Download face parotid gland cn v vii rev.

FACE
CNV&VII
PAROTIDGLAND
JacekBaj,MD,PhD
DepartmentofHumanAnatomy
THEFACE
THESCALP
Thescalpiscomposedoffive
layers:
Skin
ConnecAveAssue
Aponeurosis
LooseconnecAveAssue
Pericranium
THEFACE
THESCALP
Thescalpiscomposedoffivelayers:
SKIN:thin,exceptintheoccipitalregion,containingmanysweatandsebaceous
glandsandhairfollicles.
CONNECTIVETISSUE:richlyvascularizedsubcutaneouslayerthatiswellsupplied
withcutaneousnerves.
APONEUROSIS(epicranialaponeurosis):thebroad,strong,tendinoussheetthat
coversthecalvariaandservesastheaJachmentformuscle
LOOSEAREOLARTISSUE:asponge-likelayerincludingpotenAalspacesthatmay
distendwithfluidasaresultofinjuryorinfecAon.
PERICRANIUM:adenselayerofconnecAveAssuethatformstheexternal
periosteumoftheneurocranium
THEMUSCLESOFFACEANDSCALP
•  InnervatedbythefacialnerveCNVII,whichemergesfromthe
stylomastoidforamen
•  DerivaAvesofthe2ndpharyngealarch
•  Insertintotheskintoprovidemovement
•  Mostmusclesoffacialexpressionarelocalizedaroundthefacial
orifices
•  Thereisnodeepfasciaalongtheface
FacialnerveCNVII
supplies
themusclesoffacialexpression
CNVII
THEMUSCLESOFFACEANDSCALP
MUSCLESOFSCALP,FOREHEAD,ANDEYEBROWS
OCCIPITOFRONTALIS ORIGIN
•  Frontalbelly
•  Occipitalbelly
INSERTION
•  Skinofeyebrows
•  IntogaleaaponeuroAca
•  Lateralpartofsuperior
•  IntogaleaaponeuroAca
nuchallineofoccipital
boneandmastoidprocess
oftemporalbone
•  Frontalbellymovesscalpforwardand
raisestheeyebrows
•  OccipitalbellymovesgaleaaponeuroAca
backward
INNERVATION
Facialnerve[CNVII]
THEMUSCLESOFFACEANDSCALP
MUSCLESOFMOUTH,LIPS,ANDCHEEKS
THEORBICULARISORIS
•  controllingentryandexitthroughtheoralfissure
•  consistsoftwoparts
INNERVATION:
FacialnerveCNVII
THEMUSCLESOFFACEANDSCALP
MUSCLESOFMOUTH,LIPS,ANDCHEEKS
THEBUCCINATOR
•  aJacheslaterallytothealveolarprocessesofthe
maxillaeandmandible,oppositethemolarteeth,andto
thepterygomandibularraphe,
•  inserAon-angleofmouth(modiolus);orbicularisoris
INNERVATION:
FacialnerveCNVII
THEBUCCINATOR
TheparoAdductpiercesthebuccinator.
THEBUCCINATOR
•  TheparoPdductpiercesthebuccinator.
•  InnervaAon– CNVII
•  Passingdeeptothemandible
•  Occupiesadeeper,moremediallyplacedplanethantheother
facialmuscles
•  Ismorecloselyrelatedtothebuccalmucosathantotheskinofthe
face
THEMUSCLESOFFACEANDSCALP
MUSCLESOFMOUTH,LIPS,ANDCHEEKS
THEPTERYGOMANDIBULARRAPHE
Thepterygomandibularraphe,tendinousthickeningofthebuccopharyngealfascia
separaAngandgivingorigintothesuperiorpharyngealconstrictorposteriorly.
Itisconnectedwith:
•  buccinators
•  middlepharyngealconstrictor
•  pterygoidproccess
•  pterygoidhamulus
THEMUSCLESOFFACEANDSCALP
MUSCLESOFMOUTH,LIPS,ANDCHEEKS
THEPLATYSMA
ORIGIN:SubcutaneousAssueofinfraclavicularand
supraclavicularregions
INSERTION:Baseofmandible;skinofcheekandlowerlip;
angleofmouth(modiolus);orbicularisoris
THEPLATYSMA
Cutaneousmuscleoccupyinganextensiveareaoftheneck.
