Face and Scalp 解剖學科鄭授德 本教材之圖片取自於 1 Gray s Anatomy for Students, 3rd ed, 2015, by Drake, Vogl, and Mitchell 2 Clinically Oriented Anatomy, 7th ed, 2014, by Moore, Dalley, and Agur 3 Clinically Oriented Anatomy, 4th ed, 1999, by Moore and Dalley 4 A Regional Atlas of the Human Body, 4th ed, 1997, by Clenente 5 Gunther von Hagens Body Worlds The Anatomical Exhibition of Real Human Bodies 4th ed, 2003
Face: Muscles - 1 Orbital group 1-1 Orbicularis oculi Orbital part Palpebral part 1-2 Corrugator supercilli
2-1 Nasalis Face: Muscles - 2 Nasal group Transverse part Alar part 2-2 Procerus 2-3 Depressor septi nasi
3-1 Orbicularis oris 3-2 Buccinator Face: Muscles - 3 Oral group
Face: Muscles - 4 Lower group oral muscles 4-1 Depressor anguli oris
Face: Muscles - 4 Lower group oral muscles 4-2 Depressor labii inferioris
Face: Muscles - 4 Lower group oral muscles 4-3 Mentalis
Face: Muscles - 5 Upper group oral muscles 5-1 Risorius 5-2 Zygomaticus major 5-3 Zygomaticus minor
Face: Muscles - 5 Upper group oral muscles 5-4 Levator labii superioris
Face: Muscles - 5 Upper group oral muscles 5-5 Levator labii superioris alaeque nasi 5-6 Levator anguli oris
Face: Muscles - 6 Other muscles 6-1 Platysma
Face: Muscles - 6 Other muscles 6-2 Auricular muscles
Face: Muscles - 6 Other muscles 6-3 Occipitofrontalis
Parotid gland Parotid duct opens into oral cavity near the 2nd upper molar tooth Structures passing through gland: 1 Facial nerve 2 External carotid artery and its branches 3 Retromandibular vein and its tributaries
Parotid gland Innervation 1 Sensory innervation by auriculotemporal nerve (a br of CN V3) 2 Secretomotor fibers Branch of CN IX carries preganglionic parasympathetic fibers Postgnaglionic neurons at otic ganglion (associated with CN V3 inferior to foramen ovale) gives off postganglionic parasympathetic fibers carried by auriculotemporal nerve Parotid gland
4 3 5 2 1
Sensory innervation (of face) Trigeminal n (CN V) divides into Ophthalmic (CN V 1 ), maxillary (CN V 2 ) and mandibular nn (CN V 3 ) most of skin on face except: a small area covering angle and lower border of mandible and part of ear Skin on the ear by facial (CN VII), vagus (CN X), cervical nn
Ophthalmic nerve [V 1 ] Leaves skull through superior orbital fissure enters orbit brr innervating skin on face: Supraorbital and supratrochlear nerves Infratrochlear nerve Lacrimal nerve External nasal nerve
Maxillary nerve [V 2 ] Exits skull through foramen rotundum brr innervating skin on face: Zygomaticotemporal branch Zygomaticofacial branch Infra-orbital nerve
Mandibular nerve [V 3 ] Exits skull through foramen ovale brr innervating skin on face: Auriculotemporal nerve Buccal nerve Mental nerve
Motor innervation (of face) mm of face, external ear, and scalp are innervated by CN VII (facial n) except: chewing muscles by brr of mandibular n
Facial nerve Posterior cranial fossa internal acoustic meatus geniculate ganglion (gives off greater petrosal n) posterior to middle ear (gives off chorda tympani n and n of stampedes) stylomastoid foramen (gives off posterior auricular n) (gives off br for post belly of digastric and stylohyoid mm) enters parotid gland divides into temporofacial and cervicofacial brr forming parotid plexus five terminal brr emerge from parotid gland
5 terminal brr of facial nerve Temporal brr mm in temple, forehead, and supra-orbital area Zygomatic brr mm in infraorbital, nasal, and upper lip areas Buccal brr mm in cheek, upper lip, and corner of mouth Marginal mandibular brr mm of lower lip and chin Cervical brr platysma
Arteries of face mostly from brr of ext carotid a with some limited brr from int carotid a 1 Facial a 2 Transverse facial a 3 Brr of maxillary a 4 Brr of ophthalmic a 2 3 1
Arteries of face - 1 Ext carotid a Facial a posterior to submandibular gland inferior border of mandible, ant to masseter, pulse can be felt here upward and medially in tortuous course corner of mouth gives off superior and inferior labial brr side of nose gives off lateral nasal br ends as angular a at med corner of eye *
Arteries of face - 2 Ext carotid a Superficial temporal a Transverse facial a across face, superficial to masseter m, b/w zygomatic arch and parotid duct
Arteries of face - 3 External carotid a Maxillary a Brr on face: Infra-orbital a through infra-orbital foremen lower eyelid, upper lip, and the area b/w Buccal a superficial to buccinator Mental a through mental foramen chin
Arteries of face - 4 Internal carotid a Ophthalmic a enters orbit Brr of ophthalmic a Lacrimal br through zygomaticofacial and zygomaticotemporal foramina face area over zygomatic bone Zygomaticofacial and zygomaticotemporal aa Terminal br of ophthalmic a Dorsal nasal a exits orbit in med corner dorsum of nose
