GOOD

MORNING!
 ARTERIES VEINS AND NERVES OF
FACE

BY: DIVYA SWAROOP M

GUIDED BY : DR MADHU K 1ST YEAR POST GRADUATE STUDENT
DEPARTMENT OF PEDIATRICS AND PREVENTIVE DENTISTRY
 CONTENTS
• INTRODUCTION
Face
Skin

• ARTERIES OF FACE
Facial artery
Transverse facial artery
Maxillary artery
ophthalmic artery
Circle of willi’s
Applied aspect

• VEINS OF FACE
Classification of veins
Venous system
Veins of face
Pterygoid venous plexus
Emissary veins
Cavernous sinus
Applied aspect
NERVE SUPPLY FACE
Motor nerve supply
Sensory nerve supply
APPLIED ASPECT

• REFERENCES
FACE
• The face ,or countenance extends :

Superiorly- from the adolescent position of hairline

Inferiorly- to the chin and base of the mandible
Each side- to the auricle
Forehead is common to both the face and scalp.
SKIN
1. The facial skin is very vascular – Rich vascularity
makes the face blush and blanch. Wounds of the face
bleed profusely but heal rapidly. The results of plastic
surgery on face are excellent for the same reason.
2. The facial skin is rich in sebaceous and sweat glands -
sebaceous glands keep the face oily, but also cause
acne in young adults. Sweat glands help in regulating
body temperature.
3. Laxity of greater part of the skin facilitates rapid spread
of oedema. Renal oedema appears first in the eyelids and
face before spreading to other parts of the body.

4. Facial skin is very elastic and thick because the facial

muscles are inserted into it . The wounds of the face
therefore tend to gape.
SUPERFICIAL FASCIA
• The superficial fascia contains:
1.The facial muscles
2.The vessels and nerves
3.A variable amount of fat
• Fat is absent from the eyelids , but is well developed in the
cheek ,forming the buccal pads that are very prominent in
infants in whom they help in sucking.

• The deep fascia is absent from the face ,except over the
parotid gland where it forms the parotid fascia and over
the buccinator where it forms the buccopharyngeal fascia.
ARTERIES OF FACE
• The face is richly vascular. The arteries that supply face
arise from the common carotid artery.

COMMON
CAROTID
ARTERY

EXTERNAL INTERNAL
CAROTID CAROTID
ARTERY ARTERY

TRANSVERS
FACIAL MAXILLARY OPHTHALMI
E FACIAL
ARTERY ARTERY C ARTERY
ARTERY
FACIAL ARTERY
• The facial artery is the chief artery of face

• It is the branch of external carotid artery given off in the

carotid triangle triangle just above the tip of the greater
cornua of the hyoid bone

• In its cervical course it passes through the submandibular

region and finally enters the face.
SURFACE MARKING OF FACIAL
ARTERY:
It is marked on the face by joining the following three
points:
• A point on the base of mandible at the anterior border of
masseter muscle
• A second point 1.2cm lateral to the angle of mouth.
• A point at the medial angle of the eye.

*The Artery is tortuous in its course and is more so

between the first two points.
COURSE

• It enters the face by winding around the base of the

mandible and by piercing the deep cervical fascia at the
anteroinferior angle of the masseter muscle . It can be
palpated here and is called ANAESTHETIST’S ARTERY.

• First it runs upwards and forwards to a point 1.2cm lateral

to the angle of the mouth. Then it ascends by the side of
the nose upto the median angle of eye , where it
terminates by supplying the lacrimal sac and by
anastomosing with the dorsal nasal branch of the
ophthalmic artery.
• The facial artery is very tortuous . The tuberosity of the
artery prevents its walls from being unduly stretched
during movements of the mandible the lips and the cheek.
• It lies between the superficial and deep muscles of the
face.
BRANCHES:

• The anterior branches on the face are large and named ,

they are: ( branches on the face)
1. Inferior labial – to the lower lip
2. Superior labial – to the upper lip
3. Lateral nasal – to the ala and dorsum of the nose.

The posterior branches are small and unnamed.

