ANATOMY OF THE FACE

The most anterior region of the head is the face.

- a unique aspect of each individual because it provides our identity as an individual.
Extent: - extends from the forehead to the chin and from one ear to the other.
- contribute to the display of emotions (muscles of facial expression), feeding (mouth),
seeing (eye), smelling (nose), and communicating (mouth and ear).
- distinguishing feature/qualities for personal identification (from person to person
mostly iris recorgination).
- Note 1: that birth defects, scarring, or other alterations resulting from pathology or
trauma of the face have marked consequences beyond their physical effects on a person.
- 2. the basic shape of the face is determined by the underlying bones.
SUBDIVISIONS
The face is divided into:
1. Upper face,
2. Middle face, and
3. Lower face.
The entire face is covered by skin superficially, while the deep anatomy contains
muscles (muscles of facial expression & muscles of mastication), fat pads, nerves,
vessels, and bones.
Upper Face
- starts from the hairline superiorly and ends just under the lower eyelid. Its lateral
borders terminate around the temporal region. The upper face region contains the
forehead, eyes, and temporal region.
Middle Face
-starts superior at the lower eyelid and spans inferiorly terminating just above the
upper lip. The ears enclose the lateral borders of the central face. The central face
region has the following: the nose, cheeks, and ears.
Lower Face-bings superiorly at the upper lip and ends inferiorly at the lower border of
the chin. –its lateral border is made up of the angle of the mandible. The lower face
region contains the lips, chin, and jaws.

MUSCLES OF FACIAL EXPRESSION; see fig. 1

- are a group of striated skeletal muscles supplied by the facial nerve (cranial nerve VII).
- control facial expression.
-also called mimetic muscles; because they are only found in mammals, although
derived from neural crest cells found in all vertebrates. They are the only muscles that
attach to the dermis.
Location:
- just under the skin (subcutaneous)
-generally originate from the surface of the skull bone (rarely the fascia)
-insertion- on the skin of the face.
Function: When they contract, the skin moves leading to facial expression.
-also cause wrinkles at right angles to the muscles’ action line.
- are supplied by the facial nerve (cranial nerve VII), with each nerve serving one side of
the face
In contrast, the nearby masticatory muscles (muscles of mastication) are supplied by
the mandibular nerve, a branch of the trigeminal nerve (cranial nerve V).
 Fig. 1 muscles of facial expression and scalp: Anterior view

Development
- are derived from the second branchial/pharyngeal arch.
-like the branchial arches, originally derive from neural crest cells.
- begin to form around the eighth week of embryonic development.
List of muscles; see fig. 1, 2 and 3
The facial muscles include

1. Occipitofrontalis muscle
2. Temporoparietalis muscle (Temporalis muscle)
3. Procerus muscle
4. Nasalis muscle
5. Depressor septi nasi muscle
6. Orbicularis oculi muscle
7. Corrugator supercilii muscle
8. Depressor supercilii muscle
9. Auricular muscles (anterior, superior and posterior)
10. Orbicularis oris muscle
11. Depressor anguli oris muscle
12. Risorius
13. Zygomaticus major muscle
14. Zygomaticus minor muscle
15. Levator labii superioris
16. Levator labii superioris alaeque nasi muscle
17. Depressor labii inferioris muscle
18. Levator anguli oris
19. Buccinator muscle
20. Mentalis

NOTE: 1. The platysma is supplied by the facial nerve. Although it is mostly in the neck
and can be grouped with the neck muscles by location, it can be considered a muscle of
facial expression due to its common nerve supply.

2. The stylohyoid muscle, stapedius and posterior belly of the digastric muscle are also
supplied by the facial nerve, but are not considered muscles of facial expression
3. Most of these muscles receive innervation from the facial nerve and participate in
facial expression except for the masseter muscle. The innervation of the masseter
muscle is via the trigeminal nerve, and this muscle participates in mastication.

Fig. 2. Muscles of scalp and facial expression: Lateral view

Fig. 3. Muscles of facial expression around the mouth
SUBDIVISIONS/GROUPINGS
The Muscles of facial expression are grouped into: Muscles of the mouth, Muscles of
the nose, Muscles of the eyelid, Muscles of the cranium and neck and Muscles of the
external ear.
1. Muscles of the mouth, or buccolabial group (are 11 in number)
- a broad group of muscles that form a functional compound that controls the shape
and movements of the mouth and lips.

-majority of the mouth muscles are connected by a fibromuscular hub (called the
modiolus) onto which their fibers insert.

