FACEFACE

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INTRODUCTIONINTRODUCTION

The muscles of the The muscles of the face are face are embedded embedded in the superficial in the superficial fascia,fascia, and most and most arise from the bones arise from the bones of the skull and are of the skull and are inserted into the skin. inserted into the skin.

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• The openings in the face, namely, the orbit, nose, and mouth, are are guardedguarded by the eyelids, nostrils, and lips, respectively.

• The facial muscles serve as sphincters sphincters

• or dilators dilators of these structures.

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Another function of the facial muscles is to modify the modify the expression of expression of the face, so they the face, so they are called are called

muscles of muscles of expressionexpression

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All the muscles of the face are developed from the second pharyngeal arch so they are supplied by the facial nerve.

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MUSCLES OF THE EYELIDSMUSCLES OF THE EYELIDS

The dilator muscles are:• the Levator palpebrae Levator palpebrae

superiorissuperioris and • the frontal belly of the

occipitofrontalis.occipitofrontalis.

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Levator palpebrae superioris:Levator palpebrae superioris:• Origin: Inside the roof of the orbit from the lesser wing of the

sphenoid bone, close to the optic canal.• Insertion: into the superior tarsal plate of the upper eyelid (one of the

layers of the eyelid).

• Innervation: NB. oculomotor nerve.

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• The occipitofrontalisoccipitofrontalis forms part of the scalp.

• Action: both muscles raise the upper eyelid.

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It has two parts:• Palpebral part Palpebral part and• Orbital partOrbital part

SPHINCTER OF THE EYELIDS: SPHINCTER OF THE EYELIDS: ORBICULARIS OCULIORBICULARIS OCULI

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• Palpebral part:Palpebral part:– Origin: medial palpebral ligament– Insertion: lateral palpebral ligament– Function: gently closes the eyelids during blinking and dilates the

Lacrimal sac• Orbital part:Orbital part:

– Origin: medial palpebral ligament and adjoining bone– Insertion: loops return to origin (medial palpebral ligament)– Innervation: Both parts are supplied by the facial nerve– Function: tightly closes the eyelids (throws the skin around the

orbit into folds to protect the eyeball

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CORRUGATOR SUPERCILIICORRUGATOR SUPERCILII

Insertion: skin of eyebrow

Insertion: skin of eyebrow

Origin: supercilliary arch

Origin: supercilliary arch

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Action: Draws eyebrow downward and medially, creating vertical wrinkles above nose

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MUSCLES OF THE NOSTRILSMUSCLES OF THE NOSTRILS

The sphincter muscle is the compressor naris.compressor naris.

• Origin: frontal process of maxilla

• Insertion: aponeurosis of bridge of nose

• Innervation: facial nerve

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Action: compresses the mobile nasal cartilages.

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The dilator muscle is the dilator naris.dilator naris.

• Origin: maxilla • Insertion: ala of nose• Innervation: facial nerve

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Action: widens nasal aperture

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MUSCLES OF THE LIPS AND CHEEKSMUSCLES OF THE LIPS AND CHEEKS

• The sphinctersphincter muscle is the orbicularis oris.

• The dilatordilator muscles consist of a series of small muscles that radiate out from the lips.

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SPHINCTER MUSCLE OF THE LIPS: SPHINCTER MUSCLE OF THE LIPS: ORBICULARIS ORISORBICULARIS ORIS

Origin and insertion: The fibers encircle the oral orifice within the substance of the lips.

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• Some of the fibers arise near the midline from the maxilla above and the mandible below.

• Other fibers arise from the deep surface of the skin and pass obliquely to the mucous membrane lining the inner surface of the lips.

• Many of the fibers are derived from the buccinator muscle.

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Nerve supply: Buccal and mandibular branches of the facial nerve.

