The skin of the face includes sweat and sebaceous glands, hair, muscle fibers, nerve endings, blood and lymphatic vessels. Its structure has its own characteristics, knowledge of which is especially important for surgeons. At the same time, it will be interesting for an ordinary person to get acquainted with these features. Facial injuries are possible in everyday life, and they are especially common in car collisions. After car accidents, it is often the face that suffers. Frightening bleeding occurs, which frightens both the patient himself and those close to him.
Nevertheless, it is precisely the structural features of the facial skin, its muscles, innervation and blood supply that allow us to hope for a successful outcome with timely professional surgical care. Next, we will look at methods of providing first aid before the arrival of doctors for facial injuries. A text you read accidentally, maybe even not remembered, will come to mind in a critical situation and will allow you to avoid mistakes in car accidents and other injuries.
Not too few people in our country, in addition to doctors, have primary medical training with first aid skills. These are pharmacists, nurses, orderlies, police officers and employees of the Ministry of Emergency Situations, medical instructors after military service, sorry if we forgot anyone. For acute injuries, there are the main principles of first surgical aid; they allow you to save life and avoid dangerous consequences for the victim. Don't let special medical terms scare you. Even a simple understanding of the basic features of the structure of the body and its physiology helps in difficult times. At the same time, awareness of the threat of complications during exacerbation of surgical dental diseases will help you make the right decision.
The outer layer of the skin forms a multinucleated squamous keratinizing epithelium, which fits tightly to the underlying layer in the skin itself. The latter consists of two not clearly demarcated layers - subepithelial papillary and reticular. The papillary layer consists of loose connective tissue; it contains blood vessels and nerve endings that cause skin sensitivity.
On the face, the papillae are low and even, so the skin on the face is thin and smooth. The scars on her are clearly visible. However, experienced surgeons achieve amazing aesthetic results by connecting the edges of the wound with intradermal sutures and masking the sutures in anatomical folds.
The papillary layer contains collagen, denser, frame fibers and elastic elastic and reticular fibers, as well as cellular elements, then it passes into a denser mesh layer, which is distinguished by a large number of collagen and elastic fibers and a relatively small number of cellular elements.
The presence of elastic and collagen fibers in the connective part of the facial skin determines the skin's ability to stretch during facial expressions and conversation, and a large number of elastic fibers in the reticular layer creates constant physiological tension of the skin, which decreases with age. These lines also define the areas of the face; incisions are made in relation to them and the edges of the wound are drawn together. It is because of the presence of elastic fibers that facial injuries look so frightening - the edges of the wound diverge to the sides. At the same time, after properly bringing the edges together and applying sutures, the face restores its appearance.
The reticular layer passes into mobile connective tissue, which differs from the skin in its significant thickness and loose arrangement of bundles of fibrous tissue, as well as the lesser development of subcutaneous fatty tissue (compared to other parts of the body).
Subcutaneous fatty tissue forms an elastic lining and is a plastic support layer that softens mechanical stress from the outside. In the area of the superciliary arches and eyebrows, the subcutaneous layer is a direct continuation of the tissue of the aponeurosis of the skull, but is devoid of the characteristic cellular structure. When moving to the eyelids and nose, the subcutaneous fat layer takes on the character of delicate connective tissue.
This structure of the subcutaneous layer in some areas of the face contributes to the rapid spread of hemorrhages, swelling, and inflammatory processes along the length. An example of this is boxers during fights. Facial edema and hepatomas reach significant sizes, especially in those who neglect protective mouthguards.
Oral and maxillofacial surgeons and ordinary dentists know the ways of penetration of pus from the primary focus. Such conditions are formidable complications, life-threatening, and yet their root cause may be a complication of caries - an exacerbation of chronic periodontitis or sometimes a festering hematoma.
The buccal part of the face is rich in fatty tissue. The fatty body of the cheek runs along the anterior edge of the masseter muscle, isolated from the surrounding tissue by thin fascia. In the area of the upper and lower lips, the subcutaneous fatty tissue is much less developed; these formations are mainly formed by the orbicularis oris muscle.
The facial skin ends with a large number of striated muscle fibers, which together make up the facial muscles. A feature of the facial muscles is that they are attached at one end to the inert skeleton of the face, and at the other end they are woven into the connective tissue structures of the skin itself, which determines the mobility of the skin under the action of the facial muscles.
In places of greatest accumulation of muscle fibers, elastic fibers are especially developed. In the areas where the elastic network connects with the underlying epithelial layer, depressions form on the skin. Their sequential arrangement leads to the formation of skin grooves and folds, which are the guide lines along which it is recommended to make incisions when cutting out and comparing skin flaps. The scar located along the folds, due to the constant contraction of the facial muscles, quickly stretches in length, becomes thinner and becomes less noticeable.
As a result of constant contraction of facial muscles, the elastic frame of the skin wears out, breaks in the elastic fibers form, characteristic facial wrinkles appear, and the contractility of the skin decreases. The contractility of the skin of the face is lower than the contractility of the skin of other parts of the body. This ability of the structure of the facial skin is of great importance in skin grafting. When it is necessary to decide which area of the body’s skin is most suitable in its structure for the full replacement of soft tissue defects, the surgeon must take these directions into account.
Facial muscles determine the individual characteristics and expressiveness of the face, the emotions characteristic of a person, and also carry out the movement of the lips, eyelids, and nostrils.
Blood supply to the soft tissues of the face Arteries and veins of the head
Anatomy and topography of the temporal and facial regions
The passage of blood vessels in the soft tissues of the face has its own characteristics. It is carried out by a powerful highway - the system of the external carotid artery, as well as through the ophthalmic artery, some branches of the internal carotid artery, and then splits into the facial, superficial temporal and other arteries. An extensive network of blood vessels and powerful blood flow allow an always open face to withstand the harshest factors of the external environment. In case of injuries and damage to one vessel, the blood supply is duplicated through the flow of blood from another line. All arteries are paired.
The main arterial trunk of the anterior part of the face is arteria facialis facial artery.
It anastomoses (connects) with the frontal artery and on its way gives many branches to the surrounding tissues, the largest of which are the mental, superior and inferior labial arteries. 
Scheme of cranial topography
The largest diameter of the arteries is at the attachment points of the facial muscles of the skin. Smaller arteries are distributed in the skin evenly over the entire surface. In places where the skin is most mobile, arteries and veins are more tortuous. In most cases, arteries and veins run parallel.
It is the presence of a large number of vascular anastomoses that makes it possible to widely use soft facial tissues when replacing defects. Taking into account the direction of the main arterial trunks as well as their combinations with venous lymphatic vessels makes it possible, for various defects of the soft tissues of the face, to use skin flaps taken in certain directions, without, if possible, interfering with their blood circulation.
