anatomy of the face bmj
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MOB TCD
Professor Emeritus Moira OBrienFRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dublin
Anatomy of the Face
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Face
Sensory supply of face istrigeminal
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 ofmandible
Trigeminal neuralgia
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Sensory Trigeminal Nerve
OphthalmicV Supraorbital
Supratrochlear
Maxillary V
Infraorbital
Zygomaticofacial
Mandibular V
Mental
Buccal
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Fractured Zygoma
View from aboveshows 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
ScalpMOB TCD
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Blood and Nerve Supply of Scalp
Supraorbital vessels andnerve
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 SuperioresMOB TCD
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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 branchialarch
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 ineyelid
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 ExpressionMOB TCD
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Orbicularis oris Intrinsic: origin and
insertion inside, only
alters shape
Extrinsic: origin outside,alters position
Muscles of Facial ExpressionMOB TCD
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Incisions in the face evertedges
Platysma
Inserted into lower border of
mandible Posterior fibres form risorius
Muscles of Facial ExpressionMOB TCD
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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 intobranches
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. Bellspalsy
Facial NerveMOB TCD
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Bells Palsy
Lower motor neurone offacial nerve
Forehead and all the
muscles on the side of
lesion are affected
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Facial PalsyMOB TCD
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Corneal Reflex
Afferent (sensory) cilary branchesnasocilary 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 anteriorfacial
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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