L6: Face Flashcards
What is the extent of the face?
❖ The superior orbital margin (eyebrows) to the chin.
❖ Laterally to the external auditory meatus.
NB: The forehead is common to both scalp and face
What are the layers of the face?
❖ Skin.
❖ Muscles
What are the muscles of the face characterized by?
- They surround the openings of the face.
- They originate from the bones of the skull.
- They are inserted in the skin; they are the muscles of expression.
- They develop from the 2nd pharyngeal arch.
- They are supplied from the facial nerve.
What are the openings of te. Face?
- Orbit 2. Nose 3. Mouth 4. Ear
What are the muscles of the face?
- Orbicularis occuli
- Orbicularis oris
- Buucinator
- platysma
What are the parts of the orbicularis oculi?
Orbital, palpebral and lacrimal parts
What is the origin of the orbital part of the orbicularis oculi?
the upper part of the medial palpebral ligament
What are the insertions of the orbital part of the orbicularis oculi?
the lower part of the medial palpebral ligament.
What is the nerve that supplies the orbital, palpebral and lacrimal parts of tne orbicularis oculi?
Temporal and upper zygomatic branches of the facial nerve.
What is the action of the orbital part of the orbicularis oculi?
firm closure of the eye.
What is the origin of the palpebral part of the orbicularis oculi?
upper and lower parts of the medial palpebral ligament
What is the insertion of the palpebral part of the orbicularis oculi?
lateral palpebral raphe.
What is the action of the palpebral part of the orbicularis oculi?
gentle closure of the eye.
What is the origin of the lacrimal part of the orbicularis oculi?
lacrimal bone and the fascia covering the lacrimal sac.
What is the insertion on the lacrimal part of the orbicularis oculi?
the tarsi of the lids.
What is the function of the lacrimal part of the orbicularis oculi?
dilates the lacrimal sac to drain tears
What are the parts of the Buccinator?
Upper, lower and middle fibers
What is the origin of the upper fibers?
From the maxilla opposite the upper molars.
What is the insertion of the upper fibers?
Upper lip
What is the nerve that supplies the fibres of the buccinator?
Buccal branch of the facial nerve.
What is the action of the buccinator?
presses the cheek to the gums, to prevent the accumulation of food in the vestibule of the mouth.
What does the paralysis of the buccinator lead to?
Its paralysis leads to the accumulation of food in the vestibule of the mouth and the dripping of saliva.
What is the origin of the lower fibres of the buccinator?
From the mandible opposite the lower molars.
What is the insertion of the lower fibre of the buccinator?
Lower lip
What is the origin of the middle fibres of the buccinator?
From the Pterygomandibular ligament.
What is the insertion of the middle fibre of the buccinator?
decussate before passing to lips
What is the origin of orbicularis oris?
maxilla above incisor teeth
What is the insertion of the orbicularis oris?
the skin of the lip.
What is the nerve supply for the orbicularis oris?
Buccal branch of the facial nerve.
What is the function of the orbiculas oris?
Compresses the lips together to close the mouth.
What is the origin of the platysma?
the upper part of pectoral and deltoid fascia
What is the insertion of the platysma?
the base of the mandible, the skin of the lower face, and the lip
What is the function of the platysma?
releases pressure of skin on the subjacent veins, depress mandible, pulls the angle of the mouth downwards.
From where does the facial nerve leave the skull?
The facial nerve leaves the skull through the stylomastoid foramen to enter the parotid gland through its posteromedial surface.
Where does the facial nerve branch?
Inside the parotid
What are the branches of the facial nerve?
Temporal
Zygomatic
Buccal
Mandibular
Cervical
What does the temporal branch supply?
Supplies the frontal belly of occipitofrontalis and the upper part of orbicularis oculi.
What does the zygomatic branch supply?
- Upper zygomatic: Supplies the lower part of orbicularis oculi.
- Lower zygomatic: Supplies the nasal muscles.
What does the buccal branch supply?
Supplies the buccinator, orbicularis oris, and other muscles of the mouth except those of the lower lip.
What does the mandibular branch supply?
Supplies the muscles of the lower lip.
What does the cervical branch supply?
Supplies the platysma
What does the trigeminal nerve supply?
❖ supplies all the skin of the face EXCEPT the skin over the angle of the mandible which is supplied by the great auricular nerve.
Whata are the divisions of the trigeminal nerve?
ophthalmic division
maxillary division
mandibular division
What are the branches of the ophthalmic division? And what do they supply?
