MOB TCD

Anatomy of the Face

Professor Emeritus Moira O’Brien

FRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dublin
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Face
• Sensory supply of face is
trigeminal
• 5th cranial nerve
• C2
• Motor supply
• Muscles of facial expression
• Facial nerve 7th cranial
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Sensory Nerve Supply

• Trigeminal
• Ophthalmic
• Maxillary
• Mandibular
• Cervical plexus
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Terminal Branches of 5th

• Supraorbital
• Infraorbital damaged in blow
out fracture of orbit
• Lateral
• Mental; dentures, fracture of
mandible
• Trigeminal neuralgia
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Sensory Trigeminal Nerve

• Ophthalmic V
• Supraorbital
• Supratrochlear
• Maxillary V
• Infraorbital
• Zygomaticofacial
• Mandibular V
• Mental
• Buccal
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Fractured Zygoma
• View from above
shows depression
• Lateral X-ray view
should be done
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Great Auricular
• C2 from cervical plexus
• Skin over angle of mandible
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Scalp
• Skin
• Subcutaneous
• Epicranial aponeurosis
• Three fused together
• Loose areolar tissue
• Periosteum
• Occipito-frontalis
• Attached posteriorly
• No anterior attachment
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Scalp
• 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
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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
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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
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Levator Palpebrae Superiores

• Arises from back of roof of orbit

• Inserted into skin of upper eyelid
• The superior tarsal plate
• Superior fornix of conjunctiva
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Levator Palpebrae Superiores

• Elevates upper eyelid

• Voluntary muscle supplied by 3rd
oculomotor nerve
• Smooth muscle
• Sympathetic T1
• Superior cervical ganglion
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Lacrimal Apparatus
• Lacrimal gland
• Conjunctival sac
• Puncta
• Cananiculi
• Nasolacrimal sac
• Nasolacrimal duct
• Inferior meatus nose
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Horner's Syndrome
• Ptosis
• Drooping eyelid
• Meiosis
• Constricted pupil
• Anhydrosis
• Lack of sweating
• Enopthalmos
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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
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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
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Muscles of Facial Expression

• Occipito frontalis
• Orbicularis oculi
• Orbicularis oris
• Buccinator
• Platysma
• Skin of face
• Incisions
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Muscles of Facial Expression

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

• Incisions in the face evert
edges
• Platysma
• Inserted into lower border of
mandible
• Posterior fibres form risorius
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Buccinator
• Buccinator 7th 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
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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
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Facial Nerve
• 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
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Bell’s Palsy

• Lower motor neurone of

facial nerve
• Forehead and all the
muscles on the side of
lesion are affected
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Facial Palsy
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Corneal Reflex
• Afferent (sensory) cilary branches
nasocilary of ophthalmic of 5th
• Efferent (motor)
• Zygomatic branch of facial 7th
• Last reflex to go
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Blood Supply and Pulses in Face

Internal carotid
• Supraorbital artery
• Branch of ophthalmic
External carotid
• Superficial temporal artery
• Facial artery
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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
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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
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Lymph Glands

• Submental
• Submandibular
• Buccal and
mandibular
• Preauricural
• Occipital
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