Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Latest Face Lecture PPT
FACE
FACE
? Extent
? 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
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
temperature ) and sebaceous glands (oily face).
? Superficial Fascia
? It contains muscles of facial expression, vessels and
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
(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
covered by parotidomasseteric fascia)
? Absence of deep fascia in the face is essential for the
facial expression.
MUSCLES OF FACIAL EXPRESSION
? The muscles of facial expression are embedded in
the superficial fascia.
? Most of them arise from bones of the skull and
are inserted into the skin.
? Characteristic Features
1.Lie in superficial fascia and inserted into the skin.
2.Develop from mesoderm of 2nd pharyngeal arch,
supplied by facial nerve.
3.Perform all important functions of non-verbal
communication.
? Location and Function
? The facial muscles are arranged in groups around
the orifices of mouth, eye, and nose as sphincters
and dilators of these orifices.
? To perform fine movements of facial expressions
the facial muscles have small motor units.
Muscles Around the Orifice of the Eye
1. Orbicularis oculi
-- orbital part
-- palpebral part
--lacrimal part
2. Corrugator supercilii.
3. Frontalis.
4. Levator palpebrae
superioris.
Muscles Around the Nasal Cavity
1. Procerus
2. Nasalis
3. Depressor septi
Muscles Around the Mouth
? Orbicularis oris
? Levator labii superioris
alaeque nasi.
? Levator labii superioris.
? Levator anguli oris.
? Zygomaticus minor.
? Zygomaticus major.
? Depressor labii
inferioris.
? Depressor anguli oris.
? Risorius.
? Buccinator.
? Mentalis
Facial muscles and emotional expressions
NERVE SUPPLY
? Motor Nerve Supply
? Derived from the facial nerve.
? It leave the cranial cavity through
stylomastoid foramen
? It divides into 5 terminal branches
Temporal
Zygomatic
Buccal
marginal mandibular
cervical
? These terminal branches form the
goose-foot pattern (pes anserinus)
on the face.
? Sensory Nerve Supply
? By trigeminal nerve
? It supplies the whole of the
face.
? Except skin over the angle
of mandible [supplied by
great auricular nerve
derived from ventral rami
of the 2nd and 3rd cervical
nerves C2, C3 ].
? V1= Ophthalmic division
? V2= Maxillary division
? V3= Mandibular division
? Trigeminal neuralgia (tic douloureux)
? It is a clinical condition characterized by
sudden paroxysmal attacks of lancinating pain
lasting from few hours to several days.
? Confined to distribution of one or more
divisions of trigeminal nerve.
? 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
? It presents as severe pain and edema in the
ophthalmic territory.
? Characterized by the appearance of vesicles along
the course of cutaneous branches of the
ophthalmic nerve
Bell's palsy
? Lower motor neuron type
paralysis
? Due to compression of facial
nerve near stylomastoid foramen.
? Etiology unknown (viral infection)
? Characteristic Features on the
Side of Paralysis
1. Facial asymmetry-- unopposed
action of muscles of normal side.
2. Loss of horizontal wrinkles on
forehead -- occipitofrontalis
muscle
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
orbicularis oculi.
5. Sagging of the angle of the mouth towards the affected side
--zygomaticus major.
6. Loss of nasolabial furrow-- levator labii superioris alaeque
nasi.
7. Accumulation of food into the vestibule of the mouth--
buccinator muscle.
8. Dribbling of saliva from the angle of the mouth--
orbicularis oris.
9. Loss of resistance when one presses cheek with inflated
vestibule and air leaks out from between the lips--
buccinator muscle.
ARTERIAL SUPPLY
? The face is the highly vascular region.
? Supplied by the following arteries
1. Facial artery.
2. Transverse facial artery.
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.
? The tortuosity of art. prevents its walls from being
unduly stretched during the movements of
mandible, lips, and cheeks.
? The terminal part of art. is called angular artery.
? It ends by anastomosing with the dorsal nasal
branch of ophthalmic artery
? 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.
3. Lateral nasal artery supply the ala and dorsum
of the nose. All these branches arise anteriorly.
4. Muscular branchesare small, unnamed and
arise from the posterior aspect of the artery
1 = zygomaticotemporal
2= zygomaticofacial
3= infraorbital
4= palpebral branch of
lacrimal artery
? Transverse Facial Artery br. of superficial
temporal artery ter. br. of external carotid
artery
? Branches of the maxillary artery (ter. br. of ext.
carotid artery)
? Infra orbital artery
? Buccal artery
? Mental artery
? Branches of the ophthalmic artery (br.of int.