- the modiolus is located at the angles of the mouth and it is primarily formed by the
buccinator, orbicularis oris, risorius, depressor anguli oris and zygomaticus major
muscles.
• Elevating and everting the upper lip: levator labii superioris, levator labii
superioris alaeque nasi, risorius, levator anguli oris, zygomaticus major and zygomaticus
minor muscles.
• Depressing and everting the lower lip: depressor labii inferioris, depressor anguli
oris and mentalis muscles.
• Closing the lips: orbicularis oris muscle.
• Compressing the cheek: buccinator muscle.
 2. Muscles of the nose
-this group includes the nasalis and procerus muscles.
-are primarily involved in creating facial expressions, but they also contribute to
respiration.
3. Muscles of the eyelid
Orbicularis oculi muscle
Corrugator supercilii muscle (Corrugator glabellae muscle, Muscle of Koyter)
4. Muscles of the cranium and neck
Occipitofrontalis muscle (Musculus frontalis & galea aponeurotica)
Platysma muscle
5. Muscles of the external ear

The auricular muscles are thin, fan-shaped muscles that connect the auricle to the
scalp, and move the auricle to a certain extent. These muscles include:

1. The auricularis anterior, that arises from the lateral border of the epicranial aponeurosis
and attaches to the spine of the helix of the auricle.
2. The auricularis posterior, that arises from the mastoid process of the temporal bone and
inserts into the ponticulus on the eminentia conchae.
3. The auricularis superior that arises from the epicranial aponeurosis and converges into a
thin, flat tendon to insert onto the upper part of the auricle.
All auricular muscles are innervated by the branches of the facial nerve; the auricularis
anterior and superior are supplied by temporal branches, while the auricularis posterior
is supplied by the posterior auricular branch. The blood supply for the auricular muscles
is mostly derived from the posterior auricular artery.

Since the auricular muscles are quite rudimentary, their function is mainly insignificant
in humans. Most of the movements of the ear produced by these muscles are observed
during smiling and yawning, involving pulling the auricle anteriorly, posteriorly or
superiorly.
Summary 1: List of Muscles of facial muscles, innervation, blood supply

FACIAL MUSCLES

Definition and A group of muscles originating mainly from the bones of the skull
function and inserting onto the skin of the face, which produce facial
expressions

Muscles Occipitofrontalis, orbicularis oculi, corrugator supercilii, procerus,

nasalis, orbicularis oris, levator labii superioris, levator labii
superioris alaeque nasi, zygomaticus minor, buccinator,
zygomaticus major, levator anguli oris, risorius, depressor anguli
oris, depressor labii inferioris, mentalis, platysma

Innervation Facial nerve (CN VII)

Blood supply Facial artery

Summary 2: List of facial muscles, origin, insertion, main action innervation (see
footnote)
BLOOD SUPPLY, see fig. 4
Blood supply to face – is derived from the external carotid artery and the branches of
the external carotid artery.
Note: As the common carotid artery ascends cranially, it divides/branches into; the
internal and external carotid arteries.

Fig. 4: blood supply to the face

The external carotid artery
-branches into superior thyroid, lingual, facial, ascending pharyngeal, occipital,
posterior auricular, maxillary, and superficial temporal arteries.
The facial, superficial temporal, and maxillary arteries are the main vessels that
supply blood (provide perfusion) to the face.
The superficial temporal artery travels toward the temporal and forehead region. The
sup-[erficial temporal artery supply the structures mainly in the temporal and forehead
regions.
The maxillary artery provides some perfusion to the cheek region. The maxillary artery
travels toward the deep structures and supplies blood the deeper facial structures see
fig. 4.
FACIAL ARTERY, see fif. 4 above
- major arterial supply to the face.
- travel s toward the nose and lips,
-arises from the external carotid artery and moves to the inferior border of the
mandible, just anterior to the masseter but deep to the platysma.
Then crosses the mandible, buccinator, and maxilla as it courses over the face to the
medial angle (canthus) of the eye, where the superior and inferior eyelids meet. The
facial artery lies deep to the zygomaticus major and levator labii superioris muscles.
Near the termination of its sinuous course in the face, it passes approximately a finger’s
breadth lateral to the angle of the mouth and sends branches to the upper and lower
lips (i.e. the superior and inferior labial arteries), and then ascends along the side of the
nose, and anastomoses with the dorsal nasal branch of the ophthalmic artery. Distal to
the lateral nasal artery at the side of the nose, it terminates as the angular artery.
VENOUS DRAINAGE; see figure 5 below
- the blood in the face is drained by the facial vein.
- the facial veins are valveless
-runs parallel to the facial arteries.
- provides primary superficial drainage of the face
Tributaries of facial vein includes:
-the deep facial vein- drains the pterygoid venous plexus of the infratemporal fossa.
Inferior to the margin of the mandible, the facial vein is joined by the anterior
(communicating) branch of the retromandibular vein.
-The facial vein drains directly or indirectly into the internal jugular vein (IJV).
At the medial angle of the eye, the facial vein communicates with the superior
ophthalmic vein – this drains into the cavernous sinus.
RETROMANDIBULAR VEIN see fig. 5 below
- a deep vessel of the face.
Formation: union of superficial temporal vein and the maxillary vein.
- runs posterior to the ramus of the mandible within the substance of the parotid gland,
superficial to the external carotid artery and deep to the facial nerve.
-emerges from the inferior pole of the parotid gland,
-then divides into: 1- an anterior branch that unites with the facial vein and 2- a
posterior branch that joins the posterior auricular vein inferior to the parotid gland to
form the external jugular vein which passes inferiorly and superficially in the neck to
empty into the subclavian vein.

