Head and Neck: FACE

In which layer of the face are the muscles of facial expression located?

Subcutaneous tissue of the anterior and posterior scalp, face, and neck

How do muscles of facial expression create movement?

They attach to bone or fascia and pull the skin

From which pharyngeal arch mesoderm do muscles of facial expression develop?

2nd pharyngeal arch

Which nerve innervates all muscles of facial expression?

Facial nerve (CN VII)

What facial expression is produced by Occipitofrontalis?

Surprise

What facial expression is produced by Procerus?

Sadness

What facial expression is produced by Corrugator Supercilii?

Anger

What facial expression is produced by Orbicularis Oculi?

Winking

What is the action and nickname of the Buccinator muscle?

Blowing / Sucking; known as the "Trumpeter's" muscle

What facial expression is produced by Orbicularis Oris?

Kissing

What facial expression is produced by Risorius?

Grinning / Grimace

What facial expression is produced by Zygomaticus?

Smiling

What facial expression is produced by Depressor Anguli Oris?

Frowning

What facial expression is produced by Mentalis?

Doubt

From which branchial arch do muscles of mastication develop?

1st branchial arch

Which nerve supplies motor innervation to the muscles of mastication?

Mandibular division of Trigeminal nerve (CN V3)

What is the primary action of the Temporalis muscle?

Closes jaw

What is the primary action of the Masseter muscle?

Closes jaw

What is the primary action of the Medial Pterygoid muscle?

Closes jaw

What is the primary action of the Lateral Pterygoid muscle?

Opens jaw

Why do facial lacerations tend to gape easily?

Because the face has no deep fascia and subcutaneous tissue between cutaneous attachments is loose

Why does fluid and blood accumulate easily after facial bruising?

Because of the looseness of the subcutaneous tissue in the face

What areas receive sensory supply from the Trigeminal Nerve on the face?

Skin of the face and mucous membrane of anterior 2/3 of tongue

What muscles receive motor innervation from the Trigeminal Nerve?

Muscles of mastication

What function does the Facial Nerve provide to the tongue?

Taste buds on the anterior 2/3 of the tongue

What muscles receive motor innervation from the Facial Nerve?

Muscles of facial expression

What is the function of the Anterior Division of the Trigeminal Nerve?

MOTOR to muscles of Mastication

What is the function of the Posterior Division of the Trigeminal Nerve?

SENSORY to the face and GENERAL sensation to the anterior 2/3 tongue

Through which skull opening does Trigeminal V1 (Ophthalmic) exit?

Superior orbital fissure

What sensory areas and branches belong to Trigeminal V1 (Ophthalmic)?

Area superior to upper eyelid and dorsum of face; lacrimal, supraorbital, supratrochlear, and infratrochlear

Through which skull opening does Trigeminal V2 (Maxillary) exit?

Foramen rotundum

What sensory areas and branches belong to Trigeminal V2 (Maxillary)?

Between lower eyelid and upper lip; infraorbital and zygomaticofacial

Through which skull opening does Trigeminal V3 (Mandibular) exit?

Foramen ovale

What motor branches belong to Trigeminal V3 (Mandibular)?

Motor to muscles of mastication, muscles on floor of mouth, and tensor muscles

What sensory areas and branches belong to Trigeminal V3 (Mandibular)?

Below level of lower lip; auriculotemporal, buccal, mental, and somatic innervation to anterior 2/3 of tongue

Where does the Greater Petrosal Nerve arise, and what is its function?

Arises from Geniculate ganglion; carries secretomotor fibers to Lacrimal gland

What is the function of the Nerve to Stapedius?

Dampens vibrations of stapes by pulling on its neck (prevents hyperacusis)

What secretomotor function is carried by Chorda Tympani?

Secretomotor fibers to submandibular and sublingual glands

What special sensory function is carried by Chorda Tympani?

TASTE fibers to the ANTERIOR 2/3 of tongue and floor of mouth

What area is supplied by the Posterior Auricular Nerve?

Back of auricle, external auditory meatus, tympanic membrane, posterior belly of digastric, and stylohyoid

Where do the terminal motor branches of the Facial Nerve run and exit?

Lie within Parotid gland after leaving STYLOMASTOID FORAMEN; located between superficial and deep parts of gland; emerge anteriorly to supply face/scalp

What is the total motor scope of the Facial Nerve?

Muscles of Facial Expression, Stylohyoid, and Posterior belly of Digastric

What is the total secretomotor scope of the Facial Nerve?

Lacrimal, Submandibular, and Sublingual glands

What is the special sensory scope of the Facial Nerve?

Taste buds on the Anterior 2/3 of tongue

What general sensory scope is provided by the Facial Nerve?

Common sensation to external ear

How can a parotid gland tumor affect the facial nerve?

It may compress motor branches of the Facial nerve, causing facial muscle weakness on the side of the tumor

What are the classic clinical presentation features of Bell Palsy?

Paralysis of facial muscles on affected side, drooping of corner of mouth, and speech affected by weak lip muscles

Why is the cornea vulnerable to ulceration in Bell Palsy?

Loss of orbicularis oculi tonus causes eversion of the lower lid, preventing lacrimal fluid from spreading over the cornea

What neurological deficits occur in Bell Palsy?

Facial expression paralysis, loss of taste on anterior 2/3 of tongue, dry mouth, loss of tears, and hyperacusis

What pattern of muscle weakness occurs in an Upper Motor Neuron (UMN) Facial Nerve lesion?

Weakness of inferior facial muscles only (forehead is spared due to bilateral cortical representation)

What pattern of muscle weakness occurs in a Lower Motor Neuron (LMN) Facial Nerve lesion?

Weakness of both superior and inferior facial muscles on the entire ipsilateral half of face

What are common causes of Central Facial Palsy?