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Action:

Compresses the lips together

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DILATOR MUSCLES OF THE LIPSDILATOR MUSCLES OF THE LIPS

• The dilator musclesdilator muscles radiate out from the lips. • The muscles arise arise from the bones and fascia around the oral

aperture and convergeconverge to be inserted into the substance of the lips. • Their action is to separate the lips; this movement is usually

accompanied by separation of the jaws.

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Traced from the side of the nose to the angle of the mouth and then below the oral aperture, the muscles are named as follows:

1.1. Levator labii superioris alaeque nasiLevator labii superioris alaeque nasi

2.2. Levator labii superiorisLevator labii superioris

3.3. Zygomaticus minorZygomaticus minor

4.4. Zygomaticus majorZygomaticus major

Traced from the side of the nose to the angle of the mouth and then below the oral aperture, the muscles are named as follows:

1.1. Levator labii superioris alaeque nasiLevator labii superioris alaeque nasi

2.2. Levator labii superiorisLevator labii superioris

3.3. Zygomaticus minorZygomaticus minor

4.4. Zygomaticus majorZygomaticus major

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5.5. RisoriusRisorius

6.6. Depressor anguli orisDepressor anguli oris

7.7. Depressor labii inferiorisDepressor labii inferioris

8.8. Mentalis Mentalis

5.5. RisoriusRisorius

6.6. Depressor anguli orisDepressor anguli oris

7.7. Depressor labii inferiorisDepressor labii inferioris

8.8. Mentalis Mentalis

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9.9. Levator anguli oris Levator anguli oris (deep to the zygomatic muscles).

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Nerve Supply:

Buccal and mandibular branches of the facial nerve.facial nerve.

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MUSCLE OF THE CHEEKMUSCLE OF THE CHEEK

BuccinatorBuccinator• Origin: From the

outer surface of the alveolar margins of the maxilla and mandible opposite the molar teeth and from the pterygomandibular ligament.

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Insertion: • The muscle fibers pass forward,

forming the muscle layer of the cheek.

• The muscle is pierced by the parotid duct.parotid duct.

• At the angle of the mouth the middle fibers decussate,decussate, those from below entering the upper lip and those from above entering the lower lip.

• The highest and lowest fibers continue into the upper and lower lips, respectively.

• The buccinator muscle thus blends and forms part of the orbicularis oris muscle.

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Nerve supply:

Buccal branch of the facial nerve

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Action:

Compresses the cheeks and lips against the teeth, when paralyzed it leads to accumulation of the food in the vestibule of the mouth.

NERVESNERVES

TRIGEMINAL TRIGEMINAL NERVENERVE

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SENSORY INNERVATION OF THE FACESENSORY INNERVATION OF THE FACE

The skin of the face is supplied by branches of the three the three divisions of the trigeminal nerve,divisions of the trigeminal nerve, except for the small area over the angle of the mandible and the parotid gland, which is supplied by the great auricular nervegreat auricular nerve (C2 and 3).

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• These nerves supply the skin of the face,• in addition, they are the sensory nerve supply to the

mouth, teeth, nasal cavities, and paranasal air sinuses.

• The ophthalmic nerveophthalmic nerve supplies the region developed from the frontonasal process.frontonasal process.

• The maxillary nervemaxillary nerve serves the region developed from the maxillary process of the first pharyngeal first pharyngeal arch.arch.

• The mandibular nervemandibular nerve serves the region developed from the mandibuiar process of the first pharyngeal first pharyngeal arch.arch.

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OPHTHALMIC NERVEOPHTHALMIC NERVE

• The ophthalmic nerveophthalmic nerve supplies the skin of the forehead, the upper eyelid, the conjunctiva, and the side of the nose down to the its tip.

• Five branches of the nerve pass to the skin.

• The ophthalmic nerveophthalmic nerve supplies the skin of the forehead, the upper eyelid, the conjunctiva, and the side of the nose down to the its tip.

• Five branches of the nerve pass to the skin.

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1.1. LACRIMAL NERVELACRIMAL NERVE

The lacrimal nervelacrimal nerve supplies the skin and conjunctiva of the lateral part of the upper eyelid.

