Face

FACE   

Boundaries

• Superiorly: upto hair line
• Inferiorly: Upto chin & base of mandible
• Sides: Upto auricle 

NERVE SUPPLY

• Each half of the face is supplied by 14 nerves, one is motor & rest are sensory.
• MOTOR NERVE SUPPLY: Derived from Facial nerve (VII) which supplies all facial muscles except levator palpebrae superioris , which is supplied by sympathetic fibers & 3rd cranial nerve.
• SENSORY NERVE SUPPLY: 11 sensory nerves are derived from branches of trigeminal (5th) nerve & only 2 sensory are derived from Great auricular nerve & transverse (anterior) cutaneous nerve of neck. 

ARTERIAL SUPPLY

• Face is supplied by Facial artery, transverse facial artery & arteries that accompany cutaneous nerves.
• Facial artery is the chief artery of face. It arises from external carotid artery above the level of tip of greater cornu of hyoid bone, in carotid triangle.
• The facial artery enters the face by winding around the base of the mandible & by piercing the deep cervical fascia, at the anterioinferior angle of Masseter. It can be palpated here & is called anaesthetic artery.

BRANCHES OF FACIAL ARTERY

• Transverse facial artery is a branch of superficial temporal artery, emerges from parotid gland.
• It supplies parotid gland, overlying skin, masseter, & ends by anastomosing with neighbouring arteries. 

VEINS OF FACE

• The facial vein is the largest vein of the face with no valves.
• It begins as the angular vein at the medial angle of the eye.
• Angular vein is formed by the union of supraorbital veins & supratrochlear veins.
• The angular vein continues as facial veins which joins the anterior division of retromandibular vein (i.e deep facial vein) below the angle of the mandible to form common facial vein.
• Commin facial vein drains into the internal jugular vein.
• Facial vein communicates with cavernous sinus through deep connections:-

1.  A communication v/w supraorbital & superior ophthalmic veins.
2. With the pterygoid plexus through deep facial vein

• Therefore, infection from thr face can spread in retrograde direction & cause Cavernous sinus thrombosis (CVT).
• This is specially likely to occur in the presence of infection in the upper lip & in lower part of the nose.
• This are is therfore, called dangerous area of the face. 

LYMPHATIC DRAINAGE

• The face posss three areas from which lymphatic drainage is as follows:

1. UPPER AREA, comprising greater part of forehead, lateral 1/2 of eyelids, conjunctiva, lateral part of cheek & parotid area, drains into→preauricular (superficial) parotid nodes.
2. MIDDLE AREA, comprising central part of forehead, external nose, upper lip, lateral part of lower lip, medial halves of eyelids, medial part of cheek & greater part of lower jaw, drains into→ Submandibular nodes.
3. LOWER AREA, including central part of lower lip & the chin, drains into→Submental nodes.

• Lymphatic drainage of nose is as follows:-

1. Anterior half of nasal cavity (Both septum & lateral wall)→ Submandibular nodes.
2. Posterior half of nasal cavity (Both septum & lateral wall)→ Retropharyngeal nodes & upper deep cervical nodes.

Exam Question

• Lymphatic drainage of lateral wall of nose Submandibular nodes,  Retropharyngeal nodes & upper deep cervical nodes.
• Angular vein communicares with Cavernous sinus.
• Dangerous area of face are upper lip & lower part of the nose.
• Angle of mandible supplied by Greater auricular nerve.
• Tip of nose is supplied by External nasal branch of Ophthalmic nerve.
• Muscles of face are supplied by Facial nerve except Levator palpebrae superioris.
• Levator palpebrae superioris muscle is supplied by sympathetic fibers & Occulomotor nerve.
• Complication of trauma to danger area of face- Cavernous sinus infection.
• Lymphatic drainage of lateral part of lower lip by Submandibular nodes.