Anatomy presentation on the neurovascular topography of the face and neck. DOWNLOAD TO SEE THE COMMENTS. The slides are very basic - most of the info is contained in the comments which I read during the presentation.

1. , DDS
&
, DDS
Periodontology Residents PGY1
September 23, 2013

2. • Includes the area bordered
within the hairline, anterior
border of the auricles, and
the chin.
• Major contents: eyes, nose,
mouth, muscles of facial
expression, muscles of
mastication, parotid gland,
trigeminal nerve, and facial
nerve.
• The forehead is common to
both scalp and face.

3. Innervation of the face is
principally derived from
the three branches of the
trigeminal nerve.
V1 – Ophthalmic Nerve
V2 – Maxillary Nerve
V3 – Mandibular Nerve

4. Ophthalmic
Nerve
BRANCHES:
The ophthalmic nerve contributes several branches to the
upper eyelid, the forehead and scalp, and the external nose.

5. Maxillary
Nerve
BRANCHES:
On the face, the infraorbital nerve breaks up into three sets
of branches.

6. Mandibular
Nerve
BRANCHES:
The cutaneous contribution of the mandibular nerve to the
face is fairly widespread.

7. Trigeminal Pain
Referred Pain:
Pain seems to originate from one location, but the actual source of pain is
remote or is a different structure.
Trigeminal Neuralgia:
• Intensely painful
• Usually affects the V2 or V3 division.
• Usually unilateral
• Cause is unknown
• Treatments include:
• Tegretol (anticonvulsant)
• Sectioning the sensory route of the
nerve.
• Injection of alcohol or glycerol into
trigeminal ganglion.
• Nerve decompression.
• Radiofrequency rhizotomy

8. The cervical plexus supplies a small amount of sensory
innervation to the face

9. • Motor supply:
• Facial nerve
• Motor branches of V3
Mandibular nerve
• The facial nerve divides into
the Temporofacial and
Cervicofacial trunks.
• These trunks then divide
into the 5 main branches
before emerging from the
parotid gland.

10. Facial
Nerve
Temporofacial Division:

11. Facial
Nerve
Cervicofacial Division:

12. Bell’s
Palsy• Damage to facial nerve
• Affected side is motionless
• Loss of wrinkles
• Eye cannot be closed
• In smiling the mouth is drawn to normal side
• During mastication food accumulates in vestibule of
mouth

13. Hypoglossal Nerve
• Cranial nerve XII
• Arises from rootlets of the
medulla oblongata
• Innervates the intrinsic tongue
muscles.
Ansa Cervicalis
• From ventral rami of C1 – C3
• Innervates the omohyoid,
sternohyoid and sternothryoid
mm.

14. Main Branches of
External Carotid
• SUPERFICIAL TEMPORAL ARTERY
• MAXILLARY ARTERY
• TRANSVERSE FACIAL ARTERY
• FACIAL ARTERY
• LINGUAL ARTERY
Main Branch of
Internal Carotid
• OPHTHALMIC ARTERY

15. • SUPERFICIAL TEMPORAL ARTERY
• ORIGIN: External Carotid Artery
• COURSE: Ascends anterior to ear, to temporal region
and ends in the scalp.
• MAXILLARY ARTERY
• ORIGIN: External Carotid Artery
• COURSE: Passes anteriorly between ramus of
mandible and sphenomandibular ligament within
infratemporal fossa. Passes either superficial or deep
to lateral pterygoid unitl reaching pterygopalatine
fossa.
• TRANSVERSE FACIAL ARTERY
• ORIGIN: Superficial temporal artery
• COURSE: Crosses face external to the masseter and
inferior to the zygomatic arch.
• FACIAL ARTERY
• ORIGIN: External Carotid Artery
• COURSE: Ascends deep to the submandibular gland,
winds around the inferior border of the mandible and
enters the face.
• LINGUAL ARTERY
• ORIGIN: External Carotid Artery just inferior to facial
artery.
• COURSE: Passes deep to the posterior belly of the
digastric and sylohyoid mm. Passes deep to the
hyoglossus m. and anteriorly between the hyoglossus
and genioglossus mm.

16. OPHTHALMIC ARTERY
FROM INTERNAL CAROTID ARTERY
• SUPRATROCHLEAR
• SUPRAORBITAL
• LACRIMAL
• EXTERNAL NASAL
• DORSAL NASAL

17. Arteries of the neck arise from
• Subclavian artery
• Thyrocervical Trunk
• Transverse cervical a.
• Inferior thyroid a.
• Suprascapular & dorsal scapular aa.
• Costocervical a.
• Common carotid artery
• Internal & external carotid aa.

18. Superficial Veins
• Facial v.
• Angular v.
• Supraorbital v.
• Supratrochlear v.
• Superior/inferior labial vv.
• Lateral nasal v.
• Submental v.
• Retromandibular v.
• Maxillary v.
• Pterygoid plexus
• Inferior alveolar v.
• Mental v.
• Superficial temporal v.
• Transverse facial v.

19. Communicating Veins
• Superior ophthalmic v.
• Receives blood from the roof of the
orbit and the scalp
• Inferior ophthalmic v.
• Receives blood from the floor of the
orbit.
• Infraorbital v.
• Receives blood from the mid-face,
lateral nose, and upper lip
• Deep facial v.
Deep Veins
• Cavernous sinus
• Pterygoid plexus

20. Cavernous Sinus
Thrombosis
• Often caused by an infection that starts
in the central part of the face, and travels
back into the cavernous sinus.
• Affects the contents of the cavernous
sinus:
• Cranial nerves III, IV, V1, V2, VI
• Internal carotid
• Common clinical manifestations include:
• Ophthalmoplegia
• Periorbital edema
• Exophthalmos

21. Internal jugular
• Occipital v.
• Facial v.
• Lingual v.
• Pharyngeal v.
• Superior thyroid v.
• Middle thyroid v.
External jugular
Anterior jugular
Subclavian
• Vertebral v.