Lecture: FF (Gross)- Face: BDS-B 11: 29.09.

2015 @ 11-12pm

FACE

Dr S M Niazur Rahman
Anatomy Unit, Faculty of Medicine
Learning objectives

Outline the extent and layers of face.

Describe the muscles of facial expression.
Describe the blood supply, nerve supply (sensory
& motor) and lymphatic drainage of face.
Describe the clinical importance of face.
Face - Extent

Superior Hairline
Inferior Chin and the base
of the mandible
Side External ear.
Forehead is common to
both face and the scalp.
Face - Skin
Highly vascular bleeds profusely and wound
healing is good. Reason for blushing.
Numerous sebaceous gland infection Acne
Laxity of skin edema.
Boils on the nose and pinna are painful: fixed skin.
Face Superficial fascia
Contains facial muscles all of which are inserted into the
skin
Vessels and nerves.
Variable amount of fat.
Deep fascia is absent from the face except for parotid
fascia & buccopharyngeal fascia that covers the buccinator
muscle.
Face - Muscles
Muscles of facial expression
The muscles of facial expression are present in the
superficial fascia and inserted into to the dermis of
the face.

All the muscles of facial expression are supplied by

facial nerve (Cranial nerve VII) except Levator
palpebrae superioris supply by oculomotor
nerve (Cranial Nerve III)
Muscles of facial expression
The muscles of face can be grouped in six categories:
Muscles of-
Scalp
Auricle or ear
Eyelids
Nose
Mouth
Neck
Face - Muscles
Muscles of scalp -
Occipitofrontalis (forehead)

Muscles of auricle (around ear)

Auricularis anteiror
Auricularis posterior
Auricularis superior

Muscles of the eyelid -

Orbicularis occuli
Corrugator supercilii (nose to eye)
Levator palpebrae superioris

Muscles of the nose -

Procerus (forehead to nose)
Compressor naris (transverse)
Dilator naris (alar)
Depressor septi (tip of nose)
Face - muscles
Muscles around mouth -
Orbicularis oris
Levator labii superioris
Levator labii superioris
Levator anguli oris
Zygomaticus minor
Zygomaticus major
Depressor anguli oris
Depressor labii inferioris
Mentalis
Buccinator
Muscle in the neck -
Plastyma
Muscles of Facial expression
- Derived from second branchial arch
- Innervated by facial nerve

Smiling & laughing -

Zygomaticus major
Sadness -
Levator labii superioris
Levator anguli oris
Anger -
Dilator naris
Depressor septi
Surprise -
Frontalis
Horror,fright -
Platysma
Related : Muscles of mastication
- From first branchial arch Temporalis
- Trigeminal nerve:
V3-Mandibular division
Masseter
(superficial & deep head)
Masseter
Temporalis
Medial pterygoid
(superficial & deep head)
Lateral pterygoid
(upper & lower)

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Related Muscles:

Suprahyoid muscles - all act to elevate the hyoid bone.

1. Digastric - also opens mouth
2. Stylohyoid - splits to surround digastric tendon
3. Mylohyoid - forms muscular floor of mouth
4. Geniohyoid
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Related Muscles:

Tongue muscles
Consist of: intrinsic and
extrinsic muscles
Intrinsic muscle:
change in tongue
Shape
Extrinsic muscles
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus

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Face - Muscles
Face - Muscles
Face - Muscles
Muscle of scalp Occipito-frontalis muscle
Pairs of frontal and occipital bellies connected by broad
aponeurosis-galea aponeurosis.
Attachments :
Frontal belly - into the skin of eyelid (no bony attachment).
Occipital belly and galea aponeurosis - to occipital bone
(posterior) and zygomatic arches (lateral).
Function: moves the scalp, forehead skin (tranverse wrinkles fright)
and raise eyebrows ( surprise).
Muscle of nose- Procerus
Small pyramidal muscle lies
deep to the superior orbital
nerve.
Origin and insertion:
It arises from the fascia covering
nasal bone and lateral nasal
cartilage.
It is inserted into the skin over
the lower part of the forehead
between the two eyebrows.
Function:
It helps to pull that part of the
skin between the eyebrows
downwards, which assists in
flaring the nostrils.
It can also contribute to an
expression of anger.
Muscle of eye - Orbicularis oculi
The orbicularis oculi is a muscle in the face
that closes the eyelids.
Origin & insertion : Has 3 parts :
The palpebral part arises from the medial
palpebral ligament, forms a series of
concentric curves, and is inserted into the
lateral palpebral raph.
The orbital part is thicker; its fibers form a
complete circle around orbit.
The lacrimal part is small,situated behind the
medial palpebral ligament and lacrimal sac.
Actions:
The muscle acts to close the eye. Loss of
function results in an inability to close the eye.
It is the sphincter muscle of the eyelid.
The palpebral part acts involuntarily, closing
the lids gently, as in sleep or in blinking; the
orbital portion is voluntary.
Muscle of mouth - Orbicularis oris

