1.CONTENTS- INTRODUCTION ARTERIES OF FACE VEINS OF FACE APPLIED ASPECT LYMPHATIC DRAINAGE CONCLUSION

2. INTRODUCTION Boundaries of face or Countenance - superiorly to hair line, inferiorly to the chin & the base of mandible & on each side of auricle. 3. 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. 4. 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. 5. 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. 6. 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 7. AORTA Begins at the base of left ventricle 8. Three branches arises from convex aspect of aorta- 1. Brachiocephalic artery 2. Left common carotid 3. Left subclavian artery 9. 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. 10. 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. 11. External Carotid artery Common Carotid artery Internal Carotid artery Carotid bifurcation 12. 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. 13. 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. 14. 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. 15. APPLIED The bifurcation of CCA into ICA & ECA at anterior border of sternoclavicular muscle at the superior border of thyroid cartilage. Carotid pulse 16. CAROTID PULSE CCA may be compressed against the carotid tubercle of transverse process of C6 vertebra about 4cm above the sternoclavicular joint. 17. 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 18. 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. 19. 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 20. C. Medial : Ascending pharyngeal D. Terminal : Maxillary & Superficial temporal 21. 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. 22. 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. 23. 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 24. 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 25. 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) 26. Facial artery Ophthalmic Artery 27. 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. 28. Inferior labial artey Superior labial artery Lateral nasal 29. 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) 30. 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. 31. 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. 32. 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 33. 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. 34. 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. 35. Transverse facial artery Superficial temporal artery 36. 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 37. 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 38. 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. 39. Opthalmic artery Internal carotid artery zygomaticofacial artery Dorsal nasal artery 40. VEINS OF FACE 1. Facial vein - major vein draining the face 2. Transeverse facial vein 41. 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. 42. Supra orbital vein Supra trochlear vein Facial vein Common facial vein Retromandibular vein Superficial temporal vein Maxillary vein Posterior auricular vein 43. TRANSVERSE FACIAL VEIN Small vein supplies the face. It empties into the superficial temporal vein within the substance of parotid gland. 44. 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). 45. Facial vein Opthalmic vein Deep Facial vein 46. Pterygoid plexus Inferior ophthalmic vein Facial vein Cavernous sinus 47. 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. 48. 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. 49. 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 50. 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. 51. Symptoms- 1. Periorbital edema 2. Headache 52. 3. Photophobia 4. Proptosis bulging of the eye 53. 5. Ptosis- drooling of upper eyelid 6. Chemosis edema of the mucous membrane of the eyeball & eyelid lining. 54. LITTLES AREA The anteroinferior part of septum contains anastomoses between the superior labial branch of the facial artery and sphenopalatine artery. 55. common site of bleeding from the nose (epistaxis). known as Littles area or kiesselbachs area 56. 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 57. 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 58. 3. Lower territory Submental nodes Central part of the lower lip Chin (c) lower territory 59. 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. 60. 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. Grays anatomy for student.International Edition. 4. Sinnatamby C S. Lasts anatomy regional and applied. 11th edition.