Int carotid a Ext carotid a
from Gunther von Hagens Body Worlds The Anatomical Exhibition of Real Human Bodies
Veins of face - 1 1 Supratrochlear v + supra-orbital vv angular v at medial corner of eye Facial vein (the major v draining the face) receives tributaries from vv draining eyelids, external nose, lips, cheek, and chin posterior to facial a on inf border of mandible superficial to submandibular gland enters internal jugular v 2 Transverse facial vein Across face enters superficial temporal v in the parotid gland
Veins of face - 2 3 Intracranial venous connections Facial v connects with venous channels into deeper head regions 3-1 med corner of eye ophthalmic v 3-2 cheek vv enter infra-orbital foramen 3-3 deep facial vv enter pterygoid plexus All above connect with intracranial sinus: extracranial vv emissary vv intracranial vv
Veins of face - 3 No valves in facial v and these channels Infectious material in danger area on face region (above mouth) Intracranial direction
Lymphatic drainage of face Lymph on face drains toward: Medial part of lower lip and chin bilateral submental nodes (at inf and post to chin) Med corner of orbit, external nose, lat lower lip Submandibular nodes (superficial to submandibular gland, inferior to body of mandible) Most of eyelids, a part of nose and lat cheek Pre-auricular and parotid nodes (anterior to ear)
Facial nerve palsy (Bell s palsy) 1 Central lesions From both hemisphere Motor nucleus of facial n (in brainstem) ipsilateral upper face 2 Lesions at and around the geniculate ganglion Loss of motor function, taste sensation of anterior twothirds of tongue, and lacrimation of ipsilateral side 3 Lesions at and around the stylomastoid foramen Commonest abnormality, by viral inflammation of the nerve in bony canal Loss of motor function of ipsilateral side Taste sensation and lacrimation may not be affected if lesion is distal to greater petrosal and chorda tympani nn
2 1 X X 3 X
Trigeminal neuralgia Blood vessels adjacent to the sensory roots of mandibular and maxillary nerves may be involved
SCALP 1 Skin With large amount of hairs 2 Connective tissue Dense connective tissue with vv, aa, and nn 3 Aponeurotic layer Attaches firmly to skin, and consists of occipitofrontalis m Epicranial aponeurosis (gela aponeurotica) b/w its two bellies Frontal belly attaches to skin of eyebrows; innervated by temporal br of facial n Occipital belly arises from lateral part of superior nuchal line and mastoid processes; innervated by posterior auricular br 4 Loose connective tissue b/w aponeurotic layer and epicranium; infection may spread through 5 Pericranium Periosteum on calvaria
Innervation of scalp Anterior to the ears and the vertex by brr of trigeminal n: 1 Supratrochlear nerve exits from orbit, supplies front of forehead near midline 2 Supra-orbital nerve exits through supraorbital notch or foramen, passes through frontalis to vertex 3 Zygomaticotemporal nerve though foramen of zygomatic bone, to small ant area of temple 4 Auriculotemporal nerve through parotid gland, passes ant to ear, supplies scalp over temporal region
Innervation of scalp Posterior to the ears and the vertex by cervical nn from C2 and C3: 5 Great auricular nerve anterior rami of C2 and C3, to small area posterior to ear 6 Lesser occipital nerve anterior rami of C2, to small area posterior and superior to ear 7 Greater occipital nerve br posterior ramus of C2, supplies posterior scalp to vertex 8 Third occipital nerve br of posterior ramus of C3, supplies small area of lower scalp
3 1 2 * 7 4 6 8 * 5
Arteries of scalp 1 Branches from the ophthalmic a Internal carotid a Ophthalmic a Supratrochlear and supra-orbital aa 2 Branches from the external carotid a 2-1 Posterior auricular a 2-2 Occipital a 2-3 Superficial temporal a 1-1 1-2 2-3 2-1 2-2
Veins of scalp Ant part of scalp (superciliary arches to vertex) Supratrochlear and supra-orbital vv ophthalmic v angular v facial v Lateral scalp Superficial temporal v Retromandibular v Scalp poterior to ear Posterior auricular v Retromandibular v Posterior scalp (ext occipital protuberance and sup nuchal line to vetex) Occipital v passes through mm of post neck venous plexus in suboccipital triangle
Lymphatic drainage of scalp Occipital region Occipital node (near attachment of trapezius m) Upper deep cervical nodes directly to Upper deep cervical nodes Upper scalp (posterior to vertex) directly to mastoid nodes (or retro-auricular node or posterior auricular node) Upper deep cervical nodes Upper scalp (anterior to vertex) Preauricular and parotid nodes Forehead Facial a Submandibular node