Download Nervous System

Anatomy
training
Content
•
•
•
•
•
•
•
•
Bone
Muscle
Nervous System
Fat
Ligaments
Skin
Mid Face Anatomy
Tear Trough Anatomy
Facial bones
Key Concepts
•
The human skull comprises a total of eight cranial bones and 14
facial bones.
•
Many aspects of facial appearance are determined by the
underlying bones in the upper, middle, and lower thirds of the face.
•
Although there are 14 facial bones, the external features of the
face, including the forehead, orbits, nose, cheeks, and jaw, are
supported by five major bones:
– nasal, zygomatic, maxilla, mandibles, and frontal bones.
•
Technically, the frontal bone is part of the cranium but its height,
width, and slope determine the shape of the forehead. It also forms
both superior orbital rims, which are located beneath the eyebrows.
Between the rims is a smooth medial elevation called the glabellar.
Scanlon VC, 2007.Essentials of Anatomy and Physiology (5th Ed)
Mendelson BC & Jacobson SR. Clin Plastic Surg 35 (2008) 395–404
Continued…
•
The paired nasal bones support the top one third of the nose.
•
The zygomatic bones form the lateral portion of the inferior
orbital rims as well as the majority of the lateral orbital rims and
walls.
•
The maxilla forms the orbital floor, inferior orbital rim, lateral
nasal sidewalls, and hard palate. It also forms the alveolar ridge
that contains the upper teeth.
•
Just below the inferior orbital rim, on the midline of the pupils, is
the infraorbital foramen. The infraorbital nerve passes through it
to supply sensation to the upper lip.
•
The mandible, or jaw, contains the lower teeth.
Scanlon VC, 2007.Essentials of Anatomy and Physiology (5th Ed)
Mendelson BC & Jacobson SR. Clin Plastic Surg 35 (2008) 395–404
Depressors, Elevators and
Sphincter muscles
• Muscles of the face can be broken into
– Elevators – muscles that lift upwards
– Depressors – muscles that pull downwards
– Sphincter – muscles that contract inwardly
(like a purse string)
Carruthers J et al. Plast Reconstr Surg 2004;114(6 Suppl):1S-22S
Facial muscles - anterior view
Galea aponeurotica
Frontalis
Corrugator
Temporalis
Depressor supercilii
Levator labii superioris
alaeque nasi
Orbicularis oculi
Procerus
Nasalis
Zygomaticus minor
Zygomaticus major
Masseter
Depressor anguli oris
Depressor labii inferioris
Levator superioris
Depressor septi
Orbicularis oris
Risorius
Mentalis
Platysma
Muscles of the Upper Face
Frontalis
Corrugators
Depressor supercilii
Procerus
Orbicularis oculi
Adapted from: Primal Pictures  Anatomy
Elevators and depressors in the
upper face
•
•
•
•
•
Frontalis – elevates the eyebrows
Corrugators – depresses the eyebrows
Procerus – depresses medial brow
Orbicularis Oculi – sphincter muscle
Depressor supercilii – depresses
medial brow
Carruthers J et al. Plast Reconstr Surg 2004;114(6 Suppl):1S-22S
Muscles of the Mid Face
Nasalis
Levator Labii Superioris
Alaeque Nasi (LLSAN)
Levator Labii Superioris
Zygomaticus Major
Zygomaticus Minor
Risorius
Masseter
Adapted from: Primal Pictures  Anatomy
Elevators and depressors in the
Mid face
• Nasalis – Flares nostrils and compresses bridge
• Levator Labii Superioris Alaeque Nasi (LLSAN) elevates the upper lip
• Levator Labii Superioris - elevates upper lip
• Zygomaticus Major - elevates the corners of the
mouth
• Zygomaticus Minor – elevates the upper lip
• Risorius - pulls the corners of the mouth laterally
• Masseter – Muscles of mastication (chewing)
• Levator Anguli Oris - elevates the corners of
the mouth
Carruthers J et al. Plast Reconstr Surg 2004;114(6 Suppl):1S-22S
Muscles of the Lower face and
Neck
Pars Labialis
Depressor Septi
Orbicularis Oris
Pars Mandibularis
Pars Modiolaris
Depressor Labii Inferioris (DLI)
Mentalis
Depressor Anguli Oris
(DAO)
Primal Pictures  Anatomy
Elevators and depressors in the
Lower Face
• Orbicularis Oris - sphincter muscle