Cervical branches:

1.Ascending palatine artery

2.Tonsillar branch
3.Submental artery
4.Glandular branches
ANASTOMOSIS:

• The large anterior branches anastomose with similar

branches of the opposite side and with the mental artery.
• In lips anastomoses are large , so that cut arteries spurt
from both ends.
• Small posterior branches anastomose with the transverse
facial and infraorbital arteries.
• At the medial angle of eye , terminal branches of the facial
artery anastomose with branches of the ophthalmic
artery. This is therefore a site for anastomosis between he
branches of the external and internal carotid arteries
TRANSVERSE FACIAL ARTERY
• This small artery is the branch of superficial temporal
artery.
• After emerging from the parotid gland ,it runs forwards
over the masseter between the parotid duct and the
zygomatic arch , accompanied by the upper buccal branch
of the facial nerve.
• It supplies the parotid gland and its duct , masseter and
the overlying skin , and ends by anastomosing with the
neighbouring arteries.
MAXILLARY ARTERY
• The maxillary artery , larger of the two terminal branches
of the external carotid artery.
• Given off behind the neck of the mandible.
• It has a wide territory of distribution and supplies:
- the external and middle ears
- the duramater
- upper and lower jaws
- the muscles of temporal and infratemporal region
- the nose and pharynx , palate and the paranasal air
sinus.
COURSE AND RELATIONS:
• For descriptive purpose the maxillary artery is divided
into three parts ( by the lateral pterygoid)

1. The first (mandibular) part runs horizontally forwards,

first between the neck of the mandible and the
sphenomandibular ligament, below the
auriculotemporal nerve, and then along the lower
border of the lateral pterygoid.
2. The second (pterygoid) part runs upwards and forwards
superficial to the lower head of the lateral pterygoid.

3. The third (pterygopalatine) part passes between the two

heads of the lateral pterygoid and through the
pterygomaxillary fissure , to enter the pterygopalatine fossa
where it lies in front of the pterygopalatine ganglion.
BRANCHES OF FIRST PART OF THE MAXILLARY ARTERY
BRANCHES DISTRIBUTION

1.Deep auricular artery: • Skin of external acoustic

meatus, outer surface of
tympanic membrane.
• Inner surface of tympanic
2. Anterior tympanic: membrane.

3. Middle meningeal : • Supplies more of bone less

of meninges
• Main distribution is
4. Accessory meningeal: extracranial to pterygoids.
• lower teeth and
5. Inferior alveolar: mylohyoid muscle.
BRANCHES OF SECOND PART OF MAXILLARY ARTERY

BRANCHES DISTRIBUTION

1. Deep temporal: • Temporalis muscle

2. Pterygoid: • Lateral and medial
pterygoid.
• Masseter muscle
3. Masseteric:
• buccinator
4. Buccal:
 BRANCHES OF THIRD PART OF MAXILLARY ARTERY:
BRANCHES
1.Posterior superior alveolar
2. Infraorbital :
3. Greater palatine:
DISTRIBUTION
• Upper molar and premolar
teeth and gums ;maxillary
sinus.
• Lower orbital muscles
;lacrimal sac ; maxillary
sinus; upper incisor and
canine teeth.
• Soft palate ; palatine
glands and mucosa ; upper
gums.
 BRANCHES DISTRIBUTION

4. Pharyngeal : • Roof of nose and pharynx ;

middle ear.
• Auditory tube ; upper
5. Artery of pterygoid canal:
pharynx and middle ear

6. Sphenopaltine (terminal • Lateral and medial walls of

part) : nose and various air
sinuses.
ARTERIAL SUPPLY OF TEETH:

All teeth are supplied by vessels that branch either directly

or indirectly from the maxillary artery.

INFERIOR ALVEOLAR ARTERY:

