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Questions and Answers
The angular vein is formed by the union of the supraorbital and supratrochlear veins.
The angular vein is formed by the union of the supraorbital and supratrochlear veins.
True (A)
The posterior branch of the retromandibular vein joins the facial vein.
The posterior branch of the retromandibular vein joins the facial vein.
False (B)
The external jugular vein courses down in the subcutaneous tissue over the sternocleidomastoid muscle.
The external jugular vein courses down in the subcutaneous tissue over the sternocleidomastoid muscle.
True (A)
The facial vein is responsible for draining blood from the temple region.
The facial vein is responsible for draining blood from the temple region.
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The posterior auricular vein and the posterior branch of the retromandibular vein form the external jugular vein.
The posterior auricular vein and the posterior branch of the retromandibular vein form the external jugular vein.
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The deep facial vein passes behind the masseter muscle.
The deep facial vein passes behind the masseter muscle.
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The facial vein empties into the external jugular vein in the neck.
The facial vein empties into the external jugular vein in the neck.
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Lymph from the central forehead drains to the submandibular nodes.
Lymph from the central forehead drains to the submandibular nodes.
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All lymph from the face eventually reaches the deep cervical nodes.
All lymph from the face eventually reaches the deep cervical nodes.
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The facial vein has a direct communication with the cavernous sinus.
The facial vein has a direct communication with the cavernous sinus.
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The supertympanic nerve is a branch of the maxillary nerve.
The supertympanic nerve is a branch of the maxillary nerve.
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The lacrimal nerve is one of the cutaneous branches of the ophthalmic nerve.
The lacrimal nerve is one of the cutaneous branches of the ophthalmic nerve.
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The mental nerve supplies the lower eyelid.
The mental nerve supplies the lower eyelid.
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The auriculotemporal nerve supplies the hairy skin over the temple.
The auriculotemporal nerve supplies the hairy skin over the temple.
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Zygomaticofacial nerve branches supply skin on the forehead.
Zygomaticofacial nerve branches supply skin on the forehead.
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The buccal nerve gives off cutaneous twigs over the cheek just below the zygomatic bone.
The buccal nerve gives off cutaneous twigs over the cheek just below the zygomatic bone.
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The supratrochlear nerve passes under the medial side of the supraorbital nerve.
The supratrochlear nerve passes under the medial side of the supraorbital nerve.
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The external nasal branch is involved in dangerous corneal ulceration when affected by herpes zoster.
The external nasal branch is involved in dangerous corneal ulceration when affected by herpes zoster.
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The forehead is supplied by the supraorbital and supratrochlear branches of the maxillary artery.
The forehead is supplied by the supraorbital and supratrochlear branches of the maxillary artery.
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The facial artery hooks upwards over the inferior border of the mandible.
The facial artery hooks upwards over the inferior border of the mandible.
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The sensory nerve supply to the face includes branches of the trigeminal and vagus nerves.
The sensory nerve supply to the face includes branches of the trigeminal and vagus nerves.
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The mandibular nerve supplies both the skin over the mandible and area over the angle of the mandible originally.
The mandibular nerve supplies both the skin over the mandible and area over the angle of the mandible originally.
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The ophthalmic branch of the trigeminal nerve provides six cutaneous branches.
The ophthalmic branch of the trigeminal nerve provides six cutaneous branches.
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Pain fibers in the trigeminal nerve are arranged in an 'onion-skin' pattern.
Pain fibers in the trigeminal nerve are arranged in an 'onion-skin' pattern.
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The only facial skin part not supplied by the trigeminal nerve is served by the great auricular nerve.
The only facial skin part not supplied by the trigeminal nerve is served by the great auricular nerve.
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Facial muscles receive proprioceptive fibers from cutaneous nerves that connect with branches of the facial nerve.
Facial muscles receive proprioceptive fibers from cutaneous nerves that connect with branches of the facial nerve.
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The skin zones supplied by the trigeminal nerve originally met at the top of the skull.
The skin zones supplied by the trigeminal nerve originally met at the top of the skull.
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The pattern of a facial haemangioma can demonstrate the area of skin supplied by the facial nerve.
The pattern of a facial haemangioma can demonstrate the area of skin supplied by the facial nerve.
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The temple was named due to its vulnerability to injury, not because of greying hairs.
