Gross Anatomy II

Head I: Superficial Structures of the Head Dr. Klimek Jan 25 2007

I have never let my schooling interfere with my education. Mark Twain (1835-1910)

Special Note: 

See the lab assignment schedule (in the syllabus or online) for a list of bones and features of the skull you should identify today.

http://www.youtube.com/watch?v=UY-SCzaqxVo http://www.youtube.com/watch?v=ZyUENUFCkdE&NR

2

Objectives/Major Concepts 

Osteology of the head.
Same bones, different shapes! 

Understand topography of the head, and superficial structures of importance:
Facial and trigeminal nerves Pulse points / venipuncture points / nerve blocks  

Cutaneous innervation of the head ± clinical importance. Introduction to the guttural pouch
3

S_P_A_R_I_A_
1. 2. 3. 4.

JODVEN LRLOOY OTLRBU EKARMN
12% 5%
Y

67%

17%

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N

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V

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4

A_R_C_L_T_M_O_A_
1. 2. 3. 4.

PUORIELU UUZIASRU EOAKHQOA AINOYTEI

78%

8%

11% 2%
A O T A IN O Y E I

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5

Please select a Team.
1.

2.

3.

ft h. ..

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I remember all of the bones of the head. I remember some of the bones of the head. The head has bones?!

63%

24% 13%

!

6

Review Topic of the Day 

We will be reviewing basic information regarding the trigeminal and facial nerves.
Branches Function Communications

7

supraorbital foramen frontal bone nasal bone

Atlantal fossa

lacrimal bone nasoincisive notch incisive bone temporal bone zygomatic bone

maxilla
8

At which of these locations can you palpate the nasoincisive notch?
1. 2. 3.

A? B? Or C?

1% 0%

99%
A? B? Or C?

9

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10

Where is the zygomatic arch?
1. 2. 3.

A? B? Or C?

40% 56% 4%
A? B? Or C?

11

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12

Where are the buccal branches of the facial nerve?
1. 2. 3.

A? B? Or C?

0% 5%

95%
A? B? Or C?

13

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200% 250%

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14

15

supraorbital foramen frontal bone nasal bone

Atlantal fossa

lacrimal bone nasoincisive notch incisive bone temporal bone zygomatic bone

maxilla
16

supraorbital foramen frontal bone nasal bone

Atlantal fossa

lacrimal bone nasoincisive notch incisive bone temporal bone zygomatic bone

maxilla
17

Lateral vertebral foramen infraorbital foramen
Covered by levator labii superioris

nasoincisive notch

transverse foramen Angle of mandible facial crest

canine tooth mental foramen
Covered by depressor labii inferioris

mandibular notch

Vascular incisure

18

Lateral vertebral foramen infraorbital foramen

nasoincisive notch

transverse foramen

facial crest canine tooth mental foramen mandibular notch

Vascular incisure

19

Palpating the supraorbital foramen

20

Where is the infraorbital foramen?
1. 2. 3.

A? B? Or C?

1% 13%

86%
A? B? Or C?

22

DDDF F A A EG E E
200% 250%

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% 0% %

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DDD @ AC B A B A @ 9 7

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23

Which of the following best describes the pathway for sensory information from the nostril?
1.

2.

3. 4. 5.

Through the auriculopalpebral branch of CN VII. Through the auriculotemporal branch of CN V Through the dorsal buccal branch of CN VII. Through the infraorbital branch of CN V Through the palatine branches of CN V
ro Th

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24

If a horse presents with its nose deviated to the right, which of the following is most likely damaged?
1.

2.

3.

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Fa

Fa

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4.

Facial nerve on the right Facial nerve on the left Infraorbital nerve on the right Infraorbital nerve on the left

63%

21% 6%
ht le ft . ..

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25

Facial Nerve 


Motor function: caudal belly of digastricus Motor function: muscles of facial expression
Auriculopalpebral: ear and eyelids including levator nasolabialis Dorsal buccal: caninus to dilate nostril Dorsal & ventral buccal: buccinator & orbicularis oris Autonomic functions 

Lacrimal, mandibular & sublingual glands

26

Facial Nerve 

Sensory functions
Concave surface of the ear Taste to rostral 2/3¶s tongue 

Communications
Part of the auriculotemporal nerve (from V3, mandibular br. of trigeminal) connects to buccal branches of facial nerve This is how the mandibular branch of the trigeminal reaches the skin of the cheek.

27

Trigeminal Nerve  

Major sensory nerve to the face. Also motor to most of muscles of mastication. Three branches named the same as in dog:
Ophthalmic Maxillary Mandibular

28

(mainly)

C2

29

Which of the following best describes the pathway for sensory information from the nostril?
1.

2.

3. 4. 5.

Through the auriculopalpebral branch of CN VII. Through the auriculotemporal branch of CN V Through the dorsal buccal branch of CN VII. Through the infraorbital branch of CN V Through the palatine branches of CN V
ro Th

5%

0% 3% 1%
.. . l.. . l.. . .. ra or b rs a l.

1%
ne . al at ..

r

r

do th e

a

th e

th e

nf th e h Th ro h th e

h

h

a ro Th h

ro

Th

Th

ro

30

If a horse presents with its nose deviated to the right, which of the following is most likely damaged?
1.

