Innervation of the Skin

• Innervation of the skin is mainly through the three branches of the trigeminal nerve (CN V).
• Some skin over the angle of the mandible and anterior and posterior of the auricle is supplied by the great auricular nerve from the cervical plexus.
• Some cutaneous branches of the auricular branch of the facial nerve also supplies skin on both sides of the auricle.

• The trigeminal nerve is the general sensory nerve to the head, particularly the face, and is the motor nerve to the muscles of mastication.

The Ophthalmic Nerve

• This is the superior division of the trigeminal nerve, the smallest of the three branches and is wholly sensory.
• The ophthalmic nerve divides into three branches: the nasociliary, frontal and lacrimal just before entering the orbit through the superior orbital fissure.

• The nasociliary nerve supplies the tip of the nose through the external nasal branch of the anterior ethmoidal nerve.

• The frontal nerve is the direct continuation of CN V¹ and divides into two branches, the supraorbital and supratrochlear.
• The supratrochlear nerve supplies the middle part of the forehead.
• The supraorbital nerve supplies the lateral part and the front of the scalp.

• The lacrimal nerve, the smallest of the main ophthalmic branches, emerges over the superolateral orbital margin to supply the lacrimal gland and the lateral part of the upper eyelid.

The Maxillary Nerve

• This is the intermediate division of the trigeminal nerve.
• It has three cutaneous branches.

• The infraorbital nerve is the largest terminal branch of the maxillary nerve.
• It passes through the infraorbital foramen and breaks up into branches that supplies the skin on the lateral aspect of the nose, upper lip and lower eyelid.

• The zygomaticofacial nerve, a small branch of the maxillary, emerges from the zygomatic bone from a foramen with the same name.
• It supplies the skin over the zygomatic bone.

• The zygomaticotemporal nerve emerges from the zygomatic bone from foramen of the same name.
• It supplies the skin over the temporal region.

The Mandibular Nerve

• This is the inferior division of the trigeminal nerve.
• Of the three division of the trigeminal nerve, CN V³ is the only one that carries motor fibres (to the muscles of mastication).
• The main sensory branches of the mandibular nerve are the buccal, auriculotemporal, inferior alveolar and lingual nerves.

• The buccal nerve is a small branch of the mandibular that emerges from deep to the ramus of the mandible.
• It supplies the skin of the cheek over the buccinator muscle, the mucous membrane lining the cheek, and the buccal surface of the gingiva.

• The auriculotemporal nerve passes medially to the neck of the mandible and then turns superiorly, posterior to its head and anterior to the auricle. It then crosses over the root of the zygomatic process of the temporal bone, deep to the superficial temporal artery.

• It supplies the auricle, external acoustic meatus, tympanic membrane, and the skin in the temporal region.

• The inferior alveolar nerve is the large terminal branch of the posterior division of the mandibular nerve (the lingual nerve is the other terminal branch).
• It enters the mandible through the mandibular foramen to the mandibular canal. In the canal, it gives branches to the mandibular teeth.
• Opposite the mental foramen, this nerve divides into the mental nerve and the incisive nerve.
• The incisive nerve supplies the incisor teeth, the adjacent gingiva and the mucosa of the lower lip.
• The mental nerve emerges from the mental foramen and supplies the skin of the chin and the skin and mucous membrane of the lower lip and gingiva.

• The lingual nerve is the smaller terminal branch of the mandibular nerve.
• It supplies the general sensory fibres to the anterior two-thirds of the tongue, the floor of the mouth and the gingivae of the mandibular teeth.

The Submandibular Glands

• Each of these U-shaped salivary glands is about the size of a thumb and lies along the body of the mandible.
• It is partly superior and partly inferior to the posterior 1/2 of the base of the mandible.
• It is partly superficial and partly deep to the mylohyoid muscle.

• The submandibular duct arises from the portion of the gland that lies between the mylohyoid and hyoglossus muscle.

• The duct passes deep and then superficial to the lingual nerve.
• It opens by one to three orifices on a small sublingual papilla beside the lingual frenulum.

• The submandibular gland is supplied by parasympathetic, secretomotor fibres from the submandibular ganglion (preganglionic fibres from the chorda tympani via the lingual nerve).

The Oropharynx

• The oral part of the pharynx has a digestive function.
• It is continuous with the oral cavity through the oropharyngeal isthmus.
• The oropharynx is bounded by the soft palate superiorly, the base of the tongue inferiorly, and the palatoglossal and palatopharyngeal arches laterally.

• It extends from the soft palate to the superior border of the epiglottis.

The Palatine Tonsils

• These are usually referred to as "the tonsils".
• They are collections of lymphoid tissue the lie on each side of the oropharynx in the triangular interval between the palatine arches.

• The palatine tonsils vary in size from person to person.
• In children, the palatine tonsils tend to be large, whereas in older persons they are usual small and inconspicuous.
• The visible part of the tonsil is no guide to its actual size because much of it may be hidden by the tongue and buried in the soft palate.

The Palate

• The palate forms the arched roof of the mouth and the floor of the nasal cavities.
• The palate consists of two regions: the anterior 2/3 or bony part, called the hard palate, and the mobile posterior 1/3 or fibromuscular part, known as the soft palate.

Veins of the Face

The Supratrochlear Vein

• This vessel begins on the forehead from a network of veins connected to the frontal tributaries of the superficial temporal vein.
• It descends near the medial plane with its fellow on the other side.
• These veins diverge near the orbits, each joining a supraorbital vein to form the facial vein near the medial canthus (angle of the eye).

The Supraorbital Vein

• This vessel begins near the zygomatic process of the temporal bone.
• It joins the tributaries of the superficial and middle temporal veins.
• It passes medially and joins the supratrochlear vein to form the facial vein near the medial canthus.

The Facial Vein

• This vein provides the major venous drainage of the face.

• It begins at the medial canthus of the eye by the union of the supraorbital and supratrochlear veins.
• It runs inferoposteriorly through the face, posterior to the facial artery, but takes a more superficial and straighter course than the artery.
• Inferior to the margin of the mandible, the facial vein is joined by the anterior branch of the retromandibular vein.
• The facial veins ends by draining into the internal jugular vein.

The Superficial Temporal Vein

• This vein drains the forehead and scalp and receives tributaries from the veins of the temple and face.
• In the region of the temporomandibular joint, this vein enters the parotid gland.

The Retromandibular Vein

• The union of the superficial temporal and maxillary veins forms this vessel, posterior to the neck of the mandible.
• It descends within the parotid gland, superficial to the external carotid artery but deep to the facial nerve.
• It divides into an anterior branch that unites with the facial vein, and a posterior branch that joins the posterior auricular vein to form the external jugular vein.

• BONES OF THE CRANIUM   Occipital (1) Frontal    (1) Sphenoid (1) Ethmoid  (1) Parietal    (2) Temporal  (2)

  BONES OF THE FACE   Mandible (1) Vomer     (1) Maxillae  (2) Zygomae  (2) Lacrimal   (2) Nasal        (2) Inferior nasal conchae (2) Palatine     (2)