Chapter 6

Face

Textbook of Human Anatomy

Volume 5: Head, Neck and Face
Author: Dr Yogesh Sontakke,
JIPMER, Pondicherry

©CBS Publishers & Distributors Pvt Ltd, New Delhi

 LAYERS OF FACE
• Front aspect of head
• Extent: eExtends in between following structures
• Superiorly: Hairline (adolescent position of hairline)
• Inferiorly: Chin and base of mandible
• On each side: Auricles
• Note: Forehead – common to both face and scalp
 LAYERS OF FACE
LAYERS OF FACE
• Consists of two layers
• Skin
• Superficial fascia containing muscles of facial expressions
• Note: Deep fascia – absent in face except over parotid gland where forms parotid
fascia and over buccinator where forms buccinator fascia
 LAYERS OF FACE
Skin of face
• Has following peculiarities
• Rich vascularity
• Rich in sebaceous glands and sweat glands
• Laxity
• Fixity with underlying cartilages and bone over the nose and ear
• Elastic nature
• Mobile due to facial muscles
 LAYERS OF FACE
Superficial fascia
• Contains following structures
• Muscle of facial expression
• Nerves and vessels
• Variable amount of fat
 Clinical Integration
• Blushing: Rich vascularity makes face blush and blanch with expression
and exposure to cold
• Wounds: Rich vascularity results in profuse bleeding as well as rapid
healing of facial wounds and helps in plastic surgery
Acne (pimples)
• Occurs on face in young adults
• Occurs due to clogging of hair follicles resulting in blockage of
sebaceous glands
Edema of face
• Laxity of facial skin facilities spread of edema
 Clinical Integration
• Note: Renal edema appears first at eyelids and face and later to other
body parts
• Boils: Furuncle – infection of hair follicle
• Boils of nose and ear are painful because of fixity of skin to underlying
cartilages
• Due to action of muscle of facial expressions, wounds of facial skin tend
to gape
 Some Interesting Facts
• Muscles of facial expressions – inserted into skin of face
• Fat – absent in eyelids, whereas forms buccal pad of fat over cheeks
Suctional pad of fat
• Buccal pad of fat – prominent in infants
• Helps in suckling milk
 Cleavage lines of skin in face
• Langer lines of skin tension –
topological lines – produced due
to parallel orientation of collagen
fibers in dermis and underlying
muscle
• Orientation of cleavage line in
skin of face – region specific
 Cleavage lines of skin in face
Natural wrinkle lines
• They result from repeated folding of skin perpendicular
to long axis of underlying contracting muscle of facial
expressions
• Wrinkle lines become prominent in elderly due to loss
of skin elasticity
Clinical significance
• To excise lesions of skin (scars, pigmented patches, or
skin cancers), incisions given along natural wrinkles
lines or cleavage lines result in less scarring
 MUSCLE OF FACIAL EXPRESSIONS
Peculiarities
Are subcutaneous
• They insert into skin (except platysma), hence produces various facial expressions
• Morphologically, remnants of panniculus carnosus
• Embryologically, facial muscles – derived from 2nd pharyngeal arch
• Innervation: Supplied by 7th cranial nerve (nerve of 2nd pharyngeal arch)
• Contain small motor units
Functions
• Facial expressions
• Sphincters and dilators of facial orifices such as mouth and palpebral fissures
 GROUPS OF FACIAL MUSCLES
• According to location, muscles of
facial expressions are grouped as
follows
• Muscles of scalp
• Occipitofrontalis
• Muscle around the orbital
opening Corrugator supercilii
• Orbicularis oculi
 Facial muscles around orbital opening
Q. Write short note on orbicularis oculi

Muscle Origin Insertion Actions

Corrugator supercilia Medial end of superciliary arch Skin of middle part of eyebrow Vertical wrinkling of forehead as
Small pyramidal muscle at an expression of frowning
medial end of eyebrow Assists the orbicularis oculi

Orbicularis oculi — — —
Broad flat elliptical muscle
Surrounds circumference
of orbit
Parts: Orbital, palpebral, and
lacrimal

