1. Face
    1. Muscles of face
      1. 1. Around eyeball: orbicularis oculi: spincter
      2. 2. Frontalis: surprise muscle
      3. 3. Zygomaticus major: smiling muscle,dilators
      4. 4. Risorius: grinning muscle
      5. 5. Buccinator: wistling, helps in pushing back food on the occlusal surface, swallowing, smiling and blowing, prevents food getting trapped in vestibule
        1. Nerve supply: Motor innervation: its supplied by BUCCAL branch of VII CRANIAL NERVE
          1. Note : it’s innervated by ant division of mandibular nerve, but not supplied by it.
        2. Sensory: buccal branch of the mandibular part of trigeminal nerve.
        3. Blood supply: Buccal artery( maxillary artery), facial artery
      6. 6.Mentalis : Doubt muscle
      7. 7. Zygomaticus minor : assists in smiling
      8. 8. Levator labii superioris : elevation of upper lip
      9. 9. Depressor labii inferioris : depresses and everts lower lip
      10. 10. Depressor anguli oris : frowning muscle
      11. 11. Muscles of mastication
        1. Temporalis
        2. Masseter
        3. Lateral pterygoid
        4. Medial pterygoid
      12. 12. Modiolus
        1. Chiasma of facial muscle held together by fibrous tissue, important in moving the mouth, facial expression , fitting of lower denture
          1. Consist of: 1. Orbicularis oris: helps in closing of mouth
          2. 2. Buccinator
          3. 3. Levator anguli oris
          4. 4. Depressor anguli oris
          5. 5. Zygomaticus major
          6. 6. Risorius
          7. 7. Quadratus labii superioris
          8. 8. Quadratus labii inferioris
      13. 13. Muscles of nose
        1. Proscerus: transverse wrinkle
        2. Compressor naris : nasal aperture compressed
        3. Dilator naris: nasal aperture dilated
        4. Depressor septi: nose pulled inferiorly
      14. 14. Platysma : horror & terror
    2. Superficial Fascia
      1. Contains 1. Facial muscles, all of which are inserted into the skin
      2. 2. Vessels & nerves, to the muscles & to the skin.
      3. 3. Variable amount of fat. Fat is absent from eyelinds, but is well developed in the cheeks , they are prominent in infants ,& helps in sucking.
    3. Deep fascia is absent in face but present in two parts
      1. 1. Parotido massetric fascia
      2. 2. Buccopharyngeal fascia
    4. Blood supply of face
      1. Arterial blood supply
        1. By 8 branches of External Carotid artery
        2. Torturous artery of face are facial artery & occipital artery, facial artery is torturous to facilitate movements.
        3. Facial artery 4 branches
          1. Cervical branches
          2. Ascending palatine
          3. Supplies: auditory tube, palatine tonsil, superior pharyngeal constrictor, soft palate
          4. Tonsillar
          5. Supplies palatine tonsil
          6. Submental
          7. Supplies: submental muscle, submental region skin
          8. Glandular
          9. Supply: submandibular salivary glands and lymph nodes
          10. Facial branches
          11. Inferior labial
          12. Supplies: lower lip, labial glands
          13. Superior labial
          14. Supplies: upper lip, nasal septum, ala of the nose
          15. Lateral nasal
          16. Supplies: dorsum of the nose, ala of the nose
          17. Angular
          18. Supplies: lacrimal sac, orbicularis oculi muscle
        4. Course of Facial Artery
          1. 1. Arises from the anterior surface of external carotid
          2. 2. Has a tortuous route along the nasolabial fold towards the medial canthus of the eye
          3. 3. Moves beneath the digastric and stylohyoid muscles and it will pass through the submandibular gland
          4. 4. Artery will then curve over the body of the mandible (deep to platysma), as the anteroinferior angle of the masseter, will ascend forwards and upwards across the cheek, to the angle of the mouth and along the side of the nose
          5. 5. Terminates near the medial aspect of the eye. In the region of the head, the facial artery runs roughly parallel to the facial vein, although not adjacent to it