All the lower teeth are supplied by the inferior alveolar artery , which
originates from the maxillary artery in the infratemporal fossa. The
vessels enters the mandibular canal of the mandible , passes
anteriorly in the bone supplying vessels to the more posterior teeth,
and divided opposite the first premolar into incisor and mental
branches.
All the upper teeth are supplied by anterior and posterior superior
alveolar arteries.
• POSTERIOR SUPERIOR ARTERY:
It originates from the maxillary artery just after the maxillary artery
enters the pterygopalatine fossa and it leaves the fossa through the
pterygomaxillary fissure.
 It descends on the posterolateral surface of the maxilla., branches
and enters small canals in the bone to supply molar and premolar
teeth.
• ANTERIOR SUPERIOR ALVEOLAR:
It originates from the infra orbital artery , which arise from the
maxillary artery in the pterygopalatine fossa .
The infraorbital artery leaves the pterygopalatine fossa through the
inferior orbital fissure and enters the inferior orbital groove and canal
in the floor of the orbit.
The anterior superior alveolar artery originates from the infraorbital
artery in the infra orbital canal. It passes through bone and branches
to supply the incisor and canine teeth.
Arteries supplying teeth
GINGIVAL SUPPLY:

• The gingivae are supplied by multiple vessels and the

source depends on which side of each tooth the gingiva is-
• The side facing the oral vestibule or cheek (vestibular or
buccal side)
• Or the side facing the tongue or palate (lingual or palatal
side)
• Buccal gingiva of the lower teeth is supplied by branches from the
inferior alveolar artery whereas the lingual side is supplied by
branches from lingual artery of the tongue.
• Buccal gingiva of the upper teeth is supplied by branches of the
anterior and posterior alveolar arteries.
• Palatal gingiva is supplied by branches from nasopalatine (incisor and
canine) and greater palatine (premolar and molar) arteries.
OPHTHALMIC ARTERY

• It is the first branch of internal carotid artery distal to the

cavernous sinus.
• The branches of ophthalmic artery supply all the
structures in the orbit as well as some structures in the
face , nose and meninges.
• It gives two small branches after entering the orbit.
1. Zygomatico facial artery :
• It is the branch of lacrimal branch of the ophthalmic
artery.
• Enters the face through the zygomatico facial foramen.
• Supplies the area of face over the zygomatic bone.
• Dorsal nasal artery :
• Terminal branch of the ophthalmic artery exits the orbit in
the medial corner.
• Supplies the nose.
APPLIED ANATOMY:

During injury of the face bleeding from the facial artery can be
stopped by compressing the artery against the lower border of
mandible. The pulsation of the artery can be felt along the lower
border of the mandible near the anteroinferior angle of masseter
muscle.

In the lips branches of the facial artery are found nearer to the
mucous membrane than to the skin . Hence injuries caused by the
teeth on the mucous membrane of the mouth may develop hidden
hematomas .
CIRCLE OF WILLIS:
• The circle of Willis (also called Willis' circle, loop of Willis,
cerebral arterial circle, and Willis polygon) is a circulatory
anastomosis that supplies blood to the brain and
surrounding structures. It is named after Thomas Willis
(1621–1675), an English physician.
• The circle of Willis is a part of the cerebral circulation
and is composed of the following arteries:

• Anterior cerebral artery (left and right)

• Anterior communicating artery
• Internal carotid artery (left and right)
• Posterior cerebral artery (left and right)
• Posterior communicating artery (left and right)
• The middle cerebral arteries, supplying the brain, are not
considered part of the circle.
FUNCTION:
• The arrangement of the brain's arteries into the circle of
Willis creates redundancy for collateral circulation in the
cerebral circulation.
• If one part of the circle becomes blocked or narrowed
(stenosed) or one of the arteries supplying the circle is
blocked or narrowed, blood flow from the other blood
vessels can often preserve the cerebral perfusion well
enough to avoid the symptoms of ischemia.
CLINICAL SIGNIFICANCE:
Subclavian steal syndrome
• The redundancies that the circle of Willis introduce can
also lead to reduced cerebral perfusion.
• In subclavian steal syndrome, blood is "stolen" from the
circle of Willis to preserve blood flow to the upper limb.
• Subclavian steal syndrome results from a proximal
stenosis (narrowing) of the subclavian artery, an artery
supplied by the aorta, which is also the same blood vessel
that eventually feeds the circle of Willis via the vertebral
artery.
GOOD
MORNING
VENOUS DRAINAGE OF FACE
STRUCTURE OF VEINS:
• The walls of veins have three layers:
1. Tunica intima
2. Tunica externa
3. Tunica media
VEINS ARE CLASSIFIED AS:
• Superficial veins
• Deep veins
• Communicating veins
• Pulmonary veins
• Systemic veins
VENOUS SYSTEM
How does it work?
VEINS OF FACE:
1. Supratrochlear and Supraorbital vein
2. Facial vein
3. Superficial temporal vein
4. Maxillary vein
5. Posterior auricular vein
6. Occipital vein
7. Retromandibular vein
8. Pterygoid venous plexus
SUPRATROCHLEAR AND
SUPRAORBITAL VEIN
• Also known as frontal vein.
• Forms the facial or the angular vein.
FACIAL VEIN:
• Largest vein of the face and has no valves.
SUPERFICIAL TEMPORAL VEIN:
• Superficial temporal vein descends in front of the
tragus ,enters the parotid gland and joins maxillary vein to
form the retromandibular vein.
MAXILLARY VEIN:
• Consists of a short trunk which accompanies the first part
of the internal maxillary artery.
• It is formed by the confluence of veins of pterygoid
plexus.
POSTERIOR AURICULAR VEIN:
• Begins upon the side of the neck , in a plexus which
communicates with tributaries of occipital vein and
temporal vein.
OCCIPITAL VEIN:
• Begins in posterior network in scalp.
 RETROMANDIBULAR VEIN:
• The superficial temporal vein and the maxillary vein unites
to form the retromandibular vein.
• It divides into anterior and posterior divisions.
 To summarize…..
Superficial
Maxillary vein
temporal vein

