THE FACE Dr. Zeenat Zaidi

The bones of the facial skeleton include: Frontal bone Nasal bones Lacrimal bones Zygomatic bones Maxillae Mandible 1 3 2 4 5 6

Facial Skin Posses numerous sweat & sebaceous glands Connected to underlying bones by loose connective tissue, which encloses the underlying muscles Loss of elastic fibers in skin cause permanent wrinkles (e.g., “Crow’s feet” and “worry lines”).

Fascia of the Face Superficial fascia is copious and loose Dee fascia: there is no discrete layer of deep fascia of the face except in the regions of the parotid glands and the masseter muscles. It forms capsules around these structures.

Muscles of the Face Are embedded in loose connective tissue Mostly arise from the skull bones and get inserted into the skin All developed from the 2nd pharyngeal arch All supplied by facial nerve Act as sphincters around the orifices of face (orbit, nose, mouth) Modify the expressions of face (muscles of facial expression)

Muscles of facial expression are grouped as muscles associated with the: Forehead Orbit Nose Lips Cheek 1 2 3 5 4

Muscles of the Forehead Frontal belly of Occipitofrontalis Origin: skin & superficial fascia of the eyebrow Insertion: epicranial aponeurosis Nerve supply: temporal branches of facial nerve Action: raise the eyebrows in expressions of surprise or horror E. aponeurosis

Corrugator supercilli: Lies deep to the orbicularis oculi Origin: superciliary arches Insertion: skin of the eyebrow Supplied by temporal branches of facial nerve Action: Vertical wrinkles of forehead, as in frowning

Muscles of the eyelids Sphincter: Orbicularis oculi Dilator: Levator palpebrae superioris (muscle of the orbit) & Frontal belly of occipitofrontalis

Orbicularis oculi 3 parts: Palpebral Orbital Lacrimal palpebral part Orbicularis oculi 3 parts: Palpebral Orbital Lacrimal Supplied by temporal & zygomatic branches of facial nerve Action: palpebral part: acts involuntarily, closure of eyelids gently as in blinking orbital part: subject to the will Both orbital & palpebral parts acting together: the eyelids are firmly closed Lacrimal part: compreses the lacrimal sac Orbital part

Muscles of the nose Procerus Compressor nares & Dilator nares Supplied by buccal branch of facial nerve

Muscles of the Lips Sphincter muscle: Orbicularis oris Origin & Insertion: Near the midline from maxilla above & mandible below From the deep surface of the skin Many fibers derived from the buccinator muscle Encircles oral aperture Supplied by the buccal branch of facial nerve Action: closes lips together, “pursing” as in whistling and sucking

Dilator muscles: Levator labii superioris alaeque nasi Zygomaticus major & minor Levator anguli oris Risorius Depressor anguli oris Depressor labii inferioris Mentalis 1 2 6 3 7 4 8

Muscle of the cheek Buccinator Origin: Outer surface of the alveolar margins of the maxilla & mandible opposite the molar teeth from the pterygo-mandibular raphe Insertion: upper & lower fibers continue in upper and lower lips, central fibers decussate at the angle of mouth and blend with fibers of orbicularis oris

Supplied by buccal branch of facial nerve Pierced by parotid duct & deep facial vein Action: Compresses lips & cheek against teeth (accessory muscle of mastication). Also used in whistling, blowing and sucking Buccinator Parotid duct

Sensory Nerve Supply The skin is supplied by the branches of the three divisions of trigeminal nerve (except for the area over the angle of mandible and parotid gland, which is supplied by the great auricular nerve (C2, C3)). These nerves also supply proprioceptive fibers to the underlying muscles

Motor Nerve Supply Branches of the facial nerve: Temporal Zygomatic Buccal Mandibular (marginal) Cervical Posterior auricular

Facial Nerve Emerges from stylomastoid foramen Gives: Posterior auricular nerve to occipital belly of occipito-frontalis muscle A branch to supply posterior belly of digastric & stylohyoid muscle Then runs forward and enters into the parotid gland Breaks up in the gland, forms a plexus, and then emerges as 5 sets of branches: temporal, zygomatic, buccal, mandibular & cervical

Arterial Supply Rich arterial supply Through 2 main arteries: Facial artery (branch of external carotid artery) Transverse facial artery (branch of superficial temporal artery)

