SGD2:Face

th
1.

Givethedistinguishingfeaturesoftheskinoftheface
.(Snell9
editionpg579)
Theskin

Possessnumeroussweatandsebaceousglands.

Itisconnectedtotheunderlyingbonesbylooseconnectivetissue,inwhich
areembeddedthemusclesoffacialexpression.

Nodeepfasciaispresentintheface.

Wrinklelinesofthefaceresultfromtherepeatedfoldingoftheskin
perpendiculartothelongaxisoftheunderlyingcontractingmuscles,coupled
withlossofyouthfulskinelasticity.

Surgicalscarsofthefacearelessconspicuousiftheyfollowthewrinkle
lines.

th
2.

Illustratethesensorynervesupplytotheskinoftheface.
(Snell9
editionpg579580)

TheskinofthefaceissuppliedbybranchesoftheTHREEdivisionsofthetrigeminalnerve
exceptforthesmallareaovertheangleofthemandibleandtheparotidgland(suppliedby
greatauricularnerve).

I.

OpthalmicNerve
Suppliestheskinoftheforehead,theuppereyelid,theconjunctiva,andthesideofthenose
downtoandincludingthetip.
FiveBranchesofthenervepasstotheskin
Compiledby:AMSAUST

1.

LacrimalNervesuppliestheskinandconjunctivaofthelateralpartoftheuppereyelid.
2.

Supraorbitalnervewindsaroundtheuppermarginoftheorbitatthesupraorbitalnotch.It
dividesintobranchesthatsupplytheskinandconjunctivaonthecentralpartoftheupper
eyeliditalsosuppliestheskinoftheforehead.
3.

Supratrochlearnervewindsaroundtheuppermarginoftheorbitmedialparttothe
supraorbitalnerve.Itdividesintrobranchesthatsupplytheskindandconjunctivaonthemedial
partoftheuppereyelidandtheskinoverthelowerpartoftheforehead,closetothemedian
plane.
4.

Infratrochlearnerveleavestheorbitbelowthepulleyofthesuperiorobliquemuscle.It
suppliestheskinandconjunctivaonthemedialpartoftheuppereyelidandtheadjoiningpartof
thesideofthenose
5.

Extranasalnerveleavesthenosebyemergingbetweenthenasalboneandtheupper
nasalcartilage.Itsuppliestheskinonthesideofthenosedownasfarasthetip.
II.

MaxillaryNerve

Suppliestheskinontheposteriorpartofthesideofthenose,thelowereyelid,thecheek,
theupperlip,andthelateralsideoftheorbitalopening.
Threebranchesofthenervepasstotheskin.
1.

Infraorbitalnerveisadirectcontinuationofthemaxillarynerve.Itenterstheorbitand
appearsonthefacethroughtheinfraorbitalforamen.Itimmediatelydividesintonumeroussmall
branches,whichradiateoutfromtheforamenandsupplytheskinofthelowereyelidandcheek,
thesideofthenoseandtheupperlip.
2.

Zygomaticofacialnervepassesontothefacethroughasmallforamenonthelateralside
ofthezygomaticbone.Itsuppliestheskinovertheprominenceofthecheek.
3.

Zygomaticotemporalnerveemergesinthetemporalfossathroughasmallforamenonthe
posteriorsurfaceofthezygomaticbone.Itsuppliestheskinoverthetemple.
III.

MandibularNerve

Suppliestheskinofthelowerlip,thelowerpartoftheface,thetemporalregion,andpartof
theauricle.Itthenpassesupwardtothesideofthescalp.
Threebranchesofthenervepasstotheskin.
1.

Mentalnerveemergesfromthementalforamenofthemandibleandsuppliestheskinof
thelowerlipandchin.
2.

Buccalnerveemergesfrombeneaththeanteriorborderofthemassetermuscleand
suppliestheskinoverasmallareaofthecheek.
3.

Auricotemporalnerveascendsfromtheupperborderoftheparotidglandbetweenthe
superficialtemporalvesselsandtheauricle.Itsuppliestheskinoftheauricle,theexternal
auditorymeatus,theoutersurfaceifthetympanicmembraneandtheskinofthescalpabove
theauricle.

