Lecture 2 .t-n-* I .

Th* Face
Skin of the Face
The skin of the face possesses numerous sweat and sebaceous glands. It is
connected to the underlying bones by loose connective tissue, in which are
embedded the muscles of facial expression. No deep fascia is present in the face.
Wrinkle lines of the face resuk from the repeated folding of the skin perpendicular
to the long axis of the undetlyug contracting muscles, coupled with the loss of
youthsul skin elasticity. Surgical scars of the face are less conspicuous if tfteyfollow
the wrinkle lines

Muscles ofthe Face (Muscles of Facial Expression)

The muscles of the face are embedded in the superftcial fascia, and most arise &om
the bones of the skull and are inserted into the skin. The oriftces of the face,
namely, the orbit, nose, and mouth, are guarded by the eyefids, nostrils, and lips,
respectivelp It is the function of the facial muscles to serye as sphincters or dilators
of these structures. A secondary function of the facial muscles is to modiS the
expression of the face. Ali the muscies of the face are deveioped from tire second
pharyngeal arch and are suppliedbythe facial nerve.
Muscles of the Evelids
The sphincter musele of t"he eyelids ir the orbicularis oculi, and the dilator muscles
arefhe levator palpebrae superioris and the occipitofrontalis.
Muscles of the Nostrils
The sphincter muscle is the compressor naris and the dilator muscle is the dilator
naris"
Muscles of the Lips and Cheeks
The sphincter muscle is the orbicularis oris. The dilator muscles consist of a series
of srnall muscles that radiate out from the lips.

T-
$pldncter lVluscle of the Lips: Orbicularis Oris
Origin_and insertion: The ffbers encircle the oral oriftce within fic dra of
the lips. Some of the ffbers arise near the midline from the maxille rbG nf trE
mandible below. Other fibers arise from the deep surface of the *in rl fffi
obliquety to the mucous membrane lining the inner surface of the lips- Ibfmydfic
ftbers are derived from the buccinators muscle"
Nelve suppll,: Buccal and mandibularbranc-hes of the facial nefve

&@+i ComPresses the liPs together

Dilator Mrmcles of the LiPs

The dilator muscles radiate out from the lips, and their action is to separe frc
lips; this movement is usually accompanied by separation of the jaws' The mmrJ:s
arise from the bones and fascia around the oral aperture and conwge 6 bc

inserted into the substance of the lips"

The muscles are named as follows:

Levatorlabii superioris alaeque nasi, Levatorlabii superiorisrZygom*ticus minor
Zygomaticus major,Levator anguli oris (deep to the zygomnticmuscles)rRisorius
Depressor anguii oris, Dep(essor labii inferioris, Mentalis
Nerve Suppl)n Buccal and mandibularbranches of thefacial nefve

Musctre of the Cheek

Buccinator
Origin: From the outer surface of the alveolar margins of the maxilla and mandible
opposite the molAr teeth and from the pterygomandibular ligament'
Insertion:.The muscle ftbers pass forward, forming the muscle layer of the cheek'
The muscle is pierced by the parotid duct. At the angle of the mouth the central
ftbers decussate, those from belorv entering the upper lip and those from above
entering the lower lip; the highest and lowest ffbers continue into the upper and

2
lower lips, respectively, without intersecting. The buccinator musele thus blends
and forms part of the orbicularis oris muscle.
Nerve suoolv: Buccal branch of&e facid nerve
Action: Compresses the cheeks and lips against the teeth

Sensory Nerves of the Face

The skin of the face is suppliedbybranches ofthe three 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 nerve (C2 and 3). Th e ovedap of the
three divisions of the trigeminal nerve is sligfrt compared with the considerable
overlap of dermatomes of the trunk and limbs.These nervies not only supply the
skin of the face, but also supplyproprioceptive ftbers to the underlying muscles of
facial expression. They are, in addition, the sensory nervre supply to the mouth,
teeth, *'asa! ca-,{ties, and paranasd air sinuses.
1. Ophthalmic Nerve
The ophthalmic nerve supplies the skin of the forehead, th" upper eyelid, the
conjunctiva, md the side of the nose down to and including the tip. Five branches
ofthe neflre pass to the skin.
. The lacrimal nerve supplies the skin and conjunctiva of the lateral part of the
upper eyelid.
. The supraorbital nerve 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; it also supplies the skin of
the forehead.
. The suprarochlear 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, clase to the median plane.

