Transcript FACE - Student Life

FACE
ExtentSuperiorly- hairline
Inferiorly- chin & base
of the mandible
On each side- auricle
Forehead is common
for both scalp &
face
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Skin1. Highly vascular
2. Rich in sebaceous gland & sweat gland
3. Laxity- facilitates rapid spread of the oedma
4. Boils in the nose & ear causes intense pain
due to the fixity of the skin to the underlying
cartilage
5. Elastic and thick because the facial muscles
are inserted into it.
FACE
Superficial fasciaContents1. Fascial muscles
2. Vessels & nerves
3. Fats
Deep fascia- absent except over the parotid fascia
& over the buccinator where it forms the
buccopharyngeal fascia
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Fascial musclesTopographically
1. Muscles of the scalp- occipitofrontalis
2. Muscles of the auricle- i) auricularis anterior, ii) auricularis
superior & iii) auricularis posterior
3. Muscles around the eyelids-i) orbicularis oculi, ii) corrugator
supercilli & iii) levator palpebrae superiorsis
4. Muscles of the nose-i) Procerus, ii) Compressor naris, iii)
Dilator naris & iv) Depressor septi
5. Muscles around the mouth- i) orbicularis oris, ii) levator labii
superioris alaeque nasi, iii) zygomaticus major, iv)Levator
labii superioris, v) Levator anguli oris, vi) zygomaticus
minor, vii) Depressor anguli oris viii) Depressor labii
inferioris, ix) Mentalis x) Risorius & xi) Buccinator
6. Muscles of the neck- platysma
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Common facial
expression1. Smiling &
laughing:zygomaticus
major
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2. Sadness:levator labii
superior &
levator anguli
oris
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3. Grief:- depressor anguli oris
4. Anger:- Dilator naris & depressor septi
5. Frawning:- Corrugator supercilli & procerus
6. Horror, terror & fright:- platysma
7. surprise:- Frontalis
8. Doubt:- Mentalis
9. Grinning:- Risorius
10. Contempt:- zygomaticus minor
11. Closing of mouth:- orbicularis oris
12. Whistling:- buccinator & orbiularis oris
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Clinical anatomy1. Frontalis- patient must look upwards without moving the
head and look for the horizontal wrinkles of the forehead
2. Corrugator supercilli- frowning & making the vertical
wrinkles of the forehead
3. Orbicularis oculi- tight closure of the eyes
4. Orbicularis oris- whistling and pursing the mouth
5. Dilator of mouth- showing the teeth
6. Buccinator- puffing the mouth & then blowing forcibly as in
whistling
7. Platysma- forcible pulling of the angle of mouth downwards
and backwards forming prominent vertical fold of the skin of
the neck. Platysma contracts along with the risorius
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Motor nerve supply of the
face1. Facial nerve (TZBMC)
i) Temporal- frontalis,
auricularis muscles
and orbicularis oculi
ii) Zygomatic- orbicularis
oculi
iii) Buccal- muscles of
the cheek and upper
lip
iv) Marginal mandibularmuscles of the lower
lip
v) Cervical- platysma
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Clinical anatomy
Infranuclear lesion (Belly’s palsy)1. whole face of the same side gets paralysed.
2.
Face becomes asymmetrical and is drawn up to the normal side.
3. Affected side is motionless.
4. Wrinkles disappear from the forehead.
5.
Eyes cannot be closed
6. While smiling the mouth is drawn to the normal side
7. During mastication food accumulates in between the teeth and the
chick
8. Articulation of labials is impaired
Supranuclear lesions1. usually a part of hemiplegia, only the lower part of the opposite side
of the face is paralysed.
2. Upper part of the frontalis & orbicularis oculi escapes due to its
bilateral representation in the cerebral cortex.
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Arterial supply of
the face1. Facial artery
2. Transverse
facial artery
3. Arteries
accompanying
the cutaneous
nerves
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Facial arteryExtent-Branch of ECA given off in the carotid triangle just above
the greater cornua of the hyoid bone. In cervical course it
passes through the submandibular region and enters the
face region.
Course1. Enter face by winding around the base of mandible & by
piercing the deep cervical fascia, at the anteroinferior angle
of the masster muscle. It can be palpated here and is called
the anaesthetist’s artery.
2. First it runs upwards & forwards to a point 1.25cm lateral to
the angel of the mouth. Then it ascends by the side of the
nose up to the medial angle of the eye, where it terminates
by supplying the lacrimal sac; and by anastomosing with the
dorsal nasal branch of the ophthalmic artery.
3. Lies between the superficial and deep muscles of the face.
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Branches1. Anterior branch
(large)-i) inferior
labial to the lower
lip, ii)superior labial
to the upper lip and
anteroinferior part
of the nasal septum
&iii) lateral nasal to
the ala and dorsum
of the nose
2. Posterior branchsmall and unnamed
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Transverse facial arteryIt is a small branch of the
superficial temporal a.
