FACE

Skin Very vascular Due to rich vascularity face blush and blanch Wounds of face bleed profusely but heal rapidly Results of plastic surgery are excellent on face Facial skin is rich in sebaceous gland and sweat gland Sebaceous gland keep the skin oily but also cause acne in adult Sweat gland regulate body temperature

Facial muscle Called muscle of facial expression and lie in superficial fascia Embryologically they develop from mesoderm of 2 nd branchial arch, therefore supplied by facial nerve

Superficial fascia: contains 1. Fascial muscles 2. Blood Vessels & nerves 3. Fats Deep fascia: absent except over the parotid fascia & over the buccinator where it forms the buccopharyngeal fascia

Facial muscles 1. Muscles of the scalp: occipitofrontalis 2. Muscles of the auricle: i) auricularis anterior, ii) auricularis superior & iii) auricularis posterior 3. Muscles around the eyelids: i) orbicularis oculi, ii) corrugator supercilli & iii) levator palpebrae superioris 4. Muscles of the nose: i) Procerus, ii) Compressor naris, iii) Dilator naris & iv) Depressor septi 5. Muscles around the mouth: i) orbicularis oris, ii) levator labii superioris alaeque nasi, iii) zygomaticus major, iv)Levator labii superioris, v) Levator anguli oris, vi) zygomaticus minor, vii) Depressor anguli oris viii) Depressor labii inferioris, ix) Mentalis x) Risorius & xi) Buccinator 6. Muscles of the neck: Platysma

Muscles of Facial Expression Eye Muscles Orbicularis oculi Levator palpebrae superioris Corrugator supercilii

Orbicularis Oculi O: Medial side of eye I: Medial side of eye (returns to same attachment encircling the eye) A: Closes & squints the eye. Also assists in tear transport and drainage N: CN VII (Facial nerve) Under both conscious/unconscious control i.e. blinking When entire muscle is contracted eyelids & surrounding area will be drawn medially decreasing amount of light entering eye

Levator Palpebrae Superioris O: Sphenoid Bone I: Upper Eyelid A: Elevates upper eyelid N: CN III (Oculomotor nerve) Attaches from sphenoid bone to upper eyelid. CN III opens the eye

Corrugator Supercilii O: Inferior frontal bone I: Skin deep to medial eyebrow A: Draws eyebrow inferomedially N: CN VII (Facial nerve) Draws eyebrows inferiorly/medially as in frowning causing vertical wrinkles superomedially to eye.

Muscles of Facial Expression Nose Muscles Procerus Nasalis Depressor Septi Nasi

Procerus O: Fascia over nasal bone I: Skin between eyebrows A: Draws down medial eyebrows. Also wrinkles the skin of the nose N: CN VII (Facial nerve) Often blends with frontalis superiorly and nasalis inferiorly Gives look of frowning and also helps shield eyes from bright light Person may convey air of superiority (hence “procerus” meaning chief, noble or prince).

Nasalis O: Maxilla I: Cartilage of Nose and Opposite side Nasalis muscle A: Flares nostrils N: CN VII (Facial nerve) Transverse part sometimes called compressor nasi and alar part dilatator nasi Blends with procerus superiorly

Depressor Septi Nasi O: Incisive fossa of the maxilla I: Cartilage of Nose A: Constricts nostrils N: CN VII (Facial nerve) Sometimes considered part of alar portion of nasalis

Muscles of Facial Expression Mouth Muscles 1. Levator Labii Superioris 2. Levator Labii Suerioris alaeque nasi 3. Zygomaticus Minor 4. Zygomaticus Major 5. Levator Anguli Oris 6. Risorius 7. Depressor Anguli Oris 8. Depressor Labii Inferioris 9. Mentalis 10. Orbicularis Oris

Levator Labii Superioris O: Inferior orbital margin of the maxilla I: Upper Lip A: Elevation of Upper Lip N: CN VII (Facial nerve) Main elevators of upper lip are levator labii superioris & zygomaticus minor. Contraction alone will elevate upper lip as in showing someone our upper teeth.

Zygomaticus Minor O: Zygomatic bone I: Upper Lip A: Elevation of Upper Lip N: CN VII (Facial nerve) Blends with levator labii superioris

Zygomaticus Major O: Zygomatic bone I: Angle of Mouth A: Elevation of Angle of mouth as in smiling. Also draws laterally at the angle of the mouth N: CN VII (Facial nerve) Contributes to smiling and laughing 6 muscles attach into modiolus (fibro muscular condensation ≈ ¼” lateral to angle of mouth): zygomaticus major, levator anguli oris, risorius, depressor anguli oris, buccinator, & orbicularis oris.

Levator Anguli Oris O: Maxilla, just inferior to the infraorbital foramen I: Angle of Mouth A: Elevation of Angle of Mouth N: CN VII (Facial nerve) Also known as the caninus because contraction can result in teeth especially canine tooth becoming visible – “Dracula” expression. Contraction alone can manifest a sneer.

Risorius O: Fascia Superficial to Masseter I: Angle of Mouth Action: Draws Laterally the Angle of Mouth N: CN VII (Facial nerve) Drawing angle of mouth laterally is involved with grinning, smiling, and laughing.