Orbital part: Lies around margin Medial palpebral ligament Fibers form an ellipse and rectun Forceful closure of eyelids
of orbit Frontal process of maxilla Nasal to the point of origin margin of
part of frontal bone

Palpebral part: Lies in eyelid Medial palpebral ligament Lateral palpebral raphe Closes eyelids gently in sleep or
in blinking

Lacrimal part: Lies lateral and Lacrimal fascia, posterior Lateral palpebral raphe Dilates the lacrimal sac and
behind lacrimal sac lacrimal crest facilitates the sucking of lacrimal
Forms sheath for lacrimal sac fluid into sac
 GROUPS OF FACIAL MUSCLES
Muscles around the nasal opening
• Procerus
• Compressor nares
• Dilator nares
• Depressor septi
 Muscle around nasal opening
Muscle Origin Insertion Actions
Procerus Nasal bone Skin over the glabella Transverse wrinkles over
Small pyramidal muscle Lateral nasal cartilage (skin between eyebrows) bridge of nose
Continuation of medial Expression of frowning
most and
fibers of frontalis concentration
Nasalis
A. Compressor nares Maxilla just lateral to Fibers pass upward and Compression of nasal
(transverse part of incisive fossa medially aperture
nasalis) Expands to form
aponeurosis across
bridge of nose
B. Dilator nares Maxilla above lateral Fibers pass upward and Dilatation of nose
(alar part of nasalis) incisor (medial to anteriorly to insert on alar
compressor nares) cartilage of nose
C. Depressor septi Incisive fossa of maxilla, Lower mobile part of Dilatation of anterior nasal
above medial incisor nasal septum aperture
Pulls nose and nasal
septum downward
 GROUPS OF FACIAL MUSCLES
Muscles around the lips
• Orbicularis oris
• Buccinator
• Levator labii superioris alaeque nasi
• Zygomatics major
• Levator labii superioris
• Levator anguli oris
• Zygomatics minor
• Depressor anguli oris
• Depressor labii inferioris
• Mentalis
• Risorius
 Buccolabial muscle (muscle around the lips and cheeks)
Q. Write short note on buccinator muscle
Muscle Origin Insertion Actions
Levator labii superioris Frontal process of maxilla Fibers run downward and laterally Elevation of upper lip
alaeque nasi and divides into medial and lateral Dilates the nose
slips
Medial slip – alar cartilage of nose
Lateral slip – upper slip
Levator labii superioris Infraorbital margin of maxilla Skin of the lateral half of upper lip Elevation and eversion of upper
limb
Zygomatics major Zygomatic bone Angle of mouth Pulls angle of mouth upward
and laterally (smiling)
Zygomaticus minor Zygomatic bone Upper lip Elevation of upper lip
Exposing the upper teeth
Forms nasolabial groove
(furrow)
Levator anguli oris Maxilla, just below the Angle of mouth Elevation of angle of mouth
infraorbital foramen (smiling)
Forms nasolabial furrow
Mentalis Incisive fossa of mandible Skin of chin Eversion and protrusion of
lower lip in drinking and
expressing doubt or disdain
Wrinkling of skin of the chin
Depressor labii inferioris Oblique line of mandible Fibers pass upward and medially Pulls lower lip downward and
Quadrilateral muscle to the skin of lower lip little laterally
Expression of irony sorrow,
melancholy, and doubt
Muscle
Depressor anguli oris
Risorius
Continuation of posterior
fibers of platysma
Buccinator
Muscle of cheek
Pierced by
• Parotid duct
• Buccal branch of
mandibular
nerve
Outer surface is covered by
buccopharyngeal fascia
Orbicularis oris (Fig. 6.7)
Consists of four quadrants:
upper, lower, left, and right
Each consists of large pars
peripheralis, small pars
Marginalis
Pars marginalis is well
developed in humans
[Reference: Gray’s
Anatomy, 42nd edn.]
Origin Insertion Actions
Oblique line of mandible Angle of mouth Pulls the angle of mouth
below the canine downward and laterally
premolars and 1st molar
Parotid fascia Angle of mouth Retracts the angle of
mouth
Upper fibers: Outer Fibers converge towards the modiolus near Flattens the cheek
surface the angle of the mouth. Here the central against the gum
of alveolar process of (pterygomandibular) fibers intersect, those Prevents accumulation of
maxilla from below cross to the upper part of food
Middle fibers: orbicularis oris, and those from above cross in the vestibule of mouth
Pterygomandi-bular to the lower part. Whistling muscle
raphe The highest (maxillary) and lowest (buccinator = trumpeter in
Lower fibers: (mandibular) fibers of the buccinator Latin)
Alveolar process of continue forwards to enter their
mandible opposite the corresponding lips without decussation.
molar teeth
Pars peripheralis: Lateral These fibers diverge and form a triangular Closes lips
stem is attached to muscular sheet in each lip, cross the Compresses lips against
modiolus midline and interlace with opposite side teeth
Consists of extrinsic fibers and helps in mastication
fibers from muscles
converging at modiolus
Pars marginalis: Single In midline, these fibers interlace
band of muscle fibers with opposite side fibers Associated with speech
that originates from Insert at the side of vermilion zone of lips and
modiolus production of musical
tones
 GROUPS OF FACIAL MUSCLES
Muscle around auricle
• Auricularis anterior
• Auricularis posterior
• Auricularis superior