3
 I The infratrochlear ner',e leaves the orbit belorr the pull ey of the superior
oblique muscle. It supplies the skin and conjunctiva on the medial part of
the uppereyelid and the adjoiningpartofthe side ofthe nose.
. The external nasal nerve leaves the nose by emerging between the nasal bone
and the upper nasal cartilage. It supplies the skin on the side of the nose
down 4s faras the tip.
Maxillary Nen'e
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. Threebranches of the nerve pass to the skin.
. The infrao6ital nerve is a direct continuation of the maxillary nerve. It
enters the orbit and appeaf,s on the face through the infrao$ietforamen 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 upperlip

' The zygomaticofacial nerve passes onto the face through a small foramen on
the lateral side of the Zygomatic bone. It supplies the skin over the
prominence ofthe cheek

' The zygomaticotemporal nerve emerges tn the temporal fossa tftrough a

small foramen on the posterior surface of the zygomaticbone. It supplies the
skin overthe temple.

Nlandibular Nerve
The mandibular nerve supplies the skin of the lower lip, the lower part of the face,
the temporal regionn and part of the auricle. It then passes upward to the side of the
scalp. Three branches of the nervre pass to the skin.
. The mental nerve emerges fram the mental foramen of the mandible and
supplies the skin ofthe lowerlip and Chin.

4
 t The buccal nerve eme{ges &ombeneath the anteriorborder of the masseter
muscle and supplies the skin over a small area ofthe cheek
. The auriculotemporal nerve ascends from tLe upper border of the parotid
gland between the superffcial temporal vessels and the auricle. It supplies
the skin of the auricle, the external auditory meatus, the outer surface of the
tympmic membrane, and the slcin of the scalp above the auricle.
Arterial Supply of the Face
The face receives a rich blood supply from two main vessels: the facial and
sunerftcial temporal arteries, which
....'.....-._ are supplemented by several small arteries that
accompany the sensory nerves of the face.

* The facial artety arises from the external carotid artery. Having
arched upward and over the submandibular salivary gland, it curves

around tfue 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. It flurs upward in a tortuous course toward the angle of the mouth
and is covered by the platysma and the risorius muscles. 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 terminalbrnnches of
the ophthalmic aftery.

Branehes oftfte facial artery

tr The submental afiery arises from dre facial wtery at the lower border of the
body ofthe mandible. It supplies the skin ofthe chin and lowerlip.
tr The inferior labial arte{y arises near the angle of the mouth. It runs medially
in the lower lip and anastomoses with its fellow of the opposite side.

5
t-

tr The superior labial artery arises near the angle of the *o,rth. It runs *"diutty
in the upperlip and gives branches to the seprum and alaofthe nose.
El The lateral nasal atrery arises from the facial artery alongside the nose. It
supplies the skin on the side and dorsum ofthe nose.

* The superftcial temporal attety,the smaller terminal branch

of the externd caratid artegt cornmences in the parotid gland. It
ascends in front of the auricle to supply the scalp. The transyerse
facial arteqy, a branch of the superftcial temporal arte{fr arises within
the parotid gland. It runs forward across the eheek just above the
parotid duct.

* The supraorbital and supratrochlear arteries, branches of

the ophthalmic artetyrsupplythe skin ofthe forehead.

Venous Drainage ofthe Face

The 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 direcdy through the supraorbital vein. By means of the superior ophthalmic
vein, the facial vein is connected to the car.ernous sinus fhis connection is of great
;
clinical importance because it provides a pathway for the spread of infection from
the face to the cavernous sinus. The facialvein descends behind the facial afteryto
the lower margin of the body of the mandible. It crosses superftcial to the
submandibular gland and is joined by the anterior division of the rerromandibular
vein" The facial vein ends by draining into the internal jugular vein.
Tributaries

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The facial vein receives tributaries that correspond to the branches of the facial'
artery. It is joined to the pterygoidvenous plems bythe deep facialvein and to tfte
cavrefnous sinus by the superior ophthalmic vein.

The transvierse facial vein joins dre superftcial temporal vein within the parotid
gland.

Ly-ph Drainage of the Face

Ly*ph from the forehead and the anterior part of the face drains into the
subman&bular lymph nodes. A few buccal ly-ph nodes may be present along the
corrrse of these ly*ph rressels. The lateol prtt of the face, including the lateral
parts of the eyelids, is drained by lymph vessels that end in the parotid ly-ph
nodes. The central part of the lower lip and the skin of the chin are drained into the
submenallymph nodes.

