3. INTRODUCTION
Boundaries of face or Countenance
- superiorly to hair line, inferiorly to the chin & the base of
mandible & on each side of auricle.
4. SKIN-
The facial skin is very vascular because of which
wounds of face bleed profusely but heal rapidly.
The facial skin is rich in sebaceous and sweat
glands.
Sebaceous glands keeps the face oily to prevent
loss of moisture, but also cause acne in adults &
sweat glands helps in body temperature regulation.
5. Laxity of the greater part of the facial skin facilitates rapid
spread of edema.
Boils in the nose and ear are acutely painful due to the
fixity of the skin to the underlying cartilages.
Facial skin is very elastic and thick because of facial
muscles are inserted into it so that facial wounds tends to
gape.
6. SUPERFICIAL FASCIA-
Contains-
Facial muscles
Vessels & nerves
A variable amount of fat. which is absent in the
eyelids but well developed in the cheeks, forming
the buccal pads that are very prominent in infants
help in suckling.
Deep fascia is absent in the face, except over the
parotid gland where it forms the parotid fascia &
over the buccinator forms the bucco pharyngeal
fascia.
7. ARTERIES OF FACE
Face is richly vascular & the main arteries that supplies the
face are as follows-
1. Common carotid artery –
External & Internal carotid artery
2. External carotid artery a) facial artery
b) Transverse facial artery
c) Maxillary artery
3. Internal carotid artery- Ophthalmic artery
9. Three branches arises from convex aspect of aorta-
1. Brachiocephalic artery
2. Left common carotid
3. Left subclavian artery
10. 1. COMMON CAROTID ARTERY
It devides into right & left common carotid artery
(C4).
Right CCA is a branch of brachiocephalic artery & it
begins in the neck behind the right sternoclavicular
joint.
11. •Left CCA is a branch of the arch of aorta & it begins in the
thorax in front of trachea, little left to the centre of the
manubrium.
15. In the neck,both arteries runs upward within the carotid
sheath.
Contents of carotid sheath-
- Common carotid artery (medially)
- Internal jugular vein (laterally)
- Vagus nerve between the artery
& vein (posterially)
At the level of the upper border of thyroid cartilage the
artery dividing into the external and internal carotid
arteries.
16. Carotid sinus-
The termination of CCA or beginning of the internal
carotid artery shows a slight dilatation known as
carotid sinus.
Acts as a baroreceptor
(pressure receptor)
& regulates blood pressure.
17. Carotid body-
Small, oval reddish brown structure situated behind the
bifurcation of CCA.
Receive nerve supply from glossopharyngeal & vagus
nerve.
Act as a chemoreceptor & responds to change in the O2
& CO2 content of blood.
18. APPLIED
The bifurcation of CCA into ICA & ECA at anterior border
of sternoclavicular muscle at the superior border of
thyroid cartilage.
Carotid pulse
19. CAROTID PULSE
CCA may be compressed against the carotid tubercle of
transverse process of C6 vertebra about 4cm above the
sternoclavicular joint.
20. 2. EXTERNAL CAROTID ARTERY
One of the terminal branches of CCA.
It lies anterior to the internal carotid artery.
Chief artery that supply the face and front of the neck.
COURSE & RELATION
It begins in the carotid triangle at the level of upper border of
thyroid cartilage (C3-C4).
It runs upward & slightly backwards ,laterally & terminates
behind the neck of the mandible by dividing into-
- Maxillary artery
- Superficial temporal artery
21. The ECA has a slighly curved course-
Anteromedial to the ICA in its lower part.
Anterolateral to the ICA in its upper part.
a) In the carotid triangle-
ECA is superficial & lies under cover of the anterior border of the
sternomastoid.
Crossed superficially by the cervical branch of facial nerve,hypoglossal nerve.
22. b) Above the carotid triangle-
ECA lies deep in the substance of the parotid gland.
Within the gland, it is related superficially to the
retromandibular vein & facial nerve.
Branches-
ECA gives off eight branches-
A. Anterior : - Superficial thyroid
- Lingual
- Facial
B. Posterior : - Occipital
- Posterior auricular
23. C. Medial : Ascending pharyngeal
D. Terminal : Maxillary & Superficial temporal
24. 1. Superior thyroid artery-
Arises just below the level of greater cornu of the hyoid
bone.
It runs forward parallel and just superficial to external
laryngeal nerve.
The artery & nerve are close to each other, so to avoid
injury to the nerve the superior thyroid artery ligated as
near to the gland is possible.
25. 2. Lingual artery
Arises at the tip of greater cornu of the hyoid bone.
Supplies floor of mouth & tongue
Its course is divided into 3 parts by the hyoglossus muscle.
First part - lies in carotid triangle.
