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Nerve Supply OF THE FACE

Head and Neck Anatomy (Tanta University)

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DR. SAMEH DOSS

NERVE SUPPLY OF THE FACE

Motor : (to facial muscles) by branches of facial n.

SENSORY: to skin of the face (1) trigeminal n. (supplies most of the skin)
(2) great auricular n. ( C2 & C3) supplies the skin over the angle of
mandible

(A) MOTOR SUPPLY OF THE FACIAL MUSCLES

FACIAL NERVE
It is the 7th cranial & gives 7 motor branches to the muscles
of the face & scalp.

Course of the extracranial part :

a. It leaves the skull through the stylomastoid f.
b. It curves forwards around the lat. side of the base of the
styloid process.
c. then it pierces the postera medial surface of parotid gland.
d. It ends inside the gland by dividing into the
5 terminal branches which emerge From the ant. border,
upper & lower ends of the gland.

Branches of the facial n.:

(A) 2 branches before entering the parotid gland.

(B) 5 branches inside the parotid gland.

A- immediately after it emerges from the stylomastoid F. it gives the following 2

branches:
1. Post.auricular n.: curves upwards behind the root of the auricle & supplies the occipital belly of
occipito frontalis + the auricularis post.
2. n. to post. belly of digastric : supplies this muscle + the stylohyoid m.

B- The 5 terminal branches ( inside the parotid gland):

1. Temporal br: emerges from the upper pole of parotid gland It runs upwards and forwords to
supply:
- Frontal belly of occipito-frotalis.
- Upper part of orbicularis occuli.
- Auricularis ant. & superior.

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2. Zygomatic br: emerges from the ant. border of the gland & divides into upper & lower:
 The upper zygomatic n.: passes forwards across the zygomatie bone to supply the
orbicularis occuli m.
 The lower zygomatic : passes forwards along the lower border of the zygomatic bone to
supply the muscles between the eye & mouth including the muscles of the nose.
3. buccal br.: emerges from the ant. border of parotid & runs forwards close to the parotid duct
towards the angle of the mouth.
- it supplies the buccinator & orbicularis oris muscles.
4. marginal mandibular br.: emerges from the ant. border of paretid & runs forwards along the
mandible to supply the muscles of the lower lip & chin.
5. Cervical br.: emerges from the lower end of parotid gland and passes downwards and forwards
below the mandible to supply the platysma muscle.

(B) Sensrory supply of the face

 The skin of the face is supplied by the 3 divisions of the trigeminal n.

( Ophthalmic,maxillary and mandibular nerves)

 a small area of skin covering the angle

of mandible & parotid gland is supplied by
the great auricular n. (a branch of the Cervical plexus)

A- OPhthalmic n. (1st branch of trigeminal n.):

 It supplies the forehead, upper eye lids & front of the nose
(including its tip)

 the ophthalmic n. gives 3 divisions (lacrimal,

frontal & nasociliary nn.) in the orbit which
supply the face by the following terminal branches:

1. Palpebral br. lacrimal n.:

supplies the lat. part of the upper eye lid.
2. Supra-orbital n. (lat. br. of frontal n.)
supplies the skin of the middle part of the upper eye lid
+ the overlying skin of the forehead.
3. Supra trochlear n.: ( med. Br. of frontal n. )
supplies the skin of med. part of upper eye lid
+ the overlapping skin of the forehead.

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4. Infra-trochlear n.: ( br. of naso-ciliary n.)

supplies the skin over the bony part of the nose
5. External nasal n.: (br. of nasociliary n.)
Supplies the skin over the c artilagenous part of the nose + its tip

B- Maxillary n.: (2nd branch of trigeminal n.)

supplies the skin over maxilla including the lower eye lid, side of the nose & the upper lip by the
following branches :

1. zygomatica-temporal n.: arises in the orbit & leaves it through the zygomatico-temporal F.
to supply the antero-lateral part of the temple.
2. zygomatico-facial n.: leaves the orbit through the zygomatico-facial F. to supply the skin aver
the zygomatic bone.
3. Infra-orbital n.: is the termination of the maxillary n. It reaches the face through the infra-
orbital f. where it divides into 3 branches: palpebral, nasal and labial supplying the skin over
maxilla including the lower eye lid, side of the nose &upper lip.

