Plastic Surgery Classes: Anatomy of face

1. ANATOMY OF FACE

2. Contents
• Introduction
• Boundaries of face
• Layers of face
• Symmetry of face
• Aesthetic regions of face
• Bones
• Muscles of face
• Nerve supply
• Blood supply & venous drainage
• Lymphatic drainage
• Applied anatomy

3. Introduction
• Very vascular
• Due to rich vascularity face blush and blanch.
• Facial skin is rich in sebaceous gland and sweat
gland.
• Wounds of face bleed profusely but heal rapidly.
• Sebaceous glands keep the skin oily but also cause acne in
adult.
• No deep fascia is present in the face.

4. Boundaries of Face
Superiorly Inferiorly Each side
• To the hairline • Chin
• Base of
mandible
• Auricle
Note: forehead is common to both scalp & face.

5. Layers of Face

6. Symmetry of Face

7. Aesthetic Regions of Face

8. Bones of Face
• The facial skeleton
consists of 14 stationary
bones and the mandible.
• These 14 bones form the
basic shape of the
face, and are responsible
for providing attachments
for muscles that make the
jaw move and control
facial expressions.

9. Bones of Face

10. Bones of the Face

11. Muscles of Face
General Characters
• Called muscle of facial
expression and lie in
superficial fascia.
• Develop from mesoderm
of 2nd pharyngeal arch.
• Supplied by the Facial
nerve.
• Act as closers and
openers of facial orifices.

12. Muscles of Face
General Characters
• Surround the facial
openings.
• Originate from bone or
other muscle.
• Pass in the superficial
fascia.
• Attach to the facial skin or
other facial muscle.

13. Muscles of Face
Classification:
1. Muscles of
the eyelid
2. Muscles of
the mouth
3. Muscles of
the nose
4. Muscles of
the neck
5. Muscles of
the ear

17. Muscles of Eyelid
A. Corrugator supercillii
Origin: Medial end of
superciliary arch
Insertion: Skin of mid-
eyebrow
Action: Vertical lines in
forehead: frowning

18. B. Orbicularis Oris
ORBITAL
PART
[OUTER]
PALPEBRAL
PART
[INNER]
LACRIMAL
PART
[SMALL]
PARTS OF ORBICULARIS OCULI

19. Orbital Part
ORIGIN
INSERTION
ACTION
• Medial part of the medial
palpebral ligament & adjoining
bone
• Concentric rings return to the
point of origin
• Closes the lids tightly
• Protects eye from bright light

21. Palpebral Part
ORIGIN
INSERTION
ACTION
• Lateral part of the medial
palpebral ligament
• Lateral palpebral raphae
• Closes the lids gently
• Blinking

22. Lacrimal Part
ORIGIN
INSERTION
ACTION
• Lacrimal fascia &
lacrimal bone
• Upper & lower
eyelids
• Dilates the lacrimal
sac

24. Muscles of The Mouth
• Orbicularis oris
• Buccinator
• Lower group of oral muscles
• depressor anguli oris
• depressor labii inferioris
• Mentalis
• Upper group of oral muscles
• risorius
• zygomaticus major and zygomaticus minor
• levator labii superioris
• levator labii superioris alaeque nasi
• levator anguli oris

26. Orbicularis oris
Two parts:
1. Intrinsic part [Deep stratum]
Origin: Superior incisivus from maxilla
& Inferior incisivus from
mandible
Insertion: Angle of mouth
Action: Closes & purses the mouth
2. Extrinsic part [Two strata]
Origin:
• Thickest middle stratum – Buccinator
• Thick superficial stratum – Elevators &
depressors of lips & angles
Insertion: Lips & the angle of the mouth
Action: Closes & purses the mouth

27. Buccinator
• Origin :
• Upper fibers from maxilla above three
molar
• Lower fibers : from the mandible below
three molar
• Ptergomandibular raphe which separates
it from the constrictor pharyngis superior.
• Insertion :
• Upper fibers : to the upper lip
• Lower fibers : lower lip
• Middle fibers decussate lower ascend to
upper lib & lower descend to the lower
limb
• Action :
• Aids in holding the cheek to the teeth and
prevent accumulation of food in the
Buccinator

29. Zygomaticus major
• Strap muscle
• Forms shape of cheek
• Smiling

30. Zygomaticus minor
• Strap muscle
• Forms shape of cheek
• Smiling

31. Levator labii superioris
• Deeps the furrows on either
side of nares
• Sad

32. Levator anguli oris
• Pulls the angle of mouth
upwards
• Aka ‘Happy muscle’
• Smiling

33. Levator labii superioris alaeque nasi
• Aka ‘Elvis muscle’
• Dilates the nostrils
• Raises upper lip

34. Risorius
• Pulls the lip horizontally
• Insincere smile

35. Depressor labii inferioris
• Draws the lower lip
downwards and little
laterally
• Expression of irony.

36. Depressor anguli oris
• Lowers the corners of mouth
• Frowning

37. Mentalis
• Pouting muscle.

38. Muscles of Nose
1. Procerus
2. Nasalis (two parts)
• Dilator naris
• Compressor naris
3. Depressor septi nasi

39. Procerus
• Origin: nasal bone and
lateral nasal cartilage
• Insertion: skin
between the eyebrows
• Action:
– pulls down the medial
end of the eyebrow
– wrinkles the skin of the
nose transversely in
frowning