Second part- deep to the hyoglosssus along the upper border of hyod bone.
Third part- is called the arteria profunda or deep lingual artery.
26. 3. FACIAL ARTERY
It is chief artery of face
It arises from the ECA just above the tip of the greater
cornu of the hyoid bone
Two parts of facial artery-
1. Cervical part- runs upwards in the neck
2. Facial part- on the face
CERVICAL PART-
It runs upwards on the pharynx deep to the posterior belly
of the digastric & to the ramus of mandible
It grooves the posterior border of submandibular gland
27. BRANCHES OF CERVICAL PART-
1. Ascending palatine-
- supplies the tonsil & root of the tongue
2. Tonsillar-
- supplies the tonsils
3. Submental-
- supplies the submental triangle & sublingual
salivary gland.
4.Glandular branches-
- supplies submandibular salivary gland & lymph
nodes
28. FACIAL PART-
Course-
It enters the face by winding around the base of the mandible, by
piercing the deep cervical fascia at the antero-inferior angle of the
masseter muscle.
First it runs upwards & forwards to a point half an inch lateral to
the angle of the mouth.
Then it ascensds by the side of the nose up to the medial angle of
the eye, where it terminates by supplying the lacrimal sac & by
anastomosing with the dorsal nasal branch of the ophthalmic
artery.
The facial artery is very tortuous.( Tortuosity of the artery prevents
its walls from being unduly stretched during movement of
mandible,lips & the cheeks)
30. BRANCHES OF FACIAL PART-
1. Inferior labial –
- supplies lower lip
2. Superior labial-
- supplies the upper lip & the anteroinferior part
of the nasal septum.
3. Lateral nasal-
- supplies to the ala & dorsum of the nose.
32. ANASTOMOSES-
The large anterior branches anastomoses with
similar branches of the opposite side & with the
submental artery.
At the medial angle of the eye terminal branches
of the facial artery anastomoses with branches of
the ophthalmic artery (it is the site for
amastomosis between the branches of ECA & ICA)
33. 4. Occipital artery-
Arises from the posterior aspect of the ECA.
Opposite the origin of facial artery
Supplies the occipital belly of occipitofrontalis & skin
& pericranium associated with the scalp.
34. 5. Posterior auricular artery-
Arises from the posterior aspect of ECA just above the
posterior belly of digastric.
Supplies back of the auricle, the skin over the mastoid
process & over the back of the scalp.
6. Ascending pharyngeal artery-
Arises from the medial side of ECA.
Supplies the side wall of the pharynx, tonsil, medial
wall of the middle ear & the auditory tube.
35. 7. MAXILLARY ARTERY
The maxillary artery, larger of the two terminal
branches of the external carotid artery.
3 parts
1. Mandibular- runs horizontally between neck of
mandible & sphenomandibular ligament.
2. Pterygoid- superficial or deep to the lower head of the
lateral pterygoid.
3. Pterygopalatine- between the two heads of the lateral
pterygoid through pterygomaxillary fissure
36.
37. Infraorbital artery-
Enters the face through the infraorbital foramen.
Supplies the lower eyelid, upper lip.
Buccal artery-
Enters the face on the superficial surface of the
buccinator muscle, supplies structures in this area.
Mental artery-
Enters the face through the mental foramen & supplies
the chin.
38. TRANSVERSE FACIAL ARTERY
Branch of superficial temporal artery.
After emerging from the parotid gland, it runs
forward over the masseter between the parotid
duct & zygomatic arch.
Accompanied by the upper buccal branch of facial
nerve.
It supplies the parotid gland & its duct ,the
masseter & overlying skin.
40. 3. INTERNAL CAROTID ARTERY
The ICA begins in the neck as one of the terminal branches of
CCA (at the level of upper border of the thyroid cartilage).
It divided into 4 parts-
1. Cervical part- in the neck it gives no branches.
2. Petrous part- in the petrous part of temporal bone gives 2
branches-
a) Corticotympanic branch
b) Pterygoid branch
3. Cavernous part- within the cavernous sinus.
a) Cavernous branches to the trigeminal ganglion
b) Superior & inferior hypophyseal branches
41. 4. Cerebral part- lies at the base of the brain after emerging
from the cavernous sinus.
Ophthalmic
Anterior cerebral
Middle cerebral
Posterior communicating
Anterior choroidal
‘S’ shaped figure called as carotid siphon of angiograms
42. OPHTHALMIC ARTERY
It gives 2 small branches after enters the orbit.
a) Zygomaticofacial artery-
It is branch of lacrimal branch of the ophthalmic artery.
Enters the face through the zygomaticofacial foramen.
Supplies the area of the face over the zygomatic bone.
b) Dorsal nasal artery-
Terminal branch of the ophthalmic artery, exits the orbit
in the medial corner.
