HEAD AND NECK Notes PDF

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Warning: TT: undefined function: 32 Topic 1- frontal region and temporal region (according to Hungarian book)Frontal region Borders: ž Inferior (anterior) – supraorbital margin ž Superior (posterior) –coronal suture ž Lateral – superior temporal line. ž Medial – midline suture.Palpebral structure: ž...

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Adi L & Nir T

Topic 1- frontal region and temporal region (according to Hungarian book) Frontal region Borders: ! Inferior (anterior) – supraorbital margin ! Superior (posterior) –coronal suture ! Lateral – superior temporal line. ! Medial – midline suture. Palpebral structure: ! Frontal tuberosity ! Pulse of frontal rami- superficial temporal Contents: 1. Epicranial aponeurosis (galea aponeurosis) – attaching firmly to the skin. Attachments: zygomatic arch, supercilliary arch, Superior nuchal line. 2. Frontalis belly of occipitofrontalis muscle m. origin: epicranial aponeurosis. Insertion: skin above the eyebrows. Action: draws the scalp back which raises the eyebrows and forms wrinkles on the forehead. Innervation: temporal branch of facial nerve. 3. Orbicularis oculi m. origin: Medial orbital margin, medial palpebral ligament, lacrimal bone. insertion: Skin around margin of orbit. Action: Closes eyelids. palpebral part- does so gently, orbital part- tightly (winking). Innervation: temporal and zygomatic branches of facial nerve. 4. Corrugator supercilli m. origin: Medial end of supercilliary arch. Insertion: Skin superior to middle of supraorbital margin and supercilliary arch. Action: Draws eyebrow medially and inferiorly, creating vertical wrinkles above nose. Innervation: temporal branch of facial nerve. 5. Depressor supercilli m. origin: nasal part of frontal bone  insertion: skin of eyebrow 

6. 7. 8. 9.

action: lowers the skin of the forehead and of the eyebrows  innervation: temporal branch of facial nerve  Frontal rami of superficial temporal artery – terminal branch of the external carotid artery. Supraorbital artery - from ophthalmic artery (neuro) Supratrochlear artery - from ophthalmic artery (neuro) Supraorbital nerve – branch of frontal -> ophthalmic (V1) -> trigeminal (5th)

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Course: roof of the orbit -> supraorbital notch\foramen to forehead. Innervates: Middle part of superior eyelid and lateral part of scalp, mucosa of frontal sinus. 10. Supratrochlear nerve - branch of frontal -> ophthalmic (V1) -> trigeminal (5th) Course: roof of the orbit -> trochlear notch and ascends on the scalp. Innervates: medial part of superior eyelid and medial part of scalp. 11. Frontal sinus – communicates with the nasal cavity via infundibulum -> semilunar hiatus -> middle nasal meatus. Temporal region Borders: ! Superior: superior temporal line. ! Inferior: infratemporal crest. ! Anterior: zygomatic arch + zygomatic process of frontal bone. ! Roof: temporalis muscle + fascia. (according to Zoli: anterior, superior and posterior – superior temporal line, inferior: zygomatic arch). (according to tamas all the borders from the moore have to be accepted by the examiners). Contents: 1. Temporalis m. – covered by its own fascia (very strong fascia), temporalis fascia. Origin: temporal fossa. Insertion: coronoid process of mandible. Action: horizontal fibers retract the mandible and vertical fibers elevate it. Innervation: deep temporal branch of mandibular nerve (V3) (trigeminal 5th) 2. Auriculotemporal nerve - branch of the mandibular (V3) (trigeminal 5th). 3. Zygomaticotemporal nerve – branch of the zygomatic nerve (maxillary nerve (V2) -> trigeminal). 4. Deep temporal nerve – Somatomotory, innervates the temporalis muscle from the deep, branch of the mandibular nerve (V3) (trigeminal 5th). 5. Deep temporal artery – from maxillary artery, anterior + posterior. (according to tamas, and also visible in the cadaver, the artery can be either in the mandibular part (1st), pterygoid part (2nd) and pterygopalatine (3rd) part of the maxillary artery). 6. Superficial temporal artery (and vein) – terminal branch of the external carotid artery (gives frontal and parietal branches). (s. temporal vein will merge with maxillary vein and generate - retromandibular vein anterior to ear, union of superficial temporal and maxillary veins.)