Itextendsfromthelowerpartofthefacetotheupper
thorax
INNERVATION:
FacialnerveCNVII
THEMUSCLESOFFACEANDSCALP
• 
• 
• 
• 
• 
• 
• 
• 
• 
MUSCLESOFMOUTH,LIPS,ANDCHEEKS
Depressorangulioris
Depressorlabiiinferioris
Mentalis
Risorius
ZygomaAcusmajor
ZygomaAcusminor
Levatorlabiisuperioris
Levatorlabiisuperiorisalaequenasi Levatorangulioris
INNERVATION:
FacialnerveCNVII
THEMUSCLESOFFACEANDSCALP
MUSCLESOFORBITALOPENING
•  ORBICULARISOCULI
•  Palpebralpart
•  Orbitalpart
•  CORRUGATORSUPERCILII
isdeeptotheeyebrowsandtheorbicularisoculimuscle
andisacAvewhenfrowning.
INNERVATION:
FacialnerveCNVII
THEMUSCLESOFFACEANDSCALP
•  NASALIS
•  PROCERUS
•  DEPRESSORSEPTINASI
MUSCLESOFTHENOSE
INNERVATION:
FacialnerveCNVII
THENERVESOFFACEANDSCALP
•  AllmotornervesarefromthefacialnerveCNVIIandsupplythe
musclesoffacialexpression
•  Sensorynervesofthefacearederivedmainlyfromthe3
divisionsofthetrigeminalnerveCNV(V
1,V2,V3)
•  Somesensorybranchesarefromthecervicalplexus
Themusclesofthefacialexpression–thefacialnerveCNVII
ThesensoryinnervaAon–cutaneousinnervaAonofthefaceisby
branchesofthetrigeminalnerve[CNV]
•  ThefacialnerveCNVIIsuppliesthemusclesoffacialexpression
•  Sensorynervesofthefacearederivedmainlyfromthe3
divisionsofthetrigeminalnerveCNV(V1,V2,V3)
•  MusclesofmasPcaPonareinnervatedbyCNV3(mandibular
nerve,branchofthetrigemnalnerve)
THENERVESOFFACEANDSCALP
Themusclesofthefacialexpression–thefacialnerveCNVII
Thefacialnerve(CNVII)exitsbetweentheponsandoliveandhastwodivisions:
themotorrootandtheintermediatenerve,passeswiththevesAbulocochlear
nerveintothepetroustemporalbone.
Thelargermotorroot(facialnerveproper)innervatesthemusclesoffacial
expression.
Thesmallerintermediatenervecarriestaste,parasympatheAc,andsomaAc
sensoryfibers.
ThefacialnerveCNVIItraverses:
•  theposteriorcranialfossa
•  internalacousAcmeatus
•  facialcanal
•  stylomastoidforamenofthetemporalbone
•  andparoAdgland
THENERVESOFFACEANDSCALP
Themusclesofthefacialexpression–thefacialnerveCNVII
Thefacialnerve[CNVII]exitstheposteriorcranialfossathrough
theinternalacousAcmeatus.
Itpassesthroughthetemporalbone,alongthemedialwallofthe
tympaniccavity,givingoffseveralbranches,andemergesfromthe
baseoftheskullthroughthestylomastoidforamen,located
betweenthemastoidandthestyloidprocesses.
Thelargermotorroot(facialnerveproper)innervatesthemuscles
offacialexpression.
Thesmallerintermediatenervecarriestaste,parasympatheAc,
andsomaAcsensoryfibers.
THENERVESOFFACEANDSCALP
Themusclesofthefacialexpression–thefacialnerveCNVII
THEFACIALNERVE
Sensory:specialsensory(taste)andsomaAc(general)sensory.
Motor:somaAc(branchial)motorandvisceral(parasympatheAc)motor.
ItalsocarriespropriocepAvefibersfromthemusclesitinnervates.
Nuclei:Themotornucleusofthefacialnerveisabranchiomotornucleusinthe
ventrolateralpartofthepons.Thecellbodiesoftheprimarysensoryneurons
areinthegeniculateganglion.
