THE FACE

• The face is the anterior aspect of the head from

the forehead to the chin and from one ear to the
other.

• The face provides our identity as an individual

human.

• Thus defects (malformations, scarring, or other

alterations resulting from pathology or trauma)
have marked consequences beyond their physical
effects.
• The basic shape of the face is determined by the
underlying bones.

• The individuality of the face results primarily from

anatomical variation:
– variations in the shape and relative prominence of the
features of the underlying cranium;
– In the deposition of fatty tissue;
– In the color and effects of aging on the overlying skin; and
– In the abundance, nature, and placement of hair on the face
and scalp.
• Growth of the facial bones takes longer than those of
the calvaria.

• The ethmoid bone, orbital cavities, and superior parts of

the nasal cavities have nearly completed their growth
by the 7th year.

• Expansion of the orbits and growth of the nasal septum

carry the maxillae infero-anteriorly.

• Considerable facial growth occurs during childhood as

the paranasal sinuses develop and the permanent teeth
erupt.
Boundaries

 Superiorly – the margins of the hair

 Inferiorly – the chin

 Laterally – the auricle

N.B. the forehead is common for the scalp and the

face

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 Skin
– Very vascular; wounds bleed profusely but heal
rapidly
– Rich in sebaceous and sweat glands
– Lax except in ear and nose; edema spread rapidly
– Elastic and thick; wounds tend to gap
 Superficial fascia
– Contain facial muscles, nerves, vessels and fat (buccal
fat pad in cheeks)
 Deep fascia
– Absent except over parotid gland and over buccinator
muscle
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Muscles of the face
Lie in subcutaneous tissue

Inserted in to the skin

Named as muscles of facial expression

Arranged in groups around the orbit, nose,

mouth and auricles

Supplied from branches of facial nerve

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 Orbital group of muscles

•Palpebral part
•Orbital part
•Corrugator supercilii
Muscles around the opening of the orbit
•Orbicularis oculi muscle
•Corrugator supercillii muscle
•Depressor supercillii muscle
Orbicularis oculi muscle
- is a thin flat elliptical sphincter that surrounds
the rim of the orbit. It consists of 3 parts
1. Orbital part
2. Palpebral part
3. Lacrimal part
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Orbicularis Origin insertion innervation action
oculi s

Palpebral part Medial Lateral Facial nerve Closes the

palpebral palpebral raphe [VII] eyelids gently
ligament

Orbital part Nasal part of Fibers form an Facial nerve [VII Closes the
frontal bone; uninterrupted eyelids forcefully
frontal process ellipse around
of maxilla; orbit
medial palpebral
ligament

Corrugator Medial end of Skin of the Facial nerve [VII Draws the
supercilii the superciliary medial half of eyebrows
arch eye-brow medially and
downward
 Action of Orbicularis occuli
»Protection
»Movement of tear from the lacrimal
glands
 Corrugator supercillii- pulls the eyebrows
together
 Depressor supercillii - pulls the eyebrows
down ward

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 Nasal group of muscles
•

Nasalis
Transverse part
Alar part
Procerus
Depressor septi
Nasalis (trasverse Origin Insertion Nerve Action
and alar parts)

• Transverse part Maxilla just lateral Aponeurosis across Facial nerve [VII] Compresses nasal
to nose dorsum of nose aperture
with muscle fibers
from the other side

•Alar part Maxilla over lateral Alar cartilage of Facial nerve [VII] Draws cartilage
incisor nose downward and
laterally opening
nostril

Procerus Nasal bone and Skin of lower Facial nerve [VII] Draws down
upper part of lateral forehead between medial angle of
nasal cartilage eyebrows eyebrows
producing
transverse wrinkles
over bridge of nose

Depressor septi Maxilla above Mobile part of the Facial nerve [VII] Pulls nose inferiorly
medial incisor nasal septum
 Oral group of muscles
 Orbicularis oris,
 Buccinator,
 Depressor anguli oris,
 Depressor labii inferioris,
 Mentalis,
 Risorius,
 Zygomaticus major,
 Zygomaticus minor,
 Levator labii superioris,
 Levator labii superioris alaeque nasi, and
 Levator anguli oris,
 Muscles of the mouth
Buccinator :
Occupies the back of the interval between the
maxilla & mandible
Covered by the buccopharyngeal fascia & pierced
by the parotid duct