The venous system is well developed in the soft tissues of the face. The veins of the face widely anastomose, connecting with each other, as well as with the veins of the orbit. The veins of the middle ear and nose connect with the veins of the base of the skull and the superior sagittal sinus, through the veins of the orbit with the dura mater. The veins of the face are located in two layers with the exception of the veins of the forehead. The venous network is expressed in the area of the wings of the nose and lips. In the event of purulent inflammatory processes on the face, increased vascularization and anastomosis can act as an aggravating factor in the course of the disease. Breakthrough of infection into the vessels of the face or along these vessels leads to damage to the orbit and brain, which is practically a death sentence. This is why dentistry is such a developed field of medicine.. Complications of caries - periodontitis, periostitis, abscess and phlegmon sometimes lead to the immediate death of the patient. In critical situations, a hand with a phlegmonous lesion can be amputated, but the person will remain alive. But an infected cavernous sinus does not give us this opportunity.
Lymphatic system of the face Vessels of the lymphatic system
An extensive lymphatic network and a barrier of lymph nodes determines the lymph circulation of facial tissues and largely distinguishes the maxillofacial area from other areas. Almost every area of the face has its own group of regional lymph nodes - powerful analytical laboratories and producers of local immunity factors. Also, each section of the mucous membrane of the nasopharynx and oral cavity has its own accumulation of lymphoid tissue.
The lymphatic system forms two networks in the facial skin - superficial and deep.
Connection between the superficial and deep veins and the meninges
The superficial lymphatic network is finely looped and located under the papillary layer of the skin itself. A deep looped network lies in the reticular layer of the corium.
Due to the characteristic attachment of the facial skin facial muscles and the absence of fascia on the face, the draining lymphatic vessels of the facial skin have their own characteristics.
Arising from a deep capillary network, they form a plexus in the superficial layers of subcutaneous fatty tissue. Larger draining lymphatic vessels are directed to regional lymph nodes located on top of the facial muscles, or to the deep layers of subcutaneous fat, passing under several facial muscles.
The main lymphatic collectors in the form of large lymphatic vessels, penetrating under the muscles or their fascia, as a rule, join along the main arterial and venous trunks and follow them to the regional lymph nodes, which are divided into three sections.
Innervation of soft tissues of the face Nerve trunks of the face
Innervation of the face is carried out by the facial nerve and
The facial nerve leaves the corresponding bone canal and enters the tissue of the parotid gland, splitting into numerous branches that form the nerve plexus plexus parotideus. Fan-shaped diverging branches of the facial nerve go to all facial muscles and ensure their contraction. There is some individual variability in the structure of the facial nerve, but in general there are two types of structure. But in any case, the main branches of the facial nerve are present.
- Marginal branch of the mandible
- Buccal branch
- Zygomatic branch
- Temporal branch
These branches are directed in a fan-like fashion from the tragus of the ear (where the nerve begins on the face) to the corner of the mouth, along the lower edge of the lower jaw, to the tip of the nose and to the outer corner of the eye.
Injuries to the branches of the facial nerve lead to paralysis of the facial muscles. To avoid damage to the branches of the facial nerve, deep incisions on the face are made only relative to the lines connecting the ear with the outer canthus of the eye, the tip of the nose, the corner of the mouth and parallel to the edge of the lower jaw, retreating from it one and a half to two cm above. Surgeons know these lines by heart; a non-specialist may have no use for this information. But you never know what kind of knowledge you will need in life. Let’s say that in addition to acute injuries, there are also chronic ones. The facial nerve, before it begins to innervate the face, passes through the temporomandibular joint and the parotid gland. In both regions, problems and inflammatory processes are possible, mainly related to teeth. As luck would have it, the facial nerve is mixed, responsible for both facial muscles and sensitivity in the oral cavity and areas of the face. Moreover, it also communicates with other nerves through nerve ganglia.
People perceive problems with teeth as something ordinary and everyday, as an annoying hindrance. But problems with facial expressions and taste disturbances cannot but worry, or rather, cause panic.
And this is where the problems begin. It is very, very difficult even for a qualified and experienced dentist or surgeon to identify the source of the problem. The innervation of the head is too complex, involving many nerves and plexuses.
But that's not even sad. With disturbances in sensitivity and facial expressions, people often turn to a neurologist. He prescribes treatment based on his knowledge and his pharmacological arsenal, most often these are severe, highly specialized drugs with psychotropic side effects. People have been undergoing treatment for years without success. Meanwhile, the root cause of the disease, bad teeth, may not be eliminated, and therefore treatment will be ineffective.
This problem does exist. For those interested, here is the background information.
"Emergency care in neurostomatology."
Anyone who can get hold of this publication about syndromes affecting the cranial nerve systems, especially the autonomic parts, please write to the site’s corporate email.
Deep facial area
The sensory innervation of the face is complex. Sensitive trunks and everyone take part in it three branches of the trigeminal nerve, as well as branches of the cervical plexus. The rich innervation and blood supply of the face makes it possible to duplicate the innervation and blood circulation of each part of the head multiple times, promotes tissue stability in case of injury, and accelerates the healing of injuries on the face. Even extensive head injuries heal well in most cases. At the same time, if the disease does occur, this creates certain difficulties in diagnosis and treatment. Over the past 20 years, the problem of innervation has again become relevant, which is associated with the massive use of implants for dental prosthetics. No matter how the examination is carried out before implantation surgery, but statistically, injuries or compression of nerve trunks occur when implants are installed, which suggests that anatomy as a science must continue to develop, identifying cases of anatomical variability and atypia.
When it comes to facial injuries, it’s amazing what situations happen in life. Wanting only the best, people sometimes make serious mistakes when providing first aid. At the same time, the correct decisions have long been described; you just need to know them and implement them. But more on that in our next article.
In order to safely carry out any injection techniques for facial rejuvenation, it is necessary to know exactly the dangerous zones where the branches of nerves and large vessels pass. Today we will tell you in detail how the facial muscles are located, and we will dwell on the features of the blood supply and innervation of the areas in which aesthetic correction is necessary.
With age, the appearance and contours of the face change. The reason for such changes is the weakening of the muscles of the face and neck, which decrease in volume and become deformed, while their tone decreases. This entails the need to introduce fillers and botutoxins.
For safer work as a cosmetologist, performing any cosmetic procedures or manipulations of the facial area inevitably requires knowledge of the anatomy and topography of the formations of this area. the site will not only describe, but also demonstrate a video lesson “anatomy of facial aging for cosmetologists.”
Anatomical structures: nerves, blood vessels, facial vessels
There are several important aspects of facial anatomy for cosmetologists that need to be assessed by the doctor before starting work:
1. When using botulinum toxin in your work, it is necessary to clearly understand and imagine the work of facial muscles, the place of origin and attachment of the muscle, its size, strength, the number of muscle bundles and fibers, the interweaving and interaction of muscles with each other.
2. Working with needles requires precise knowledge of the location of the vessels, possible places of their damage or puncture, and pressure points in emergency cases.