Muscle of neck
• Platysma
 Subcutaneous muscle of neck: Platysma
Muscle Origin Insertion Actions
Platysm Upper part Fibers run upward Depression of
a of fascia and medially mandible Decreases
Sheet of covering Anterior fibers: Base pressure over veins
muscle in pectoralis of mandible of neck by tensing
the neck major and Posterior fibers: Skin skin
deltoid of lower face and lip
muscles (continuous with
risorius)
 Some Interesting Facts
• Corrugator supercilii lies deep to medial parts of frontalis and orbicularis
oculi
• Runs upwards and laterally
• Orbicularis oculi has concentric rings of muscle fibers around orbital and
in eyelids
• Some fibers of palpebral part of orbicularis oculi, close to margin of each
eyelids form ciliary bundle
Crow’s feet
• Contraction of entire orbicularis oculi muscle produces radiating skin folds
from lateral angle of eyelids
• Such folds form permanent wrinkles in old age called crow’s feet
 Some Interesting Facts
Temporoparietalis
• Occasionally present between frontalis and auricularis anterior and
auricularis superior
• Originates from galea aponeurotica and inserted on root of auricle
• Action: Raises auricle
• Innervation: Temporal branch of facial nerve
• Occipitofrontalis has two parts frontalis and occipitalis
 Some Interesting Facts
• Dilator nares anterior (apices nasi) – small muscle attached to upper lateral
cartilage and lateral alar crus
• Encircles nares and acts as primary dilator of nostril
 Some Interesting Facts
Previous concept
• Orbicularis oris consists of intrinsic and extrinsic parts
• Intrinsic part – very thin sheet of fibers confined to lips
• They – arising from maxilla and mandible and inserts at angles of mouth
• Extrinsic part – contributed by fibers from facial muscles converging at modiolus
• These fibers insert on lips
Malaris
• Thin sheet of muscle found occasionally
• originates from superficial temporal fascia lateral to orbicularis oculi and inserts on
zygomatic arch
• Creates dimple below cheek bone
 Some Interesting Facts
Modiolus
• Point located lateral to angle of mouth
• At modiolus, many muscles of facial
expressions converge
• These include orbicularis oris,
buccinator, depressor anguli oris,
zygomatic major, risorius, levator labii
superioris, and depressor labii inferioris
 Some Interesting Facts
Pterygomandibular raphe
• Thin band of connective tissue
• Extends from pterygoid hamulus of medial pterygoid
plate to posterior end of mylohyoid line of mandible
Muscles attached
• Superior constrictor of pharynx posteriorly and
middle fibers of buccinator anteriorly
Clinical integration
• Pterygomandibular raphe – useful guide for inferior
alveolar nerve block
 Clinical Integration
• Neck lacerations and surgical suturing: In neck lacerations, careful
suturing of lacerated part is essential because may cause large
scarring and delayed healing
Platysma bands
• Vertical cord appears as one of first sign of aging
• May be sagging of skin and loss of muscle tone
Paralysis of facial muscles
• Paralysis of orbicularis oculi
• Results in drooping of lower eyelid called ectropion
• Causes spilling of tears on face (epiphora)
 Clinical Integration
Paralysis of orbicularis oris
• Prevents closure of lips
• Causing slurred speech and dribbling of saliva from angle of mouth
Paralysis of buccinator
• Results in accumulation of food in vestibule of mouth during
mastication
• Person cannot blow his cheek (whistling)
 Emotional expressions of face
Emotional expression Muscle Actions
Laughing Zygomaticus major Pulling of angle of mouth
upward and laterally
Sadness, sorrow, grief Levator labii superioris Accentuation of nasolabial
Zygomatics minor and levator furrow
