Transcript Anatomy of the Face

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Anatomy of the Face
Professor Emeritus Moira O’Brien
FRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dublin
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Face
• Sensory supply of face is
trigeminal
• 5th cranial nerve
• C2
• Motor supply
• Muscles of facial expression
• Facial nerve 7th cranial
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Sensory Nerve Supply
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Trigeminal
Ophthalmic
Maxillary
Mandibular
Cervical plexus
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Terminal Branches of 5th
• Supraorbital
• Infraorbital damaged in blow
out fracture of orbit
• Lateral
• Mental; dentures, fracture of
mandible
• Trigeminal neuralgia
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Sensory Trigeminal Nerve
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Ophthalmic V
Supraorbital
Supratrochlear
Maxillary V
Infraorbital
Zygomaticofacial
Mandibular V
Mental
Buccal
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Fractured Zygoma
• View from above
shows depression
• Lateral X-ray view
should be done
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Great Auricular
• C2 from cervical plexus
• Skin over angle of mandible
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Scalp
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Skin
Subcutaneous
Epicranial aponeurosis
Three fused together
Loose areolar tissue
Periosteum
Occipito-frontalis
Attached posteriorly
No anterior attachment
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Scalp
• Occipital portion of occipitofrontals and epicranial
aponeurosis attached to bone
posterior
• Frontal no bony attachment
• Scalp wounds cause black eyes
• Occipital belly
• Posterior auricular of facial
nerve
• Frontal belly by temporal of
facial nerve
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Blood and Nerve Supply of Scalp
• Supraorbital vessels and
nerve
• Scalp as far as vertex
• Posterior scalp
• Greater occipital C2
• Occipital and posterior
auricular vessels
• Zygomatico temporal
• Greater auricular
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Eyelid
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Skin
Orbicularis oculi
Palpebral portion
Orbital septum and tarsal
plates, mebonium glands
• Medial palpebral ligament
anchors tarsal plates to
anterior lacrimal crest
• Conjunctival sac
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Levator Palpebrae Superiores
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Arises from back of roof of orbit
Inserted into skin of upper eyelid
The superior tarsal plate
Superior fornix of conjunctiva
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Levator Palpebrae Superiores
• Elevates upper eyelid
• Voluntary muscle supplied by 3rd
oculomotor nerve
• Smooth muscle
• Sympathetic T1
• Superior cervical ganglion
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Lacrimal Apparatus
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Lacrimal gland
Conjunctival sac
Puncta
Cananiculi
Nasolacrimal sac
Nasolacrimal duct
Inferior meatus nose
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Horner's Syndrome
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Ptosis
Drooping eyelid
Meiosis
Constricted pupil
Anhydrosis
Lack of sweating
Enopthalmos
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Muscles of Facial Expression
• Muscles of second branchial
arch
• Nerve second arch is facial
nerve
• Inserted into skin of face
• Buccal pad of fat
• No deep fascia in face
• Except around parotid
• Parotid duct
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Orbicularis Oculi
• Orbital closes eyelid tightly,
buries eyelashes
• Makes conjunctival sac
smaller
• Finer palpebral portion in
eyelid
• Anterior to tarsal plate
• Closes eye in blinking and
sleep
• No action on conjunctival sac
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Muscles of Facial Expression
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Occipito frontalis
Orbicularis oculi
Orbicularis oris
Buccinator
Platysma
Skin of face
Incisions
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Muscles of Facial Expression
• Orbicularis oris
• Intrinsic: origin and
insertion inside, only
alters shape
• Extrinsic: origin outside,
alters position
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Muscles of Facial Expression
• Incisions in the face evert
edges
• Platysma
• Inserted into lower border of
mandible
• Posterior fibres form risorius
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Buccinator
• Buccinator 7th nerve
• Accessory muscle of
mastication
• Outer aspect of maxilla and
mandible
• Related to molar teeth
• Pterygomandibular raphe
• Action keeps food out of
vestibule
• Sucking
• Blowing trumpet
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Facial Nerve
Motor nerve to:
• Posterior auricular to occipital
belly
• Posterior belly of digastric
Enters parotid and divides into
branches
• Temporal
• Zygomatic
• Buccal
• Mandibular
• Cervical
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Facial Nerve
• Stroke
• Upper motor neurone of
facial
• Forehead is spared
• Can wrinkle forehead
• Bilaterally innervated
• All muscles of one side
paralysed if it is a lower
motor neurone e.g. Bell’s
palsy
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Bell’s Palsy
• Lower motor neurone of
facial nerve
• Forehead and all the
muscles on the side of
lesion are affected
Facial Palsy
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Corneal Reflex
• Afferent (sensory) cilary branches
nasocilary of ophthalmic of 5th
• Efferent (motor)
• Zygomatic branch of facial 7th
• Last reflex to go
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Blood Supply and Pulses in Face
Internal carotid
• Supraorbital artery
• Branch of ophthalmic
External carotid
• Superficial temporal artery
• Facial artery
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Venous Drainage of Face
• Supraorbital and anterior
facial
• Communicate superior
ophthalmic veins which
drain into cavernous sinus
• Deep facial vein
• Superficial temporal
• Retromandibular
• Common facial
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Emissary Veins Cavernous Sinus
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Superior ophthalmic veins
Anterior facial
Deep facial
Pterygoid plexus
Danger area of face
Parietal emissary veins from
scalp to superior sagittal sinus
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Lymph Glands
• Submental
• Submandibular
• Buccal and
mandibular
• Preauricural
• Occipital
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