3. Knowledge of the innervation of the face, the difference between the sensory and motor branches of the nerves sometimes becomes a decisive factor in determining the cause of deformation or asymmetry on the face.
Facial nerves anatomy
Motor innervation of the face(innervation of facial muscles) is provided by branches of the facial nerve (n.facialis):
- rr.colii cervical branches - innervation of the platysma;
- rr.marginalis mandibulae extreme branches of the lower jaw - innervation of the muscles of the chin and lower lip;
- rr.buccalis buccal branches - innervate the muscle of the same name and the muscle depressing the angle of the mouth;
- rr.zygomatici zygomatic branches - innervate the zygomaticus major and minor, the levator labii superioris and alae nasi, partially the orbicularis oculi muscle and the buccal muscle;
- rr.temporalis temporal branches - innervate the orbicularis oculi muscle, the corrugator muscle, the frontalis muscle and the anterior part of the ear.
- Sensitive innervation of the face and neck area is provided by the branches of the trigeminal nerve (n. trigeminus), supratrochlearis (n. supratrochlearis), supraorbital (suprorbitalis), infraorbital (n.infraorbitalis) and mental (n.mentalis) nerves.
Blood supply to the face anatomy
The blood supply to the face is carried out to a greater extent by the branches of the external carotid artery (a.carotis externa): a.facialis, a.temporalis superfacialis, a.maxillaris.
In the orbital area there is an anastomosis between the external and internal carotid arteries with the help of a.ophthalmica. The vascular network on the face is very developed, which, on the one hand, provides impeccable nutrition to all zones, and on the other hand, means that injury to one of the vessels can lead to severe bleeding.
Facial muscles anatomy
The name "facial muscles" is functional. During evolution, they were transformed from specially adapted structures for capturing food, acute sense of smell and hearing into facial muscles, the contraction of which moves the skin of the face in accordance with the psycho-emotional state of a person, and is also responsible for the articulation of speech;
The facial muscles are mainly concentrated around the natural openings of the face, expanding or closing them;
The muscles surrounding the oral cavity have the most complex structure and the largest number;
In accordance with their development, facial muscles have a close connection with the skin of the face, into which they are woven with one or two ends. This is important for us because during the aging process of the skin, its loss of elasticity and firmness, they cannot contract adequately, and the muscle frame weakens. This underlies skin ptosis and the appearance of facial wrinkles;
Most often, botulinum toxin injections are given to the frontal belly of the occipitofrontalis muscle, the orbicularis oculi muscle, the orbicularis oris muscle, the depressor anguli oris and lower lip muscles, and the mental muscle, since their active contraction causes the reflection of our psycho-emotional state in facial expressions.
We present to your attention a visual representation of the location of anatomically important formations in the facial area from the site:
We hope that by paying attention to how facial muscles work, blood vessels and nerve endings pass through, you will be able to work more confidently and bring amazing aesthetic results to your patients!
The skin of the face is innervated by the trigeminal nerve. The first branch receives sensation from the skin of the inner forehead (frontal nerve), outer forehead (supraorbital nerve), root of the nose (supratrochlear nerve), and tip of the nose (anterior branch of the ethmoidal nerve).
The second branch of the nerve innervates the skin of the lower eyelid, lateral wall and wings of the nose, upper lip (infraorbital nerve), cheek, outer corner of the eye and temple (zygomatic nerve). The third branch of the nerve provides sensation to the skin of the temporal region, the auricle (auriculotemporal nerve), lower lip, chin (mental nerve) and the corner of the mouth (buccal nerve) (Fig. 24).
Rice. 24. Areas of distribution of the cutaneous nerves of the head.
1 - n. frontalis; 2 - n. supraorbitalis: 3 - n. zygomaticotemporalis; 4 - n. auriculotemporalis; 5 - n. occipitalis major: 6 - n. occipitalis minor; 7 - n. zygomaticofacialis; 8 - n. mentalis; 9 - n. infraorbitalis; 10 - rr. nasales n. ethmoidalis anterior; 11 - n. supratrochlearis.
The main nerve branches (supraorbital, infraorbital and mental) innervating the facial skin can be projected onto the surface. Their position is subordinate to the bone holes located along a vertical line passing 0.5 cm inward from the middle of the upper edge of the orbit.
The facial muscles are innervated by the facial nerve.
The facial part of the head contains important receptor organs that perceive light, olfactory and taste stimuli. The topography of these organs is subordinated to the shape of the bones that organize independent spaces: the orbital sockets, the nasal cavity with the paranasal sinuses, and the oral cavity. The skeleton that forms these cavities consists of a group of fixed bones and one movable one.
The fixed bones are integral with the skull. Characteristic of these bones is the complexity of their shape, which in the upper jaw and ethmoid bone is even more pronounced due to the presence of air-containing sinuses in their thickness.
The fixed bones of the face include the maxilla, zygomatic, palatine, nasal and lacrimal bones, inferior turbinates and vomer.
Innervation and blood supply of the maxillofacial area
Afferent innervation of the maxillofacial region is carried out by branches of the cranial nerves: trigeminal (V pair), glossopharyngeal (IX pair) and vagus nerve (X pair).
The trigeminal nerve (Fig. 6.7.) arises from the bridge and contains sensory and motor fibers. The zone of sensitivity (innervation) of the trigeminal nerve is as follows: facial skin, skin of the frontoparietal and temporal region, eyeball, mucous membrane of the oral cavity, nose, anterior third of the tongue, teeth, gums, periosteum of the facial skull bones, dura mater of the anterior and middle cranial pits, proprioceptors of masticatory, ocular, facial muscles, salivary and lacrimal glands. In the cranial cavity (temporal bone), the trigeminal nerve forms the gasserian ganglion (trigeminal ganglion), from which the three terminal branches of the trigeminal nerve arise:
Rice. 6. Branches of the trigeminal nerve.
1 – trigeminal node; 2 – optic nerve; 3 – maxillary nerve;
4 - mandibular nerve; 5 – bridge; 6 – trigeminal nerve.
1) the optic nerve is completely sensitive. It innervates the meninges, the mucous membrane of the frontal sinus, the conjunctiva of the eye, the mucous membrane of the upper part of the nose, the lacrimal gland, the skin of the upper eyelid, forehead and parietal region, the skin of the dorsum of the nose, and also provides proprioception of the eye muscles. The ophthalmic nerve enters the soft tissues of the face through the superior orbital fissure and is divided into the following branches: nasociliary, lacrimal and frontal nerves;
2) the maxillary nerve is completely sensitive, exits the cranial cavity through the round opening of the pterygopalatine fossa, where it divides into the infraorbital nerve and zygomatic nerve. The branches of the maxillary nerve innervate the teeth and gums of the upper jaw, the hard and soft palate, the mucous membrane of the nasal cavity, the skin of the lower eyelid, the skin of the temporal, zygomatic, buccal area, external nose and upper lip.
