THE FACE. 39 



Where may the pulsations of the temporal artery be felt ? 



In what situations may neurectomy of the supraorbital and of the occipitalis major nerves be per- 

 formed ? 



Into what cleft-like spaces may the blood be poured from a wound of the middle meningeal artery ? 



What are the locations of the trephine openings for both branches of the middle meningeal artery? 



How is access to the lateral sinus best gained from the exterior ? What is the relation of the 

 lateral sinus to the mastoid cells ? 



What is the explanation of the symptom of pulsating exophthalmos ? 



How is the semilunar ganglion best exposed from the outside of the skull, and what neighboring 

 structures are thereby endangered ? 



Which cranial nerves and which large arteries are endangered in fractures of caries of the petrous 

 portion of the temporal bone ? 



Which lobe of the brain lies upon the tegmen tympani? Why is it important to know this? 



THE FACIAL REGION. 



THE FACE. 



The skin of the face, on account of its thinness and vascularity, furnishes the physician with 

 an important diagnostic aid in forming a conclusion as to the general condition of his patient 

 (redness, paleness, cyanosis). In contrast to the skin of the scalp (see page 24), it possesses great 

 movability, which, together with its vascularity, markedly favors the performance of plastic 

 operations. The connection of the skin with the muscles of expression is a further character- 

 istic demanding attention. Effusions of blood into the loose subcutaneous tissue spread dif- 

 fusely, so that sharply circumscribed swellings are not observed after contusions; in dropsy the 

 entire face may be swollen. [Because of its vascularity facial wounds, even when much lacerated 

 and contused, heal rapidly. ED.] 



The bony framework of the face, the facial skeleton, is composed of the fourteen facial bones. 

 Six of these are paired: the superior maxilla, the palatine, the malar, the nasal, the lachrymal, 

 and the inferior turbinated bones. The remaining two are single bones, the inferior maxilla 

 and the vomer. The bones as well as the large portion of the ethmoid entering into the facial 

 skeleton should be reviewed in a systematic text-book and with specimens ; the same is true of the 

 muscles of expression and of mastication. 



Arteries. Disregarding the branches which extend into the face from the vessels of the 

 cranial region, the four main trunks particularly supplying the face are : 



1. The facial artery, from the external carotid (see Plate 2). 



2. The internal maxillary artery, one of the terminal branches of the external carotid. 



3. The ophthalmic artery, from the internal carotid (see Plate 18). 



4. The lingual artery, from the external carotid (see page 64). 



In addition to these vessels, there are some small branches of the temporal artery, such as 

 those passing to the parotid gland and to the auricle, as well as the transverse facial artery below, 

 and the orbital artery above, the zygoma (Plate 2). 



The facial artery in the neck runs in the submaxillary triangle, imbedded in the substance of 

 the submaxillary gland [imbedded in a groove on the posterior end of the submaxillary gland, which 



