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Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D.

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Presentation on theme: "Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D."— Presentation transcript:

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

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

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

4 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.

5 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

6 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

7 Muscles of the Mouth

8 Muscle of the Eyelids Orbicularis oculi Orbital part Palpebral part

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

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

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

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

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

14 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

15 Veins of the Face Two important veins Facial veins have no valves
Retromandibular vein Facial veins have no valves Connection of facial veins, pterygoid plexus and cavernous sinus

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

17 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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

32 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

33 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.

34 Eyeball

35 Eyeball Muscles Extrinsic (Extra-ocular) Intrinsic

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

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

38 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

39 Superior Rectus Make a 10-15 o with an AP axis adduct medial rotate

40 Inferior Rectus depress adduct lateral rotate

41 Medial and Lateral Recti
Medial Rectus adduction Lateral Rectus abduction

42 Superior Oblique depress abduction medial rotate

43 Inferior Oblique elevate abduction lateral rotate

44 Periorbita and Orbital Fat

45 Insertions of the Extra-Ocular Muscles

46 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

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

48 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

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

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

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

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

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

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

55 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 inferior oblique) ciliary ganglion short ciliary n. Eyeball ciliary muscle & iris (circular fibers)

56 Ciliary Ganglion

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

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

59 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

60 Orbital Septum, Medial & Lateral Palpebral Ligament

61 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)

62 Submandibular Region Inferior border of mandible Suprahyoid muscles
Including submandibular triangle Submandibular gland Nerves lingual hypoglossal mandibular branch of CN VII Blood vessels facial Lymph nodes, submandibular lymph nodes

63 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

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

65 Suprahyoid Muscles Digastric Mylohyoid Geniohyoid Hyoglossus

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

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

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

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

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

71 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

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

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

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

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

76 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

77 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

78 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.

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

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

81 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

82 Pterygopalatine Ganglion
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

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

84 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

85 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.)

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

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

88 Artery & Nerves of the Tongue
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

89 The Palate Hard palate Soft palate, muscles Clinical relevant
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

90 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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