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Topic 2 – infraorbital and buccal region (according to Hungarian book) Borders: ! Superior: infraorbital margin. ! Inferior: mandibular base. ! Medial: the nasolabial groove and a line in its continuation to the medial angle of the eye. ! Lateral: anterior margin of the masseter muscle. 1. Buccinator m. (pierced by the parotid duct, covered by fat pad) Origin: alveolar process of maxilla and mandible. Insertion: angle of the mouth. Action: tension of the lips. innervation: buccal nerve of trigeminal nerve (5th). 2. Depressor anguli oris m. Origin: Anterolateral base of mandible. Insertion: angle of the mouth. Action: depresses labial commissure (-the line where the upper and lower lips meet). Innervation: marginal mandibular branch of facial nerve (7th). 3. Levator anguli oris m. Origin: canine fossa. Insertion: angle of the mouth. Action: widens oral fissure. Innervation: buccal branch of facial nerve (7th). 4. Levator labii superioris m. Origin: canine fossa. Insertion: angle of the mouth. Action: elevates or everts upper lip. Innervation: buccal branch of facial nerve (7th). 5. Zygomaticus major m. Origin: posterior aspect of zygomatic bone. Insertion: Angle of mouth. Action: elevates labial commissure. (sadness) Innervation: buccal branch of facial nerve (7th). 6. Zygomaticus minor m. Origin: anterior aspect of zygomatic bone. Insertion: skin of upper lip. Action: elevates or everts upper lip. Innervation: buccal branch of facial nerve (7th).

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7. Orbicularis oris m. Origin: Medial maxilla and mandible. Insertion: membrane of lips. Action: Tonus closes oral fissure. Innervation: buccal branch of facial nerve (7th). 8. Masseter muscle m. Origin: zygomatic arch and maxillary process of zygomatic bone (medial surface). Insertion: lateral surface of ramus of mandible Action: elevates and closes the mandible. Innervation: masseter nerve of mandibular (V3) (5th). 9. platysma muscle m. Origin: Subcutaneous tissue of infra and supraclavicular. Insertion: Base of mandible and skin of cheek and lower lip. Action: Depresses mandible against resistance. Innervation: cervical branch of facial nerve (7th). 10. orbicularis oculi m. origin: Medial orbital margin, medial palpebral ligament, lacrimal bone. insertion: Skin around margin of orbit. Action: Closes eyelids. palpebral part- does so gently, orbital part- tightly (winking). Innervation: temporal and zygomatic branches of facial nerve 11. risorius m. origin: parotid fascia, masseteric fascia. Insertion: upper lip, angle of the mouth (modilos). Action: pulls the angle of mouth laterally and upwards (creates the cheek dimple), dilator of the mouth. Innervation: buccal branch of facial nerve (7th). 12. Levator labii superioris alaeque nasi m. origin: frontal process of the maxilla, orbicularis oculi m. Insertion: alar cartilage of nose and upper lip.  Action: raises upper lip and dilate nostrils. Innervation: buccal branch of facial nerve (7th). 13. Parotid duct -pierces the buccinator muscle and enter to the oral cavity opposite to 2nd maxillary molar tooth. 14. Fat pad – runs with the buccal nerve, proportionately much larger in infants, presumably to reinforce the cheeks and keep them from collapsing during sucking. 15. Infraorbital nerve – branch of the maxillary (V2) (trigeminal 5th). Gives the superior anterior + middle alveolar nerves. Pterygopalatine fossa -> inferior orbital fissure -> infraorbital groove -> infraorbital canal -> infraorbital foramen