Depressor Anguli Oris O: Mandible I: Angle of Mouth A: Depresses the Angle of Mouth. Also assists the risorius in drawing the angle of the mouth laterally N: CN VII (Facial nerve) Blends into the platysma Contribute to facial expression of sadness or uncertainty.

Depressor Labii Inferioris O: Mandible I: Lower Lip A: Depression of Lower Lip. Also assists in drawing the lower lip laterally and everting it. N: CN VII (Facial nerve) Contribute to facial expressions of sorrow, doubt, and irony/funny.

Mentalis O: Mandible I: Skin of the Chin A: -Elevation of Lower Lip -Eversion and Protracts the Lower Lip - Wrinkles the skin of the chin N: CN VII (Facial nerve) Contributes to facial expressions of doubt, pouting, or disdain

Buccinator O: Maxilla and Mandible I: Lips (buccinator muscle is located in the tissue of the cheek) A: Compression of Cheeks (against teeth) N: CN VII (Facial nerve)

Buccinator Parotid duct pierces through buccinator to enter mouth Action of compressing the cheeks against the teeth by the 2 buccinators working bilaterally is important for forcefully expelling air from the mouth. Latin word for trumpeter is “buccinator” Important with whistling, blowing up a balloon and with helping keep food from lingering in vestibule of mouth. Contributes to expression (puckering the cheeks) made when person eats something sour.

Orbicularis Oris O: Surrounds the mouth Action: Closes mouth and protracts the lips N: CN VII (Facial nerve) Causes lips to close and protrude as in puckering lips or whistling.

Orbicularis Oris

FACE

Common facial expression 1. Smiling & laughing:- zygomaticus major

Common facial expression 2. Sadness:- levator labii superior & levator anguli oris

FACE

Contempt : Grinning Slight sneer Raised side of mouth

Frowning

Common facial expression 1. Smiling & laughing:- zygomaticus major 2. Sadness:- levator labii superior & levator anguli oris 3. Grief:- depressor anguli oris 4. Anger:- Dilator naris & depressor septi 5. Frowning:- Corrugator supercilli & procerus 6. Horror, terror & fright:- platysma 7. Surprise:- Frontalis 8. Doubt:- Mentalis 9. Grinning:- Risorius 10. Contempt:- zygomaticus minor 11. Closing of mouth:- orbicularis oris 12. Whistling:- buccinator & orbiularis oris

FACE Clinical anatomy- 1. Frontalis- patient must look upwards without moving the head and look for the horizontal wrinkles of the forehead 2. Corrugator supercilli- frowning & making the vertical wrinkles of the forehead 3. Orbicularis oculi- tight closure of the eyes 4. Orbicularis oris- whistling and pursing the mouth 5. Dilator of mouth- showing the teeth 6. Buccinator- puffing the mouth & then blowing forcibly as in whistling 7. Platysma- forcible pulling of the angle of mouth downwards and backwards forming prominent vertical fold of the skin of the neck. Platysma contracts along with the risorius

Motor nerve supply of the face: Facial nerve (TZBMC) i) Temporal- frontalis, auricularis muscles and orbicularis oculi ii) Zygomatic- orbicularis oculi iii) Buccal- muscles of the cheek and upper lip iv) Marginal mandibular-muscles of the lower lip v) Cervical- platysma

Facial nerve

Bell’s palsy: It is lower motor neuron type paralysis of facial muscles due to compression of facial nerve in the facial canal near stylomastoid foramen. The exact etiology is not known but it is probably due to viral infection.

Upper motor neuron paralysis In upper motor neuron type paralysis of facial muscles due to involvement of the pyramidal tract, the upper part of the face is not affected. This part of face remains normal because lower motor neurons supplying this part of face receive corticonuclear fibres (upper motor neurons) from cerebral cortex of the both sides (bilateral cortical innervation

Infranuclear lesion (Bell’s palsy)- 1. whole face of the same side gets paralysed. 2. Face becomes asymmetrical and is drawn up to the normal side. 3. Affected side is motionless. 4. Wrinkles disappear from the forehead. 5. Eyes cannot be closed 6. While smiling the mouth is drawn to the normal side 7. During mastication food accumulates in between the teeth and the chick 8. Articulation of labials is impaired Supranuclear lesions- 1. usually a part of hemiplegia, only the lower part of the opposite side of the face is paralysed. 2. Upper part of the frontalis & orbicularis oculi escapes due to its bilateral representation in the cerebral cortex.

Sensory nerve supply

Chalazion

Stye or hordeolum

Blepharitis

Horner's syndrome Horner's syndrome results from an interruption of the sympathetic nerve supply to the eye and is characterized by the classical triad of miosis (ie, constricted pupil), partial ptosis, and loss of hemifacial sweating (ie, anhidrosis).

Horner's Syndrome Ptosis Drooping eyelid Meiosis Constricted pupil Anhydrosis Lack of sweating Enopthalmos Horner syndrome is due to a deficiency of sympathetic activity