![Page 1: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/1.jpg)
Skull and Face
Boonsirm Withyachumnarnkul, M.D., Ph.D.
Department of Anatomy, Faculty of Science
Mahidol University
![Page 2: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/2.jpg)
Bony Landmarks of Skull and Face
• Vertex• Superciliary arch• Zygoma• Mental symphysis• Entrance to orbit• Anterior nasal
aperture
![Page 3: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/3.jpg)
Three foramina vertically alligned
• Supraorbital foramen … for supraorbital nerve
• Infraorbital foramen … for infraorbital nerve
• Mental foramen ... for mental nerve
![Page 4: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/4.jpg)
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.
![Page 5: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/5.jpg)
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
![Page 6: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/6.jpg)
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
![Page 7: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/7.jpg)
Muscles of the Mouth
![Page 8: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/8.jpg)
Muscle of the Eyelids
• Orbicularis oculi– Orbital part
– Palpebral part
![Page 9: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/9.jpg)
Buccal Pad Fat
• Between masseter and buccinator muscles
• Brown fat … for heat generation, especially for children
![Page 10: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/10.jpg)
Parotid Duct
• One finger-breadth below zygomatic arch
• Open into the mouth cavity (vestibule) at the level of the 2nd molar tooth (crown)
![Page 11: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/11.jpg)
Facial Nerve
• Comes out from stylomastoid foramen
• Five branches– Temporal
– Zygomatic
– Buccal
– Mandibular
– Cervical
![Page 12: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/12.jpg)
Facial Palcy
• No wrinkle of forehead
• Angle of mouth drops
• Sagging lower eyelid• Other signs relating
to malfunctions of structures innervated by facial nerve
![Page 13: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/13.jpg)
Trigeminal Nerve• Sensory
– Ophthalmic division
– Maxillary division
– Mandibular division
• Motor .. To 1st branchial arch
– Muscles of mastication
• Messeter
• Temporalis
• Medial pterygoid
• Lateral pterygoid
![Page 14: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/14.jpg)
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
![Page 15: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/15.jpg)
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
![Page 16: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/16.jpg)
Lymph Drainage of the Face
• Submental lymph nodes
• Submandibular lymph nodes
• Parotid lymph nodes
![Page 17: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/17.jpg)
Scalp, Cranial Cavity and Venous Sinuses
Boonsirm Withyachumnarnkul, M.D., Ph.D.
Department of Anatomy, Faculty of Science
Mahidol UniversityHead2.ppt in C (Mahidol)
![Page 18: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/18.jpg)
Scalp• Five layers of scalp
– skin– dense subcutaneous tissue– epicranial aponeurosis– loose areolar connective tissue– periosteum
![Page 19: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/19.jpg)
Scalp• Clinical relevance
– infection spreading from loose areolar connective tissue, via emissary veins, to meninges-meningitis
– hematoma
![Page 20: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/20.jpg)
Skull Cap or Calvaria• Suture
– coronal (frontoparietal)• anterior fontanelle
– sagittal (interparietal)– lambdoid (occipitoparietal)
• posterior fontanelle
![Page 21: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/21.jpg)
Skull Cap or Calvaria• Three layers of skull cap
– outer table– diploe– inner table
![Page 22: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/22.jpg)
Cranial Fossae
• Anterior cranial fossa• Middle cranial fossa• Posterior cranial fossa
• Boundaries– lesser wing of sphenoid– superior border of petrous bone
![Page 23: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/23.jpg)
Anterior Cranial Fossa• important landmarks
– crista galli & cribriform plate of ethmoid
– sella turcica• tuberculum sellae• hypophyseal fossa• dorsum sellae
![Page 24: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/24.jpg)
Middle Cranial Fossa• important landmarks
– foramina• superior orbital fissure• foramen rotundum• foramen ovale• foramne spinosum
– groove for middle meningeal artery
![Page 25: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/25.jpg)
Posterior Cranial Fossa• important landmarks
– grooves for transverse & sigmoid sinuses– foramen magnum
![Page 26: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/26.jpg)
Dura Mater
• Outer and inner layers– position of the middle meningeal
artery
![Page 27: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/27.jpg)
Dura Mater• Falx cerebri• Falx cerebelli• Tentorial cerebelli and notch• Diaphragmatic sellae
![Page 28: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/28.jpg)
Intradural Venous Sinuses• Superior and inferior sagittal sinuses• Straight sinus• Transverse and sigmoid sinuses
![Page 29: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/29.jpg)
Intradural Venous Sinuses• Cavernous sinus
– relationship among internal carotid artery, CN III, CN IV, CN V1 and CN VI
– venous connections– clinical relevance
• thrombophlebitis
![Page 30: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/30.jpg)
Orbit and Eye
Boonsirm Withyachumnarnkul, M.D., Ph.D.