Origin: Arises from maxilla

and mandible.
Insertion: Skin around the
lips.
Action:
The muscle acts to close
the mouth.
Also known as the kissing
muscle because it is used
to pucker the lips.
Muscle of mouth - Zygomaticus major
It elevates the angle of the
mouth superiorly and
posteriorly.
It extends from each
zygomatic arch
(cheekbone) to the corners
of the mouth.
It raises the corners of the
mouth when a person
smiles.
Muscle of mouth - Zygomaticus minor

Small muscle.
It arises from the zygomatic
bone.
Inserted into the upper lip.
It raises the corners of the
mouth in smiling.
Muscle of mouth - Buccinator

A thin quadrilateral muscle, occupying

the interval between the maxilla and
the mandible at the side of the face.
Origin:
It arises from the outer surfaces of the
alveolar processes of the maxilla and
mandible.
Insertion:
Inserted into the lip.
Action:
To pull back the angle of the mouth
and to flatten the cheek area as in
blowing.
Muscle of neck- Platysma
The platysma is a superficial muscle that
overlaps the sternocleidomastoid.
Origin:
Broad sheet arising from the fascia
covering the upper part of the chest.
Insertion:
Into the skin and subcutaneous tissue of
the lower part of the face, many of these
fibers blending with the muscles about the
angle and lower part of the mouth.
Action:
It produces a slight wrinkling of the surface
of the skin of the neck.
Its anterior portion, depresses the lower
jaw.
It pulls down the lower lip and angle of the
mouth in the expression of horror.
Face Blood supply

Arterial supply
 Face Arterial supply
Facial artery is tortuous.
Cervical part
Face is supplied by-
1. Facial artery branch from
external carotid artery.
Facial part
2.Transverse facial artery-
branch from superficial
temporal artery-external
carotid artery.
3.Supra trochlear and supra
orbital arteries-from internal
carotid arteries.
 Face Facial artery
Origin :
The facial artery arises from the external
carotid artery in the carotid triangle.
Course :
Passes upward and over the
submandibular salivary gland, it curves
around the inferior margin of the body of
the mandible at the anterior border of the
masseter muscle. It is here that the pulse
can be easily felt.
It runs upward in a tortuous course
toward the angle of the mouth and is
covered by the platysma and the risorius
muscles.
It then ascends deep to the zygomaticus
muscles, runs along the side of the nose
to the medial angle of the eye, where it
anastomoses with the terminal branches
of the ophthalmic artery.
Face Facial artery

Branches of facial artery:

1. Submental artery arises from the facial artery at
the lower border of the body of the mandible. It
supplies the skin of the chin and lower lip.
2. Inferior labial artery arises near the angle of the
mouth. It runs medially in the lower lip and
anastomoses with its fellow of the opposite side.
3. Superior labial artery arises near the angle of
the mouth. It runs medially in the upper lip and
gives branches to the septum and ala of the nose.
4. Lateral nasal artery arises from the facial artery
alongside the nose. It supplies the skin on the
side and dorsum of the nose.
All these branches anastomose with their
counterparts from the other side of the face.
Arterial supply of Face
Other Arteries of face:
Superficial temporal artery, the smaller terminal branch of the external carotid
artery, ascends in front of the auricle to supply the scalp.
Transverse facial artery, a branch of the superficial temporal artery, arises
within the parotid gland. It runs forward across the cheek just above the parotid
duct .
Supraorbital and supratrochlear arteries, branches of the ophthalmic artery,
supply the skin of the forehead.
Face Arteries
Facial artery

Facial artery
OSPA
Face Blood supply

Venous drainage
Face - Facial vein

Formation:
Formed at the medial angle of the eye by the
union of the supraorbital and supratrochlear
veins.
Course :
The facial vein descends behind the facial
artery to the lower margin of the body of the
mandible.
It crosses superficial to the submandibular
gland and is joined by the anterior division of
the retromandibular vein to form the common
facial vein which drains into the internal jugular
vein.
Tributaries:
The facial vein receives tributaries that
correspond to the branches of the facial artery.
It is joined to the pterygoid venous plexus by
the deep facial vein and to the cavernous sinus
by the superior ophthalmic vein.
Face - Veins
 Veins of the face
Suprathrochlear Supraorbital Superficial Maxillary
vein vein temporal vein vein

Anterior jugular vein Retromandibular

Angular
vein External jugular vein vein
Post.
Facial Auricular
Ant. Post.
vein vein

Common facial Subclavian vein

vein Internal jugular Left and right
vein Brachiocephalic vein

Sup.vena cava
Veins of the face clinical importance

The area of facial skin bounded by the nose, the eye, and the upper lip
is a potentially dangerous zone to have an infection.
Infection in this region can cause thrombosis of the facial vein, with
spread of organisms through the inferior ophthalmic veins to the
cavernous sinus. The resulting cavernous sinus thrombosis may be fatal
unless adequately treated with antibiotics.
Face Nerve supply

