Face 1

Dr. Sina Mojaverrostami

Assistant professor in TUMS

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• The human face refers to the area that extends from the superior
margin of the forehead to the inferior border of the mandible,
and from one ear to another.
• The basic shape of the human face is determined by the
underlying facial skeleton (i.e. viscerocranium), the facial
muscles and the amount of subcutaneous tissue present.
• The face plays an important role in communication and
the expression of emotions and mood.

Important structures in the face:

1. Skin
2. Superficial fascia (with the muscles of facial expression are located
within the subcutaneous tissue )
3. Deep fascia
4. Parotidomassetric region
5. Infratemporal region

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• Skin:
The skin of the face is full of blood vessels, and for this reason, the
wounds that are created in the face area are repaired very quickly, and
plastic surgery in the face area is very successful. The face is richly
perfused by a subdermal plexus formed mainly by arteries coming
from the superficial temporal and facial arteries.
Sensation on the face is innervated by the trigeminal nerves (V) as are
the muscles of mastication, but the muscles of facial expression are
innervated mainly by the facial nerve (VII) as is the sensation of taste.

• The superficial nerves of the face and scalp are derived from three
sources located in the head and neck:
• Facial nerve (CN VII), which provides motor innervation to the
muscles of the face
• Trigeminal nerve (CN V), which provides sensory innervation to
the face via its ophthalmic division (CN V1), maxillary division (CN
V2) and mandibular division (CN V3)
• The cervical plexus, which provides innervation to the scalp.

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• Superficial and deep fascia
Superficial fascia has subcutaneous muscle, superficial vessels and
nerves. The muscles of facial expression are located within the
subcutaneous tissue of the face. They originate from bone or fascia
and insert onto the skin. As they contract, the muscles pull on the
skin to exert their effects. They are all innervated by branches of
the facial nerve.

Deep fascia is the continuation of the investing fascia and has 2

parts: parotid fascia and masseteric fascia
The masseteric fascia (parotideomasseteric fascia) is a strong layer
of fascia derived from the deep cervical fascia on the human head
and neck. It covers the masseter, and is firmly connected to it.
Above, this fascia is attached to the lower border of the zygomatic
arch, and behind, it invests the parotid gland proceeding into
the parotid fascia.

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The facial muscles are also known as the muscles of the facial
expression or the mimetic muscles. These muscles are a group of
approximately 20 superficial skeletal muscles of the face
and scalp divided into five different groups according to their
location and function. 3 groups for face and 2 groups for scalp.
These groups include:

Orbital group: Orbicularis oculi and corrugator

supercilii muscles.
Nasal group: Nasalis , depressor septi muscles
and procerus muscles.
Oral group: Levator labii superioris, levator labii superioris
alaeque nasi, risorius, levator anguli oris, zygomaticus
major, zygomaticus minor, depressor labii inferioris, depressor
anguli oris, mentalis, orbicularis oris and buccinator muscles.

Epicranial group: Occipitofrontalis.

Auricular group: Auricularis anterior, auricularis superior,
auricularis posterior muscles.

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 Orbicularis oculi
Orbicularis oculi is a flat, broad muscle that forms an ellipse around the
circumference of the orbit. It is composed of orbital, palpebral and
lacrimal parts.
Orbital part: overlays the orbital rim and originates from the nasal part
of frontal bone, frontal process of maxilla and medial palpebral ligament.
The fibers encircle the orbit completely, extending into the soft tissues of
adjacent regions.
Palpebral part: originates from the superficial surface of the medial
palpebral ligament. The muscle fibers compose the eyelids as they travel
towards the lateral commissure of the eye. Here, the superior and
inferior fibers unite and insert into the lateral palpebral ligament (raphe).
Lacrimal part: originates from the lateral surface and lacrimal crest
(superior part) of lacrimal bone. The fibers course laterally, passing
posterior to the lacrimal sac. Some insert into the superior and
inferior tarsi of eyelids, while others continue past the tarsi to insert into
the lateral palpebral ligament.
Action:
Orbital part: Closes eyelids tightly
Palpebral part: Closes eyelids gently
Deep palpebral part: Compresses lacrimal sac