The lacrimal nervelacrimal nerve supplies the skin and conjunctiva of the lateral part of the upper eyelid.

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The supraorbital The supraorbital nervenerve winds around the upper margin of the orbit at the supraorbital notch.

• It divides into branches that supply the skin and conjunctiva on the central part of the upper eyelid;

2.2. SUPRAORBITAL NERVESUPRAORBITAL NERVE

• it also supplies the skin of the forehead.

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3.3. SUPRATROCHLEAR NERVESUPRATROCHLEAR NERVE

The supra-trochlear nerveThe supra-trochlear nerve winds around the upper margin of the orbit medial to the supraorbital nerve.

• It divides into branches that supply the skin and conjunctiva on the medial part of the upper eyelid and the skin over the lower part of the forehead, close to the median plane.

The supra-trochlear nerveThe supra-trochlear nerve winds around the upper margin of the orbit medial to the supraorbital nerve.

• It divides into branches that supply the skin and conjunctiva on the medial part of the upper eyelid and the skin over the lower part of the forehead, close to the median plane.

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4.4. INFRATROCHLEAR NERVEINFRATROCHLEAR NERVE

The infratrochlear nerveThe infratrochlear nerve leaves the orbit below the pulley (trochlea) of the superior oblique muscle.

• It supplies the skin and conjunctiva on the medial part of the upper eyelid and the adjoining part of the side of the nose.

The infratrochlear nerveThe infratrochlear nerve leaves the orbit below the pulley (trochlea) of the superior oblique muscle.

• It supplies the skin and conjunctiva on the medial part of the upper eyelid and the adjoining part of the side of the nose.

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5.5. EXTERNAL NASAL NERVEEXTERNAL NASAL NERVE

The external nasal The external nasal nervenerve leaves the nose by emerging between the nasal bone and the nasal cartilage.

• It supplies the skin on the side of the nose down as far as the tip.

The external nasal The external nasal nervenerve leaves the nose by emerging between the nasal bone and the nasal cartilage.

• It supplies the skin on the side of the nose down as far as the tip.

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MAXILLARY NERVEMAXILLARY 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.

• Three branches of the nerve pass to the skin.

• 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.

• Three branches of the nerve pass to the skin.

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1.1. ZYGOMATICOTEMPORAL NERVEZYGOMATICOTEMPORAL NERVE

The zygomaticotemporal The zygomaticotemporal nervenerve emerges in the temporal fossa through a small foramen on the posterior surface of the zygomatic bone.

• It supplies the skin over the temple.

The zygomaticotemporal The zygomaticotemporal nervenerve emerges in the temporal fossa through a small foramen on the posterior surface of the zygomatic bone.

• It supplies the skin over the temple.

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2.2. ZYGOMATICOFACIAL NERVEZYGOMATICOFACIAL NERVE

The zygomaticofacial zygomaticofacial nervenerve passes to 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 zygomaticofacial zygomaticofacial nervenerve passes to the face through a small foramen on the lateral side of the zygomatic bone.

• It supplies the skin over the prominence of the cheek.

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3.3. INFRAORBITAL NERVEINFRAORBITAL NERVE

The infraorbital nerveThe infraorbital nerve is a direct continuation of the maxillary nerve.

• It enters the orbit and appears on the face through the infraorbital foramen.

• It immediately divides into numerous small branches, which radiate out from the foramen and supply the skin of the lower eyelid and cheek, the side of the nose, and the upper lip.

The infraorbital nerveThe infraorbital nerve is a direct continuation of the maxillary nerve.

• It enters the orbit and appears on the face through the infraorbital foramen.

• It immediately divides into numerous small branches, which radiate out from the foramen and supply the skin of the lower eyelid and cheek, the side of the nose, and the upper lip.

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MANDIBULAR NERVEMANDIBULAR NERVE

• The mandibular nervemandibular nerve supplies the skin of the lower lip, the lower part of the face, the temporal region, and part of the auricle. It then passes upward to the side of the scalp.