anguli oris Elevation and eversion of upper
Depressor anguli oris lip
Depression of angle of mouth
Surprise Frontalis Transverse wrinkling of
forehead
Frowning Corrugator supercilia Vertical wrinkling of forehead
Procerus Transverse wrinkling of
forehead
Anger Dilator naris Dilation of anterior nasal
Depressor septi aperture
Downward pulling of nose
Disdain, doubt Mentalis Elevation and protrusion of
lower lip
Wrinkling of skin of chin
Irony Depressor labii inferioris Pulls lower lip downward
 Bell’s palsy
Write short note on Bell’s palsy
• Injury to facial nerve near or outside
stylomastoid foramen produces
Bell’s palsy
• Lower motor neuron type of
paralysis of muscles of facial
expressions
• May be due to viral infection or
unknown cause
Features
• Following features – present on side
of paralysis
 Bell’s palsy
• Facial asymmetry due to
unopposed action of muscle of
unaffected side
• Loss of horizontal wrinkles of
forehead due to paralysis of
occipitofrontalis muscle
• Inability to close eye and widening
of palpebral fissure due to
paralysis of orbicularis oculi
 Bell’s palsy
• Epiphora (spilling of tears on the
face) due to paralysis of
orbicularis oculi
• Drooping of angle of mouth
toward affected side and drooling
of saliva due to paralysis of
orbicularis oris
• Inability of whistling and
accumulation of food in vestibule
of mouth due to paralysis of
buccinator
 Bell’s palsy
• Loss of nasolabial furrow due to paralysis
of levator labii superioris alaeque nasi
Note
• Facial muscles of upper half of face –
controlled by both cerebral hemisphere
• Damage to one cerebral hemisphere or
fibers from to nucleus of facial nerve get
damaged; called supranuclear palsy of
facial nerve
• In this type of paralysis, muscles of upper
half of face remain unaffected
 NERVE SUPPLY OF FACE
Motor Nerve Supply of Face
• Write short note on nerve supply of face
• Are supplied by facial nerve as they are derived from
2nd pharyngeal arch
• Facial nerve supplies these muscles through five
terminal branches, namely, temporal, zygomatic,
buccal, margin mandibular, and cervical
 Some Interesting Facts
• Muscles of facial expressions supplied by branches of facial nerve are
as follows
• Temporal branch: Frontalis, auricular muscles, orbicularis occuli
(upper part), corrugator supercilli
• Zygomatic branch: Lower half of orbicularis oculi
• Buccal branches: Muscles of cheek and upper lip
• Marginal mandibular: Muscle of lower lip
• Cervical branch: Platysma
 Clinical Integration
Clinical testing of muscle of facial expressions
• Helps in examination of facial nerve
• Can be performed in following ways
• Frontalis: Ask patient to look upwards without moving his head upward
• Observe for transverse wrinkling of forehead
Corrugator supercilia
• Ask patient to frown
• Observe for vertical wrinkling between two eyebrows
 Clinical Integration
Clinical testing of muscle of facial expressions
• Orbicularis oculi: Ask patient to close eyes tightly
• Orbicularis oris: Ask patient to close mouth tightly
• Buccinator: Ask patient to blow out air forcefully (whistling)
• Zygomaticus major: Ask patient to laugh
• Dilators of mouth: Ask patient to show teeth
 Sensory Nerve Supply of Face
Q. Write short note on sensory nerve supply
of face
• Supplied by branches of trigeminal nerve
except skin angle of mandible which
supplied by great auricular nerve
 Sensory Nerve Supply of Face
• Upper one-third of face developing from
frontonasal process – supplied by ophthalmic
division of trigeminal neve
• Middle one-third of face developing from maxillary
processes – supplied by maxillary division of
trigeminal neve
• Lower third of face developing from mandibular
processes – supplied by maxillary division of
