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The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

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Page 1: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6
Page 2: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6
Page 3: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

The bones of theThe bones of the facial skeleton facial skeleton include:include:

1.1. Frontal boneFrontal bone

2.2. Nasal bonesNasal bones

3.3. Lacrimal bonesLacrimal bones

4.4. Zygomatic bonesZygomatic bones

5.5. MaxillaeMaxillae

6.6. MandibleMandible

13

2

4

5

6

Page 4: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Facial SkinFacial Skin Posses numerous sweat Posses numerous sweat

& sebaceous glands& sebaceous glands Connected to underlying Connected to underlying

bones by loose bones by loose connective tissue, which connective tissue, which encloses the underlying encloses the underlying muscles muscles

Loss of elastic fibers Loss of elastic fibers in skin cause in skin cause permanent wrinkles permanent wrinkles (e.g., “Crow’s feet” (e.g., “Crow’s feet” and “worry lines”).and “worry lines”).

Page 5: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Fascia of the FaceFascia of the Face Superficial fascia Superficial fascia is is

copious and loosecopious and loose Dee fasciaDee fascia:: there is there is nono

discrete layer of deep discrete layer of deep fascia of the face fascia of the face except in the regions of except in the regions of the the parotid glands parotid glands and and the the masseter musclesmasseter muscles. . It forms capsules It forms capsules around these around these structures.structures.

Page 6: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Muscles of the FaceMuscles of the Face

Are embedded in loose connective tissueAre embedded in loose connective tissue Mostly Mostly arisearise from the skull bones and get from the skull bones and get

inserted inserted into the skin into the skin All developed from the All developed from the 22ndnd pharyngeal arch pharyngeal arch All supplied by All supplied by facial nervefacial nerve Act as sphincters Act as sphincters around the orifices of around the orifices of

face (orbit, nose, mouth)face (orbit, nose, mouth) Modify the expressions Modify the expressions of face (muscles of of face (muscles of

facial expression) facial expression)

Page 7: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Muscles of facial expressionMuscles of facial expression are are grouped as muscles associated with grouped as muscles associated with the:the:

1.1. ForeheadForehead

2.2. OrbitOrbit

3.3. NoseNose

4.4. LipsLips

5.5. CheekCheek

2

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1

3

Page 8: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Muscles of the ForeheadMuscles of the ForeheadFrontal belly of Occipitofrontalis

Origin:Origin: skin & skin & superficial fascia of superficial fascia of the eyebrowthe eyebrow

Insertion:Insertion: epicranial epicranial aponeurosisaponeurosis

Nerve supply: Nerve supply: temporal branches of temporal branches of facial nervefacial nerve

ActionAction: raise the : raise the eyebrows in eyebrows in expressions of expressions of surprise or horrorsurprise or horror

E. aponeurosis

Page 9: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Lies deep to the Lies deep to the orbicularis oculiorbicularis oculi Origin:Origin: superciliary superciliary

archesarches Insertion:Insertion: skin of the skin of the

eyebroweyebrow SuppliedSupplied by by

temporal branches of temporal branches of facial nervefacial nerve

Action:Action: Vertical Vertical wrinkles of forehead, wrinkles of forehead, as in frowningas in frowning

Corrugator supercilliCorrugator supercilli::

Page 10: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Muscles of the eyelidsMuscles of the eyelids

SphincterSphincter: Orbicularis oculiOrbicularis oculi

DilatorDilator: : Levator palpebrae Levator palpebrae

superioris superioris (muscle of the orbit) &

Frontal belly of Frontal belly of occipitofrontalisoccipitofrontalis

Page 11: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Orbicularis oculiOrbicularis oculi 3 parts:3 parts:

• PalpebralPalpebral• OrbitalOrbital• LacrimalLacrimal

SuppliedSupplied by temporal & zygomatic by temporal & zygomatic branches of facial nervebranches of facial nerve

Action:Action:• palpebral partpalpebral part: acts : acts

involuntarily, closure of eyelids involuntarily, closure of eyelids gently as in blinkinggently as in blinking

• orbital partorbital part: subject to the will: subject to the will• Both orbital & palpebral parts Both orbital & palpebral parts

acting togetheracting together: the eyelids : the eyelids are firmly closedare firmly closed

