Face

Key Surface Anatomy Landmarks

Face

Boundaries• Extends superiorly to

the hair line, • inferiorly to the chin

and base of mandible,• and on each side to

auricle• Forehead is common to

both scalp and face.

Face Very vascular Due to rich vascularity

face blush and blanch. Facial skin is rich in

sebaceous gland and sweat gland.

Wounds of face bleed profusely but heal rapidly.

Sebaceous gland keep the skin oily but also cause acne in adult.

FACIAL MUSCULATURE

2 main groups of muscle are located on the face: muscles of facial expression innervated by

the facial nerve (cranial nerve VII)and muscles of mastication supplied by

the mandibular division of the trigeminal nerve (cranial nerve V)

FACIAL MUSCULATURE

Muscles of facial expression  are superficial muscles which can move skin and fascia in various directions.

They are also dilators and sphincters for the various orifices in the face region. The 2 major groups are around the eye and the mouth.

Bones of the Face The facial skeleton

consists of 14 stationary bones and the mandible.

These 14 bones form the basic shape of the face, and are responsible for providing attachments for muscles that make the jaw move and control facial expressions.

• Foramina:• Supraorbital (Supraorbital nerve)• Infraorbital (Infraorbital nerve)• Mental (Mental nerve)

Bones of the Face

Muscles of the Face (Muscles of Facial Expression) The muscles of the face develop from the 2nd

pharyngeal arch and are innervated by branches of the facial nerve [VII].

They are in the superficial fascia, with origins from either bone or fascia, and insertions into the skin.

these muscles control expressions of the face. They act as sphincters and dilators of the orifices

of the face (i.e. the orbits, nose, and mouth).

Muscles of the Face Orbital group Nasal group Oral group Other muscle

groups

Orbital group The muscles are

Orbicularis oculi Corrugator supercilii

Dilator levator palpebrae

superioris

Orbicularis oculi Has 3 parts- Orbital part (outer)

Originate from medial part of medial palpebral ligament and form concentric rings, return to point of origin

Action –closes the lids tightly The orbital part causes radiating skin wrinkles from the lateral corner of the eye

Palpebral part (Inner) Originate from lateral part of medial palpebral ligament Insert into lateral palpebral raphe

Action-closes the lids gently Lacrimal part (Small)

Originate from lacrimal fascia & lacrimal bone Insert into upper &lower tarsi

Action-dilate lacrimal sac

Orbicularis oculi

Orbicularis oculi Palpebr

al part Orbital

part

Orbicularis oculi

levator palpebrae superioris The dilator is the levator palpebrae

superioris innervated by the oculomotor nerve (cranial nerve III) and postganglionic sympathetic fibers from the superior cervical ganglion.

  

Corrugator supercillii Origin : superciliary

arch Insertion: skin of the

eyebrow Action: produces

vertical wrinkles of the forehead in frowning as an expression of annoyance

Nasal group

Three muscles are associated with the nasal group: Nasalis Procerus Depressor septi nasi

Nasal group Nasalis Origin: transverse part—canine

eminence; alar part—maxilla, superior to the lateral incisor

Insertion: transverse part—side of the nose; alar part—ala of the nose

Action: transverse part—compression of the nostril; alar part—dilation of the nostril

Innervation: buccal branches of the facial nerve

Nasal group Procerus

Origin: nasal bone Insertion: skin overlying the

glabella Action: depresses the medial

end of the eyebrow, producing transverse wrinkles at the bridge of the nose

Innervation: buccal branches of the facial nerve

Compressor naris Origin: Frontal

process of the maxilla Insertion:

Aponeurosis which crosses the bridge of the nose

Action: Compresses the mobile nasal cartilages

Dilator naris Origin : Maxilla bone Insertion: Ala of the

nose Action: Widens the

nasal aperture (by pulling the alar laterally) in deep inspiration; is also a sign of anger

Oral group The muscles in the oral group

move the lips and cheek: Orbicularis oris Buccinator Lower group of oral muscles

depressor anguli oris depressor labii inferioris Mentalis

Upper group of oral muscles risorius zygomaticus major and

zygomaticus minor levator labii superioris levator labii superioris alaeque

nasi levator anguli oris

Orbicularis oris Origin: from maxilla

above incisor teeth Insertion: into skin of lip. Action: closes the mouth closes the lips but can

also protrude the lips as in whistling, or kissing

Buccinator Upper fibers

Origin- from maxilla opposite molar teeth

Insertion-upper lip Lower fibers

Origin-from mandible opposite molar teeth

Insertion-lower lip Middle fibers

Origin –from pterygomandibular raphe Insertion-decussate before passing to

lips Action- it aids in mastication by prevent

accumulation of food in vestibule of mouth. It is used every time air expanding the cheeks is forcefully expelled

Depressor anguli oris Origin: anterior part of the

oblique line of the mandible Insertion: corner of the mouth Action: draws the corner of the

mouth inferiorly and laterally Depressor labii inferioris

Origin: anterior part of the oblique line of the mandible, deep to depressor anguli oris

Insertion: lower lip Action: draws the lower lip

inferiorly and laterally Mentalis

Origin: incisive fossa of the mandible

Insertion: descends to insert into the skin of the chin

Action: elevation and protrusion of the lower lip

Lower group of oral muscles

Upper group of oral muscles Risorius:

Origin: fascia covering the parotid gland

Insertion: corner of the mouth Action: draws the corner of

the mouth posteriorly Zygomaticus major:

Origin: lateral surface of the zygomatic bone

Insertion: corner of the mouth Action: draws the corner of

the mouth superiorly and laterally.