3.

Discusstheattachments.Neurovascularsupplyandactions(withdemonstration)of
th
thethreegroupsofmusclesofthefacialexpression.
1.

(Snell9
editionpg574589)
Compiledby:AMSAUST


MusclesofFacialExpression
Muscle

Origin

Insertion Nerve Action

Supply

OrbicularisOculi

Palpebralpart

Medial
palpebr
al
ligamen
t

Lateral
Palpebr
alraphe

Facial
Nerve

Closes
eyelids
and
dilates
lacrimal
sac

OrbitalPart

Medial
palpebr
al
ligamen
tand
adjoinin
gbone

Loops
Facial
returnto Nerve
origin

Throws
skin
around
orbitinto
foldsto
protect
eyeball

Corrugatorsupercilii

Supercil
iary
arch

Skinof
Facial
eyebrow Nerve

Vertical
wrinkles
of
forehea
d,asin
frowning

Compressornasi

Frontal
process
of
maxilla

Aponeur
osisof
bridge
ofnose

Facial
Nerve

Compre
sses
mobile
nasal
cartilage
s

DilatorNaris

Maxilla

Alaof
nose

Facial
Nerve

Widens
nasal
aperture

Procerus

Nasal
Bone

Skin
Facial
between Nerve
eyebrow
s

Wrinkles
skinof
nose

Compiledby:AMSAUST

OrbicularisOris

Maxilla,
mandibl
e,and
skin

Encircle
soral
orifice

Facial
Nerve

DilatorMusclesofLips
Muscle

Origin

Levatorlabii
superioris
alaequenasi

NerveSupply

Action

Arisefrombones
andfasciaaround
oralapertureand
insertunto
substanceoflips

FacialNerve

Separate
Lips

Levatorlabii
superioris

Arisefrombones
andfasciaaround
oralapertureand
insertunto
substanceoflips

FacialNerve

Separate
Lips

Zygomaticus
minor

Arisefrombones
andfasciaaround
oralapertureand
insertunto
substanceoflips

FacialNerve

Separate
Lips

Zygomaticus
major

Arisefrombones
andfasciaaround
oralapertureand
insertunto
substanceoflips

FacialNerve

Separate
Lips

Levator
angulioris

Arisefrombones
andfasciaaround
oralapertureand
insertunto
substanceoflips

FacialNerve

Separate
Lips

Risorius

Arisefrombones
andfasciaaround
oralapertureand
insertunto
substanceoflips

FacialNerve

Separate
Lips

Compiledby:AMSAUST

Insertion

Compre
sseslips
together

Depressor
angulioris

Arisefrombones
andfasciaaround
oralapertureand
insertunto
substanceoflips

FacialNerve

Separate
Lips

Depressor
Arisefrombones
labiiinferioris andfasciaaround
oralapertureand
insertunto
substanceoflips

FacialNerve

Separate
Lips

Mentalis

Arisefrombones
andfasciaaround
oralapertureand
insertunto
substanceoflips

FacialNerve

Separate
Lips

Buccinator

Outersurfaceof
alveolarmargins
ofmaxillaand
mandibleand
pterygomandibula
rligament

FacialNerve

Compresses
cheeksand
lipsagainst
teeth

Platysma

Deepfasciaover
pectoralismajor
anddeltoid

Bodyof
mandible
andangle
ofmouth

FacialNerve
Cervical
Branch

*Suprascapular
andfacial
arteries

Depresses
mandible
andangleof
mouth

MuscleofMastication
Muscle

Origin

Insertion

NerveSupply

Action

Masseter

Zygomatic
arch

Lateral
surface
ramusof
mandible

Mandibular
divisionof
trigeminal
nerve

Elevates
mandibleto
occludeteeth

Compiledby:AMSAUST

Temporalis

Floorof
temporalfossa

Coronoid
processof
mandible

Mandibular
divisionof
trigeminal
nerve

Anteriorand
superior
fiverselevate
mandible
posterior
fibersretract
mandible

Lateral
pterygoid(
twoheads)

