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REGIONS OF HEAD
Regions of head (cranium)
From topographic point of view, the head presents two parts: cranium and facies.
The limit between cranium and facies – glabella, supraorbitary border of frontal bone,
frontozygomatic suture, posterior border of frontal process of zygomatic, inferior border of
zygomatic arch, base of mandible condyle, inferior part of external acoustic meatus, base
of mastoid process.
Regions of head (cranium)
Regiones capitis
Regiones facialis
Limits:
- Anterior – glabella and margo supraorbitalis
- Posterior – external occipital prottruberance an
superior nuchal line – mastoid process
- Lateral – superior temporal line and mastoid
process
Regions of head (cranium)
Fronto-parietal-occipital region
Stratigraphy
Tegument – thick, hairless on forehead except
for the eyebrows and otherwise covered with
hair
Fronto-parietal-occipital region
Stratigraphy
Blood vessels
1. Supraorbital artery , branch of ophthalmic
artery, leaves the orbit through supraorbital
foramen and goes to vertex.
2. Supratrochlear artery, superior terminal
branch of ophthalmic artery leaves the orbti
through frontal foramen and goes through
orbit septum
3. Frontal branch of superficial temporal artery
– external carotid artery
4. Parietal branch of superficial temporal
artery
5. Occipital artery
6. Occipital branch of posterior auricular artery
– external carotid artery.
Those arteries create anastomosis between
them and to the others from the opposite side.
Regions of head (cranium)
Fronto-parietal-occipital region
Stratigraphy
Veins form a rich network with many
anastomosis.
Emissary and diploic veins connect the
exocranian venous network to dura mater
sinuses.
Thus, exocranian infections can spread to the
venous sinuses of dura mater
Regions of head (cranium)
Fronto-parietal-occipital region
Stratigraphy
Nerves – sensitive
- Supraorbital nerve – from frontal nerve
of ophthalmic nerve
- Supratrochlear nerve – from frontal
nerve of ophthalmic nerve
- Auriculotemporal nerve
- Greater occipital nerve – dorsal
branches of C2
- Lesser occipital nerve – cervical plexus
– ventral branches C2C3
Regions of head (cranium)
Fronto-parietal-occipital region
Stratigraphy
Nerves
- Temporal branches – facial nerve
- Frontal branches – mimic muscles
- Posterior auricular nerve – occipital
muscle
Regions of head (cranium)
Fronto-parietal-occipital region
Stratigraphy
Muscle and aponeurosis place
Epicranius muscle (mimic, cutaneous
muscle) is made of:
- occipital-frontal muscle
- Temporal-parietal muscle
- Galea aponeurotica – covers the skull
and serve as insertion for occipital-
frontal and temporal-parietal muscles.
Fronto-parietal-occipital region
Stratigraphy
Sub-aponevrosis plane – between scalp and periosteal there is a lax conjunctive tissue that
allows the scalp to lift during accidents.
Thus hematomas appear – they do not respect the limits of calvaria bones.
Sub-periosteal plane – periosteum is weakly adherent to calvaria bones but strongly fixed to
their sutures.
Cephalic-hematoma – is a blood collection, under periosteum , limited by sutures.
Regions of head (cranium)
Fronto-parietal-occipital region
Stratigraphy
Osseous plane
- Calvaria – squamos part of frontal, parietal and occipital bones
- Temporal lines
- Sutures – sagittal, coronal, lambdoid
- Parietal foramen
Regions of head (cranium)
Fronto-parietal-occipital region
Stratigraphy
Osseous plane
Fronto-parietal-occipital region
Stratigraphy
Osseous plane
Fronto-parietal-occipital region
Stratigraphy
Temporal region
Temporal region
Stratigraphy
Temporal region
Stratigraphy
Sub-cutaneous layer
Blood vessels
- Superficial temporal artery – terminal
branch of external carotid artery,
located anterior from tragus, has an
ascending trajectory. With age, it
becomes visible, prominent under the
skin. It has terminal branches: frontal
and parietal.
- Superficial temporal veins – together
with maxillary veins, they will form
retromandibular vein inside parotid
gland.
Regions of head (cranium)
Temporal region
Stratigraphy
Sub-cutaneous layer
Nerves
- Auriculotemporal nerve – from
mandibular nerve; located posterior
from superficial temporal vessels;
sensitive
- Zygomaticotemporal nerve – from
zygomatic nerve from maxillary nerve;
sensitive
- Temporal branches – motor; from facial
nerve.