40. Dilator naris
• Origin : Maxilla bone
• Insertion: Ala of the
nose
• Action: Widens the nasal
aperture (by pulling the
alar laterally) in deep
inspiration; is also a sign
of anger

41. Compressor naris
• Origin: Frontal process of
the maxilla
• Insertion: Aponeurosis
which crosses the bridge of
the nose
• Action: Compresses the
mobile nasal cartilages

42. Depressor septi nasi
• Origin: incisive fossa of
maxilla
• Insertion:nasal septum &
back part of the alar part of
nasalis muscle
• Action: depression of nasal
septum. Dilates the nostril.
Moves the ape of nose
during movement of upper
lip (talking).

43. Muscles of Neck
Platysma
• Origin– upper part of
pectoral and deltoid
fascia
• Insertion– base of
mandible, skin of
lower face and lip
• Action– releases
pressure of skin on the
subjacent veins, depress
mandible, pulls angle of
mouth downwards.

44. Muscles of Ear
Auricularis
3 parts:
1. Auriculars anterior
•Origin: temporal fascia
•Insertion: major helix (ear)
•Action: pulls ear forward
2. Auricularis posterior
•Origin: mastoid process
•Insertion: posterior ear
•Action: pulls ear backward
3. Auricularis superior
•Origin: temporal fascia
•Insertion: above the ear
•Action: pulls ear upward

46. Nerve Supply of Face
A. Sensory nerve supply:
• Trigeminal nerve :
•Ophthalmic division
•Maxillary division
•Mandibular division
• Great auricular nerve of
cervical plexus

52. B. Motor Supply of Face
(Facial Nerve)
• Orgin : from the pons
• Type: mixed nerve motor , sensory
and containing parasympathetic.
• Course in the face: after
the facial nerve comes out
from the stylomandibular
foramen it enter the parotid
gland superficial to
external carotid artery and
posterior facial vein and
within the parotid gland
the nerve gives five
terminal branches .

53. Branches of facial nerve
• Before it enter the parotid gland
(distal to the stylomastoid foramen:
1. Postetrior auricular- to the
occiptal belly of
occiptofrontalis muscle
and muscles around ear
2. Branch to posterior belly
of digasteric and
stylohyoid muscle
• Within the parotid gland:
1. Temporal
2. Zygomatic
3. Buccal
4. Marginal mandibular
5. Cervical

54. TEMPORAL
•Frontalis
•Auricularis
muscles
•Orbicularis oculi
ZYGOMATIC
•Orbicularis oculi
BUCCAL
•Cheek
•Upper lip
•Lower lip
MARGINAL
MANDIBULAR CERVICAL
•Platysma
Supply to Various Muscles

55. Blood Supply & Venous Drainage
A. Arterial Supply:
1. Facial Artery:
-Chief artery of the face
• Origin: branch from external
carotid
• Course: arise from external
carotid and inter the digasteric
triangle in the neck and run
between submandibular gland
and mandible then inter the face
in front of masseter muscle and
terminate by giving angular
artery.

56. •Branches of facial artery
A. In the neck (cervical
branches)
1. Ascending palatine
2. Tonsilar
3. Submental
4. Glandular branches
B. In the face (facial
branches)
1. Inferior labial
2. Superior labial
3. Lateral nasal
4. Angular (terminal)

60. B. Venous drainage
• Veins accompany the arteries
• Drains into common facial & retromandibular
veins.
• W-shaped arrangement
• Facial vein – Largest – No valves

61. Facial vein
• Begins as angular vein @ medial angle of
the eye
• Formed by the union of Supratrochlear &
Supraorbital veins
• Angular vein – Continues as facial vein –
Running downwards & backwards behind
facial artery – STRAIGHT COURSE

65. Dangerous Area of the Face
This includes the upper lip and the
lower part of the nose. It is drained by
the f a c i a l v e i n , w h i c h
communicates with the cavernous
sinus. Infections of this area can
therefore, spread in retrograde
direction and cause thrombosis of the
cavernous sinus.

66. Lymphatic Drainage of Face

67. Applied Anatomy of Face
• Trigeminal neuralgia
– Maxillary and mandibular nerve are involved
– Excruciating pain in the region of distribution of these nerve
• In infranuclear lesions of facial nerve (eg, bell’s palsy)-
Ipsilateral whole face is paralyzed
– c/f
• Affected side is motionless
• Loss of wrinkles
• Eye cannot be closed
• In smiling the mouth is drawn to normal side
• During mastication food accumulates in vestibule of mouth

68. Bell’s Palsy

70. Facial nerve lesion ( Bell’s palsy )

71. References
• Text book of Human anatomy by B D
Chaurasia
• Atlas of Human Anatomy by
Nater
• Gray’s anatomy
• Internet sources