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Face
• Muscles of facial expression
• Nerves of face and scalp
• Blood supply of face and scalp
Muscles of facial expression
- important but confusing
-act by pulling the skin
-supplied by facial nerve (VII)
-derived from 2nd brachial arch
1. epicranial m..
2. oral m.
3. periorbital
4. mental m.
5. cervical m (Platysma)
6. nasal m.
7. auricular m.
2
1. Epicranial muscle
Muscles for scalp, forehead, and eyebrow
Occipitofrontalis
• Digastric muscle;Connected by galea aponeurosis
• Elevate the eyebrow and wrinkles the forehead
3
Posteriorly: “O” is attached to sup. nuchal line
Anteriorly: “F” interdigitates with orbicularis oculi
Epicranial aponeurosis
7.Auricularis
2. Oral muscles
A 3-dimensional group of muscular slips
•orbicularis oris (oo)
- sphincter around the mouth
- Interlacing muscles from others
lao : levator angularis oris
- arise from canine fossa of maxilla
(inferior to infra-orbital foramen)
- inserts into the skin of mouth angle
Dilator muscles of the mouth
• Radiate from lips and angle of the mouth
Zygomatic major (zma)
Zygomatic minor (zmi)
Risorius (r)
discontent
smile
Laugh, painful
levator labii superioris (lls)
levator labii superioris alaeque nasi (llsan)
Depressor anguli oris (dao)
Depressor labii inferioris (dli)
Risorius
llsan
Z.ma
lls
o.o
R
DAO
Disagree/ Sorrow
• Risorius: Parotid fascia and buccal skin—angle of mouth
•
Depressor anguli oris: anterolateral base of mandible– lower lip
Parotid
fascia
Buccinator 頰肌
ZMA
Pterygomandibular
raphe
Parotid
duct
Masseter
DAO
Arise from
1. Alveolar process on
• 1.Max-o: maxillary origin
• 2.Mand-o: mandibular origin
2. Pterygomandibular raphe (pr)
Buccinator
Its fibers are inseparably from orbicularis oris
Buccinator
• Compress the cheek
• Retract the angle of mouth
Smile/ Buck teeth
彰化縣文化局典藏
3. Periorbital muscles
-Orbicularis oculi
-origin: medial palpebral ligament (med.)
(no bony attachment laterally)
MPL: medial palpebral lig.
CS: corrugator supercilli
P: procerus
orbicularis oculi:
-sphincter
-palpebral part and orbital part
11
Corrugator supercilii
Procerus
produce a vertical furrow
nasal bone  skin between eyebrows
produce transverse furrows
4.Mental muscle
Elevate and protrude the lower lip
Mental ms.
•
anterior to Root of 2nd lower incisor – skin of the chin
Muscle of the nose
Levator labii superioris alaeque nasi.
Ilsan + alar part of nasalis.
Nasalis.
Nerves of face and scalp
• Motor: facial nerve (CN VII)
• Sensory: trigeminal nerve (CN V)
cervical plexus: greater auricular nerve
Ophthalmic nerve
(V1)
Posterior ramus of cervical spinal nerves
(Greater and Lesser occipital nerves)
Maxillary nerve
(V2)
Mandibular nerve
(V3)
Great auricular nerve
(C2,3)
Inferior part of auricle;
parotid region
Trigeminal nerve
• Sensory root for the face: 3 divisions (ophthalmic, maxillary,
mandibular)
• Motor root: for the muscles of mastication (CN V3).
Ophthalmic.
Trigeminal
ganglion
Maxillary
Mandibular
Ophthalmic nerve (CN V1, sensory fiber only)
Frontal nerve/ Lacrimal nerve/Nasocilliary nerve
Frontal n.
Lacrimal n.
Nasocilliary n.
Ophthalmic n.
Lacrimal gl.
Ophthalmic nerve (CN V1, Supra-orbital fissure)
1. Frontal nerve
- supratrochlear n./ supra-orbital n.
- forehead and scalp
Supratrochlear n.
Supraorbital n.
S.T
S.O
Frontal n.
CN IV
Lacrimal n.
2. Lacrimal nerve
-
Ophthalmic n.
gland/ skin, conjunctiva from
superior eyelid
Ophthalmic nerve (CN V1)
Ant. ethmoidal n.
Post. ethmoidal n.
3. Nasocilliary nerve
- Posterior ethmoidal n.
Anterior ethmoidal n. (*)
Infratrochlear n.
- external nose*/ cornea /sinus
Infratrochlear n.
Nasociliary n.
Infratrochlear n.
Ophthalmic n.
Lacrimal
gland.
Ant. ethmoidal n.
Nasocilliary n.
Lacrimal n.
Ext. nasal nerve from ant. ethmoidal n.
Maxillary nerve (CN V2)
Wholly sensory
via foramen rotundum; inferior aspect of the orbit; end as infraorbital nerve
Lacrimal gland
1.Zygomatic nerve
Meningeal branch
Maxillary nerve
2.Infraorbital
nerve
Zygomatic nerve (branch of CN V2)
Inferior orbital fissure/ Lateral wall of orbit
3.secretomotor br. lacrimal g
Zygomatic nerve
1.Zygomaticotemporal n.