trigeminal nerve
 Sensory Nerve Supply of Face
• Following branches of trigeminal nerve and cervical
plexus supply face
• Ophthalmic division of trigeminal nerve
• Supratrochlear nerve
• Supraorbital nerve
• Lacrimal nerve
• Infratrochlear nerve
• External nasal nerve
• Maxillary division of trigeminal nerve
• Infraorbital nerve
• Zygomaticofacial nerve
 Sensory Nerve Supply of Face
• Zygomaticotemporal nerve
• Mandibular division of trigeminal nerve
• Auriculotemporal nerve
• Buccal nerve
• Mental nerve
• Branches from cervical plexus
• Anterior division of great auricular nerve (C2, C3)
• Transverse (anterior) cutaneous nerve of neck (C2, C3)
• Lesser occipital nerve (C2)
• Supraclavicular nerve (C3, C4)
 Some Interesting Facts
• Supratrochlear nerve supplies middle of forehead and scalp
• Supraorbital nerve turns upward at supraorbital notch
• Supplies forehead and scalp, upper eyelid, and frontal air sinus
• Lacrimal nerve supplies lateral part of upper eyelid and conjunctiva
• Infratrochlear nerve passes downward below trochlea of superior oblique muscle
• Supplies medial part of upper eyelid and side of nose
• External nasal nerve – continuation of anterior ethmoid nerve
 Some Interesting Facts
• Enters face between nasal bone and upper nasal cartilages
• Supplies lower part of dorsum and tip of nose
• Infraorbital nerve – continuation of maxillary nerve
• Enters face through infraorbital foramen
• Gives palpebral branch for lower eyelid, labial branch for upper lip,
cheek, and nasal branch to supply ala of nose
 Some Interesting Facts
• Zygomaticofacial nerve emerges through zygomaticofacial foramen
located on external surface of zygomatic bone
• Supplies upper part of cheek
• Zygomaticotemporal nerve emerges through zygomaticotemporal
foramen located on posterior surface of zygomatic bone
• Supplies skin over anterior part of temporal region
• Note: Zygomaticofacial and zygomaticotemporal nerves – branches of
zygomatic branch of maxillary nerve
 Some Interesting Facts
• Auriculotemporal nerve winds around neck of mandible, ascends
upward along with superficial temporal vessels
• Gives auricular branches for anterosuperior part of external acoustic
meatus and adjoining part of tympanic membranes and pinna
• Also gives temporal branch for skin of temporal fossa
 Some Interesting Facts
• Buccal nerve enters face through buccal pad of fat at interval between masseter
and buccinator
• Supplies skin over buccinator and mucosa of mouth covering buccinator
• Mental nerve – branch of inferior alveolar branch of mandibular nerve
• Enters face through mental foramen of mandible
• Supplies skin and mucous membrane of lower lip and skin over chin
• Note: Junction line between territories of branches of trigeminal nerve curves
upward and backward from lateral angles of eye and mouth to vertex
 Some Interesting Facts
• Due to developing brain drags facial skin forward and pulls skin of neck
upward and over angle of mandible
Arteries accompanying cutaneous nerves
• Infraorbital artery, buccal artery, and mental artery
• They all – derived from maxillary artery
 Clinical Integration
• Trigeminal neuralgia (tic douloureux): Condition with sudden paroxysmal
attacks of very severe burning and scalding pain lasts for few hours to
several days, confined to distribution of one or more division of
trigeminal nerve
• Trigeminal nerve gives meningeal branches cause headache on
inflammation, and infection of areas supplied by divisions of mandibular
nerve
• For example, headache in case of common cold, boil sinusitis
(inflammation of paranasal air sinuses), and infections in gums around
teeth
 BLOOD SUPPLY AND LYMPHATIC DRAINAGE OF FACE