Department of Anatomy, Faculty of Science
Mahidol University
![Page 31: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/31.jpg)
•eyelids•palpebral fissure•plica semilunaris•caruncle•lacrimal puncta•cornea•sclera •conjunctiva
•bulbar•palpebral
•Sty•pterygium
Eye From the Outside
![Page 32: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/32.jpg)
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
![Page 33: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/33.jpg)
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.
![Page 34: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/34.jpg)
Eyeball
![Page 35: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/35.jpg)
Eyeball
Muscles•Extrinsic (Extra-ocular)•Intrinsic
![Page 36: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/36.jpg)
Levator Palpebrae Superioris
•Supplied by CN III•insert on the upper lid•if paralyzed ptosis
![Page 37: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/37.jpg)
Extra-Ocular Muscles•Superior
Rectus• Inferior
Rectus•Lateral Rectus•Medial Rectus
•Superior Oblique
• Inferior Oblique
![Page 38: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/38.jpg)
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
![Page 39: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/39.jpg)
elevate
adduct
medial rotate
Make a 10-15 o with an AP axis
Superior Rectus
![Page 40: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/40.jpg)
depress
adduct
lateral rotate
Inferior Rectus
![Page 41: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/41.jpg)
Medial and Lateral Recti
Medial Rectus•adduction
Lateral Rectus•abduction
![Page 42: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/42.jpg)
•depress•abduction•medial rotate
Superior Oblique
![Page 43: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/43.jpg)
•elevate•abduction•lateral rotate
Inferior Oblique
![Page 44: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/44.jpg)
Periorbita and Orbital Fat
![Page 45: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/45.jpg)
Insertions of the Extra-Ocular Muscles
![Page 46: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/46.jpg)
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
![Page 47: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/47.jpg)
Oculomotor nerve (CN III)
Superior Division• levator palpebrae superioris*• superior rectusInferior Division• inferior rectus• inferior oblique• medial rectus*not an extra-ocular muscle
![Page 48: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/48.jpg)
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, elevateTherefore, test for the superior rectus function is to abduct and elevate
![Page 49: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/49.jpg)
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
![Page 50: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/50.jpg)
•lenticular cataract•glaucoma•Schlemn’s canal•Myopia (near sightedness)•hyperopia (far sightedness)•presbiopia (old-aged sightedness)
Clinical Relevance
![Page 51: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/51.jpg)
Blood Vessels of the Orbit & Eyeball
in the choroid layer
Ophthalmic•Frontal
•anterior & posterior ethmoidal•supraorbital•supratrochlear
•lacrimal•central retinal
![Page 52: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/52.jpg)
Ophthalmoscopic Examination
•optic disc•macula lutea & fovea centralis•retinal vessels in DM & hypertension
![Page 53: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/53.jpg)
•superior & inferior ophthalmic veins•drained to cavernous sinus•connection to pterygoid plexus•connection to facial veins
Veins of the Eyeball
![Page 54: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/54.jpg)
Sensory Nerves of the Eyeball and Orbit
•frontal•supraorbital•supratrochlear
•lacrimal nerve•nasociliary nerve
•anterior ethmoidal•posterior ethmoidal•infratrochlear
![Page 55: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/55.jpg)
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 ganglion short ciliary n.
