MAXILLOFACIAL ANATOMY

Rachmanda Haryo Wibisono

Hendra Benyamin
Joana De Fatima
• BONES
• MUSCLES
• VASCULARIZATION
• SINUSES
• INNERVATION
• TMJ
Moore - Clinically Oriented Anatomy, 5th Ed 2006
• Os. Temporal
• Os. Maxilla
• Os. Mandibula
• Os. Zygoma
• Os. Nasal
• Os. Sphenoid
• Os. Ethmoid
• Os. Lacrimal
Netter – Neuroanatomy, 2007
 Netter – Neuroanatomy, 2007

• Canalis opticus (CNII)

• Fissura orbitalis superior (CN III,IV,VI, V1,V2)
Moore - Clinically Oriented Anatomy, 5th Ed 2006
• BONES
• MUSCLES
• VASCULARIZATION
• SINUSES
• INNERVATION
• TMJ
Moore - Clinically Oriented Anatomy, 5th Ed 2006
Musclea Origin Insertion Main Action(s)
Occipitofrontalis      
  Frontal belly1 Epicranial aponeurosis Skin and subcutaneous Elevates eyebrows and
tissue of eyebrows and wrinkles skin of forehead;
forehead protracts scalp
(indicating surprise or
curiosity)
  Occipital belly a
Lateral two thirds of Epicranial aponeurosis Retracts scalp; increasing
superior nuchal line effectiveness of frontal
belly
Orbicularis oculi (orbital Medial orbital margin; Skin around margin of Closes eyelids: palpebral
sphincter)1,2 medial palpebral orbit; superior and part does so gently;
ligament; lacrimal bone inferior tarsal plates orbital part tightly
(winking)
Corrugator supercilii 1
Medial end of superciliary Skin superior to middle of Draws eyebrow medially
arch supraorbital margin and and inferiorly, creating
superciliary arch vertical wrinkles above
nose (demonstrating
concern or worry)
Procerus plus transverse Fascia aponeurosis Skin of inferior forehead, Depresses medial end of
part of nasalis 3
covering nasal bone and between eyebrows eyebrow; wrinkles skin
lateral nasal cartilage over dorsum of nose
(conveying disdain or
dislike)
Alar part of nasalis plus Frontal process of maxilla Major alar cartilage Depresses ala laterally,
levator labii superioris (inferomedial margin of dilating anterior nasal
alaeque nasii3 orbit) aperture (i.e., “flaring
nostrils,” as during
anger or exertion)
Orbicularis oris (oral Medial maxilla and Mucous membrane of lipsTonus closes rima oris;
sphincter)3 mandible; deep surface of phasic contraction
perioral skin; angle of compresses and
mouth (modiolus) protrudes lips (kissing) or
resists distension (when
blowing)
Levator labii superioris3 Infraorbital margin Skin of upper lip Part of dilators of mouth;
(maxilla) retract (elevate) and/or
Zygomaticus minor3 Anterior aspect, evert upper lip; deepen
zygomatic bone nasolabial sulcus
(showing sadness)
Buccinator (cheek Mandible, alveolar Angle of mouth Presses cheek against
muscle)3 processes of maxilla and (modiolus); orbicularis molar teeth; works with
mandible, oris tongue to keep food
pterygomandibular raphe between occlusal surfaces
and out of oral vestibule;
resists distension (when
blowing)
Zygomaticus major3 Lateral aspect of Angle of mouth Part of dilators of mouth;
zygomatic bone (modiolus) elevate labial
Levator anguli oris3 Infraorbital maxilla commissure—bilaterally
(canine fossa) to smile (happiness);
unilaterally to sneer
(disdain)
Risorius3 Parotid fascia and buccal Part of dilators of mouth;
skin (highly variable) widens rima oris, as when
grinning or grimacing
Depressor anguli oris4 Anterolateral base of Part of dilators of mouth;
mandible depresses labial
commissure bilaterally to
frown (sadness)
Depressor labii inferioris4 Platysma and Skin of lower lip Part of dilators of mouth;
anterolateral body of retracts (depresses)
mandible and/or everts lower lip
(pouting, sadness)
Mentalis4 Body of mandible Skin of chin (mentolabial Elevates and protrudes
(anterior to roots of sulcus) lower lip; elevates skin of
inferior incisors) chin (showing doubt)
Platysma5 Subcutaneous tissue of Base of mandible; skin of Depresses mandible
infraclavicular and cheek and lower lip; angle (against resistance);
supraclavicular regions of mouth (modiolus); tenses skin of inferior
orbicularis oris face and neck (conveying
tension and stress)
• BONES
• MUSCLES
• VASCULARIZATION
• SINUSES
• INNERVATION
• TMJ
Artery Origin Course Distribution
Facial External carotid artery Ascends deep to Muscles of facial
submandibular gland; expression and face
winds around inferior
border of mandible
and enters face
