Anatomy Presentation Script

INTRO- Talking about blood supply, muscles, then nerves, with clinical considerations
spread within the presentation.

So today I will be talking about the muscles and neurovasculature of the face. So, the face is
made up of 6 pairs of bones and 2 single bones. The pairs are zygomatic, maxillary, nasal, inf
nasal concha, lacrimal, and palatine, with the single ones being the vomer and mandible. 

First with the blood supply, it is important to note that the carotid artery branches into the
internal and external arteries. For blood supply to the face, the external carotids will be the
primary vessels for the face, while the internal carotids and vertebral artery will be supplying the
brain. Branches of the external carotid (more internally) include the superficial temporal (where
you measure the temporal pulse), maxillary, posterior auricular, occipital, facial, lingual,
ascending pharyngeal, superior thyroid. The facial artery is the major arterial supply to the
superficial face, which travels to the inferior border of the face, anterior to the masseter. and runs
tortuously at an angle across the corner of the mouth to the medial angle of the eye. The
maxillary artery supplies much of the deep face, including the upper and lower jaws, then gives
off the middle meningeal artery.

The venous supply consists of the external jugular vein, which receives contributions from the
retromandibular, anterior jugular, and facial veins, then eventually drains to the subclavian vein,
but the internal jugular is much bigger and drains more blood. Clinical considerations is the
danger triangle of the face, where the facial vein can spread infections to the superior ophthalmic
vein and then the cavernous sinus and finally the dural venous sinus, which can then spread to
the brain. Also you can have thrombophlebitis, where veins in the orbit become inflamed and pt
presents with inflamed and red eyes. 

And now for the muscles, first we have the occipitofrontalis (connected by the epicranial
aponeurosis) and wrinkles the forehead and moves the scalp. Next we have the orbicularis oculi,
which has 2 parts: the orbital part and the palpebral part. The orbital part does forceful closure of
the eye, while the palpebral part does gentle closer (like going to sleep). Next, we have the
orbicularis oris, which purses the lips, the zygomaticus major, which helps us smile, and the
depressor angularis oris, which depresses the corners of the mouth. After, we have the
buccinator, which holds food in the mouth and expels air (to help us play the trumpet). We also
have the nasalis muscles, which flare the nostrils. Remember, all these muscles are attached to
the deep skin, which allows us to make facial expressions, without moving bone.

Now onto the nerves. The 2 cranial important cranial nerves here are CN5 and 7, the trigeminal
nerve and facial nerve. First let’s talk about the trigeminal nerve, which provides the sensory
innervation to the face. This nerve is for the first pharyngeal arch and has 3 divisions:
ophthalmic, maxillary, and mandibular. Ophthalmic and maxillary provide only general sensory
innervation, while the mandibular division does mostly general sensory, but also includes motor
innervation to the 4 muscles of mastication, ant digastric, mylohyoid, tensor veli palatini, and
tensor tympani. Tracing these branches, V1 travels through the cavernous sinus and exits the
superior orbital fissure as the subraorbital nerve and provides sensory to the nose, eyes, and
forehead. V2 travels from the cavernous sinus and exits the foramen rotundum as the infraorbital
nerve and provides sensory to the mid face/upper teeth. V3 exits the foramen ovale as the mental
nerve and provides sensory for the lower face and motor for muscles mentioned previously.

Then we have the facial nerve with 5 branches, temporal, zygomatic, buccal, mandibular, and
cervical and is the nerve to the second pharyngeal arch. These branches exit the stylomastoid
foramen (and sit deep to the parotid gland and superficial to the masseter muscles) and help with
motor innervation of facial muscles, special sensory to the ant 2/3 of tongue and parasympathetic
innervation to glands like the lacrimal, sublingual..)

Lastly, we have the parotid gland and duct. There are 3 main structures passing through the
parotid gland: facial nerve, external carotid artery, and the retromandibular vein (branch of
external jugular). The parotid gland is the largest of 3 paired saliva glands. The parotid duct,
similarly to the facial nerve branches, passes anteriorly over the masseter, and then pierces the
buccinator muscle to enter superiorly to the oral cavity at the 2nd molar. Parasympathic motor is
with CN 9, the glossopharyngeal nerve, (where stimulation results in secretion of saliva) while
sensory innervation is from the 3rd branch of the trigeminal nerve (auriculotemporal branch).
Here we have to consider Bell’s Palsy, where compression of the facial nerve by the
masseter/parotid gland may result in stroke or paralysis to the brain and lower eyelid drop and
drooling. Here, it is important to note that the upper face gets innervation from both hemispheres
of the brain, while the lower face gets innervated by the contralateral hemisphere. Therefore, if
there is a distal lesion, both the upper and lower parts will be affected.