Superficial Face

and
Parotid Region
Dr. Nitin Vishwakarma
Email: nitinv@nu.edu.om
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 Learning objectives
At the end of this session, students should be able to:
• Describe the sensory supply of skin of the face

• Corneal reflex – anatomical aspect and clinical importance

• Outline the muscles of facial expression

• Describe the course of facial and superficial temporal arteries on face and site of palpation

• Describe venous drainage of face, venous communications with intracranial venous sinuses and understand their clinical
importance

• Describe the position and gross anatomy of parotid gland, understand the structures related to the gland; parotid duct – site of
opening

• Enumerate the structures passing through parotid gland and understand their clinical importance

• Describe the location and branches of facial nerve; understand clinical aspects of facial palsy

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Ref. – Clinical anatomy by Regions, R.S. Snell, 9th ed. Pages: 579-583 and 630-632
Self Review of Bones of Face

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Self Review of Surface Features of Face

Superciliary arches can cut the

overlying skin.

In which syndrome, epicanthal

folds are prominent with flat
nasal bridge?

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 By 3 branches of trigeminal (CN V) nerve:
Cutaneous nerves face
1. Ophthalmic (V1 –violet area)
2. Maxillary (V2 – blue area)
3. Mandibular (V3- pink area)

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• Ophthalmic division (V1) of Trigeminal nerve (Cranial nerve V):
1. Supraorbital: supplies lateral part of forehead, scalp
2. Supratrochlear: supplies medial forehead
3. Infratrochlear: supplies root of nose
4. External nasal: supplies tip of nose (** NOT Ala of nose)
5. Lacrimal: also carries secretomotor fibers to lacrimal gland

• Maxillary division (V2) :

1. Infraorbital: lower eyelid upto upper lip, supplies ala of nose (not tip of nose)
2. Zygomaticofacial: temple
3. Zygomaticotemporal: temple

• Mandibular division (V3) :

1. Mental: lower lip, chin
2. Buccal: cheeks
3. Auriculotemporal: parts of skin of auricle, tympanic membrane

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 Testing the sensory portion of
Trigeminal nerve

1. Touch over the skin supplied by trigeminal nerve

2. Corneal reflex - Testing by cotton wick on cornea – tests Danger zones related to branches of
ophthalmic branches to cornea (afferent limb) and facial nerve trigeminal nerve
to muscles closing the eyelid (efferent limb)

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 Muscles of Face
• Embedded in superficial
fascia

• Origin from bones & inserted on

skin; move skin

• Arranged around orifices – as

dilator/ sphincters – guard
mouth, eyes, nostrils

• Also used for facial expression

• Supplied by facial nerve

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Muscles of Eyelids
1. Occipitofrontalis
2. Orbicularis oculi:
○ Palpebral part
○ Orbital part
3. Corrugator supercilii
Paralysis of orbicularis oculi leads to drooping
of lower eyelids - ECTROPION, and tear
outflow - EPIPHORA

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 Muscles of Nostrils
5. Dilator naris
6. Compressor naris
7. Procerus

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Sphincter: Orbicularis oris
Dilator muscles:
Muscles of Lips & Cheeks
• Upper lip:
– Levator labii
superioris
alaeque nasi
– Levator labii
superioris
• Angle of mouth:
– Zygomaticus minor
– Zygomaticus major
– Levator anguli oris
– Risorius
– Depressor anguli
oris
• Lower lip:
– Depressor labii
inferioris
– Mentalis
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 Buccinator & Platysma
Buccinator is muscle of cheek
• Takes origin from maxilla, mandible,
pterygomandibular raphe
• Pierced by duct of parotid gland
• Supplied by buccal branch of facial nerve

Platysma is present in superficial fascia and extends into

neck superficial to clavicle

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 Facial artery
• Branch of external carotid artery
• Palpated at inferior margin of mandible at anterior
border of masseter muscle
• Terminates near medial angle of eye
Superficial temporal artery
• Terminal branch of external carotid artery
• Arises in parotid gland substance
• Runs upwards; pulsation can be felt against zygomatic
arch
• Branch: Transverse facial artery

**Supraorbital & Supratrochlear are branches of Ophthalmic artery which is br of internal carotid artery
Facial vein

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 Facial vein
• Formation: at medial angle of eye by joining of
supratrochlear & supraorbital veins

• Retromandibular vein is formed by joining of

superficial temporal and maxillary vein (from deep
aspect). RMV divides into ant. and post. division.

