Dr. Ahmed Fathalla Ibrahim

FACIAL INFECTION

• DANGEROUS AREA OF FACE1. A triangular area bounded with an apex opposite

the medial angles of eyes & nose and a base formed by the upper lip

2. It is drained by facial vein3. It has important communications with cavernous

sinus:

supraorbital & superior ophthalmic veins

Facial vein Cavernous sinus

deep facial vein pterygoid plexus of veins emmissary veins

FACIAL INFECTION

• DANGEROUS AREA OF FACE

• Infection of this area may lead to:

1. Thrombosis of facial vein

2. Infection may be transmitted to cavernous sinus leading to cavernous sinus thrombosis

TRIGEMINAL NERVE

• Supplies the skin of the face EXCEPTEXCEPT the area over the angle of mandible & parotid gland

• Is represented by 3 divisions:

1. Ophthalmic

2. Maxillary

3. Mandibular

TRIGEMINAL NERVE

TRIGEMINAL NERVE

• OPHTHALMIC:1. Supratrochlear:

forehead + medial part of upper eyelid

2. Supraorbital: same3. Palpebral branch of

lacrimal: lateral part of upper eyelid

4. Infratrochlear: upper part of nose

5. External nasal: lower part of nose

TRIGEMINAL NERVE

• MAXILLARY:

1. Infraorbital: divides into: a) palpebral for lower eyelid, b) nasal for ala of nose, c) labial for upper lip

2. Zygomaticofacial: upper part of cheek

TRIGEMINAL NERVE

• MANDIBULAR:

1. Buccal: lower part of cheek

2. Mental: lower lip & chin

TRIGEMINAL NEURALGIA

• Inflammatory condition affecting one or more of the three divisions of trigeminal nerve

• Gives rise to severe pain in the area of distribution of the affected nerve

• Surgical treatment may involve:

1. Alcohol injection of the trigeminal ganglion

2. Section of the central root of the nerve or of the appropriate division

FACIAL NERVE

FACIAL NERVE• Extracranial course:Extracranial course:1. The nerve leaves the cranial cavity through stylomastoid stylomastoid

foramenforamen2. The nerve enters the parotid gland & divides into 5 terminal 5 terminal

motor branchesmotor branches that emerge from the gland• Extracranial distribution:Extracranial distribution:• After emergence from stylomastoid foramen:After emergence from stylomastoid foramen:1.1. Posterior auricular:Posterior auricular: to occipital belly of occipitofrontalis muscle2.2. Muscular branchMuscular branch to posterior belly of digastric3.3. Muscular branchMuscular branch to stylohyoid• After emergence from parotid gland:After emergence from parotid gland:1.1. Temporal:Temporal: to orbicularis oculi, frontal belly of occipitofrontalis

muscles2.2. Zygomatic:Zygomatic: to orbicularis oculi muscle3.3. Buccal:Buccal: to buccinator, muscles of upper lip & nose4.4. Mandibular:Mandibular: to muscles of lower lip5.5. Cervical:Cervical: to platysma

FACIAL NERVE INJURY

• UPPER MOTOR NEURONE LESION (SUPRANUCLEAR LESION): e.g. lesion in pyramidal tracts: paralysis of muscles on the lower quadrant of face opposite to the side of lesion (the patient can close his eye but cannot expose his teeth on the affected side)

• LOWER MOTOR NEURONE LESION (NUCLEAR OR INFRANUCLEAR LESION): e.g. Bell’s palsy: paralysis of all muscles of face on same side of lesion (the patient cannot close his eye and cannot expose his teeth on the affected side)

ARTERIES OF FACE

FACIAL ARTERY

• ORIGIN: A branch of external carotid in the neck• COURSE IN FACE:1. Curves around the lower border of mandible (pulse

can be felt)2. Ascends: lateral to lips & nose,

anterior to facial vein3. Runs a tortuous course• TERMINATION: at the medial angle of eye, where it

anastomoses with branches of ophthalmic artery• BRANCHES IN FACE:1.1. Inferior labial Inferior labial 2.2. Superior labialSuperior labial3.3. Lateral nasalLateral nasal

SUPERFICIAL TEMPORAL ARTERY

• ORIGIN: One of the 2 terminal branches of external carotid artery in the parotid gland

• COURSE: 1. Ascends in front of auricle (pulse can be felt)2. Accompanies the auriculotemporal nerve• BRANCHES:1.1. Transverse facial:Transverse facial: arises inside the parotid

gland & runs transversally above parotid duct

2.2. anterior & posterior branches:anterior & posterior branches: supply the scalp