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FACE
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[Dr.%J.M.%Santicruz]%|%[August%29,%2019]!
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! IV.)DANGEROUS)AREA)OF)THE)FACE
OUTLINE !
I.$Arterial$Pulsation$ VII.$Facial$Expression$
A.$ Facial$Artery$ A.$ Muscles$of$Facial$
B.$ Superficial$Temporal$ Expression$
Artery$ B.$ Facial$Nerve$
II.$Skin$of$the$Face$ C.$ Bell's$Palsy$
III.$Fascia$ VIII.$Dislocation$of$Jaw$
A.$ Superficial$Fascia$ IX.$Trauma$to$the$Face$
IV.$Dangerous$Area$of$the$ A.$ Nasal$Fracture$
Face$ B.$ Orbital$Fracture$
V.$Parotid$Gland$ C.$ Mandibular$Fracture$
A.$Parotitis$ A.$ LeFort$
VI.$Nerve$Supply$of$the$Face$ Fractures$
A.$ Sensory$Nerves$
B.$ Trigeminal$Nerve$
A.$ Frey$
Syndrome$
•$ Angular$vein$$
I.)ARTERIAL)PULSATIONS •$ At$the$sides$of$the$nose$
•$ Valveless$vein$
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•$ Communicates$ with$ the$ cavernous$ sinus$ by$ superior$
A.)FACIAL)ARTERY) ophthalmic$vein$
•$ 3$cm$anterior$to$angle$of$mandible$ •$ Wounds$ or$ infections$ in$ this$ area$ of$ the$ face$ can$ lead$ to$
•$ Bends$around$lower$body$of$mandible$ cavernous$sinus$thrombosis$and$meningitis$
•$ Origin$is$the$external$carotid$artery$ •$ Danger$ triangle$ consists$ of$ area$ from$ the$ corners$ of$ the$
•$ Alternative$area$for$palpation:$anterior$border$of$masseter$ mouth$to$the$bridge$of$the$nose$including$nose$and$maxilla$
B.)SUPERFICIAL)TEMPORAL)ARTERY •$ Facial$vein$has$no$valves[$blood$can$move$in$any$direction$
•$ Ascends$over$zygomatic$arch$ •$ Blood$can$move$in$any$direction$
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•$ Can$be$palpated$anterior$to$the$auricle$
V.)PAROTID)GLAND

II.)SKIN)OF)THE)FACE !
A.)PAROTITIS
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•$ Inflammation$of$the$parotid$gland[$mumps$
•$ Thin,$fine,$very$vascular$
•$ With$severe$pain$
•$ Promotes$rapid$healing$of$the$wound$
•$ Pain$is$not$due$to$enlargement$but$stretching$of$the$capsule$
•$ Numerous$sweat$and$sebaceous$glands$
•$ Worse$during$chewing$
•$ Skin$is$connected$to$underlying$bones$via$loose$connective$
tissue$ •$ Gland$is$wrapped$around$posterior$border$of$the$mandible,$
and$is$compressed$against$the$mastoid$process$
•$ Wrinkle$ lines$ formed$ because$ of$ frequent$ folding$ of$ the$ $
skin$$perpendicular$to$the$long$axis$of$the$contracting$muscle$
VI.)NERVE)SUPPLY)OF)THE)FACE
•$ Langer’s$line$is$followed$(where$muscles$run)$
•$ Follows$orientation$of$facial$muscles$of$expression$ !
•$ Incisions$follow$the$lines$especially$during$cosmetic$surgery$

