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Parotid Region Boundaries: Posteriorly  mastoid process Anteriorly  ramus of the mandible Superiorly  the floor of the external acoustic meatus Medially  the styloid process The posterior wall of this region extends between the mastoid and styloid processes and this the muscles attached to these processes (sternocleidomastoid, posterior belly of the digastric and the stylohyoid) are closely related to the gland The anterior wall of this region is formed by the ramus of the mandible and the two muscles applied to it (masseter and the medial pterygoid) The parotid gland is traversed by branches of the facial nerve, artery and vein 1. Structures of the Parotid Region 1. Parotid Duct 2. Transverse Facial Artery 3. Facial Nerve a. stem of the facial nerve The first part of the facial nerve that emerges from the stylomastoid foramen b. temporal branches of the facial nerve Branches that go to the temporal region of the skull May form two communications with the auriculotemporal nerve (a branch of V3) 4. Parotid Sheath The parotid gland is enclosed within the parotid sheath 5. Auriculotemporal nerve A branch of V3 Carries secretory fibers to the parotid gland Runs toward the neck of the mandible Runs medial and deep to the parotid gland 6. Retromandibular Vein 7. External Carotid Artery Runs through the parotid gland Is deeply placed and is sheltered by the ramus of the mandible Posterior to the neck of the mandible, the external carotid divides into its two terminal branches: the maxillary artery and the superficial temporal artery 8. Maxillary Artery 9. Superficial Temporal Artery 10. Parotid Bed 11. Posterior belly of the digastric 12. Stylohyoid Anterior Aspect of Skull and Face The muscles of facial expression and the muscles of the scalp originate from the right and left 2nd branchial arches The nerve associated with the 2nd arch is CN VII (facial nerve) and thus innervates all facial muscles of expression, muscles of the scalp and external ear and the platysma The nerves associated with the 1st branchial arch is CN V (trigeminal nerve) and thus innervates all the muscles of mastication The main part of the trigeminal nerve is sensory  each of the three divisions of this nerve (V1,V2,V3) supplies an area of skin in the facial region The central V shaped region (forehead, eyes and nose) is supplies by V1 (1st or ophthalmic division) The intermediate area (cheek) belongs to V2 (2nd or maxillary division) The lower part of the face (mandibular region) is supplied by sensory fibers from V3 (3rd or mandibular division)

A. Frontalis B. Facial Nerve, Vessels and Related Structures 1. Platysma Reaches as far inferiorly as the 2nd rib Attaches superiorly to the inferior border of the mandible 2. Masseter Muscle Extends from the zygomatic arch to the ramus of the mandible 3. Parotid Duct Crosses the lateral aspect of the masseter muscle (inferior to the zygomatic arch) An empty, collapsed and flattened duct At the anterior border of the masseter, the duct makes a right angle turn and pierces the buccinator 4. Transverse Facial Artery Located superior to the parotid duct, near the buccinator muscle 5. Branches of the Facial Nerve a. Temporal Branch The highest branch of the facial nerve Crosses the zygomatic bone b. Zygomatic Branch Has interconnection with the buccal branch c. Buccal Branch Has interconnection with the zygomatic branch d. Cervical Branch The lowest branch of the facial nerve Runs below the angle of the mandible Sends “twigs” to the platysma 6. Buccal Fat Pad Is located anterior tot he masseter 7. Buccinator Muscle Located under the buccal fat pad The parotid duct pierces this muscle Two different nerves enter the substance of the buccinator: the buccal branch of the facial nerve  runs lateral to the masseter to supply the buccinator with motor fibers and the buccal branch of the trigeminal nerve (V3)  runs medial to the masseter and does not supply the buccinator; it sends sensory fibers to the buccal mucosa of the vestibule of the mouth 8. Buccal Branch of the Trigeminal Nerve V3 Runs medial to the masseter and does not supply the buccinator; it sends sensory fibers to the buccal mucosa of the vestibule of the mouth 9. Facial Artery Crosses the mandible at the anterior border of the masseter Travels to the medial angle of the eye 10. Facial Vein Lies posterior to the facial artery Travels to the medial angle of the eye C. Muscles of the Mouth 1. Depressor Anguli Oris Depresses the corners of the mouth Is aided by the posterior fibers of the platysma 2. Zygomaticus Major Descends from the zygomatic bone to the corner of the mouth Draws the angle of the mouth superiorly and inferiorly 3. Levator Labii Superioris Descends from the infraorbital margin to the upper lip It elevates the upper lip 4. Orbicularis Oris

The important sphincter muscle of the mouth Its muscular fibers have a circular arrangment The muscle fibers blend in with fibers from other muscles of the mouth 5. Buccinator Its superior and inferior attachments are to the lateral surfaces of the alveolar process of the maxilla and mandible Buccinator fibers blend in with the muscle fibers of the orbicularis oris Infraorbital Nerve Sends branches to the inferior eyelid, side of the nose and upper lip Lower Lip 1. Labial Glands Small glands that are located immediately deep to the mucus membrane 2. Inferior Labial Artery Located at the red line of the lip A branch of the facial artery 3. Mental Nerve These nerve branches ascend in the flap of the lower lip Traverses the mental foramen 4. Mental Foramen The mental nerve traverses this foramen External Nose 1. Nasal Cartilages The nose is held in shape by these hyaline cartilages 2. Lateral Nasal Cartilages Paired cartilages Located adjacent to the inferior borders of the two nasal bones They are not independent structures, but are triangular expansions of the large septal cartilage 3. Septal Cartilages A median, unpaired cartilage 4. Alar Cartilage Located on each side of the septal cartilage U-shaped cartilages that are responsible for the formation of the nares (nostrils) External Ear 1. Auricle The characteristic shape of the auricle is maintained by a single piece of elastic cartilage There is no cartilage in the lobule a. Helix The prominent rim b. Antihelix The curves prominence anterior to the helix c. concha d. tragus Usually shows hairs on the medial surface e. antitragus f. lobule 2. External Acoustic Meatus The external ear canal Inspection of Eye and Eyelids 1. Tarsus Located superior and inferior 2. Medial Palpebral Ligament A fibrous band that is located deep to the medial commissure 3. Margins of the Eyelids Are flat and thick They carry double or triple irregular rows of eyelashes or cilia

