Face

Aliyu Sabo Aliyu

Department of Anatomy
Faculty of Basic Medical Sciences
Bayero University Kano

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The Face
Boundaries
• Extends superiorly to the hair line,

• Inferiorly to the chin and base of

mandible,

• On each side to auricle.

• Forehead is common to both

scalp and face.
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 Skin of the Face
• The skin of the face is thick, elastic, and very vascular.

• Facial skin is rich in sebaceous glands and sweat glands. The

sebaceous glands keep the face greasy by their secretion, and sweat
glands helps regulate the body temperature.

• Except on the nose, where it’s securely connected to the inherent

cartilages and gives insertion to the muscles of facial expression,
the skin of the face is lax.

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Face
Very vascular
• Due to rich vascularity face blush
and blanch.

• Wounds of face bleed profusely

but heal rapidly.

• Sebaceous gland keep the skin

oily but also cause acne in adult.

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 APPLIED ANATOMY
• The blood supply to the skin of the face is profuse; as such, it’s
uncommon in plastic surgery for skin flaps to necrose.

• The laxity of the greater part of the skin eases the fast spread of oedema
in the region of the face.

• Face is also the common site for acne due to the presence of many
sebaceous glands in this region.

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 Fascia of the face
Superficial fascia Deep fascia
• Contains muscles of facial • Is absent in the region of face
expression, vessels and nerves, and except over the parotid gland
variable amount of fat. and masseter muscle, which are
covered by parotidomasseteric
• The fat is absent in the eyelids but fascia.
is well-developed in cheeks forming
buccal pad of fat, which provides
rounded contour to cheeks. • The absence of deep fascia in
the face is essential for the facial
expression.
• Very prominent in infants in whom
they help in suckling the milk and
are called suctorial pad of fat
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FACIAL MUSCULATURE
• 2 main groups of muscle are located on the face:
• Muscles of facial expression innervated by the facial
nerve (cranial nerve VII)

• Muscles of mastication supplied by the mandibular

division of the trigeminal nerve (cranial nerve V3)

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FACIAL MUSCULATURE
• Muscles of facial expression are superficial muscles which can move
skin and fascia in various directions.

• They are also dilators and sphincters for the various orifices in the
face region.

• The two major groups are around the eye and the mouth with the
nose also having a few.

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 Muscles of Facial Expression
• They lie in superficial fascia and inserted into the skin.

• Embryologically, they develop from mesoderm of 2nd pharyngeal arch,

hence supplied by facial nerve.

• Functionally, they perform all important functions of non-verbal

communication in addition to closing and opening the orifices in the
region of the face.

• They act as sphincters and dilators of the orifices of the face (i.e., the
orbits, nose, and mouth).
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 Muscles of
the Face
- Orbital group
- Nasal group
- Oral group
- Other muscle groups

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11
Orbital group
• The muscles are
• Orbicularis oculi
• Corrugator supercilii
• levator palpebrae superioris

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Orbicularis oculi Has 3 parts-
• Orbital part (outer)
• Originate from medial part of medial palpebral
ligament and form concentric rings, return to point of
origin
Action –closes the lids tightly The orbital part causes
radiating skin wrinkles from the lateral corner of the eye
• Palpebral part (Inner)
• Originate from lateral part of medial palpebral
ligament
• Insert into lateral palpebral ligaments.
Action-closes the lids gently
• Lacrimal part (Small)
• Originate from lacrimal fascia & lacrimal bone
• Insert into tarsal plates of eyelids.
Action-dilate lacrimal sac 13
Orbicularis oculi
Palpebral part Orbital part

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Levator palpebrae
superioris

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Levator palpebrae superioris
• The levator palpebrae superioris
elevates the superior eyelid. It
originates on the lesser wing of the
sphenoid bone, just above the optic
foramen.

• The levator palpebrae superioris is

innervated by the oculomotor nerve
(cranial nerve III) and postganglionic
sympathetic fibres from the superior
cervical ganglion.