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16. Branches of facial nerve – temporal, zygomatic, buccal (the thickest), marginal mandibular, cervical (branches\rami, not nerves). 17. Buccal nerve – sensor branch of the mandibular (V3) (trigeminal 5th). 18. Infraorbital artery – branch of the maxillary artery from the pterygopalatine (3rd) part, gives the anterior superior alveolar artery. 19. Facial artery (and vain) – curvy branch (only the artery) of the external carotid artery, Branches: submental, tonsillar, inferior labial, superior labial, ascending palatine and terminates as angular. 20. Transvers facial artery (and vein) - artery that branches from the superficial temporal artery (one of the two terminations of the external carotid artery). 21. Buccal artery - branch of the maxillary artery from the pterygoid (2nd) part 22. Mental artery - branch of the inferior alveolar artery from the mandibular (1st) part of the maxillary artery (-> external carotid artery).

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Topic 3 – parotideo–masseteric region (according to Hungarian book) Parotideo–masseteric region Borders (by Tamas): ! Superior: zygomatic arch ! Inferior: base of the mandible ! Anterior: anterior margin of masseter muscle ! Posterior: posterior edge of parotid gland ! Roof: parotideo-masseteric fascia Contents: 1. Masseter muscle m. Origin: zygomatic arch and maxillary process of zygomatic bone (medial surface). Insertion: lateral surface of ramus of mandible Action: elevates and closes the mandible. Innervation: masseter nerve of mandibular (V3) (5th). 2. Buccinator m. (pierced by the parotid duct, covered by fat pad) Origin: alveolar process of maxilla and mandible. Insertion: angle of the mouth. Action: tension of the lips. innervation: buccal nerve of trigeminal nerve (5th). 3. Parotid gland - The largest salivary gland. Only serous production. It enclosed by tough capsule (derive from investing cervical fascia), It has irregular shape due to the area occupied by the gland – parotid bed Innervation (focus!) – Auriculotemporal which is usually somatosensory, carries also postsynaptic parasympathetic fibers from the otic ganglion to the gland (origin of the fibers: glossopharyngeal nerve – lesser petrosal nerve (9th)). 4. Parotid duct - Passes horizontally from the anterior edge of the gland, it pierces the buccinator muscle and enter to the oral cavity behind the 2nd molar tooth (extra points answer if asked: on the surface of the duct – transverse facial artery (not visible). 5. Branches of facial nerve - temporal, zygomatic, buccal (the thickest), marginal mandibular, cervical (branches\rami, not nerves). 6. Auriculotemporal nerve - branch of the mandibular (V3) (trigeminal 5th). 7. Zygomaticofacial nerve – branch of the zygomatic nerve (maxillary nerve (V2) -> trigeminal). 8. Facial artery (and vein) - curvy branch (only the artery) of the external carotid artery, Branches: submental, ascending palatine, tonsillar, inferior labial, superior labial, and terminates as angular. 9. Maxillary artery + vein - artery that branches from the external carotid artery. (separate topic) 10. Superficial temporal artery (and vein) - terminal branch of the external carotid artery. 11. Retromandibular vein - anterior to ear, union of superficial temporal and maxillary veins.