Greaterwing
ofsphenoid
andlateral
pterygoidplate

Neckof
Mandibular
mandibleand divisionof
articulardisc trigeminal
nerve

Pullsneckof
mandible
forward

Medial
pterygoid(
Twoheads)

Tuberosityof
maxillaand
lateral
pterygoidplate

Medial
surfaceof
angleof
mandible

Elevates
mandible

Mandibular
divisionof
trigeminal
nerve

4.
MasseterMusclemuscleofmastication
Origin:Zygomaticarch
Insertion:Lateralsurfaceoframusofmandible
Action:Strongelevatorofthemandibletooccludeteeth
Innervation:Mandiblenerve

5.FacialNerve
5Branches:
1.
Temporalbranch
emergesfromtheupperborderoftheglandandsuppliestheanteriorand
superiorauricularmuscles,thefrontalbellyoftheoccipitofrontalis,theorbicularisoculi,andthe
corrugatorsupercilii.
2.
Zygomaticbranch
emergesfromtheanteriorborderoftheglandandsuppliesthe
orbicularisoculi.
3.
Buccalbranch
emergesfromtheanteriorborderoftheglandbelowtheparotidductand
suppliesthebuccinatormuscleandthemusclesoftheupperlipandnostril.
4.
Mandibularbranch
emergesfromtheanteriorborderoftheglandandsuppliesthemuscles
ofthelowerlip.
5.C
ervicalbranch
emergesfromthelowerborderoftheglandandpassesforwardintheneck
belowthemandibletosupplytheplatysmamuscleitmaycrossthelowermarginofthebodyof
themandibletosupplythedepressoranguliorismuscle.
Thefacialnerveisthenerveofthesecondpharyngealarchandsuppliesallthemusclesof
facialexpression.
Itdoes

notsupplytheskin,
butitsbranchescommunicatewithbranchesof
thetrigeminalnerve.Itisbelievedthattheproprioceptivenervefibersofthefacialmuscles
Compiledby:AMSAUST

leavethefacialnerveinthesecommunicatingbranchesandpasstothecentralnervoussystem
viathetrigeminalnerve.

Origin

Commencement

Termination

Branches/
Tributaries

Temporal
Branch

FacialNerve

Upperborderof
theparotidgland

Zygomaticarch

Frontalisand
periorbital
muscles

Zygomatic
Branch

FacialNerve

Anteriorborderof
thegland

Infraorbital
fibersofthe
orbicularisoculi

Orbicularisoculi
andmuscles
thatmovethe
upperlip

BuccalBranch

FacialNerve

Anteriorborderof
theglandbelow
theparotidduct

Buccinator
muscle

Buccinator
muscle

Mandibular
Branch

FacialNerve

Anteriorborderof
thegland

Musclesofthe
lowerlip

Musclesofthe
lowerlip

CervicalBranch

FacialNerve

Lowerborderof
thegland

Belowtheangle
ofthemandible

Platysma
muscleinthe
neck

6.Illustratetheretromandibularvein
Itformstheexternaljugularvein.
Formedbythemergerofthesuperficialtemporalveinandmaxillaryvein.
Thisveinanditsbeginningvenulesdrainareassimilartothosesuppliedbythesuperficial
temporalandmaxillaryarteries.
Inferiortotheparotidglanditdividesinto2divisions:
theanteriordivisionjoinsthefacialveinandtheposteriordivisioncontinuesdownwardand
joinstheposteriorauricularveintobecometheexternaljugularvein.

7.Discusstheparotidglandastoitslocation,division,fascialcovering,relations,
neurovascularsupplyandvenousdrainage.(Moore,Snell630631,Netters4243)

Location:belowexternalauditorymeatusbehindramusofmandible,frontof
sternocleidomastoidmuscle,withinthecervicalfascia

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Division:Facialnervepassesthrough,dividesglandtosuperficialanddeeplobes

Fascialcovering:coveredbythecervicalfascia

Relations:facialnerve,retromandibularvein,externalcarotidartery,auriclotemporalnerve

Neurovascularsupply:Parasympatheticsecretomotorviaglosspharyngealnerve.Reachgland
viatympanicbranch,lesserpetrosalnerve,oticganglion,auriculotemporalnerve