Sympathetic fibres contribute to upper eyelid retraction by

innervation of the superior tarsal muscle, also known as 16
Corrugator supercillii
• Origin : superciliary
arch
• Insertion: skin of the
eyebrow
• Action: produces
vertical wrinkles of the
forehead in frowning as
an expression of
annoyance

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 Nasal group
• Four muscles are associated with
the nasal group:
• Procerus
• Nasalis
• Depressor septi

These muscles are poorly developed

because anterior nares are open.

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Nasal group
 Nasalis: has 2 Parts
 It consists of two parts: transverse part
called compressor naris and alar part
called dilator naris.

• Origin: transverse part —canine eminence;

alar part —maxilla, superior to the lateral
incisor
• Insertion: transverse part—side of the
nose; alar part—ala of the nose
• Action: transverse part—compression of
the nostril; alar part—dilation of the nostril
• Innervation: buccal branches of the facial
nerve 19
Nasal group
• Procerus
• Origin: nasal bone
• Insertion: skin overlying the glabella
• Action: depresses the medial end of the
eyebrow, producing transverse wrinkle at the
bridge of the nose
• Innervation: buccal branches of the facial
nerve

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Depressor septi nasalis (DSN)
• The depressor septi nasalis muscles
(DSN) are paired muscles of the
nose

• Origin: Incisive fossa of maxilla

• Insertion: lower mobile part of the
nasal septum

• Innervation: facial nerve (VII)

• Action: It fixes the nasal septum to
allow dilatation of anterior nasal
aperture by dilator naris.
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Oral group
The muscles around the mouth are responsible
for the movement of lips and cheek. They
include;
• Orbicularis oris
• Buccinator
• Lower group of oral muscles
1. Depressor anguli oris
2. Depressor labii inferioris
3. Mentalis
• Upper group of oral muscles
1. Risorius
2. Zygomaticus major and zygomaticus minor
3. Levator labii superioris
4. Levator labii superioris alaeque nasi
5. Levator anguli oris
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 Orbicularis oris
• This complex muscle surrounds the
oral orifice and forms the greater part
of the lips.

• Origin: From maxilla above incisor

teeth.

• Insertion: into skin of lip.

• Action: capable of producing wide

variety of movements of lips such as
closing, pouting, pursing, twisting,
whistling, or kissing. 23
 Buccinator (Bugler’s
•
muscle/trumpeter’s muscle)
Upper fibers
• Origin- Outer surface of the alveolar process of maxilla
(opposite molar teeth)
• Insertion-upper lip
• Lower fibers
• Origin - Outer surface of the alveolar process of
mandible (opposite molar teeth)
Insertion-lower lip
• Middle fibers
• Origin –from pterygomandibular raphe
• Insertion-decussate before passing to lips
• Action- It is responsible for blowing the cheek and expelling
the air between the lips from inflated vestibule as in
blowing the trumpet (hence the name trumpeter’s muscle).
• Prevents the accumulation of food in the vestibule of mouth
during mastication.

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Paralysis of the buccinator muscle
• If the buccinator muscle is
paralyzed, as it happens in facial
palsy, food accumulate in the
vestibule of mouth during
mastication and the person can not
blow his cheek.

