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The Face
Shape of face depend on :
- facial skeleton
- disposition of soft tissue
- type of face
**Facial growth during child
hood as the paranasal sinus
develop and permanent teeth
erupt.
Type of face
There are two types of face:1- Leptoprosopic face
- long , narrow
- protruding maxilla
- retruding mandible
2- Euryprosopic face
- upper part of face is less prominent
- nose is short
- eyes are wide set
- cheek bones are usually more
prominent.
Sexual Variation of face
- face show sexual dimorphism although
facial types are similar until the age of 12
year.
- face of female attains its mature form
earlier than the male.
- male face tend to be more protuberant,
bulky and coarse.
- nose of female have a concave to straight
profile.
- supra orbital ridge of male overhang the
face, those of female are at same level as
inferior orbital margin and cheek bones.
**On reflection the skin of the face,
the following main structures are
revealed:
1- muscles of facial expression
2- facial nerve
3- cutane. branches of trigeminal nerve
and great auricular n.
4- parotid gland and duct
5- buccal pad of fat
6- facial L.N.
Skin of face:
- Thin
- Vascular
- Movable
- Abundly supplied with
sebaceous and sweat gland
- No deep fascia
- So it especially adaptable for
surgical plastic operation.
Muscles of the face
*Characterized by subcutaneous location
move the skin and change facial expression.
*Placed around orifice of eye (palpebral
fissure), ear nose and mouth ( oral fissure).
* All muscle of face developed from 2nd
pharyngeal arch which supply by facial
nerve.
2 orbicalaris : orbiculais ocul
orbiculais oris
2 associated with nose : procerus
compressor nares(in infant)
2 associated with nose : zygomaticus minor
Zygomatoe area :
zygomaticus major(m.of smiling)
2 elevator of upper lip : levator labii superioris
alaeque nasi
Levator labii superioris
2 muscle with angle of mouth :levator anguli oris
Depressor angel oris
2 muscles with lower lip: risorius
Depressor labii inferioris
2 muscle associated with
chin and cheek:
Mentalis
buccinator muscle
Orbicularis Oculi:
3 parts:
1- Orbital part: strongly close of eye
protecting it from dust, bright
light , mingling with fiber of
frontalis muscle.
2- Palpebral part: gently close the eye lid as
in blinking or in sleep to keep
the cornea from drying
3- Lacrimal part: posterior border of lacrimal
fossa to lid , its function to dilate
lacrimal sac so that fluid
discharge from conjunctiva to
lacrimal sac.
Buccinator:* Attached to alveolar process of maxilla,
mandible opposite molar tooth to
ptergomandibular raphe.
* Active in smile.
* Keep check taut, preventing it from folding
and being injured during chewing
* Mingle medially with orbicularis oris
* Aid in mastication
* Used during whistling , sucking and blowing
Nerve Supply of the face
Face have both motor and sensory
* Motor: nerve derived from facial nerve (nerve of
second pharyngeal arch)
* Sensory: innervations is primarly from three
division of trigeminal nerve (CN V) with
exception of small area over angle of
mandible and parotid gland which
supply by great auricular nerve(C2,C3).
* Motor nerve of the face:- facial nerve to muscle of facial expression
- motor root of mandibular nerve to muscle of
mastication
Facial nerve:- leave the skull at stylomastoid foramen
give off posterior auricular nerve
- send fiber to :- Stapedius muscle
- Stylohyoid muscle
- Posterior belly of digastric muscle
- Scalp muscles
- Auricular muscle
- Platysma muscle
- Buccinator
* Provides secretary fiber to salivary and
sensory (taste) fibers to anterior 2/3 of
tongue.
* Enter parotid isthmus and passes
between superior and deep loops of
gland.
* It is superficial to external carotid artery
and retromandibular vein so may be
injured in operation in parotid region .
* Terminal branches appear at margin of
parotid (antromedial surface of gland).
Five terminal branches of facial
nerve
1- Temporal branch- frontalis- orbicularis
oculi(upper).
2- Zygomatic branch – orbicularis oculi:(lower)
3- Buccal branch- Buccinator- orbicularis oris.
4- Mandibular- (marginal) passes along lower
border of mandible crossing facial
artery and vein and submundibular
L.N.
5- Cervical branch – platysma
Facial Nerve Injury
Non-traumatic cause of facial parlay is inflammation of
facial nerve near stylomastoid foramen so patient has;
1- Can not close his eyes and palpebral fissure appear
wider, lacrimal fluids drips on cheeks laterally, drying
of cornea.
2- Patient van not whistle, blow or chew effictualey so
food will accumulate between cheeks and gum so
patient use his finger to remove food due to parlysis
of buccintor muscle.