THENERVESOFFACEANDSCALP
Themusclesofthefacialexpression–thefacialnerveCNVII
THEFACIALNERVE
THEBRANCHES
Whiletraversingthetemporalbonewithinthefacialcanal,CNVIIgivesrisetothe:
•  Greaterpetrosalnerve:emergingfromtheanteriorwallofthepetrouspartof
thetemporalbone.ItincorporatesparasympatheAcandsensoryfibers,and
penetratesthecoveringplateoftheforamenlacerumlateraltotheinternal
caroAdarterywhereitisjoinedbythedeeppetrosalnerve.
•  Nervetothestapedius:slenderbranchsupplyingthestapediusmuscle.
•  Chordatympaninerve:nervebundlewithparasympatheAcfibersforthe
submandibularglandandsensoryfibersfromthetastebudsoccupyingthe
anterior2/3ofthetongue.
THENERVESOFFACEANDSCALP
Themusclesofthefacialexpression–thefacialnerveCNVII
THEFACIALNERVE
THEBRANCHES
CNVIIemergesfromthecraniumviathestylomastoidforamen:
•  atthispointitgivesofftheposteriorauricularbranch-thisbranchpasses
upward,behindtheear,tosupplytheoccipitalbellyoftheoccipitofrontalis
muscleofthescalpandtheposteriorauricularmuscleoftheear
•  themainstemofthefacialnervethengivesoffanotherbranch,which
innervatestheposteriorbellyofthedigastricmuscleandthestylohyoid
muscle
•  atthispoint,thefacialnerveentersthedeepsurfaceoftheparoPdgland;
•  onceintheparoAdgland,themainstemofthefacialnerveusuallydivides
intoupper(temporofacial)andlower(cervicofacial)branches
•  theymaybranchfurtherortakepartinananastomoAcnetworkandform
theparoPdplexus,whichgivesrisetothefiveterminalmotorbranches:
temporal,zygomaPc,buccal,marginalmandibular,andcervical
THENERVESOFFACEANDSCALP
Themusclesofthefacialexpression–thefacialnerveCNVII
THEFACIALNERVE
TemporalbranchesexitfromthesuperiorborderoftheparoAdglandtosupply
musclesintheareaofthetemple,forehead,andsupra-orbitalarea.
ZygomaPcbranchesemergefromtheanterosuperiorborderoftheparoAd
glandtosupplymusclesintheinfra-orbitalarea,thelateralnasalarea,andthe
upperlip.
BuccalbranchesemergefromtheanteriorborderoftheparoAdglandtosupply
musclesinthecheek,theupperlip,andthecornerofthemouth.
Marginalmandibularbranchesemergefromtheanteroinferiorborderofthe
paroAdglandtosupplymusclesofthelowerlipandchin.
CervicalbranchesemergefromtheinferiorborderoftheparoAdglandtosupply
theplatysma.
THENERVESOFFACEANDSCALP
Themusclesofthefacialexpression–thefacialnerveCNVII
THEFACIALNERVE
SOMATIC(BRANCHIAL)MOTOR
Thefacialnervesuppliesmainlythemusclesoffacialexpressionandauricular
muscles.Italsosuppliestheposteriorbelliesofthedigastric,stylohyoid,and
stapediusmuscles.
VISCERAL(PARASYMPATHETIC)MOTOR
CNVIIprovidespresynapAcparasympatheAcfibersto:
•  thepterygopalaPneganglionviathegreaterpetrosalnerveforinnervaAon
ofthelacrimalglands,andto
•  thesubmandibularganglionchordatympaniforinnervaAonofthesublingual
andsubmandibularsalivaryglands.
SOMATIC(GENERAL)SENSORY
Somefibersfromthegeniculateganglionsupplyasmallareaoftheskinofthe
conchaoftheauricle,closetoexternalacousAcmeatus.
SPECIALSENSORY(TASTE)
Fiberscarriedbythechordatympanijointhelingualnervetoconveytaste
sensaAonfromtheanteriortwothirdsofthetongueandsogpalate.
THENERVESOFFACEANDSCALP
Duringdevelopmentacranialnervebecomesassociatedwitheach
ofthepharyngealarches.
Thetrigeminalnerve[CNV]innervatesfacialstructuresderivedfrom
thefirstarch.
