THE FACE

o Fractures that affect the facial skeleton:

1. La Fort 1: A horizontal fracture through the maxilla, at the base of alveolar process (i.e. at the top of the upper teeth).

§ The alveolar process of the maxilla and upper teeth come of as a unit.

§ The rest of the maxilla remains attached to the zygomatic bone.

2. La Fort 2: Complete separation of the maxilla. Essentially, the nose is separated from the facial skeleton.

3. La Fort 3: Zygomatic bone separates from the frontal bone. Essentially, the entire face breaks lose from the cranium.

§ The orbits drop down, causing double vision.

o FACE LACERATIONS: Because facial skin is loose, lacerations in the face tend to gape. Injuries in the face tend to swell more than other tissues.

o GALEA APONEUROTICA: Superficial fascia of the scalp. The frontalis muscle inserts into the Galea Aponeurotica.

o STARVATION: The Buccal Fat Pad, directly deep to the Buccinator Muscle, and the Retro orbital Fat Pad are the last fat stores to be used when energy is needed. Thus depletion of these fat-pads (sunken eyes and hollowed out cheeks) indicates starvation.

THE FACIAL ARTERY supplies blood to the superficial structures of face.

• The facial artery is one of the principle branches given off the External Carotid.

• Course:
• It is given off just deep to the angle of the mandible.
• It crosses the inferior border of the mandible just anterior to the masseter muscle.
• Once it’s on the anterior surface of the face, it goes up the cheek, past the angle of the mouth, and heads toward the inner canthus (medial corner) of the eye.
• A Facial Artery Pulse can be palpated as the artery crosses the mandible just anterior to the masseter muscle.
• Branches:
• Superior Labial Branch above mouth
• Has anastomoses with the Infraorbital Artery
• Inferior Labial Branch below mouth
• Angular Artery heads up to the nose
• Has anastomoses with the Ophthalmic Artery
Lateral Nasal Branch
• 
  

SUPERFICIAL TEMPORAL ARTERY: The terminal branch of the External Carotid.

• Goes straight up the temporal region of the skull.
• Branches:
• Frontal Branch
• Parietal Branch.
• Transverse Facial Artery crosses Masseter muscle
• Anesthesiologists use it to take a pulse. It is found just anterior to the ear, superficial to the zygomatic arch.
  

VEINS OF THE FACE:

1. Venous Channels:

• Facial Vein provides the major venous drainage ------> Internal Jugular Vein.
• Facial vein is formed from the Supraorbital + Supratrochlear Veins ------> Angular Vein (comes down from medial canthus of eye) ------> Facial Vein.
• Facial vein then joins with the Submental Vein to lead to the Internal and External Jugular Veins.
• Retromandibular Vein is formed by the union of the Superficial Temporal Vein and Maxillary Vein.
• It then joins with the Posterior Auricular Vein to form the External Jugular Vein.
• It also gives off a branch back to the facial vein ------> Internal Jugular.

2. Anastomoses with Cranial Fossa: Clinically important collateral circulation with the dural sinuses occurs at two places:

• Deep Facial Vein is a communication between the Facial Vein and the Pterygoid Plexus.
• Superior Ophthalmic Vein is a communication between the Facial Vein and the Cavernous Sinus.

3. Dangerous Area of Face: A triangle approximately covering the nose and maxilla, and going up to the region between the eyes. Superficial Veins communicate with dural sinuses in this region.

• The Facial Vein has no valves. Backflow can cause infection to get into the dural sinuses, through the Deep Facial Vein (via pterygoid plexus) and Superior Ophthalmic Vein (via Cavernous Sinus)
  

LYMPHATIC DRAINAGE:

1. Parotid Nodes: Superficial and deep set.

2. Submandibular Nodes

3. Retroauricular Nodes

Category: Anatomy Notes