3- Displacement of corner of mouth , so food and saliva
dripling outside of mouth.
Facial Nerve Pulsy has many
causes:
1- Idiopathic (Belly pulsy) Exposure to
cold (30 to 50 years).
2- Complication of surgery in Parotid
gland.
3- Dental manipulation-vaccination.
4- Infection of middle ear .
Injury to Branch of facial nerves
1- By stab wound- gunshots.
2- Injury at birth.
3- Injury of temporal bones.
4- Surgical approach to sub mandibular
gland- resulting in dropping of corner of
mouth.
Sensory Nerves of face
Trigeminal nerve (5)
V1- Ophthalmic nerve :
Forehead – upper eyelid- conjunctiva of
eye- side of nose
5 Branches
1-Lacrimal nerve
2- Supraorbital nerve
3- Supratrochler nerve
4- Infratochlear nerve
5- External nasal nerve
V2- Maxillary nerve:
Side of nose- lower eyelid-check-upper
lip-lateral side of orbital opening
3 Branches
1- Infraorbital nerve
2- Zygomatico facial nerve
3- Zygomatico temporal nerve
V3- Mandibular Nerve:
Lower lip- lower part of face- temporal
region –part of auricle
3Branches
1- Mental nerve-inferior alveolar nerve
2- Buccal nerve- Mucous membrane of
check.
3- auriculo temporal nerve-accompany
superficial temporal vessels
1- Facial Artery:
- from external carotid artery
- winds its way to inferior border of mandible
- interior to massetor so artery lies
superficial deep to platysma
- cross mandible, buccinator, maxilla to
medial canthus of eye
- lies deep to Zygomaticus major, levator
labii superioris.
- lies fingerbirth lateral to angle of
mouth.
- give superior,inferior labial arteries
- ascend alongside of nose joined
dorsal nasal branches of ophthalmic
artery.
- terminal branch of facial artery is
called angular artery.
2- Superficial temporal artery:
transverse facial artery.
3- Maxillary artery: mental arterybuccal artery- infra orbital artery
4- Opthlmic artery: supra orbital
artery- supra trochlear artery- lacrimal
artery – dorsal nasal artery- external
nasal artery
Venous drainage of face
* Is formed by union of supra orbital and
supra trochlear.
* Connected to superior ophthalmic vein
which connected facial vein to cavernous
sinus.
* Join anterior division of retro mandibular
vein.
* Drain into internal jugular vein directly or
indirectly.
* Taking a less tortuous but more superficial
course.
Lymphatic drainage of face:
1- submundibular L.N.- forehead- anterior
part of face.
2- Buccal L.N.
3- Parotid L.N. lateral part of face- lateral
part of eyelid.
4- Submental L.N.-central part of lower lip,
skin of chin.
Veins of the face
Supra temporp v.
+
Maxillary v.
supratrochele v.
+
supraorbital v.
Angular v.
Retromandibular v. Ant. +
Facial v.
Post.
+
Post. Amicular v.
Ext. jugular v.
common facial v.
int. jugular v.
Dangerous Area of face
* Is triangle bounded by lines join root
of nose with angle of mouth.
* Venus drainage from this area enter
angular veins which communicate with
cavernous sinus.
* Therefore boil, carbuncle in this
region produce cavernous sinus
thrombosis.
The Scalp
*Consist of five layers of soft tissue
covering calvaria:S=skin
C= C.T.
A= Aponeurotic
L= loose C.T. (dangerous area)
P= Pericranium
* Frontalis muscle has no bony
attachments.
Nerve of the scalp
- Trigeminal nerve
- Cervical plexus C2-C3 ( great auricular, lesser
occipital, greater occipital)
Artery of the scalp
1- external carotid artery – occipital – posterior –
auricular – superficial temporal
2- internal carotid artery – supra trochlear- supra
orbital.
Lymphatic Drainage of the scalp
- there is no L.N. in the scalp
- superficial ring of L.N. (submental ,
submandibular, parotid, retro auricular and
occipital L.N.
Quiz
Q1/ Could you explain the following:
1- In Bells palsy there is decrease of lacrimation
2- Loss of tast in the anterior 2/3 of tongue
3- Painful sensitivity to sound
4- Deviation of the lower jaw and tongue
Q2/ What are the efferent and afferent limbs of cornel blink
reflex (closing of the eyes)
Q3/ Death may result from bilateral severance of which of
the following nerve ?
A- Trigeminal nerve
B- Facial nerve
C- Vague nerve
D- Spinal accessory nerve
E- Hypoglossal nerve