Venousdrainage:drainedbytheretromandibularveinwhichrunstraversesthroughthegland

8.Describethecourseoftheparotidduct

Parotidduct/Stensen'sduct
emergesfromtheanteriorborderoftheparotidgland
coursestransverselyorobliquelydownwardacrossthelateralsurfaceofthemassetertocurve
inwardarounditsanteriorborder,piercingthebuccalfatandbuccinatormuscleswhich
perforatesthebuccalmucosaandterminatesatthelevelofthesecondmolartooth

9.Discussthe3mainneurovascularstructuresthattraversethesubstanceoftheparotid
gland:facialnerve,retromandibularveinandexternalcarotidartery.

RETROMANDIBULARVEIN
tributaries:maxillaryveinsandtemporalvein
anteriordivisiontributaries:facialveinandretromandibularvein
posteriordivisiontributaries:posteriorauricularveinandretromandibularvein

EXTERNALCAROTIDARTERY
mostmedial
commenceattheupperborderofthethyroidcartilageandenterthecarotidtriangleoftheneck
andonceitleavesthetriangle,itwallpassdeeptotheposteriorbellyofthedigastricmuscle
andascendtoentertheparotidgland.Attheleveloftheneckofthemandible,itwillbifurcate
intothesuperficialtemporalarteryandmaxillaryartery

TRANSVERSEFACIALARTERY
branchofthesuperficialtemporalartery
belowtheinferiorborderofthezygomaticarchliessuperiorandparalleltotheStensen'sduct

10.Describethefacialarteryandfacialvein

FacialArtery
Origin:externalcarotidartery
Compiledby:AMSAUST

Course:Ascendsdeeptosubmandibularglandwindsaroundinf.borderofmandibleandenters
face
coveredbyplatysma&risoriusmuscles,ascendstozygomaticusmuscles&levatorlabii
superiorismuscle
Branchesout*anastomoseswithterminalbranchesofophthalmicartery
Branches:submentalartery,inferorlabialartery,superiorlabialarterylateralnasalartery,
superficialtempporalartery,transversefacialartery,supraorbitalandsupratrochleararteries
Areasupplied:musclesoffacialexpressionandface
1

FacialVein
Origin:continuationofangularveinpastinferiormarginoforbit
Course:descendsalonglat.borderofnose,receiveex.nasal&inf.palpebralveins
passesobliqueacrossfaceto(x)inferiorborderofmandible
receivescommfromretromandibularvein(after,sometimescalledcommonfacialvein)
Termination:internaljugularveinopposite/inferiortolevelofhyoidbone
Areadrain:anteriorscalpandforeheadeyelidsexternalnosenoseanteriorcheeklipschin
submandibulargland

11.Discussthebloodsupplyandvenousdrainageoftheface.

Bloodsupply
Facereceivesbloodsupplyfrom
facial
and
temporal
arteries(supplementedbysmallarteries)
The
facialartery
curvesaroundtheinferiormarginofthebodyofthemandibleattheanterior
borderofthemassetermuscle.(
Pulsecaneasilybefelthere
)

Branches:
1.Submentalarterysuppliestheskinofthechinandlowerlip
2.Lateralnasalarterysuppliestheskinonthesideanddorsumofthenose.
3.Superficialtemporalarteryascendsinfrontoftheauricletosupplythescalp
4.supraorbitalandsupratrochleararteriessupplytheskinoftheforehead

Venousdrainage
Facialvein
formedatthemedialangleoftheeyebytheunionofthesupraorbitaland
supratrochlearveins

Facialvein>supraorbitalvein>superiorophthalmicvein>
cavernoussinus*
>internaljugular
vein(endsandisdrainedhere)

*pathwayforthespreadofinfectionfromthefacetothecavernoussinus

Compiledby:AMSAUST

12.Discusstheclinicalsignificanceofthedangerousareaoftheface.
Potentiallydangerouszoneforinfection:
areaoffacialskinboundedbythenose,theeye,
andtheupperlip

Why?
Infectioncanspreadthroughtheinferiorophthalmicveinstothecavernoussinus(see
question11)

Compiledby:AMSAUST