Download MBBS Face Lecture PPT

FACE
FACE

? Extent

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? Superiorly up to the hair line,
? Inferiorly up to the chin and base of the mandible
? on each side up to the auricle.
? The forehead is common to both the face and the

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scalp.

? Skin of the Face
? The skin of the face is thick, elastic, and very vascular.
? It contains large number of sweat (regulate the body

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temperature ) and sebaceous glands (oily face).
? Superficial Fascia
? It contains muscles of facial expression, vessels and

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nerves, and variable amount of fat.

? Fat absent in the eyelids
well-developed in cheeks (buccal pad of fat)
buccal pads very prominent in infants

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(suctorial pad of fat).
? Deep Fascia
? The deep fascia is absent in the region of face (except

over the parotid gland and masseter muscle, which are

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covered by parotidomasseteric fascia)

? Absence of deep fascia in the face is essential for the

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facial expression.
MUSCLES OF FACIAL EXPRESSION

? The muscles of facial expression are embedded in

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the superficial fascia.

? Most of them arise from bones of the skull and

are inserted into the skin.

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? Characteristic Features
1.Lie in superficial fascia and inserted into the skin.
2.Develop from mesoderm of 2nd pharyngeal arch,

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supplied by facial nerve.

3.Perform all important functions of non-verbal

communication.

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? Location and Function
? The facial muscles are arranged in groups around

the orifices of mouth, eye, and nose as sphincters

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and dilators of these orifices.

? To perform fine movements of facial expressions

the facial muscles have small motor units.

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Muscles Around the Orifice of the Eye

1. Orbicularis oculi

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-- orbital part
-- palpebral part
--lacrimal part
2. Corrugator supercilii.
3. Frontalis.

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4. Levator palpebrae

superioris.

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Muscles Around the Nasal Cavity

1. Procerus
2. Nasalis
3. Depressor septi

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Muscles Around the Mouth

? Orbicularis oris

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? Levator labii superioris

alaeque nasi.

? Levator labii superioris.

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? Levator anguli oris.
? Zygomaticus minor.
? Zygomaticus major.
? Depressor labii

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inferioris.

? Depressor anguli oris.
? Risorius.
? Buccinator.

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? Mentalis


Facial muscles and emotional expressions

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NERVE SUPPLY

? Motor Nerve Supply
? Derived from the facial nerve.

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? It leave the cranial cavity through

stylomastoid foramen

? It divides into 5 terminal branches

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Temporal
Zygomatic
Buccal
marginal mandibular
cervical

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? These terminal branches form the

goose-foot pattern (pes anserinus)

on the face.

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? Sensory Nerve Supply

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? By trigeminal nerve
? It supplies the whole of the

face.

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? Except skin over the angle

of mandible [supplied by

great auricular nerve

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derived from ventral rami

of the 2nd and 3rd cervical

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nerves C2, C3 ].

? V1= Ophthalmic division
? V2= Maxillary division
? V3= Mandibular division

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? Trigeminal neuralgia (tic douloureux)

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? It is a clinical condition characterized by

sudden paroxysmal attacks of lancinating pain

lasting from few hours to several days.

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? Confined to distribution of one or more

divisions of trigeminal nerve.

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? It commonly starts in the maxillary territory

and more frequently on the right side
? Herpes zoster ophthalmicus
? It is a viral infection involving the ophthalmic nerve

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? It presents as severe pain and edema in the

ophthalmic territory.

? Characterized by the appearance of vesicles along

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the course of cutaneous branches of the

ophthalmic nerve

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Bell's palsy

? Lower motor neuron type

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paralysis

? Due to compression of facial

nerve near stylomastoid foramen.

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? Etiology unknown (viral infection)
? Characteristic Features on the

Side of Paralysis

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1. Facial asymmetry-- unopposed

action of muscles of normal side.

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2. Loss of horizontal wrinkles on

forehead -- occipitofrontalis

muscle

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3. Widening of palpebral fissure and inability to close the eye--

orbicularis oculi.

4. Tears flow down from the eye (epiphora) -- lower part of the

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orbicularis oculi.

5. Sagging of the angle of the mouth towards the affected side

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--zygomaticus major.

6. Loss of nasolabial furrow-- levator labii superioris alaeque

nasi.

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7. Accumulation of food into the vestibule of the mouth--

buccinator muscle.

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8. Dribbling of saliva from the angle of the mouth--

orbicularis oris.

9. Loss of resistance when one presses cheek with inflated

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vestibule and air leaks out from between the lips--

buccinator muscle.
ARTERIAL SUPPLY

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? The face is the highly vascular region.
? Supplied by the following arteries
1. Facial artery.
2. Transverse facial artery.

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3. Arteries that accompany the cutaneous nerves.
? Chief artery of the face is facial artery.
? Facial Artery
? It arises from external carotid artery in the neck
? In the face, the it passes tortuously.

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? The tortuosity of art. prevents its walls from being

unduly stretched during the movements of

mandible, lips, and cheeks.

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? The terminal part of art. is called angular artery.
? It ends by anastomosing with the dorsal nasal

branch of ophthalmic artery

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? Branches of the Facial Artery in the Face

? In the face it gives three sets of named branches
1. Inferior labial artery supply the lower lip.
2. Superior labial artery supply the upper lip.

