Transcript Skull and Face - Faculty of Science, Mahidol University

Skull and Face
Boonsirm Withyachumnarnkul, M.D., Ph.D.
Department of Anatomy, Faculty of Science
Mahidol University
Bony Landmarks of Skull and Face
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Vertex
Superciliary arch
Zygoma
Mental symphysis
Entrance to orbit
Anterior nasal
aperture
Three foramina vertically alligned
• Supraorbital
foramen … for
supraorbital nerve
• Infraorbital foramen
… for infraorbital
nerve
• Mental foramen ...
for mental nerve
Muscles of Facial Expression
• Develop from the 2nd
branchial arch, thus all
are supplied by CN VII.
• Most are thin, originate
from facial bones to
insert on facial skin,
except platysma, and are
intermingled at their
insertions.
Muscles of Facial Expression
• Muscle of the
forehead … frontalis,
as part of the
occipitofrontalis
• Muscles of the mouth
• Muscle of the eyelids
• Muscle of the nose
• Platysma
Muscles of the Mouth
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Orbicularis oris
Zygomaticus major
Zygomaticus minor
Levator labii superioris
Levator labii superioris alaque nasi
Buccinator
Depressor anguli oris
Depressor labii inferioris
Mentalis
Risorius
Platysma
Muscles of the Mouth
Muscle of the Eyelids
• Orbicularis oculi
– Orbital part
– Palpebral part
Buccal Pad Fat
• Between masseter
and buccinator
muscles
• Brown fat … for
heat generation,
especially for
children
Parotid Duct
• One finger-breadth
below zygomatic
arch
• Open into the mouth
cavity (vestibule) at
the level of the 2nd
molar tooth (crown)
Facial Nerve
• Comes out from
stylomastoid
foramen
• Five branches
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Temporal
Zygomatic
Buccal
Mandibular
Cervical
Facial Palcy
• No wrinkle of
forehead
• Angle of mouth
drops
• Sagging lower eyelid
• Other signs relating
to malfunctions of
structures innervated
by facial nerve
Trigeminal Nerve
• Sensory
– Ophthalmic division
– Maxillary division
– Mandibular division
• Motor .. To 1st branchial arch
– Muscles of mastication
• Messeter
• Temporalis
• Medial pterygoid
• Lateral pterygoid
Arteries of the Face
(rich, tortuous and highly anastomosed)
• From external carotid
artery
– Facial artery
– Superficial temporal
artery
– Transverse facial
artery
• From internal carotid
artery
– supraorbital artery
– supratrochlear artery
Veins of the Face
• Two important veins
– Facial vein
– Retromandibular
vein
• Facial veins have no
valves
• Connection of facial
veins, pterygoid
plexus and cavernous
sinus
Lymph Drainage of the Face
• Submental lymph
nodes
• Submandibular
lymph nodes
• Parotid lymph nodes
Scalp, Cranial Cavity and Venous Sinuses
Boonsirm Withyachumnarnkul, M.D., Ph.D.
Department of Anatomy, Faculty of Science
Mahidol University
Head2.ppt in C (Mahidol)
Scalp
• Five layers of scalp
– skin
– dense subcutaneous tissue
– epicranial aponeurosis
– loose areolar connective tissue
– periosteum
Scalp
• Clinical relevance
– infection spreading from loose areolar connective tissue, via emissary veins, to
meninges-meningitis
– hematoma
Skull Cap or Calvaria
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Suture
– coronal (frontoparietal)
• anterior fontanelle
– sagittal (interparietal)
– lambdoid (occipitoparietal)
• posterior fontanelle
Skull Cap or Calvaria
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Three layers of skull cap
– outer table
– diploe
– inner table
Cranial Fossae
• Anterior cranial fossa
• Middle cranial fossa
• Posterior cranial fossa
• Boundaries
– lesser wing of sphenoid
– superior border of petrous bone
Anterior Cranial Fossa
• important landmarks
– crista galli & cribriform plate of ethmoid
– sella turcica
• tuberculum sellae
• hypophyseal fossa
• dorsum sellae
Middle Cranial Fossa
• important landmarks
– foramina
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superior orbital fissure
foramen rotundum
foramen ovale
foramne spinosum
– groove for middle
meningeal
artery
Posterior Cranial Fossa
• important landmarks
– grooves for transverse
& sigmoid sinuses
– foramen magnum
Dura Mater
• Outer and inner layers
– position of the middle meningeal artery
Dura Mater
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Falx cerebri
Falx cerebelli
Tentorial cerebelli and notch
Diaphragmatic sellae
Intradural Venous Sinuses
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Superior and inferior sagittal sinuses
Straight sinus
Transverse and sigmoid sinuses
Intradural Venous Sinuses
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Cavernous sinus
– relationship among internal carotid artery, CN III, CN IV, CN V1 and CN VI
– venous connections
– clinical relevance
• thrombophlebitis
Orbit and Eye
Boonsirm Withyachumnarnkul, M.D., Ph.D.