• Depressor Anguli Oris (DAO) - depresses the
mouth corners
• Depressor Labii Inferioris (DLI) - depresses the
lower lip
• Depressor Septi – depresses the tip of the nose
• Mentalis – elevates lower lip
• Platysma – depresses superficial
musculoaponeurotic system and lower lip (works with
gravity to pull down lower face)
Adapted from: Primal Pictures  Anatomy
Upper Facial Line Muscles
Source: Allergan Photo Library 2009
Frontalis
FRONTALIS
ORIGIN
Galea aponeurotica
INSERTION
Skin of eyebrows and nose
Source: Primal Pictures  Anatomy
Source: Allergan Photo Library 2009
Marieb, EN. (1998 ) Human Anatomy and Physiology (4th Ed) p 313
Carruthers J et al. Plast Reconstr Surg 2004;114(6 Suppl):1S-22S
Glabellar Complex
CORRUGATOR
ORIGIN
Medial end of superciliary arch
INSERTION
skin of eyebrow
PROCERUS
ORIGIN
Nasal bone and cartilages
INSERTION
Skin of medial forehead
DEPRESSOR SUPERCILII
ORIGIN
Frontal Bone – supermedial aspect of orbital rim
INSERTION
Skin of the medial portion of the eyebrow
Source: Allergan Photo Library 2009
Marieb, EN. (1998 ) Human Anatomy and Physiology (4th Ed) p 313
Carruthers J et al. Plast Reconstr Surg 2004;114(6 Suppl):1S-22S
Corrugator
Source: Allergan Photo Library 2009
Source: Reproduced from Park JI et al. Arch Facial Plast Surg 2003;5(5):412–415.
Orbicularis Oculi
ORBICULARIS OCULI
ORIGIN
Medial wall of orbit
INSERTION
Circular path around orbit.
Orbital
Palpebral
Lacrimal
Source: Primal Pictures
Pretarsal
Preseptal
Primal Pictures
Nervous System
• Overview
• Mandibular nerve – buccal and mental
nerves
• Maxillary nerve – infra orbital and
zygomatical facial
• Ophthalmic nerve – supra orbital
Barton FE. Aesthet Surg J 2009; 29:449-463
Components of the nervous system
Marieb, EN. (1998 ) Human Anatomy and Physiology (4th Ed) p 364
The Central Nervous System
•
•
•
•
•
CNS consists of:
– Brain
• protected by bones of the skull
– Spinal cord
• protected by the bones of the spine
Both brain and spinal cord are cushioned by cerebrospinal fluid
Brain is centre of sensory awareness, movement, emotions,
rational thought and behaviour, memory, speech and language
Spinal cord conveys ascending and descending impulses
Spinal cord is centre for spinal reflexes, source of motor
commands for muscles below head and receiver of sensory input
below head
Marieb, EN. (1998 ) Human Anatomy and Physiology (4th Ed) pp 405 - 447
Peripheral nervous system
Autonomic
Sympathetic
Parasympathetic
Somatic
Motor
Sensory
Marieb, EN. (1998 ) Human Anatomy and Physiology (4th Ed) p456
The peripheral nervous system
somatic system
• Often referred to as nervous system of awareness
• Information is collected from senses and conveyed to
CNS to make us aware of changes in environment
• Information is also collected from muscles and joints
to make us aware of our body position
• Striated or skeletal muscles, which are involved in
both voluntary and involuntary movements, are
controlled by somatic system
• Motor nerves relay instructions from CNS to skeletal
muscle to cause movement
Marieb, EN. (1998 ) Human Anatomy and Physiology (4th Ed) pp 456 - 461
The peripheral nervous system autonomic system
•
Generally operates below level of awareness
•
Controls some muscles, but they are generally smooth muscles such as those in
gastrointestinal tract
•
Further divided into two subsystems:
– Sympathetic nervous system
• prepares body for its ‘fight or flight’ responses to stress by raising heart
rate, blood pressure and circulation to facilitate physical activity
– Parasympathetic nervous system
• directs ‘repair and repose’ activities by slowing body down and returning
it to its maintenance level of functioning
Marieb, EN. (1998 ) Human Anatomy and Ph ysiology (4th Ed) pp 456 - 461
Facial nerve VII
• Facial nerve has five branches,
including temporal, zygomatic, buccal,
mandibular, and cervical, that control
muscles of facial expression.