Thefacialnerve[CNVII]innervatesfacialstructuresderivedfromthe
secondarch.
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
FUNCTIONS:SomaAc(general)sensoryandsomaAc(branchial)motorto
derivaAvesofthe1stpharyngealarch.
NUCLEI:Thereare4trigeminalnuclei–onemotor(motornucleusoftrigeminal
nerve)andthreesensory(mesencephalic,principalsensoryandspinalnucleiof
trigeminalnerve).
Thetrigeminalnerveexitslaterallyfromtheponswithtwogroupsoffibers
(largeposteriorsensoryandsmallanteriormotorrootsoftrigeminalnerve),
suppliesthemasAcaAonmusclesandprovidessensoryinnervaAontotheface.
ThetrigeminalnerveCNVistheprincipalsomaAc(general)sensorynervefor
thehead(face,teeth,mouth,nasalcavity,andduramaterofthecranialcavity).
Thesensoryrootleadstothetrigeminalganglion.
Themotorrootrunsparalleltothesensoryroot,thenbypassestheganglionand
becomespartofthemandibularnerve(CNV3)
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
TRIGEMINAL(SEMILUNAR,GASSERIAN)GANGLION
Semilunarganglionthatisequivalenttoaspinalganglion.
ItislocatedinanoutpockeAngofthesubarachnoidspace(cavumtrigeminale)
abovetheforamenlacerumatthemedial,anteriorborderofthepetrouspartof
thetemporalbone.
TheophtalmicV1andmaxillaryV2divisionsarewhollySENSORY.
ThemandibularV3divisionislargelysensory,butalsoreceivesthemotor
fibresthatsupplythemusclesofmasPcaPon.
Thetrigeminalnerveisdividedasfollows:
•  ophthalmicV1division:exitstheskullviathesuperiororbitalfissure
•  maxillaryV2division:exitstheskullviatheforamenrotundum
•  mandibularV3division:exitstheskullviatheforamenovale
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
ThebranchesoftheophthalmicnerveV1thatinnervatethefaceinclude:
•  thesupra-orbitalandsupratrochlearnerves(fromfrontalnerve),whichleave
theorbitsuperiorlyandinnervatetheuppereyelid,forehead,andscalp;
•  theinfratrochlearnerve,whichexitstheorbitinthemedialangletoinnervate
themedialhalfoftheuppereyelid,theskinintheareaofthemedialangle,and
thesideofthenose;
•  thelacrimalnerve,whichexitstheorbitinthelateralangletoinnervatethe
lateralhalfoftheuppereyelidandtheskinintheareaofthelateralangle;and
•  theexternalnasalnerve,whichsuppliestheanteriorpartofthenose.
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
Thetrigeminalnerveisdividedasfollows:
•  maxillaryV2division:exitstheskullviatheforamenrotundum
ItpassesthroughtheforamenrotundumtothepterygopalaAnefossaand
subsequentlythroughtheinferiororbitalfissureintotheorbit.
Thetrigeminalnerveisdividedasfollows:
•  maxillaryV2division:exitstheskullviatheforamenrotundum
ItssomaAc(general)sensoryfibersaregenerallydistributedtoskinandmucous
membranesassociatedwiththeupperjaw.
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
ThebranchesoftheMAXILLARYNERVEV2thatinnervatethefaceinclude:
•  asmallzygomaPcotemporalbranch,whichexitsthezygomaAcboneand
suppliesasmallareaoftheanteriortempleabovethezygomaAcarch;
•  asmallzygomaPcofacialbranch,whichexitsthezygomaAcboneandsuppliesa
smallareaofskinoverthezygomaAcbone;and
•  thelargeinfra-orbitalnerve,whichexitsthemaxillathroughtheinfra-orbital
foramenandimmediatelydividesintomulAplebranchestosupplythelower
eyelid,cheek,sideofthenose,andupperlip
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
THEPTERYGOPALATINE(PARASYMPATHETIC)GANGLIONisassociatedwiththis
divisionofCNV,involvedininnervaAngthelacrimalglandandglandsofthenose
andpalate.
