Topography of fasciae and cellular spaces of the head

The head is divided according to the conventional division of the skull into two sections - the cerebral and facial. The dense skin of the frontal-parietal-occipital region, covered with hair, having a large number of sweat and sebaceous glands, is firmly connected by vertically oriented connective tissue bundles with the tendon helmet of the epicranial muscle. Due to this, the subcutaneous tissue is divided into many cells filled with fatty tissue. Therefore, the intradermal arteries passing here (including the smallest ones), fused with connective tissue bundles, do not collapse even with minor wounds to the skin of the scalp and cause profuse bleeding. The tendon helmet (epicranial muscle) is weakly fused with the periosteum, therefore the skin together with the tendon helmet is quite mobile. In the lateral parts of the head, the tendon helmet becomes thinner and continues into the superficial fascia of the temporal region. Under the tendon helmet of the epicranial muscle, between it and the periosteum, there is a subaponeurotic tissue 2-3 mm thick, limited by the places of origin and attachment of this muscle. Under the periosteum of the bones of the cranial vault lies a thin layer of loose tissue 0.5-1 mm thick, which is divided by suture lines. Along the suture lines, the periosteum grows together with the bones of the cranial vault.

The skin of the face is thin and contains a large number of sebaceous and sweat glands. A moderately expressed layer of subcutaneous tissue is present in all parts of the face, except for the bridge of the nose. There is no superficial fascia on the face, since the facial muscles are woven into the skin. At the same time, each facial muscle is covered with its own thin connective tissue fascia and well-defined subcutaneous fat, which forms a fat body on the buccinator muscle in children, giving a specific rounded expression to children's faces. The fat body of the cheek is adjacent to the anterior edge of the masseter muscle. It is located in a fairly dense connective tissue capsule, which is fused with the fascial case of the temporal muscle. The fat body of the cheek has temporal, orbital and pterygopalatine processes, which can serve as pathways for the spread of inflammatory processes from the lateral region of the face to the eye socket and into the cranial cavity. The temporal process of the fat pad of the cheek penetrates upward and forward, under the fascia of the temporal muscle, the lower part of which descends into the anterolateral parts of the face (into the subzygomatic region). From the fat pad, its orbital process extends into the infratemporal fossa, to the inferior orbital fissure. The pterygopalatine process of the fat pad penetrates into the pterygopalatine (pterygopalatine) fossa. The pterygopalatine process sometimes enters the cranial cavity through the lower medial part of the superior orbital fissure, where it is adjacent to the wall of the intercavernous sinus of the dura mater of the brain. The buccinator muscle is covered externally by the so-called buccal-pharyngeal fascia, where the fascia of the buccinator muscle passes into the adventitia of the lateral wall of the pharynx. Between the pterygoid hook of the sphenoid bone above and the lower jaw below, there passes a dense part of this fascia, called the pterygomandibular suture. The mucous membrane of the oral cavity is adjacent to the buccal muscle from the inside.

The temporal fascia (fascia temporalis), covering the temporalis muscle, begins on the lateral surface of the skull, on the temporal line and tendinous helmet. Above the zygomatic arch (3-4 cm above it), the temporal fascia divides into a superficial plate, which is attached to the lateral edge of the zygomatic arch, and a deep plate, which is attached to the medial edge of the zygomatic arch. Between these plates there is a small amount of fatty tissue, in which the superficial blood vessels and nerves (branches of the auriculotemporal nerve and the facial nerve - frontal and zygomatic branches) pass. This fatty interfascial tissue continues downward and anteriorly beyond the boundaries of the temporal region. Together with the anterior part of the superficial plate of the temporal fascia, it passes onto the outer anterior surface of the zygomatic bone and onto the zygomatic muscles.

Between the temporal fascia and the temporal muscle there is a small amount of connective tissue (subfascial tissue), which continues downwards under the zygomatic arch into a narrow gap between the temporal and masseter muscles and passes into the connective tissue between the masseter muscle and the lateral surface of the ramus of the lower jaw. The masseter artery and nerve penetrate into this space, heading for the masseter muscle, and the vein of the same name exits. In the space between the anterior edge of the temporal muscle (under the fascia of the temporal muscle) and the outer wall of the orbit, there is also fatty tissue communicating with the area of the fat pad of the cheek.

The masseteric fascia (fascia masseterica), covering the muscle of the same name and firmly fused with its superficial bundles, is attached to the lateral surface of the zygomatic bone and zygomatic arch at the top, fuses with the buccal fascia at the front, and with the capsule of the parotid salivary gland located in the submandibular fossa at the back. The duct of the parotid salivary gland passes along the lateral surface of the fascia-covered masseter muscle in the posteroanterior direction. The orifice of this duct is located on the mucous membrane at the level between the first and second upper molars.

The deep cellular space of the temporal region is located between the temporal muscle and the periosteum in the region of the temporal fossa. The deep temporal vessels (anterior and posterior deep temporal arteries) pass through this cellular space, rising here from the infratemporal fossa.

In the area of the infratemporal fossa, which should be considered a deep area of the face, near the lower part of the temporal and pterygoid muscles, there is fatty tissue where vessels and nerves pass. According to the location here, there are temporopterygoid and interpterygoid cellular spaces that communicate with each other. The temporopterygoid space, in which the maxillary artery and venous pterygoid plexus are located, lies between the temporal and lateral pterygoid muscles. Some of the veins of this venous plexus are found in the thickness of the fascia of the lateral pterygoid muscle. The interpterygoid cellular space occupies the place between the medial and lateral pterygoid muscles, covered with their own fascia. Where these muscles touch, the fascia form a single sheet, called the interpterygoid fascia. The mandibular nerve and its branches (mandibular, auriculotemporal, buccal and lingual nerves) pass through the interpterygoid space. Blood vessels that feed the pterygoid muscles and the lower jaw also pass through here.

To the inside of the deep area of the face is the peripharyngeal cellular space of the head. It is limited from the outside by the medial pterygoid muscle covered with fascia. On the inside is the lateral wall of the pharynx, behind are the transverse processes of the upper cervical vertebrae covered with prevertebral fascia and muscles. The muscles originating on the styloid process (styloglossus, styloglossus, stylohyoid), covered with their own fascia, divide the peripharyngeal space into anterior and posterior parts. This muscular-fascial bundle, originating on the styloid process, connects with the so-called buccal-pharyngeal fascia. This bundle divides the peripharyngeal space into anterior and posterior parts; in scientific literature it is called the stylodiaphragm. The internal carotid artery, internal jugular vein and 4 cranial nerves (glossopharyngeal, vagus, accessory and hypoglossal nerves) pass through the posterior part of the peripharyngeal space. The lymph nodes located near the internal jugular vein are also located here. The anterior part of the peripharyngeal space is occupied by fatty tissue and small blood vessels.