Innervation: Temporal and zygomatic branches of facial nerve (CN VII) 6

 Corrugator supercilii
• Corrugator supercilii is a paired muscle found deep to the medial end of each eyebrow. Upon contraction,
these muscles draw the two eyebrows together medially and inferiorly, thereby producing vertical wrinkles
over the glabella and an expression of frowning.
• Origin and insertion: Corrugator supercilii originates from the medial end of the superciliary arch of frontal
bone, cranially to the root of the nose. Its fibers extend diagonally, laterally and slightly superiorly to insert
into the skin of the eyebrow above the middle part of the supraorbital margin.
• Action: pulls the eyebrows medially and inferiorly. This action can serve different functions, such
as protecting the eyes from bright sunlight or rain and frowning.
• Corrugator supercilii is innervated by the temporal branches of the facial nerve (CN VII).

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 Nasalis
• Nasalis muscles are found on each side of the midline,
respectively. Each muscle is composed of two parts; lateral
or transverse part (compressor naris) and medial or alar
part (dilator naris posterior).
• The transverse part covers the dorsum of the nose. It
originates from the maxilla, attaching superolateral to the
incisive fossa. Its fibers then course superomedially,
expanding into a thin aponeurosis at the bridge of the
nose. Via this aponeurosis, the muscle inserts at the
dorsum of the nose by blending with its counterpart from
the opposite side.
• The alar part comprises the nostrils. It originates from the
frontal process of maxilla, just superior to the
lateral incisor. After a short superoanterior course, it
inserts to the skin of ala, superior to the lateral crus of
major alar cartilage.
• Nasalis muscle is innervated by the buccal branch of facial
nerve (CN VII).

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 Procerus
• Procerus muscle originates from the nasal bone and
superior part of the lateral nasal cartilage. Its muscle fibers
diverge superiorly, mostly inserting into the dermis of skin
over the glabella. A small portion of muscle fibers
indistinguishably blend with the lower part of the frontal
belly of occipitofrontalis muscle.
• Action: Procerus muscle depresses the medial end of
eyebrows and wrinkles the glabellar skin. This produces the
characteristic frowning expression shown by an individual
upon exposure to strong and bright light, while focusing or
when experiencing emotional distress.
• Innervation to procerus comes from the temporal, lower
zygomatic or buccal branches of facial nerve (CN VII).

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 Depressor septi nasi
• The depressor septi nasi is a nasal muscle of facial expression. It
assists the alar part of the nasalis muscle in widening the nasal
opening.
• Attachments – Originates from the maxilla (above the medial
incisor tooth) and inserts onto the nasal septum.
• Actions – Pulls the nasal septum inferiorly to widen the nasal
opening.
• Innervation – Buccal branches of the facial nerve.

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 Levator labii superioris
Levator labii superioris originates from the zygomatic
process of maxilla and maxillary process of zygomatic
bone, just superior to the infraorbital foramen. It courses
inferomedially towards the upper lip, gradually tapering
and becoming triangular in shape.
Action: Together with zygomaticus minor and levator labii
superioris alaeque nasi, this muscle is a direct tractor of
the upper lip. It has an important function in several facial
expressions; smiling, smugness and contempt.
Levator labii superioris is innervated by the zygomatic and
buccal branches of facial nerve (CN VII).

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 levator labii superioris alaeque nasi
• The levator labii superioris alaeque nasi muscle
originates from the frontal process of the maxilla. And
inserts into the skin of the ala of the nose and upper
lip.
• Action: Contractions of the levator labii superioris
alaeque nasi dilate the nostril and elevate the wing of
the nose and upper lip. This muscle is responsible for
the facial expression that accompanies snarling.
• Innervation: The levator labii superioris alaeque nasi
muscle is innervated by the zygomatic branches of
the facial nerve (CN VII).

