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
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 branches | Muscle innervation | Testing |
| Temporal | Frontalis Orbicularis oculi Corrugator supercilia Efferent limb of corneal reflex | Frown and wrinkle forehead Corneal reflex |
| Zygomatic | Orbicularis oculi | Close eyes tightly |
| Buccal | Small muscles of the nose Buccinator Orbicularis oris | Puff up cheeks Smile/show teeth |
| Marginal | Depressor labii inferioris Depressor angel oris Mentalis | |
| Cervical | Platysma |
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:
| Artery | Supply area |
| Inferior labial | Lower lip |
| Superior labial | Upper lip Branch to nasal septum |
| Angular | Side of the nose Corner of the eye |
The branches of the facial artery anastomoses with branches from superficial temporal artery (temporal region and forehead), the maxillar artery and the ophthalmic artery.
Acknowledgments
Illustrators: Christian Kaare Paaskesen med.stud.