 Origin
- Alveolar processes of maxilla &mandible
 Insertion
- Orbicularis oris, upper & lower lips

The buccal pad of fat overlying the buccinator and

masseter muscles possesses several extensions,
and contributes to the roundness of a child’s
cheek 18
Action-
• It keeps the cheek taut during chewing
• keep food between the opposing surface of
the teeth
•concerned with whistling, blowing ,
swallowing and is active in smiling

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 Orbicularis oris:
• A sphincter that contains fibres from
other facial muscles as well as fibres
proper to the lips.
Action - closes and protrudes the lips
Muscle origin insertion innervations action

Orbicularis From Forms Facial nerve Closes

oris muscles in ellipse [VII] lips;
area; maxilla around protrudes
and mouth lips
mandible in
midline
Muscles Origin Insertion Nerve Action
supply
Depressor Oblique line of Skin at the Facial nerve Draws corner
anguli oris mandible corner of [VII] of mouth
below canine, mouth and down and
premolar and blending with laterally
first molar orbicularis
teeth oris

Depressor Anterior part Lower lip at Facial nerve Draws lower

labii inferioris of oblique line midline; [VII] lip downward
of mandible blends with and laterally
muscle from
opposite side
Depressor anguli oris and
Depressor labii inferioris
 Mentalis and Risorius
Muscles Origin Insertion Nerve Action
supply
Mentalis Mandible Skin of chin Facial nerve Raises and
inferior to [VII] protrudes
incisor teeth lower lip as it
wrinkles skin
on chin

Risorius Fascia over Skin at the Facial nerve Retracts corner

masseter corner of the [VII] of mouth
muscle mouth
 Zygomaticus major and minor
Muscles Origin Insertion Nerve Action
supply
Zygomaticus Posterior part Skin at the Facial nerve Draws the
major of lateral corner of the [VII] corner of the
surface of mouth mouth upward
zygomatic bone and laterally
Zygomaticus Anterior part of Upper lip just Facial nerve Draws the
minor lateral surface medial to [VII] upper lip
of zygomatic corner of upward
bone mouth
Zygomatic major and minor
 Levator labii superioris, Levator labii superioris alaeque
nasi and Levator anguli oris

Muscles Origin Insertion Nerve Action

supply
Levator labii Infra-orbital Skin of upper Facial nerve Raises upper
superioris margin of lateral half of [VII] lip; helps form
maxilla upper lip nasolabial
furrow
Levator labii Frontal process Alar cartilage of Facial nerve Raises upper lip
superioris of maxilla nose and upper [VII] and opens
alaeque nasi lip nostril

Levator anguli Maxilla below Skin at the Facial nerve Raises corner of
oris infra-orbital corner of mouth [VII] mouth; helps
foramen form nasolabial
furrow
 Levator labii superioris and
Levator labii superioris alaeque nasi
 Auricular group of muscles
Muscles Origin Insertion Nerve Action

Anterior Anterior part of Into helix of Facial nerve Draws ear

auricular temporal fascia ear [VII] upward and
forward

Superior Epicranial Upper part of Facial nerve Elevates ear

auricular aponeurosis on auricle [VII]
side of head
Posterior Mastoid Convexity of Facial nerve Draws ear
auricular process of concha of ear [VII] upward and
temporal bone backward
 Other group of muscles
Occipitofronta Origin Insertion Nerve Action
lis

Frontal belly Skin of Into galea Facial nerve Wrinkles

eyebrows aponeurotica [VII] forehead; raises
eyebrows

Occipital belly Lateral part of Into galea Facial nerve Draws scalp
superior nuchal aponeurotica [VII] backward
line of occipital
bone and
mastoid
process of
temporal bone
 Platysma
• A thin & broad sheet extending over the
front & sides of the neck