Supplemented by many smaller arteries which accompany the sensory nerves. These are branches of the internal and the external carotid arteries i.e. Supratrochlear Supraorbital Lacrimal External nasal Zygomaticotemporal Zygomaticofacial Infra-orbital Mental

Facial Artery Arises from anterior aspect of external carotid artery in the neck Arches upwards & over the submandibular salivary gland Curves around the inferior margin of the body of the mandible at the anterior border of the masseter muscle

Lies deeper to the muscles, anterior to the facial vein Runs a tortuous course towards the angle of the mouth, and then along the side of nose to the medial angle of the eye Lies deeper to the muscles, anterior to the facial vein Anastomosis with terminal branches of ophthalmic artery (a branch of the internal carotid artery) Facial vein Facial artery

Branches of facial artery Lateral nasal Superior labial Inferior labial Submental

Transverse Facial Artery A branch of the superficial temporal artery (which is one of the terminal branches of external carotid artery) Runs forward across the cheek over the masseter muscle accompanying the parotid duct Lies above the parotid duct along with upper zygomatic branches of facial nerve Transverse facial artery Parotid duct

Venous Drainage Transverse facial vein Facial vein Smaller veins accompanying small arteries & sensory nerves

Facial Vein Formed at the medial angle of the eye by the union of supraorbital and supratrochlear veins Descends behind the facial artery to the lower border of mandible Runs superficial to the submandibular gland Joins the anterior division of retromandibular vein, and opens into the internal jugular vein

Tributaries: Communications: Lateral nasal, superior labial, inferior labial and mental veins Communications: With the pterygoid venous plexus through the deep facial vein, which pierces the buccinator muscle With the cavernous sinus through superior opthalmic vein

Transverse facial Vein Accompanies the corresponding artery Drains into the superficial temporal vein (which Joins the maxillary vein to form the retomandibular vein),

Retro-auricular (Mastoid) Lymphatic Drainage Vessels carrying lymph from the face pass through superficial nodes arranged like a “collar” around the base of the head and finally drain into the deep cervical lymph nodes that lie along the internal jugular vein. Occipital Retro-auricular (Mastoid) Parotid Deep cervical lymph nodes Submandibular Submental

Clinical Anatomy Facial lacerations tend to gape. Skin needs to be sutured with great care to prevent scarring Bruises & inflammations of the face cause considerable swelling because of the looseness of superficial fascia. With age, the skin looses its resiliency and wrinkles appear. Wrinkle lines lie at right angle of pull of underlying muscles. Surgical incisions along these wrinkle lines heal with minimum scarring Trigeminal neuralgia, a common condition usually involving maxillary & mandibular nerves and sparing the ophthalmic division

Damage to facial nerve results in Facial (Bell’s) palsy (paralysis of facial muscles) on the side of the lesion In lower motor neuron lesion the whole face is affected In upper motor neuron lesion, only lower face is affected, upper face is normal as it receives bilateral supply.

Face is distorted, and shows: drooping of lower eyelid sagging of the angle of the mouth dribbling of saliva loss of facial expressions loss of chewing, blowing, sucking Person is unable to show teeth or close the eye on affected side Test individual branch of facial nerve

Dangerous zone: Infection in the marked triangular area of the face are dangerous as it may spread to the cavernous sinus and result in thrombosis of the sinus Because of its superficial position, damage to parotid duct can occur in facial lacerations or in surgical procedure on the face

Where can one feel the pulsation of the arteries of the face? Facial artery: Lower margin of mandible along the anterior border of masseter Superficial temporal artery: As it crosses the zygomatic arch in front of the auricle

why do we look different from one another? Our faces are a major part of our identity. Our brains are specialized for recognizing faces; we identify each other by our faces. A person's face provides a wealth of information; within seconds of seeing a person's face we immediately know much about him or her (including gender, age, race, emotional state, overall health etc. etc.). why do we look different from one another? Familial traits Size & shape of bones Amount & distribution of subcutaneous fatty tissue

It takes 43 muscles to frown and only 17 muscles to smile, but it doesn't take any to just sit there with a dumb look on your face

SMILE SO….. ….And keep on smiling….

What matters most is how you see yourself….… Thank You & Good Luck