• It also controls taste to the anterior twothirds of the tongue.
Marieb, EN. (1998 ) Human Anatomy and Physiology (4th Ed) p471
Barton FE. Aesthet Surg J 2009; 29:449-463
The Trigeminal Nerve V
• The trigeminal nerve (the fifth cranial
nerve, also called the fifth nerve or simply V)
is responsible for sensation in the face.
• Sensory information from the face and body
is processed by parallel pathways in the
central nervous system.
• The fifth nerve is primarily a sensory nerve,
but it also has certain motor functions (biting,
chewing, and swallowing).
Marieb, EN. (1998 ) Human Anatomy and Physiology (4th Ed) p470
Sensory branches of the
trigeminal nerve
• The ophthalmic nerve carries sensory information from
the scalp and forehead, the upper eyelid, the conjunctiva
and cornea of the eye, the nose (including the tip of the
nose), the nasal mucosa, the frontal sinuses, and parts of
the meninges (lining of brain).
• The maxillary nerve carries sensory information from the
lower eyelid and cheek, upper lip, the upper teeth and
gums, the nasal mucosa, the palate and roof of the
pharynx, the maxillary sinuses, and parts of the meninges.
• The mandibular nerve carries sensory information from
the lower lip, the lower teeth and gums, the chin and jaw
(except the angle of the jaw, which is supplied by a
different nerve), parts of the external ear, and parts of the
meninges.
Marieb, EN. (1998 ) Human Anatomy and Physiology (4th Ed) p470
Fat - Subcutaneous Fat
• Subcutaneous layer:
– Consists of mesh of connective tissue and adipose (fatty)
tissues
– Fibres from dermis anchor skin to this subcutaneous layer,
which in turn is attached to organs and tissues
– Subcutaneous layer provides storage site for large amounts
of fat and contains large blood vessels that supply skin
– Important because the subcutaneous fat stores contribute to
the shape of the face.
Rohrich RJ & Pessa JE; Plast. Reconstr. Surg. 2007; 119: 2219 – 2227
Subcutaneous compartments of
the face
Rohrich RJ & Pessa JE Plast. Reconstr. Surg. 2007; 119: 2219 – 2227.
Malar Fat Pad
Photos courtesy of Hervé Raspaldo, MD.
Ligaments
• The retaining ligaments of the face support
facial soft tissue in normal anatomic position,
resisting gravitational change
• Facial skin is supported in normal anatomical
position by retaining ligaments that run from
deep fixed facial structures to the overlying
dermis
Özdemir R, Plast. Reconstr. Surg 2002, vol. 110, no4, pp. 1134-1149.
Skin
•
•
•
•
•
Function
Layers - Dermis
Collagen
Elastin
Hyaluronic acid
Function of the skin
• Protection from injuries, bacteria, and microorganisms
• Assist in regulating body temperature via perspiration
• Excrete impurities via perspiration
• Prevent dehydration through fluid conservation
• Function as a reservoir for food and water
• Provide sensory reception for pain, touch, and
temperature
• Synthesis of vitamin D when exposed to ultraviolet
radiation from the sun
Marieb, EN. (1998 ) Human Anatomy and Physiology (4th Ed) p153 - 155
Layers of the skin
The Dermis
•
•
•
The function of the dermis –
– Provides strength and shape to the skin by producing the fibrous
protein collagen and fine elastic fibres (elastin)
– Protects the skin by supplying a reservoir of cells and molecules
essential for combating infection and repairing wounds
– Supplies nutrients and oxygen to the epidermis
Consists of two layers which relate to proper needle angle and depth
when injecting dermal fillers
– Papillary dermis consists largely of connective tissue containing
elastin
– Reticular dermis consists of dense connective tissues containing
fibroblasts, bundles of collagen, and course elastic fibres
Fibres and cells of dermis are surrounded by a substance called ground
substance
– Main component of ground substance is hyaluronic acid which
provides volume to skin and lubricates collagen and elastic fibres as
they move and stretch
Marieb, EN. (1998 ) Human Anatomy and Physiology (4th Ed) 145 - 147
Mid Face
anatomy
Mid Face anatomy and its
importance in aesthetics
•
•
•
•
The midface is one of the most important areas in facial
aesthetics because perceptions of facial attractiveness are
largely founded on the synergy of the eyes, nose, lips and cheek
bones.