Department of Anatomy, Faculty of Science
Mahidol University
Eye From the Outside
•eyelids
•palpebral fissure
•plica semilunaris
•caruncle
•lacrimal puncta
•cornea
•sclera
•conjunctiva
•bulbar
•palpebral
•Sty
•pterygium
Bony Parts of the Orbit
Entrance of the Orbit
•frontal bone
•zygomatic bone
•maxillary bone
More Bones Inside
•ethmoid bone
•greater and lesser wing of sphenoid
•lacrimal bone
Foramina of the Orbit
•optic foramen (canal)
•optic n.
•ophthalmic a.
•superior orbital fissure
•all other nerves
•superior ophthalmic vein
•inferior orbital fissure
•infraorbital n. & a.
•inferior ophthalmic v.
•infraorbital groove & foramen
•zygomatic & infraorbital n.
•supraorbital notch & foramen
•supraorbital n.
Eyeball
Eyeball
Muscles
•Extrinsic (Extra-ocular)
•Intrinsic
Levator Palpebrae Superioris
•Supplied by CN III
•insert on the upper lid
ptosis
•if paralyzed
Extra-Ocular Muscles
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Superior Rectus
Inferior Rectus
Lateral Rectus
Medial Rectus
• Superior Oblique
• Inferior Oblique
Actions of the Extra-Ocular Muscles
• Around vertical axis
– medial or adduction
– lateral or abduction
• Around horizontal axis
– upward or elevation
– downward or depression
• Around antero-posterior axis
– medial rotation
– lateral rotation
Superior Rectus
Make a 10-15 o
with an AP axis
adduct
medial rotate
elevate
Inferior Rectus
depress
adduct
lateral rotate
Medial and Lateral Recti
Medial Rectus
•adduction
Lateral Rectus
•abduction
Superior Oblique
•depress
•abduction
•medial rotate
Inferior Oblique
•elevate
•abduction
•lateral rotate
Periorbita and Orbital Fat
Insertions of the Extra-Ocular Muscles
Nerves of
the Extra-Ocular Muscles
• Oculomotor Nerve (CN III)
– supplies all except lateral rectus and superior oblique
• Trochlear Nerve (CN IV)
– superior oblique
• Abducens Nerve (CN VI)
– lateral rectus
Oculomotor nerve (CN III)
Superior Division
• levator palpebrae superioris*
• superior rectus
Inferior Division
• inferior rectus
• inferior oblique
• medial rectus
*not an extra-ocular muscle
Functional Tests of
the Extra-Ocular Muscle
Principle
•align the muscle axis with the eyeball AP axis
•contract the muscle
e.g., for Superior Rectus
•abduct, first
•then, elevate
Therefore, test for the superior rectus
function is to abduct and elevate
Parts of the Eyeball
Three layers
•sclera
•choroid
•anterior chamber
•retina
•posterior chamber
•cornea
•iris
•ciliary muscle
•suspensory ligament
•lens
•hyaloid canal
•vitreous body
•aqueous humor
Clinical Relevance
•lenticular cataract
•glaucoma
•Schlemn’s canal
•Myopia (near sightedness)
•hyperopia (far sightedness)
•presbiopia (old-aged sightedness)
Blood Vessels of the Orbit & Eyeball
Ophthalmic
•Frontal
•anterior & posterior ethmoidal
•supraorbital
•supratrochlear
•lacrimal
•central retinal
in the choroid layer
Ophthalmoscopic Examination
•optic disc
•macula lutea & fovea centralis
•retinal vessels in DM & hypertension
Veins of the Eyeball
•superior & inferior ophthalmic veins
•drained to cavernous sinus
•connection to pterygoid plexus
•connection to facial veins
Sensory Nerves of the Eyeball and Orbit
•frontal
•supraorbital
•supratrochlear
•lacrimal nerve
•nasociliary nerve
•anterior ethmoidal
•posterior ethmoidal
•infratrochlear
Autonomic Nerves of the Eyeball and Orbit
Sympathetic
post-ganglionic sympathetic fibers
artery (ophthalmic a) long ciliary n. eyeball
iris (radial fibers)
Parasympathetic
pre-ganglionic parasympathetic fibers (in the nerve to
ciliary ganglion
short ciliary n.