• Located in the subcutaneous tissue of the

superficial cervical fascia

• This muscle varies considerably in extent &

may even be absent
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 Platysma
• Origin - subcutaneous tissue and skin
over the upper part of deltoid and
pectoralis major.
• Insertion - lower border of the mandible,
skin of the face and muscles around the
mouth
• All muscles of facial expression develop
from the second pharyngeal arch and
hence are supplied by the facial nerve
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 Sensory Nerves of the face
Two sources –
• Skin around the angle of the mandible – great auricular nerve
• The rest of the face- trigeminal branches
Trigeminal nerve
 Sensory to face and motor to muscles of mastication,3 branches
1. Ophthalmic –three branches
• Lacrimal –supply lacrimal gland and conjunctiva and lateral
part of the upper eye lid
• nasociliary –
– infratrochlear -skin and conjunctiva medial part of the eye
lid and skin of upper half of nose
– External nasal – ½ of lower nose
• Frontal – 2 branches
– Supraorbital- lateral forehead & front of scalp
– Supratrochlear- middle forehead 41
2. Maxillary – three branches
A. Infraorbital – terminal branch; three branches
• Palpebral – skin and conjunctiva of the lower
eye lid
• Nasal – skin of the side of the nose
• Labial – skin and mucus membrane of the
upper lip
B. Zygomaticotemporal- skin the anterior ½ of
the temple and the scalp
C. Zygomaticofacial- skin over the zygomatic
bone
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3. Mandibular
• Auriclotemporal- posterior 1/2 of the temple,
upper 2/3 of the lateral surface of the auricle &
skin of the external acoustic meatus
• Buccal- pierce the masseter, skin and mucus
lining of the cheeks
• Mental – arise from inferior alveolar branch of
the mandibular nerve, skin and mucus lining of
the lower lip
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 Facial nerve (Ⅶ)
• Is also called Queen of the face
Course
internal acoustic meatus, facial canal and stylomastoid
foramen
Branches within the facial canal
• Chorda tympani : joins lingual branch of mandibular
nerve
– To taste buds on anterior two-thirds of tongue
– Relayed in submandibular ganglion, the postganglionic
fibers supply submandibular and sublingual glands

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 Facial nerve cont…

• Greater petrosal nerve: its fibers pass to

pterygopalatine ganglion and there relayed
through the zygomatic and lacrimal nerves to
lacrimal gland

• Stapedial nerve to stapedius

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 …
• Pterygopalatine ganglion : lies in
pterygopalatine fossa under maxillary
nerve

• Submandibular ganglion: lies between

lingual nerve and submandibular gland

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Branches outside of facial canal
• Posterior auricular
• Temporal
• Zygomatic
• Buccal
• Marginal mandibular
• Cervical

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Surface Anatomy of Face
 Clinical correlations
• Bell's palsy
– Lesions of the facial nerve
• Results in dribbling of tears and saliva due to
paralysis of the orbicularis muscles; and
paralysis of buccinators lead to accumulation of
food in the vestibule
• Test by asking patients to smile or to whistle
– loss of muscle tone causes the normal skin
folds to disappear on the side of the lesion
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• Injury to the facial nerve (CN VII) or its branches
produces paralysis of some or all facial muscles on
the affected side (Bell palsy).
• The affected area sags, and facial expression is
distorted, making it appear passive or sad.
• The loss of tonus of the orbicularis oculi causes
the inferior eyelid to evert (fall away from the
surface of the eyeball).
• As a result, lacrimal fluid is not spread over the
cornea, preventing adequate lubrication,
hydration, and flushing of the surface of the
cornea.
• This makes the cornea vulnerable to ulceration. A
resulting corneal scar can impair vision.
• If the injury weakens or paralyzes the buccinator
and orbicularis oris, food will accumulate in the
oral vestibule during chewing, usually requiring
continual removal with a finger.
• When the sphincters or dilators of the mouth are
affected, displacement of the mouth (drooping of
its corner) is produced by contraction of
unopposed contralateral facial muscles and
gravity, resulting in food and saliva dribbling out
of the side of the mouth.
• Weakened lip muscles affect speech as a result of
an impaired ability to produce labial (B, M, P, or
W) sounds.
• Affected persons cannot whistle or blow a wind
instrument.
• They frequently dab their eyes and mouth with a
handkerchief to wipe the fluid (tears and saliva),
which runs from the drooping lid and mouth; the
fluid and constant wiping may result in localized
skin irritation.
 Infra-Orbital Nerve Block
• For treating wounds of the upper
lip and cheek or, more commonly,
for repairing the maxillary incisor
teeth, local anesthesia of the inferior
part of the face is achieved by
infiltration of the infra-orbital nerve
with an anesthetic agent.