Fig.5: venous drainage of the face and scalp

Table 1 venous drainage of the face.
LYMPHATIC DRAINAGE, see fig. 5
Except for the parotid/buccal region, there are no lymph nodes in the face. The nasal
region contains facial lymph nodes, while the region closer to the ears and angle of the
mandible contain preauricular lymph nodes.
The lymph in the face tends to drain to submental, submandibular, and cervical lymph
nodes depending on which is closer. The right side of the face will eventually drain into
the right lymphatic duct while the left side will drain into the thoracic duct. The right
lymphatic duct and the thoracic duct then drain back into the central circulation.
Fig. 5: Lymphatic drainage of the scalp and face
NOTE:
1. Lymph from the lateral part of the face and scalp, including the eyelids, drains to the
superficial parotid lymph nodes.
2. Lymph from the deep parotid nodes drains to the deep cervical lymph nodes.
3. Lymph from the upper lip and lateral parts of the lower lip drains to the
submandibular lymph nodes.
4. Lymph from the chin and central part of the lower lip drains to the submental lymph
nodes.
INNERVATION
The face has two main nerve innervations.
1. The facial nerve is responsible for the innervation of the muscles that participate in
facial expression. The facial nerve penetrates through the parotid gland and then
branches into five nerves:
i. temporal, ii. zygomatic, iii. buccal, iv. marginal mandibular, and v. posterior cervical
nerve.
1. The temporal branch of the facial nerve travels toward the temporal and forehead
region. 2. The zygomatic branch of the facial nerve travels along the zygoma and cheek
region. 3. The buccal branch of the facial nerve travels toward the buccal region.
4. The marginal mandibular branch of the facial nerve travels toward the mandible.
5. The posterior cervical branch of the facial nerve travels toward the cervical region.
These nerve branches provide motor innervation to the facial muscles.

Fig. 6: innervation of face 1

Fig. 7: innervation of face 2
2. SENSORY INNERVATION OF THE FACE: the trigeminal (CN V) nerve proves the
sensory innervation to the face. The trigeminal nerve branches into three nerve
branches: the ophthalmic, maxillary, and mandibular nerves.
The ophthalmic nerve moves toward the forehead and provides sensory to the
forehead and eye region.
The maxillary nerve moves toward the maxilla bone and provides sensory innervation
to the cheek and nose.
The mandibular nerve travels with the mandible and provides sensory innervation to
the jaw and lips.
The trigeminal nerve also innervates the masseter muscle that contributes to the
fullness of the cheeks.
The eyes also receive additional innervation from the optic, oculomotor, trochlear,
trigeminal, abducens, and facial nerves.
The nose also receives special sensory innervation from the olfactory nerve. The ear
funnel receives sound and convert it into audible sound via the vestibulocochlear
nerve.
Clinical significance/Applied Anatomy
1. Damage to the facial nerve results in facial paralysis of the muscles of facial
expression (Bell palsy) with or without loss of taste on the anterior two thirds of the
tongue or altered secretion of the lacrimal and salivary glands, see fig. 7.
2. This damage can occur with a stroke or parotid salivary gland cancer (malignant
neoplasm) because the facial nerve travels through the gland.
3. Parotid gland can be damaged permanently by surgery or temporarily by trauma. This
condition can inhibit facial expression and seriously impair the patient’s ability to speak,
either permanently or temporarily.