After emerging from the parotid
gland it runs forward over the
masseter between the parotid
duct and the zygomatic arch,
accompanied by the upper
buccal branch of the facial
nerv. It supplies the parotid
gland and its duct, masseter
and the overlying skin and
ends by anastomosing with
the neighbouring arteries
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Veins of the face
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Lymphatic drainage1. Preauricular lymph nodes (upper territory)- greater
part of forehead,lateral halves of the eyelids,
conjunctiva,lateral part of cheek and parotid
region
2. Submandibular lymph nodes ( middle territory)median part of the forehead, the external nose,
the upper lip, lateral part of the lower lip, the
medial halves of the eyelids, the medial part of the
cheek and greater part of the lower jaw
3. Submental nodes ( lower territory)- central part of
the lower lip and chin
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Mucus glands
1. Labial glands
2. Buccal glands
3. Molar glands
1& 2 are numerous and lies in the submucosa of
the lips and cheeks
3 lies on the buccopharyngeal fascia around the
parotid duct
Finally all these opens into the vestibule of the
mouth
Eyelids or palpebrae
1. Upper & lower eyelids
Space between this two eye lidpalpebral fissure
Two lids fused with each other to
form medial & lateral angles
or canthi of the eye.
At the inner canthi- small
triangular space, lacus
lacrimalis
Lacrimal caruncle(elevated
portion in the lacus
lacrimalis)
Lateral to the caruncle-bulbular
conjunctiva is pinched up to
form a vertical fold called the
plica semilunaris
Eyelids or palpebrae
Eyelids- attached at margins of
the orbital opening.
free edges is broad and has
rounded outer lip and a
sharp inner lip.
Outer lip-2 or more rows of
eyelashes or cilia except in
the boundary of the lacus
lacrimalis.
At the point where the
eyelashes cease- lacarimal
papilla on the summit there is
lacrimal punctum.
Near the inner lip of the free
edge-a row of openings of
the tarsal glands
Eyelids or palpebrae
StructuresSkin- thin, loose & easily distensible by oedema fluid or blood
Superficial fascia- absence of fat, contains palperbral part of the
orbicularis oculi
Palpebral fascia- two lids forms orbital septum, its thickening
forms tarsal plates or tarsi in the lids & palperbral ligs at the
angles.
Upper tarsus- levator palpebrae superioris & tarsal glands or
Meibomian glands embedded in the posterior surface of the
tarsi- ducts open in a row behind the cilia
Conjunctiva- lines the posterior surface of the tarsus
Glands- large sebaceous gland or Zeis’s gland, modified sweat
glands or Moll’s gland & sebaceous or tarsal glands or
Meibomian glands
Eyelids or palpebrae
Eyelids or palpebrae
Blood supply1. Superior & inferior palpebral branches of the ophthalamic
a
2. Lateral palpebral branch of the lacrimal a
Veins- ophthalamic and facial vein
Lymphatic drainage:medial halves of the lids -submandibular nodes & lateral
halves -preauricular nodes
Nerve supply:Upper eyelid- lacrimal,supraorbital, supratrochlear &
infratrochlear nerves
Lower eyelid- infraorbital and infratrochlear nerves
Lymphatic drainage- medial ½ into the submandibular &
lateral ½ into preauricular nodes.
Lacrimal apparatus
Lacrimal apparatus
1. Lacrimal gland & its
ducts
2. Conjunctival sac
3. Lacrimal puncta &
lacrimal canaliculi
4. Lacrimal sac
5. Nasolacrimal duct
Lacrimal apparatus
Lacrimal glandSerous gland
located in lacrimal
fossa
J shaped, intended
by the tendons of
the levator
palpebrae
superioris muscle.
a)Orbital part- large
& deeper
b) Palpebral partsmall & superficial
Lacrimal apparatus
Nerve supply- lacrimal nerve
Arterial supply- ophathalamic a
Secretomotor fibres- lacrimatory nucleus----nervus
intermedius---- geniculate ganglion—greater
petrosal nerve—nerve to pteryoid canal–
pterygopalatine ganglion– relay– zygomatic
nerve—zygomatotemporal– lacrimal nerve–
lacrimal gland
Lacrimal apparatus
Conjunctival sacPotential space
between the
bulbular
conjunctiva and the
palpaberal
conjunctiva
Reflected parted into
the eyeball are
superior and
inferior fronices
Lacrimal apparatus
Lacrimal puncta &
canaliculi10cm long- lacrimal
canaliculi
2mm vertical & 8mm
horizontal parts
Opens into the lateral
wall of the lacrimal
sac
Lacrimal apparatus
Lacrimal sac12cm long & 5mm
wide- situated in the
lacrimal groove
behind the medial
palpebral lig
Upper end blind &
lower end continues
with nasolacrimal
duct
Inflammationdacrocystitis
Lacrimal apparatus
Nasolacrimal duct18mm long
Begins at the lower end of
the lacrimal sac, runs
downwards, backwards
and laterally and opens
into the inferior meatus
of the nose.
Valve of Hanser
Clinical anatomy
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Palpebral conjunctiva is examined for anaemia & for
conjunctivitis; bulbar conjunctiva for jaundice
Conjunctivitis is one of the commonest diseases of the
eye
Trachoma- trachoma virus. Which causes the
blindness
Stye or hordeolum is a suppurative inflammation of
one of the glands of the Zeis.
Chalazion- inflammation of the tarsal gland
Blepharitis – inflammation of the eyelids specially of
the lid margins