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• Depressor anguli oris
• Origin: Oblique line of the mandible Lower group of oral
• Insertion: corner of the mouth muscles
• Action: depresses corner of the mouth
inferiorly and laterally
• Depressor labii inferioris
• Origin: Oblique line of the mandible,
deep to depressor anguli oris.
• Insertion: lower lip
• Action: depresses lower lip inferiorly and
laterally
• Mentalis
• Origin: incisive fossa of the mandible
• Insertion: Descends to insert into the skin
of the lower lip.
• Action: Elevates and protrudes lower lip
(doubt) 26
• Risorius:
• Origin: fascia covering the parotid
Upper group of oral
gland muscles
• Insertion: corner of the mouth
• Action: It retracts the angle of the
mouth gently
• Zygomaticus major:
• Origin: Lateral surface of the zygomatic
bone
• Insertion: Corner of the mouth
• Action: Draws the corner of the mouth
superiorly and laterally.
• Zygomaticus minor
• Origin: lateral surface of the zygomatic
bone, anterior to zygomaticus major
• Insertion: upper lip
• Action: Elevation of the upper lip 27
• Levator labii superioris alaeque nasi
Origin: The frontal process of the maxilla
Upper group of oral
Insertion: medial part—ala of the nose; muscles
lateral part—upper lip
Action: medial part—dilation of the nostril;
lateral part—elevation of the upper lip
• Levator labii superioris
• Origin: inferior border of the orbital
aperture
• Insertion: upper lip
• Action: elevation of the upper lip
• Levator anguli oris
• Origin: canine fossa of the maxilla
(inferior to the infraorbital foramen)
• Insertion: corner of the mouth
• Action: elevation of the corner of the
mouth
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 Modiolus
• It’s a compact, mobile, fibromuscular mass situated about 1.25 cm
lateral to the angle of the mouth.
• It’s created because of the interlacing of fibres of 5 muscles which
converge in the direction of the angle of the mouth.
• These muscles (modiolar muscles) are levator anguli oris, zygomaticus
major, buccinator, depressor anguli oris and risorius.

It can be easily palpated by using opposed thumb and

index finger to compress the skin and mucosa
simultaneously.

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Other muscle groups
• They include:
• Platysma
• Auricular (anterior,
superior, and posterior
auricular muscles)
• Occipitofrontalis

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Auricular muscles
• The Auricularis anterior (smallest) is thin and fan-shaped. It arises from the
lateral edge of the temporal fascia (galea aponeurotica), and its fibres converge
to be inserted into a projection on the front of auricle.

• The Auricularis superior (largest) is also thin and fan-shaped. Its fibres arise from
the epicranial aponeurosis and converge to be inserted by a thin, flattened tendon
into the upper part of the cranial surface of the auricula.

• The Auricularis posterior arise from the mastoid process of the temporal bone.
They are inserted into the posterior part of the auricle.
• Actions.; retract and elevate the ears

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Platysma
• Origin: deep fascia covering the
upper part of the pectoralis major
• Insertion: inferior border of the
mandible and corner of the mouth
• Action: depression of the mandible;
draws the corner of the mouth
inferiorly and laterally, producing
ridges in the skin of the anterior
neck
• Innervation: cervical branch of the
facial nerve

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CLINICAL TESTING OF THE MUSCLES OF
FACIAL EXPRESSION
• Frontalis, by requesting the patient to look upwards without moving his head and after that
look for horizontal wrinkles on the brow.

• Corrugator supercilii, by requesting the patient to frown and after that look for vertical
wrinkles between both eyebrows.

• Orbicularis oculi, by requesting the patient to shut the eyes closely.

• Orbicularis oris, by requesting the patient to whistle.

• Dilators of the mouth, by requesting the patient to show his teeth.

• Buccinator, by requesting the patient to smoke his mouth and after that blow out the air
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powerfully.
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Blood supply of face

• Facial artery: (chief artery of the face) arises

from the external carotid artery (ECA). The
branches are:
• Inferior labial artery: Supplies: lower lip, labial
glands
• Superior labial artery: Supplies: upper lip, nasal
septum, ala of the nose
• Lateral nasal branch: Supplies: dorsum of the nose,
ala of the nose
• Angular artery: Supplies: lacrimal sac, orbicularis
oculi muscle

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Blood supply of
face
• Superficial temporal artery arises
from the external carotid artery
(ECA)
• Ophthalmic artery: arises from the
internal carotid artery and
distributes over the forehead
• Ophthalmic artery
• Supraorbital and
• Supratrochlear

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Clinical Anatomy
• Since the face is richly vascular, the wounds of face bleed profusely but
fortunately they heal quickly.
• The pulsations of facial artery can be felt at two sites, viz.
– At the base of the mandible close to anteroinferior angle of the
masseter.
– About 1.25 cm lateral to the angle of the mouth.

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 Venous drainage
• Facial vein: drains into the
internal jugular vein directly or as
a common facial vein

• Retromandibular vein: formed

by the union of the maxillary and
superficial temporal veins;
ultimately drains into the
external jugular vein.