Sensory supply
Face - Sensory nerve supply
The skin of the face is
supplied by branches of the
three divisions of the
trigeminal nerve (Opthalmic,
maxillary and mandibular).
Except for the small area over
the angle of the mandible and
the parotid gland which is
supplied by the great auricular
nerve from cervical plexus.
Face - Sensory nerve supply
1. Ophthalmic Nerve:
The ophthalmic nerve supplies the skin of the
forehead, the upper eyelid, the conjunctiva, and the
side of the nose down to and including the tip by its 5
branches.
Five branches of the nerve:
The lacrimal nerve supplies the skin and conjunctiva
of the lateral part of the upper eyelid.
The supraorbital nerve supplies the skin and
conjunctiva on the central part of the upper eyelid
and skin of the forehead.
The supratrochlear nerve supplies the skin and
conjunctiva on the medial part of the upper eyelid
and the skin over the lower part of the forehead.
The infratrochlear nerve supplies the skin and
conjunctiva on the medial part of the upper eyelid
and the adjoining part of the side of the nose.
The external nasal nerve supplies the skin on the
side of the nose down as far as the tip.
Face - Sensory nerve supply
2. Maxillary Nerve:
The maxillary nerve supplies the skin on the posterior part of the side of the nose, the
lower eyelid, the cheek, the upper lip, and the lateral side of the orbital opening by 3
branches.
Three branches of the nerve:
The infraorbital nerve is a direct continuation of the maxillary nerve emerges through
infraorbital foramen. It supplies the skin of the lower eyelid and cheek, the side of the
nose and the upper lip.
The zygomatico-facial nerve passes onto the face through a small foramen on the
lateral side of the zygomatic bone. It supplies the skin over the prominence of the
cheek.
The zygomatico-temporal nerve emerges in the temporal fossa through a small
foramen on the posterior surface of the zygomatic bone. It supplies the skin over the
temple.
Face - Sensory nerve supply
3. Mandibular Nerve:
The mandibular nerve supplies the skin of the lower lip, the lower part of the
face, the temporal region, and part of the auricle by 3 branches.
Three branches of the nerve:
The mental nerve emerges from the mental foramen of the mandible and
supplies the skin of the lower lip and chin.
The buccal nerve emerges from beneath the anterior border of the masseter
muscle and supplies the skin over a small area of the cheek.
The auriculo-temporal nerve supplies the skin of the auricle, the external
auditory meatus, the outer surface of the tympanic membrane, and the skin of
the scalp above the auricle.
Motor nerve supply
Face Nerve supply
Motor:
All the muscles of the face supplied by the 7th
cranial nerve, facial nerve except levator
palpbrae superioris by the 3rd cranial nerve
oculomotor.
Facial nerve
Origin Arise from the motor nucleus present in the
pons.
Course Passes through internal acoustic meatus,
middle ear and exit through the stylomastoid foramen to
enter the parotid salivary gland.
Branches in the face Within the parotid salivary gland
divides into 5 branches to supply the muscles of facial
expression.
1. Temporal branch
2. Zygomatic branch
3. Buccal branch
4. Mandibular branch
5. Cervical branch.
Facial Nerve
Face lymphatic drainage
Upper part of face drains
into the preauricular group
of lymph nodes
Middle part of face drains
into the submandibular
group of lymph nodes
Lower part of face drains
into submental group of
lymph nodes
Finally to deep cervical
lymph nodes.
Face- applied anatomy
Trigeminal neuralgia - common condition in
which the patient experiences excruciating pain
in the distribution of the mandibular or maxillary
division, with the ophthalmic division usually
escaping. A physician should be able to map out
accurately on a patient's face the distribution of
each of the divisions of the trigeminal nerve.

Facial nerve paralysis:

1) Supra-nuclear: Lower face paralysis
2) Infra-nuclear: Bells palsy- Whole face paralysis
Bells palsy
Paralysis of the facial nerve resulting in inability to
contract the facial muscles on the affected side.
Named after Scottish anatomist Charles Bell, who first
described it, Bell's palsy is the most common cause of
acute facial nerve paralysis.
To sum up
 Extent and layers of face
Extent: Hairline above, chin below & pinna on sides.

Layers:
Skin- Lax, plenty of sebaceous gland
No deep fascia- Allows expression
Vascularity- High
 Muscles of facial expression
Occipito frontalis-
Orbicularis occuli-
Orbicularis oris-
3
Buccinator-
Platysma-
4
Muscles are actually
guarding the orifices in 1 2
face; expression are
secondary
5
 Blood, nerve supply & lymphatic drainage
Arteries:
Facial & Transverse facial
Veins:
Facial & Retro-mandibular
Nerve:
Motor-Facial; Sensory-Trigeminal (V1, V2, V3)
Lymph nodes:
Pre-auricular, parotid, sub-mandibular & sub-mental
 Clinical importance of face
Danger area of face- Upper lip & adjoining nose
Facial Palsy- Leison of facial nerve
Tetanus- Lock jaw/ Rhisus sardonicus