Carotid art.)
? zygomaticofacial art.
? zygomaticotemporal art.
? dorsal nasal artery
? Supraorbital art.
? supratrochlear art.
* Branches of the ophthalmic artery
VENOUS DRAINAGE
? Venous blood from the face is drained by two veins
1. Facial vein.
2. Retromandibular vein
? Facial Vein
? It is the largest vein of the face.
? It is formed by the union of supratrochlear and
supraorbital veins.
? It joins the ant. div. of retromandibular vein and form
the common facial vein, which drains into the internal
jugular vein.
? Tributaries of facial vein correspond to the branches of
facial artery.
? Deep Connections
? The facial vein communicates with the cavernous
sinus through the following two routes
1.Facial vein communicates superior ophthalmic
vein drains into cavernous sinus
2. Facial vein is joined to the pterygoid venous
plexus by the deep facial vein.
? Deep facial vein communicates with pterygoid
venous plexus which in turn communicates with
the cavernous sinus through an emissary vein
? Retromandibular Vein
? Formed by the union of the superficial temporal
and the maxillary vein.
? it divides into two divisions: anterior and
posterior.
? The anterior division joins the facial vein to form
the common facial vein.
? posterior division joins the posterior auricular
vein to form the external jugular vein.
Dangerous area of the face
? The facial vein and its
communications are devoid of
valves
? the spread of septic emboli from
infected area of the
lower part of the nose,
upper lip, and
adjoining part of the cheek
in retrograde direction through
deep facial vein pterygoid
venous plexus emissary vein
cavernous sinus leading to
meningitis and cavernous sinus
thrombosis
LYMPHATIC DRAINAGE
? Preauricular (superficial
parotid) L.N Forehead, later
halves of the eyelids including
conjunctiva, parotid area, and
adjoining part of the cheek.
? Submandibular L.N Central
part of the forehead, medial
halves of the eyelids, external
nose, upper lip, lateral part of
lower lip, medial part of cheek,
and greater part of the lower
jaw.
? Submental L.N Central part
of the lower lip and chin
LACRIMAL APPARATUS
Components of lacrimal apparatus
1. Lacrimal gland.
2. Ducts of lacrimal gland.
3. Conjunctival sac.
4. Lacrimal puncta.
5. Lacrimal canaliculi.
6. Lacrimal sac.
7. Nasolacrimal duct.
1.Lacrimal gland:
? J-shaped serous gland.
? It consists of
Orbital part upper large
Palpebral part lower small.
? The two parts are continuous with each other
around the lateral margin of the levator palpebrae
superioris.
2.Ducts of the lacrimal gland:
? 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
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
into lacrimal sac.
Functions of lacrimal fluid
i. Flushes the conjunctiva and keeps the cornea moist
ii. Provides nourishment to cornea.
iii. Serves to express emotions
iv. Prevents infection (bactericidal lysozyme).
? Accessory lacrimal glands (glands of Krause):
? Very small serous glands located beneath the
palpebral conjunctiva near the fornices.
? They are about 35?40 in the upper eyelid and 6?8 in
the lower eyelid.
3.Conjunctival sac: It is a potential space between
palpebral and bulbar conjunctiva.
4.Lacrimal puncta: These are small openings on the
lid margins.
5.Lacrimal canaliculi: There are two lacrimal canaliculi
, superior and inferior in upper and lower eyelids,
respectively.
6.Lacrimal sac: It is the upper dilated end of the
nasolacrimal duct.
? 7.Nasolacrimal duct: It is a membranous canal. Its
lower opening presents lacrimal fold or valve of
Hasner
Epiphora
? It is an overflow of tears from conjunctival sac over
the cheeks.
? It may occur due to:
(a) excessive secretion of tears (hyperlacrimation)
following intake of spicy food or emotional outbreak,
or
(b) obstruction in lacrimal passages, viz. lacrimal
punctum, lacrimal canaliculi, lacrimal sac and
nasolacrimal duct,
(c) eversion of lower eyelid (ectropion), hence that of
lacrimal papilla and lacrimal punctum due to laxity of
orbiculi oculi in old age or loss of its tone due to
paralysis
This post was last modified on 30 November 2021