Anatomy :III
SHS : 201
Resource person: Dr. Mahnoor Shafi
REFERENCE TEXT: SNELL’S CLINICAL ANATOMY
SEMESTER: 3
Review Of Previous Topic
The muscle of mastication
with their origin, insertion,
nerve supply & action.
OUTLINE OF TOPIC
To understand the sensory nerve supply of
face.
Facial nerve and its branches
Clinical anatomy of facial nerve.
Skin Of The Face
The skin of the face is supplied by branches of
the three divisions of the trigeminal nerve.
Skin Of The Face
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).
Trigeminal Nerve
• There are three divisions of trigeminal nerve
Ophthalmic nerve
Maxillary nerve
Mandibular nerve
Trigeminal Nerve
• The ophthalmic nerve supplies the region developed
from the frontonasal process.
• The maxillary nerve serves the region developed from
the maxillary process of the first pharyngeal arch.
• The mandibular nerve serves the region developed from
the mandibular process of the first pharyngeal arch.
Trigeminal Nerve
• These nerves not only supply the skin of the
face, but also supply proprioceptive fibers to
the underlying muscles of facial expression.
Trigeminal Nerve
• In addition, these sensory nerve supply to the
• Mouth,
• Teeth,
• Nasal cavities,
• Paranasal air sinuses.
Ophthalmic Nerve
• The ophthalmic nerve [V1] exits the skull
through the superior orbital fissure and enters
the orbit.
Branches Of Ophthalmic Nerve
• Lacrimal Nerve
• Supraorbital Nerve
• Supratrochlear Nerve
• Infratrochlear Nerve
• External Nasal Nerve
Lacrimal Nerve
• The lacrimal nerve supplies the skin and
conjunctiva of the lateral part of the upper
eyelid.
Supraorbital Nerve
• The supraorbital nerve winds around the upper
margin of the orbit at the supraorbital notch.
• It divides into branches that supply the skin and
conjunctiva on the central part of the upper eyelid.
• It also supplies the skin of the forehead.
Supratrochlear Nerve
• The supratrochlear nerve winds around the upper
margin of the orbit medial to the supraorbital nerve
• It divides into branches that supply
• Upper eyelid (medial part)
• Lower forehead
• Scalp
Infratrochlear Nerve
• The infratrochlear nerve leaves the orbit below the
pulley of the superior oblique muscle.
• It supplies the skin and conjunctiva on the medial
part of the upper eyelid
• Supplies the adjoining part of the side of the nose
External Nasal Nerve
• The external nasal nerve leaves the nose by
emerging between the nasal bone and the upper
nasal cartilage.
• It supplies the skin on the side of the nose down
as far as the tip.
Maxillary Nerve
• The maxillary nerve [V2] exits the skull
through the foramen rotundum.
Branches Of Maxillary Nerve
• Infraorbital nerve
• Zygomaticofacial nerve
• Zygomaticotemporal nerve
Infraorbital Nerve
• The infraorbital nerve is a direct continuation
of the maxillary nerve.
• It enters the orbit and appears on the face
through the infraorbital foramen.
Infraorbital Nerve(cont.)
• It immediately divides into numerous small branches,
which radiate out from the foramen and supply the
skin of
• the lower eyelid and cheek,
• the side of the nose,
• the upper lip
Zygomaticofacial Nerve
• The zygomaticofacial nerve passes onto the
face through a small foramen on the lateral
side of the zygomatic bone.
• It supplies the skin over the prominence of the
cheek
Zygomaticotemporal Nerve
• The zygomaticotemporal nerve emerges in the
temporal fossa through a small foramen on
the posterior surface of the zygomatic bone.
• It supplies the skin over the temple.
Mandibular Nerve
• The mandibular nerve [V3] exits the skull
through the foramen ovale.
Branches Of Mandibular Nerve
• Mental nerve
• Buccal nerve
• Auriculotemporal nerve
Mental
Nerve
Mental Nerve
• The mental nerve emerges from the mental
foramen of the mandible
• It supplies the skin of the lower lip and chin.
Buccal Nerve
• The buccal nerve emerges from beneath the
anterior border of the masseter muscle
• It supplies the skin over a small area of the
cheek.
BUCCAL
NERVE
Auriculotemporal Nerve
• The auriculotemporal nerve ascends from the
upper border of the parotid gland.
Auriculotemporal Nerve(cont.)
This nerve supplies
• the skin of the auricle,
• the external auditory meatus,
• the outer surface of the tympanic membrane,
• the skin of the scalp above the auricle
Sensory Innervation and Trigeminal Neuralgia
• The facial skin receives its sensory nerve supply
from the three divisions of the trigeminal nerve.
Remember that a small area of skin over the
angle of the jaw is supplied by the great auricular
nerve (C2 and 3)
Sensory Innervation and Trigeminal Neuralgia
• Trigeminal neuralgia is a relatively common
condition in which the patient experiences
excruciating pain in the distribution of the
mandibular or maxillary division, with the
ophthalmic division usually escaping
Facial Nerve
• The muscles of the face, as well as those
associated with the ear and the scalp, are
derived from the second pharyngeal arch.
Facial Nerve
• The facial nerve is the nerve of the second
pharyngeal arch and supplies all the muscles
of facial expression.
Facial Nerve
• It does not supply the skin, but its branches
communicate with branches of the trigeminal
nerve.
Facial Nerve
• It is believed that the proprioceptive nerve fibers
of the facial muscles leave the facial nerve in
these communicating branches and pass to the
central nervous system via the trigeminal nerve.
Branches of Facial Nerve
Extra Cranial Route Of Facial Nerve
• The facial nerve [VII] exits the posterior cranial
fossa through the internal acoustic meatus.