Regions of head (cranium)
Temporal region
Stratigraphy
Aponevrosis layer
- the lateral part of galea
aponeurotica that gives insertion
to anterior and superior auricular
muscles and temporal-parietal
muscle.
Regions of head (cranium)
Temporal region
Stratigraphy
Fascial layer
Temporal fascia – superior it inserts to
superior temporal line and inferior
doubles, containing between the
sheaths, adipose tissue.
Muscle plane
Temporal muscle – masticatory muscle
Temporal region
Stratigraphy
Osseous plane
Temporal region
Stratigraphy
Temporal region
Stratigraphy
Mastoid region
Auricular region
Auricular region
Ear pavilion
Lateral face:
- Cavity of concha
- Helix – a prominence that starts by
the root of helix, limits the free
border of the pavilion and ends by
tail of helix at the level of lobule. The
root of helix divides the cavity of
concha into cavum concha (inferior)
and cymba concha (superior)
- Antihelix – a prominence parallel to
helix. It starts superiorly by the root
of antihelix (triangular fossa) and
ends inferiorly by antitragus
- Scaphoid fossa – depression
between helix and antihelix
- Tragus – a prominence located
anterior from antitragus
Auricular region
Ear pavilion
Ear pavilion presents fiber-elastic cartilage that takes part to the formation of cartilaginous
external acoustic meatus. One can describe some atrophied muscles in humans.
The pavilion is covered by tegument; it presents hair and ceruminous glands.
Regions of head (cranium)
Auricular region
External acoustic meatus has a cartilaginous part that starts at concha and an osseous part –
tympanic and squamous part of temporal bone.
It has a sinuous trajectory and it is in relation: superior – base of cranium; inferior – parotid
gland; anterior – temporomandibular joint; posterior – mastoid process.
Through external acoustic meatus one can feel the head of mandible.
Regions of head (cranium)
Auricular region
Blood vessels
Innervation:
Regio nasalis
Regio nasalis
Regio nasalis
Nose:
- Radix nasi
- Dorsum nasi
- Apex nasi
- Ala nasi – two orifices called narina, separated
by the membranous part of nasal septum.
Regiones facialis
Regio nasalis
Stratigraphy
Muscle plane
Mimic muscles, innervated by facial nerve:
- Procerus muscle
- Depressor septi nasi muscle
- Levator labii superioris alaeque nasi
muscle
- Nasalis muscle – transverse and alar
parts
Regiones facialis
Regio nasalis
Stratigraphy
- Angular artery – from facial artery
- Dorsal nasal artery – from ophthalmic
artery
- Branches of infraorbital artery from
maxillary artery
Veins drain into facial and ophthalmic veins.
Ophthalmic vein drains into cavernous sinus
– thus, an inflammatory process can spread
to cavernous sinus.
Sensitive nerves
- External nasal nerve – from anterior
ethmoidal nerve – nasociliary nerve –
ophthalmic nerve
- Infratrochlear nerve – from nasociliary
nerve – ophthalmic nerve
- Infraorbital nerve – from maxillary nerve
Regiones facialis
Regio nasalis
Stratigraphy
Periosteum and perichondrium plane
Perichondrium continues to periosteum joining the cartilages.
The osseous plane – nasal bone, nasal part of frontal bone, frontal process of maxilla
Cartilage plane – lateral nasal cartilages, septal cartilage, greater alar cartilage, lesser alar
cartilage and accessory alar cartilage.
Regiones facialis
Regio nasalis
At the level of external nose, there are the anterior parts of nasal fossa – nasal vestibule.
Nasal vestibule is covered by tegument that contains sebum glands and hair.
The limit between nasal vestibule and proper nasal cavity - limen nasi.
