue Pericranium Skin Subcutaneous connective tissue An infection in which scalp layer is likely to spread most readily? A. B. C. D. E. Skin. Connective tissue layer. Aponeurotic layer. Loose areolar tissue. Pericranium. An elderly patient developed fever and worsening headache a few days after sustaining a scalp laceration and subsequent infection due to a car accident. At the hospital the case was diagnosed as meningitis and superior sagittal sinus thrombosis. The attending physician suggested that infection to the sinus initially spread through one of the scalp layers. The scalp layer involved is: A. Areolar tissue B. Connective tissue C. Epicranial aponeurosis D. Periosteum E. Skin What structure lies deepest in the parotid gland? A. B. C. D. E. External carotid artery External jugular vein Facial artery Facial nerve Retromandibular vein A deep laceration of the face in the middle of the parotid gland could affect the: A. B. C. D. E. External jugular vein Facial nerve Glossopharyngeal nerve Hypoglossal nerve Lingual artery A 38-year-old female patient complained of parotid pain that increased while eating. Intraoral examination detected some pus oozing from the parotid duct opening. What was the most likely anatomical reference that the physician considered to locate the parotid duct opening? A. Mucosa of the sublingual caruncle behind the central incisor teeth B. Mucosa of the cheek across the 2nd upper (maxillary) molar tooth C. Mucosa of the floor of the mouth along the sublingual fold D. Mucosa of the cheek across the 2nd lower (mandibular) molar tooth