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Region 2: Superficial Face and Parotid Area Landmarks on Face --Frontal Eminences: 2 prominences of the forehead --Superciliary arches: just below frontal eminence w/ glabella b/w arches --Nasion: depression below glabella and commencement of nose --Supraorbital margins and notches --Infraorbital foramen: below orbit, in maxilla, below supraorbital notch --ala and vestibule of nose --philtrum: vertical, midline groove running from upper lip to nasal septum --vestibule: area of oral cavity b/w cheeks and teeth --frenulum of lips: attaches lips to gums at midline of vestibule --mandible: body, angle, oblique line, ramus, head and neck --mental foramen: on mandible, in line with supra and infraorbital foramina Skin of Face --Sensory Innervation of face is TRIGEMINAL NERVE (CN V) *V1: Ophthalmic Division a. supraorbital nerve (off frontal n.): through supraorbital notch/foramen b. supratrochlear nerve (off frontal n.): pierces orbital fascia c. lacrimal nerve: pierces orbital fascia d. infratrochlear nerve (off nasociliary n.) e. external nasal nerve (off anterior ethmoidal n. branch of nasociliary n.) *V2: Maxillary Division a. infraorbital nerve: through infraorbital forament b. zygomaticotemporal nerve (off zygomatic n.): enters temporal fossa c. zygomaticofacial nerve (off zygomatic n.): supply cheek *V3: Mandibular Division a. auriculotemporal nerve: travels with superficial temporal artery b. buccal nerve (enters face over buccinators muscle): supplies skin over buccinators and mucous membranes in gums and mouth in same area c. mental nerve (off inferior alveolar n.): supplies chin and lower lip Fascia --Temporal fascia: strong fascia over temporal fossa, attached to superior temporal line above and zygomatic arch below Muscles of Facial Expression: ALL innervated by FACIAL NERVE --Muscles of Scalp *Epicranius: consists of frontal (frontalis) and occipital (occipitalis) bellies with galea aponeurotica between --Muscles Around Eye *Obicularis Oculi: encircles palpebral fissure, closes orbit and covers globe *Corrugator Supercilii --Muscles Around Nose *Procerus *Nasalis: alar and transverse parts *Depressor Septi --Muscles Around Mouth *Obicularis Oris: important in closing the mouth *Buccinator: important accessory muscle of mastication ~pterygomandibular raphe: one of the origins of buccinators, attached above to hamulus of medial pterygoid plate and below to mandible behind the third molar tooth, serves as origin for superior pharyngeal constrictor *Levator Labii Superioris Alaeque Nasi *Levator Labii Superioris *Zygomaticus Minor *Zygomaticus Major: pulls angle of mouth upward and lateral as in laughing *Levator Anguli Oris *Risorius: retracts angle of mouth *Depressor Anguli Oris *Depressor Labii Inferioris *Mentalis *Platysma Parotid Gland --largest salivary gland in head and neck --facial nerve and its branches basses THROUGH the gland --structures emerging from the margins of the gland *parotid/Stensen’s duct: crosses masseter muscle and passes through buccinators muscle at level of 2nd upper molar *superficial temporat artery and vein *auriculotemporal nerve *branches of facial nerve *transverse facial artery Facial Nerve --nerve to muscles of facial expression --after emerging from stylomastoid foramen it supplies: posterior belly of digasric and stylohyoid muscles --gives off posterior auricular nerve --in parotid gland divides into upper and lower divisions *Upper division: temporal, zygomatic, and buccal branches *Lower division: buccal, marginal mandibular, and cervical branches Blood Supply: Arterial --Facial artery (from external carotid artery) *Angular artery (terminal brach of facial artery): anastomoses with dorsal nasal branch of ophthalmic artery *Often makes a loop at angle of mouth to prevent stretching during opening of mouth --inferior labial artery --superior labial artery --Transverse facial artery (from superficial temporal artery) Blood Supply: Venous --Facial Vein: empties into internal jugular vein --Retromandibular Vein (joins with Posterior auricular v. to form external jugular v.) Scalp --Layers of Scalp *S: Skin *C: Connective tissue (dense, gapes when cut, hence bleeds profusely) *A: Aponeurosis of the epicranius muscle (galea aponeurotica) *L: Loose CT (allowing epicranius muscle to move) *P: Periosteum of skull --Nerves *Trigeminal Nerve (CN V): all 3 divisions *Anterior Primary Rami of C2 and C3 of cervical Plexus ~Lesser occipital nerve ~Great auricular nerve *Posterior primary rami of C2 and C3 ~greater occipital nerve (C2) ~least occipital nerve (C3) --Blood Supply *Internal Carotid Artery ~ophthalmic artery --supraorbital branches *External Carotid Artery ~maxillary and superficial temporal arteries (terminal branches of external carotid) ~posterior auricular artery ~occipital artery