3) mandibular nerve - mixed, contains sensory and motor fibers. It leaves the cranial cavity through the foramen ovale. Sensitive branches of the mandibular nerve come from the dura mater, skin of the temporal region, skin of the lower jaw, lower lip, from the mucous membrane of the anterior 2/3 of the tongue, cheeks, teeth and gums of the lower jaw, salivary glands. The motor fibers of the nerve innervate the muscles of mastication and the muscles of the diaphragm of the mouth.
Fig. 7. Zones of sensitive innervation of the face by the branches of the trigeminal nerve.
Rice. 8. Branches of the facial nerve.
1 – bridge; 2 – motor nucleus of the facial nerve; 3- stylomastoid
hole; 4 – branches of the facial nerve; 5 – muscle that lowers the angle of the mouth;
6 – muscle that lowers the lower lip; 7 – mental muscle;
8 – buccal muscle; 9 – orbicularis oris muscle; 10 – muscle,
levator labii superioris; 11 – muscle that lifts the angle of the mouth;
12 – zygomaticus major and minor muscles; 13 – orbicularis oculi muscle;
14 – muscle that wrinkles the eyebrow; 15 – occipitofrontal muscle;
16 – facial nerve; 17 – vestibulocochlear nerve.
The glossopharyngeal nerve (1X pair) innervates the mucous membrane of the posterior third of the tongue, palatine arches, tonsils and pharynx. The parasympathetic branches of the glossopharyngeal nerve innervate the parotid gland. The axons of the vagus nerve, together with the branches of the glossopharyngeal nerve, form the pharyngeal plexus.
The facial nerve (VII pair) (Fig. 8) has an extensive area of muscle innervation. Axons of the motor nucleus of the facial nerve control all facial muscles, the posterior belly of the digastric muscle, and the stylohyoid muscle. Sensitive fibers carry out taste perception of the anterior 2/3 of the tongue. Autonomic parasympathetic fibers end in the lacrimal gland, in the salivary sublingual and submandibular glands, as well as in the glands of the palate and nasal cavity.
Motor innervation of the maxillofacial area is also carried out by: fibers of the vagus nerve (X pair - muscles of the pharynx), hypoglossal nerve (XII pair - muscles of the tongue).
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Innervation of the maxillofacial region, facial nerves
TOPIC No. 5 Innervation of the head and neck.
Eyebrow tattooing is carried out only in the salon using an acupuncture needle or a special device
Permanent makeup or eyebrow tattooing is a procedure for introducing paint under the skin between the hairs. Tattooing allows you to avoid daily touch-ups. As a rule, plant pigments are used for permanent makeup, which are completely absorbed by the skin within 2 years.
Permanent makeup should only be done in a salon that has a medical license, the sterility of which resembles an operating room. The work is complex and delicate; the technique of insertion, the depth of the puncture, the selection of paint, and the ability to choose the appropriate shape for the face type are important. It is better if the master has at least two years of experience in such work.
There are no specific eyebrow diseases as such. Eyebrows may fall out if the hair follicle is infected or injured during the process of correction, tattooing or coloring.
Eyebrow loss is always a symptom of some other disease. This may be a reaction to circulatory disorders, radiation, diseases of the skin and thyroid gland, malnutrition (including deficiency of iron, vitamins A, C, group B), diabetes mellitus, stress, overwork, insomnia, menopause, a consequence of severe infectious diseases. For diagnosis and treatment, you should consult a doctor.
The maxillofacial region receives innervation from motor, sensory and autonomic (sympathetic, parasympathetic) nerves. Of the twelve pairs of cranial nerves, the fifth (trigeminal), seventh (facial), ninth (glossopharyngeal), tenth (vagus) and twelfth (hyoid) pairs participate in the innervation of the maxillofacial region. The sense of taste is associated with the first pair - the olfactory nerve.
The sensory nerves include the trigeminal, glossopharyngeal, vagus nerves, as well as branches coming from the cervical plexus (the greater auricular nerve and the lesser occipital). Nerve fibers go from the motor nuclei (located in the brain stem) to the muscles of mastication (trigeminal nerve), to the muscles of facial expression (facial nerve), to the muscles of the palate and pharynx (vagus nerve), to the muscles of the tongue (hypoglossal nerve).
Along the branches of the trigeminal nerve the following autonomic ganglia are located: 1) ciliary; 2) pterygopalatine; 3) submandibular; 4) sublingual; 5) ear.
The ciliary ganglion is associated with the first branch of the trigeminal nerve, the pterygopalatine ganglion with the second, and the submandibular, sublingual and auricular ganglia with the third.
Sympathetic nerves to the tissues and organs of the face come from the superior cervical sympathetic ganglion.
A. The trigeminal nerve is mixed. Sensitive nerve fibers carry information about pain, tactile and temperature sensitivity from the skin of the face, mucous membranes of the nasal and oral cavities, as well as impulses from the mechanoreceptors of the masticatory muscles, teeth, and temporomandibular joints. Motor fibers innervate the following muscles: masticatory, temporal, pterygoid, mylohyoid, anterior belly of the digastric muscle, as well as the muscle that strains the tympanic membrane and the levator velum palatine. They depart from the trigeminal ganglion three sensory nerves:1. orbital, 2.maxillary and 3.mandibular. Motor fibers that are not involved in the formation of the trigeminal (Gasserian) ganglion join the mandibular nerve and make it a mixed (sensory and motor) nerve.
1.Orbital nerve is the first branch of the trigeminal nerve. It passes along with the oculomotor and trochlear nerves in the thickness of the outer wall of the cavernous (cavernous) sinus and enters the orbit through the superior orbital fissure. Before entering this fissure, the nerve divides into three branches: frontal, nasociliary and lacrimal.
Frontal nerve in its middle part it is divided into the supraorbital (branches in the skin of the forehead), supratrochlear (emerges at the inner corner of the eye and goes to the skin of the upper eyelid, root of the nose and the inferomedial part of the frontal region) and the frontal branch (innervates the skin of the medial half of the forehead).
Nasociliary nerve enters the orbit along with the optic nerve and ophthalmic artery through the common tendon ring. Its branches are the long and short ciliary nerves, which go to the eyeball from the ciliary ganglion, as well as the anterior ethmoidal nerve (innervates the mucous membrane of the anterior part of the lateral wall of the nasal cavity, the skin of the apex and wings of the nose) and the posterior ethmoidal nerve (to the mucous membrane of the sphenoid and posterior wall of the ethmoid sinus).
Lacrimal nerve approaching the lacrimal gland, it divides into superior and inferior branches. The latter, at the outer wall of the orbit, anastomoses with the zygomatic nerve coming from the maxillary branch of the trigeminal nerve. Innervates the lacrimal gland, conjunctiva, outer corner of the eye and the outer part of the upper eyelid.
2.Maxillary nerve- second sensory branch of the trigeminal nerve. It leaves the cranial cavity through the foramen rotundum and enters the pterygopalatine fossa. In the latter, the maxillary nerve divides into the zygomatic, infraorbital and branches heading to the pterygopalatine ganglion.