Fig. 8: Damage to the facial nerve results in facial paralysis of the muscles of facial
expression (Bell palsy)

SCALP
- is the soft tissue that covers the cranial vault.
- extends from the external occipital protuberance and superior nuchal lines posteriorly
to the supraorbital margins anteriorly; and on each side, the superior temporal lines.
- is made up of five layers (as below, fig.1 & 2).
1. S= skin
2. C= Connective tissue (superficial fascia)
3. A= Aponeurosis – a deep fascia in the form of the epicranial aponeurosis or galea
aponeurotica with the occipitofrontalis muscle.
4. L= Loose areolar tissues
5. P= Pericranium
Note: the first 3 layers (i.e. the skin, connective tissue /superficial fascia and
aponeurosis/deep superficial fascia are bound together as a single unit. This single unit
can move along the loose areolar tissue over the pericranium, which is adherent to the
calvaria.

Fig.1 layers of the scalp

Fig.2. Coronal section of scalp that shows layers of the scalp (From Snell RS, Clinical
Anatomy for Medical Students, 5th ed), the cerebral vein in the subarachnoid space is
also displayed
1. Skin
- is thick and hair bearing and contains numerous sebaceous and sweat glands. As a
result, the scalp is a common site for sebaceous cysts.
-has an abundant arterial supply and good venous and lymphatic drainage.
2. Connective tissue (also called subcutaneous layer or superficial fascia)
The superficial fascia is a fibrofatty layer that connects skin to the underlying
aponeurosis of the occipitofrontalis muscle and provides a passageway for nerves and
blood vessels. Blood vessels are attached to this fibrous connective tissue. If the vessels
are cut, this attachment prevents vasospasm, which could lead to profuse bleeding after
injury.
- thus this lay is thick, dense, richly vascularized and well supplied with cutaneous
nerves.
3. Epicranial aponeurosis (galea aponeurotica) - a deep fascia
- is a broad, strong, tendinous structure that covers the calvaria and provides an
insertion site for the occipitofrontalis muscle. Posterolaterally, the epicranial
aponeurosis attachment extends from the superior nuchal line to the superior temporal
line. Laterally, the epicranial aponeurosis continues as the temporal fascia where it
covers the temporoparietalis and superior auricular muscles). Anteriorly, the
subaponeurotic space extends to the upper eyelids due to the lack of a bony insertion.
This loose areolar tissue provides a potential subaponeurotic space that allows fluids
and blood to pass from the scalp to the upper eyelids.
Collectively, these structures (muscles and aponeurosis) make up the musculo-
aponeurotic epicranius.
4. Loose areolar tissue
Areolar tissue loosely connects the epicranial aponeurosis to the pericranium and
allows the superficial 3 layers of the scalp (i.e the skin, connective tissue, and epicranial
aponeurosis) to move over the pericranium. This layer is sponge-like and includes
potential spaces that may distend with fluid as a result of injury or infection. Note: scalp
flaps are elevated along a relatively avascular plane in craniofacial and neurosurgical
procedures. However, certain emissary veins traverse this layer, which connects the
scalp veins to the diploic veins and intracranial venous sinuses, see fig.2 above.
5. Pericranium
- is a dense layer of connective tissue that forms the periosteum of the skull bones.
-along the suture lines become continuous with the endosteum.
Note: it is firmly attached but can be stripped from the crania of living persons, except
where the pericranium is continuous with the fibrous tissue in the cranial sutures.

Occipitofrontalis muscle
- consists of 2 occipital bellies and 2 frontal bellies. The occipital bellies arise from the
superior nuchal lines on the occipital bone. The frontal bellies originate from the skin
and superficial fascia of the upper eyelids. The occipital and frontal bellies insert into
the epicranial aponeurosis.
Each occipital belly is innervated by the posterior auricular branch of the facial nerve,
and each frontal belly is innervated by the frontal branch of the facial nerve.
Action: The frontal belly pulls the scalp anteriorly, wrinkles the forehead, and
elevates/raises the eyebrows while the occipital belly pulls the scalp posteriorly,
smoothing the skin of the forehead.
Superior auricular muscle (a specialized posterior part of the temporoparietalis)
elevates the auricle of the external ear.
Innervation of scalp muscle: The epicranius (muscle and aponeurosis) are innervated
by the facial nerve.