The temple was named due to its vulnerability to injury, not because of greying hairs.
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In herpes zoster, the ophthalmic nerve is more frequently affected than the mandibular nerve.
In herpes zoster, the ophthalmic nerve is more frequently affected than the mandibular nerve.
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Study Notes
Sensory Nerve Supply of the Face
- The face is supplied by branches of the trigeminal nerve, with three zones meeting at eyelid and mouth margins.
- The zones' arrangement is developmental, curving upwards from original horizontal lines extending from eye and mouth angles; the mandibular nerve originally covered the mandible.
- The cranial cavity expanding over the brain moves face skin, including beard skin to the temple and neck replacing it.
- The great auricular nerve supplies skin over the mandible angle and area above and in front of it, the only area not served by trigeminal nerve branches.
- Face muscles' proprioceptive fibers originate in these branches along with multiple junctions with facial nerve branches.
- The trigeminal nerve has three divisions (ophthalmic, maxillary, mandibular) each with specific cutaneous branches (see graphic).
Trigeminal Nerve Branches
-
Ophthalmic Nerve: Five cutaneous branches—lacrimal, supraorbital, supratrochlear, infratrochlear, and external nasal.
- Lacrimal: lateral upper eyelid skin.
- Supraorbital: forehead and scalp.
- Supratrochlear: middle forehead.
- Infratrochlear: medial upper eyelid and nose bridge.
- External nasal: middle external nose.
-
Maxillary Nerve: Three cutaneous branches—infraorbital, zygomaticofacial, and zygomaticotemporal.
- Infraorbital: lower eyelid, cheek, side/ala of nose, upper lip and labial gum.
- Zygomaticofacial: overlying zygomatic bone skin.
- Zygomaticotemporal: front temple skin.
-
Mandibular Nerve: Three cutaneous branches—auriculotemporal, buccal, and mental
- Auriculotemporal: external acoustic meatus, tympanic membrane, auricle, temple skin.
- Buccal: cheek skin below zygomatic bone, between infraorbital nerve and great auricular nerve areas.
- Mental: lower lip and labial gum.
Sensory Distribution "Onion Skin" Pattern
- Pain fibers in the trigeminal nerve follow a pattern where fibers from the front of the face synapse with cells at the highest (pontine) part of the spinal trigeminal nucleus.
- Concentric areas from mouth and nose regions synapse at successively lower nucleus levels.
- This "onion skin" arrangement for pain doesn't precisely correspond with cutaneous nerve distribution areas.
Blood Supply of the Face
- The facial artery, originating from the external carotid artery, has tortuous path, curving over the posterior digastric and masseter. Supplies the lips (important labial branches).
- Superficial temporal artery from external carotid supplies temple. Transverse facial artery branches across cheek.
- Ophthalmic artery from orbit supplies forehead via supraorbital and supratrochlear branches, and anastomoses with superficial temporal artery, connecting the internal and external carotid systems.
Venous Return and Drainage
- Venous return is predominantly superficial.
- Forehead veins (supraorbital & supratrochlear) converge at medial canthus forming the angular vein; eventually uniting with the facial vein.
- Facial vein joins the retromandibular vein below mandible. The retromandibular vein splits into ant/post branches, with the ant connecting with the internal jugular vein and post branch connecting with the external jugular vein.
- Temple blood drains into superficial temporal vein, which connects with the maxillary veins from pterygoid plexus to form the retromandibular vein.
- Deep venous anastomoses occur, and facial vein communicates with cavernous sinus, affecting "danger area" for facial infection.
Lymph Drainage of the Face
- Face drains into three superficial node groups (submental, submandibular, preauricular) from wedge-shaped blocks of tissue.
- Chin and tongue tip drain to submental nodes.
- A wedge of tissue (including parts of the nose, upper lip, lower face etc.) drains to submandibular nodes. The forehead and frontal sinuses are included in this wedge-shape area.
- Forehead, temple, orbital contents, and cheek drain to preauricular nodes.
- Lymph ultimately reaches deep cervical nodes.
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Description
Explore the intricate sensory nerve supply of the face, focusing on the trigeminal nerve and its three major divisions. This quiz delves into the branches that serve different facial zones and their developmental arrangement. Test your understanding of facial innervation and its implications.