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The retromandibular vein

• Formed by the union of the superficial

temporal and maxillary veins.

• It divides into two branches:

• Anterior, which passes forward and
joins the facial vein to form the common
facial vein, draining into the internal
jugular vein.

• A posterior, which is joined by

the posterior auricular vein and becomes
the external jugular vein.
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Venous drainage
• Drain to internal and external jugular
veins:
I. Facial
II. Supraorbital
III. Supratrochlear
IV. Superficial temporal
V. Transverse facial
VI. Angular
VII. Posterior auricular
• Mnemonic: For Some Students Studying
Time Alters Psychosis
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Clinical Anatomy
Dangerous area of the face
 The facial vein and its communications are devoid of
valves in their lumens.

 The movements of facial muscles may facilitate the spread

of septic emboli from infected area of the lower part of
the nose, upper lip, and adjoining part of the cheek
through deep facial vein, and emissary vein into the
cavernous sinus.

 These could lead to meningitis and cavernous sinus
thrombosis.

 For this reason, this portion of the face is called

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dangerous area of the face.
Lymphatic drainage (3 territories)
• Upper territories- greater part of
forehead, lateral ½ of eye lid,
conjunctiva, lateral part of cheek and
parotid area– preauricular lymph node
(parotid)

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Lymphatic drainage
• Middle territories- median part of forehead,
external nose, upper lip, lateral part of lower lip,
medial ½ of eye lid, medial part of cheek, greater
part of lower jaw– submandibular lymph node.
• Lower territories- central part of lower lip, chin–
submental lymph node

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 APPLIED ANATOMY
• Ulcers of the tip of the tongue or boils in the chin causes
enlargement of submental nodes.

• Submandibular lymph nodes are enlarged and tender during

the inflammation of their area of drainage, e.g. sinusitis
involving frontal and maxillary sinuses, dental caries, infection
of tongue and palate.

• During carcinoma of cheek, lips, tongue etc. Secondary

deposits enter the submandibular nodes. Subsequently the
submandibular, salivary gland and mandible are affected.
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 Sensory Nerves of the Face
• The skin of the face is supplied by
the trigeminal nerve (V), except for
the small area over the angle of the
mandible and the parotid gland
which is supplied by the great
auricular nerve (C2 and 3).

• The trigeminal nerve (V) divides into

three major divisions-the
ophthalmic (V1), maxillary (V2), and
mandibular (V3) nerves.

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46
 The Facial Nerve
• The facial nerve exits the skull
through the stylomastoid
foramen and immediately gives
off the post. auricular nerve and
other branches that supply the
1. occipitalis,
2. stylohyoid, and
3. posterior digastric muscles
4. posterior auricular muscle.

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• CN VII courses superficial to the
external carotid artery and the
retromandibular vein, enters
the parotid gland, and divides
into the following five terminal
branches:
• Temporal,
• Zygomatic,
• Buccal,
• Mandibular, and
• Cervical nerves, which in
turn supply the muscles of
facial expression.
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Applied Anatomy
Injury to the facial nerve (CN VII) or its branches
produces paralysis of some or all of the facial
muscles on the affected side (Bells palsy).

Characteristic Features on the Side of Paralysis

 Facial asymmetry (affected side is drawn to the
healthy side)—due to unopposed action of
muscles of normal side.

• Loss of horizontal wrinkles on forehead—due to

paralysis of occipitofrontalis muscle.

• Widening of palpebral fi ssure and inability to

close the eye—due to paralysis of orbicularis
oculi. 49
Bell’s Palsy
• Tears flow down from the eye (epiphora)
—due to paralysis of the lower part of the
orbicularis oculi.

• Sagging of the angle of the mouth

towards the affected side and inability of
the angle of the mouth to move upwards
and laterally during laughing—due to
paralysis of zygomaticus major.

• Loss of nasolabial furrow—due to

paralysis of levator labii superioris
alaeque nasi.
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Bell’s palsy

• Accumulation of food into the vestibule of

the mouth— due to paralysis of
buccinator muscle.