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Eyelashes (Cilia) There is a lack of cilia close to the medial angle of the eye 5. Tarsal Glands Located posterior to the cilia Appear to be yellowish streaks shining through the conjunctiva (on the inner surfaces of the eyelids) 6. Medial Palpebral Commissure 7. Lacus Lacrimalis (Lacrimal Lake) A triangular space that separates the upper and lower lids Contains a small, reddish prominence called the caruncula 8. Caruncula A small, reddish prominence that is located in the lacus lacrimalis 9. Lacrimal Papilla A small elevation located at the base of the lacus lacrimalis (where it meets the eyelid) Located on both eyelids 10. Lacrimal Punctum The minute orifice located on each lacrimal papilla This is the opening of the lacrimal canaliculis that drains fluid into the lacrimal sac 11. Lacrimal Canaliculis Drains fluid into the lacrimal sac 12. Lacrimal Sac Orbital Region 1. Orbicularis Oculi This sphincteric muscle consists of two parts A thick orbital portion, which surrounds the orbital, margin and is responsible for the tight closure of the eye A thin, palpebral portion, which is contained in the eyelids and is involved in the blinking of the eye It originates from the medial part of the bony orbital margin and from the medial palpebral ligament 2. Medial Palpebral Ligament Its lower border is free Fibers of the orbicularis oculi arise from is upper border 3. Frontalis Muscle It interlaces with the orbicularis oculi 4. Supraorbital Nerve (V1) and Vessels These emerge form the supraorbital foramen 5. Supraorbital foramen The supraorbital nerve and vessels emerge from this foramen 6. Orbital Septum Also known as palpebral fascia It is an oval membranous sheet that is attached to the margin of the orbit It is continuous with the periorbita (the periosteum of the orbital cavity) 7. Tarsus There are two Each one is a condensed thickening of the orbital septum, designed to stiffen the eyelid 8. Tarsal Glands 9. Lacrimal Gland There are 6-10 ducts that connect the lacrimal gland to the fornix of the upper part of the conjunctival sac 10. Lacrimal Fossa Houses the lacrimal sac 11. Lacrimal Sac Located in the lacrimal fossa Lies posterior to the medial palpebral ligament 12. Medial Palpebral Ligament

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Connected to the anterior crest of the lacrimal fossa 13. Nasolacrimal Duct A duct that enters the inferior meatus of the nose J. Sensory Nerves of the Face Derived from the three divisions of the trigeminal nerve 1. Supraorbital Nerve A branch of the ophthalmic division (V1) 2. Infraorbital Nerve A branch of the maxillary division (V2) 3. Mental Nerve A branch of the mandibular division (V3) 4. External Nasal Nerve A branch of V1 Supplies the skin of the nose Temporal Region Consists of two fossae: the temporal fossa and the infratemporal fossa Temporal Fossa: Located superior to the zygomatic arch Its floor consists of portions of 4 bones and gives rise to the fan-shaped temporalis muscle A. Structures of the Temporal Region 1. Masseter Muscle 2. Maseteric nerve and vessels Located on the posterior side of the masseter muscle Passes through the mandibular notch 3. Temporal Fascia It attaches to the temporal line B. Infratemporal Fossa It is situated inferior and deep to the zygomatic arch It contains two muscles of mastication, the mandibular nerve (V3) and the maxillary vessels Its lateral wall is the ramus of the mandible Its medial wall is the lateral plate of the pterygoid process The roof is formed by the greater wing of the sphenoid bone 1. Inferior Alveolar Nerve Enters the mandibular foramen Leads to the inferior border of the lateral pterygoid muscle Traverses the mandibular canal Also goes through the mental foramen into the region of the chin and lower lip 2. Inferior Alveolar Artery Enters the mandibular foramen Tranverses the mandibular canal A branch of the maxillary artery Runs within the bony mandible to supply the mandibular teeth 3. Lingual Nerve Is closely related to the ramus of the mandible Runs anterior to the inferior alveolar nerve Emerges from the inferior border of the lateral pterygoid 4. Mylohyoid Nerve Located posterior to the inferior alveolar nerve 5. Lateral pterygoid muscle This muscle has two heads: one arises from the roof of the fossa and the other from the lateral pterygoid plate 6. Chorda Tympani A nerve that joins the lingual nerve It can be seen posterior to the lingual nerve 7. Foramen Ovale The inferior alveolar and lingual nerves travel to this foramen

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It is located in the roof of the infratemporal fossa Buccal Nerve Its branches pierce the buccinator to supply the buccal mucosa with sensory fibers

Maxillary Artery Traverses through the infratemporal region Crosses superficial to the lateral pterygoid 10. Middle Meningeal Artery A branch of the maxillary artery Travels through the foramen spinosum 11. Foramen Spinosum The middle meningeal artery traverses through this foramen 12. Pterygopalatine Fossa Within this fossa, the maxillary artery gives off several branches, one of which is the posterior superior alveolar artery 13. Posterior Superior Alveolar Artery A branch of the maxillary artery that occurs in the pterygopalatine fossa C. Temporomandibular Joint

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