inferior oblique)
Eyeball
ciliary muscle & iris (circular fibers)
Ciliary Ganglion
Lacrimal Gland and Lacrimal Apparatus
•Lacrimal puncta
•lacrimal canaliculi
•lacrimal sac
•nasolacrimal duct
•opening into the inferior meatus of nasal cavity
Parasympathetic Supply to the Lacrimal Gland
Preganglionic parasympathetic fibers
maxillary n
zygomatic branch
lacrimal n
lacrimal gland
pterygopalatine ganglion
zygomatico-temporal branch
Eyelid
•upper & lower eyelids
•conjunctiva
•palpebral fissure & palpebral sac
•tarsal plates (superior & inferior)
•tarsal muscle & nerve (sympathetic n)
•tarsal gland & ciliary gland; Meibomitis & sty
•attachment of levator palpebrae superioris
Orbital Septum,
Medial & Lateral Palpebral Ligament
Submandibular Region, Nasal Region and Oral Cavity
Boonsirm Withyachumnarnkul, M.D., Ph.D.
Department of Anatomy, Faculty of Science
Mahidol University
Head 6. ppt in C (Mahidol)
Submandibular Region
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Inferior border of mandible
Suprahyoid muscles
Including submandibular triangle
Submandibular gland
Nerves
– lingual
– hypoglossal
– mandibular branch of CN VII
Blood vessels
– lingual
– facial
Lymph nodes, submandibular lymph nodes
Submandibular Triangle
• Anterior belly of digastric muscle
– Origin, digastric fossa of mandible
– Nerve, nerve to mylohyoid (CN V)
• Posterior belly of digastric muscle
– Origin, mastoid notch
– Nerve, CN VII
• Inferior border of mandible
Actions of Digastric Muscle
• Elevate hyoid bone
• Open jaw
• Raising floor of mouth for swallowing reflex
Suprahyoid Muscles
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Digastric
Mylohyoid
Geniohyoid
Hyoglossus
Stylohyoid
Mylohyoid Muscle
• Origin, mylohyoid line of mandible
• Insertion
– Body of hyoid bone
– Median fibrous raphe
• Nerve, nerve to mylohyoid (CN V)
Geniohyoid Muscle
• Origin, mental spine
• Insertion, hyoid bone
• Nerve, C1 spinal nerve
Hyoglossus Muscle
• From hyoid bone to side of the tongue
• Nerve, hypoglossal nerve
Stylohyoid Muscle
• Origin, styloid process
• Insertion, hyoid bone (two slips)
• Nerve, CN VII
Concerted Action of Suprahyoid Muscles
Elevate floor of mouth for swallowing reflex
Submandibular Gland
• superficial part
• deep part
• the two parts are separated by mylohyoid
muscle
• mixed serous and mucous gland
• submandibular duct
– from deep part
– open at sublingual caruncle
Anatomical Relationship
• Hypoglossal and lingual nerves are between
mylohyoid and hyoglossus muscles
• Closed relationship between lingual nerve
and submandibular duct
Chorda tympani
• special sense (taste) from anterior 2/3 of tongue
• preganglionic parasympathetic fibers to submandibular and
sublingual gland, via submandibular ganglion
The Nasal Region
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Nostrils
Vestibule
Nasal cavity
Choanae
Nasal septum
– Cartilage, septal cartilage
– Bone
• perpendicular plate of ethmoid
• vomer
• maxillary & palatine
Lateral Wall of the Nasal Cavity
Chonchae
• superior, part of ethmoid
• middle, part of ethmoid
• inferior, separate bone
Lateral Wall of the Nasal Cavity
Meatuses
• sphenoethmoidal recess, opening of sphenoidal sinus
• superior, opening of posterior ethmoidal air cells
• middle
– bulla ethmoidalis, opening of middle ethmoidal air cells
– hiatus semilunaris, opening of
• maxillary sinus
• anterior ethmoidal air cells
• frontal sinus, infundibulum
• inferior, opening of nasolacrimal duct
• common meatus
Nerves of the Nasal Cavity
• Special sense, olfactory n. "olfactory mucosa"
• General sense, "respiratory mucosa"
– branch of nasociliary n.