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 Levator anguli oris
Levator anguli oris originates from the canine fossa
of maxilla, inferior to the infraorbital foramen. After a
short inferior course, it blends with the modiolus at the
angle of the lips.
Action: Levator anguli oris elevates the angle of lips,
which deepens the nasolabial folds and enables smiling.
Innervation: Zygomatic and buccal branches of facial
nerve (CN VII) innervate the levator anguli oris muscle.

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 Zygomaticus minor
• Zygomaticus minor originates from the anterior portion of the
lateral surface of zygomatic bone, just posterior to the
zygomaticomaxillary suture. It courses inferoanteriorly towards
the lips, passing obliquely across the lateral surface of the maxilla.
The muscle inserts medial to the zygomaticus major muscle.

• Action: Zygomaticus minor is a direct tractor of the upper lip,

together with levator labii superioris alaeque nasi and levator
labii superioris. This means that it inserts to the upper lip
directly, thus acting upon it without an intermediary.

• Zygomaticus minor is innervated by the buccal branches

of facial nerve (CN VII).

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 Zygomaticus major
• The zygomaticus major muscle originates from the lateral
surface of the zygomatic bone, just anterior to the
zygomaticotemporal suture and lateral to the origin of
zygomaticus minor. It courses inferomedially over the lateral
surface of the maxilla to insert to the angle of the mouth. This
attachment point is located lateral to zygomaticus minor and
medial to risorius muscles.
• zygomaticus major interlaces with other muscles that
converge towards the angle of the mouth, forming a dense,
mobile, fibromuscular mass called the modiolus. It is not
entirely clear which muscles exactly attach to the modiolus,
but some of the certain ones include depressor anguli oris,
buccinator, risorius, zygomaticus major and orbicularis oris
muscles.
• Action: As zygomaticus major contracts, it pulls the angle of
the mouth superolaterally. In synergy with risorius,
zygomaticus major produces the expression of smiling.
• Zygomaticus major is innervated by the zygomatic and buccal
branches of facial nerve (CN VII).
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 Depressor labii inferioris
Depressor labii inferioris originates from the oblique
line of mandible, between the symphysis menti and
mental foramen. From here, the muscle courses
superomedially, inserting to the skin and submucosa of
lower lip. The mandibular end of depressor labii
inferioris is continuous with platysma, while the labial
attachment fuses with its counterpart and inferior
fibers of the orbicularis oris muscle.
Action: Together with the labial part of platysma,
depressor labii inferioris is a direct tractor of the lower
lip, meaning that it inserts to, and acts directly upon,
the lip without an intermediary. When contracting, this
muscle pulls the lower lip inferomedially. This action
helps in producing the facial expressions associated
with sadness, doubt and melancholy.
Depressor labii inferioris is innervated by the
mandibular branch of facial nerve (CN VII).

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 Depressor anguli oris
Depressor anguli oris originates from the oblique
line and mental tubercle of mandible located on the
anterior aspect of the bone. The muscle fibers
converge into a narrow fascicle running superiorly
towards the angle of the mouth. It then blends with
other muscles that insert into the lips.
Depressor anguli oris pulls the angle of the
mouth inferolaterally. Its action plays an important
part in facial expression, as it helps expressing
feelings of sadness or anger. This is why depressor
anguli oris is deemed one of the “frowning muscles”.

Depressor anguli oris receives motor innervation

from marginal mandibular and buccal branches
of facial nerve (CN VII).

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 Mentalis
Mentalis muscle originates from the incisive fossa
of mandible. Its short fibers descend inferiorly to insert
to the skin of the chin, at the level of mentolabial
sulcus.
Action: Pullings its cutaneous attachment superiorly,
mentalis muscle elevates the base of the lower lip, thus
everting and protruding it. This movement also wrinkles
the skin of the chin.
Mentalis is innervated by the mandibular branch
of facial nerve (CN VII).

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 Orbicularis oris
Orbicularis oris is a composite muscle that consists of two
parts; a larger peripheral part, and a smaller marginal part.
The border between these two portions corresponds to the
margins of the lips that separates them from the
surrounding skin. Both parts span between the left and
right modiolus, which is a dense fibromuscular nodule at
the angle of the mouth onto which most of the buccolabial
muscles attach.
Action: Can closes mouth, compresses and protrudes lips.

