msc medical anatomy

1. FACE
Blood Supply,
Nerve Supply &
Lymphatics

2. Blood Supply
The face is richly vascular,
it is supplied by :
• The facial artery
• Transverse facial
• Arteries that
accompany the
cutaneous nerves

3. Facial Artery
It is chief artery of face
It is branch of external
carotid artery
Two parts of facial artery-
1. Cervical part- runs
downwards in the neck
2. Facial part- on the face

4. 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 1.25cm lateral to the angle of the
mouth.
•Then it ascends by the side of the nose
up to the medial angle of the eye, where
it terminates 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.
Facial
artery
Masseter
muscle

5. 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.

6. 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

7. Transverse facial
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.

8. Venous Drainage of Face
The venous blood from the face is drained by
two veins-
1. Facial vein
2. Retromandibular vein
Formation- it is the largest vein of
the face
• At the medial angle of the eye by
the union of supratrochlear and
supraorbital veins, angular vein is
formed.
Facial Vein

9. • Course- The angular vein
continues as the facial vein ,
running downwards and
backwards behind the facial
artery ,but with a straighter
course at anteroinferior angle
of masseter.
• Here it pierces the deep
fasia, crosses superficial to
submandibular gland and
joins the anterior division of
retromandibular vein below
the angle of the mandible to
form the common facial
vein, which drains into the
internal jugular vein.

10. The facial vein communicates
with the cavernous sinus
through the two routes:-
1. A communication between the
supraorbital and superior
ophthalmic vein.
2. Connection with the pterygoid
plexus through the deep facial
vein which passes backward
over the buccinator. The
connection between facial vein
and cavernous sinus is shown
in :-
facial vain – Deep facial vein
–pterygoid venous plexus–
Emissary vein –cavernous sinus

11. Dangerous area of face
• Infection from face can spread in a retrograde direction and cause
thrombosis of the cavernous sinus.
• This is specially likely to occur in the presence of infection in the upper lip
and in the lower part of the nose, this is known as dangerous area of face.
• facial vein is connected to cavernous sinus through superior ophthalmic
vein & it provides a pathway for spread of infection from face to
cavernous sinus.

12. NERVE SUPPLY
Each half of face has
Sensory Motor
Branches of Branches of
Trigeminal Nerve Facial nerve
5th cranial nerve 7th cranial nerve

13. Sensory supply
Cutaneous innervation of the face is by
Trigeminal nerve
Areas supplied :
-Ophthalmic zone includes tip and side of
the nose, upper eye lid and forehead
- Maxillary zone upper lip, part of the side
of nose, lower eye lid, cheeks and small
part of temple
- Mandibular zone include lower chin, skin
overlying mandible, part of pinna, external
acoustic meatus and temple

14. Clinical aspect
Trigeminal neuralgia
• It may involve one or more
division of trigeminal nerve
• It causes attack of very severe
burning and scalding pain along
the distribution of the affected
nerve
Pain is relieved either :
• By injecting 90% alcohol into
the affected division of
trigeminal ganglion
• By sectioning the affected
nerve, the main sensory root,or
the spinal tract of trigeminal
nerve which is situated
superficially in medulla so the
procedure is known as
Medullary Tractotomy

15. Facial Nerve
(Motor supply)
It emerges from
stylomastoid foramen to enter
the parotid gland , it supplies
all muscles of facial
expression except masseter.
Stylomastoid Foramen

16. It runs within substance
of parotid gland, it
divides into 5
terminal branches :
• Temporal- frontalis,
auricular muscles,
orbicularis oculi
• Zygomatic- orbicularis
oculi
• Buccal – muscles of
cheek and upper lip
• Mandibular –muscles
Of lower lip
• Cervical - platysma
Temporal
Zygomatic
Buccal
Mandibular
Cervical

17. Clinical aspect
Infranuclear lesion
Also known as Bell’s Palsy
Clinical features :
• Whole face of the same side gets paralysed.
• Face becomes asymmetrical
• Face drawn up to normal side
• Affected side is motionless
• Wrinkles disappear from the forehead
• Eye cannot be closed
• Any attempt to smile draws the mouth to
normal side
• During mastication ,food accumulates
between teeth and cheek
• Articulation of labials is impaired.

18. Supra nuclear lesion
• They are usually
part of hemiplegia
• Only lower part of
opposite side of face
is paralysed
• Upper part of
frontalis and
orbicularis oculi
escapes
• due to its bilateral
representation in the
cerebral cortex

19. Lymphatic Drainage of the 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

20. 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

21. Lower territory –
Submental nodes
• Central part of the lower
lip
• Chin

23. Thank you