III.)FASCIA
•$ Has$no$deep$fascia$
•$ Lacerations$tend$to$gape$
A.)SUPERFICIAL)FASCIA
•$ Delicate$and$Lax$
•$ Favors$the$spread$of$inflammatory$conditions$that$produce$
great$swellings$
•$ Edema$is$readily$manifested$especially$over$the$eyelids$
and$lips$
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CA2$ TG$8:$Sarmiento,$Sarrosa,$Sastre,$Sayson,$Secerio$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$TG$20:$Valino,$Vargas,$Vega,$Ventura,$Vergel$de$Dios$ 1$of$2$
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A.)SENSORY)NERVES) •$ When$mouth$is$widely$open,$condyloid$process$of$mandible$
•$ Facial$ skin$ receives$ its$ sensory$ nerve$ supply$ from$ the$ slides$forward$to$the$articular$eminence$
trigeminal$nerve$$ •$ Blow$or$yawn$can$cause$dislocation$in$infratemporal$fossa$on$
B.)TRIGEMINAL)NERVE both/one$side$
•$ Ophthalmic:$Forehead$and$scalp$ •$ ”lock$jaw”$
•$ Maxillary$:$areas$below$orbit$and$cheeks$ •$ Treatment:$reduction=press$down$on$the$molar$teeth$with$the$
thumbs$(to$stretch$masseter$and$temporalis$muscle)$placed$in$
•$ Mandibular:$lower$parts$of$face$
the$mouth$and$at$the$same$time$pull/lift$the$chin$
•$ Trigeminal$supplies$most$except$the$skin$over$the$angle$of$the$
jaw$(supplied$by$the$great$auricular$nerve:$C2,$C3)$
•$ Trigeminal$neuralgia$ IX.)TRAUMA)TO)THE)FACE
•$ Patient$ experiences$ excruciating$ pain$ in$ distribution$ of$ !
mandibular$and$maxillary$ A.)NASAL)FRACTURE)
•$ Caused$by$aging,$multiple$sclerosis$and$tumor$ •$ Most$common$fracture$of$the$face$
C.)FREY)SYNDROME) •$ Septal$or$nasal$deviation$(caused$by$external$trauma)$
•$ Develops$after$penetrating$wounds$at$the$parotid$gland$ •$ Treatment:$closed$reduction$or$rhinoplasty$
•$ 64%$seen$in$patients$after$parotidectomy$ B.)ORBITAL)FRACTURE
•$ Causes$damage$in$auriculotemporal$and$great$auricular$nerve$ •$ Large$object$striking$orbital$
•$ When$patient$eats,$beads$of$perspiration$appear$on$skin$over$ •$ Least$protected$or$weakest$part$is$the$lateral$part$of$the$orbital$
parotid$ bone$(blowout$fracture$of$the$orbital$floor)$
•$ During$healing,$the$parasympathetic$secretory$motor$fibers$in$ •$ Diplopia$or$double$vision$
auriculotemporal$nerve$grow$out$and$join$the$distal$end$of$
great$auricular$nerve.$Eventually,$fibers$reach$sweat$glands$in$ •$ Fracture$of$orbital$floor$entraps$the$inferior$rectus$muscle$
skin$ C.)MANDIBULAR)FRACTURE
•$ Stimulus$for$salivary$production$results$in$sweating$ •$ Most$ common$ mandibular$ fracture$ is$ the$ condylar$ fracture[$
secondary$is$in$the$body$part$of$the$mandible$then$angle$part$
of$the$mandible$
VII.)FACIAL)EXPRESSION
•$ Non$reduced$fracture:$malocclusion$(unbalanced$facial$profile)$
! D.)LEFORT)FRACTURES
A.)MUSCLES)OF)FACIAL)EXPRESSION) $
•$ Primary$ function:$ protection$ and$ manipulation/control$ of$ the$ •$ The$fractures$are$named$after$French$surgeon$René$Le$Fort$
orifices$$ (1869–1951),$who$discovered$the$fracture$patterns$by$
•$ Orifices$of$the$face:$orbits,$nose,$mouth$a$guarded$by$eyelids,$ examining$crush$injuries$in$cadavers$
nostrils,$and$lips$ •$ Applies$to$the$transverse$fractures$of$midface$
•$ Secondary$function:$facial$expression$ •$ Identified$most$common$fracture$sites$on$skull$
B.)FACIAL)NERVE •$ Weakest$bones$of$the$face$are$the$maxilla$and$zygomatic$
bones$
•$ Injury$to$the$facial$nerve$may$cause$paresis$(weakness)$and$
paralysis$(loss$of$voluntary$movement)$ •$ Treatment:$Internal$Fixation$
C.)BELL'S)PALSY)
•$ Occurs$ after$ exposure$ to$ cold$ draft$ or$ post$ systemic$ viral$
infection$$$$$$$$$

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LeFort)I)Fracture
•$ Horizontal$
•$ Fracture$of$maxilla$immediately$above$teeth$and$palate$
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•$ Patients$are$unable$to$close$their$eyes$(on$affected$eye)$and$
LeFort)II)Fracture
lips$
•$ Test$ for$ facial$ nerve$ integrity:$ look$ at$ the$ ceiling,$ wrinkle$ •$ Subasubheading$$
forehead,$frown,$smile,$raise$eyebrows$aaaa>$check$symmetry$ •$ Pyramidal$
•$ Possible$symptoms:$ •$ Blow$to$the$lower$and$mid$maxilla$
•$ Droopy$eyelid,$dry$eye,$or$excessive$tears$
•$ Facial$paralysis,$twitching,$or$weakness$ LeFort)III)Fracture
•$ Drooping$corner$of$mouth,$dry$mouth,$impaired$taste$ •$ Transverse$
$ •$ Craniofacial$separation$
VIII.)DISLOCATION)OF)JAW $
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ANA$ Face% 2$of$2$
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