Stroke or other Upper Motor Neuron (UMN) lesions

What is the most common cause of Peripheral Facial Palsy?

Bell palsy

What is the Corneal Blink Reflex?

Closure of eyelids in response to blowing on cornea or touching with cotton wisp, caused by orbicularis oculi contraction

Which nerve forms the AFFERENT limb of the Corneal Blink Reflex?

Nasociliary nerve of the Ophthalmic division of Trigeminal (CN V1)

Which nerve forms the EFFERENT limb of the Corneal Blink Reflex?

Facial nerve (CN VII)

What is the clinical presentation of Trigeminal Neuralgia (Tic Douloureux)?

Episodes of sharp, stabbing pain radiating over sensory distributions of maxillary (V2) or mandibular (V3) divisions of CN V

What triggers pain attacks in Trigeminal Neuralgia?

Moving the mandible, smiling, yawning, or light cutaneous stimulation

What is the underlying etiology of Trigeminal Neuralgia?

Pressure on or interruption of blood supply to the trigeminal ganglion

What is the standard first-line medical treatment for Trigeminal Neuralgia?

Carbamazepine

What are the branches of the External Carotid Artery?

Superior thyroid, Ascending Pharyngeal, Lingual, Facial, Occipital, Posterior Auricular, Superficial Temporal, and Maxillary

How is the Angular Vein formed, and what does it communicate with?

Formed by union of Supraorbital and Supratrochlear veins; communicates with Superior Ophthalmic vein

What is the drainage route of the Facial Vein into the Internal Jugular Vein?

Facial vein joins anterior branch of Retromandibular vein to form Common facial vein, which drains into IJV

Which two veins unite to form the Retromandibular Vein?

Superficial temporal vein and Maxillary vein

Where does the Anterior Branch of the Retromandibular Vein drain?

Joins Facial vein to form Common facial vein (drains to Internal Jugular)

Where does the Posterior Branch of the Retromandibular Vein drain?

Joins Posterior auricular vein to form External jugular vein (EJV)

Which nerve carries sensory fibers to the skin on the side of the nose?

Maxillary division of Trigeminal (CN V2)

Which head muscles do NOT derive from pharyngeal arches?

Muscles of the Eyeball (extraocular muscles derive from pre-otic myotomes)

Which veins join to form the Angular Vein?

Supraorbital vein + Supratrochlear vein -> Angular vein

What is the pathway from Facial Vein to Internal Jugular Vein (IJV)?

Angular vein -> Facial vein + Anterior branch of Retromandibular vein -> Common facial vein -> Internal Jugular Vein (IJV)

Which veins join to form the Retromandibular Vein?

Superficial temporal vein + Maxillary vein -> Retromandibular vein

What is the pathway from Retromandibular Vein to External Jugular Vein (EJV)?

Posterior branch of Retromandibular vein + Posterior auricular vein -> External Jugular Vein (EJV)

Where do superficial lymph vessels of the Face, Scalp, and Ear drain?

Superficial Lymph Nodes (Occipital, Retroauricular parotid, Buccal, Submandibular, Submental, Superficial cervical)

Where do all superficial lymph nodes of the head ultimately drain?

Into Deep Cervical Lymph Nodes

Which deep lymph nodes receive drainage from the Middle Ear?

Retropharyngeal and Upper deep Cervical

Which deep lymph nodes receive drainage from the Nasal Cavity & Paranasal Sinuses?

Submandibular, Retropharyngeal, and Upper deep cervical

Which deep lymph nodes receive drainage from the Tongue?

Submental, Submandibular, and Upper/Lower cervical

Which deep lymph nodes receive drainage from the Larynx?

Upper/Lower cervical

Which deep lymph nodes receive drainage from the Pharynx?

Retropharyngeal and Upper/Lower deep Cervical

Which deep lymph nodes receive drainage from the Thyroid Gland?

Lower deep cervical, Prelaryngeal, Pretracheal, and Paratracheal

What bone and cartilage structures derive from Pharyngeal Arch 1?

Meckel's cartilage (Malleus, Incus; Maxilla, Mandible, Zygomatic)

What muscle function derives from Pharyngeal Arch 1?

Mastication

What epithelial structures derive from Pharyngeal Pouch 1?

Epithelium of auditory tube and middle ear cavity

What epithelial structures derive from Pharyngeal Groove 1?

Epithelium of External auditory meatus; skin over tympanic membrane

What bone and cartilage structures derive from Pharyngeal Arch 2?

Stapes; Hyoid upper

What muscle function derives from Pharyngeal Arch 2?

Facial expression

What epithelial structure derives from Pharyngeal Pouch 2?

Palatine tonsil

What bone and cartilage structures derive from Pharyngeal Arch 3?

Hyoid lower

What muscle function derives from Pharyngeal Arch 3?

Deglutition

What epithelial structures derive from Pharyngeal Pouch 3?

Inferior Parathyroid; Thymus

What cartilage structures derive from Pharyngeal Arch 4?

Laryngeal cartilages

What muscle function derives from Pharyngeal Arch 4?

Phonation

What epithelial structures derive from Pharyngeal Pouch 4?

Superior Parathyroid; Ultimobranchial body

What cartilage structures derive from Pharyngeal Arch 6?

Laryngeal cartilages

What muscle function derives from Pharyngeal Arch 6?

Phonation

What is the sympathetic effect on the Eyes?

Dilates pupil

What is the parasympathetic effect on the Eyes?

Constricts pupil; contracts ciliary muscle to thicken lens

What is the sympathetic effect on the Lacrimal Gland?

Reduces secretion

What is the parasympathetic effect on the Lacrimal Gland?

Promotes secretion

What is the sympathetic effect on Nasal Mucous Glands?

Reduces secretion