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Nest of the parotid gland Pyramid shaped, narrowed down wedge, bounded by the styloid muscles (stylohyoid, styloglossous and stylopharyngeus) Borders: ! Superior: zygomatic arch ! Inferior: posterior belly digastric ! Anterior: masseter and medial pterygoid muscles ! Lateral: parotid fascia. ! Posterior: mastoid process, SCM, ! Medial: “stylo muscles” (SS, SH, SG). Retromandibular fossa Contents: 1. Masseter muscle m. Origin: zygomatic arch and maxillary process of zygomatic bone (medial surface). Insertion: lateral surface of ramus of mandible. Action: elevates and closes the mandible. Innervation: masseter nerve of mandibular (V3) (5th). 2. Medial pterygoid m. Origin 1: medial surface of lateral pterygoid plate and pyramidal process of palatine bone. Origin 2: tuberosity of maxilla. Insertion: Medial surface of ramus of mandible. Action: synergistically with masseter to elevate mandible. Innervation: pterygoid nerve of the mandibular (V3) (trigeminal 5th). 3. lateral pterygoid m. Origin 1: infratemporal surface and crest of greater wing of sphenoid. Insertion 1: joint capsule and articular disc of TMJ. Origin 2: lateral surface of lateral pterygoid plate. Insertion 2: anteromedial aspect of neck of condyloid process of mandible. Action: protracts mandible and depresses chin. Innervation: pterygoid nerve of the mandibular (V3) (trigeminal 5th). 4. Artery for mastication muscles - from palatine (2nd) part of maxillary artery. 5. Nerves for mastication muscles - from mandibular nerve V3 (trigeminal 5th). 6. Branches of mandibular nerve a. Inferior alveolar nerve – somatosensory, gives a motor nerve to the mylohyoid and ant. Belly of digastric. b. Lingual nerve – somatosensory, anterior 2/3 of the tounge. c. Buccal nerve – motor branch of the mandibular (V3) (trigeminal 5th), Runs Deep to the buccinator muscle and innervates it.

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7. Chorda tympanic nerve – branch of the facial nerve exits the skull through the petrotympanic fissure, carries postsynaptic (from geniculate ganglion) parasympathetic fibers and combines to the lingual nerve as special sensory for the taste buds of the anterior 2\3 of the tounge. 8. Branches of maxillary artery a. Deep auricular (mandibular 1st part) b. Inferior alveolar (mandibular 1st part) - gives branches for mylohyoid and ant. Belly of digastric. c. Middle meningeal (mandibular 1st part, can be found at the pterygopalatine 3rd part also). 9. Retromandibular vein - anterior to ear, union of superficial temporal and maxillary veins.

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Topic 4- vasculature + innervation of the parotid gland + structures pass through the parotid gland (according to moore) Located in the posterolateral region of the facial region. Borders: ! Anterior: anterior surface of master and medial pterygoid muscles ! Lateral: parotid fascia. ! Posterior: mastoid process, SCM ! Inferior: posterior belly of digastric muscle. ! Medial: stylo muscles ! Superior: zygomatic arch Contents: 1. Parotid gland - The largest salivary gland. Only serous production. In enclosed by tough capsule (derive from investing cervical fascia), It has irregular shape due to the area occupied by the gland – parotid bed. 2. Parotid duct - Passes horizontally from the anterior edge of the gland, it pierces the buccinator muscle and enter to the oral cavity opposite to 2nd maxillary molar tooth. 3. Retromandibular vein - anterior to ear, union of superficial temporal and maxillary veins. 4. External carotid branches a. Maxillary artery - artery that branches from the external carotid artery. (separate topic). b. Superficial temporal artery - terminal branch of the external carotid artery. 5. Masseter m. Origin: zygomatic arch and maxillary process of zygomatic bone (medial surface). Insertion: lateral surface of ramus of mandible. Action: elevates and closes the mandible. Innervation: masseter nerve of mandibular (V3) (5th). 6. Facial nerve and its branches – nerve for facial expression, temporal, zygomatic, buccal, marginal mandibular and cervical branches. 7. Parotid papilla - Small elevation of tissue that marks the opening of the duct on the inner surface of the cheek, just lateral to the 2nd maxillary molar. Arterial supply branch of superficial temporal artery. Vein draining retromandibular vein - anterior to ear, union of superficial temporal and maxillary veins.

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Parotid innervation 1. Auriculotemporal nerve - branch of mandibular (V3) (trigeminal 5th), Postganglionic parasympathetic fibers of otic ganglion) 2. Greater auricular nerve - cervical plexus (C2-C3), somatosensory innervation for parotid sheath. 3. Lesser petrosal nerve - leaves the skull via foramen lacerum and gives Preganglionic parasympathetic fibers from the tympanic plexus to the otic ganglion, Auriculotemporal nerve (mandibular V3 trigeminal 5th) carries the fibers to the parotid gland. 4. Superior sympathetic trunk via internal carotid plexus – caroticotympanic plexus and from external carotid plexus via – middle meningeal plexus. structures pass through the parotid gland 1. Nerves a. the facial nerve § §

§ §

from posterior and medial to anterior and lateral divides into: • cervicofacial trunk. • temporofacial trunk. then it forms the parotid plexus of nerves (a.k.a. intraparotid plexus). does not innervate the parotid gland:

b. auriculotemporal nerve § § §

from medial to lateral. provides sensory innervation to the gland. carries postganglionic parasympathetic fibers from the otic ganglion to the gland.

