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Excision of Facial Tumors

Relevant anatomy

Authors: Frederik Gulmark Hansen, med.stud. and Magnus Balslev Avnstorp, MD

Incisions should be placed parallel to the langers lines when performing an excision of a facial tumor. This leads to the most aesthetic result.

Langers lines

Figure 1 | Facial langers lines

Facial nerve

The facial nerve (n. VII) exits the skull through the stylomastoid foramen. It then gives rise to the following 5 major branches which among other things innervates the muscles responsible for facial expression (See figure 2 below):

Nerve branchesMuscle innervation
Testing
TemporalFrontalis
Orbicularis oculi
Corrugator supercilia
Efferent limb of corneal reflex
Frown and wrinkle forehead
Corneal reflex
ZygomaticOrbicularis oculi
Close eyes tightly

BuccalSmall muscles of the nose
Buccinator
Orbicularis oris
Puff up cheeks
Smile/show teeth
MarginalDepressor labii inferioris
Depressor angel oris
Mentalis
CervicalPlatysma
Table 1 | Branches of the Facial nerve (n. VII), their innervation and how to test them
Figure 2 | Branches of the Facial nerve (n. VII). Be especially aware of the temporal branch.
Figure 3 | Danger-zones when performing excisions of facial tumors. Notice the depth and layers in which the nerves run.

Arterial blood supply

The face is well-vascularized and has several minor and intermediate sized arteries.These arteries are forming a lot of anastomoses, which gives facial flaps good conditions and a low risk of becoming necrotic. It is therefore fundamental to know the basic vascular anatomy before performing excision of facial tumors. 
The facial artery arises from the external carotid artery. It exits the neck at the inferior margin of the mandibleand gives rise to the following branches, which are illustrated on the figure below:

ArterySupply area
Inferior labialLower lip
Superior labialUpper lip 
Branch to nasal septum
AngularSide of the nose
Corner of the eye
Table 2 | Facial artery branches

The branches of the facial artery anastomoses with branches from superficial temporal artery (temporal region and forehead), the maxillar artery and the ophthalmic artery.

Figure 4 | Arterial blood supply of the skull and face

Acknowledgments

IllustratorsChristian Kaare Paaskesen med.stud.

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