Nerve Supply, Fig.3 below

Sensory supply
The following 6 sensory nerve branches of either the trigeminal nerve or the cervical
nerve supply the scalp (see the image below):
1. Supratrochlear nerve - A branch of the ophthalmic division of the trigeminal nerve;
this nerve supplies the scalp in the medial plane at the frontal region, up to the vertex
 2. Supraorbital nerve - Also a branch of the ophthalmic division of the trigeminal nerve;
this nerve supplies the scalp at the front, lateral to the supratrochlear nerve
distribution, up to the vertex
3. Zygomaticotemporal nerve - A branch of the maxillary division of the trigeminal
nerve; it supplies the scalp over the temple region
4. Auriculotemporal nerve - A branch of the mandibular division of the trigeminal
nerve; it supplies the skin over the temporal region of the scalp
5. Lesser occipital nerve - A branch of the cervical plexus (C2); it supplies the scalp over
the lateral occipital region
6. Greater occipital nerve - A branch of the posterior ramus of the second cervical
nerve; it supplies the scalp in the median plane at the occipital region, up to the vertex
Motor supply
The frontal branch of the facial nerve supplies the frontal bellies of the occipitofrontalis
muscle, and the auricular branch of the facial nerve supplies the occipital bellies of the
muscle.
Arterial Supply, see Fig.3
-scalp has a rich vascular supply.
-blood vessels traverse the connective tissue layer, which receives vascular contribution
from the internal and external carotid arteries. The blood vessels anastomose freely in
the scalp. From the midline anteriorly, the arteries present as follows:
1. Supratrochlear artery
2. Supraorbital artery
3. Superficial temporal artery
4. Posterior auricular artery
5. Occipital artery
See the image fig. 3 below.
Fig.3 Sensory innervation and arterial supply of the scalp
- Supratrochlear and supraorbital arteries are 2 branches of the ophthalmic artery,
from internal carotid artery. These arteries accompany the corresponding nerves.
-Superficial temporal artery - a terminal branch of the external carotid artery that
ascends in front of the auricle- supplies the scalp over the temporal region, travels with
the auriculotemporal nerve and divides into:
a) Anterior and b) Posterior branches.
The posterior auricular artery is a branch of the external carotid artery that ascends
posterior to the auricle.
The occipital artery- a branch of the external carotid artery; is accompanied by the
greater occipital nerve.

Venous Drainage
-veins of the scalp freely anastomose with one another and are connected to the
diploic veins of the skull bones and the intracranial dural sinuses through several
emissary veins, see fig. 2 & 4
Emissary veins are valveless.
 Fig. 4 veins of the scalp and face

The veins of scalp include the following, accompany the arteries and have similar names
(see the image below):
1. Supratrochlear and supraorbital veins - Drain the anterior region of the scalp; these
2 veins unite to form the angular vein at the medial angle region of the eye and
continue further as the facial vein
2. Superficial temporal vein - Descends in front of the auricle and enters the parotid
gland; it joins the maxillary vein to form the retromandibular vein, the anterior
division of which unites with the facial vein to form the common facial vein, which
then drains into the internal jugular vein
3. Posterior auricular vein - Joins the posterior division of the retromandibular vein to
form the external jugular vein
4. The occipital vein - Terminates in the suboccipital venous plexus, which lies
beneath the floor of the upper part of the posterior triangle
Lymphatic drainage
The part of the scalp that is anterior to the auricles drains into the parotid
(preauricular), submandibular, and deep cervical lymph nodes.
The posterior part of the scalp is drained to the posterior auricular (mastoid) and
occipital lymph nodes.

Applied Anatomy
1. Wounds in the scalp bleed profusely, because the fibrous fascia prevents
vasoconstriction. However, wounds superficial to the aponeurosis gap much less than
do wounds that cut through it, because aponeurosis holds the skin tight. Also,
Collection of blood in the layer of loose connective tissue causes generalised swelling of
the scalp. The blood may extend anteriorly into the root of the nose and into the
eyelids, causing black eye.

2. During a difficult birth, bleeding may occur between the neonate's pericranium and
calvaria, usually over 1 parietal bone, because of a rupture of multiple minute
periosteal arteries. The resulting collection of blood several hours after birth is known
as cephalohematoma.

3. The emissary veins do not have valves and open in the loose areolar tissue;
therefore, infection can be transmitted from the scalp to the cranial cavity. The layer of
loose areolar tissue is known as the dangerous area of the scalp.

4. Metastatic spread of malignant lesions in front of the auricle is to the parotid and
cervical groups of lymph nodes. The posterior part of the scalp is drained to the
occipital and posterior auricular groups of lymph nodes.

5. Anastomosis exists at the medial angle of the eye, between the facial branch of the
external carotid artery and the cutaneous branch of the internal carotid artery. During
old age, if the internal carotid artery undergoes atherosclerotic changes, the intracranial
structures can receive blood from the connection of the facial artery to the dorsal nasal
branch of the ophthalmic artery.
6. Because the scalp contains numerous sebaceous glands, the scalp is one of the most
common sites for sebaceous cysts.