Arteries of tFace
Q. List arteries of face
• Richly vascular
• Supplied by branches of
• Facial artery
• Transverse facial artery
• Arteries accompany cutaneous
nerves
 Facial artery
Q. Write short note on facial artery
• Major artery of face
Beginning
• Branch of external carotid artery
• Begins in neck at level of greater cornua of
hyoid bone
Termination
• Continues upward as angular artery near
medial angle of eye
• angular artery anastomoses with dorsal
nasal branch of ophthalmic artery
 Facial artery
Course
• Ascends upward in neck to reach base
of mandible
• Enters face by winding around lower
border of mandibleat anteroinferior
angle of mandible
• Pierces investing layer of deep cervical
fascia
• Crossed by marginal mandibular
branchesof facial nerve
• Accompanied by facial vein on posterior
side
 Facial artery
• Runs upward and forward tortuously
to point 1.25 cm lateral to angle of
mouth
• Then ascends upward along side of
nose to medial angle of eye where
continues as angular artery
• Lies deep to platysma, risorius,
zygomaticus major, and minor
 Facial artery
Branches
• In face, gives three set of branches as follow
• Inferior labial artery for lower lip
• Superior labial artery for upper lip, nasal septum, and ala of nose
• Lateral nasal artery for ala and dorsum of nose
• In addition to these branches, gives muscular branches
• Peculiarities of facial artery
• Tortuous course of facial artery permits movement of mandible, lips,
and cheeks
 Facial artery
• Branches anastomose with branches coming from internal
carotid artery, thus, establishes communication between
external and internal carotid arteries
Clinical integration
• Pulsation of facial artery: Can be felt at two sites
• At base of mandible along anterioinferior angle of masseter
• At about 1.25 cm lateral to angle of mouth
• Rich vascularity of face helps in rapid healing of wounds
 Some Interesting Facts
• Tortuosity of facial artery prevents undue pull of wall during
movement of mandible
Transverse facial artery
• Branch of superficial temporal artery begins in parotid glands
• Emerges from anterior border of glands to enter in face
• Runs forward between masseter and zygomatic arch to
supply face
• Accompanied by buccal branch of facial nerve
 Venous Drainage of Face
Drained by two veins
• Facial vein
• Retromandibular vein
 Some Interesting Facts
Facial vein
• Main vein of face
• Lies behind facial artery and has straight course
• Formation: Begins as angular vein by union of
supratrochlear and supraorbital veins
Course
• Runs straight, downward, and backward to
anteroinferior angle of mouth
• Pierces investing layer of deep cervical facia
• Termination: Joins with anterior division of
retromandibular vein below angle of mouth to form
common facial vein, which drains into internal jugular
veins
 Some Interesting Facts
• Tributaries: Corresponding to the branches of facial
artery
Retromandibular vein
• Formation: Formed by union of superficial temporal
vein and maxillary vein in parotid glands
• Retromandibular vein exits parotid glands and divides
into
• Anterior division which joins facial vein to form
common facial vein
• Posterior division which joins posterior auricular vein to
form external jugular vein
 Dangerous area of face
Q. Write short note on dangerous area of
face (explain anatomical basis)
• Lower part of nose, upper lip, and
adjoining parts of cheek
• Anatomical basis: Venous blood from this
area – drained by facial vein
• This facial vein has two peculiarities make
this area as dangerous area of face
• Devoid of valves
• Communication with cavernous sinus
through
 Dangerous area of face
• Angular vein and supraorbital vein
communicate with superior ophthalmic