7
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Facial Nenre
As the facial nerve runs forward within the substance of the parotid salivary gland,
it divides into its ftve terminalbranches.
. The temporal branch emerges from the upper border of the gland and
supplies the anterior and superior auricular muscles, the fronal belly of the
occipitofrontalis, the orticularis oculi, and the corrugators supercilii.
 ' The zygomatic branch emerges from the anterior border of the gland and
supplies the orbicularis oculi.

' The buccal branch emerges frorn the anterior border of the gland below the
parotid duct and supplies the buccinator muscle and the muscles of the
upperlip and nostril.
. The mandibular branch emerges from the anterinr border of the gland and
supplies the muscles of the lowerlip.
. The cervical branch emerges from the lower border of the gland and passes
forward in the neck below the mandible to supply the platysma musclel it
may cross the lower margin of the body of the mandible to supply the
depressor anguli oris muscle.
The facial nerve is the nerve of the second pharyngeal arch and supplies all the
muscles of facid expression. It does not supply the skin, but its branches
coflurrunicate with branches of the trigeminal nsrvie.

h{nsde$ of Frrirrl Exprerrion

Artteri*r \ielv
aponeurolica
bellg [frontalisJ of epicranius muscle
Procerus muscle
Conugator supercilii muscle
bital part of
orbicularis oculi muscles

alpebral prrt of
orbieularis of oculi museles
Leuator labii saperioris
alaeque nasi muscle

ansserse Part of nnsalis musc

Levator labii supefioris musc
Auriculatis snterior muscle

minor muscle
pa* of nasalis muscle

major muscle
Levator anguli oris muscle

Buccina?sr muscls
Bisorius muscle
0rbicularis oris muscte
anguii oris muscle

Bepressor labii inferiaris musqf

3
Platusma musclp ,, t f diff
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.rr.1Llqil€ rt*rsi nr'sclr _
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e}r$1661t*.;, oris n.r*sr:le

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Zygonatticus nr irrtr rnuscfe

Z1.gr-urr*ticus rlrajr;r. 111115g1s1

Lev"ttr:r anguli r:ris nrusr:le

E*c,cinatr:r nruscle
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Orliital parr 1 of trhicr.rlaris

Palpebral part I ':x-uli tttuscle

TratrEt'er:;r: pat t I ol n.rs.tf is

Alar part I rttusc le

Depre*sor' s€pri n;!si nuscle

r Tr.uLcl.erse rrxin&,les of fomhe"ld. r Front.llis

r Trnn-*r'erse rvrinkles rrt lrri<{ge oll nrxe, r Frcx..gnrs
i rrowaing Verti.-al rrrinkhs of t'orehe.rtl Corruga tor srrpercilli
I Artgrr r Diht.rtion of .urterior rrns.rl .rPerhre r Dil.ttor naris
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. DePr€.55i.tt of tr\vef F.ut of ' r Depressor sel.rti
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i Lrrughing Smlting Angle t,f rrorrl-h is drartrr up!firds .md later.dlv
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Zlgonratir:us nrajor
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i Sorrowand grief Accenhr.rtiorr of nitsolabirrl hrrrornr rvith eler.,ation . Levator l"rbii superioris
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13
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tlc{ipit*tront*lis nruscle, fr,}nial b€lly

ffi$. ,ffi.ft,m
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,- - $tsratrochlsar n*r'rs

*--- $upraortril'al ner*e

Prncerus mugcle
- Cffrugator suBercilii mu*cle
{cutl

Zlgonullrotemporal nerve
Orbicul*ris ocrdi muscls:
{}rbilal parl *-,Auricul*tamporal $err"€
Pdpebml part -- - ---<
Zy$omatic+fcici*l nerve
Nasslis muscls ---.-*,-:- * Levator tabii superiaris
Lmrabr bbii sup€rkxis ..- musil€ {fft}
al*eque naa mus*l*
lnfraorbital rsrw
LevElter labii
sr.rpsfisris $ars{ls
.'-- Le{ator anguli sris muscle
eygcneticrs nrinrrr nrumb
Zygometicus maJor nrrncla -
Paroiid duei afld gland
Risorius muscla .*^*^- **--guc{rd nervfr
Sepres$$r ssFli nflsi nrutcle inator nruscle
orbleulflns sris rnu$cl* Masseiermusele
Depressc'r a*guli oris muscle *----
Dapressor labii infsriariE mu*cls--**-
ftle*lal rwrve
Plaff*ra muscle
Mer$al-s rnuscle truil

L4