Inferior labial Facial artery near Runs medially in lowerLower lip
angle of mouth lip
Superior labial Runs medially in Upper lip and ala
upper lip (side) and septum of
nose
Lateral nasal Facial artery as it Passes to ala of nose Skin on ala and
ascends alongside dorsum of nose
nose
Angular Terminal branch of Passes to medial angle Superior part of cheek
facial artery (canthus) of eye and inferior eyelid
Occipital External carotid artery Passes medial to Scalp of back of head,
posterior belly of as far as vertex
digastric and mastoid
process;
Posterior auricular Passes posteriorly, Scalp posterior to
deep to parotid gland auricle and auricle
Superficial temporal Smaller terminal Ascends anterior to ear Facial muscles and
branch of external to temporal region and skin of frontal and
carotid artery ends in scalp temporal regions
Transverse facial Superficial temporal Crosses face superficial Parotid gland and
artery within parotidto masseter and duct, muscles and skin
gland inferior to zygomatic of face
arch
Mental Terminal branch of Emerges from mental Facial muscles and
inferior alveolar foramen and passes to skin of chin
artery chin
Supraorbitala Terminal branch of Passes superiorly from Muscles and skin of
ophthalmic artery, a supraorbital foramen forehead and scalp
Supratrochleara branch of internal Passes superiorly from Muscles and skin of
carotid artery supratrochlear notch scalp
Vein Origin Course Termination Area Drained
Supratrochlear Begins from venous Descends near Angular vein at root Anterior part of
plexus on forehead midline of forehead of nose scalp and forehead
and scalp, through to root of nose,
which it where it joins
communicates with supraorbital vein
frontal branch of
superficial temporal
vein, its
contralateral
partner, and
supraorbital vein
Supraorbital Begins in the Passes medially
forehead by superior to orbit;
anastomosing with joins supratrochlear
frontal tributary of
vein; a branch
superficial temporal
passes through
vein supraorbital notch
and joins with
superior ophthalmic
vein
Angular Begins at root of Descends obliquely Becomes facial vein Anterior part of
nose by union of along root and side at inferior margin of scalp and forehead;
supratrochlear and of nose to inferior orbit superior and inferior
supraorbital veins orbital margin eyelids and
conjunctiva; may
receive drainage
from cavernous
sinus
Facial Continuation of Descends along Internal jugular vein Anterior scalp and
angular vein past lateral border of opposite or inferior fore-head; eyelids;
inferior margin of nose, receiving to level of hyoid external nose;
orbit external nasal and bone anterior cheek; lips;
inferior palpebral chin; and
veins; passes submandibular
obliquely across face gland
to cross inferior
border of mandible;
receives
communication
from retro
mandibular vein
Deep facial Pterygoid venous Runs anteriorly on Enters posterior Infratemporal fossa
plexus maxilla superior to aspect of facial vein (most areas supplied
buccinator and deep by maxillary artery)
to masseter,
emerging medial to
anterior border of
masseter onto face
Superficial temporal Begins from Frontal and parietal Joins maxillary vein Side of scalp;
widespread plexus tributaries unite posterior to neck of superficial aspect of
of veins on side of anterior to the mandible to form temporal muscle;
scalp and along auricle; crosses retromandibular and external ear
zygomatic arch temporal root of vein
zygomatic arch to
pass from temporal
region and enter
substance of the
parotid gland
Retromandibular Formed anterior to Runs posterior and Unites with Parotid gland and
ear by union of deep to ramus of posterior auricular masseter muscle
superficial temporal mandible through vein to form external
and maxillary veins substance of parotid jugular vein
gland;
communicates at
inferior end with
facial vein
• BONES
• MUSCLES
• VASCULARIZATION
• SINUSES
• INNERVATION
• TMJ
• BONES
• MUSCLES
• VASCULARIZATION
• SINUSES
• INNERVATION
• TMJ
 CN5
Trigeminal Nerves
• Biggest cranial nerve
• Originates in the pons and
eventually splits into 3
divisions:
▫ Ophthalmic (V1), Maxillary
(V2), &
Mandibular (V3).
• Sensory info (touch, temp.,
and pain) from face.
• Motor info to muscles of
mastication
Cutaneous nerves derived from ophthalmic nerve (CN V1)