vein (which is tributary of cavernous
sinus)
• Deep facial vein communicates with
pterygoid veinous plexus (which has
communication with cavernous sinus
via emissary veins)
 Dangerous area of face
• Rests on facial muscles which facilitates
spread of infection and emboli from facial
vein to cavernous sinus
• Thus, infection from dangerous area of
face may spread intracranially to the
cavernous sinus
 Lymphatic Drainage of Face
Q. Write short note on lymphatic
drainage of face
• Has three different areas as follows
• Upper area: Includes greater part of
forehead, temporal region, lateral
halves of eyelid, conjunctiva, cheeks,
and parotid region
• Drains into preauricular or superficial
parotid group of lymph nodes
 Lymphatic Drainage of Face
• Middle area: Includes central part of
forehead, frontal air sinuses, medial
half of eyelid, nose, maxillary air
sinuses, upper lip, and lateral part of
lower jaw
• Drains into submandibular lymph nodes
• Lower area: Includes central part of
lower lip and chin
• Drains into submental lymph nodes
 Some Interesting Facts
• Superficial parotid nodes lie just anterior to tragus
• Posterior auricular nodes drain skin over posterior part of temporal
fossa, mastoid process, parietal region of scalp, posterior part of
auricle, and posterior part of external acoustic meatus
• Posterior most part of scalp drains into occipital nodes
• They lie superficial to trapezius near origin or at apex of posterior
triangle of neck
 DEVELOPMENT OF FACE
• Develops from five mesodermal processes appear in 4th week
surrounding stomodeum
These processes are
• Frontonasal process (unpaired)
• Maxillary process (paired)
• Mandibular process (paired)
• Takes place between 4th and 8th weeks
• Various parts of face are derived as follow
• Lower lip: Bilateral mandibular process fuses in midline to
form lower lip and jawbone
 DEVELOPMENT OF FACE
Upper lip
• Central part (philtrum) of upper lip – derived from
medial nasal process
• Lateral parts of upper lip – derived from bilateral
maxillary processes
• Note: Ectoderm (skin) of maxillary process
overgrows and covers central part (philtrum) of
upper lip; hence, skin of upper lip – supplied by
maxillary nerve
 DEVELOPMENT OF FACE
• Muscles of face – derived from second
pharyngeal arch, hence supplied by facial nerve
• Cheeks: Maxillary and mandibular processes
undergo fusion from lateral side and form
smaller stomodeum or normal oral fissure,
where fused part forms cheeks
 DEVELOPMENT OF FACE
External nose derived as follows
• Bridge of nose from frontonasal process
• Dorsum and tip of nose from fused medial nasal processes
• Ala of nose from lateral nasal processes
• Anterior nares (nostrils) from nasal pit
• Nasal cavity from nasal sacs
• Posterior nares (choanae) from rupture of bucconasal
membrane
 Development Anomalies of Face
Cleft lip
• Definition: Congenital split in upper lip of one
or both sides of center
• Usually, upper lip of hare has cleft; hence,
commonly called harelip
Embryological basis
• Failure of fusion of maxillary processes with
medial nasal process (part of frontonasal
process) results in cleft lip
• Midline cleft lip – due to failure of fusion of
two medial nasal processes
 Development Anomalies of the Face
• Harelip may be unilateral, bilateral, or
midline harelip
• Cleft lip occurs more frequently (80%)
in males than in females
• Incidence of cleft lip is 1 in 1000 births.
Incidence of cleft lip increases with
increasing maternal age
 Development Anomalies of the Face
• If couple has cleft lip child, there are
4% chances – next baby will have cleft
lip
• If two babies of couple – affected, then
the chances of cleft lip increase up to
9%
• Treatment: Cleft lip can be corrected
surgically
Thank you…