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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 sinussup. 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