Anatomy of the face

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2. MOB TCD
Professor Emeritus Moira O’Brien
FRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dublin
Anatomy of the Face

3. Face
•Sensory supply of face is
trigeminal
•5
th
cranial nerve
•C2
•Motor supply
•Muscles of facial expression
•Facial nerve 7
th
cranial
MOB TCD

4. Sensory Nerve Supply
•Trigeminal
•Ophthalmic
•Maxillary
•Mandibular
•Cervical plexus
MOB TCD

5. Terminal Branches of 5
th
•Supraorbital
•Infraorbital damaged in blow
out fracture of orbit
•Lateral
•Mental; dentures, fracture of
mandible
•Trigeminal neuralgia
MOB TCD

6. Sensory Trigeminal Nerve
•Ophthalmic V
•Supraorbital
•Supratrochlear
•Maxillary V
•Infraorbital
•Zygomaticofacial
•Mandibular V
•Mental
•Buccal
MOB TCD

7. Fractured Zygoma
•View from above
shows depression
•Lateral X-ray view
should be done
MOB TCD

8. Great Auricular
•C2 from cervical plexus
•Skin over angle of mandible
MOB TCD

9. Scalp
•Skin
•Subcutaneous
•Epicranial aponeurosis
•Three fused together
•Loose areolar tissue
•Periosteum
•Occipito-frontalis
•Attached posteriorly
•No anterior attachment
MOB TCD

10. •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

11. 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
MOB TCD

12. 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
MOB TCD

13. Levator Palpebrae Superiores
•Arises from back of roof of orbit
•Inserted into skin of upper eyelid
•The superior tarsal plate
•Superior fornix of conjunctiva
MOB TCD

14. •Elevates upper eyelid
•Voluntary muscle supplied by 3
rd

oculomotor nerve
•Smooth muscle
•Sympathetic T1
•Superior cervical ganglion
Levator Palpebrae Superiores
MOB TCD

15. Lacrimal Apparatus
•Lacrimal gland
•Conjunctival sac
•Puncta
•Cananiculi
•Nasolacrimal sac
•Nasolacrimal duct
•Inferior meatus nose
MOB TCD

16. Horner's Syndrome
•Ptosis
•Drooping eyelid
•Meiosis
•Constricted pupil
•Anhydrosis
•Lack of sweating
•Enopthalmos
MOB TCD

17. 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
MOB TCD

18. 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
MOB TCD

19. •Occipito frontalis
•Orbicularis oculi
•Orbicularis oris
•Buccinator
•Platysma
•Skin of face
•Incisions
Muscles of Facial Expression
MOB TCD

20. •Orbicularis oris
•Intrinsic: origin and
insertion inside, only alters
shape
•Extrinsic: origin outside,
alters position
Muscles of Facial Expression
MOB TCD

21. •Incisions in the face evert
edges
•Platysma
•Inserted into lower border of
mandible
•Posterior fibres form risorius
Muscles of Facial Expression
MOB TCD

22. Buccinator
•Buccinator 7
th
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
MOB TCD

23. 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
MOB TCD

24. •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

25. Bell’s Palsy
•Lower motor neurone of
facial nerve
•Forehead and all the
muscles on the side of
lesion are affected
MOB TCD

26. Facial Palsy
MOB TCD
MOB TCD

27. Corneal Reflex
•Afferent (sensory) cilary branches
nasocilary of ophthalmic of 5
th
•Efferent (motor)
•Zygomatic branch of facial 7
th
•Last reflex to go
MOB TCD

28. Blood Supply and Pulses in Face
Internal carotid
• Supraorbital artery
• Branch of ophthalmic
External carotid
• Superficial temporal artery
• Facial artery
MOB TCD

29. 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
MOB TCD

30. 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
MOB TCD

31. Lymph Glands
•Submental
•Submandibular
•Buccal and
mandibular
•Preauricural
•Occipital
MOB TCD

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