C- Mandibular n: ( 3rd beanch of trigeminal n. )

Supplies the skin over the mandible by the following branches:

1. auriculo-temporal n.: arises from the post. division of mandibular

n. & appears at the upper end of the parotid gland to supply the skin
of the post. part of side of the face (post. part of temporal region +
upper ½ of outer surface of auricle + ant. part of ext. auditory meatus).
2. buccal n.: arises from the ant. division of mandibular n. & runs superficial
to buccinator m. Supplying the skin Covering it & the mucous membrane lining it.
3. mental n. : is the termination of the inf. alveolar n. (br. of post. division of mandibular n.)
it emerges through the mental F. of mandible to supply the skin of the chin and lower lip.

D- The great auricular n. (see page 42):

- Is a branch of the cervical plexus (from the ant. rami of C2, C3)
- It supplies the skin over the angle of mandible & parotid gland.

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ARTERIAL SUPPLY OF THE FACE

The face is supplied by 2 sets of arteries ant. & post.

A) Anterior Set of arteries include:

1) Facial artery:
it is the principal artery of the face.

origin : it arises from the ant. aspect of ext. carotid a. in the

upper part of neck

Course and relation in the neck: (see p. 145)

Course & relations in the face:

 it enters the face by winding around the lower border of mandible

at the antero-inf. angle of Masseter m.

 in the face, it runs a tortuous course upwards & forwards infront of the ant. facial v. first ,
superficial to buccinator m. till it reaches a point 1cm. behind the angle of the mouth . then it
ascends along the side of the nose to reach the med. angle of the eye.

It ends: at the med. angle of the eye by becoming the angular a.

Branches in the face:

 inf. labial a. : to the lower lip .

 Sup. labial a. : to the upper lip .
 nasal a. : to the nose.

2) Supra trochlear a.: arise in the orbit from the ophthalmic a. br of int. carotid a. (see p. 39)
3) Supra orbital a.: arise in the orbit from the ophthalmic a. br of int. carotid a. (see p. 39)
4) infra-orbital a. it is the continuation of maxillary a. (br.of ext. carotid a.) It reaches the face
through the infra-orbital foramen to supply the cheek.
5) mental a: it is a br. of inf. alveolar a. (from maxillary a.) it reaches the face through mental F. &
supplies the chin.

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B) Posterior set of arteries :

a) transverse facial a.: (br. of Supeficial temporal a. inside parotid gland)

it emerges from the ant. border of the parotid gland &runs below the zygomatic arch.
b) zygomatico-orbital a.: arises from superficial temporal a. after it emerges from the parotid & runs
transversely across the zygomatic arch towards the orbit..

VENOUS DRAINAGE OF THE FACE

The face is drained by the following veins:

(1) anterior facial vein :

a) begins at the med. angle of the eye by the union of the supra-orbital and supra-trochlear veins.
b) it runs downwards & backwards behind the facial artery.
c) it leaves the face at the antero-inferior angle of masseter m. by piercing the deep fascia.
d) it ends by uniting with the ant. division of the retromandibular v. to form Common facial which
ends in the internal jugular vein.
e) Tributaries :
(1) supra-orbital & subratrochlear vv.
(2) tributaries corresponding to the branches of facial a.
(3) the deep facial v.: which passes deep to the mandible connecting the ant. facial V.
with the pterygoid plexus of vv.
N.B:

the pterygoid plexus of veins (page 68) is connected to the cavernous sinus via
an emissary v. passing through F. ovale & may transmit infection from the dangerous
area of face to the cavernous sinus.

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(2) Retromandibular (post. facial) vein :

 begins inside parotid gland by the union of 2 veins:
a. maxillary (draining the pterygoid plexus of vv.).
b. superficial temporal v.
 it descends inside the parotid gland (deep to the facial n.& its branches).
 it ends at the lower end of the gland by dividing into 2 divisions (ant.& post.).
a. the ant. division: joins the ant. facial v. to form the common facial v. which ends in the I. J.V.
b. the post. division: joins post. auricular v. to form the ext. jugular v. which ends in the subclavian v.

Lymphatic drainage of the scalp & face

 Lymphatics from the back of the scalp drain into the occipital L.Ns .
 Lymphatics from the side of the scalp drain into the parotid L.Ns .
 Lymphatics from the forehead drain into the submandibular L.Ns.
 Lymphatics from the side of the face drain into the superficial & deep parotid L.Ns.
 Lymphatics from the front of the face drain into the buccal, submandibular &submental L.Ns.