The orbicularis oris is innervated by the buccal and

mandibular branches of facial nerve (CN VII).

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 Buccinator
Its superior part arises from the outer surface of the alveolar
process of the maxilla . The inferior part also arises from the
alveolar part of the mandible. The posterior part of the buccinator
originates from the anterior margin of the pterygomandibular raphe
( tendinous band behind the third molar spanning from the
pterygoid hamulus to the posterior end of the mylohyoid line).
Converging towards the angle of the mouth, the three parts of
buccinator fill the space between the upper and lower jaws. At the
angle of the mouth, the buccinator fibers interlace with other
muscles that attach at the same site, including orbicularis oris,
risorius, depressor anguli oris and zygomaticus major. These
muscles blend and form a dense fibromuscular mass called
the modiolus.
Action: The buccinator maintains the tightness of the cheeks and
presses them against the teeth during chewing. It also assists
the tongue to keep the bolus of food central in the oral cavity. The
buccinator muscle expelling the air from the inflated vestibule while
playing a wind instrument such as the trumpet. This is why the
buccinator muscle is also called the "trumpet muscle".
The buccinator is innervated by the buccal branches of facial nerve
(CN VII).

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 Risorius
It is deemed as the ‘smiling muscle’ as its bilateral contraction pulls
the angles of the mouth laterally and slightly superiorly and
produces a smile.
Risorius muscle has a very variable form, ranging from a fleshy
slender fascicle to a broad thin superficial fan. It has a number of
origin points which are sometimes inconsistent and include the
parotid fascia, fascia over the masseter anterior to the parotid
gland.
From these origin points, the muscle fibers of risorius converge
medially taking an almost horizontal course towards the angle of
the mouth.
As the risorius contracts in an outward and upward motion, the
muscle pulls the angle of the mouth laterally.
Risorius is innervated by the buccal branch of facial nerve (CN VII).

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 Occipitofrontalis
Occipitofrontalis is a long and wide muscle of the scalp, spanning from the
eyebrows to the superior nuchal lines of occipital bones.
Occipitofrontalis consists of frontal and occipital bellies, each containing a
pair of quadrangular muscle heads. The bellies are connected by a thick
fibrous sheath called epicranial aponeurosis (galea aponeurotica) onto
which both of them attach. The function of occipitofrontalis muscle is to
elevate the eyebrows and wrinkle the forehead skin with its frontal part,
and to retract the scalp with its occipital part.
Frontal belly overlies the forehead and has no bony attachments. Its
superficial fibers originate from the dermis of the skin and subcutaneous
tissue of the eyebrows, while deeper fibers arise from the superior parts
of procerus, orbicularis oculi and corrugator supercilii muscles. The belly
then courses posterolaterally to insert into the epicranial aponeurosis
anteriorly to the coronal suture of the skull.
Occipital belly overlies the back of the skull. It originates from the lateral
two-thirds of the superior nuchal lines of occipital bone. After a short
course superiorly, their muscle fibers insert into the epicranial
aponeurosis posteriorly to the lambdoid suture.
Both parts of the muscle are supplied by the facial nerve (CN VII) that
gives off temporal branches for the frontal belly, and the posterior
auricular nerve for the occipital belly.

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 Parotidomassetric region
This region is located anterior and inferior to the ear and consists of
masseter muscle and parotid gland.
Masseter muscle is a paired, strong, thick and rectangular muscle that
is originating from the zygomatic arch and extends down to
the mandibular angle. It consists of a superficial and a deep part.
It is one of the masticatory muscles, a group of muscles which also
includes the temporalis muscle, lateral pterygoid muscle and medial
pterygoid muscle.

The parotid gland is a bilateral salivary gland located in the face.

It produces serous saliva – a watery solution rich in enzymes – which is
then secreted into the oral cavity, where it lubricates and aids in the
breakdown of food.
3 structures are located inside of parotid gland: Fascial nerve,
Retromandibular vein (which forms external jugular vein) and external
carotid artery.