        5. Facial artery is main artery of face aka. Anaesthetists artery.
      2. Venous drainage
        1. 1. Supratrochlear vein + supra orbital vein = Angular vein( facial vein)
        2. 2. Sf temporal vein+ maxillary vein = Retro Mandibular vein
        3. 3. Retromandibular vein( RMV) divides into ant and post division
        4. 4 . Ant division of RMV+ facial vein = common facial vein—> Internal jugular vein
        5. 5. Post division of RMV + post auricular vein = External jugular vein
    5. Dangerous area of face
      1. Maxillofacial Death Pyramid
        1. Emissary vein joins intra cranial vein from cavernous sinus to extra cranial veins in PTERYGOID PLEXUS OF VEIN
          1. Deep facial vein a branch of facial vein is a link between extra cranial vein & pterygoid plexus of vein
    6. Nerve supply of face
      1. Sensory branches of Trigeminal N on face
        1. 1.Ophthalmic (5 branches)
          1. 1. Supratrochlear
          2. 2. Supra-orbital
          3. 3. Infratrochlear
          4. 4. External nasal
          5. 5. Lacrimal
        2. 2. Maxillary (3 branches)
          1. 1. Zygomatico-temporal
          2. 2. Zygomatico-facial
          3. 3. Infra- orbital
        3. 3. Mandibular( 3 branches)
          1. 1. Auriculotemporal
          2. 2. Buccal
          3. 3. Mental
      2. Motor supply by Facial N
        1. 1. Temporal : frontalis & procerus
        2. 2. Zygomatic 1 : eye & around orbit
        3. 3. Zygomatic 2 : mid face & smile
        4. 4. Buccal : buccinator & upper lip
        5. 5. Mandibular: lower lip & orbicularis oris
        6. 6. Cervical : platysma
    7. Lymphatic Drainage
      1. 1. Pre auricular/ parotid lymph nodes
      2. 2. Submandibular lymph node
      3. 3. Submental lymph node
        1. Drains tip of Tongue
        2. Lower lip
        3. Central part of chin
        4. Lower incisor gum
        5. Frenula
    8. Applied
      1. Laxity of facial skin is responsible for early development of edema on face
      2. Boils on nose & ear are painful due to fixity of skin to underlying cartilage
      3. Wounds of face gape due to attachment of underlying muscles , they bleed profusely but heal rapidly
      4. As Facial vein is devoid of valves: spread of infection occurs in both directions, i.e between cavernous sinus and extra cranial veins.
  2. SCALP(5)
    1. Soft tissue covering over cranial vault
    2. Layers of scalp(5)
      1. S: Skin
      2. C: Connective tissue or superficial fascia
      3. A: Aponeurosis or deep fascia
      4. L: Loose areolar tissue- Dangerous area of scalp( emissary veins ,may transmit infection from scalp to cranial venous sinus)
        1. Black eye is seen
      5. P: Pericranium
    3. Blood supply (5 artery and vein)
      1. Scalp has rich blood supply derived from both internal & external carotid arteries, they anastomose over the temple
      2. Front of auricle
        1. 1.Supratrochlear A & v
        2. 2. Supraorbital A & V
        3. 3. Superficial temporal A & V
      3. Back of auricle
        1. 4. Posterior auricular A & V
        2. 5. Occipital A & V
      4. Note: vein connecting extra cranial vein & intra cranial vein is Emmisary vein & is valveless - hence infection spread in both direction
    4. Lymphatic drainage
      1. Front of auricle
        1. Preauricular nodes (parotid)
      2. Back of auricle
        1. Post Auricular nodes(Mastoid & occipital)
    5. Nerve supply(5: 4 sensory and 1 motor)
      1. Front of auricle
        1. Sensory nerve supply
          1. 1. Supra orbital
          2. 2. Supra trochlear
          3. 3. Zygomatico temporal
          4. 4.Auriculo temporal
        2. Motor nerve supply
          1. 1.Temporal branch of facial nerve
      2. Back of auricle
        1. Sensory nerve supply
          1. 1. Posterior division of greater auricular
          2. 2. Lesser occipital
          3. 3. Greater occipital
          4. 4. Third occipital
        2. Motor nerve supply
          1. 1. Posterior auricular branch of facial nerve
    6. Applied
      1. Scalp is most common site for occurrence of sebaceous cysts
      2. Cephal+hematoma= blood collection
        1. External pressure on the fetal head cause rupture of small blood vessels between the periosteum and calvarium
      3. Caput succedenum: Generalised swelling of scalp
      4. Scalp wounds gape and bleed profusely
        1. Aponeurosis anchors the scalp to the head. If this layer is breached wounds gape
        2. Wounds in scalp bleed profusely ,because the fibrous fascia prevents vasoconstriction
  3. How to learn : everything is 5
  4. First three layers of scalp are known as surgical layers of scalp or scalp proper
  5. As fibrous fascia of scalp is densly packed with blood vessels and nerves they bleed profusely , and cause huge swelling
  6. Boundaries of face : Extends superiorly to hair line, inferiorly to the chin & base of mandible & on each side to auricle. Forehead is common to both scalp & face
  7. Mnemonic: Two Zebras Befriended My Cat
  8. Embryologically they develop from mesoderm of 2nd brachial arch, hence supplied by facial nerve.
  9. Mnemonic: Anna, PLS SIT
    1. Ascending palatine artery, Premasseteric artery, Lateral nasal artery, Submental artery, Superior labial artery, Inferior labial artery, Tonsillar artery