Zygomatic nerve enters the orbit through the inferior orbital fissure and divides in the zygomatic canal into the zygomaticotemporal and zygomaticofacial branches, which exit through the corresponding openings in the zygomatic bone and are directed to the skin of this area.
Infraorbital nerve innervates the skin of the lower eyelid, the mucous membrane of the nasal vestibule, the wings of the nose, the upper lip, the skin, the mucous membrane and the anterior surface of the gums.
The superior alveolar nerves extend over a considerable distance from the infraorbital nerve. The posterior superior alveolar branches depart even before the infraorbital nerve enters the orbit, then descend along the tubercle of the upper jaw and enter it through the corresponding foramina. The middle superior alveolar branch departs in the region of the infraorbital groove, through an opening at its bottom it penetrates into the middle alveolar canal, along which it descends down in the thickness of the lateral wall of the maxillary sinus. The anterior superior alveolar branches depart in the anterior sections of the infraorbital canal, through the corresponding openings they penetrate into the alveolar canals and descend down them in the thickness of the anterior wall of the maxillary sinus. All of the listed upper alveolar branches anastomose with each other (through numerous bone canals), forming the upper dental plexus. Branches extend from the latter to innervate the teeth and mucous membrane of the gums of the upper jaw.
3.Mandibular nerve is the third branch of the trigeminal nerve. Mixed, as it consists of a smaller (anterior) part, almost exclusively motor, and a larger (posterior) part, almost exclusively sensitive. From the anterior branch depart the masticatory nerve (motor branches to the masticatory muscle and the temporomandibular joint), deep temporal nerves (to the temporal muscle), lateral pterygoid nerve (goes to the lateral pterygoid muscle), buccal nerve (sensitive branches that innervate the skin and mucous membranes). cheek membrane). Thus, the anterior part (branch) of the mandibular nerve is predominantly motor. The posterior part (branch) of the mandibular nerve consists of both motor fibers - the medial pterygoid nerve (to the tensor soft palate muscle), the tensor palatine nerve and the nerve of the tensor tympani muscle, as well as three large sensory nerves - the auriculotemporal, inferior alveolar and lingual.
Auriculotemporal nerve(auriculotemporal) contains both sensory branches (innervate the skin of the temporal region) and postnodal sympathetic and secretory parasympathetic fibers from the ear node (provide autonomic innervation of the parotid gland and vessels of the temporal region). Having separated under the foramen ovale, it is directed along the inner surface of the lateral pterygoid muscle, and then goes outward, bending around the back of the neck of the condylar process of the mandible. Then it goes upward, penetrating through the parotid gland and approaches the skin of the temporal region, where it branches into terminal branches.
Inferior alveolar nerve(mandibular) is the largest branch of the mandibular nerve. Contains mainly sensory fibers. Its motor branches are the mylohyoid nerve (branches in the mylohyoid and anterior belly of the digastric muscle). In the mandibular canal, a large number of inferior dental branches depart from the inferior alveolar nerve, forming the inferior dental plexus. When exiting the mandibular canal through the mental foramen, this nerve is already called the mental nerve.
B. Facial nerve- seventh pair of cranial nerves. It is a motor nerve that innervates the facial muscles of the face, the muscles of the calvarium, the stapes muscle, the subcutaneous muscle of the neck, the stylohyoid muscle and the posterior belly of the digastric muscle. In addition to motor fibers, the nerve carries taste (for the tongue) and secretory fibers (for the salivary glands of the floor of the mouth).
All branches are divided into three groups:
1) upper - temporal and zygomatic branches (for the muscles of the external ear, forehead, zygomatic and orbicularis orbital muscles);
2) middle - buccal branch (for the buccal muscle, muscles of the nose, upper lip, orbicularis oris, triangular and quadratus muscles of the lower lip);
3) lower - marginal branch of the mandible (for the quadratus muscle of the lower lip, mental muscle), cervical branch (for the subcutaneous muscle of the neck).
The glossopharyngeal nerve (ninth pair) is primarily sensory. The lingual branches, innervating the posterior third of the tongue, contain both sensory and taste fibers.
The vagus nerve (tenth pair) innervates the facial area, the pharyngeal cavity and the upper part of the larynx. It is a mixed nerve, because contains motor, sensory and autonomic (parasympathetic) fibers.
The lingual nerve runs in an arcuate manner from the mandibular nerve between the internal pterygoid muscle and the medial surface of the ramus of the mandible.
The hypoglossal nerve (twelfth pair) innervates only the muscles of the tongue (both its own and the skeletal muscles intertwined with it).
Autonomic innervation of the maxillofacial region is carried out through the nodes of the autonomic nervous system, closely connected with the trigeminal nerve.
In this article we will look at the topography of blood vessels and nerves in relation to the facial muscles, but we will go from deep layers to superficial ones.
Rice. 1-41. The external carotid artery passes anterior to the auricle and continues into the superficial temporal artery, which divides into parietal and anterior branches. Also, the maxillary and facial branches depart from the external carotid artery, most of which are not visible when viewed from the front. departs from the external carotid and, bending over the edge of the lower jaw, goes to the corner of the mouth, where it gives off branches to the upper and lower lips, and itself goes up and inward to the inner corner of the palpebral fissure. The portion of the facial artery that runs lateral to the external nose is called the angular artery. At the inner canthus, the angular artery anastomoses with the dorsal nasal artery, which arises from the supratrochlear artery, which, in turn, is a branch of the ophthalmic artery (from the internal carotid artery system). The main trunk of the supratrochlear artery ascends to the middle of the forehead. The area of the superciliary arches is supplied with blood by the supraorbital artery, which emerges from the supraorbital foramen. The infraorbital region is supplied with blood by the infraorbital artery, emerging from the foramen of the same name. The mental artery, which arises from the inferior alveolar artery and emerges from the mental foramen, supplies the soft tissues of the chin and lower lip.
Rice. 1-42. The veins of the forehead form a dense, variable network and usually merge anteriorly into the supratrochlear vein, also called the frontal vein. This vein runs in the midface medially from the orbit to the edge of the mandible and ultimately connects with the internal jugular vein. The name of this vein varies depending on the anatomical region. On the forehead it is called the frontal vein. In the region of the glabella, it connects with the supraorbital vein, and inward from the orbit - with the superior orbital vein, thus providing outflow from the veins of the orbit and cavernous sinus. Near the bony part of the external nose, it connects with the veins of the upper and lower eyelids (venous arch of the upper and lower eyelids) and is called the angular vein. On its way along the external nose, it collects blood from the small veins of the nose and cheeks, and also anastomoses with the infraorbital vein, which emerges from the infraorbital foramen. In addition, blood from the zygomatic region enters this vein through the deep vein of the face. On the cheek, the main vein connects with the superior and inferior labial veins and is called the facial vein. Connecting with the veins of the chin, the facial vein bends over the edge of the lower jaw and flows into the internal jugular vein on the neck. The veins of the parietal region unite into the superficial temporal vein, which, in turn, flows into the external jugular vein.
