~ ~ ~ THE FACE ~ ~ ~ Ann Nguyen -- NYUCD 2008

Dr. Singh & Dr. Von Hagens D1 Anatomy Notes -- Spring '05

LAYERS OF THE FACE

Skin of the face
- thin to medium thickness
- pliable and moveable over a layer of loose areloar CT
- skin of external ear & ala of nose is fixed directly to underlying cartilage w/o any CT in b/t

Superficial Fascia of the face

- includes variable amts of fat to smooth out contours (buccal sucking fat pad has the most amt of fat)
- includes superficial muscles of expression
- includes BV-N’s

Deep Fascia of the face

- none in the face

SENSORY CUTANEOUS NERVES OF THE FACE

V1 Ophthalmic Cutaneous Nerves

• Supraorbital upper eyelid, forehead, scalp
• Supratrochlear medial upper eyelid, medial forehead
• Infratrochlear medial angle of upper eyelid (follows the Dorsal Nasal Artery)
• Palpebral (Lacrimal) lateral upper eyelid
• External Nasal cartilaginous nose below the nasal bones

V2 Maxillary Cutaneous Nerves

• Infraorbital
- inferior palpebral lower eyelid
- lateral nasal lateral nose
- superior labial upper lip
• Zygomaticofacial zygomatic prominence
• Zygomaticotemporal anterior temporal region

V3 Mandibular Cutaneous Nerves

• Auriculotemporal external ear, middle temporal region (follows the Superficial Temporal Artery & Vein)
• Long Buccal cheek skin, buccal mucosa, Md posterior buccal gingiva
• Mental
- mental chin
- inferior labial lower lip
- gingival Md anterior labial gingiva

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ARTERIES OF THE FACE Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05
Ophthalmic Artery Branches
• Supraorbital upper eyelid, forehead, scalp
• Supratrochlear upper eyelid, forehead, scalp
• Dorsal Nasal medial upper eyelid, nose bridge, lacrimal sac (follows the Infratrochlear Nerve)
• Lacrimal lateral upper eyelid
• External Nasal cartilaginous nose below the nasal bones
• Zygomaticofacial zygomatic prominence
• Zygomaticotemporal anterior temporal region

Maxillary Artery Branches

• Infraorbital
- inferior palpebral lower eyelid
- lateral nasal lateral nose
- superior labial upper lip
• Buccal cheek skin, buccal mucosa, md post buccal gingiva
• Mental chin skin, labial mucosa, md anterior labial gingiva

Facial Artery Branches

• Angular Artery medial eyelids, nose

• Lateral Nasal lateral nose
• Superior Labial upper lip
• Inferior Labial lower lip

Superficial Temporal Artery (follows the Auriculotemporal Nerve)

• Transverse Facial

VEINS OF THE FACE

Ophthalmic & Maxillary arteries have corresponding same-name veins

from the Superior Ophthalmic & Pterygoid Plexus

Superior Ophthalmic Vein (in the orbit) = upper eyelid, forehead, scalp

Pterygoid Plexus (in the infratemporal region) = lower eyelid, lateral nose, upper lip

Facial Vein
• Angular = formed by the union of the Supraorbital + Supratrochlear veins
- one branch goes into the orbit to communicate w/ Superior Ophthalmic Vein
- one branch remains superficial and continues inferiorly as the Facial Vein
• Deep Facial = communicates w/ Pterygoid Plexus in the Infratemporal region
• Nasal = communicates w/ Infraorbital Vein
• Superior Labial = communicates w/ Infraorbital Vein
• Inferior Labial = communicates w/ Mental Vein

Retromandibular Vein = Superficial Temporal + Maxillary veins

Anterior Retromandibular + Facial Vein = Common Facial Vein  Internal Jugular Vein

Posterior Retromandibular + Posterior Auricular = External Jugular Vein

Important Venous Communications

Because of the extensive routes of venous anastomoses, infections arising

from the face or orbit can potentially drain into the Cavernous Sinus in the skull