• anterior ethmoidal n.
– branches of maxillary n.
• nasopalatine n.
• posterior superior lateral nasal n.
• posterior inferior lateral nasal n.
• Test of olfactory function
Third Part of the Maxillary Artery
• superior alveolar a.
– posterior
– anterior, from infraorbital a.
• infraorbital a.
• descending palatine a.
– greater palatine a.
– lesser palatine a.
• sphenopalatine a.
Blood Supply of the Nasal Cavity
• from sphenopalatine a.
– posterior lateral nasal br.
– posterior septal br.
• from ophthalmic a.
– anterior and posterior ethmoidal a
Paranasal Air Sinuses
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– frontal sinuses
– ethmoidal air cells
• posterior
• middle
• anterior
– sphenoidal sinuses
– maxilary sinus
Functions
– warm and humidify air
– resonance
Maxillary Nerve
• out of the skull through foramen rotundum
• branches
– zygomatic n.
• zygomaticotemporal n.
• zygomaticofacial n.
– infraorbital n., out from the infraorbital foramen
– superior alveolar n.; anterior, middle, posterior
– two small br. to pterygopalatine ganglion
Pterygopalatine Ganglion
In
• pterygopalatine br. from maxillary n., general sense
• nerve of pterygoid canal
– parasympathetic
– sympathetic
Out
• pterygopalatine br. to maxillary n., parasympathetic fibers to lacrimal gland
• pharyngeal n.
• greater and lesser palatine n.
• superior and inferior lateral nasal n.
• nasopalatine n
Pterygopalatine Ganglion
All the "out" branches supply
• submucosal gland, parasympathetic
• general sense
• lacrimal gland, parasympathetic
Mouth & Lips
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vestibule
oral cavity proper
nasolabial sulcus
philtrum
labial gland
frenulum
palatoglossal arch
palatopharyngeal arch
opening of parotid duct
opening of submandibular & sublingual ducts
The Teeth
Types
• incisor, 2
• canine, 1
• premolar, 2
• molar, 3
Nerves and vessels (to teeth and gingivae)
• alveolar
– superior (maxillary n. and a.)
• anterior
• middle
• posterior
– inferior (mandibular n., maxillary a.)
• nasopalatine (maxillary n. and a.)
• greater palatine (maxillary n. and a.)
The Tongue
• sulcus terminalis
• foramen caecum
• papillae
– circumvallate
– fungiform
– filiform
– foliform
• lingual tonsil
Muscles of the Tongue
• Intrinsic
– longitudinal
– transverse
– vertical
• Extrinsic
– hyoglossus
– genioglossus (movement of tongue)
– styloglossus
– palatoglossus
Artery & Nerves of the Tongue
Artery
• lingual a.
Nerves
• motor, hypoglossal n., except palatoglossus (vagus n.)
• sensory
– general, CN V, IX & X
– special, CN VII (anterior 2/3) & CN IX (posterior 1/3),
CN X
The Palate
• Hard palate
• Soft palate, muscles
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tensor veli palatini (CN V)
levator veli palatini (CN X)
musculus uvulae (CN X)
palatoglossus (CN X)
palatopharyngeus (CN X)
• Clinical relevant
– openning of auditory
tube
– test of CN X
Blood Supply of Palatine Tonsil (important for
tonsillectomy)
from lingual a.
• dorsal lingual a.
from facial a.
• tonsillar br.
• ascending palatine a.
from ascending pharyngeal a.
• palatine br.
lesser palatine a.