According to Raspaldo, the midface region is one of the first
areas of the face that ages and in the past ten years this area
has grown in importance in facial rejuvenation.
Mendelson proposes that “the youthful mid-cheek conveys an
overall look of freshness to the face, whereas the changes that
occur in the midcheek over time epitomise the ‘tired look’ of the
ageing face”.
Hinderer proposed that the malar region is especially pertinent
to the oblique or ‘social’ profile – the view of the face seen in
most social interactions.
Coleman SR and Grover R. Aesthetic Surg J 2006;26(suppl):S4-S9
Raspaldo H. J Cosmet Laser Ther 2008; 10:134–42.
Mendelson BC, Jacobson SR.. Clin Plast Surg 2008; 35:395-404; discussion 393
Hinderer UT. Plast Reconstr Surg 1975; 56:157–65.
Anatomy and Physiology
What is Mid-Face?
Mendelson BC, Jacobson SR. Clin Plast Surg 2008; 35:395-404;
Anatomy: Skeleton of MidFace
•
•
•
The shape and degree of projection of
the underlying skeleton are the major
determinants of the individual
appearance of the mid-face.
The anterior surface of the mid face
skeleton provide the base for the
attachment for the muscles of the lower
eyelid and the upper lip as well as the
related ligaments that support the mid
face soft tissue.
The midface skeleton is formed by the
zygoma, anterior surface of the maxilla,
and to a minor degree, the lacrimal
bone.
Mendelson BC, Jacobson SR. Clin Plast Surg 2008; 35:395-404
Anatomy: Soft Tissue – ‘extra
layers’
The soft tissues of the face
are composed of 5 basic layers:
1. The skin
2. The subcutaneous layer
3. The superficial
musculo-aponeurotic
system (SMAS)
1. Retaining ligaments and
spaces
2. The fixed periostium and
deep fascia
Mendelson BC, Jacobson SR. Clin Plast Surg 2008; 35:395-404;.
Anatomy: Malar Fat Pad
• In a youthful midface, the malar fat pad is located over the
zygomatic bone.
• The triangular pad lies along the edge of the nasolabial
fold.
• Its upper border covers the orbital rim and the orbital part
of the orbicularis oculi.
• The lateral border can be identified by drawing a
perpendicular line from the lateral canthus down to the
triangular apex of the malar fat pad.
• The malar fat pad is located beneath the skin and
subcutaneous fat, but it is superficial to the SMAS. It is
fibrous and fatty, and it is readily distinguishable from the
overlying subcutaneous fat.
Mendelson BC, Jacobson SR..Clin Plast Surg 2008; 35:395-404; discussion 393.
Tear
Trough
anatomy
What is a Tear Trough?
• A natural depression extending
inferolaterally from the medial canthus
• It is short in length and generally
terminates in the midpupillary line
• The tear trough deformity becomes more
visible with age
Haddock NT, et al, Plast and Reconstr Surg 2009; 123:1332-1340
Tear Trough Changes with Age
Source: Allergan Photo Library 2009
What is the Lid Cheek
Junction?
• Extension from the lateral half of the
inferior orbit
• It is below and approximately parallel to
the infraorbital rim. It also becomes
more visible with age
Haddock NT, et al, Plast and Reconstr Surg 2009; 123:1332-1340
Lid Cheek Junction Changes with Age
Source: Allergan Photo Library 2009
Summary
•
The tear trough and lid/cheek junction extend significantly below the
orbital rim and are explained primarily by anatomical features in the
subcutaneous plane
•
Specifically these landmarks overlie the junction between the
palpebral and orbital portions of the orbicularis oculi muscle and are
made more obvious by the absence of subcutaneous fat, a
difference in skin quality, and the presence of the malar fat pad
whose cephalic border is immediately caudal to the lid/cheek
junction and the tear trough
•
The two landmarks differ in their attachment to the bone. Along the
tear trough, the muscle is rigidly attached to the bone. Along the
lid/cheek junction, the orbicularis retaining ligament attaches the
muscle to the bone.
AU/0044/2010
Haddock NT, et al, Plast and Reconstr Surg 2009; 123:1332-1340