Anatomy of the Face By Dr.ayat eldomouky

Auricle Forehead

Very vascular,rich in sweat& sebaceous glands . Skin of the face Receives the insertion of facial muscles . Contains :- vessels & nerves & fat . Facial muscles Deep fascia ABSENT except ………

Auricle Buccinator Parotid gland Masseter Facial vessels

Blood Supply of the Face

Arteries

Superficial temporal A. Supraorbital A. Superficial temporal A. Supratrochlear A. Buccal A. Infraorbital A. Facial A. Mental A.

Facial vein Masseter Facial artery

Branches Lat.nasal a. Sup.labial A. Inf.labial A. Facial A.

Superficial temporal A. Transverse facial A. Parotid duct

Superficial temporal A. Pulsation sites Facial A.

Facial V. Masseter Facial A. Transverse facial Vs. superficial temporal Vs. Tragus Lat.Nasal Vs. Sup.Labial Vs. Inf.Labial Vs. Masseter Facial A. Facial V.

Facial Vein

Supratrochlear V. Supra-orbital V. facial vein

Superficial Temporal V. Maxillary V. Superficial Temporal V. Retro- Mandibular V. Facial Vs. Post.auricular V. Ext.jugular V. C.Facial V. Int.jugular V.

+ + = = Superficial Temporal V. Anterior Posterior devision devision Maxillary V. Retro- Mandibular V. Anterior devision Posterior devision + + Post.auricular V. Facial vein = = I.J.V. Common facial vein External Jugular vein

facial V. Cavernous sinus Pterygoid venous plexus To sup.ophthalmic V. Supratrochlear V. Supraorbital V. Cavernous sinus To sup.ophthalmic V. Emissary Vs. facial V. Pterygoid venous plexus Deep Facial V.

Cavernous Sinus Sup.Ophth. V. Pterygoid Venous Plexus Facial V.

facial vein Pterygoid venous Cavernous sinus plexus Sup.oph.V. Deep facial V. Sup.oph.V. Cavernous sinus Pterygoid venous plexus Emissary veins

Dangerous area of the face

Lymph Drainage

Lymph Drainage Parotid L.N.

Lymph drainage of the face Lat.part of the face……..parotid lymph nodes . Medial part of the face…submandibular lymph nodes . Central part of lower lip & chin…………submental lymph nodes .

Nerve Supply of the Face

Nerve supply of the face Sensory Motor

Facial Nerve

Facial Nerve

Sensory supply

Ophthalmic n Maxillary n. Great auricular n. Mandibular n.

Zygomaticotemporal nerve Supra-orbital n. Supra trochlear n. Lacrimal n. Infra trochlear n. External nasal Infra orbital n. Auriculotemporal n. Buccal n. Mental n. Zygomaticofacial n.

Supra-orbital nerve Infra-orbital nerve Mental nerve

Ophthalmic nerve Supraorbital & supratrochlear nerves…...forehead & upper eyelid. Lacrimal nerve…lateral part of upper eyelid Infratrochlear nerve…lower eyelid . External nasal…nose till the tip .

Maxillary nerve Infraorbital….palpebral & nasal &labial . Zygomaticofacial….skin over zygomatic bone . Zygomaticotemporal….skin of temple.

Mandibular nerve Mental……lower lip&chin Buccal….skin over buccinator . Auriculotemporal…skin over auricle&temple .

Important short account

Important artery facial artery Begin: It is a branch from the front of the E.C.A. above the tip of the hyoid bone. Course : It ascends in the anterior triangle of the neck till it reaches the submandibular salivary gland . The artery grooves the post. end of the gland → descends between the gland and mandible → curves around the lower border of the mandible → pierces the cervical investing fascia at the antero-inferior angle of masseter m. → enters the face where it ascends in a tortuous course (lat. To buccinator) towards the med. angle of eye (end = angular a.) . Branches: (1) In the neck : a) Tonsillar a. → tonsil. b) Ascending palatine a. → soft palate. c) Submental a. d) Glandular branches. : To the submandubular salivary gland. (2) In the face : a) Inferior labial a. b) Superior labial a. c) Nasal br.