TEMPORAL & INFRATEMPORAL REGIONS

Boundaries & Contents : See page 8

MUSCLES OF MASTICATION
 General rules:
 They include 4 muscles: (1) Masseter (2) Temporalis (3) Med. plerygoid (4) Lat. pterygoid.
 Origin: they arise from the temporal & infratemporal fossae .
 Insertion : they all are inserted into the ramus of the mandible.
 N. Supply: they all are supplied by the mandibular n.
 Action:
- all of them elevate the mandible except lat. pterygoid which lowers it.
- all of them protrude the mandible except temporalis which retracts it
- the pterygoid muscles move the mandible from side to side (chewing).

1-MASSETER M.
It is a quadrilateral m. covering the ramnus of mandible.

 Origin: it has 2 heads:

1. Superficial head: from lower border of Zygomatic arch &adjoing part of
zygomatic process of maxilla Its fibres pass obliquely downwards &backwards

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2. Deep head :from the inner surface of zygomatic arch. Its fibres pass
vertically downwards .

 Insertion:
into the outer surface of the ramus of mandible
(except its postero-superior part to give space for parotid).

 N.Supply: masseteric n. ( from ant. division of mandibular n .)

 Action:
1) Strong elevator of the mandible e.g biting (one of the strongest muscles in the body).
2) antigravity muscle.
3) protrudes the mandible (by the superficial oblique fibres)

 Relations:
1. deep relations: Buccinator m, Buccal pad of fat & Buccal n.
2. Superficial relation : parotid gland & its duct , brs. Of facial n. trnsverse facial a.

2-TEMPORALIS M.

It is a fan-shaped m. filling the temporal fossa.

Origin:
(1) inferior temporal line.
(2) Floor of the temporal fossa.
(3) deep surface of the temporal fascia.

Insertion:
into tip, ant. border & inner Surface of the Coronoid process.

N.B:
(1) the ant. fibres are nearly Vertical, the middle are oblique while the post. fibres are nearly horizontal.
(2) the muscle forms a tapering tendon which passes deep to the zygomatic arch to reach its insertion.

N. Supply: 2 deep temporal nerves from the ant. division of mandibular n.

Action:
1. Strong elevator of the mandible ( like masseter).
2. an antigravity muscle (like masseter).
3. retracts the protruded mandible(unlike masseter) ,by the post. horizontal fibres.

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3- MEDIAL PTERYGOID M.
a quadrilateral m. having a small superficial & a large deep head.

Origin:
(1) deep head from med. surface of lat. pterygoid plate.
(2) Superficial head from maxillary tuberosity .

Insertion: med. surface of angle of mandible .

N. Supply : main trunk of mandibular n.

Action:
1. side to side movement of the mandible.
2. protrusion of the mandible.
3. elevates the mandible.

Deep relations:
1. tensor palati m.
2. Sup. constrictor m. of pharynx
3. Styloglossus m.
4. Stylopharyngeus m.

4- LATERAL PTERYGOID M.
short conical muscle having upper &lower heads.

Origin:
 upper head: infra temporal surface & crest of greater wing of sphenoid.
 lower head: lat. surface of the lat. pterygoid plate .

Insertion:
 pterygoid fossa on ant. aspect of neck of mandible .
 Capsule & articular disc of the temporomandibular J.

N. Supply: ant. division of mandibular n.

Action:
(1) lowering of the mandible to open the mouth.
(2) protraction of mandible (when Rt.&Lt . muscles act together ).
(3) protrusion of the mandible to the opposite side (when one muscle act alone).
(4) side to side movement (when alternating with muscles of the opposite side).

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Relations:
1) Upper border: related to:
- deep temporal nerves.
- masseteric nerve.

2) Between the 2 heads .

- maxillary a. dips in .
- buccal n. comes out.

3) Lower border:related to
- lingual n.
- inf. alveolar n.

4) Superficial relations:
a) ramus of mandibe, masseter & temporalis muscles.
b) maxillary a. & pterygoid plexus of veins & buccal n.
c) superficial head of medial pterygoid muscle.

5) Deep Relations:
a) sphenomandibular ligament.
b) Med. pterygoid (deep head) & tensor palatimuscles.
c) middle accessory meningeal arteries.
d) mondibular nerve & its branches.
e) chorda tympani n.
f) lesser superficial petrosal n. &otic ganglion.

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