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Anatomy of the Face Professor Emeritus Moira O’Brien MOB TCD Anatomy of the Face Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinity College Dublin

Face Sensory supply of face is trigeminal 5th cranial nerve C2 MOB TCD Sensory supply of face is trigeminal 5th cranial nerve C2 Motor supply Muscles of facial expression Facial nerve 7th cranial

Sensory Nerve Supply Trigeminal Ophthalmic Maxillary Mandibular MOB TCD Trigeminal Ophthalmic Maxillary Mandibular Cervical plexus

Terminal Branches of 5th MOB TCD Supraorbital Infraorbital damaged in blow out fracture of orbit Lateral Mental; dentures, fracture of mandible Trigeminal neuralgia

Sensory Trigeminal Nerve MOB TCD Ophthalmic V Supraorbital Supratrochlear Maxillary V Infraorbital Zygomaticofacial Mandibular V Mental Buccal

Fractured Zygoma View from above shows depression Lateral X-ray view MOB TCD View from above shows depression Lateral X-ray view should be done

Great Auricular C2 from cervical plexus Skin over angle of mandible MOB TCD C2 from cervical plexus Skin over angle of mandible

Scalp Skin Subcutaneous Epicranial aponeurosis Three fused together MOB TCD Skin Subcutaneous Epicranial aponeurosis Three fused together Loose areolar tissue Periosteum Occipito-frontalis Attached posteriorly No anterior attachment

Scalp MOB TCD 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

Blood and Nerve Supply of Scalp MOB TCD Supraorbital vessels and nerve Scalp as far as vertex Posterior scalp Greater occipital C2 Occipital and posterior auricular vessels Zygomatico temporal Greater auricular

Eyelid Skin Orbicularis oculi Palpebral portion MOB TCD Skin Orbicularis oculi Palpebral portion Orbital septum and tarsal plates, mebonium glands Medial palpebral ligament anchors tarsal plates to anterior lacrimal crest Conjunctival sac

Levator Palpebrae Superiores MOB TCD Arises from back of roof of orbit Inserted into skin of upper eyelid The superior tarsal plate Superior fornix of conjunctiva

Levator Palpebrae Superiores MOB TCD Elevates upper eyelid Voluntary muscle supplied by 3rd oculomotor nerve Smooth muscle Sympathetic T1 Superior cervical ganglion

Lacrimal Apparatus Lacrimal gland Conjunctival sac Puncta Cananiculi MOB TCD Lacrimal gland Conjunctival sac Puncta Cananiculi Nasolacrimal sac Nasolacrimal duct Inferior meatus nose

Horner's Syndrome Ptosis Drooping eyelid Meiosis Constricted pupil MOB TCD Ptosis Drooping eyelid Meiosis Constricted pupil Anhydrosis Lack of sweating Enopthalmos

Muscles of Facial Expression MOB TCD 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

Orbicularis Oculi Orbital closes eyelid tightly, buries eyelashes MOB TCD 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

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

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

Muscles of Facial Expression MOB TCD Incisions in the face evert edges Platysma Inserted into lower border of mandible Posterior fibres form risorius

Buccinator Buccinator 7th nerve Accessory muscle of mastication MOB TCD 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

Facial Nerve Motor nerve to: Posterior auricular to occipital belly MOB TCD Motor nerve to: Posterior auricular to occipital belly Posterior belly of digastric Enters parotid and divides into branches Temporal Zygomatic Buccal Mandibular Cervical

Facial Nerve Stroke Upper motor neurone of facial Forehead is spared MOB TCD 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

Bell’s Palsy Lower motor neurone of facial nerve MOB TCD Lower motor neurone of facial nerve Forehead and all the muscles on the side of lesion are affected

Facial Palsy MOB TCD MOB TCD

Corneal Reflex MOB TCD Afferent (sensory) cilary branches nasocilary of ophthalmic of 5th Efferent (motor) Zygomatic branch of facial 7th Last reflex to go

Blood Supply and Pulses in Face MOB TCD Internal carotid Supraorbital artery Branch of ophthalmic External carotid Superficial temporal artery Facial artery

Venous Drainage of Face MOB TCD Supraorbital and anterior facial Communicate superior ophthalmic veins which drain into cavernous sinus Deep facial vein Superficial temporal Retromandibular Common facial

Emissary Veins Cavernous Sinus MOB TCD Superior ophthalmic veins Anterior facial Deep facial Pterygoid plexus Danger area of face Parietal emissary veins from scalp to superior sagittal sinus

Lymph Glands Submental Submandibular Buccal and mandibular MOB TCD Submental Submandibular Buccal and mandibular Preauricural Occipital

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