Important artery facial vein Beginning: At the med. angle of the eye by the union of supratrochlear and supraorbital veins. - Course: It descends posterior to the facial a. (untortuous) to pierce the cervical investing fascia at the antero-inferior angle of masseter. - End: It unites with the ant. division of retromandibular v. → common facial v. → ends in the internal jugular vein (I.J.V) . - Connections of ant facial v.: a) At the beginning, it is connected to the ophthalmic veins. b) On the buccinator, it is connected to the pterygoid plexus of veins by the deep facial vein which passes deep to the masseter. Both the ophthalmic veins and the pterygoid plexus of veins are connected also to the cavernous sinus. So, pus in the dangerous area of the face shouldn't be squeezed for fear of spread of infection with a resulting cavernous sinus thrombosis. N.B. : The facial veins are : * Anterior facial v. (facial vein) * Posterior facial v. (retromandibular v.). * Common facial v. * Deep facial v.

Nerves : Motor and sensory : [A] The motor supply: By the temporal, zygomatic, buccal and mandibular terminal brs. of the facial n. N.B. : The cervical br. of facial n. supplies the platysma of the neck. [B] The sensory supply : By the trigeminal n. except the area of skin covering the angle of the mandible which is supplied by branches from the upper cervical spinal nerves. The trigeminal n. supplies the facial skin by the branches of its 3 divisions : a) The ophthalmic division . b) The maxillary division . Notice that it supplies the skin of the upper lip. c) The mandibular division . Notice that it supplies the skin of the lower lip.

Important nerve facial nerve Begin: the 7th crasnial nerve start as motor and sensory roots End: enter parotid gland then divided into 5 branches Branches: Grater petrosal nerve. Chorda tympanic nerve Nerve to stapedius Posterior auricular nerve 5 terminal: temporal, zygomatic, buccal, mandibular and cervical branches

Clinical case A 17-year-old girl visited her dermatologist because of severe acne of the face. On examination, it was found that a small abscess was present on the side of the nose. The patient was given antibiotics and was warned not to press the abscess. The following facts concerning this patient emphasize why it is important to adequately treat this condition except which? (a) The skin area between the eye, the upper lip, and the side of the nose is a hazardous area to have an infection of the skin. (b) The danger area is drained by the facial vein. (c) Interference with a boil by squeezing or pricking it can lead to spread of the infection and thrombosis of the facial vein. (d) The facial vein communicates with the cavernous sinus via the superior and inferior ophthalmic veins. (e) Cavernous sinus thrombosis can occur by the spread of infection by the venous blood. (f) The blood in the facial vein is unable to spread upward because of valves.

Clinical case A 7-year-old boy with right-sided otitis media was treated with antibiotics. The organisms did not respond to the treatment, and the infection spread to the mastoid antrum and the mastoid air cells. The surgeon decided to perform a radical mastoid operation. After the operation, it was noticed that the boy's face was distorted. The following signs and symptoms suggest that the right facial nerve had been damaged during the operation except which? (a) The mouth was drawn upward to the right. (b) He was unable to close his right eye. (c) Saliva tended to accumulate in his right cheek. (d) The saliva tended to dribble from the corner of his mouth. (e) All the muscles of the right side of his face were paralyzed.

MCQ

MCQ.1- Pulse felt in front of auricle against the zygomatic arch is that of:- a.Facial A. b.Transverse facial A. c.Zygomatico facial A. d.Superficial temporal A. e.Infraorbital A.

MCQ.1- Pulse felt at the inferior margin of the body of the mandible is that of:- a.Facial A. b.Transverse facial A. c.Zygomatico facial A. d.Superficial temporal A. e.Infraorbital A.

MCQ.2. Nerve supply of skin of forehead includes:- a.Auriculotemporal nerve. b.Infraorbital nerve. c.Supra-orbital nerve d.Supratrochlear nerve. e. © and (d)

+ + = = Superficial Temporal V. Anterior Posterior devision devision Maxillary V. Retro- Mandibular V. Anterior devision Posterior devision + + Post.auricular V. Facial vein = = I.J.V. Common facial vein External Jugular vein