Extra Cranial Route Of Facial Nerve
• It passes through the temporal bone, giving
off several branches, and emerges from the
base of the skull through the stylomastoid
foramen.
Posterior Auricular Nerve
• After passing through stylomastoid foramen it
gives off the Posterior Auricular Nerve.
Posterior Auricular Nerve(cont.)
• This branch passes upward, behind the ear, to supply
occipital belly of occipitofrontalis muscle of the
scalp
the posterior auricular muscle of the ear
Digastric Branch
• The main stem of the facial nerve [VII] then gives off another
branch, which innervates
the posterior belly of the digastric muscle
the stylohyoid muscle.
• At this point, the facial nerve [VII] enters the deep surface of
the parotid gland.
Facial Nerve In Parotid Gland
• Once in the parotid gland, the main stem of
the facial nerve [VII] usually divides into
Upper (temporofacial)
lower (cervicofacial) branches.
The Parotid Plexus
• As two branches of main stem pass through
the substance of the parotid gland they may
branch further or take part in an anastomotic
network (the parotid plexus).
Terminal Branches Of Facial Nerve
• Whatever types of interconnections occur, five
terminal groups of branches of the facial nerve
emerge from the parotid gland.
Terminal Branches Of Facial Nerve
• Temporal,
• Zygomatic,
• Buccal,
• Marginal mandibular,
• Cervical branches
Temporal Branches
• Temporal branches exit from the superior
border of the parotid gland to supply muscles
in the area of
• Temple,
• Forehead,
• Supra-orbital area.
Zygomatic Branches
• Zygomatic branches emerge from the
anterosuperior border of the parotid gland to
supply muscles in the
• Infra-orbital area,
• The lateral nasal area,
• the upper lip.
Buccal Branches
• Buccal branches emerge from the anterior
border of the parotid gland to supply muscles
in the
• Cheek,
• The upper lip,
• And the corner of the mouth.
Buccal Branch Supply these Muscles
Marginal Mandibular
• Marginal mandibular branches emerge from the
anteroinferior border of the parotid gland to supply
muscles of the
• Lower lip
• Chin
Cervical Branches
• Cervical branches emerge from the inferior
border of the parotid gland to supply the
platysma.
Functions Of Facial Nerve
The facial nerve is responsible for:
Contraction of the muscles of the face
Production of tears from a gland (Lacrimal gland)
Conveying the sense of taste from the front part of the
tongue (via the Chorda tympani nerve)
The sense of touch at auricular conchae
Ganglia associated with Facial Nerve
• Geniculate ganglion
• Submandibular ganglion
• Pterygopalatine ganglion
Disorders of Facial Nerve
• Supranuclear type
• Nuclear type
• Peripheral lesions
Bell’s Palsy
Background
• One of the most common neurologic disorders
affecting the cranial nerves.
• Abrupt, unilateral, peripheral facial paresis or
paralysis without a detectable cause.
Incidence
• The incidence of Bell palsy in the United States is
approximately 23 cases per 100,000 persons.
• Internationally: The incidence is the same as in
the United States.
Demographics
• Race: slightly higher in persons of Japanese descent.
• Sex: No difference exists
• Age: highest in persons aged 15-45 years. Bell palsy
is less common in those younger than 15 years and
in those older than 60 years.
Pathophysiology
• Main cause of Bell's palsy is latent herpes
viruses (herpes simplex virus type 1 and
herpes zoster virus), which are reactivated
from cranial nerve ganglia.
Pathophysiology
• Inflammation of the facial nerve initially
results in a reversible neurapraxia (temporary
loss in motor and sensory functions)
History
• The palsy is often sudden in onset and evolves
rapidly, with maximal facial weakness developing
within two days.
• The most alarming symptom of Bell's palsy is
paresis
Physical Examiation
• Bell's phenomenon
upward diversion of the eye on attempted
closure of the lid—is seen when eye closure is
incomplete.
Physical Examiation
It manifests as the
• Unilateral impairment of movement in the facial and platysma
muscles,
• Drooping of the brow
• Corner of the mouth,
• Impaired closure of the eye and mouth.
Summary
• Facial nerve supply all muscles of facial
expression
• Bell’s palsy is lower motor neuron disorder
that effect muscles of facial expression
Thank You For Your
Concentration
Question
• Which of the following nerve is not only
sensory
A. Ophthalmic
B. Mandibular
C. Maxillary
D. Both A & C
Question
• Which of the following nerve is not only
sensory
A. Ophthalmic
B. Mandibular
C. Maxillary
D. Both A & C
Question
• Cutaneous supply of face is
A. Trigeminal nerve only
B. Facial nerve only
C. Both A & B
D. None of the above
Question
• Cutaneous supply of face is
A. Trigeminal nerve only
B. Facial nerve only
C. Both A & B
D. None of the above
Question
• Theory of bell’s palsy is
A. Viral
B. Bacterial
C. Unknown
D. Both A & B
Question
• Theory of bell’s palsy is
A. Viral
B. Bacterial
C. Unknown
D. Both A & B
Question
• In upper motor neuron facial palsy.
A. Paralysis of upper face
B. Paralysis of lower face
C. Paralysis of whole side of face
D. none of above
Question
• In upper motor neuron facial palsy.
A. Paralysis of upper face
B. Paralysis of lower face
C. Paralysis of whole side of face
D. none of above
Question
• Parotid plexus lie
A. Outside the parotid gland
B. Inside the parotid gland
C. Inside cranium
D. Outside cranium
Question
• Parotid plexus lie
A. Outside the parotid gland
B. Inside the parotid gland
C. Inside cranium
D. Outside cranium