• Lacrimal part:Lacrimal part: compreses the compreses the lacrimal saclacrimal sac

Orbital partpalpebral part

Page 12: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Muscles of the noseMuscles of the nose

ProcerusProcerus Compressor Compressor

nares & Dilator nares & Dilator naresnares

Supplied by Supplied by buccal branch of buccal branch of facial nervefacial nerve

Page 13: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Muscles of the LipsMuscles of the Lips Sphincter muscle:Sphincter muscle: Orbicularis orisOrbicularis oris

Origin & Insertion:Origin & Insertion: • Near the midline from maxilla Near the midline from maxilla

above & mandible belowabove & mandible below• From the deep surface of the From the deep surface of the

skinskin• Many fibers derived from the Many fibers derived from the

buccinator musclebuccinator muscle• Encircles oral apertureEncircles oral aperture

SuppliedSupplied by the buccal by the buccal branch of facial nervebranch of facial nerve

ActionAction: closes lips together, : closes lips together, “pursing” as in whistling and “pursing” as in whistling and suckingsucking

Page 14: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Dilator muscles:Dilator muscles: 1.1. Levator labii superioris Levator labii superioris

alaeque nasialaeque nasi2.2. Levator labii superiorisLevator labii superioris3.3. Zygomaticus major & Zygomaticus major &

minorminor4.4. Levator anguli orisLevator anguli oris5.5. RisoriusRisorius6.6. Depressor anguli orisDepressor anguli oris7.7. Depressor labii Depressor labii

inferiorisinferioris8.8. MentalisMentalis

1

4

2

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7

8

Page 15: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Muscle of the cheekMuscle of the cheek BuccinatorBuccinator Origin:Origin:

Outer surface of the alveolar Outer surface of the alveolar margins of the maxilla & margins of the maxilla & mandible opposite the molar mandible opposite the molar teethteeth

from the pterygo-mandibular from the pterygo-mandibular rapheraphe

Insertion:Insertion: upper & lower fibers upper & lower fibers continue in upper and lower lips, continue in upper and lower lips, central fibers decussate at the central fibers decussate at the angle of mouth and blend with angle of mouth and blend with fibers of orbicularis orisfibers of orbicularis oris

Page 16: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

SuppliedSupplied by buccal by buccal branch of facial nervebranch of facial nerve

PiercedPierced by parotid duct by parotid duct & deep facial vein & deep facial vein

ActionAction: : Compresses lips & Compresses lips &

cheek against teeth cheek against teeth (accessory muscle of (accessory muscle of mastication).mastication).

Also used in Also used in whistling, blowing whistling, blowing and sucking and sucking

Parotid duct

Buccinator

Page 17: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Sensory Nerve SupplySensory Nerve Supply The skin is supplied by The skin is supplied by

the branches of the the branches of the three three divisions of trigeminal divisions of trigeminal nervenerve (except for the area (except for the area over the angle of over the angle of mandible and parotid mandible and parotid gland, which is supplied gland, which is supplied by the by the great auricular great auricular nerve (C2, C3)nerve (C2, C3)))..

These nerves also supply These nerves also supply proprioceptive fibers proprioceptive fibers to to the underlying musclesthe underlying muscles

Page 18: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Motor Nerve SupplyMotor Nerve Supply Branches of the Branches of the

facial nerve:facial nerve: TemporalTemporal ZygomaticZygomatic BuccalBuccal Mandibular Mandibular

(marginal)(marginal) CervicalCervical

Posterior auricular

Page 19: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Facial NerveFacial Nerve Emerges from Emerges from stylomastoid stylomastoid

foramenforamen Gives:Gives:

Posterior auricular nerve Posterior auricular nerve toto occipital belly of occipito-occipital belly of occipito-frontalis musclefrontalis muscle

A branch to supplyA branch to supply posterior posterior belly of digastric & stylohyoid belly of digastric & stylohyoid musclemuscle

Then runs forward and enters Then runs forward and enters into the into the parotid glandparotid gland

