2. THE FACE
Dr. Zeenat Zaidi

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

4. 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”).

5. 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.

6. 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)

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

8. 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

9. 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

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

11. 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

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

13. 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

14. 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

15. 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

16. 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

17. 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

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

19. 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

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

21. 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

22. 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

23. 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

24. Branches of facial artery
Lateral nasal
Superior labial
Inferior labial
Submental

25. 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

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

27. 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

28. 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

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

30. 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

31. 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

32. 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.

33. 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

34. 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

35. 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

36. 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

38. 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

39. SMILE
SO…..
….And keep on smiling….

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