Eyeball ciliary muscle & iris (circular fibers)
post-ganglionic sympathetic fibers
![Page 56: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/56.jpg)
Ciliary Ganglion
![Page 57: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/57.jpg)
•Lacrimal puncta•lacrimal canaliculi•lacrimal sac•nasolacrimal duct•opening into the inferior meatus of nasal cavity
Lacrimal Gland and Lacrimal Apparatus
![Page 58: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/58.jpg)
Parasympathetic Supply to the Lacrimal Gland
Preganglionic parasympathetic fibers pterygopalatine ganglionmaxillary n zygomatic branch zygomatico-temporal branch
lacrimal n lacrimal gland
![Page 59: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/59.jpg)
•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
![Page 60: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/60.jpg)
Orbital Septum, Medial & Lateral Palpebral
Ligament
![Page 61: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/61.jpg)
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)
![Page 62: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/62.jpg)
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
![Page 63: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/63.jpg)
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
![Page 64: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/64.jpg)
Actions of Digastric Muscle
• Elevate hyoid bone• Open jaw• Raising floor of mouth for
swallowing reflex
![Page 65: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/65.jpg)
Suprahyoid Muscles• Digastric• Mylohyoid• Geniohyoid• Hyoglossus• Stylohyoid
![Page 66: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/66.jpg)
Mylohyoid Muscle
• Origin, mylohyoid line of mandible• Insertion
– Body of hyoid bone– Median fibrous raphe
• Nerve, nerve to mylohyoid (CN V)
![Page 67: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/67.jpg)
Geniohyoid Muscle• Origin, mental spine• Insertion, hyoid bone• Nerve, C1 spinal nerve
![Page 68: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/68.jpg)
Hyoglossus Muscle
• From hyoid bone to side of the tongue
• Nerve, hypoglossal nerve
![Page 69: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/69.jpg)
Stylohyoid Muscle• Origin, styloid process• Insertion, hyoid bone (two
slips)• Nerve, CN VII
![Page 70: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/70.jpg)
Concerted Action of Suprahyoid Muscles
Elevate floor of mouth for swallowing reflex
![Page 71: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/71.jpg)
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
![Page 72: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/72.jpg)
Anatomical Relationship
• Hypoglossal and lingual nerves are between mylohyoid and hyoglossus muscles
• Closed relationship between lingual nerve and submandibular duct
![Page 73: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/73.jpg)
Chorda tympani• special sense (taste) from anterior
2/3 of tongue• preganglionic parasympathetic fibers
to submandibular and sublingual gland, via submandibular ganglion
![Page 74: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/74.jpg)
The Nasal Region
• Nostrils• Vestibule• Nasal cavity• Choanae• Nasal septum
– Cartilage, septal cartilage– Bone
•perpendicular plate of ethmoid
•vomer•maxillary & palatine
![Page 75: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/75.jpg)
Lateral Wall of the Nasal Cavity
Chonchae• superior, part of ethmoid• middle, part of ethmoid• inferior, separate bone
![Page 76: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/76.jpg)
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
![Page 77: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/77.jpg)
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
![Page 78: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/78.jpg)
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.
![Page 79: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/79.jpg)
Blood Supply of the Nasal Cavity
• from sphenopalatine a.– posterior lateral
nasal br.– posterior septal br.
• from ophthalmic a.– anterior and
posterior ethmoidal a
![Page 80: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/80.jpg)
Paranasal Air Sinuses
• Locations– frontal sinuses– ethmoidal air cells
• posterior• middle• anterior
– sphenoidal sinuses– maxilary sinus
• Functions– warm and humidify air– resonance
![Page 81: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/81.jpg)
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
![Page 82: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/82.jpg)
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
![Page 83: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/83.jpg)
Pterygopalatine Ganglion
All the "out" branches supply• submucosal gland,
parasympathetic• general sense• lacrimal gland,
parasympathetic
![Page 84: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/84.jpg)
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
![Page 85: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/85.jpg)
The TeethTypes• incisor, 2• canine, 1• premolar, 2• molar, 3Nerves 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.)
![Page 86: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/86.jpg)
The Tongue
• sulcus terminalis• foramen caecum• papillae
– circumvallate– fungiform– filiform– foliform
• lingual tonsil
![Page 87: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/87.jpg)
Muscles of the Tongue
• Intrinsic– longitudinal– transverse– vertical
• Extrinsic– hyoglossus– genioglossus (movement of tongue)– styloglossus– palatoglossus
![Page 88: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/88.jpg)
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
![Page 89: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/89.jpg)
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
![Page 90: Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D. Department of Anatomy, Faculty of Science Mahidol University](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649c815503460f949384af/html5/thumbnails/90.jpg)
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.