FACIAL ANATOMY

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 SCALP FACIAL ANATOMY

Layer of dense connective tissue:- scalp is characterized by a layer of  dense connective tissue deep to skin- contains profuse neurovasculature- dense connective tissue promotes  bleeding following scalp injuries- skin, connective tissue & aponeurosis  are tightly joined (first 3 layers):  “scalp proper”

(flaps)

Harvesting oftemporal fascia

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 SCALP FACIAL ANATOMY

Aponeurotic layer:- deep to dense connective  tissue, & adherent to overlying skin- consists chiefly of  occipitofrontalis muscle - anterior & posterior muscle   bellies linked by   aponeurosis - moves scalp, contracts   forehead, elevates eyebrows - innervated by temporal   branch of facial nerve   anteriorly and posterior   auricular branch posteriorly

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 INNERVATION OF SCALP FACIAL ANATOMY

Cranial nerves (CN 5 branches)- anterior to ears & vertex of head:  - supratrochlear  - supra-orbital  - auriculotemporal  - zygomaticotemporal

Cervical nerves (spinal nervesfrom cervical vertebrae)- posterior to ears & vertex (C2, C3):  - great auricular  - lesser occipital  - greater occipital  - third occipital

http://img.medscape.com/pi/emed/ckb/clinical_procedures/834279-834808-1745.jpghttp://www.touchpoint.dk/xdoc/209/images/occipitaleXnerverXny.jpg

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SCALP BLOOD SUPPLY  1) branches of the internal   carotid artery (anterior only)   - supratrochlear & supra-orbital arteries      supplies antero-superior scalp2) or external carotid artery    (lateral & posterior scalp)    - superficial temporal artery    - posterior auricular artery    - occipital arteries artery

http://img.medscape.com/pi/emed/ckb/clinical_procedures/834279-834808-1745.jpghttp://www.touchpoint.dk/xdoc/209/images/occipitaleXnerverXny.jpg

FACIAL ANATOMY

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MUSCLES OF HEAD   FACIAL ANATOMY

Functional ClassificationExtraocular Muscles:- move eyeball and open upper eyelidMiddle Ear Muscles:- regulate movement of middle earFacial Muscles:- facial movements and expressionMastication Muscles:- move jaw at temporomandibular jointSoft Palate Muscles:- elevate & lower palateTongue Muscles:- move tongue

http://cnx.org/resources/92104ea27d9dc1e7c8342578d3b7ab5f00cf1367/1109_Muscles_that_Move_the_Tongue.jpg6

 FACIAL MUSCLES FACIAL ANATOMY

Orbital group:- orbicularis oculi   - surrounds orbit   - closes eyelids   - parts:     - outer orbital muscle       (forceful closure of eye)     - palpebral muscle of eyelids       (closes eye smoothly)- corrugator supercilii   - interior & superior to orbicularis   - muscle for frowns,     medial eyebrow motion 

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 FACIAL MUSCLES FACIAL ANATOMY

Nasal group:nasalis  - largest, modulates nares opening  - transverse & alar parts procerus  - nasal bone into skin     between eyebrows  - used for frowning, pulls     medial eyebrows downward depressor septi nasi  - also expands nares     & draws nose inferiorly

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 FACIAL MUSCLESOral group (move lips & cheek): Orbicularis oris   - surrounds mouth to move lips  - fibers originate from medial     maxilla, buccinator, etc. Buccinator   - muscles of cheek, deep muscle    between mandible & maxilla  - buccinator fibers insert into lips to    merge with orbicularis oris  - contributes to movement of lips    & brings cheek against teeth  - facilitates mastication & forcing of air from cheek Lower group   - depressor anguli oris (frowning, lowers corners of mouth)  - depressor labii inferioris (depresses & lateral movements    of lower lip)  - mentalis (deep muscle; protrudes lower lip) 9

FACIAL MUSCLES   FACIAL ANATOMY

Occipitofrontalis- interconnects frontal & occipital regions- frontal region covers forehead to eyebrows- adjusts scalp & wrinkles forehead

Platysma- broad, thin sheet of muscle in superficial fascia of neck- from clavicle to mandible (some fibers extending to mouth)

Upper group - risorius (thin superficial muscle, for grinning,    mouth corners up & out) - zygomaticus major (superficial, to corner    of mouth for smiling) - zygomaticus minor (inserts into upper    lip medial to mouth corner) - levator labii superioris (moves corner    of mouth relative to nose) - levator labii superioris alaeque nasi    (between nose & skin of upper lip) - levator anguli oris (deep, elevates    corner of mouth)

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 FACIAL MUSCLES FACIAL ANATOMY

Muscles of Mastication  Masseter  Temporalis  Lateral Pterygoid  Medial Pterygoid

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FACIAL INNERVATION   FACIAL ANATOMY

Face innervated by:- CN V (trigeminal)- CN VII (facial)

CN V (trigeminal) branches:    - V1: ophthalmic (sensory)    - V2: maxillary (sensory)    - V3: mandibular (mixed)

CN VII (facial)- chiefly motor innervation to   muscles of facial expression- sensory:    - taste (anterior 2/3 tongue)       via chorda tympani    - portion of oropharynx    - region around pinna of ear- parasympathetic:    - submandibular & sublingual glands 12

FACIAL NERVE  

Supplies:- muscles of facial expression;- posterior belly of digastric muscle;- stylohyoid, and stapedius

CN VII:- has multiple branches- enters posterior cranial fossa via   internal acoustic meatus- leaves cranium via stylomastoid foramen- yields posterior auricular nerve

Sensory:- taste sensation from the   anterior 2/3 of tongue;- hard and soft palates.

