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    MOB TCD

    Professor Emeritus Moira OBrienFRCPI, FFSEM, FFSEM (UK), FTCD

    Trinity College

    Dublin

    Anatomy of the Face

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    Face

    Sensory supply of face istrigeminal

    5th cranial nerve

    C2

    Motor supply

    Muscles of facial expression

    Facial nerve 7th cranial

    MOB TCD

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    Sensory Nerve Supply

    Trigeminal

    Ophthalmic

    Maxillary

    Mandibular

    Cervical plexus

    MOB TCD

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    Terminal Branches of 5th

    Supraorbital Infraorbital damaged in blow

    out fracture of orbit

    Lateral

    Mental; dentures, fracture ofmandible

    Trigeminal neuralgia

    MOB TCD

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    Sensory Trigeminal Nerve

    OphthalmicV Supraorbital

    Supratrochlear

    Maxillary V

    Infraorbital

    Zygomaticofacial

    Mandibular V

    Mental

    Buccal

    MOB TCD

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    Fractured Zygoma

    View from aboveshows depression

    Lateral X-ray view

    should be done

    MOB TCD

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    Great Auricular

    C2 from cervical plexus Skin over angle of mandible

    MOB TCD

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    Scalp

    Skin Subcutaneous

    Epicranial aponeurosis

    Three fused together

    Loose areolar tissue

    Periosteum

    Occipito-frontalis

    Attached posteriorly

    No anterior attachment

    MOB TCD

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    Occipital portion of occipito-frontals and epicranial

    aponeurosis attached to bone

    posterior

    Frontal no bony attachment Scalp wounds cause black eyes

    Occipital belly

    Posterior auricular of facial

    nerve Frontal belly by temporal of

    facial nerve

    ScalpMOB TCD

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    Blood and Nerve Supply of Scalp

    Supraorbital vessels andnerve

    Scalp as far as vertex

    Posterior scalp

    Greater occipital C2

    Occipital and posterior

    auricular vessels

    Zygomatico temporal

    Greater auricular

    MOB TCD

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    Eyelid

    Skin Orbicularis oculi

    Palpebral portion

    Orbital septum and tarsal

    plates, mebonium glands

    Medial palpebral ligament

    anchors tarsal plates to

    anterior lacrimal crest

    Conjunctival sac

    MOB TCD

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    Levator Palpebrae Superiores

    Arises from back of roof of orbit Inserted into skin of upper eyelid

    The superior tarsal plate

    Superior fornix of conjunctiva

    MOB TCD

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    Elevates upper eyelid Voluntary muscle supplied by 3rd

    oculomotor nerve

    Smooth muscle

    Sympathetic T1 Superior cervical ganglion

    Levator Palpebrae SuperioresMOB TCD

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    Lacrimal Apparatus

    Lacrimal gland Conjunctival sac

    Puncta

    Cananiculi

    Nasolacrimal sac

    Nasolacrimal duct

    Inferior meatus nose

    MOB TCD

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    Horner's Syndrome

    Ptosis Drooping eyelid

    Meiosis

    Constricted pupil

    Anhydrosis

    Lack of sweating

    Enopthalmos

    MOB TCD

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    Muscles of Facial Expression

    Muscles of second branchialarch

    Nerve second arch is facial

    nerve

    Inserted into skin of face Buccal pad of fat

    No deep fascia in face

    Except around parotid

    Parotid duct

    MOB TCD

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    Orbicularis Oculi

    Orbital closes eyelid tightly,buries eyelashes

    Makes conjunctival sac

    smaller

    Finer palpebral portion ineyelid

    Anterior to tarsal plate

    Closes eye in blinking and

    sleep No action on conjunctival sac

    MOB TCD

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    Occipito frontalis Orbicularis oculi

    Orbicularis oris

    Buccinator

    Platysma Skin of face

    Incisions

    Muscles of Facial ExpressionMOB TCD

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    Orbicularis oris Intrinsic: origin and

    insertion inside, only

    alters shape

    Extrinsic: origin outside,alters position

    Muscles of Facial ExpressionMOB TCD

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    Incisions in the face evertedges

    Platysma

    Inserted into lower border of

    mandible Posterior fibres form risorius

    Muscles of Facial ExpressionMOB TCD

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    Buccinator

    Buccinator 7th

    nerve Accessory muscle of

    mastication

    Outer aspect of maxilla and

    mandible Related to molar teeth

    Pterygomandibular raphe

    Action keeps food out of

    vestibule Sucking

    Blowing trumpet

    MOB TCD

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    Facial Nerve

    Motor nerve to: Posterior auricular to occipital

    belly

    Posterior belly of digastric

    Enters parotid and divides intobranches

    Temporal

    Zygomatic

    Buccal

    Mandibular

    Cervical

    MOB TCD

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    Stroke Upper motor neurone of

    facial

    Forehead is spared

    Can wrinkle forehead Bilaterally innervated

    All muscles of one side

    paralysed if it is a lower

    motor neurone e.g. Bellspalsy

    Facial NerveMOB TCD

    MOB TCD

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    Bells Palsy

    Lower motor neurone offacial nerve

    Forehead and all the

    muscles on the side of

    lesion are affected

    MOB TCD

    MOB TCD

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    Facial PalsyMOB TCD

    MOB TCD

    MOB TCD

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    Corneal Reflex

    Afferent (sensory) cilary branchesnasocilary of ophthalmic of 5th

    Efferent (motor)

    Zygomatic branch of facial 7th

    Last reflex to go

    MOB TCD

    MOB TCD

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    Blood Supply and Pulses in Face

    Internal carotid Supraorbital artery

    Branch of ophthalmic

    External carotid

    Superficial temporal artery

    Facial artery

    MOB TCD

    MOB TCD

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    Venous Drainage of Face

    Supraorbital and anteriorfacial

    Communicate superior

    ophthalmic veins which

    drain into cavernous sinus Deep facial vein

    Superficial temporal

    Retromandibular

    Common facial

    MOB TCD

    MOB TCD

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    Emissary Veins Cavernous Sinus

    Superior ophthalmic veins Anterior facial

    Deep facial

    Pterygoid plexus

    Danger area of face Parietal emissary veins from

    scalp to superior sagittal sinus

    MOB TCD

    MOB TCD

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    Lymph Glands

    Submental Submandibular

    Buccal and

    mandibular

    Preauricural Occipital

    MOB TCD

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    BMJ Publishing Group Limited (BMJ Group) 2012. All rights reserved.


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