- Supratrochlear nerve: Supplies the medial 1/3 of the upper eyelid.
- Supraorbital nerve: Supplies the middle 1/3 of the upper eyelid.
- Palpebral of lacrimal: Supplies the lateral 1/3 of the upper eyelid.
- External nasal nerve: Supplies the lower 1/2 of the dorsum of the nose.
- Infratrochlear nerve: Supplies the upper 1/2 of the dorsum of the nose and the adjoining part of the lower eyelid.
What are the branches of the maxillary division?
- Zygomaticofacial nerve: Supplies the skin over the bony cheek.
- Infraorbital nerve (the continuation of the maxillary nerve):
Palpebral branch: Supplies the skin of the lower eyelid.
Nasal branch: Supplies the skin of the side of the nose.
Labial branch: Supplies the skin of the upper lip.
What are the branches of the mandibular division?
- Buccal nerve: Supplies the skin of the cheek.
- Mental nerve: Supplies the skin of the lower lip
Do the wounds of the face heal fast?
Yes
What are the arteries of the face?
1)The facial artery:
It arises from the anterior aspect of the external carotid artery.
It turns around the lower border of the mandible at the inferior angle of the masseter to reach the face.
In the face, it takes a tortuous course, passes upwards till a point 1 cm behind the angle of the mouth, then continues upwards on the side of the nose till the medial
the angle of the eye.
2) Supraorbital and Supratrochlear:
branches of the ophthalmic artery which is a branch of the internal carotid artery.
3) Transverse facial and zygomaticorbital arteries Which are branches of the superficial temporal artery.
4) Small twigs accompanying nerves supplying the face.
What are the veins of the face?
1) Anterior facial vein:
formed by the union of supratrochlear & supraorbital veins at the medial angle of the eye.
2) Posterior facial vein (retromandibular vein):
formed by the union of the superficial temporal vein with the maxillary vein. It ends by dividing into anterior and posterior divisions.
3) Common facial vein:
formed by the union of the anterior facial with the anterior division of the posterior facial veins.
4) External Jugular vein:
formed by the union of the posterior division of retromandibular with posterior auricular veins
5) Deep facial vein:
connect the anterior facial vein with the pyrgotid plexus.
Communications of the anterior facial vein
a) At its beginning:
it receives the ophthalmic veins which are connected to the cavernous sinus through the superior orbital fissure.
b) Along its course:
it receives veins corresponding to the branches of the facial artery.
c) While crossing the buccinator:
it is connected with the pterygoid venous plexus through the deep facial vein that passes deep to the ramus of the mandible.
The pterygoid venous plexus is connected to the cavernous sinus through emissary veins passing through the foramen ovale.
Infection in the triangular area of the face between the two anterior facial veins (Dangerous area of the face) can lead to cavernous sinus thrombosis in two ways:
Anterior facial vein — ophthalmic veins — cavernous sinus.
Anterior facial vein — deep facial vein — pterygoid venous plexus — emissary veins through foramen ovale — cavernous sinus.
Lymph drainage in the face
Upper region
preauricular lymph nodes (parotid):
the greater part of the forehead, lateral 1⁄2 of the eyelid, conjunctiva, lateral part of the cheek, and parotid area:
Middle region
submandibular lymph nodes:
median part of the forehead, external nose, upper lip, lateral part of the lower lip.
medial 1⁄2 of the eyelid, the medial part of the cheek, the greater part of the lower jaw.
Lower region
submental lymph nodes:
the central part of the lower lip, chin.
Trigeminal neuralgia
pain in the region of distribution of maxillary and mandibular branches of the trigeminal nerve.
❖ Infranucleur lesions of the facial nerve (eg, bell’s palsy)
the whole face is paralyzed, Affected side is motionless.
Loss of wrinkles.
The eye cannot be closed.
In smiling the mouth is drawn to the normal side.
During mastication, food accumulates in the vestibule of the mouth.
❖ Supranuclear lesions of the facial nerve
only the lower part of the face is paralyzed.
The upper part (frontalis &part of orbicularis oculi) escapes due to its bilateral innervation
Characters of face wounds
❖ Face wounds bleed profusely, heal rapidly, and are sutured with thin threads
Dangerous area of the face
infections from face mainly from upper lip & nose can go
to cavernous sinus through ophthalmic vein and deep facial vein.