• Anterior division joins with facial vein to form

common facial vein, which drains into int. jugular
vein

• Posterior division joins with posterior auricular

vein to form external jugular vein

• External jugular vein = Posterior auricular vein +

posterior division of RMV External Jugular Vein
• Internal jugular vein comes from cranium; carries
blood from brain

• Deep facial vein emerges from pterygoid venous

plexus (from deep aspect) 16
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 Danger Triangle of Face
● It is that region of face from where the draining veins communicate with intracranial veins. Facial vein
communicates with superior & inferior ophthalmic veins which join cavernous sinus.
● Also the deep facial vein communicates with Pterygoid venous plexus which communicates with Cavernous
sinus
● Infections may reverse-spread from face to cavernous sinus by these routes causing cavernous sinus
thrombosis

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A 52-year-old man was admitted due to high-grade fever with chills

and cranial nerve deficits. Fifteen days prior to hospitalization, a

furuncle had developed over the tip of the nose and had extended to

involve the surrounding area and upper lip. He was prescribed oral

antibiotics. However, fever persisted, and 1 day prior to admission he

noticed pain in his right eye and forehead, with drooping of the eyelid

and diplopia. On examination, complete right ophthalmoplegia was

found
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 Lymphatic Drainage of Face

● Forehead & anterior part: buccal nodes→submandibular nodes

● Lateral part → Parotid nodes
● Central part: lower lip & chin → Submental nodes
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Location:
• Anteriorly: masseter, ramus of
mandible
Parotid Gland
• Posteriorly: mastoid
process, styloid process,
sternocleidomastoid
• Above: external acoustic meatus,
TM joint

Capsules: True (loose, derived from

gland stroma) & False (tough,
parotidomasseteric fascia derived from
investing layer of deep cervical fascia -
from neck)

Gland is divided into superficial & deep

lobes by facial nerve passing through it

Parotid duct: Begins from anterior

border; runs over masseter, pierces
buccinator and opens in the vestibule
of mouth against crown of upper
second molar teeth 21
 Structures related to parotid gland
Lateral surface:
1. Skin,
2. Great auricular nerve
Anteromedial surface:
3. Posterior border of ramus of mandible
[alongwith medial pterygoid muscle & masseter
muscle]
Posteromedial surface:
4. Styloid process & muscles attached
(styloglossus, stylohyoid, stylopharyngeus)
5. mastoid process & muscles attached (SCM,
posterior belly of digastric muscle);
6. facial nerve enters from this surface and passes
anteriorly Transverse section of Head
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 Structures present in the gland
From superficial to deep
• Facial nerve
• Retromandibular vein
• Terminal part of external carotid artery – dividing into superficial temporal & maxillary artery

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 Parasympathetic Supply of Parotid Gland
• From glossopharyngeal (IX cranial nerve)

• Branches pass thr. Tympanic branch >>>> Lesser petrosal nerve >>> relay in OTIC
GANGLION >>> postganglionic fibers pass through auriculotemporal nerve to reach parotid
gland

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 Facial nerve
• Emerges from stylomastoid foramen; gives posterior auricular nerve and branch to digastric
muscle 🡪 enters into parotid gland
• Within parotid gland divides into smaller branches which emerge from anterior border of parotid gland

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Test for the branches of facial nerve:

● Frowning of forehead - Temporal branch

● Tight closing of eyelids - Zygomatic branch
● Puffing cheeks/ show teeth/ smile - Buccal
branch

Danger zones associated with facial nerve branches

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 Bell’s Palsy
Due to damage to facial nerve
Features:
• Paralysis of muscles of facial expression
• Drooping of lower eyelid,
• Sag of the angle of mouth of affected side
• Distortion of face