• Three branches of the nerve pass to the skin.

• The mandibular nervemandibular nerve supplies the skin of the lower lip, the lower part of the face, the temporal region, and part of the auricle. It then passes upward to the side of the scalp.

• Three branches of the nerve pass to the skin.

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1.1. AURICULOTEMPORAL NERVEAURICULOTEMPORAL NERVEThe auriculotemporal The auriculotemporal nervenerve ascends from the upper border of the parotid gland in front of the auricle

• It supplies the skin of the auricle, the external auditory meatus, the outer surface of the ear drum, and the skin of the scalp above the auricle.

The auriculotemporal The auriculotemporal nervenerve ascends from the upper border of the parotid gland in front of the auricle

• It supplies the skin of the auricle, the external auditory meatus, the outer surface of the ear drum, and the skin of the scalp above the auricle.

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2.2. BUCCAL NERVEBUCCAL NERVE

The buccal nerveThe buccal nerve emerges from beneath the anterior border of the masseter muscle and supplies the skin over a small area of the cheek.

The buccal nerveThe buccal nerve emerges from beneath the anterior border of the masseter muscle and supplies the skin over a small area of the cheek.

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3.3. MENTAL NERVEMENTAL NERVE

The mental nervemental nerve emerges from the mental foramen of the mandible and supplies the skin of the lower lip and chin.

The mental nervemental nerve emerges from the mental foramen of the mandible and supplies the skin of the lower lip and chin.

SKINSKIN BRANCHES OF BRANCHES OF THE TRIGEMINAL THE TRIGEMINAL

NERVENERVE

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SURFACE SURFACE ANATOMYANATOMY

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Test your knowledge

FACIAL NERVEFACIAL NERVE

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As the facial nerve runs forward within the substance of the parotid salivary gland, it divides into its five terminal branches.

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The facial nerve is the nerve of the second pharyngeal arch and supplies all the muscles of facial supplies all the muscles of facial expression. expression.

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• The facial nerve does not supply the skin, but its branches communicate with branches of the trigeminal nerve.

• It is believed that the proprioceptive nerve fibers of the facial muscles leave the facial nerve in these communicating branches and pass to the central nervous system via the trigeminal nerve.

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1.1. TEMPORAL BRANCHTEMPORAL BRANCH

The temporal branchThe temporal branch emerges from the upper border of the gland and supplies the anterior and superior auricular muscles, the frontal belly of the occipitofrontalis, the orbicularis occuli,

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2.2. ZYGOMATIC BRANCHZYGOMATIC BRANCH

The zygomatic branchThe zygomatic branch emerges from the anterior border of the gland and supplies the orbicularis occuli.

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3.3. BUCCAL BRANCHBUCCAL BRANCH

The buccal branchThe buccal branch emerges from the anterior border of the gland below the parotid duct and supplies the buccinator muscle and the muscles of the upper lip and nostril.

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4.4. MANDIBULAR BRANCHMANDIBULAR BRANCH

The mandibular branchThe mandibular branch emerges from the anterior border of the gland and supplies the muscles of the lower lip.

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5.5. CERVICAL BRANCHCERVICAL BRANCH

The cervical branchThe cervical branch emerges from the lower border of the gland and passes forward in the neck below the mandible to supply the platysma muscle.

ARTERIAL ARTERIAL SUPPLYSUPPLY

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• The face receives a rich blood supply from two main vessels:

• the facialfacial and • superficial superficial

temporal arteries,temporal arteries, • which are

supplemented by several small arteries that accompany the sensory nerves of the face.

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FACIAL ARTERYFACIAL ARTERY

• The facial artery arises from the external carotid artery.

• Having arched 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.

• The facial artery arises from the external carotid artery.

• Having arched 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.

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• It runs upward in a tortuous course toward the angle of the mouth and is covered by the platysma.