FACIAL ANATOMY

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FACIAL NERVE  Extracranial Branches:- temporal        - marginal mandibular- zygomatic      - cervical- buccal

FACIAL ANATOMY

Note in illustration:  - motor component  - sensory component  - autonomic branches

http://accessmedicine.mhmedical.com/data/Books/waxm27/waxm27_c008f013.png

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TRIGEMINAL NERVE  V1 branches innervating face:- supra-orbital- supratrochlear- infratrochlear (upper eyelid, side of nose, etc.)- lacrimal (lateral half of upper eyelid   & skin of lateral angle)- external nasal (anterior nose)

FACIAL ANATOMYV2 branches innervating face:- zygomaticotemporal branch (supplies  region near temple above zygomatic arch)- zygomaticofacial branch  (skin over zygomatic bone)- infraorbital nerve (branches from infraorbital   foramen to innervate lower eyelid, cheek,   side of nose & upper lip)

V3 branches innervating face:- auriculotemporal nerve (external acoustic   meatus, tympanic membrane & temple)- buccal nerve  (cheek)- mental nerve (branches from mental foramen   to innervate skin of lower lip & chin)

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 TRIGEMINAL NERVE FACIAL ANATOMY

Trigeminal Ganglion (Semilunar)- contains pseudo-unipolar soma of sensory    neurons innervating the face (cavum trigeminale)  - trigeminal cave filled with CSF- Fibers in each of 3 branches:    - ophthalmic: 26,000    - maxillary: 50,000    - mandibular: 78,000- Proprioceptive fibers from extrinsic eye      muscles, muscles of mastication & probably   facial muscles terminate in cranial nuclei

Muscles innervated by motor root (in V3): - muscles of mastication - tensor tympani - tensor veli palatini - mylohyoid - anterior digastric

http://www.yourarticlelibrary.com/biology/human-beings/trigeminal-nerve-the-largest-of-all-cranial-nerves-1166-words/9555/16

 BLOOD SUPPLY TO FACE FACIAL ANATOMY

Arteries supplying face arise chieflyfrom external carotid artery- facial artery terminates as angular  artery at medial margin of eye- branches of facial a. include  superior & inferior labial arteries- transverse facial artery is technically a  branch of superficial temporal artery- mental a. is one of five branches of  maxillary artery

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BLOOD SUPPLY TO FACE   FACIAL ANATOMY

Maxillary artery- larger of two terminal   branches of external   carotid artery

Maxillary a. gives rise to:- infra-orbital artery: lower  eyelid, upper lip, etc.- buccal artery: cheek region- mental artery: via mental   foramen; supplies chin

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 VENOUS DRAINAGE FACIAL ANATOMYVenous drainage of face is chiefly via facial vein- supratrochlear & supra-orbital veins   converge to form angular vein which   empties into facial vein

Note branches ofretromandibular vein

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 VENOUS DRAINAGE FACIAL ANATOMY

Facial vein:- receives small vessels draining  eyelids, nose, cheek, etc.

- collects blood from   deeper regions that   communicate with   intracranial cavernous   sinus through emissary   veins - facial infections may be    transmitted intracranially    by such pathways

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 LYMPHATIC DRAINAGE FACIAL ANATOMY

The lymphatic system is important forimmunological defense and for regulation ofbody fluid compartments.- lymph consists of fluid, cellular  debris, protein, etc.- and is returned to the venous  circulatory system

Superficial lymphatics draintoward ring system in neck.Deep lymphatics drain into leftand right jugular lymphatic trunks.

Enlarged lymph nodes may be indicative ofpathology (e.g. infection, cancer, etc.).

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 PAROTID GLAND FACIAL ANATOMY

Location and morphology:- largest of 3 major salivary glands- anterior & inferior to lower ear- extends from zygomatic arch to lower margin of   mandible- extends over anterior sternocleidomastoid   muscle to partially cover the masseter muscle- sensory innervation via auriculotemporal   nerve (branch of mandibular n.)- multiple structures extend through the parotid gland

Parotid duct:- enters buccinator m. from   anterior margin of gland- enters interior of mouth near   second upper molarBuccal

fat pad

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PAROTID GLAND   FACIAL ANATOMY

Surgery of the parotid requiresspecial precautions to avoiddamaging the facial nerve.

The facial nerve passesthrough the parotid gland:- after passing through  skull via the  stylomastoid foramen- the nerve branches at   least once at the level   of the parotid gland

superficial temporal artery & vein

facial nerve

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 PAROTID GLAND FACIAL ANATOMY

External carotid- deep to lower margin of gland- runs superiorly yielding:   - posterior auricular artery   - maxillary artery   - superficial temporal artery

superficial temporal artery & vein

facial nerve

Retromandibular vein- union of superficial temporal &   maxillary veins- runs inferiorly through parotid- dividing into anterior & posterior   branches below gland

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PAROTID GLAND   FACIAL ANATOMY

Benign tumors often necessitate removal only of superficial lobe.Malignant tumors usually require that entire gland be excised.

Rarely, secretory cells of the parotidsgive rise to tumors.- acinar cells are most commonly   affected- most tumors are benign: pleomorphic   adenoma, adenolymphoma- care must be taken to spare facial   nerve during surgical procedures

Parotid surgery often causes damage to facial branches- impairing movement of facial muscles- various techniques have been proposed to spare   the facial nerve during parotid surgery- devices that monitor integrity of facial nerve (stimulators)   are often used during surgical procedures in this region

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TRANSPLANT   FACIAL ANATOMY

https://www.youtube.com/embed/B7OcH1YkWRI?enablejsapi=1

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