Breaks up in the gland, forms a Breaks up in the gland, forms a plexusplexus, and then emerges as , and then emerges as 5 5 sets of branchessets of branches: : temporaltemporal, , zygomaticzygomatic, , buccalbuccal, , mandibularmandibular & & cervicalcervical

Page 20: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Arterial SupplyArterial Supply

Rich arterial supply Rich arterial supply Through Through 22 main main

arteries: arteries: Facial artery Facial artery (branch (branch

of of external carotid external carotid artery)artery)

Transverse facial Transverse facial arteryartery (branch of (branch of superficial temporal superficial temporal artery)artery)

Page 21: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Supplemented by many Supplemented by many smaller arteries which smaller arteries which accompany the sensory accompany the sensory nerves.nerves.

These are branches of the These are branches of the internalinternal and the and the externalexternal carotid arteries i.e.carotid arteries i.e. SupratrochlearSupratrochlear SupraorbitalSupraorbital LacrimalLacrimal External nasalExternal nasal ZygomaticotemporalZygomaticotemporal ZygomaticofacialZygomaticofacial Infra-orbitalInfra-orbital MentalMental

Page 22: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Facial ArteryFacial Artery Arises from anterior Arises from anterior

aspect of aspect of external carotid external carotid arteryartery in the neck in the neck

Arches upwards & over Arches upwards & over the the submandibular submandibular salivary glandsalivary gland

Curves around the Curves around the inferior margin of the inferior margin of the body of the mandible at body of the mandible at the the anterior border of the anterior border of the massetermasseter muscle muscle

Page 23: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Runs a tortuous course Runs a tortuous course towards the towards the angle of angle of the mouththe mouth, and then , and then along the along the side of nose side of nose to the to the medial angle of medial angle of the eyethe eye

Lies deeper to the Lies deeper to the muscles, anterior to the muscles, anterior to the facial veinfacial vein

Anastomosis with Anastomosis with terminal branches of terminal branches of ophthalmic artery ophthalmic artery (a (a branch of the internal branch of the internal carotid artery)carotid artery) Facial arteryFacial vein

Page 24: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Lateral nasalLateral nasal

Superior labialSuperior labial

Inferior labialInferior labial

SubmentalSubmental

Branches of facial artery

Page 25: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Transverse Facial ArteryTransverse Facial Artery A branch of the A branch of the superficial superficial

temporal arterytemporal artery (which is (which is one of the terminal one of the terminal branches of external carotid branches of external carotid artery)artery)

Runs forward across the Runs forward across the cheek over the cheek over the massetermasseter muscle accompanying the muscle accompanying the parotid ductparotid duct

Lies above the parotid duct Lies above the parotid duct along with along with upper zygomatic upper zygomatic branchesbranches of facial nerve of facial nerve

Parotid ductTransverse facial artery

Page 26: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Venous DrainageVenous Drainage

Smaller veins accompanying small arteries & sensory nerves

Facial vein

Transverse facial vein

Page 27: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Facial VeinFacial Vein Formed at the medial angle Formed at the medial angle

of the eye by the union of of the eye by the union of supraorbitalsupraorbital and and supratrochlearsupratrochlear veins veins

Descends behind the facial Descends behind the facial artery to the lower border of artery to the lower border of mandiblemandible

Runs superficial to the Runs superficial to the submandibular glandsubmandibular gland

Joins the anterior division of Joins the anterior division of retromandibular vein, and retromandibular vein, and opens into the opens into the internal internal jugular veinjugular vein

Page 28: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Tributaries:Tributaries: Lateral nasal, superior Lateral nasal, superior

labial, inferior labial labial, inferior labial and mental veinsand mental veins

Communications:Communications: With the With the pterygoid pterygoid

venous plexusvenous plexus through through the the deep facial veindeep facial vein, , which pierces the which pierces the buccinator musclebuccinator muscle

With the With the cavernous cavernous sinussinus through through superior superior opthalmic veinopthalmic vein

Page 29: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Transverse facial VeinTransverse facial Vein

Accompanies the Accompanies the corresponding arterycorresponding artery

Drains into the Drains into the superficial temporal superficial temporal veinvein (which Joins the (which Joins the maxillary vein maxillary vein to form to form the the retomandibular retomandibular veinvein), ),

Page 30: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Lymphatic DrainageLymphatic DrainageVessels carrying lymph from the face pass through superficial nodes arranged like a “collar” around the base of the head and finally drain into the deep cervical lymph nodes that lie along the internal jugular vein.