2. Arteries external carotid artery carries postganglionic sympathetic fibers to the gland (in the form of periarterial plexuses) from the external carotid plexus § §

superficial temporal artery - terminal branch of the external carotid artery. maxillary artery – artery that branches from the external carotid artery. (separate topic)

3. veins superficial temporal vein. o maxillary vein. o retromandibular vein. o

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Topic 5- borders and connections of the infratemporal and pterygopalatine fossae Infratemporal fossa (according to moore and to anatomy department, both acceptable!) Borders: ! superiorly: infratemporal surface of the sphenoid and temporal bones lateral to the infratemporal crest and the superior opening to the temporal fossa. ! Inferiorly: where the medial pterygoid muscle attaches to the mandible near its angle (stylohyoid and posterior belly of the digastric muscle according to anatomy department) ! Medially: lateral pterygoid plate. ! Laterally: ramus of mandibular (zygomatic arch according to anatomy department). ! Anteriorly: posterior surface of maxilla. ! Posteriorly: the tympanic plate, mastoid and styloid processes of the temporal bone (mastoid process with the fissure tympanic according to anatomy department) Connections: 1. Inferior orbital fissure Connection: infratemporal fossa and sphenopalatine fossa with the orbit. [Contents: infraorbital artery, vein and nerve, zygomatic nerve (branch of V/2) and inferior ophthalmic vein]. 2. Pterygomaxillary fissure Connection: btw infratemporal fossa and pterygopalatine fossa [content: maxillary artery, posterior superior alveolar artery vein and nerve]. 3. Foramen ovale connection: btw MCF and infratemporal fossa [contents: mandibular nerve (V/3), accessory meningeal artery (also lesser petrosal nerve according to netter)]. 4. foramen spinosum connection: btw MCF and infratemporal fossa [contents: middle meningeal artery and vein, meningeal branch of mandibular nerve]. posterior laterally communicate with parapharyngeal space contents:

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Pterygopalatine fossa Borders: ! Anterior: infratemporal surface of maxilla ! Posterior: lateral surface of the lateral pterygoid process ! Medial: perpendicular plate of palatine bone ! Lateral: open, Communicate with the infratemporal fossa via ptergomaxillary fissure ! Superior: inferior surface of greater wing of sphenoid bone, and lateral side of the body of sphenoid. • • •

Two foramina: foramen rotundum and sphenopalatine foramen. Two canals: pterygoid canal and greater palatine canal. Two fissures: inferior orbital fissure and ptergomaxillary fissure.

1. Foramen rotundum connection: btw MCF and sphenopalatine fossa contents: maxillary nerve (V2) (trigeminal 5Th). 2. Sphenopalatine foramen – located between the sphenoid and orbital processes of the palatine bone and the body of the sphenoid bone. Connection: pterygopalatine fossa with the nasal cavity. Content: sphenopalatine artery (->maxillary artery). 3. Pterygoid canal – located at the root of the pterygoid process. Connection: pterygopalatine fossa with the external cranial base. Content: greater petrosal nerve, deep petrosal nerve (arriving from the internal carotid plexus) and the Vidian artery. 4. Greater palatine canal – originates from the inferior border of the pterygopalatine fossa. Connection: pterygopalatine fossa with the oral cavity. Content: descending palatine artery and greater palatine nerve (pterygopalatine ganglion ->maxillary V2 -> trigeminal 5th). 5. pterygomaxillary fissure Connection: btw infratemporal fossa and pterygopalatine fossa content: maxillary artery, posterior superior alveolar artery vein and nerve (...