Supraorbital Largest branch from Continues anteriorly Mucosa of frontal sinus;

bifurcation of frontal along roof of orbit, skin and conjunctiva of
nerve, approximately in emerging via supraorbital middle of superior eyelid;
middle of orbital roof notch or foramen; skin and pericranium of
ascends forehead, anterolateral forehead
breaking into branches and scalp to vertex
(interauricular line)
Supratrochlear Smaller branch from Continues anteromedially Skin and conjunctive of
bifurcation of frontal along roof of orbit, medial aspect of superior
nerve, approximately in passing lateral to trochlea eyelid; skin and
middle of orbital roof and ascending forehead pericranium of
anteromedial forehead
Lacrimal Smallest branch from Runs superolaterally Lacrimal gland
trifurcation of CN V1 through orbit, receiving (secretomotor fibers);
proximal to superior secretomotor fibers via a small area of skin and
orbital fissure communicating branch conjunctiva of lateral
from the part of superior eyelid
zygomaticotemporal
nerve
Infratrochlear Terminal branch (with Follows medial wall of Skin lateral to root of
anterior ethmoidal nerve) orbit, passing inferior to nose; skin and
of nasociliary nerve trochlea conjunctiva of eyelids
adjacent to medial
canthus, lacrimal sac,
and lacrimal caruncle
External nasal Terminal branch of Emerges from nasal Skin of nasal ala,
anterior ethmoidal nerve cavity by passing between vestibule, and dorsum of
nasal bone and lateral nose, including apex
nasal cartilage
Cutaneous nerves derived from maxillary nerve (CN V2)
Infraorbital Continuation of CN V2 Traverses infraorbital Mucosa of maxillary
groove and canal in
distal to its entrance into sinus; premolar, canine,
orbital floor, giving rise to and incisor maxillary
the orbit via the inferior
orbital fissure superior alveolar teeth; skin and
branches; then emerges conjunctiva of inferior
via infraorbital foramen, eyelid; skin of cheek,
immediately dividing into lateral nose, and
inferior palpebral, anteroinferior nasal
internal and external septum; skin and oral
nasal, and superior labial mucosa of superior lip
branches
Zygomaticofacial Smaller terminal branch Traverses Skin on prominence of
(with zygomaticofacial canal in cheek
zygomaticotemporal zygomatic bone at
nerve) of zygomatic inferolateral angle of
nerve orbit
Zygomaticotemporal Larger terminal branch Sends communicating Hairless skin anterior
(with zygomaticofacial branch to lacrimal nerve part of temporal fossa
nerve) of zygomatic in orbit; then passes to
nerve temporal fossa via
zygomaticotemporal
canal in zygomatic bone
Cutaneous nerves derived from mandibular nerve (CN V 3)

Auriculotemporal In infratemporal fossa via Passes posteriorly deep to Skin anterior to auricle
two roots from posterior ramus of mandible and and posterior two thirds
trunk of CN V3 that superior deep part of of temporal region; skin
encircle middle parotid gland, emerging of tragus and adjacent
meningeal artery posterior to helix of auricle; skin of
temporomandibular joint roof of external acoustic
meatus; and skin of
superior tympanic
membrane
Buccal In infratemporal fossa as Passes between two parts Skin and oral mucosa of
sensory branch of of lateral pterygoid cheek (overlying and deep
anterior trunk of CN V3 muscle, emerging to anterior part of
anteriorly from cover of buccinator); buccal
ramus of mandible and gingivae (gums) adjacent
masseter, uniting with to second and third
buccal branches of facial molars
nerve
Mental Terminal branch of Emerges from Skin of chin and skin; oral
inferior alveolar nerve mandibular canal via mucosa of inferior lip
(CN V3) mental foramen in
anterolateral aspect of
body of mandible
 CN III
• “Eye mover”
• Originate at the Oculomotor Nerves
ventral midbrain.
• Synapse on:
▫ Extraocular muscles
 Inferior oblique;
Inferior, medial, and
superior rectus
▫ Iris constrictor muscle
▫ Ciliary muscle
• Disorders can result
in eye paralysis,
diplopia or ptosis.
 CN IV
• Controls the superior
oblique muscle which Trochlear Nerves
depresses the eye via
pulling on the superior
oblique tendon which
loops over a ligamentous
pulley known as the
trochlea.
• Originates on the dorsal
midbrain and synapses
on the superior oblique
• Trauma can result in
double vision.
• Runs between inferior CN VI
pons and lateral rectus. Abducens Nerves
 CN VII
Facial Nerves
• Originates at the pons
• Convey motor impulses to facial
skeletal muscles – except for
chewing muscles.
• Convey parasympathetic motor
impulses to tear, nasal, and
some salivary glands.
• Convey sensory info from taste
buds on anterior
2/3 of the tongue.
• Facial nerve damage may yield
Bell’s palsy, total ipsilateral
hemifacial paralysis
• BONES
• MUSCLES
• VASCULARIZATION
• SINUSES
• INNERVATION
• TMJ
TERIMA KASIH