Zygomaticus minor Origin: lateral surface of the

zygomatic bone, anterior to zygomaticus major

Insertion: upper lip Action: elevation of the upper

lip

Upper group of oral muscles Levator labii superioris a. Origin: inferior border of the

orbital aperture b. Insertion: upper lip c. Action: elevation of the upper lip

Levator labii superioris alaeque nasi a. Origin: frontal process of the

maxilla b. Insertion: medial part—ala of the

nose; lateral part—upper lip c. Action: medial part—dilation of

the nostril; lateral part—elevation of the upper lip

Levator anguli oris a. Origin: canine fossa of the

maxilla (inferior to the infraorbital foramen)

b. Insertion: corner of the mouth c. Action: elevation of the corner of

the mouth

Other muscle groups They include:

Platysma Auricular (anterior,

superior, and posterior auricular muscles)

Occipitofrontalis

Platysma Origin: deep fascia

covering the upper part of pectoralis major

Insertion: inferior border of the mandible and corner of the mouth

Action: depression of the mandible; draws the corner of the mouth inferiorly and laterally, producing ridges in the skin of the anterior neck

Innervation: cervical branch of the facial nerve

Blood supply of face (Arterial supply) Facial artery: arises from the

external carotid artery (ECA) Superficial temporal artery:

arises from the ECA Ophthalmic artery: arises �

from the internal carotid artery, and distributes over the forehead Ophthalmic artery

Supraorbital and Supratrochlear

Venous drainage Facial vein: drains into the internal

jugular vein, directly or as a common facial vein

Retromandibular vein: formed by the union of the maxillary and superfi cial temporal veins; ultimately drains into the external jugular vein

Ophthalmic veins: tributaries from the forehead drain into superior and inferior ophthalmic veins in the orbit (and also anastomose with the facial vein) and then posteriorly into the cavernous dural sinus

Lymphatic drainage (3 territories) Upper territories- greater part

of forehead, lateral ½ of eye lid, conjunctiva, lateral part of cheek and parotid area– preauricular lymph node (parotid)

Middle territories- median part of forehead, external nose, upper lip, lateral part of lower lip, medial ½ of eye lid, medial part of cheek, greater part of lower jaw– submandibular lymph node

Lower territories- central part of lower lip, chin– sub mental lymph node

Sensory Nerves of the Face The skin of the face is supplied

by the trigeminal nerve (V), except for the small area over the angle of the mandible and the parotid gland which is supplied by the great auricular nerve (C2 and 3).

The trigeminal nerve (V) divides into three major divisions-the ophthalmic (V1), maxillary (V2), and mandibular (V3) nerves

Sensory Nerves of the Face

Sensory supply Ophthalmic division

Supratrochlear Supraorbital Lacrimal Infratrochlear External nasal

Maxillary nerve Infraorbital Zygomaticofacial and

zygomaticotemporal Mandibular nerve

Auriculotemporal Buccal nerve Mental

Skin over the mandibular angle is supplied by ant. Div. Of greater auricular n.

Sensory Nerves of the Face

Testing the Integrity of the Trigeminal Nerve (temperature & pain)

The facial nerve exits the skull through the stylomastoid foramen and immediately gives off the post. auricular nerve and other branches that supply the occipitalis, stylohyoid, and posterior digastric muscles and the posterior auricular muscle.

CN VII courses superficial to the external carotid artery and the retromandibular vein, enters the parotid gland, and divides into the following five terminal branches: temporal, zygomatic, buccal, mandibular, and cervical nerves, which in turn supply the muscles of facial expression.

Other muscles of the face include muscles of mastication (temporalis, masseter, and the medial pterygoid and lateral pterygoid muscles), which are innervated by the motor division of CN V-3.

Motor Nerves of the Face Motor supply:

Facial nerve (VII)

• Facial nerve divides into five terminal branches for muscles of facial expression: Temporal Zygomatic Buccal Marginal mandibular Cervical

Applied Trigeminal neuralgia

Maxillary and mandibular nerve are involved Excruciating pain in the region of distribution of these

nerve In infranuclear lesions of facial nerve (e.g., Bell’s

palsy)- whole face is paralyzed c/f

Affected side is motionless Loss of wrinkles Eye cannot be closed In smiling the mouth is drawn to normal side During mastication food accumulates in vestibule

of mouth

Trigeminal neuralgia Herpes zoster, or shingles,

is the most common infection of the peripheral nervous system (PNS). It is an acute neuralgia confined to the dermatome distribution of a specific spinal or cranial sensory nerve root.

Applied Injury to the facial nerve (CN VII) or its branches produces

paralysis of some or all of the facial muscles on the affected side (Bell palsy).

The affected area sags, and facial expression is distorted. The loss of tonus of the orbicularis oculi causes the inferior lid to evert (fall away from the surface of the eyeball). As a result, the lacrimal fluid is not spread over the cornea, preventing adequate lubrication, hydration, and flushing of the cornea. This makes the cornea vulnerable to ulceration. If the injury weakens or paralyzes the buccinator and orbicularis oris, food will accumulate in the oral vestibule during chewing, usually requiring continual removal with a finger.

Applied When the sphincters or dilators of the mouth are

affected, displacement of the mouth (drooping of the corner) is produced by gravity and contraction of unopposed contralateral facial muscles, resulting in food and saliva dribbling out of the side of the mouth.

Weakened lip muscles affect speech. Affected people cannot whistle or blow a wind instrument effectively. They frequently dab their eyes and mouth with a handkerchief to wipe the fluid (tears and saliva) that runs from the drooping lid and mouth.

Bell’s palsy

Facial nerve lesion ( Bell’s palsy )