• Slurred speech and Dribbling of saliva

from the angle of the mouth—due to
paralysis of orbicularis oris.

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Other muscles
• Other muscles of the face
include muscles of mastication
(temporalis, masseter, and the
medial pterygoid and lateral
pterygoid muscles), which are
innervated by the motor division
of CN V-3.

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Muscles of mastication
• The muscles of mastication are associated with movements of the
jaw (temporomandibular joint).
• They are one of the major muscle groups in the head:
• Masseter
• Temporalis
• Medial pterygoid
• Lateral pterygoid
• The muscles of mastication develop from the first pharyngeal arch.
Thus, they are innervated by a branch of the trigeminal nerve (CN
V).
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54
Masseter
• The masseter muscle is the
most powerful muscle of
mastication. It is quadrangular
in shape and has two parts:
deep and superficial.

• Lies superficially to the

pterygoids and temporalis,
covering them.

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Masseter
• Origin: The superficial part originates
from maxillary process of the
zygomatic bone. The deep part
originates from the zygomatic arch of
the temporal bone.

• Insertion: Both parts attach to the

ramus of the mandible.

• Actions: Elevates the mandible, closing

the mouth.

• Innervation: Mandibular nerve (V3). 56

 The temporalis
muscle
• The temporalis muscle
originates from the temporal
fossa.

• The muscle is covered by

tough fascia, which can be
harvested surgically and used
to repair a perforated
tympanic membrane (an
operation known as a
myringoplasty).
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• Origin: from the temporal
fossa.
• Insertion: It condenses into a
tendon, which inserts onto the
coronoid process of the
mandible.
• Actions: Elevates the mandible,
closing the mouth. Also
retracts the mandible, pulling
the jaw posteriorly.
• Innervation: Mandibular nerve
(V3)
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 Medial
Pterygoid
• The medial pterygoid muscle has a quadrangular shape with two heads:
deep and superficial.
• It is located inferiorly to the lateral pterygoid.

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• Origin: The superficial head originates Medial
from the maxillary tuberosity and the
pyramidal process of the palatine bone. Pterygoid
• The deep head originates from the
medial aspect of the lateral pterygoid
plate of the sphenoid bone.
• Insertion: Both heads attach to the
mandible's ramus near the mandible's
angle.
• Actions: Elevates the mandible, closing
the mouth.
• Innervation: Mandibular nerve (V3)

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Lateral Pterygoid
• The lateral pterygoid muscle
has a triangular shape with
two heads: Superior and
inferior.

• It has horizontally orientated

muscle fibres, and thus is the
major protractor of the
mandible.

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Lateral Pterygoid
• Origin: The superior head originates
from the greater wing of the
sphenoid.
• The inferior head originates from
the lateral pterygoid plate of the
sphenoid.
• Insertion: The two heads converge
into a tendon which attaches to the
neck of the mandible.

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Lateral
Pterygoid
• Actions: Acting bilaterally,
the lateral
pterygoids protract the mandible,
pushing the jaw forwards.

• Unilateral action produces the ‘side to

side’ movement of the jaw.
• Note: Contraction of the lateral pterygoid
will produce lateral movement on the
contralateral side. For example, contraction
of left lateral pterygoid will deviate the
mandible to the right.

• Innervation: Mandibular nerve (V3)

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Motor Nerves of the Face
• Motor supply:
• Facial nerve (VII)

• Facial nerve divides into five

terminal branches for muscles
of facial expression:
• Temporal
• Zygomatic
• Buccal
• Marginal mandibular
• Cervical

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Applied
• Trigeminal neuralgia
• Maxillary and mandibular nerve are involved
• Excruciating pain in the region of distribution of these nerve
• In infranuclear lesions of facial nerve (e.g., Bell’s palsy)- whole face is paralyzed
• Clinical features
• 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

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Trigeminal neuralgia
• Herpes zoster, or shingles, is the
most common infection of the
peripheral nervous system (PNS).
• It is an acute neuralgia confined
to the dermatome distribution
of a specific spinal or cranial
sensory nerve root.

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