1. Cover slide

2. 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

3. 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

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

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

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

7. 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

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

9. 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

10. 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

11. 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

12. 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

13. 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

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

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

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

17. 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

18. 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

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

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

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

22. 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

23. 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

24. 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

25. 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

26. Facial Palsy
MOB TCD
MOB TCD

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

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

29. 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

30. 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

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

32. “BMJ Publishing Group Limited (“BMJ Group”) 2012. All rights reserved
Copyright slide