2.

3.

th e

e

on

on

er

e

ta ln

ne

ne

rb

al

fra o

Fa

Fa

In

In

fra o

al

rb

ta ln

e

r

r

er

e

4.

Facial nerve on the right Facial nerve on the left Infraorbital nerve on the right Infraorbital nerve on the left

3%

2%
ht le ft r on th e

3% 2%
on t .. . ..

31

Break

Pulse Points of the Head 

Pulse: all of these are challenging. The equine pulse is slow. Horse chews, moves head.
Transverse facial artery ± ventral to zygomatic arch Masseteric artery ± caudal edge of masseter Facial artery ± at mandibular notch
33

Venipuncture Points of the Head 

Venipuncture:
Transverse facial vein Masseteric artery ± caudal to masseter

34

PI 120; compare to Fig. 7-3 Auriculopalpebral n. (VII)

Auriculotemporal n. (V)
Communicating and transverse facial branches

Facial nerve

Facial vessels, parotid duct

Viborg¶s triangle 35

Locate:
Parotid salivary gland Transverse facial artery

Facial nerve Masseteric artery

Viborg¶s triangle Facial artery

Locate:
Parotid salivary gland Transverse facial artery

Facial nerve Masseteric artery

Viborg¶s triangle Facial artery
37

Parotid and Mandibular Salivary Glands  

Parotid is largest salivary gland in the horse. Separated from mandibular salivary gland by maxillary v., sternomandibularis, brachiocephalicus & occipitomandibularis muscles Route of parotid duct takes it through Viborg¶s triangle, after which it becomes associated with the facial artery.

38

Other Salivary Glands 

Sublingual salivary gland
Polystomatic portion only 30 +/- small ducts that open on the sublingual fold, extending from the mandibular symphysis, to M/1 or M/2 



Dorsal and ventral buccal glands Minor salivary glands are associated with lips, especially at commissures; tongue; and soft palate.
39

Mandibular salivary gland

Parotid salivary gland
40

Guttural Pouches  

What is presented here is an overview; more details will be in upcoming assignments. The guttural pouches are air-filled diverticula from the auditory tubes in Equidae, separated by a thin septum on the midline. Other perissodactylids also have them, eg. hippos and tapirs. You can see them on the cut section of the head.

41

Function of the Guttural Pouch  

Blood temperature increases with exercise, but the brain of any animal cannot tolerate much of an increase in temperature; all animals must carefully regulate the temperature of blood to the brain. Horses have a guttural pouch to help perform this; others animals have a rete system associated with the carotid artery that performs this function.
42

Function of the Guttural Pouch  

It has been proven that the blood in the internal carotid artery of a horse at exercise is cooler after the artery leaves contact with the pouch, than the blood in the artery before it reaches the pouch, but that not much of a difference occurs at rest. What is not known is how cool air circulates inside the pouch, to keep the pouch cool enough during exercise to affect the arterial blood temperature. The anatomy of the pouch does not seem to promote circulation. However, some air does enter the pouch on a regular basis; some foals get tympany, where the air continually builds up in the pouch and cannot escape.

43

Clinical Relevance of the Guttural Pouch 

Not normally palpable and largely medial to the mandible/parotid gland, but may greatly enlarge with certain conditions. If enlarged, you see swelling in the parotid region, and variable dysphagia and dyspnea.
empyema (filling with exudate). This can lead to ³chondroids´ (stone-like foreign bodies) tympany (filling with trapped air)

44

Clinical Relevance of the Guttural Pouch 

Another common condition is mycosis (fungal infection ± does not normally swell, but can rupture associated arteries)

45

Viborg¶s Triangle 

This is a surgical access point for approach to the guttural pouch.
Usually used to relieve enlargement due to empyema. Boundaries of triangle: ramus of mandible; linguofacial vein; tendon of sternomandibularis 

Approach through Viborg¶s triangle
Skin incision in Viborg¶s triangle (or a variation: ventral to and parallel to linguofacial vein) Use blunt dissection; angle toward opposite eye; enters ventral part of medial compartment. Parotid duct at risk. It is parallel to linguofacial vein and 2-3 cm dorsal.
46

nose

Auditory tube

Stylohyoid bone

Pharyngeal orifice of auditory tube

Medial view into the right guttural pouch.
47

The probe is passing into the guttural pouch (opened) through its pharyngeal opening.
48

Useful images for these labs:    

Dyce Chapter 18 and Plate 23 should help you visualize the guttural pouch and its associated structures. This isn¶t easy« Dyce Plate 3 shows endoscopic view of the opening of the guttural pouch. Excellent pictures of the vessels and nerves in the area of the guttural pouch are in the Budras atlas available in the lab. Refer to pages 43-45. Refer to page 32 for a good schematic of the arteries and veins of the head. Page 35 shows some deeper vessels.
49

Objectives/Major Concepts 

Osteology of the head.
Same bones, different shapes! 

Understand topography of the head, and superficial structures of importance:
Facial nerve/trigeminal nerve Pulse points / venipuncture points / nerve blocks  

Cutaneous innervation of the head ± clinical importance. Introduction to the guttural pouch
50

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