Rice. 1-43. The face is innervated by fibers of the trigeminal (mainly sensory fibers; motor fibers innervate the masticatory muscles) and facial nerves (motor fibers). In addition, the large auricular nerve, which belongs to the spinal nerves, takes part in the sensitive innervation of the face.
The trigeminal nerve (5th pair of cranial nerves, CN V) has three branches: the ophthalmic (CN V1), maxillary (CN V2) and mandibular (CN V3) nerves.
The optic nerve is divided into the frontal, lacrimal and nasociliary nerves. The frontal nerve runs in the orbit above the eyeball and divides into the supratrochlear and supraorbital nerves. The supraorbital nerve has two branches, the larger of which, the lateral one, exits the orbit onto the face through the supraorbital foramen or supraorbital notch and innervates the skin of the forehead to the vertex, as well as the conjunctiva of the upper eyelid and the mucous membrane of the frontal sinus. The medial branch of the supraorbital nerve emerges from the orbit medially through the frontal notch and branches in the skin of the forehead.
Another branch of the frontal nerve, the supratrochlear nerve, emerges from the inner canthus and innervates the skin of the nose and conjunctiva.
The outer canthus is innervated by the lacrimal nerve. It separates from the optic nerve in the orbital cavity and before exiting it gives off branches to the lacrimal gland. The nasociliary nerve, a branch of the ophthalmic nerve, gives off the anterior ethmoidal nerve, the terminal branch of which, the external nasal nerve, in turn passes through the cells of the ethmoidal labyrinth.
Through the infraorbital foramen, the infraorbital nerve, a large branch of the maxillary nerve (CN U2), enters the face. Its other branch, the zygomatic nerve, passes laterally in the orbit and enters the zygomatic region through separate canals in the zygomatic bone. The zygomaticotemporal branch of the zygomatic nerve innervates the skin of the temple and forehead. The zygomaticofacial branch of the zygomatic nerve exits through the zygomaticofacial foramen (sometimes there may be several holes) and branches in the skin of the cheekbone and lateral canthus.
The auriculotemporal nerve, a branch of the mandibular nerve, runs under the foramen ovale. Having passed along the inner surface of the branch of the lower jaw, it bends around it from behind, innervates the skin in the area of the condylar process and the external auditory canal, pierces the parotid salivary gland and ends in the skin of the temple. The teeth of the upper jaw are innervated by the maxillary nerve. The teeth of the mandible are innervated by the inferior alveolar nerve, which arises from the mandibular nerve (CN, V3) and enters the mandibular canal through the mandibular foramen. The branch of the mandibular nerve emerging from the mental foramen is called the mental nerve; it provides sensitive innervation to the skin of the chin and lower lip.
Facial muscles are innervated by the facial nerve(CN V2). It emerges from the stylomastoid foramen and gives off numerous branches to the facial muscles. The branches of the facial nerve include the temporal branches, going to the temporal region and innervating the muscles of the forehead, temple and eyelids; zygomatic branches innervating the zygomatic muscles and muscles of the lower eyelid; buccal branches to the muscles of the cheeks, the muscles surrounding the oral cavity, and the muscle fibers around the nostrils; the marginal mandibular branch, innervating the muscles of the chin, and the cervical branch to the platysma.
Rice. 1-44. General view of the arteries, veins and nerves of the face.
Rice. 1-45. Deep arteries, veins (right) and nerves of the face (left).
Rice. 1-45. The vessels and nerves of the face passing through the bone canals and openings are located close to each other. On the right side of the face, deep arteries and veins and their exit points onto the face are shown. The branches of the ophthalmic artery from the internal carotid artery system pass through the orbital septum in one or several places - the supratrochlear artery and the medial arteries of the eyelids (pass through the upper edge of the septum). Veins of the face also pass through the orbital septum, forming the superior orbital vein.
The supraorbital artery and vein pass through the supraorbital foramen. Sometimes this opening may not be closed and is called the supraorbital notch, by analogy with the medially located supratrochlear notch, through which the supratrochlear artery and vein pass. Even more medial are the branches of the dorsal nasal artery and the superior branches of the ophthalmic artery, connecting with the arterial arch of the upper eyelid. Venous drainage occurs in the superior ophthalmic vein.
The lateral and medial arteries of the eyelids extend from the ophthalmic artery to the lower eyelid, forming the arterial arch of the lower eyelid and giving off branches to the dorsum of the nose. All arterial branches are accompanied by veins of the same name. The infraorbital artery and vein pass through the infraorbital foramen. They branch in the tissues of the lower eyelid, cheek and upper lip and have many anastomoses with the angular artery and vein.
The zygomaticofacial vessels exit into the face through the zygomaticofacial foramen.
Through the mental foramen, which opens the canal of the lower jaw, the mental branches of the mandibular artery and nerve pass. Through the same opening, the mental branch of the inferior alveolar vein enters the mandibular canal. In the figure, the facial artery and vein at the edge of the lower jaw are crossed. The transverse facial artery is shown at the lower edge of the zygomatic arch. The superficial temporal artery and vein are divided at the entrance to the temporal fossa.
The left side of the face also shows the exit points of the nerves. The supraorbital nerve passes through the supraorbital foramen, arising from the ophthalmic nerve (the first branch of the trigeminal nerve CN V1), which provides sensory innervation to the supraorbital region. Inside the orbit, the supratrochlear nerve arises from the optic nerve, which, passing through the opening in the orbital septum (septum), is divided into medial, lateral and palpebral branches. Through the infraorbital canal, which opens with the infraorbital foramen, passes the infraorbital nerve, a branch of the maxillary nerve (second branch of the trigeminal nerve, CN V2). It provides sensory innervation to the lower lip, cheek and part of the nose and upper lip.
Thus, the lower eyelid is innervated by two nerves: the palpebral branch of the infratrochlear nerve (from the ophthalmic nerve) and the inferior palpebral branches of the infraorbital nerve (from the maxillary nerve).
The zygomaticofacial nerve enters the face from the foramen of the same name and provides sensitive innervation to the zygomatic region. The mental nerve exits the mandibular canal through the mental foramen and carries sensory fibers to the mental region and lower lip. To avoid loss or impairment of sensitivity in the lower lip due to damage to this nerve when performing complicated wisdom tooth extraction and osteotomy of the mandibular branch, it is necessary to have a good knowledge of its topography in the mandibular canal.
Rice. 1-46. Individual branches of the supratrochlear and supraorbital arteries and veins run very close to the bone and are covered with fibers of the corrugator muscle. Other branches run in a cranial direction above the muscle. The lateral and medial branches of the supraorbital and supratrochlear nerves pass under, above, and through the fibers of the corrugator brow muscle. The motor innervation of this muscle is provided by the anterior temporal branches of the facial nerve (CN VII).