OccipitalRetro-

auricular (Mastoid)

Parotid

Submandibular

Submental

Deep cervical lymph nodes

Page 31: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Clinical AnatomyClinical Anatomy Facial lacerations Facial lacerations tend to gape. Skin needs to be tend to gape. Skin needs to be

sutured with great care to prevent scarringsutured with great care to prevent scarring Bruises & inflammations Bruises & inflammations of the face cause of the face cause

considerable swelling because of the looseness of considerable swelling because of the looseness of superficial fascia. superficial fascia.

With age, the skin looses its resiliency and wrinkles With age, the skin looses its resiliency and wrinkles appear. Wrinkle lines lie at right angle of pull of appear. Wrinkle lines lie at right angle of pull of underlying muscles. Surgical incisions along these underlying muscles. Surgical incisions along these wrinkle lines wrinkle lines heal with minimum scarringheal with minimum scarring

Trigeminal neuralgiaTrigeminal neuralgia, a common condition usually , a common condition usually involving maxillary & mandibular nerves and sparing involving maxillary & mandibular nerves and sparing the ophthalmic divisionthe ophthalmic division

Page 32: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

In In upper motor neuronupper motor neuron lesion, lesion, only lower face is affected, only lower face is affected, upper face is normal as it upper face is normal as it receives bilateral supply.receives bilateral supply.

In lower motor neuron lesion the whole face is affected

Damage to facial nerve results in Facial (Bell’s) palsy (paralysis of facial muscles) on the side of the lesion

Page 33: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Face is distortedFace is distorted, , and and shows:shows: drooping of lower eyeliddrooping of lower eyelid sagging of the angle of the sagging of the angle of the

mouthmouth dribbling of salivadribbling of saliva loss of facial expressionsloss of facial expressions loss of chewing, blowing, loss of chewing, blowing,

suckingsucking Person is unable to show Person is unable to show

teeth or close the eye on teeth or close the eye on affected sideaffected side

Test individual branch Test individual branch of facial nerveof facial nerve

Page 34: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Dangerous zoneDangerous zone: : Infection in the marked Infection in the marked triangular area of the triangular area of the face are dangerous as it face are dangerous as it may spread to the may spread to the cavernous sinus and cavernous sinus and result in thrombosis of result in thrombosis of the sinus the sinus

Because of its superficial Because of its superficial position, position, damage to damage to parotid ductparotid duct can occur in can occur in facial lacerations or in facial lacerations or in surgical procedure on the surgical procedure on the face face

Page 35: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

Facial arteryFacial artery: : Lower Lower margin of mandible margin of mandible along the anterior along the anterior border of masseterborder of masseter

Superficial temporal Superficial temporal arteryartery: : As it crosses As it crosses the zygomatic arch the zygomatic arch in front of the auriclein front of the auricle

Where can one feel the pulsation of Where can one feel the pulsation of the arteries of the face?the arteries of the face?

Page 36: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

why do we look different from one another?why do we look different from one another? Familial traitsFamilial traits Size & shape of bonesSize & shape of bones Amount & distribution of subcutaneous fatty Amount & distribution of subcutaneous fatty

tissuetissue

Our faces are a major part of our identity. Our brains are specialized for recognizing faces; we identify each other by our faces. A person's face provides a wealth of information; within seconds of seeing a person's face we immediately know much about him or her (including gender, age, race, emotional state, overall health etc. etc.).

Page 37: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6
Page 38: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

It takes 43 muscles to frown and only 17 muscles to smile, but it doesn't

take any to just sit there with a dumb look on your face

Page 39: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

SO….. ….And keep on smiling….

Page 40: The bones of the facial skeleton include: 1.Frontal bone 2.Nasal bones 3.Lacrimal bones 4.Zygomatic bones 5.Maxillae 6.Mandible 1 3 2 4 5 6

What What matters matters most is most is how you how you see see yourselfyourself….…….…