1. The Face

2. The Face
Shape 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.

3. Type of face There are two types of face:- 1- Leptoprosopic face
- long , narrow
- protruding maxilla
- retruding mandible
2- Euryprosopic face
- upper part of face is less prominent
- nose is short
- eyes are wide set
- cheek bones are usually more prominent.

4. Sexual 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 expression
2- facial nerve
3- cutane. branches of trigeminal nerve and great auricular n.
4- parotid gland and duct
5- buccal pad of fat
6- facial L.N.

14. Skin of face: - Thin - Vascular - Movable
- Abundly supplied with sebaceous and sweat gland
- No deep fascia
- So it especially adaptable for surgical plastic operation. c

15. Muscles 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.

20. 2 orbicalaris : orbiculais ocul
orbiculais oris
2 associated with nose : procerus
compressor nares(in infant)
2 associated with nose : zygomaticus minor
Zygomatoe area : zygomaticus major(m.of smiling)
2 elevator of upper lip : levator labii superioris alaeque nasi
Levator labii superioris
2 muscle with angle of mouth :levator anguli oris
Depressor angel oris
2 muscles with lower lip: risorius Depressor labii inferioris
2 muscle associated with
chin and cheek: Mentalis
buccinator muscle

22. Orbicularis 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 drying
3- Lacrimal part: posterior border of lacrimal fossa to lid , its function to dilate lacrimal sac so that fluid discharge from conjunctiva to lacrimal sac.

23. Buccinator:-
* 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

25. Nerve 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

31. Facial 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).

33. Five 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

34. Facial Nerve Injury
Non-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.

35. Facial 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 .

36. Injury 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.

38. Sensory Nerves of face Trigeminal nerve (5) V1- Ophthalmic nerve :
Forehead – upper eyelid- conjunctiva of eye- side of nose
5 Branches
1-Lacrimal nerve
2- Supraorbital nerve
3- Supratrochler nerve
4- Infratochlear nerve
5- External nasal nerve

41. V2- Maxillary nerve:
Side of nose- lower eyelid-check-upper lip-lateral side of orbital opening
3 Branches
1- Infraorbital nerve
2- Zygomatico facial nerve
3- Zygomatico temporal nerve

44. V3- Mandibular Nerve:
Lower lip- lower part of face- temporal region –part of auricle
3Branches
1- Mental nerve-inferior alveolar nerve
2- Buccal nerve- Mucous membrane of check.
3- auriculo temporal nerve-accompany superficial temporal vessels

45. 1- 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.

49. 2- Superficial temporal artery: transverse facial artery.
3- Maxillary artery: mental artery-buccal artery- infra orbital artery
4- Opthlmic artery: supra orbital artery- supra trochlear artery- lacrimal artery – dorsal nasal artery- external nasal artery

51. Venous 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.

52. Lymphatic 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.

54. Veins 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.

55. Dangerous 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.

58. The Scalp *Consist of five layers of soft tissue covering calvaria:-
S=skin
C= C.T.
A= Aponeurotic
L= loose C.T. (dangerous area)
P= Pericranium
* Frontalis muscle has no bony attachments.

63. Lymphatic Drainage of the scalp
Nerve of the scalp
- Trigeminal nerve
- Cervical plexus C2-C3 ( great auricular, lesser occipital, greater occipital)
Artery of the scalp
1- external carotid artery – occipital – posterior – auricular – superficial temporal
2- 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.

64. Quiz Q1/ Could you explain the following:
1- In Bells palsy there is decrease of lacrimation
2- Loss of tast in the anterior 2/3 of tongue
3- Painful sensitivity to sound
4- Deviation of the lower jaw and tongue
Q2/ 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 nerve
B- Facial nerve
C- Vague nerve
D- Spinal accessory nerve
E- Hypoglossal nerve