- scalp, anterior temporal region
Meningeal branch
2.Zygomaticofacial n.
- region over cheekbone
ZT
2.Infraorbital
nerve
ZF
Maxillary nerve (CN V2)
Infra-orbital nerve
-pterygopalatine ganglion
-branches to teeth (alveolar n.)
-maxillary sinus
-palate (hard, soft)
-Infra-orbital foramen: mid-face
Pterygopalatine ganglion.
anterior superior alveolar n.
middle superior alveolar n.
Posterior superior alveolar n.
Distribution of CN V1 and CN V2
* Nasopalatine nerve: palate and part of nasal septum
Mandibular nerve (CN V3)
• Combined motor and sensory (motor root of CN V courses with this division)
Auriculotemporal n.
Motor fibers:
• muscles of mastication
• digastric muscle, anterior belly
• Mylohyoid m., tensor tympani
Buccal n.
Bucinnator
ms.
Inferior alveolar n
(cut)
Mental n.
Lingual nerve
(sensory innervation
of the tongue)
•
1.
2.
3.
4.
Sensory branches
Mandibular nerve (CN V3)
Auriculotemporal nerve
Buccal nerve (inside cheek)
Inferior alveolar n. Mental nerve (mental foramen)
Lingual nerve (ant. 2/3 tongue)
Mental n.
Buccal n.
Auriculotemporal n.
Facial nerve (CN VII)
•Motor + sensory/parasympathetic
•Muscles of facial expression
•Stylomastoid foramen
F. ovale
Styloid process
Mastoid process
Chorda
tympani
Stylomatoid foramen
Stylomastoid
foramen
Lingual n.
Facial nerve
•Main trunk in parotid plexus
 2 divisions
 5 terminal branches
1) Temporal branch
2) Zygomatic branch
*
3) Buccal branch
4) Marginal mandibular branch
5) Cervical branch
Remark: posterior auricular nerve*
1.Temporal branch
2.Zygomatic branch
-Auricularis ant./ sup.; Frontalis
-Orbicularis oculi, superior part
-Orbicularis oculi, inferior part
-Infra-orbital muscles
3.buccal branch
-buccinator
- muscles of upper lip
1
2
4.Marginal mandibular br.
-Inf. border of parotid, mandible
- muscles of lower lip, chin; risorius
-parallel parotid duct
3
4
5
* Posterior auricular n.
-Auricularis post. ; Occipitalis
5.Cervical branch
-Post. to mandible
-Platysma
Parotid gland
Auditory
meatus
Masseter
SCM
buccal branch
Parotid duct
Horizontal section
Mandible
Masseter m.
Mastoid proc.
Motor nerve of the face
(CN V3)
Great auricular nerve (C2,3)
Parotid sheath; skin over angle of
mandible
32
Superficial arteries of the face:
branches of external carotid artery
Pulses of arteries of the face:
superficial temporal, facial a.
33
Facial artery
Angular
Sup. labial
Inf. labial
• Major arterial supply
• Inf. border of mandible
• Angle of mouth: superior and
inferior labial arteries
• Medial angle of eye: lat. dorsal
a. angular artery
• Anastomosis: Ophthalmic artery
Transverse facial artery
• 1 fb below zygoma arch
• Within parotid gland
• Many branches to parotid gland
Blood supply of the face and eye:
in relation to the sites of cosmetic facial filler injections
Ophthalmic a.
Central retinal a.
American Journal of Ophthalmology, Volume 154, Issue 4, 2012, 653
Superficial temporal artery
• Between TM joint and auricle;Superficial, pulsation
• Accompany auriculotemporal nerve (CN V3)
Remarks:
arteries accompany cutaneous
nerves
•Superficial temporal a. and
auriculotemporal n.
•Supraorbital nerve and artery
•Supratrochlear nerve and artery
•Mental artery (branch of
maxillary a.) and nerve
External veins of face
•
•
Variation/ Accompany arteries
Anastomosis: superficial and deep
Retromandibular v. (ant. br.) +facial v.
Retromandibular v. (post. br.) +posterior
auricular v.
Post. auricular v.
*
Ext. jugular v.
Facial v.
Int. jugular v.
* Retromandibular vein
Deep anastomosis
•Pterygoid venous plexus Deep facial vein  facial v.
•Cavernous sinussup. Ophthalmic vein  facial v.
Cavernous
sinus
Sup. Ophthalmic v.
Deep facial vein
Pterygoid venous plexus
Maxillary v
Retromandibular v
Facial vein
Lymphatic drainage of the face and scalp
No lymph nodes in scalp and face,
- except parotid and buccal regions
Superficial ring of lymph nodes:
- junction of head and neck
1. lat. face & scalp 
parotid lymph nodes
2. deep parotid nodes 
deep cervical lymph nodes
3. upper lip & lat. lower lip 
submandibular lymph nodes
4. chin & central lower lip 
submental lymph nodes
39
Bell palsy
Herpes Zoster Ophthalmicus
Am Fam Physician 2002;66:1723
Infra-orbital nerve block