MOB TCD

Professor Emeritus Moira O’Brien

FRCPI, FFSEM, FFSEM (UK), FTCD

Trinity College

Dublin

Anatomy of the Face

Face

• Sensory supply of face is trigeminal

• 5th cranial nerve• C2 • Motor supply• Muscles of facial expression• Facial nerve 7th cranial

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Sensory Nerve Supply

• Trigeminal• Ophthalmic• Maxillary• Mandibular• Cervical plexus

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Terminal Branches of 5th

• Supraorbital• Infraorbital damaged in blow

out fracture of orbit• Lateral• Mental; dentures, fracture of

mandible • Trigeminal neuralgia

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Sensory Trigeminal Nerve

• Ophthalmic V• Supraorbital• Supratrochlear• Maxillary V• Infraorbital• Zygomaticofacial• Mandibular V• Mental• Buccal

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Fractured Zygoma

• View from above shows depression

• Lateral X-ray view

should be done

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Great Auricular

• C2 from cervical plexus• Skin over angle of mandible

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Scalp

• Skin • Subcutaneous• Epicranial aponeurosis• Three fused together• Loose areolar tissue• Periosteum• Occipito-frontalis• Attached posteriorly• No anterior attachment

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• Occipital portion of occipito-frontals 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

Scalp 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

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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

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Levator Palpebrae Superiores

• Arises from back of roof of orbit• Inserted into skin of upper eyelid • The superior tarsal plate• Superior fornix of conjunctiva

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• Elevates upper eyelid• Voluntary muscle supplied by 3rd

oculomotor nerve• Smooth muscle • Sympathetic T1• Superior cervical ganglion

Levator Palpebrae Superiores MOB TCD

Lacrimal Apparatus

• Lacrimal gland• Conjunctival sac• Puncta• Cananiculi• Nasolacrimal sac• Nasolacrimal duct• Inferior meatus nose

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Horner's Syndrome

• Ptosis• Drooping eyelid• Meiosis• Constricted pupil• Anhydrosis• Lack of sweating• Enopthalmos

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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

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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

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• Occipito frontalis • Orbicularis oculi• Orbicularis oris • Buccinator• Platysma• Skin of face• Incisions

Muscles of Facial Expression MOB TCD

• Orbicularis oris• Intrinsic: origin and

insertion inside, only alters shape

• Extrinsic: origin outside, alters position

Muscles of Facial Expression MOB TCD

• Incisions in the face evert edges

• Platysma• Inserted into lower border of

mandible• Posterior fibres form risorius

Muscles of Facial Expression 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

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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

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• 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

Facial Nerve MOB TCD

Bell’s Palsy

• Lower motor neurone of facial nerve

• Forehead and all themuscles on the side of lesion are affected

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Facial Palsy MOB TCD

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Corneal Reflex

• Afferent (sensory) cilary branches nasocilary of ophthalmic of 5th

• Efferent (motor)• Zygomatic branch of facial 7th

• Last reflex to go

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Blood Supply and Pulses in Face

Internal carotid• Supraorbital artery • Branch of ophthalmic

External carotid• Superficial temporal artery• Facial artery

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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

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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

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Lymph Glands

• Submental• Submandibular• Buccal and

mandibular• Preauricural• Occipital

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