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 Masseter muscle
The superficial part originates from the maxillary process of the
zygomatic bone. The deep originates from the entire length of the
inferior border of the zygomatic arch. The 2 parts insert onto
the coronoid process, ramus of mandible and angle of the
mandible.
The entire superficial (lateral) aspect of the muscle is covered with
thin but very strong masseteric fascia.
Also on the superficial side, below the zygomatic process, the duct
of the parotid gland passes across the surface of the muscle. This
duct courses mostly over the anterior part of the lateral aspect.
Anterior to the muscle, the buccinator muscle is located. The
abovementioned duct of the parotid gland actually penetrates the
fibers of the buccinator muscle to find its way to the inside of the
oral cavity and finally open onto the inner side of the cheek.
Innervation: The masseter muscle is innervated by the special
branch of the mandibular nerve, called the masseteric nerve.
Action: The masseter is one of the four muscles of the masticatory
apparatus. It elevates the mandible causing a powerful jaw
closure.
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 Parotid gland
Parotid glands that are situated in the preauricular area on
each side of the face. It is the largest of the three major
salivary glands (the others being the submandibular and
sublingual glands), and weigh around 15 – 30 grams each.
Each gland is irregular, consisting of a superficial and a deep
lobe, and is tan-yellow in appearance. Although the parotid
gland is described as being irregular, its general outline is that
of an inverted pyramid.
The base is the most superior part of the gland, while the
blunted apex points inferiorly. It also has anteromedial,
posteromedial, and lateral (superficial) surfaces.
The borders of the parotid gland are as follows:
Superiorly by the zygomatic arch
Posterosuperiorly by the external acoustic meatus and the
ramus of the mandible
Posteroinferiorly by the mastoid process and distal part of the
mastoid head of sternocleidomastoid muscle
Inferiorly the gland is limited by the sternocleidomastoid
muscle and posterior belly of digasteric
Anteriorly the masseter muscle forms another boundary

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The Lateral surface of the gland is covered by the investing layer of
the deep cervical fascia (Parotid sheath), the medial surface gland,
this deep cervical fascia formed stylomandibular ligaments.

Structures passing through the parotid gland:

The gland is separated into the superficial and deep lobes by
the facial nerve (CN VII). The nerve enters the posterior border of
the parotid gland after leaving the stylomastoid foramen. Within the
substance of the gland, CN VII bifurcates into the superior (or
temporofacial) and inferior (cervicofacial) divisions. The part of the
gland that is medial to CN VII is the deep lobe, while the part that is
lateral to the nerve is the superficial lobe.
Another important structure that passes through and divides within
the substance of the parotid gland is the external carotid artery. As
it passes through the posteromedial aspect of the gland, it gives off
the maxillary artery, as well as the superficial temporal artery.
The third structure that passes through the parotid gland is
the retromandibular vein. It is the product of the union of the
superficial temporal and maxillary veins. Posterior branch of
retromandibular vein latter joins the posterior auricular vein and
form external jugular vein.

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 The parotid duct of Stensen
The parotid duct is roughly 7 cm x 3 mm long and leaves the superior part of the anteromedial
surface of the gland. It passes horizontally over the surface of the masseter muscle then courses
medially toward the anterior border of the muscle. The duct then makes an abrupt right turn to
cross the buccinator muscle and associated buccal fat pad.
Parotid duct (lateral-right view)The parotid duct has a short submucosal course beginning at the
crown of the upper third molar, then anteriorly and obliquely toward the upper second molar. The
duct will eventually pierce the buccal mucosa to enter the oral cavity via a papilla adjacent to the
upper second molar tooth.

