MOB TCD Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinity College Dublin...
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Transcript of MOB TCD Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinity College Dublin...
MOB TCD
Professor Emeritus Moira O’Brien
FRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dublin
Anatomy of the Face
Face
• Sensory supply of face is trigeminal
• 5th cranial nerve• C2 • Motor supply• Muscles of facial expression• Facial nerve 7th cranial
MOB TCD
Sensory Nerve Supply
• Trigeminal• Ophthalmic• Maxillary• Mandibular• Cervical plexus
MOB TCD
Terminal Branches of 5th
• Supraorbital• Infraorbital damaged in blow
out fracture of orbit• Lateral• Mental; dentures, fracture of
mandible • Trigeminal neuralgia
MOB TCD
Sensory Trigeminal Nerve
• Ophthalmic V• Supraorbital• Supratrochlear• Maxillary V• Infraorbital• Zygomaticofacial• Mandibular V• Mental• Buccal
MOB TCD
Fractured Zygoma
• View from above shows depression
• Lateral X-ray view
should be done
MOB TCD
Great Auricular
• C2 from cervical plexus• Skin over angle of mandible
MOB TCD
Scalp
• Skin • Subcutaneous• Epicranial aponeurosis• Three fused together• Loose areolar tissue• Periosteum• Occipito-frontalis• Attached posteriorly• No anterior attachment
MOB TCD
• 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
Scalp MOB TCD
Blood and Nerve Supply of Scalp
• Supraorbital vessels and nerve
• Scalp as far as vertex• Posterior scalp• Greater occipital C2 • Occipital and posterior
auricular vessels• Zygomatico temporal• Greater auricular
MOB TCD
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
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
• Elevates upper eyelid• Voluntary muscle supplied by 3rd
oculomotor nerve• Smooth muscle • Sympathetic T1• Superior cervical ganglion
Levator Palpebrae Superiores MOB TCD
Lacrimal Apparatus
• Lacrimal gland• Conjunctival sac• Puncta• Cananiculi• Nasolacrimal sac• Nasolacrimal duct• Inferior meatus nose
MOB TCD
Horner's Syndrome
• Ptosis• Drooping eyelid• Meiosis• Constricted pupil• Anhydrosis• Lack of sweating• Enopthalmos
MOB TCD
Muscles of Facial Expression
• Muscles of second branchial arch
• 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
Orbicularis Oculi
• Orbital closes eyelid tightly, buries eyelashes
• Makes conjunctival sac smaller
• Finer palpebral portion in eyelid
• Anterior to tarsal plate • Closes eye in blinking and
sleep • No action on conjunctival sac
MOB TCD
• Occipito frontalis • Orbicularis oculi• Orbicularis oris • Buccinator• Platysma• Skin of face• Incisions
Muscles of Facial Expression MOB TCD
• Orbicularis oris• Intrinsic: origin and
insertion inside, only alters shape
• Extrinsic: origin outside, alters position
Muscles of Facial Expression MOB TCD
• Incisions in the face evert edges
• Platysma• Inserted into lower border of
mandible• Posterior fibres form risorius
Muscles of Facial Expression MOB TCD
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
Facial Nerve
Motor nerve to:• Posterior auricular to occipital
belly• Posterior belly of digastric
Enters parotid and divides into branches
• Temporal• Zygomatic • Buccal • Mandibular• Cervical
MOB TCD
• 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. Bell’s palsy
Facial Nerve MOB TCD
Bell’s Palsy
• Lower motor neurone of facial nerve
• Forehead and all themuscles on the side of lesion are affected
MOB TCD
Facial Palsy MOB TCD
MOB TCD
Corneal Reflex
• Afferent (sensory) cilary branches nasocilary of ophthalmic of 5th
• Efferent (motor)• Zygomatic branch of facial 7th
• Last reflex to go
MOB TCD
Blood Supply and Pulses in Face
Internal carotid• Supraorbital artery • Branch of ophthalmic
External carotid• Superficial temporal artery• Facial artery
MOB TCD
Venous Drainage of Face
• Supraorbital and anterior facial
• Communicate superior ophthalmic veins which drain into cavernous sinus
• Deep facial vein• Superficial temporal• Retromandibular• Common facial
MOB TCD
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
Lymph Glands
• Submental• Submandibular• Buccal and
mandibular• Preauricural• Occipital
MOB TCD
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