Major Arteries of the Face

The Face

Muscles of the Face: ALL innervated by FACIAL Nerve [VII], located in the superficial fascia

Muscle Attachment Function Medial palpebral ligament and frontal bone, Close eyelids gently (palpebral part) Orbicularis oculi frontal part of maxilla, medial palpebral and close eyelids forcefully (orbital ligament to lateral palpebral raphe part) Corrugator Medial end of superciliary arch to skin of Draws eyebrows medially and supercilii medial half of eyebrow downward Maxilla to aponeurosis across dorsum of nose Compress nasal aperture Nasalis and alar cartilage of nose (transverse part) and draws cartilage downward and laterally opening the nostril (alar part) Nasal bone and upper part of lateral nasal Draws down medial angle of Procerus cartilage to skin of lower forehead between eyebrows producing transverse eyebrows wrinkles over bridge of nose Depressor septi Maxilla to mobile part of nasal septum Pulls nose inferiorly Depressor Oblique line of mandible to skin at corner of Draws corner of mouth down and anguli oris mouth, blending with orbicularis oris laterally Depressor labii Oblique line of mandible to lower lip at Draws lower lip downward and inferioris midline, blending with muscle from opposite laterally side Mentalis Mandible to skin of chin Raises and protrudes lower lip as it wrinkles skin on chin Risorius Fascia over masseter muscle to skin at corner Retracts corner of mouth of mouth Zygomaticus Posterior part of lateral surface of zygomatic Draws corner of mouth upward and major bone to skin at corner of mouth laterally Zygomaticus Anterior part of lateral surface of zygomatic Draws upper lip upward minor bone to upper lip just medial to corner of mouth Levator labii Infra-orbital margin of maxilla to skin of upper Raises upper lip, helps form superioris lateral half of upper lip nasolabial furrow Lavator labii Frontal process of maxilla to alar cartilage of Raises upper lip and opens nostril superioris nose and upper lip alaeque nasi Levator anguli Maxilla below infra-orbital foramen to skin at Raises corner of mouth, helps form oris corner of mouth nasolabial furrow Orbicularis oris From muscles in area; maxilla and mandible in Closes and protrudes lips midline to ellipse around mouth Posterior mandible and maxilla, Presses check against teeth, Buccinator pterygomandibular raphe to blend with compresses distended cheeks orbicularis oris and into lips Anterior Anterior temporal fascia into helix of ear Draws ear upward and forward auricular Superior Epicranial aponeurosis to upper part of auricle Elevates ear auricular Posterior Mastoid process to convexity of concha of ear Draws ear upward and backward auricular Skin of eyebrows and lateral superior nuchal Wrinkles forehead and raises Occipitofrontali line and mastoid process to galea aponeurotica eyebrows (frontal belly) Draws s scalp backward (occipital belly)

Major Arteries of the Face:

- Facial Artery: a branch of the external carotid artery, major artery supplying the face

o Passes posterior or through submandibular gland

o Curves around inferior border of the mandible, just anterior to the masseter: pulse point

o Branches include: inferior labial, superior labial, lateral nasal, and terminates as the angular artery at the medial corner of the eye

o Supplies the upper and lower lip, lateral surface and dorsum of nose, and nasal septum

- Transverse Facial Artery: a branch of the superficial temporal artery

o Arises within the parotid gland and crosses the face transversely, on the superficial surface of the masseter muscle

o Supplies the area around the zygomatic arch

- Maxillary Artery: a branch from the external carotid artery

o Branches include: infra-orbital, buccal, and mental arteries o Supplies the lower eyelid, upper lip, and area between the two, the buccinator muscle, and the chin

- Ophthalmic Artery: a branch of the internal carotid artery

o Branches include: zygomaticofacial (from lacrimal branch), zygomaticotemporal (from lacrimal branch), dorsal nasal (terminal), supra-orbital, and supratrochlear arteries

o Supplies the dorsum of the nose, the anterior scalp, and the area over the zygomatic bone

Major Veins of the Face:

- Facial Vein: major vein draining the face

o Originates when the supratrochlear and supra-orbital veins join to form the angular vein which becomes the facial vein as it proceeds inferiorly, nearing the facial artery

o The facial vein runs with the facial artery until it reaches the inferior border of the mandible where it passes superficially to the submandibular gland to enter the internal jugular vein

o Drains the eyelids, external nose, lips, cheek, and chin

- Transverse Facial Vein: empties into the superficial temporal vein within the parotid gland

- Intracranial Venous Connections: the facial vein connects with many other venous channels:

o Ophthalmic veins

o Veins passing into the infra-orbital foramen

o Veins passing into deeper regions of the face (deep facial vein, pterygoid plexus of veins)

. All of these venous channels have interconnections with the intracranial cavernous sinus through emissary veins that connect the intracranial with extracranial veins

. No valves in the veins of the face or head  blood can move in any direction  The “danger area” (face/mouth/head) can allow infections to easily pass through these venous channels all throughout the head, cranial cavity, and neck

Lymphatics of the Face: 3 groups of lymph nodes receive drainage from the face

- Submental Nodes: drain the medial lower lip and chin bilaterally - Submandibular Nodes: drain medial corner of the orbit, most of external nose, medial cheek, upper lip, lateral part of lower lip

- Pre-auricular and Parotid Nodes: drain most of the eyelids, a part of the external nose, and the lateral part of the cheek

Innervation of the Face:

- The Trigeminal nerve [V] innervates facial structures derived from the first pharyngeal arch

o Cutaneous: ophthalmic [V1], maxillary [V2], and mandibular [V3] branches exit from the cranial cavity to innervate all of the face except for a small area covering the angle and lower border of the mandible ramus and parts of the ear ([V], [VII], and [X])

. Ophthalmic branch: exits skull through superior orbital fissure and enters orbit where it branches into supra-orbital, supratrochlear, infratrochlear, lacrimal, and external nasal nerves

. Maxillary branch: exits skull through foramen rotundum and branches into the zygomaticotemporal, zygomaticofacial, and infra-orbital nerves

. Mandibular branch: exits skull through foramen ovale and branches into the auriculotemporal, buccal, and mental nerves

- The Facial nerve [VII] innervates facial structures derived from the second pharyngeal arch

o Motor: exits skull through the internal acoustic meatus and gives off 7 branches (5 are terminal), arrives inside the parotid gland and gives off two branches: temporofacial (upper) and cervicofacial (lower) before giving off terminal branches

. Posterior auricular nerve: to the occipital belly of the occipitofrontalis and the posterior auricular muscles

. Digastric branch: to the posterior belly of the digastric muscle and the stylohyoid muscle

. Temporal branches: supply muscles in temple, forehead, and supra-orbital region

. Zygomatic branches: supply muscles in infra-orbital area, lateral nasal area, and the upper lip

. Buccal branches: supply muscles in cheek, upper lip, and corner of the mouth

. Marginal Mandibular branches: supply muscles of the lower lip and chin . Cervical branches: supply the platysma

Parotid Gland:

- Largest of the 3 pairs of salivary glands

- Anterior and below lower half of ear, superficial/posterior/deep to ramus of mandible, extend down to lower border of mandible and up to zygomatic arch

- Covers parts of SCM and masseter muscles

- Innervated by the auriculotemporal nerve (branch of mandibular nerve [V3]) for sensory and also receives secretomotor fibers (postganglionic parasympathetic) from the otic ganglion. Preganglionic parasympathetic fibers from the otic ganglion come from [IX]

- Parotid duct leaves anterior portion of parotid gland midway between zygomatic arch and corner of mouth. It transversely crosses the medial border of the masseter, turns deeply into the buccal fat pad, and pierces the buccinators muscle to open into the oral cavity near the 2 nd upper molars

- The external carotid artery, transverse facial artery, retromandibular vein, auriculotemporal and facial nerves pass through (or just deep):

o 5 branches of facial nerve emerge: temporal, zygomatic, buccal, marginal mandibular, and cervical

o Retromandibular vein forms in the parotid gland when the maxillary and superficial temporal veins unite

o External carotid artery gives off: posterior auricular branch and the maxillary and superficial temporal (terminal branches)  which all supply the parotid gland

. Transverse facial artery branches from the superficial temporal artery

o Makes surgical removal difficult: 5 branches of facial nerve may be compromised along with the vasculature running through and alongside the gland