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MOB TCD Anatomy of the Face Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinity College Dublin MOB TCD Face • Sensory supply of face is trigeminal • 5th cranial nerve • C2 • Motor supply • Muscles of facial expression • Facial nerve 7th cranial MOB TCD Sensory Nerve Supply • • • • • Trigeminal Ophthalmic Maxillary Mandibular Cervical plexus MOB TCD Terminal Branches of 5th • Supraorbital • Infraorbital damaged in blow out fracture of orbit • Lateral • Mental; dentures, fracture of mandible • Trigeminal neuralgia MOB TCD Sensory Trigeminal Nerve • • • • • • • • • Ophthalmic V Supraorbital Supratrochlear Maxillary V Infraorbital Zygomaticofacial Mandibular V Mental Buccal MOB TCD Fractured Zygoma • View from above shows depression • Lateral X-ray view should be done MOB TCD Great Auricular • C2 from cervical plexus • Skin over angle of mandible MOB TCD Scalp • • • • • • • • • Skin Subcutaneous Epicranial aponeurosis Three fused together Loose areolar tissue Periosteum Occipito-frontalis Attached posteriorly No anterior attachment MOB TCD 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 MOB TCD 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 MOB TCD Eyelid • • • • Skin Orbicularis oculi Palpebral portion Orbital septum and tarsal plates, mebonium glands • Medial palpebral ligament anchors tarsal plates to anterior lacrimal crest • Conjunctival sac MOB TCD Levator Palpebrae Superiores • • • • Arises from back of roof of orbit Inserted into skin of upper eyelid The superior tarsal plate Superior fornix of conjunctiva MOB TCD Levator Palpebrae Superiores • Elevates upper eyelid • Voluntary muscle supplied by 3rd oculomotor nerve • Smooth muscle • Sympathetic T1 • Superior cervical ganglion MOB TCD Lacrimal Apparatus • • • • • • • Lacrimal gland Conjunctival sac Puncta Cananiculi Nasolacrimal sac Nasolacrimal duct Inferior meatus nose MOB TCD Horner's Syndrome • • • • • • • Ptosis Drooping eyelid Meiosis Constricted pupil Anhydrosis Lack of sweating Enopthalmos MOB TCD 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 MOB TCD 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 MOB TCD Muscles of Facial Expression • • • • • • • Occipito frontalis Orbicularis oculi Orbicularis oris Buccinator Platysma Skin of face Incisions MOB TCD Muscles of Facial Expression • Orbicularis oris • Intrinsic: origin and insertion inside, only alters shape • Extrinsic: origin outside, alters position MOB TCD Muscles of Facial Expression • Incisions in the face evert edges • Platysma • Inserted into lower border of mandible • Posterior fibres form risorius MOB TCD 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 MOB TCD 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 MOB TCD 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 MOB TCD Bell’s Palsy • Lower motor neurone of facial nerve • Forehead and all the muscles on the side of lesion are affected Facial Palsy MOB TCD MOB TCD MOB TCD Corneal Reflex • Afferent (sensory) cilary branches nasocilary of ophthalmic of 5th • Efferent (motor) • Zygomatic branch of facial 7th • Last reflex to go MOB TCD Blood Supply and Pulses in Face Internal carotid • Supraorbital artery • Branch of ophthalmic External carotid • Superficial temporal artery • Facial artery MOB TCD 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 MOB TCD Emissary Veins Cavernous Sinus • • • • • • Superior ophthalmic veins Anterior facial Deep facial Pterygoid plexus Danger area of face Parietal emissary veins from scalp to superior sagittal sinus MOB TCD Lymph Glands • Submental • Submandibular • Buccal and mandibular • Preauricural • Occipital “BMJ Publishing Group Limited (“BMJ Group”) 2012. All rights reserved.”