Retromandibular
vein

Anterior div Posterior div

Posterior
Facial vein
auricular vein

Common facial External

vein jugular vein
drains
drains
Internal Subclavian
jugular vein vein
PTERYGOID PLEXUS OF VEINS:
• It lies around and within the lateral pterygoid muscle.
• The tributaries correspond to the branches of maxillary
artery.
• The plexus is drained by the maxillary vein.
THE PLEXUS COMMUNICATES WITH:
CAVERNOUS SINUS:
• So named because they present in a reticulated structure
• Situated in the middle cranial fossa.
• It is a paired sinus.
• 2cm long and 1cm wide
• Receive blood from the brain , meninges and bones of skull.
• It communicates with veins outside the skull through emissary
veins
The cavernous sinus drains into :
a) Transverse sinus through superior petrosal sinus
b) Internal jugular vein through the inferior petrosal sinus
c) Pterygoid plexus through emissary veins
d) Facial vein through superior ophthalmic vein
e) Left and right cavernous sinus communicate through
the anterior and posterior inter-cavernous sinus.

* [All these communications are valve-less and blood can

flow through them in any direction .
Emissary veins:
• Emissary veins connect the extracranial veins with the
intracranial venous sinuses to equalize the pressure.
• Extracranial infections may spread through these veins to
intracranial venous sinuses.
APPLIED ASPECT:
• DANGEROUS AREA OF FACE:
• PTERYGOID VENOUS PLEXUS - INFECTION
• LINGUAL VARICOSITY:
• JUGULAR PHLEBECTASIA IN CHILDRES:
INNERVATION OF FACE
INNERVATON OF FACE
• The trigeminal nerve innervates facial structures derived
from the first arch.
• The facial nerve innervates facial structures derived from
the second arch.
SENSORY INNERVATION
• Cutaneous innervation of the face is by branches of the
trigeminal nerve
• The trigeminal nerve divides into three major divisions:
1. Ophthalmic
2. Maxillary
3. Mandibular
 TRIGEMINAL NERVE

MIDDLE CRANIAL FOSSA

TRIGEMINAL GANGLION

1ST DIV OPHTHALMIC 2ND DIV MAXILLARY 3RD DIV MANDIBULAR

SUPERIOR ORBITAL FORAMEN FORAMEN

FISSURE ROTUNDUM OVALE
OPHTHALMIC BRANCH:
MAXILLARY BRANCH
MANDIBULAR BRANCH:
MOTOR NERVE SUPPLY:
• The facial nerve is the motor nerve of face.
Applied aspect:
• BELL’S PALSY:
• TIGEMINAL NEURALGIA:
References:
• B D Chaurasia. Human anatomy: Regional and applied
dissection and clinical, vol 3 ,5th edition.
• Drake L R , Vogi W , Mitchell A W M. Gray’s anatomy for
students.
THANK YOU!