Regiones facialis
Regio oralis
Limits:
Regio oralis
Innervation - sensitive:
- infraorbital nerve (maxillary
nerve) for the superior lip
- - submental nerve (inferior
alveolar nerve- mandibular
nerve) for the inferior lip
Regiones facialis
Regio mentalis
Contains the soft parts which, together with the mandible body, form “the chin”
Regiones facialis
Regio mentalis
Delimitation:
- superior: mentolabial ditch
(oral region)
- inferior: mandibular inferior
margin (neck)
- lateral: the vertical line that
passes at 1 cm lateral to the
mouth’s angle (anguli oris), to
the inferior margin of
mandible
Regiones facialis
Regio mentalis
Layers:
1. Tegument: thick, adherent, containing hair follicles
2. Subcutaneous layer: poorly developed, containing
fibers of platysma muscle
3. Muscular layer: - depressor labii inferioris muscle
- depressor anguli oris muscle
Regio mentalis
Muscular and subcutaneous layers contain vascular-nervous structures:
- mental arteries (inferior alveolar artery- maxillary artery)
- submental arteries (facial artery)
- Inferior labial arteries (facial artery)
Veins drain into facial veins
Regiones facialis
Regio mentalis
- Lymphatics drain into submandibular and submental lymph nodes
- Sensitive innervation: mental nerve (inferior alveolar nerve- mandibular nerve)
Regiones facialis
Regio mentalis
Osseous layer: anterior face of mandible body:
- mental protuberance
- mental tubercles
- mental foramen (mental vascular-nervous bundle- for anesthesia)
Regiones facialis
Regio orbitalis
- At the surface, it corresponds to all
the soft parts located anterior to
the aditus orbitalis: palpebral
region
- Corresponds to the orbit (in the
depth), where the eye ball is
located
Regiones facialis
Regio orbitalis
• Eyelids unite themselves laterally and medially, and form:
- lateral palpebral commissure
- medial palpebral commissure
The medial angle of the eye consists of lacrimal caruncle and the semilunar fold. It
delineates the lacrimal sac.
The lateral angle of the eye is sharper
Regiones facialis
Regio orbitalis (at the surface)
The stratigraphic structure of eyelids:
- Tegument: thin, pigmented skin
- Subcutaneous layer: connective
tissue which allows edema
formation
- Muscular layer: orbicularis muscle
(palpebral part)
- Conjunctive submuscular layer:
contains blood vessels, nerves
- Fibrous layer = the skeleton of the
eyelid- orbital septum (in the
periphery) and the tarsi (superior
and inferior)
- Smooth muscle layer: superior
tarsal muscle and inferior tarsal
muscle
- Mucous layer: palpebral
conjunctiva
Regiones facialis
Regio orbitalis
- Orbital septum continues with the periorbital septum and attaches to the tarsal
margins
- Superior and inferior tarsi form the central part
- They attach to the margins of aditus orbitalis through lateral and medial palpebral
ligaments
Regiones facialis
Regio orbitalis
- Palpebral conjunctiva covers the posterior face of tarsi and tarsal muscles and
continues with the bulbar conjunctiva, which covers the sclera.
- The superior conjunctiva fornix and the inferior conjunctiva fornix form
Regiones facialis
Regio orbitalis - Vascularization:
- Lateral palpebral arteries (superior and inferior) from the lacrimal artery (ophthalmic
artery)
- Medial palpebral arteries (superior and inferior) from the ophthalmic artery
- Branches from the infraorbital artery (maxillary artery), transverse facial artery,
supraorbital artery
Veins drain into facial vein, superficial temporal artery and orbital veins
Regiones facialis
Genian region
Limits:
- anterior: nasogenian groove, prolonged by the line that descends at 1 cm lateral to the
oral commissure, to the inferior margin of mandible
- posterior: anterior margin of masseter muscle
- superior: infraorbital margin
- inferior: inferior margin of mandible
Stratigraphy:
1. Tegument: skin containing sebaceous and sweat glands, hair follicles (in males)
Regiones facialis
Genian region
Genian region
• Bichat fat pad is located at the
cheeks level, between
buccinator and masseter
muscles
• The parotid duct penetrates the
buccinator muscle
Genian region
Genian region
• Sensitive nerves:
- infraorbital nerve (maxillary nerve)
- zygomaticofacial nerve (zygomatic
nerve of maxillary nerve)
- buccal nerve (mandibular nerve)
Branches of facial nerve parotid plexus
innervate mimic muscles
Regiones facialis
Parotideomasseteric region
At the surface, it has a quadrilateral
shape
Delimitation:
• anterior: anterior margin of masseter
muscle
• posterior: anterior margin of
sternocleidomastoid muscle
• inferior: inferior margin of mandible,
prolonged till the anterior margin of
sternocleidomastoid muscle
• superior: inferior margin of zygomatic
bone, till the anterior margin of
sternocleidomastoid muscle
It contains two regions:
• masseteric region