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• There are two major modalities that are transmitted to
and from the parotid gland - autonomic instructions
and sensory perceptions. These nerve impulses are
transmitted along cranial nerves to the gland.
• The gland is under parasympathetic regulation. It receives
these fibers via the lesser petrosal nerve, which is a branch
of the glossopharyngeal nerve (CN IX). Of note, CN IX
synapses on the otic ganglion. The postganglionic
secretomotor fibers that emerge from the otic ganglion
reach the parotid gland via the auriculotemporal nerve (a
branch of the mandibular division of the trigeminal nerve
[CN V3]).
• The sympathetic supply is derived from the
adjacent sympathetic plexus of the carotid sheath.
• The auriculotemporal nerve (a branch of mandibular
nerve) is also responsible for carrying general visceral
afferent (sensory) stimuli from the gland as well.

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 Facial nerve
The seventh cranial nerve (CN VII), the facial nerve, is
responsible for providing motor innervation to these
facial muscles, enabling you to smile or frown. In
addition to motor fibers, this multitasking nerve also
contains sensory and parasympathetic components.
The facial nerve leaves the facial canal through
the stylomastoid foramen. It then gives off the posterior
auricular nerve before continuing to enter the parotid
gland located in the parotidomasseteric region of the
face. It concludes its course by piercing the parotid
gland, of which five terminal branches arise to form the
parotid plexus.

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The facial nerve exits the skull via the stylomastoid foramen,
after which it gives off the following branches:
The posterior auricular nerve is the first extracranial branch to
emerge which continues to provide motor innervation to
the occipital belly of the occipitofrontalis muscle (occipital
branch) and intrinsic auricular muscles (auricular branch). It
equally provides innervation of the skin around the external
acoustic meatus and the retroauricular region.
Digastric and stylohyoid branches of the facial nerve are given off
which carry motor fibers to the respective muscles.
Finally, the facial nerve pierces the parotid gland (but does not
innervate it) and bifurcates into superior (temporofacial)
and inferior (cervicofacial) trunks, which further give rise to its
five terminal branches:
Temporal branches: supply the frontalis, orbicularis
oculi and corrugator supercilii muscles.
Zygomatic branches: supply the orbicularis oculi muscle.
Buccal branches: supply the orbicularis
oris, buccinator and zygomaticus muscles.
Marginal mandibular branch: supplies the depressor labii
inferioris, depressor anguli oris and mentalis muscles.
Cervical branch: supplies the platysma muscle in the neck.

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 External carotid artery
The maxillary and superficial temporal arteries form the
two terminal branches of the external carotid artery in the
parotid gland.
The superficial temporal artery arises as the smaller
terminal branch of the external carotid artery. It similarly
arises within the substance of the parotid gland behind
the neck of the mandible. It ascends from the parotid
gland superficially alongside the auriculotemporal nerve
to the scalp.
The maxillary artery is the larger of the
two terminal branches and arises from the external
carotid artery within the parotid gland. From the parotid
gland, the maxillary artery passes anteriorly between the
neck of the mandible and the sphenomandibular ligament
to enter the infratemporal fossa.

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 Superficial temporal artery
Branches of the superficial temporal artery include
the transverse facial, zygoaticoorbital and middle
temporal arteries. Additionally it provides parotid,
anterior auricular, frontal and parietal branches.
The superficial temporal artery provides
arterial supply to the skin and muscles of the side of
the face and scalp. It also provides arterial supply to
the parotid gland and temporomandibular joint.

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 Retromandibular vein
The retromandibular vein arises posterior to the
mandibular ramus, from the confluence of
the superficial temporal and maxillary veins.
The retromandibular vein runs within the substance of
the parotid gland, superficial to the external carotid
artery, and deep to the facial nerve. Along its course,
the retromandibular vein drains the jaw, the lateral
skull, the parotid gland and the masseter muscle. Upon
reaching the inferior pole of the parotid gland, the
retromandibular gland divides into an anterior and
posterior branch.
The anterior branch joins the facial vein just
anteroinferior to the mandibular angle to form the
common facial vein. The common facial vein continues
inferiorly to reach the upper angle of the carotid
triangle, where it drains into the internal jugular vein.
The posterior branch pierces the investing layer of
deep cervical fascia and joins the posterior auricular
vein just below the apex of the parotid gland, forming
the external jugular vein. This vein descends across the
neck over sternocleidomastoid muscle to drain into
the subclavian vein.
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