The temporalis muscle is supplied by the deep temporal arteries and veins. The sensory innervation of this area is carried out by the deep temporal nerve (from CN V3). The muscle receives motor innervation from the temporal branches of the facial nerve.
The superficial temporal artery and vein, together with the temporal branches (from the facial nerve) go above the zygomatic arch and are crossed in this figure.
The vessels and nerves emerging from the infraorbital foramen (artery, vein and infraorbital nerve) supply the area around it and also branch into the tissues of the lower eyelid (branches of the lower eyelid), the muscles of the nose and the upper lip.
The facial artery and vein bend over the edge of the lower jaw anterior to. More medially, they cross the buccal muscle and branch in an arcuate manner in an oblique direction, located superficially to the branches of the infraorbital artery and vein. At the intersection of the branch of the lower jaw, the pulsation of the artery is palpated.
The buccal muscle is innervated by the buccal branches of the facial nerve.
The neurovascular bundle of the mandibular canal exits onto the face through the mental foramen. The mental artery, the mental branch of the inferior alveolar vein and the nerve of the same name branch in the soft tissues of the lower lip and chin. The motor innervation of the adjacent muscles is carried out by the marginal branches of the mandible, arising from the facial nerve (CN V2).
Rice. 1-47. Topography of arteries and veins (right half) and facial nerves (left half) in relation to facial muscles.
Rice. 1-47. The branches of the supratrochlear and supraorbital arteries and veins pass through the frontal belly of the occipitofrontal muscle. The lateral and medial branches of the supratrochlear and supraorbital nerves pass through and above the muscle. The motor innervation of this muscle is carried out by the anterior temporal branches of the facial nerve.
The dorsum of the nose is innervated by the external nasal branches arising from the anterior ethmoidal nerve. This nerve passes between the nasal bone and the lateral nasal cartilage and runs along the surface of the cartilage. The branches of the infraorbital nerve (external nasal branches) branch in the wings of the nose. The motor innervation of the muscles is carried out by the zygomatic branches of the facial nerve (CN V2).
Rice. 1-48. Topography of arteries and veins (right half) and facial nerves (left half) in relation to facial muscles.
Rice. 1-48. Additional venous drainage from the forehead occurs through accessory branches of the supratrochlear nerve.
The orbicularis oculi muscle, covering the orbital septum (septa), is supplied by thin branches of the medial and lateral eyelid arteries, and venous outflow is carried out through the venous arches of the upper and lower eyelids. The lateral artery of the eyelids arises from the lacrimal artery, and the medial artery arises from the ophthalmic artery. Both of these arteries belong to the internal carotid artery system. Venous blood from the upper and lower eyelids flows into the veins of the same name, which flow medially into the angular vein, and laterally into the superior ophthalmic vein (upper eyelid) and inferior ophthalmic vein (lower eyelid).
The lateral and medial branches of the supratrochlear nerve pass through the proud muscle and the depressor brow muscle, which are located in the glabella and supraorbital region. The muscle receives motor innervation from the temporal branches of the facial nerve (CN, V2).
The nasal muscles are supplied by branches of the angular artery. Somewhat more cranially from the angular artery its terminal branch, the dorsal nasal artery, departs. Venous blood flows through the external nasal veins, which drain into the angular vein. Also, part of the venous blood flows into the infraorbital vein. Sensitive innervation is carried out by the branches of the external nasal nerve, extending from the ethmoidal nerve (a branch of the frontal nerve), motor innervation of the adjacent muscles is carried out by the zygomatic branches of the facial nerve.
The levator anguli oris muscle, covering the superior and lateral parts of the orbicularis oris muscle, is supplied by the facial artery and vein, and innervated by the superior labial branches, which arise from the infraorbital nerve, which runs along the surface of this muscle.
The mental foramen is closed by the muscle that depresses the lower lip.
Rice. 1-49. Topography of arteries and veins (right half) and facial nerves (left half) in relation to facial muscles.
Rice. 1-49. Venous drainage from the superficial epifascial layers of the forehead and parietal region occurs through the parietal branches of the superficial temporal vein. Here it also anastomoses with the supratrochlear vein. The main artery of this area is the superficial temporal. At the inner corner of the palpebral fissure, the angular vein connects with the supratrochlear vein. Thus, the superficial veins of the face connect with the superior ophthalmic vein, which opens into the cavernous sinus. It is also possible to connect with the subtrochlear vein, which is also called the nasofrontal vein. The external nasal vein collects blood from the dorsum of the nose and opens into the angular vein.
The angular vein accompanies the angular artery, which lies more medially. When it reaches the levator labii superioris muscle, the vein passes above it and the artery below it.
Blood from the upper lip flows into the superior labial vein, which, in turn, connects to the facial vein. The infraorbital vein enters the infraorbital foramen, closed by the levator labii superioris muscle. Its branches connect with the branches of the angular vein and thus connect the superficial veins of the face with the pterygoid venous plexus. Blood from the lower lip flows into the facial vein through the inferior labial vein. The arterial blood supply to the upper lip is provided by the superior labial artery, and the lower lip by the inferior labial artery. Both of these vessels arise from the facial artery. The inferolateral part of the chin is closed by the depressor anguli oris muscle, which receives motor innervation from the marginal mandibular branch of the facial nerve. Sensory innervation of this area is carried out by branches of the mental nerve, which arise from the inferior alveolar nerve.
Rice. 1-50. Topography of arteries and veins (right half) and facial nerves (left half) in relation to facial muscles.
Rice. 1-50. In the forehead area, the supratrochlear vein also forms anastomoses with the anterior branches of the superior temporal vein.
The angular artery and vein run in a long groove between the levator labii superioris and alae nasi muscle and the orbicularis oculi muscle and are partially covered by the medial edge of the latter. The facial vein passes under the levator labii superioris muscle, and the artery runs above it. Both of these vessels pass under the zygomaticus minor, with the exception of individual arterial branches that may run along the surface of the muscle and then pass under the zygomaticus major. The topography of neurovascular formations in this area is very variable.
Next, the artery and vein are located in the space between the masticatory muscle and the depressor angle oris muscle, and cross the lower edge of the lower jaw.
Rice. 1-51. Topography of arteries and veins (right half) and facial nerves (left half) in relation to facial muscles.
Rice. 1-51. Most of the masseter muscle is covered by the parotid salivary gland. The gland itself is partially covered by the laughter muscle and platysma. All the arteries, veins and nerves of the area pass through these muscles.
Rice. 1-52. Topography of arteries and veins (right half) and nerves of the face (left half) in the subcutaneous fat layer.
Rice. 1-52. The muscles and superficial fascia of the face are covered with a subcutaneous fat layer of varying thickness, through which blood vessels are visible in some places. Small arteries, veins and nerve endings go through the layer of fat to the skin.
Rice. 1-76. Arteries of the face, side view.