OPHTHALMICNERVE(CNV1)-SENSORYONLY
MAXILLARYNERVE(CNV2)-SENSORYONLY
MANDIBULARNERVE(CNV3)-SENSORYANDMOTOR
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
THESOMATIC(BRANCHIOMOTOR)BRANCHESOFTHETRIGEMINAL
NERVE
THEMANDIBULARNERVEV3ONLY(!):
•  masseter
•  temporalis
•  medialandlateralpterygoids
•  mylohyoid
•  anteriorbellyofdigastric
•  tensortympani
THENERVESOFFACEANDSCALP
THEFACIALNERVE
VS.
Buccalbranchesemergefrom
theanteriorborderofthe
paroAdglandtosupply
musclesinthecheek,the
upperlip,andthecornerof
themouth.
BRANCHES
THEMANDIBULARNERVE
Thebranchesofthemandibular
nerveV3innervaAngthefaceinclude:
•  thebuccalnerve,whichisonthe
surfaceofthebuccinatormuscle
supplyingthecheek;
NERVE
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
ThebranchesofthemandibularnerveV3innervaAngthefaceinclude:
•  theauriculotemporalnerve,whichentersthefacejustposteriortothe
temporomandibularjoint,passesthroughtheparoAdgland,andascendsjust
anteriortotheeartosupplytheexternalacousAcmeatus,thesurfaceofthe
tympanicmembrane(eardrum),andalargeareaofthetemple;
•  thebuccalnerve,whichisonthesurfaceofthebuccinatormusclesupplyingthe
cheek;and
•  thementalnerve,whichexitsthemandiblethroughthementalforamenand
immediatelydividesintomulAplebranchestosupplytheskinandmucous
membraneofthelowerlipandskinofthechin.
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
OPHTHALMICNERVE(CNV1)-SENSORYONLY
MAXILLARYNERVE(CNV2)-SENSORYONLY
MANDIBULARNERVE(CNV3)-SENSORYANDMOTOR
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
THESOMATIC(BRANCHIOMOTOR)BRANCHESOFTHETRIGEMINALNERVE
THEMANDIBULARNERVEV3ONLY(!):
•  masseter
•  temporalis
•  medialandlateralpterygoids
•  mylohyoid
•  anteriorbellyofdigastric
•  tensortympani
THETRIGEMINALNERVECNVissensoryto:
•  theduraoftheanteriorandmiddlecranialfossae
•  skinoftheface
•  teeth
•  gingiva
•  mucousmembraneofthenasalcavity
•  paranasalsinuses
•  andmouth
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
TwoparasympatheAcganglia,theoPcandsubmandibular,areassociatedwiththe
mandibulardivisionV3;bothareconcernedwiththeinnervaAonofsalivaryglands.
THENERVESOFFACEANDSCALP
Thespinalcutaneousnerves
Posteriortotheear,thescalpreceivescutaneousinnervaAonfromthespinal
cutaneousnervesthatoriginateintheneck(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
Mostsuperficialarteriesofthefacearebranches
orderivaAvesofbranchesoftheexternalcaroAd
artery
THEVASCULATUREOFFACIALANDSCALP
THESUPERFICIALARTERIESOFFACE
THEFACIALARTERY
ThirdanteriorbranchofexternalcaroAdartery.Itrunsbelowthestylohyoid
muscle,firstupward,thenlateral,andcrossesthemandibleattheanteriormargin
ofthemasseter.
THEFACIALARTERY
crossesthemandibleattheanteriormarginofthemasseter.
THEFACIALARTERY
Thefacialarterycrossesthemandible,buccinator,andmaxillaasitcoursesover
thefacetothemedialangle(canthus)oftheeye,wherethesuperiorandinferior
eyelidsmeet.
THEFACIALARTERY
Thefacialarteryprovidesthemajorarterialsupplytotheface.
THEVASCULATUREOFFACIALANDSCALP
THESUPERFICIALARTERIESOFFACE
THEFACIALARTERY
Thefacialarterypassesapproximatelyafinger’sbreadthlateraltotheangleofthe
mouth
THEFACIALARTERY
sendsbranchestotheupperandlowerlips(thesuperiorandinferiorlabial
arteries),ascendsalongthesideofthenose.
Theterminalpartofthefacialarteryiscalledtheangularartery,itanastomoses
withtheophthalmicartery.