• The injection is made in the region

of the infra-orbital foramen, by
elevating the upper lip and passing
the needle through the junction of
the oral mucosa and gingiva at the
superior aspect of the oral vestibule.
• To determine where the infra-
orbital nerve emerges, pressure is
exerted on the maxilla in the region
of the infra-orbital foramen.
• Too much pressure on the nerve
causes considerable pain. Because
companion infra-orbital vessels
leave the infra-orbital foramen with
the nerve, aspiration of the syringe
during injection prevents
inadvertent injection of anesthetic
fluid into a blood vessel.
• Because the orbit is located just
superior to the injection site, a
careless injection could result in
passage of anesthetic fluid into the
orbit, causing temporary paralysis
of the extraocular muscles.
 Blood vessels of the face

A. Arteries – six arteries which have free

anastomosis
1. From ophthalmic artery- two arteries
originating in the orbit
• Supratrochlear
• Supraorbital
2. From external carotid artery – four arteries;
external carotid artery in the parotid gland
divides in to two terminal branches: maxillary
and superficial temporal arteries
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A. Facial artery – origin in the neck, major blood
supply of the face
Course - tortuous course lower border of
mandible at the anterior border of the
masseter (feel the pulse) first to the angle of
the mouth and then up at the side of the
nose to the medial angle of the eye.
main branches
– Superior labial – upper lip
– Inferior labial – lower lip
– Lateral nasal – nose

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B. Transverse facial – a branch of superficial temporal
artery
– enters the face at the anterior upper border of
the gland.
– distribution- the face, parotid gland and its
ducts.
C. Infraorbital – one of the terminal branch of
maxillary artery
D. Mental artery- from inferior alveolar artery ( a
branch of external carotid artery)

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 B. Veins
– Free anastomosis
1. Veins draining in to anterior facial vein
– Supratrochlear veins
– supraorbital veins
• two veins unite to form anterior facial vein at the
medial angle of the orbit.
• Course - leave the face at the anteroinferior angle
of masseter; pierce the deep fascia of the neck;
crosses the submandibular gland; join the
anterior division of posterior facial vein/
retromandibularvein to form the common facial
vein draining in to the internal jugular vein. 67
The tributaries of anterior facial vein - veins
accompanying facial artery. Anterior facial vein
communicates
– Pterygoid plexus
» Deep veins → deep facial veins on the
surface of buccinator muscle
– cavernous sinuses through Ophthalmic
veins through supraorbital &
supratrochlear veins.

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2. veins draining in to the superficial temporal and
maxillary veins
– Transverse facial- end in the superficial
temporal veins
– Infraorbital- in to the maxillary veins
– Mental - in to the maxillary veins
• Retromandibular vein
– formed by union of superficial temporal and
maxillary veins
– descend within parotid gland and at end divide
into anterior and posterior divisions

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 Dangerous triangle of the face
• consists of the area from the corners of the
mouth to the bridge of the nose, including the
nose and maxilla.
• Due to the special nature of the blood supply to
the human nose and surrounding area, it is
possible (although very rare) for retrograde
infections from the nasal area to spread to the
brain.
• This is possible because of venous
communication (via the ophthalmic veins)
between the facial vein and the cavernous sinus .

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Lymphatic drainage

– Parotid lymph nodes – face above the

root of the nose / upper territory
– Submandibular lymph nodes –from the
face below the root of the face/ middle
territory
– Submental lymph nodes – from chin and
median part of the lower lip/lower
territory

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