Rice. 1-76. The external carotid artery runs anterior to the auricle and gives off the superficial temporal artery, which branches into parietal and anterior branches. Also from the external carotid artery branches extend to the face and upper jaw: the posterior auricular artery departs under the auricle, even lower is the occipital artery, at the level of the lobe is the maxillary artery, which goes medially under the branch of the mandible, at the level between the lobe and the external auditory canal – transverse artery of the neck, which runs along the branch of the mandible. The facial artery bends over the lower edge of the lower jaw and goes to the corner of the mouth.
The main artery of the face is the maxillary artery, which gives off many large branches, which will be described below.
The inferior and superior labial arteries extend from the facial artery to the corner of the mouth. The terminal branch of the facial artery leading to the external nose is called the angular artery. Here, at the medial canthus, it anastomoses with the dorsal nasal artery, which arises from the ophthalmic artery (from the internal carotid artery system). In the upper part of the face, the supratrochlear artery runs to the middle of the frontal region. The supraorbital and infraorbital regions are supplied with blood, respectively, by the supraorbital and infraorbital arteries, emerging through the foramina of the same name. The mental artery, a branch of the inferior alveolar artery, enters the face through the opening of the same name and supplies the soft tissues of the chin and lower lip.
In addition to the facial nerve, the facial part of the head is innervated by the trigeminal nerve (mixed motor nerves to the masticatory muscles and sensory nerves).
Branch I - the ophthalmic nerve enters the orbit through the superior orbital fissure and innervates part of the dura mater, the lacrimal gland, the nasal mucosa, the inner corner of the eye, and the brow ridges. The innervation zone is above the orbit and its upper wall.
Branch II - the maxillary nerve leaves the cavity of the skull through the round foramen and innervates the middle part of the dura mater, upper teeth, and the area of the zygomatic bone. Next, the nerve enters the buccal region in the form of the infraorbital nerve, which splits into a large number of branches (lesser pes anserine) and innervates the maxillary sinus, the anterior teeth of the upper jaw and the skin of the cheek. Innervation zone is the upper jaw.
Branch III - the mandibular nerve exits through the foramen ovale from the cranial cavity and is located in the interpterygoid space of the deep region of the face. Innervation zone is the lower jaw.
The projection of the exit of the terminal branches of the trigeminal nerve onto the surface of the face (supraorbital, infraorbital and mental nerves) corresponds to a vertical line drawn through the middle of the lower edge of the orbit.
TOPOGRAPHY OF THE DEEP FACIAL AREA
Borders:
Externally: ramus of the mandible.
Anterior and medial: tubercle of the mandible.
Above: the outer base of the skull, formed by the greater wing of the sphenoid bone.
There are two gaps in this area:
Temporopterygoid (located between the temporal and lateral pterygoid muscles);
Interpterygoid (enclosed by the lateral and medial pterygoid muscles).
The pterygoid venous plexus and the maxillary artery are located in the cellular space of the temporopterygoid space.
The pterygoid venous plexus anastomoses with the cavernous sinus of the dura mater through the emissary vein of the foramen lacerum, as well as through an anastomosis that penetrates through the inferior orbital fissure and flows into the inferior ophthalmic vein. This is especially true when infectious emboli spread with retrograde blood flow into the cranial cavity. From the pterygoid plexus, blood flows into the retromandibular vein, which merges with the facial vein and both flow into the internal jugular vein.
The maxillary artery arises from the external carotid artery in the parotid salivary gland, bends around the neck of the articular process of the mandible and runs transversely along the outer surface of the lateral pterygoid muscle. In the initial section, the deep auricular artery and the middle meningeal artery (passes through the foramen spinosum of the base of the skull) depart upward from it, and the inferior alveolar artery (goes into the mandibular canal) extends downwards. From the middle part of the maxillary artery, the buccal artery departs (runs along the anterior surface of the buccal muscle) and branches to all masticatory muscles: the artery to the masticatory muscle (runs along its inner surface), the anterior and posterior deep temporal arteries (runs up the anterior surface of the temporal muscle) , pterygoid arterial branches (to the pterygoid muscles). From the terminal section, located in the pterygopalatine fossa, depart: the posterior superior alveolar arteries, the sphenopalatine artery (through the opening of the same name it penetrates into the nasal cavity and gives off the anterior nasal arteries), the descending palatine artery (descends along the large palatine canal to the area of the hard palate), the pterygoid artery canal (passes through the canal of the same name) and the infraorbital artery (passes through the infraorbital canal and gives off the anterior superior alveolar arteries).
The mandibular nerve (III branch of the trigeminal nerve) and its branches are located in the interpterygoid cellular space. There are four main branches: auriculotemporal, buccal, lingual and inferior alveolar nerves.
The auriculotemporal nerve departs from the mandibular nerve immediately after the latter exits the cranial cavity through the foramen ovale and penetrates the parotid salivary gland. Next, with the superficial temporal artery, it rises to the temporal region in front of the external auditory canal. Innervates the gland itself, the external auditory canal, and the eardrum.
The buccal nerve pierces the buccal muscle and branches into the buccal mucosa.
The inferior alveolar nerve is located under the lateral pterygoid muscle, runs in the interpterygoid fascia and enters the mandibular canal.
The lingual nerve is located in the interpterygoid fascia between the buccal and inferior alveolar nerves, and is joined by the chorda tympani (from the facial nerve).
TOPOGRAPHY OF THE pterygopalatine fossa
Borders:
Above: sphenoid bone;
Posterior: pterygoid process;
Anterior: tubercle of the maxilla;
Internally: perpendicular to the plate of the palatine bone.
Gradually narrowing downwards, the fossa passes over the greater palatine canal.
Communications: through the pterygopalatine process of Bichat's fat pad with the buccal area; through the foramen rotundum via the maxillary nerve with the middle cranial fossa; through the inferior orbital fissure along the inferior orbital artery with the orbital cavity; through the pterygopalatine canal - with the oral cavity; along the course of the sphenopalatine artery through the opening of the same name with the nasal cavity; with the outer base of the skull.
TOPOGRAPHY OF THE PERIPHARYNGEAL FELLOW SPACE
It is located inwardly from the deep region of the face and is delimited externally by the medial pterygoid muscle, externally and posteriorly by the transverse processes of the cervical vertebrae, internally by the lateral wall of the pharynx and by lateral pharyngeal-vertebral fascial spurs running from the pharynx to the base of the transverse processes, separating the peripharyngeal and retropharyngeal spaces.
A strong “styloid diaphragm” formed by the muscles starting from the styloid process and their fascial sheaths divides the peripharyngeal space into anterior and posterior sections. In the posterior section there are: outside - the internal jugular vein, inside - the internal carotid artery, glossopharyngeal, vagus, accessory and hypoglossal cranial nerves. At the border of the peripharyngeal and retropharyngeal spaces is the superior cervical ganglion of the sympathetic trunk.
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