2The FaceShape of face depend on :- facial skeleton- disposition of soft tissue- type of face**Facial growth during child hood as the paranasal sinus develop and permanent teeth erupt.
3Type of face There are two types of face:- 1- Leptoprosopic face - long , narrow- protruding maxilla- retruding mandible2- Euryprosopic face- upper part of face is less prominent- nose is short- eyes are wide set- cheek bones are usually more prominent.
4Sexual Variation of face - face show sexual dimorphism although facial types are similar until the age of year.- face of female attains its mature form earlier than the male.- male face tend to be more protuberant, bulky and coarse.- nose of female have a concave to straight profile.- supra orbital ridge of male overhang the face, those of female are at same level as inferior orbital margin and cheek bones.
5**On reflection the skin of the face, the following main structures are revealed: 1- muscles of facial expression2- facial nerve3- cutane. branches of trigeminal nerve and great auricular n.4- parotid gland and duct5- buccal pad of fat6- facial L.N.
14Skin of face: - Thin - Vascular - Movable - Abundly supplied with sebaceous and sweat gland- No deep fascia- So it especially adaptable for surgical plastic operation.c
15Muscles of the face*Characterized by subcutaneous location move the skin and change facial expression.*Placed around orifice of eye (palpebral fissure), ear nose and mouth ( oral fissure).* All muscle of face developed from 2nd pharyngeal arch which supply by facial nerve.
22Orbicularis Oculi: 3 parts: 1- Orbital part: strongly close of eye protecting it from dust, bright light , mingling with fiber of frontalis muscle.2- Palpebral part: gently close the eye lid as in blinking or in sleep to keep the cornea from drying3- Lacrimal part: posterior border of lacrimal fossa to lid , its function to dilate lacrimal sac so that fluid discharge from conjunctiva to lacrimal sac.
23Buccinator:-* Attached to alveolar process of maxilla, mandible opposite molar tooth to ptergomandibular raphe.* Active in smile.* Keep check taut, preventing it from folding and being injured during chewing* Mingle medially with orbicularis oris* Aid in mastication* Used during whistling , sucking and blowing
25Nerve Supply of the face Face have both motor and sensory* Motor: nerve derived from facial nerve (nerve of second pharyngeal arch)* Sensory: innervations is primarly from three division of trigeminal nerve (CN V) with exception of small area over angle of mandible and parotid gland which supply by great auricular nerve(C2,C3).* Motor nerve of the face:-- facial nerve to muscle of facial expression- motor root of mandibular nerve to muscle of mastication
31Facial nerve:-- leave the skull at stylomastoid foramen give off posterior auricular nerve- send fiber to :-- Stapedius muscle- Stylohyoid muscle- Posterior belly of digastric muscle- Scalp muscles- Auricular muscle- Platysma muscle- Buccinator
32* Provides secretary fiber to salivary and sensory (taste) fibers to anterior 2/3 of tongue. * Enter parotid isthmus and passes between superior and deep loops of gland.* It is superficial to external carotid artery and retromandibular vein so may be injured in operation in parotid region .* Terminal branches appear at margin of parotid (antromedial surface of gland).
33Five terminal branches of facial nerve 1- Temporal branch- frontalis- orbicularis oculi(upper).2- Zygomatic branch – orbicularis oculi:(lower)3- Buccal branch- Buccinator- orbicularis oris.4- Mandibular- (marginal) passes along lower border of mandible crossing facial artery and vein and submundibular L.N.5- Cervical branch – platysma
34Facial Nerve InjuryNon-traumatic cause of facial parlay is inflammation of facial nerve near stylomastoid foramen so patient has;1- Can not close his eyes and palpebral fissure appear wider, lacrimal fluids drips on cheeks laterally, drying of cornea.2- Patient van not whistle, blow or chew effictualey so food will accumulate between cheeks and gum so patient use his finger to remove food due to parlysis of buccintor muscle.3- Displacement of corner of mouth , so food and saliva dripling outside of mouth.
35Facial Nerve Pulsy has many causes: 1- Idiopathic (Belly pulsy) Exposure to cold (30 to 50 years).2- Complication of surgery in Parotid gland.3- Dental manipulation-vaccination.4- Infection of middle ear .
36Injury to Branch of facial nerves 1- By stab wound- gunshots.2- Injury at birth.3- Injury of temporal bones.4- Surgical approach to sub mandibular gland- resulting in dropping of corner of mouth.
44V3- Mandibular Nerve:Lower lip- lower part of face- temporal region –part of auricle3Branches1- Mental nerve-inferior alveolar nerve2- Buccal nerve- Mucous membrane of check.3- auriculo temporal nerve-accompany superficial temporal vessels
451- Facial Artery: - from external carotid artery - winds its way to inferior border of mandible- interior to massetor so artery lies superficial deep to platysma- cross mandible, buccinator, maxilla to medial canthus of eye- lies deep to Zygomaticus major, levator labii superioris.
48- lies fingerbirth lateral to angle of mouth. - give superior,inferior labial arteries- ascend alongside of nose joined dorsal nasal branches of ophthalmic artery.- terminal branch of facial artery is called angular artery.
492- Superficial temporal artery: transverse facial artery. 3- Maxillary artery: mental artery-buccal artery- infra orbital artery4- Opthlmic artery: supra orbital artery- supra trochlear artery- lacrimal artery – dorsal nasal artery- external nasal artery
51Venous drainage of face * Is formed by union of supra orbital and supra trochlear.* Connected to superior ophthalmic vein which connected facial vein to cavernous sinus.* Join anterior division of retro mandibular vein.* Drain into internal jugular vein directly or indirectly.* Taking a less tortuous but more superficial course.
52Lymphatic drainage of face: 1- submundibular L.N.- forehead- anterior part of face.2- Buccal L.N.3- Parotid L.N. lateral part of face- lateral part of eyelid.4- Submental L.N.-central part of lower lip, skin of chin.
54Veins of the face Supra temporp v. supratrochele v. + + Maxillary v supraorbital v.Angular v.Retromandibular v. Ant Facial v.Post.+Post. Amicular v common facial v.Ext. jugular v int. jugular v.
55Dangerous Area of face* Is triangle bounded by lines join root of nose with angle of mouth.* Venus drainage from this area enter angular veins which communicate with cavernous sinus.* Therefore boil, carbuncle in this region produce cavernous sinus thrombosis.
63Lymphatic Drainage of the scalp Nerve of the scalp- Trigeminal nerve- Cervical plexus C2-C3 ( great auricular, lesser occipital, greater occipital)Artery of the scalp1- external carotid artery – occipital – posterior – auricular – superficial temporal2- internal carotid artery – supra trochlear- supra orbital.Lymphatic Drainage of the scalp- there is no L.N. in the scalp- superficial ring of L.N. (submental , submandibular, parotid, retro auricular and occipital L.N.
64Quiz Q1/ Could you explain the following: 1- In Bells palsy there is decrease of lacrimation2- Loss of tast in the anterior 2/3 of tongue3- Painful sensitivity to sound4- Deviation of the lower jaw and tongueQ2/ What are the efferent and afferent limbs of cornel blink reflex (closing of the eyes)Q3/ Death may result from bilateral severance of which of the following nerve ?A- Trigeminal nerveB- Facial nerveC- Vague nerveD- Spinal accessory nerveE- Hypoglossal nerve