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CUTANEOUS INNERVATION AND VASCULATURE OF THE FACE

BIG PICTURE

The sensory innervation of the face is provided by the three divisions of the trigeminal nerve (cranial nerve [CN] V), with each division supplying the upper, middle, and lower third of the face. The facial artery and the superficial temporal artery provide vascular supply. The parotid gland resides on the masseter muscle, produces and secretes saliva into the oral cavity, and is innervated by the glossopharyngeal nerve (CN IX).

CUTANEOUS INNERVATION OF THE FACE

The skin of the face and scalp receives general sensory innervated from cutaneous branches of the three divisions of CN V and by some nerves from the cervical plexus (Figure 20-1A and B).

  • CN V-1 (ophthalmic nerve). Anterior region of the scalp via the supraorbital and supratrochlear nerves, skin of the upper eyelid via the lacrimal nerve, and bridge of the nose via the external nasal and infratrochlear nerves.

  • CN V-2 (maxillary nerve). Along the zygomatic arch, via the zygomaticofacial and zygomaticotemporal nerves, and the skin of the maxillary region, lower eyelid, and upper lip via infraorbital nerve branches.

  • CN V-3 (mandibular nerve). Lateral aspect of the scalp and face, anterior to the external acoustic meatus via the auriculotemporal nerve, the skin covering the mandible via the buccal nerve, and the skin of the lower lip via the mental nerve.

  • Great auricular nerve (C2–C3) (cervical plexus). Skin over the angle of the mandible just in front of the ear.

Figure 20-1:

A. CN V and its cutaneous fields of the face. B. Branches of CN V in the face. C. Facial vessels and nerves and the parotid gland.

Image not available. Trigeminal neuralgia (tic douloureux). A condition marked by paroxysmal pain within the cutaneous distribution of CN V. Sectioning the sensory root of CN V at the trigeminal ganglion may alleviate the pain.▼

VESSELS OF THE FACE

The face has a very rich blood supply provided primarily from the following vessels (Figure 20-1C):

  • Facial artery. Arises from the external carotid artery and courses deep to the submandibular gland; winds around the inferior border of the mandible, anterior to the masseter muscle, and supplies the face via the inferior labial, superior labial, lateral nasal, and angular arteries.

  • Supraorbital and supratrochlear arteries. Terminal branches of the ophthalmic artery, a branch of the internal carotid artery, which supply the anterior portion of the scalp.

  • Superficial temporal artery. A terminal branch of the external carotid artery provides arterial supply to the lateral surface of the face and scalp.

  • Facial vein. Formed by the union of the supraorbital and supratrochlear veins. The facial vein descends in the face and receives tributaries corresponding to the branches of the facial artery. The facial vein ...

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