Supplies the nose.
44. VEINS OF FACE
1. Facial vein - major vein draining the face
2. Transeverse facial vein
45. FACIAL VEIN
Facial vein is the major vein draining the face.
Its begins as the angular vein at the medial angle of the eye.
It is formed by the union of the supratrochlear and supraorbital
veins.
The angular vein continues as the facial vein, running downwards &
backwards behind the facial artery.
It crosses the anteroinferior angle of the masseter,pierces the deep
fascia, crosses the submandibular gland & joins the anterior division
of retromandibular vein (below the angle of the mandible) to form
common facial vein.
Drains into internal jugular vein.
46. Supra orbital vein
Supra trochlear vein
Facial vein
Common facial vein
Retromandibular vein
Superficial temporal vein
Maxillary vein
Posterior auricular vein
47. TRANSVERSE FACIAL VEIN
Small vein supplies the face.
It empties into the superficial temporal vein within the
substance of parotid gland.
48. INTRACRANIAL VENOUS CONNECTION
The facial vein has numerous connections with venous
channels passing into deeper regions of the head.
1. Near the medial corner of the orbit it comminicates with
ophthalmic veins.
2. In the area of the cheek it communicates with veins
passing into the infra orbital foramen.
3. It communicates with veins passing into deeper regions of
the face (i.e. the deep facial vein connecting with the
pterygoid plexus of veins).
51. All these venous channels have interconnections with the
intracranial cavernous sinus through emissary veins that
connect intracranial with extracranial veins.
There are no valves in the facial vein or any others venous
channels in the head,so blood can move in any direction.
So infection from the face can spread in the retrograde
direction & cause thrombosis of the cavernous sinus.
This is specially likely to occur in presence of infection in
upper lip & lower part of the nose, this area is therefore
called as dangerous area of the face.
52.
53. CAVERNOUS SINUS THROMBOSIS
Cavernous sinus-
It is paired sinus & present against the lateral aspect of the body of
sphenoid bone on either side of sella turcica.
It receives blood not only from cerebral vein but also from –
a) Ophthalmic vein (from orbit)
b) Emissary veins (from the pterygoid plexus of veins in the
infratemporal fossa)
These connections provide pathways for infections to pass from
the extracranial sites into intracranial locations.
Structure pass through the cavernous sinuses are located in the
walls of these sinuses they are vulnerable to injury due to
inflammation.
54. Structure passing through in center of each cavernous
sinus-
1. Internal carotid artery
2. Abducent nerve
lateral wall of each
cavernous sinus-
1. Occulomotor nerve
2. Trochlear nerve
3. Ophthalmic nerve
4. Maxillary nerve
55. Cavernous Sinus Thrombosis
Cavernous sinus thrombosis (CST) is the formation of
blood clot within the cavernous sinus (a cavity at the base of
brain which drains deoxygenated blood from the brain back
to the heart).
Causes-
1. CST is typically caused by an infection that has spread
beyond the face, sinuses or teeth.
2. Less commanly infection of the ears or eyes may cause
CST.
58. 5. Ptosis- drooling of upper eyelid
6. Chemosis – edema of the mucous membrane of the
eyeball & eyelid lining.
59. LITTLE’S AREA
The anteroinferior part of septum contains anastomoses
between the superior labial branch of the facial artery and
sphenopalatine artery.
60. common site of bleeding from the nose
(epistaxis).
known as Little’s area or kiesselbach’s area
61. LYMPHATIC DRAINAGE OF FACE
The face has 3 lymphatic territories-
1. Upper territory- Preauricular (parotid) nodes
including the greater part of the forehead
Lateral halves of the eylids
The conjunctiva
Lateral part of the cheek
Parotid area
(a) Upper territory
62. 2. Middle territory- Submandibular nodes
Median part of the forehead
External nose
Upper lip
Lateral part of lower lip
Medial halves of eyelids
Medial part of cheek
Greater part of the lower jaw
(b) middle territory
63. 3. Lower territory – Submental nodes
Central part of the lower lip
Chin
(c) lower territory
64.
65. CONCLUSION
Some infection from the face can spread in the
retrograde direction, because of venous channels
of face have interconnections with the intracranial
cavernous sinus through emissary veins, so for
proper diagnosis & management it is important to
know the facial anatomy & blood supply of face.
66. References-
1. B D Chaurasia.Human anatomy:Regional and applied dissection amd clinical,5th
edition
2. B D Chaurasia.Human anatomy:Regional and applied dissection amd clinical,3rd
edition
3. Drake L R, Vogl W, Mitchell A W M. Gray’s anatomy for student.International
Edition.
4. Sinnatamby C S. Last’s anatomy regional and applied. 11th edition.