• Facial Vein ↔ [Angular Vein] ↔ Superior Ophthalmic Vein  Cavernous Sinus

Therefore, infections arising from the inner angle of the eye can travel
down to the neck via communicating w/ the Facial Vein or
into the orbit or Cavernous Sinus via communicating w/ the Superior Ophthalmic Vein

• Deep Facial Vein ↔ [Pterygoid Plexus] ↔ Cavernous Sinus Compiled for you by:
LIPS Ann Nguyen -- NYUCD 2008
• nasolabial groove, labiomental groove D1 Anatomy Notes -- Spring '05
• philtrum of the upper lip  columella of the nose
• orbicularis oris muscle
• vermillion border
• labial mucous glands
• mucolabial fold
• labial frenula
♦ blood supply
- upper lip = Superior Labial branches of Facial artery; Infraorbital artery
- lower lip = Inferior Labial branches of Facial artery; Mental artery
♦ sensory innervation
- upper lip = Superior Labial branch of Infraorbital nerve (V2)
- lower lip = Inferior Labial branch of Mental nerve (V3)
○ Clinical Considerations…
• labial frenectomy = excessively large frenula may cause central diastemmas / gingival recession
• angular cheilosis = may be caused by vitamin-B deficiency or candidiasis infection (perleche)
• herpes labialis = vesicular blisters at vermillion border caused by Herpes Simplex Virus (lays dormant Trigeminal Ganglion)
• mucocoele = a mucous gland w/ a blocked secretory duct  bluish color
• squamous cell carcinoma = ulcerated lesions that don’t heal in 2 weeks should be suspected & further investigated

CHEEKS
• buccinator muscle
• buccal sucking fat pad
• buccal mucous glands
• mucobuccal fold
• buccal frenula
nd
• parotid duct opens thru the buccal mucosa at Mx 2 molar region
♦ blood supply = Buccal branch of Maxillary artery
♦ sensory innervation = Long Buccal branch of V3

NOSE
• nasal bones
• midline septum (hyaline cartilage)
• lateral cartilage
• alar cartilage
• dilator nares muscle = flares the nostrils
• compressor nares muscle = flattens the nostrils
♦ blood supply
- Dorsal Nasal branch of Ophthalmic artery
- External Nasal branch of Anterior Ethmoidal artery
- Nasal branch of Infraorbital artery from the Maxillary artery
- Nasal branch of Facial artery
♦ sensory innervation
- External Nasal nerve of V1’s Nasociliary branch
- Infratrochlear nerve of V1’s Nasociliary branch
- Nasal branches of V2’s Infraorbital branch

EXTERNAL EAR
• auricle = skin is tightly bound directly to elastic cartilage
• earlobe = fibroareloar CT, but no cartilage
• superior, anterior, posterior auricular muscles
• ceruminous (wax) glands
♦ blood supply
- branches of Superficial Temporal artery (from External Carotid)
- branches of Posterior Auricular artery (from External Carotid)
♦ sensory innervation
- Auriculotemporal nerve of V3
- Great Auricular nerve from APR of C2, C3
- Lesser Occipital nerve from APR of C2, C3
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EYELIDS Ann Nguyen -- NYUCD 2008
• superior palpebral margin = covers the superior 1/5 of the iris when the lids are open D1 Anatomy Notes -- Spring '05
• inferior palpebral margin = covers the inferior part of the iris when the lids are open
• palpebral commissures = the lateral and medial jxns of the upper and lower lids
• palpebral fissure = the opening between the upper and lower lids
• eyelashes (cilia) w/ sebaceous ciliary glands (Glands of Zeis) -- “STYLE” = infected ciliary glands
• superior + inferior papillae = small raised bumps at the jxn of the ciliated and hairless margins
• punctum = the openings of the papillae that soaks up excess tears
• conjunctivum = the skin of the inner lining of the lids that reflects up on to the anterior surface of the eyeball as simple cuboidal EP
• conjunctival sac = the vestibule where tears accumulate
• lacus lacrimalis w/ caruncle = the small raised red triangular part of the medial angle
• plica semilunaris = the fold at the medial angle of the eye that separates the white sclera from the red lacus lacrimalis
• orbicularis oculi muscle (motor innervation by Facial VII)
• levator palpebrae superioris (motor innervation by Oculomotor III)
♦ blood supply = arteries that accompany the sensory nerves
♦ sensory nerve supply = from branches of Ophthalmic V1…
- Supraorbital
- Supratrochlear
- Infratrochelar
- Lacrimal

