Auricle

Forehead

Skin of the face•Very vascular,rich in sweat& sebaceous glands .•Receives the insertion of facial muscles .

Facial muscles Contains :-

vessels & nerves & fat .

Deep fascia ABSENT except ………

Auricle

Parotid gland

MasseterFacial

vessels

Buccinator

Facial A.

Superficial temporal

A.

Supraorbital A.

Infraorbital A.

Supratrochlear A.

Buccal A.

Mental A.

Facial artery

Masseter

Facial vein

Sup.labial A.

Inf.labial A.

Facial A.

Lat.nasal a.

Superficial temporal A.

Transverse facial A.

Parotid duct

Superficial temporal A.

Facial A.Pulsation

sites

Facial A.

Facial V.

Inf.Labial Vs.

Sup.Labial Vs.

Lat.Nasal Vs.

superficial temporal Vs.

Transverse facial Vs.

Tragus

Masseter

Supratrochlear V.

Supra-orbital V.

facial vein

Retro-Mandibular V.

Ext.jugular V.

Post.auricularV.

C.Facial V.

SuperficialTemporal V.

Maxillary V.

Int.jugular V.

Facial Vs.

SuperficialTemporal V.

Maxillary V.

Retro-Mandibular V.

Post.auricularV.

Facial vein

Posteriordevision

Anterior devision

++

Common facialvein

=

ExternalJugular vein

=

I.J.V.

Supratrochlear V.

Supraorbital V.

facial V.

To sup.ophthalmic V.

Cavernous sinus

Deep Facial V.Pterygoid venousplexus

Em

issary Vs.

Cavernous Sinus

PterygoidVenous Plexus

Facial V.

Sup.Ophth.V.

facial vein

Pterygoid venousplexus

Cavernous sinus

Emissary veins

Deep facial V. Sup.oph.V.

Parotid L.N.

Lymph drainage of the Lymph drainage of the faceface

•Lat.part of the face……..parotid lymph nodes .

•Medial part of the face…submandibular lymph nodes .

•Central part of lower lip & chin…………submental lymph nodes .

Nerve supply of the face

Sensory Motor

Ophthalmic n

Maxillary n.

Mandibular n.

Great auricular

n.

Auriculotemporal n.

Mental n. Zygomaticofacial n.

Supra-orbital n.

Supra trochlear n.

Lacrimal n.

Buccal n.

Infra trochlear n.

External nasal

Infra orbital n.

Zygomaticotemporal nerve

Supra-orbital nerve

Infra-orbital nerve

Mental nerve

Ophthalmic nerve

•Supraorbital & supratrochlear nerves…...forehead & upper eyelid.

•Lacrimal nerve…lateral part of upper eyelid

•Infratrochlear nerve…lower eyelid .

•External nasal…nose till the tip .

Maxillary nerveMaxillary nerve

• Infraorbital….palpebral & nasal &labial .

•Zygomaticofacial….skin over zygomatic bone .

•Zygomaticotemporal….skin of temple.

Mandibular nerveMandibular nerve

• Mental……lower lip&chin

• Buccal….skin over buccinator .

• Auriculotemporal…skin over auricle&temple .

Important short account

Important artery facial artery

Begin: It is a branch from the front of the E.C.A. above the tip of the hyoid bone.

Course : It ascends in the anterior triangle of the neck till it reaches the submandibular salivary

gland . The artery grooves the post. end of the gland → descends between the gland and mandible

→ curves around the lower border of the mandible → pierces the cervical investing fascia at the

antero-inferior angle of masseter m. → enters the face where it ascends in a tortuous course (lat. To buccinator) towards the med. angle of eye (end = angular a.) .

Branches:

(1) In the neck :

a) Tonsillar a. → tonsil.

b) Ascending palatine a. → soft palate.

c) Submental a.

d) Glandular branches. : To the submandubular salivary gland.

(2) In the face :

a) Inferior labial a.

b) Superior labial a.

c) Nasal br.

Important artery facial vein

Beginning: At the med. angle of the eye by the union of supratrochlear and

supraorbital veins.

