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Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University.

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Presentation on theme: "Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University."— Presentation transcript:


2 Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University

3 Bony Landmarks of Skull and Face Vertex Superciliary arch Zygoma Mental symphysis Entrance to orbit Anterior nasal aperture

4 Three foramina vertically alligned Supraorbital foramen … for supraorbital nerve Infraorbital foramen … for infraorbital nerve Mental foramen... for mental nerve

5 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.

6 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

7 Muscles of the Mouth Orbicularis oris Zygomaticus major Zygomaticus minor Levator labii superioris Levator labii superioris alaque nasi Buccinator Depressor anguli oris Depressor labii inferioris Mentalis Risorius Platysma

8 Muscles of the Mouth

9 Muscle of the Eyelids Orbicularis oculi –Orbital part –Palpebral part

10 Buccal Pad Fat Between masseter and buccinator muscles Brown fat … for heat generation, especially for children

11 Parotid Duct One finger-breadth below zygomatic arch Open into the mouth cavity (vestibule) at the level of the 2nd molar tooth (crown)

12 Facial Nerve Comes out from stylomastoid foramen Five branches –Temporal –Zygomatic –Buccal –Mandibular –Cervical

13 Facial Palcy No wrinkle of forehead Angle of mouth drops Sagging lower eyelid Other signs relating to malfunctions of structures innervated by facial nerve

14 Trigeminal Nerve Sensory –Ophthalmic division –Maxillary division –Mandibular division Motor.. To 1st branchial arch –Muscles of mastication Messeter Temporalis Medial pterygoid Lateral pterygoid

15 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

16 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

17 Lymph Drainage of the Face Submental lymph nodes Submandibular lymph nodes Parotid lymph nodes

18 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)

19 Scalp Five layers of scalp –skin –dense subcutaneous tissue –epicranial aponeurosis –loose areolar connective tissue –periosteum

20 Scalp Clinical relevance –infection spreading from loose areolar connective tissue, via emissary veins, to meninges-meningitis –hematoma

21 Skull Cap or Calvaria Suture –coronal (frontoparietal) anterior fontanelle –sagittal (interparietal) –lambdoid (occipitoparietal) posterior fontanelle

22 Skull Cap or Calvaria Three layers of skull cap –outer table –diploe –inner table

23 Cranial Fossae Anterior cranial fossa Middle cranial fossa Posterior cranial fossa Boundaries –lesser wing of sphenoid –superior border of petrous bone

24 Anterior Cranial Fossa important landmarks –crista galli & cribriform plate of ethmoid –sella turcica tuberculum sellae hypophyseal fossa dorsum sellae

25 Middle Cranial Fossa important landmarks –foramina superior orbital fissure foramen rotundum foramen ovale foramne spinosum –groove for middle meningeal artery

26 Posterior Cranial Fossa important landmarks –grooves for transverse & sigmoid sinuses –foramen magnum

27 Dura Mater Outer and inner layers –position of the middle meningeal artery

28 Dura Mater Falx cerebri Falx cerebelli Tentorial cerebelli and notch Diaphragmatic sellae

29 Intradural Venous Sinuses Superior and inferior sagittal sinuses Straight sinus Transverse and sigmoid sinuses

30 Intradural Venous Sinuses Cavernous sinus –relationship among internal carotid artery, CN III, CN IV, CN V1 and CN VI –venous connections –clinical relevance thrombophlebitis

31 Orbit and Eye Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University

32 eyelids palpebral fissure plica semilunaris caruncle lacrimal puncta cornea sclera conjunctiva bulbar palpebral Sty pterygium Eye From the Outside

33 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

34 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.

35 Eyeball

36 Muscles Extrinsic (Extra-ocular) Intrinsic

37 Levator Palpebrae Superioris Supplied by CN III insert on the upper lid if paralyzed ptosis

38 Extra-Ocular Muscles Superior Rectus Inferior Rectus Lateral Rectus Medial Rectus Superior Oblique Inferior Oblique

39 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

40 elevate adduct medial rotate Make a o with an AP axis Superior Rectus

41 depress adduct lateral rotate Inferior Rectus

42 Medial and Lateral Recti Medial Rectus adduction Lateral Rectus abduction

43 depress abduction medial rotate Superior Oblique

44 elevate abduction lateral rotate Inferior Oblique

45 Periorbita and Orbital Fat

46 Insertions of the Extra-Ocular Muscles

47 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

48 Oculomotor nerve (CN III) Superior Division levator palpebrae superioris* superior rectus Inferior Division inferior rectus inferior oblique medial rectus *not an extra-ocular muscle