THEVASCULATUREOFFACIALANDSCALP
THESUPERFICIALARTERIESOFFACE
THEOCCIPITALARTERY
SeconddorsalbranchofexternalcaroAdartery.
Itpassesmedialtothemastoidprocessattheocciputandanastomoseswiththe
superficialtemporal,vertebral,deepcervicalandposteriorauriculararteries.
THEPOSTERIORAURICULARARTERY
ThirddorsalbranchofexternalcaroAdartery.
ItliesundertheparoAdglandonthestyloidprocessbetweenthemastoidprocess
andtheear.
THESUPERFICIALTEMPORALARTERY
OneoftwoterminalbranchesoftheexternalcaroAdartery.
Itpassesupwardinfrontoftheauricle(pinna)accompaniedbythe
auriculotemporalnerve.
THETRANSVERSEFACIALARTERY
Branchofthesuperficialtemporalartery,thatiscoveredbytheparoAdglandand
passesbelowthezygomaAcarchtothecheek.
Approximatelyafinger’sbreadthinferiortothezygomaAcarch.
THEVASCULATUREOFFACIALANDSCALP
THESUPERFICIALARTERIESOFFACE
THEMENTALARTERY
Terminalbranchofinferioralveolarartery.
Theonlysuperficialbranchderivedfromthemaxillaryartery,accompaniesthe
nerveofthesamenameinthechin.
THESUPRAORBITALandSUPRATROCHLEARARTERIES
Thebranchesoftheophthalmicartery,accompanynervesofthesamenameacross
theeyebrowsandforehead.
*
THEVASCULATUREOFFACIALANDSCALP
THEARTERIESOFSCALP
THEARTERIESOFSCALP
ThearterialsupplyisfromtheexternalcaroAdarteriesthrough:
•  theoccipital
•  posteriorauricular
•  andsuperficialtemporalarteries
AndfromtheinternalcaroAdarteriesthrough:
•  thesupratrochlear
•  andsupra-orbitalarteries
THEEXTERNALVEINSOFFACE
•  Supratrochlear
•  Supra-orbital
•  Angular
•  Facial
•  Deepfacial
•  Superficialtemporal
•  Retromandibular
THEVASCULATUREOFFACIALANDSCALP
THEEXTERNALVEINSOFFACEOFSCALP
THEFACIALVEINS
Thefacialveins,coursingwithorparalleltothefacialarteries,arevalvelessveins
thatprovidetheprimarysuperficialdrainageoftheface.Itcoursesfromthemedial
angleoftheeye,behindthefacialartery.Thefacialveindrainsdirectlyorindirectly
intotheinternaljugularvein.
THEFACIALVEINS
Atthemedialangleoftheeye,thefacialveincommunicateswiththesuperior
ophthalmicvein,whichdrainsintothecavernoussinus.
THEANGULARVEIN
Formedbytheunionofthesupratrochlearandsupraorbitalveins;itbecomes
conAnuouswiththefacialveinatthemedialangleoftheeyeandanastomoses
withtheophthalmicvein.
THEVASCULATUREOFFACIALANDSCALP
THEEXTERNALVEINSOFFACEOFSCALP
THEDEEEPFACIALVEIN
Arisesfromthepterygoidplexus(drainsthepterygoidvenousplexusofthe
infratemporalfossa)andpassesanteriorlyonthemaxilla.
THERETROMANDIBULARVEIN
Itdrainsintothefacialveinagerreceivingtheconfluenceofmanybranchesinfront
oftheear.Theretromandibularveindividesintoananteriorbranchthatunites
withthefacialveinandaposteriorbranchthatjoinstheposteriorauricularvein
inferiortotheparoAdglandtoformtheexternaljugularvein.Thisveinpasses
inferiorlyandsuperficiallyinthenecktoemptyintothesubclavianvein.
THEVASCULATUREOFFACIALANDSCALP
THEVEINSOFSCALP
THEVEINSOFSCALP
Thesupra-orbitalandsupratrochlearveinsuniteatthemedialcanthusoftheeye
toformthefacialvein.
Thesuperficialtemporalveinjoinsthemaxillaryveintocreatethe
retromandibularveinjustposteriortotheneckofthemandible.
