Neurovascular topography of the face and neck

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Anatomy presentation on the neurovascular topography of the face and neck. DOWNLOAD TO SEE THE COMMENTS. The slides are very basic - most of the info is contained in the comments which I read during the presentation.

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Neurovascular topography of the face and neck

  1. 1. , DDS & , DDS Periodontology Residents PGY1 September 23, 2013
  2. 2. • Includes the area bordered within the hairline, anterior border of the auricles, and the chin. • Major contents: eyes, nose, mouth, muscles of facial expression, muscles of mastication, parotid gland, trigeminal nerve, and facial nerve. • The forehead is common to both scalp and face.
  3. 3. Innervation of the face is principally derived from the three branches of the trigeminal nerve. V1 – Ophthalmic Nerve V2 – Maxillary Nerve V3 – Mandibular Nerve
  4. 4. Ophthalmic Nerve BRANCHES: The ophthalmic nerve contributes several branches to the upper eyelid, the forehead and scalp, and the external nose.
  5. 5. Maxillary Nerve BRANCHES: On the face, the infraorbital nerve breaks up into three sets of branches.
  6. 6. Mandibular Nerve BRANCHES: The cutaneous contribution of the mandibular nerve to the face is fairly widespread.
  7. 7. Trigeminal Pain Referred Pain: Pain seems to originate from one location, but the actual source of pain is remote or is a different structure. Trigeminal Neuralgia: • Intensely painful • Usually affects the V2 or V3 division. • Usually unilateral • Cause is unknown • Treatments include: • Tegretol (anticonvulsant) • Sectioning the sensory route of the nerve. • Injection of alcohol or glycerol into trigeminal ganglion. • Nerve decompression. • Radiofrequency rhizotomy
  8. 8. The cervical plexus supplies a small amount of sensory innervation to the face
  9. 9. • Motor supply: • Facial nerve • Motor branches of V3 Mandibular nerve • The facial nerve divides into the Temporofacial and Cervicofacial trunks. • These trunks then divide into the 5 main branches before emerging from the parotid gland.
  10. 10. Facial Nerve Temporofacial Division:
  11. 11. Facial Nerve Cervicofacial Division:
  12. 12. Bell’s Palsy• Damage to facial nerve • Affected side is motionless • Loss of wrinkles • Eye cannot be closed • In smiling the mouth is drawn to normal side • During mastication food accumulates in vestibule of mouth
  13. 13. Hypoglossal Nerve • Cranial nerve XII • Arises from rootlets of the medulla oblongata • Innervates the intrinsic tongue muscles. Ansa Cervicalis • From ventral rami of C1 – C3 • Innervates the omohyoid, sternohyoid and sternothryoid mm.
  14. 14. Main Branches of External Carotid • SUPERFICIAL TEMPORAL ARTERY • MAXILLARY ARTERY • TRANSVERSE FACIAL ARTERY • FACIAL ARTERY • LINGUAL ARTERY Main Branch of Internal Carotid • OPHTHALMIC ARTERY
  15. 15. • SUPERFICIAL TEMPORAL ARTERY • ORIGIN: External Carotid Artery • COURSE: Ascends anterior to ear, to temporal region and ends in the scalp. • MAXILLARY ARTERY • ORIGIN: External Carotid Artery • COURSE: Passes anteriorly between ramus of mandible and sphenomandibular ligament within infratemporal fossa. Passes either superficial or deep to lateral pterygoid unitl reaching pterygopalatine fossa. • TRANSVERSE FACIAL ARTERY • ORIGIN: Superficial temporal artery • COURSE: Crosses face external to the masseter and inferior to the zygomatic arch. • FACIAL ARTERY • ORIGIN: External Carotid Artery • COURSE: Ascends deep to the submandibular gland, winds around the inferior border of the mandible and enters the face. • LINGUAL ARTERY • ORIGIN: External Carotid Artery just inferior to facial artery. • COURSE: Passes deep to the posterior belly of the digastric and sylohyoid mm. Passes deep to the hyoglossus m. and anteriorly between the hyoglossus and genioglossus mm.
  16. 16. OPHTHALMIC ARTERY FROM INTERNAL CAROTID ARTERY • SUPRATROCHLEAR • SUPRAORBITAL • LACRIMAL • EXTERNAL NASAL • DORSAL NASAL
  17. 17. Arteries of the neck arise from • Subclavian artery • Thyrocervical Trunk • Transverse cervical a. • Inferior thyroid a. • Suprascapular & dorsal scapular aa. • Costocervical a. • Common carotid artery • Internal & external carotid aa.
  18. 18. Superficial Veins • Facial v. • Angular v. • Supraorbital v. • Supratrochlear v. • Superior/inferior labial vv. • Lateral nasal v. • Submental v. • Retromandibular v. • Maxillary v. • Pterygoid plexus • Inferior alveolar v. • Mental v. • Superficial temporal v. • Transverse facial v.
  19. 19. Communicating Veins • Superior ophthalmic v. • Receives blood from the roof of the orbit and the scalp • Inferior ophthalmic v. • Receives blood from the floor of the orbit. • Infraorbital v. • Receives blood from the mid-face, lateral nose, and upper lip • Deep facial v. Deep Veins • Cavernous sinus • Pterygoid plexus
  20. 20. Cavernous Sinus Thrombosis • Often caused by an infection that starts in the central part of the face, and travels back into the cavernous sinus. • Affects the contents of the cavernous sinus: • Cranial nerves III, IV, V1, V2, VI • Internal carotid • Common clinical manifestations include: • Ophthalmoplegia • Periorbital edema • Exophthalmos
  21. 21. Internal jugular • Occipital v. • Facial v. • Lingual v. • Pharyngeal v. • Superior thyroid v. • Middle thyroid v. External jugular Anterior jugular Subclavian • Vertebral v.

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