SCALP
- extends from the supraorbital margin anteriorly, to the superior nuchal line posteriorly, to the temporal fossa laterally
- layers (mnemonic: S-C-A-L-P)
• skin = has lots of hair follicles, sweat glands, sebaceous glands
• connective tissue (dense)
• aponeurosis (aka: “galea aponeurotica”)
• loose connective tissue (areolar)
• periosteum
♦ blood supply
• anterior to the ears • posterior to the ears
- supraorbital - posterior auricular
- supratrochlear - occipital
- zygomaticotemporal
- superficial temporal
♦ sensory innervation
• anterior to the ears • posterior to the ears
- supraorbital (V1) - lesser occipital (APR of C2, C3)
- supratrochlear (V1) - great occipital (PPR of C2)
- zygomaticotemporal (V2) - third occipital (PPR of C3)
- auriculotemporal (V3)

Compiled for you by:

 Ann Nguyen -- NYUCD 2008
MUSCLES OF FACIAL EXPRESSION D1 Anatomy Notes -- Spring '05
Innervation -- Facial Nerve VII

Forehead Location Action Origin Insertion VII Branch

Occipitalis occipital region pulls the scalp back superior nuchal line aponeurosis of scalp C

Frontalis frontal region raises the eyebrows aponeurosis of scalp forehead skin T

Corrugator Supercilii inner eyebrow furrows the eyebrows medial supraorbital margin eyebrow skin T

Procerus nasoglabella region wrinkles the nose bridge nasal bone and cartilage glabella skin T, Z

Eyes Location Action Origin Insertion VII Branch

Orbicularis Oculi
- Orbital part encircles the eye closes the eyes forcefully medial supraorbital margin medial palpebral ligament T, Z
- Palpebral part closes the eyes gently medial palpebral ligament lateral palpebral ligament
Nose Location Action Origin Insertion VII Branch
Nasalis
- Compressor lateral to the bridge compresses the nostrils mx canine fossa aponeurosis of midline nasal cartilage Z, B
- Dilator inferior to the ala flares the nostrils mx nasal notch nostril skin
Mouth / Lips Location Action Origin Insertion VII Branch

Orbicularis Oris encircles the mouth puckers the lips, closes the mouth other muscles that converge here skin of the lips Z, B, M

Levator Labii Superioris angle of the mouth (highest) pulls up the upper lip in a stink infraorbital margin orbicularis oris Z, B

Levator Anguli Oris angle of the mouth (deep) pulls angles upward to smile mx canine fossa orbicularis oris Z, B

Zygomaticus Minor angle of the mouth (middle) pulls angles up and laterally to laugh zygomatic bone orbicularis oris Z, B

Zygomaticus Major angle of the mouth (lower) pulls angles up and laterally to laugh zygomatic bone orbicularis oris Z, B

Risorius angle of the mouth (lowest) pulls angles laterally to grin platysma, masseter & parotid fascia orbicularis oris Z, B

pterygomandibular raphe,
Buccinator deep to the Risorius blowing; removing vestibular food orbicularis oris B
Mx & Md alveolar processes

Depressor Anguli Oris lateral chin pulls angles downward to frown md external oblique ridge orbicularis oris M

Depressor Labii Inferioris medial chin pulls down the lower lip in a pout md external oblique ridge orbicularis oris M

Chin Location Action Origin Insertion VII Branch

Mentalis medial chin wrinkles the chin md incisive fossa chin skin M

Neck Location Action Origin Insertion VII Branch

Platysma anterior & lateral neck tenses the neck pectoral & deltoid fascia inferior border of md, risorius C
 Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05

Pathology of the upper motor neuron causes

paralysis of the lower face on the contralateral side,
but upper face continues to receive ipsilateral innervation

Pathology of the lower motor neuron causes

paralysis of both upper and lower face on the ipsilateral side