MOB TCD Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinity College Dublin...

MOB TCD

Professor Emeritus Moira O’Brien

FRCPI, FFSEM, FFSEM (UK), FTCD

Trinity College

Dublin

Anatomy of the Face

Face

• Sensory supply of face is trigeminal

• 5th cranial nerve• C2 • Motor supply• Muscles of facial expression• Facial nerve 7th cranial

MOB TCD

Sensory Nerve Supply

• Trigeminal• Ophthalmic• Maxillary• Mandibular• Cervical plexus

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Terminal Branches of 5th

• Supraorbital• Infraorbital damaged in blow

out fracture of orbit• Lateral• Mental; dentures, fracture of

mandible • Trigeminal neuralgia

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Sensory Trigeminal Nerve

• Ophthalmic V• Supraorbital• Supratrochlear• Maxillary V• Infraorbital• Zygomaticofacial• Mandibular V• Mental• Buccal

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Fractured Zygoma

• View from above shows depression

• Lateral X-ray view

should be done

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Great Auricular

• C2 from cervical plexus• Skin over angle of mandible

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Scalp

• Skin • Subcutaneous• Epicranial aponeurosis• Three fused together• Loose areolar tissue• Periosteum• Occipito-frontalis• Attached posteriorly• No anterior attachment

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• Occipital portion of occipito-frontals and epicranial aponeurosis attached to bone posterior

• Frontal no bony attachment • Scalp wounds cause black eyes• Occipital belly• Posterior auricular of facial

nerve• Frontal belly by temporal of

facial nerve

Scalp MOB TCD

Blood and Nerve Supply of Scalp

• Supraorbital vessels and nerve

• Scalp as far as vertex• Posterior scalp• Greater occipital C2 • Occipital and posterior

auricular vessels• Zygomatico temporal• Greater auricular

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Eyelid

• Skin• Orbicularis oculi• Palpebral portion• Orbital septum and tarsal

plates, mebonium glands• Medial palpebral ligament

anchors tarsal plates to anterior lacrimal crest

• Conjunctival sac

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Levator Palpebrae Superiores

• Arises from back of roof of orbit• Inserted into skin of upper eyelid • The superior tarsal plate• Superior fornix of conjunctiva

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• Elevates upper eyelid• Voluntary muscle supplied by 3rd

oculomotor nerve• Smooth muscle • Sympathetic T1• Superior cervical ganglion

Levator Palpebrae Superiores MOB TCD

Lacrimal Apparatus

• Lacrimal gland• Conjunctival sac• Puncta• Cananiculi• Nasolacrimal sac• Nasolacrimal duct• Inferior meatus nose

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Horner's Syndrome

• Ptosis• Drooping eyelid• Meiosis• Constricted pupil• Anhydrosis• Lack of sweating• Enopthalmos

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Muscles of Facial Expression

• Muscles of second branchial arch

• Nerve second arch is facial nerve

• Inserted into skin of face• Buccal pad of fat• No deep fascia in face• Except around parotid• Parotid duct

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Orbicularis Oculi

• Orbital closes eyelid tightly, buries eyelashes

• Makes conjunctival sac smaller

• Finer palpebral portion in eyelid

• Anterior to tarsal plate • Closes eye in blinking and

sleep • No action on conjunctival sac

MOB TCD

• Occipito frontalis • Orbicularis oculi• Orbicularis oris • Buccinator• Platysma• Skin of face• Incisions

Muscles of Facial Expression MOB TCD

• Orbicularis oris• Intrinsic: origin and

insertion inside, only alters shape

• Extrinsic: origin outside, alters position

Muscles of Facial Expression MOB TCD

• Incisions in the face evert edges

• Platysma• Inserted into lower border of

mandible• Posterior fibres form risorius

Muscles of Facial Expression MOB TCD

Buccinator

• Buccinator 7th nerve• Accessory muscle of

mastication • Outer aspect of maxilla and

mandible• Related to molar teeth• Pterygomandibular raphe• Action keeps food out of

vestibule • Sucking • Blowing trumpet

MOB TCD

Facial Nerve

Motor nerve to:• Posterior auricular to occipital

belly• Posterior belly of digastric

Enters parotid and divides into branches

• Temporal• Zygomatic • Buccal • Mandibular• Cervical

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• Stroke• Upper motor neurone of

facial• Forehead is spared• Can wrinkle forehead• Bilaterally innervated• All muscles of one side

paralysed if it is a lower motor neurone e.g. Bell’s palsy

Facial Nerve MOB TCD

Bell’s Palsy

• Lower motor neurone of facial nerve

• Forehead and all themuscles on the side of lesion are affected

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Facial Palsy MOB TCD

MOB TCD

Corneal Reflex

• Afferent (sensory) cilary branches nasocilary of ophthalmic of 5th

• Efferent (motor)• Zygomatic branch of facial 7th

• Last reflex to go

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Blood Supply and Pulses in Face

Internal carotid• Supraorbital artery • Branch of ophthalmic

External carotid• Superficial temporal artery• Facial artery

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Venous Drainage of Face

• Supraorbital and anterior facial

• Communicate superior ophthalmic veins which drain into cavernous sinus

• Deep facial vein• Superficial temporal• Retromandibular• Common facial

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Emissary Veins Cavernous Sinus

• Superior ophthalmic veins• Anterior facial• Deep facial• Pterygoid plexus• Danger area of face• Parietal emissary veins from

scalp to superior sagittal sinus

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Lymph Glands

• Submental• Submandibular• Buccal and

mandibular• Preauricural• Occipital

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