- Course: It descends posterior to the facial a. (untortuous) to pierce the cervical

investing fascia at the antero-inferior angle of masseter.

- End: It unites with the ant. division of retromandibular v. → common facial v.

→ ends in the internal jugular vein (I.J.V) .

- Connections of ant facial v.:

a) At the beginning, it is connected to the ophthalmic veins.

b) On the buccinator, it is connected to the pterygoid plexus of veins by the deep facial vein

which passes deep to the masseter.

Both the ophthalmic veins and the pterygoid plexus of veins are connected also to the cavernous

sinus. So, pus in the dangerous area of the face shouldn't be squeezed for fear of spread of

infection with a resulting cavernous sinus thrombosis.

N.B. : The facial veins are :

* Anterior facial v. (facial vein)

* Posterior facial v. (retromandibular v.).

* Common facial v.

* Deep facial v.

Nerves : Motor and sensory :

[A] The motor supply: By the temporal, zygomatic, buccal and mandibular terminal brs. of the

facial n.

N.B. : The cervical br. of facial n. supplies the platysma of the neck.

[B] The sensory supply : By the trigeminal n. except the area of skin covering the angle of the

mandible which is supplied by branches from the upper cervical spinal nerves.

The trigeminal n. supplies the facial skin by the branches of its 3 divisions :

a) The ophthalmic division .

b) The maxillary division . Notice that it supplies the skin of the upper lip.

c) The mandibular division . Notice that it supplies the skin of the lower lip.

Important nervefacial nerve

• Begin: the 7th crasnial nerve start as motor and sensory roots

• End: enter parotid gland then divided into 5 branches

• Branches:1. Grater petrosal nerve.2. Chorda tympanic nerve3. Nerve to stapedius4. Posterior auricular nerve5. 5 terminal: temporal, zygomatic, buccal,

mandibular and cervical branches

Clinical caseA 17-year-old girl visited her dermatologist because of severe acne of the face. On examination, it was found that a small abscess was present on the side of the nose. The patient was given antibiotics and was warned not to press the abscess.

The following facts concerning this patient emphasize why it is important to adequately treat this condition except which?

)a (The skin area between the eye, the upper lip, and the side of the nose is a hazardous area to have an infection of the skin.

)b (The danger area is drained by the facial vein.

)c (Interference with a boil by squeezing or pricking it can lead to spread of the infection and thrombosis of the facial vein.

)d (The facial vein communicates with the cavernous sinus via the superior and inferior ophthalmic veins.

)e (Cavernous sinus thrombosis can occur by the spread of infection by the venous blood.

)f (The blood in the facial vein is unable to spread upward because of valves.

Clinical caseA 7-year-old boy with right-sided otitis media was treated with

antibiotics. The organisms did not respond to the treatment, and the infection spread to the mastoid antrum and the mastoid air cells. The surgeon decided to perform a radical mastoid operation. After the operation, it was noticed that the boy's face was distorted.

The following signs and symptoms suggest that the right facial nerve had been damaged during the operation except which?

(a) The mouth was drawn upward to the right.

(b) He was unable to close his right eye.

(c) Saliva tended to accumulate in his right cheek.

(d) The saliva tended to dribble from the corner of his mouth.

(e) All the muscles of the right side of his face were paralyzed.

MCQ

MCQ.1- Pulse felt in front of auricleagainst the zygomatic arch is that of:-a.Facial A.b.Transverse facial A.c.Zygomatico facial A.d.Superficial temporal A.e.Infraorbital A.

MCQ.1- Pulse felt at the inferior margin of the body of the mandible is that of:-a.Facial A.b.Transverse facial A.c.Zygomatico facial A.d.Superficial temporal A.e.Infraorbital A.

MCQ.2. Nerve supply of skin of forehead includes:-

a.Auriculotemporal nerve.

b.Infraorbital nerve.

c.Supra-orbital nerve

d.Supratrochlear nerve.

e. © and (d)

SuperficialTemporal V.

Maxillary V.

Retro-Mandibular V.

Post.auricularV.

Facial vein

Posteriordevision

Anterior devision

++

Common facialvein

=

ExternalJugular vein

=

I.J.V.