Head & neck
Clinical anatomy
ASHIQ
Anatomy
AIMST
FACE
Facial Lacerations & Incisions :
Wrinkle lines
Langers lines
Gaping of wound no deep fascia
Scar
Langers lines
Langers lines correspond to the natural orientation of fibers in the , and are
generally parallel to the orientation of the underlying muscle fibers.
Danger area of Face :
Middle third of face area drained by Angular vein
communication with Cavernous sinus inside the
Cranium spread of infection from face to Meninges .
Inferior Alveolar Nerve block :
Local anesthetic agent injected in the retro-molar
area medial to the ramus of the Mandible .
Done during Dental procedures in the Mandible .
Herpes zoster ( Shingles ) of the Trigeminal nerve .
Painful condition can cause ulceration of the Cornea
.
Carcinoma of lip,cheek &
tongue
Squamous cell carcinoma
Smoking & Tobacco chewing
Spread through Lymphatic
drainage
Reconstructive surgery
Musculo-cutaneous flaps
Parotiditis
Infection of parotid gland Incision & drainage can
damage facial nerve.
Sialolithiasis :Calculi in salivary glands more
common in submandibular salivary gland . Blockage of
salivary ducts .
Sialography : Contrast X-ray to study salivary glands .
Fig. Occlusal radiograph showing a sialolith (arrow) in
Whartons duct.
A
Fig. Sialolith (arrow) in a lingual salivary
gland on the floor of the mouth.
Tempero-mandibular Joint dislocation :
Injury
Yawning
Subluxation
T-M Joint arthritis :
Pain during chewing
Can lead to Ankylosis
Ankylosis, or Anchylosis (from Greek , bent,
crooked) is a stiffness of a joint, the result of
injury or disease.
Cleft Lip : ( 99.9 % in upper lip )
Development of Face
Non-fusion of Fronto-nasal process with Maxillary
process .
Complete or incomplete defect
Unilateral or bilateral defect
Maybe associated with Cleft Palate
Cleft Palate :
Non-fusion of the horizontal plate of the Maxillary
process with its opposite counterpart .
Cleft of soft palate alone-> incomplete
Cleft of both soft & hard palate -> complete
Difficulty in swallowing & speech
Cleft lip
Tongue-tie :
Short frenulum on inferior surface of tongue .
Speech defect can occur
Caries Tooth :
Decay of hard tissues of tooth (Enamel & Dentine )
results in formation of cavities .
Pulpitis & Tooth abscess :
Neglected Caries will invade the pulp of tooth & cause
inflammation of the pulp & root of the tooth .
Fracture Mandible :
Fracture neck of
mandible
angle
body
symphysis A
symphysis is a fibrocartilaginous fusion
between two bones. The more prominent
symphyses are:
the pubic symphysis
the symphyses between the bones of the
skull, most notably the mandible (symphysis
menti)
sacrococcygeal symphysis
Unilateral or bilateral
Fracture nasal bone
Injury Frontal
Lateral
Boxers nose
Nasal deformity
Epistaxis
Fracture zygoma
Tripod fracture
Black-eye- due to circum-orbital
hemorrhage .
Sub-conjunctival hemorrhage
on the lateral aspect of eyeball .
Fracture maxilla
LeFort fracture
Type 1- Horizontal above the alveolus
Type 2- Pyramidal, involving nasal bones also . Can
present with bilateral black eye Raccoon eye .
Type 3- Cranio-facial dysostosis .
A dysostosis is a disorder of the development of [Link] include craniofacial dysostosis,
Klippel-Feil syndrome, and Rubinstein-Taybi [Link] the disorder involves the joint
between two bones, the term synostosis is often used.
Deviated nasal septum
Can cause sinusitis &
rhinitis
Sinusitis :
Paranasal air sinuses
Allergy
Infection acute & chronic
Anosmia
CSF rhinorrhoea
CSF leak through nose.
Fracture base of skull anterior cranial fossa
cribriform plate of ethmoid.
CSF Otorrhoea
CSF leak through ear.
Fracture of middle cranial fossa Tegmen tympani of
temporal bone with rupture of tympanic membrane.
Sebaceous cyst
Sebaceous glands- numerous
in scalp.
Sebaceous horns.
Scalping Injury :
Avulsion of scalp complete or partial
Profuse bleeding scalp highly vascular
Industrial injury
Red Indians type of punishment
Micro-vascular surgery -> re-anastomosis
Torticollis or Wry neck
Torti twisted
Collis - neck
Congenital- sterno-mastoid
tumor.
Acquired- Spasmodic due
to local pathology in the
neck, eg. cervical
lymphadenitis.
Subclavian vein & internal
jugular vein puncture
To administer intravenous
fluids & to measure central
venous pressure .
Procedure called Central line
placement.
External Jugular vein
Severance can produce sucking in of air, due to
negative intra-thoracic pressure. This will cause air
embolism.
External Jugular vein can be used as a barometer to
measure right heart failure, when it becomes
prominent even in reclined position .
Carotid Artery
Carotid pulse
Carotid artery thrombosis & emboli-
Transient ischemic attacks
Carotid endarterectomy- re-canalisation of the
blocked artery .
External carotid artery ligation to stop bleeding from
one of its branches,especially superior thyroid artery
during thyroid surgery .
Trigeminal nerve
Injury causes deviation of mandible to same side of
lesion .
Loss of sensation over face .
Loss of corneal reflex corneal ulceration can occur
.
Trigeminal neuralgia ( Tic Douloureux )
Characterised by excruciating pain along the
sensory distribution of Trigeminal nerve.
Etiology not known , but could be caused by
aberrant artery compressing the nerve .
Trigeminal Neuralgia :
Tic Douloureux
Sudden severe pain along the distribution of
Trigeminal nerve especially along the Ophthalmic
division .
? Caused by aneurysm of artery in the Circle of Willis .
FACIAL AND TRIGEMINAL NERVE
Fig: The facial nerve. A, B, and C denote lesions of the facial nerve at the stylomastoid
foramen, distal and proximal to the geniculate ganglion, respectively. Green lines
indicate the parasympathetic fibers, red line indicates motor fibers, and purple lines
indicate visceral afferent fibers (taste).
Facial nerve injury
Upper motor neuron type
Lower motor neuron type
Parotid surgery
Bells palsy
Complications :
Corneal ulceration
Blindness
Facial nerve
Most frequently paralysed of all cranial nerves.
Injury at parotid region & Bells palsy paralysis of
facial muscles -eyes cannot close , no forehead
wrinkling , angle of mouth drooping .
Lesion in facial canal as above with loss of taste in
anterior 2/3 tongue .
Lesion in pons Upper part of facial muscles are
spared due to bilateral innervation .
Case of Left Facial nerve injury
Vagus nerve
Isolated lesion uncommon.
Damage to superior & recurrent laryngeal nerves can
occur during thyroid surgery . This causes weakness
/ hoarseness of voice.
Vagotomy is a procedure for treatment of peptic
ulcer,the vagus being divided at the esophago-
gastric junction .
Case study
1. A 37 year old man was sleeping near an open
window on a cold night . The next day morning he
found that he could not close his right eye . He also
found that his right angle of mouth was drooping &
saliva was drooling on that side .
Questions :
1. What is your diagnosis ?
2. What type of nerve injury has occurred ?
2. A 50 year old man came to a clinic complaining of
severe pain on the left side of his face for the past 1
month . The pain comes in paroxysms & is more so
while brushing his teeth & chewing food . His intra-
oral examination was found to be normal . There was
paresthesia over his left cheek & upper lip .
Questions :
1. What is your diagnosis ?
Thank you