• It then ascends deep to the zygomaticus muscles and the levator labii superioris muscle and 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.

• It runs upward in a tortuous course toward the angle of the mouth and is covered by the platysma.

• It then ascends deep to the zygomaticus muscles and the levator labii superioris muscle and 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.

BRANCHES OF THE BRANCHES OF THE FACIAL ARTERYFACIAL ARTERY

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1.1. SUBMENTAL ARTERYSUBMENTAL ARTERY

The submental arteryThe submental arteryThe submental arteryThe submental artery

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2.2. INFERIOR LABIAL ARTERYINFERIOR LABIAL ARTERY

The inferior labial arteryThe inferior labial arteryThe inferior labial arteryThe inferior labial artery

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3.3. SUPERIOR LABIAL ARTERYSUPERIOR LABIAL ARTERY

The superior labial arteryThe superior labial arteryThe superior labial arteryThe superior labial artery

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4.4. LATERAL NASAL ARTERYLATERAL NASAL ARTERY

The lateral nasal arteryThe lateral nasal artery arises from the facial artery alongside the nose.

• It supplies the skin on the side and dorsum of the nose.

The lateral nasal arteryThe lateral nasal artery arises from the facial artery alongside the nose.

• It supplies the skin on the side and dorsum of the nose.

OTHER FACIAL OTHER FACIAL ARTERIESARTERIES

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SUPERFICIAL TEMPORAL ARTERYSUPERFICIAL TEMPORAL ARTERY

The superficial temporal The superficial temporal artery,artery, the smaller terminal branch of the external carotid artery, commences in the parotid gland.

• It ascends in front of the auricle to supply the scalp.

The superficial temporal The superficial temporal artery,artery, the smaller terminal branch of the external carotid artery, commences in the parotid gland.

• It ascends in front of the auricle to supply the scalp.

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TRANSVERSE FACIAL ARTERYTRANSVERSE FACIAL ARTERY

The transverse facial artery,The 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.

The transverse facial artery,The 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.

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SUPRAORBITAL AND SUPRAORBITAL AND SUPRATROCHLEAR ARTERIESSUPRATROCHLEAR ARTERIES

The supraorbital The supraorbital and supratrochlear arteries, supratrochlear arteries, branches of the ophthalmic artery, supply the skin of the forehead.

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ARTERIAL SUPPLY OF THE FACE ARTERIAL SUPPLY OF THE FACE (in brief)(in brief)

VENOUS VENOUS DRAINAGEDRAINAGE

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• The facial veinThe facial vein is formed at the medial angle of the eye by the union of the supraorbital and supratrochlear veins.

• It is connected to the superior ophthalmic vein directly through the supraorbital vein.

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• By means of the superior ophthalmic vein,By means of the superior ophthalmic vein, the facial vein is the facial vein is connected to the cavernous sinus;connected to the cavernous sinus;

• this connection is of great clinical importance because it provides a pathway for the spread of infection from the face to the cavernous sinus.

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• 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.

• The facial vein ends by draining into the internal jugular vein.

• 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.

• The facial vein ends by draining into the internal jugular vein.

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The facial vein receives tributaries that correspond to the branches of the facial artery.

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The facial vein is joined: The facial vein is joined: • to the pterygoid venous plexus by the deep facial vein and • to the cavernous sinus by the superior ophthalmic vein.

Clinical importance

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Clinical importance

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LYMPH LYMPH DRAINAGEDRAINAGE

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• Lymph from the forehead and the anterior part of the face drains into the submandibular lymph nodes. submandibular lymph nodes.

• A few buccal lymph nodesbuccal lymph nodes may be present along the course of these lymph vessels.

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The lateral part of the face, including the lateral parts of the eyelids, is drained by lymph vessels that end in the parotid lymph nodes.parotid lymph nodes.

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The central part of the lower lip and the skin of the chin are drained into the submental lymph nodessubmental lymph nodes..

Clinical importance

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Clinical importance

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