• parotid region
Regiones facialis
Masseteric region
Masseteric region
Masseteric region
4. Masseteric fascia
5. Masseter muscle
• The masseteric vascular-nervous bundle pass through incisura mandibulae
(comunication with infratemporal fossa, masseteric artery from maxillary artery,
masseteric nerve from mandibular nerve)
Regiones facialis
Masseteric region
Parotid region
• Corresponds to retromandibular
fossa, where the profound
portion of parotid gland is found
=parotid lodge
• Delimitation (at the surface):
- anterior: posterior margin of
ramus of mandible
- posterior: mastoid process and the
anterior margin of
sternocleidomastoid muscle
- superior: external acoustic pore
- inferior: the horizontal from the
angle of the mandible to the
anterior margin of mandible
Regiones facialis
Parotid lodge
Parotid lodge
• Walls- delimitation:
- anterior: posterior margin of mandible
- posterior and medial: muscle-facial layer
and the ligament from the anterior
margin of sternocleidomastoid muscle
and styloid process to the posterior
margin of mandible; posterior belly of
digastric muscle, stylohyoidian muscle,
stylohyoidian and stylomandibular
ligament (styloid process- angle of
mandible)
- superior: external acoustic pore and
incisura mandibulae (communicates
with infratemporal region)
- inferior: fibrous structure from the
anterior margin of sternocleidomastoid
muscle to the angle of mandible, that
separates parotid lodge and
submandibular lodge
Regiones facialis
Parotid lodge
• Within parotid lodge, are located: the profound portion of parotid gland and
vascular-nervous elements that cross the gland, forming vascular-nervous pedicles
(the majority must be known and ligatured in total parotidectomy)
Regiones facialis
Parotid lodge
• External carotid artery crosses
parotid gland (arterial plane has a
medial disposition). It has a
trajectory until it reaches the
mandible neck; superficial
temporal artery, maxillary artery
(terminal branches)
• Sometimes, posterior auricular
artery detach inside the parotid
gland
• Branches of external carotid artery
will form, outside the gland, the
following pedicles:
- condylian pedicle:
- maxillary artery- passes through
infratemporal region
- maxillary vein- enters the parotid
gland
- auriculotemporal nerve (mandibular
nerve)- enters the parotid gland
Regiones facialis
Parotid lodge
- Superior pedicle:
- superficial temporal artery (passes into temporal region)
- superficial temporal veins (enter the parotid gland)
- auriculotemporal nerve (exits the gland)
Regiones facialis
Parotid lodge
- posterior pedicle:
- posterior auricular artery
- posterior auricular veins
Regiones facialis
Parotid lodge
• Facial nerve enters the parotid
gland and forms another posterior
pedicle.
• A lateral located nervous plane
crosses the parotid gland and
forms the parotid plexus, from
which branches for mimic muscles
innervation detach:
- temporal branches
- zygomatic branches
- buccal branches
- marginal branch of mandible
- cervical branch (r.coli)
Facial nerve and its branches (mostly
temporal branches) will be
protected (lagophthalmie with
corneal lesions because orbicularis
oculi muscle does not contract.)
Regiones facialis
Parotid lodge
Infratemporal region
• Is located deeply, at the border between cranial basis, calvaria and face.
Regiones facialis
Infratemporal region
• One of the access ways is by sectioning the zygomatic arcade and the removal of
temporal muscle tendon
Regiones facialis
Infratemporal region
4. mandibular nerve- comes from middle cranial fossa, through oval orifice and divides into
its branches:
- auriculotemporal nerve (enters the parotid region)
- lingual nerve
- inferior alveolar nerve (towards mandible orifice
Medial from this nerve, there is the otic ganglion vegetative ganglion which functionally
belongs to glossopharyngeal nerve)
Regiones facialis
Infratemporal region
- masseteric nerve
- profound temporal nerves (anterior, middle, posterior)
- lateral pterygoid nerve
- medial pterygoid nerve
- buccal nerve
Regiones facialis
Infratemporal region
Infratemporal region
Infratemporal region
Pterygomaxillary fissure is the entering place into pterygopalatine fossa:
- posterior wall: anterior face of pterygoid process
- medial wall: perpendicular plate of palatine bone
- anterior wall: maxillary tuberosity inferior orbital fissure)
- superior wall: - sphenopalatine orifice (nasal cavity)
- round orifice (middle cranial fossa
- orifice of pterygoid canal
Regiones facialis
Infratemporal region
Pterygopalatine fossa contains:
- terminal portion of maxillary artery with its terminal branch: sphenopalatine
artery (passes through sphenopalatine orifice, into/and nasal cavity)
- maxillary nerve- passes through the round orifice
- Pterygomaxillary ganglion