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3. Lateral nasal artery supply the ala and dorsum

of the nose. All these branches arise anteriorly.

4. Muscular branchesare small, unnamed and

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arise from the posterior aspect of the artery


1 = zygomaticotemporal

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2= zygomaticofacial

3= infraorbital

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4= palpebral branch of

lacrimal artery
? Transverse Facial Artery br. of superficial

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temporal artery ter. br. of external carotid

artery

? Branches of the maxillary artery (ter. br. of ext.

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carotid artery)

? Infra orbital artery
? Buccal artery

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? Mental artery

? Branches of the ophthalmic artery (br.of int.

Carotid art.)

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? zygomaticofacial art.
? zygomaticotemporal art.
? dorsal nasal artery
? Supraorbital art.

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? supratrochlear art.


* Branches of the ophthalmic artery
VENOUS DRAINAGE

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? Venous blood from the face is drained by two veins

1. Facial vein.

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2. Retromandibular vein
? Facial Vein
? It is the largest vein of the face.
? It is formed by the union of supratrochlear and

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supraorbital veins.

? It joins the ant. div. of retromandibular vein and form

the common facial vein, which drains into the internal

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jugular vein.

? Tributaries of facial vein correspond to the branches of

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facial artery.

? Deep Connections
? The facial vein communicates with the cavernous

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sinus through the following two routes

1.Facial vein communicates superior ophthalmic

vein drains into cavernous sinus

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2. Facial vein is joined to the pterygoid venous

plexus by the deep facial vein.

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? Deep facial vein communicates with pterygoid

venous plexus which in turn communicates with

the cavernous sinus through an emissary vein

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? Retromandibular Vein
? Formed by the union of the superficial temporal

and the maxillary vein.

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? it divides into two divisions: anterior and

posterior.

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? The anterior division joins the facial vein to form

the common facial vein.

? posterior division joins the posterior auricular

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vein to form the external jugular vein.


Dangerous area of the face

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? The facial vein and its

communications are devoid of

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valves

? the spread of septic emboli from

infected area of the

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lower part of the nose,
upper lip, and
adjoining part of the cheek
in retrograde direction through

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deep facial vein pterygoid

venous plexus emissary vein

cavernous sinus leading to

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meningitis and cavernous sinus

thrombosis

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LYMPHATIC DRAINAGE

? Preauricular (superficial

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parotid) L.N Forehead, later

halves of the eyelids including

conjunctiva, parotid area, and

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adjoining part of the cheek.

? Submandibular L.N Central

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part of the forehead, medial

halves of the eyelids, external

nose, upper lip, lateral part of

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lower lip, medial part of cheek,

and greater part of the lower

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jaw.

? Submental L.N Central part

of the lower lip and chin

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LACRIMAL APPARATUS

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Components of lacrimal apparatus

1. Lacrimal gland.
2. Ducts of lacrimal gland.
3. Conjunctival sac.

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4. Lacrimal puncta.
5. Lacrimal canaliculi.
6. Lacrimal sac.
7. Nasolacrimal duct.
1.Lacrimal gland:

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? J-shaped serous gland.
? It consists of
Orbital part upper large
Palpebral part lower small.
? The two parts are continuous with each other

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around the lateral margin of the levator palpebrae

superioris.
2.Ducts of the lacrimal gland:

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? Approximately 12 in number,
? From orbital part 4 or 5 ducts
? From palpebrae part 6?8 ducts.
? They open into the lateral parts of the superior

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fornix of the conjunctival sac.

? Lacrimal gland secretes the lacrimal (tear) fluid
? About 1 ml of lacrimal fluid is secreted per day.
? Half of it evaporates and remaining half is drained

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into lacrimal sac.
Functions of lacrimal fluid
i. Flushes the conjunctiva and keeps the cornea moist
ii. Provides nourishment to cornea.

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iii. Serves to express emotions
iv. Prevents infection (bactericidal lysozyme).
? Accessory lacrimal glands (glands of Krause):
? Very small serous glands located beneath the

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palpebral conjunctiva near the fornices.

? They are about 35?40 in the upper eyelid and 6?8 in

the lower eyelid.

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3.Conjunctival sac: It is a potential space between

palpebral and bulbar conjunctiva.

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4.Lacrimal puncta: These are small openings on the

lid margins.

5.Lacrimal canaliculi: There are two lacrimal canaliculi

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, superior and inferior in upper and lower eyelids,

respectively.

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6.Lacrimal sac: It is the upper dilated end of the

nasolacrimal duct.

? 7.Nasolacrimal duct: It is a membranous canal. Its

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lower opening presents lacrimal fold or valve of

Hasner
Epiphora

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? It is an overflow of tears from conjunctival sac over

the cheeks.

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? It may occur due to:
(a) excessive secretion of tears (hyperlacrimation)

following intake of spicy food or emotional outbreak,

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or

(b) obstruction in lacrimal passages, viz. lacrimal

punctum, lacrimal canaliculi, lacrimal sac and

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nasolacrimal duct,

(c) eversion of lower eyelid (ectropion), hence that of

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lacrimal papilla and lacrimal punctum due to laxity of

orbiculi oculi in old age or loss of its tone due to

paralysis

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