anatomy of the face
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MOB TCD
Professor Emeritus Moira O’Brien
FRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dublin
Anatomy of the Face
Face
• Sensory supply of face is trigeminal
• 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 of
mandible • Trigeminal neuralgia
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Sensory Trigeminal Nerve
• Ophthalmic V• Supraorbital• Supratrochlear• Maxillary V• Infraorbital• Zygomaticofacial• Mandibular V• Mental• Buccal
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Fractured Zygoma
• View from above shows 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
Scalp MOB TCD
Blood and Nerve Supply of Scalp
• Supraorbital vessels and nerve
• 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 Superiores MOB TCD
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 branchial arch
• 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 in eyelid
• 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 Expression MOB TCD
• Orbicularis oris• Intrinsic: origin and
insertion inside, only alters shape
• Extrinsic: origin outside, alters position
Muscles of Facial Expression MOB TCD
• Incisions in the face evert edges
• Platysma• Inserted into lower border of
mandible• Posterior fibres form risorius
Muscles of Facial Expression MOB TCD
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 into branches
• 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. Bell’s palsy
Facial Nerve MOB TCD
Bell’s Palsy
• Lower motor neurone of facial nerve
• Forehead and all themuscles on the side of lesion are affected
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Facial Palsy MOB TCD
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Corneal Reflex
• Afferent (sensory) cilary branches nasocilary 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 anterior facial
• 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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