Theposteriorauricularveinoriginatesbehindtheearandchannelsvenousblood
fromtheposteriorofthescalptowardtheexternaljugularvein.
THEVASCULATUREOFFACIALANDSCALP
THEVEINSOFSCALP
THEVEINSOFFACIALANDSCALP
Somesmallveinsalsocommunicatewiththecavernoussinuswithintheskull.This
connecAonoffacialvenousdrainagewithintracranialvenousdrainageaccountsfor
thespreadofsomeinfecPonsfromthefacetothebrain.
ThethrombophlebiPsofthecavernoussinusmaybecausedbyaninflammaAon
limitedtothe:
•  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.
Allofthesecranialnervescourseinthelateralwallofthesinusexceptfor
abducentCNVI,whichcoursesthroughthemiddleofthesinus.Asaresult,
CNVIistypicallyaffectedfirstinacavernoussinusthrombosisorbyan
aneurysmoftheinternalcaroAdartery,withtheothernervesbeing
affectedlater.
THEVASCULATUREOFFACIALANDSCALP
THELYMPHATICDRAINAGEOFFACEANDSCALP
LYMPHATICDRAINAGEOFFACEANDSCALP
Therearenolymphnodesinthescalp,andexceptfortheparoAd/buccalregion,
therearenolymphnodesintheface.
LYMPHATICDRAINAGEOFFACEANDSCALP
•  Lymphfromthelateralpartofthefaceandscalp,includingtheeyelids,drainsto
thesuperficialparoAdlymphnodes.
•  LymphfromthedeepparoAdnodesdrainstothedeepcervicallymphnodes.
•  Lymphfromtheupperlipandlateralpartsofthelowerlipdrainstothe
submandibularlymphnodes.
•  Lymphfromthechinandcentralpartofthelowerlipdrainstothesubmental
lymphnodes.
THEVASCULATUREOFFACIALANDSCALP
THELYMPHATICDRAINAGEOFFACEANDSCALP
LYMPHATICDRAINAGEOFFACEANDSCALP
Thesuperficialring(pericervicalcollar)oflymphnodes:
•  submental
•  submandibular
•  paroAd
•  mastoid
•  andoccipital
Lymphfromthescalp,face,andneckdrainsintothesuperficialringoflymphnodes
LYMPHATICDRAINAGEOFFACEANDSCALP
AlllymphaAcvesselsfromtheheadandneckdraindirectlyorindirectlyintothe
deepcervicallymphnodes
THEPAROTIDGLAND
THEPAROTIDREGION
THEPAROTIDREGION
TheparoAdregionistheposterolateralpartofthefacialregion,boundedbythe:
•  ZygomaAcarchsuperiorly
•  Externalearandanteriorborderofthesternocleidomastoidposteriorly
•  Ramusofthemandiblemedially
•  Anteriorborderofthemassetermuscleanteriorly
•  Angleandinferiorborderofthemandibleinferiorly
THEPAROTIDREGION
TheparoAdregionincludes:
•  theparoAdglandandduct
•  theparoAdplexusofthefacialnerve(CNVII)
•  theretromandibularvein
•  theexternalcaroAdartery
•  andthemassetermuscle
THEPAROTIDGLAND
THEPAROTIDGLAND
TheparoAdglandisenclosedwithinatough,unyielding,theparoPdsheath
(capsule)
THEPAROTIDGLAND
TheapexoftheparoAdglandisposteriortotheangleofthemandible,
anditsbaseisrelatedtothezygomaAcarch.
THEPAROTIDDUCT
TheparoAdductpasseshorizontallyfromtheanterioredgeofthegland
•  theductturnsmedially
•  piercesthebuccinator
•  andenterstheoralcavitythroughasmallorificeoppositethe
2ndmaxillarymolartooth
THEPAROTIDGLAND
THEPAROTIDGLAND
Fromsuperficialtodeepthereare:
•  theparoAdplexusofthefacialnerve(CNVII)anditsbranches
•  theretromandibularvein
•  theexternalcaroAdartery
TheparoAdectomymaydamage
thefacialnerveCNVII
(theparoAdplexus)
THEPAROTIDGLAND
OntheparoAdsheathandwithintheglandareparoAdlymphnodes.