49 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

50 Parts of the Eyeball anterior chamber posterior chamber cornea iris ciliary muscle suspensory ligament lens hyaloid canal vitreous body aqueous humor Three layers sclera choroid retina

51 lenticular cataract glaucoma Schlemn’s canal Myopia (near sightedness) hyperopia (far sightedness) presbiopia (old-aged sightedness) Clinical Relevance

52 Blood Vessels of the Orbit & Eyeball in the choroid layer Ophthalmic Frontal anterior & posterior ethmoidal supraorbital supratrochlear lacrimal central retinal

53 Ophthalmoscopic Examination optic disc macula lutea & fovea centralis retinal vessels in DM & hypertension

54 superior & inferior ophthalmic veins drained to cavernous sinus connection to pterygoid plexus connection to facial veins Veins of the Eyeball

55 Sensory Nerves of the Eyeball and Orbit frontal supraorbital supratrochlear lacrimal nerve nasociliary nerve anterior ethmoidal posterior ethmoidal infratrochlear

56 Autonomic Nerves of the Eyeball and Orbit Sympathetic artery (ophthalmic a)long ciliary n.eyeball iris (radial fibers) Parasympathetic pre-ganglionic parasympathetic fibers (in the nerve to inferior oblique) ciliary ganglionshort ciliary n. Eyeballciliary muscle & iris (circular fibers) post-ganglionic sympathetic fibers

57 Ciliary Ganglion

58 Lacrimal puncta lacrimal canaliculi lacrimal sac nasolacrimal duct opening into the inferior meatus of nasal cavity Lacrimal Gland and Lacrimal Apparatus

59 Parasympathetic Supply to the Lacrimal Gland Preganglionic parasympathetic fibers pterygopalatine ganglion maxillary n zygomatic branch zygomatico-temporal branch lacrimal n lacrimal gland

60 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 Eyelid

61 Orbital Septum, Medial & Lateral Palpebral Ligament

62 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)

63 Submandibular Region 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

64 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

65 Actions of Digastric Muscle Elevate hyoid bone Open jaw Raising floor of mouth for swallowing reflex

66 Suprahyoid Muscles Digastric Mylohyoid Geniohyoid Hyoglossus Stylohyoid

67 Mylohyoid Muscle Origin, mylohyoid line of mandible Insertion –Body of hyoid bone –Median fibrous raphe Nerve, nerve to mylohyoid (CN V)

68 Geniohyoid Muscle Origin, mental spine Insertion, hyoid bone Nerve, C1 spinal nerve

69 Hyoglossus Muscle From hyoid bone to side of the tongue Nerve, hypoglossal nerve

70 Stylohyoid Muscle Origin, styloid process Insertion, hyoid bone (two slips) Nerve, CN VII

71 Concerted Action of Suprahyoid Muscles Elevate floor of mouth for swallowing reflex

72 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

73 Anatomical Relationship Hypoglossal and lingual nerves are between mylohyoid and hyoglossus muscles Closed relationship between lingual nerve and submandibular duct

74 Chorda tympani special sense (taste) from anterior 2/3 of tongue preganglionic parasympathetic fibers to submandibular and sublingual gland, via submandibular ganglion

75 The Nasal Region Nostrils Vestibule Nasal cavity Choanae Nasal septum –Cartilage, septal cartilage –Bone perpendicular plate of ethmoid vomer maxillary & palatine

76 Lateral Wall of the Nasal Cavity Chonchae superior, part of ethmoid middle, part of ethmoid inferior, separate bone

77 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

78 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

79 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.

80 Blood Supply of the Nasal Cavity from sphenopalatine a. –posterior lateral nasal br. –posterior septal br. from ophthalmic a. –anterior and posterior ethmoidal a

81 Paranasal Air Sinuses Locations –frontal sinuses –ethmoidal air cells posterior middle anterior –sphenoidal sinuses –maxilary sinus Functions –warm and humidify air –resonance

82 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

83 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

84 Pterygopalatine Ganglion All the "out" branches supply submucosal gland, parasympathetic general sense lacrimal gland, parasympathetic

85 Mouth & Lips vestibule oral cavity proper nasolabial sulcus philtrum labial gland frenulum palatoglossal arch palatopharyngeal arch opening of parotid duct opening of submandibular & sublingual ducts

86 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.)

87 The Tongue sulcus terminalis foramen caecum papillae –circumvallate –fungiform –filiform –foliform lingual tonsil

88 Muscles of the Tongue Intrinsic –longitudinal –transverse –vertical Extrinsic –hyoglossus –genioglossus (movement of tongue) –styloglossus –palatoglossus

89 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

90 The Palate Hard palate Soft palate, muscles –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

91 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.

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