Nerves and vessels of the face and scalp

Definitions & Key takeaways

The face and the scalp are supplied by several nerves and blood vessels that serve various functions.

Major nerves of the face and scalp include: The trigeminal nerve: a mixed nerve that supplies the muscles of the face, the skin of the face and scalp, and the mucous membranes of the mouth, nose, and sinuses. It is the main nerve responsible for facial sensation. The facial nerve: a mixed nerve that supplies the muscles of facial expression and the parotids glands, and the lacrimal glands (tear glands). It is also involved in the sense of taste and the production of tears and saliva. The occipital nerves: innervate the scalp and the back of the neck.

Major vessels of the face and scalp include: The external carotid artery supplies blood to the face and scalp. It gives rise to several branches, including the superficial temporal artery, the maxillary artery, and the facial artery. The internal carotid artery supplies blood to the brain and the eyes. The jugular vein drains blood from the head and neck back to the heart. Lymph from the face drains into the superficial lymph nodes, mainly the submental, the submandibular, and the parotid lymph nodes.

Chapters:

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Introduction0:00–0:27

The face contains an abundance of small muscles that work together to help us show our emotions. You can thank these muscles for everything your face does, from smiling and frowning to making funny faces in group pictures!
Naturally, for these muscles to work, there are many tiny nerves, arteries, and veins that supply them. Let’s start off with the sensory innervation of the face.

Sensory innervation0:27–0:43

Almost all of its sensory innervation is provided by the fifth cranial nerve, also known as the trigeminal nerve, which has three divisions.
Its superior division is known as the ophthalmic nerve, and it provides sensory innervation for the part of the scalp anterior to the vertex of the head, the forehead, the upper eyelids, the dorsum of the nose and the roof of the nasal cavity.

Ophthalmic nerve (CN V1)0:43–3:09

The ophthalmic nerve arises from the trigeminal ganglion, leaves the skull through the superior orbital fissure, and enters the orbit, where it gives rise to three branches; the frontal nerve, the nasociliary nerve and the lacrimal nerve.
So let’s look at them one by one! The frontal nerve runs across the roof of the orbit, and it gives rise to the supraorbital and the supratrochlear nerves.
The supraorbital nerve exits the orbit through the supraorbital notch and supplies the skin of the anterior part of the scalp, the anterolateral forehead, and the middle of the upper eyelids.
The supratrochlear nerve exits the orbit lateral to the trochlea and supplies the skin of the anteromedial forehead. Next is the nasociliary nerve, which divides into the anterior ethmoidal, the posterior ethmoidal, and the infratrochlear nerves.
The anterior ethmoidal nerve travels a long way through the nasal cavity, and exits between the nasal bone and the lateral nasal cartilage as the external nasal nerve.
It supplies sensory innervation to the skin of the dorsum of the nose, the nasal ala, and the nasal vestibule. So, whenever the tip of your nose feels itchy, you know it’s that pesky external nasal nerve.
The infratrochlear nerve is the terminal branch of the nasociliary nerve, and exits the orbit on the medial angle. It innervates the medial part of the upper eyelid, the skin around it, and lateral to the root of the nose.
The last branch of the ophthalmic nerve is the lacrimal nerve, which exits the orbit on the lateral angle and innervates the lateral side of the upper eyelid, and the skin around it.The intermediate division of the trigeminal nerve is called the maxillary nerve and supplies the skin of the anterior part of the temporal region, the skin over the zygomatic bone, the lower eyelid, the cheek, the side of the nose, the nasal septum, and the upper lip.It travels anteriorly from the trigeminal ganglion, leaves the skull through the foramen rotundum in the sphenoid bone, and enters the pterygopalatine fossa.

Maxillary nerve (CN V2)3:09–4:37

It then passes through the inferior orbital fissure to enter the orbit, where it gives off the zygomatic nerve. The maxillary nerve continues on, and travels within the infraorbital groove and exits the orbit through the infraorbital foramen as the infraorbital nerve.It supplies sensory innervation to the skin of the lower eyelid, the side of the nose, part of the nasal septum, the cheek, and the upper lip.
Now, let’s take a look at the zygomatic nerve, which travels to the lateral wall of the orbit. It gives rise to the zygomaticofacial nerve, which supplies the skin over the zygomatic bone, and the zygomaticotemporal nerve, which supplies the skin of the anterior part of the temporal region.

Mandibular nerve (CN V3)4:37–6:07

Let’s move to the inferior division of the trigeminal nerve, called the mandibular nerve. This nerve supplies the skin of the posterior part of the temporal region, the skin anterior to the auricle, the skin over the body of the mandible, and the skin of the lower lip and the chin.The mandibular nerve arises from the trigeminal ganglion and leaves the skull through the foramen ovale in the sphenoid bone.
It gives rise to three branches that innervate the skin of the face: the auriculotemporal nerve, the buccal nerve, and the inferior alveolar nerve.
The auriculotemporal nerve passes posterior to the mandible, deep to the parotid gland and emerges posterior to the temporomandibular joint.
It supplies the skin of the posterior part of the temporal region, the skin anterior to the auricle, and some parts of the external ear.
The buccal nerve passes through the buccina tor muscle and supplies the skin of the cheek. Finally, the inferior alveolar nerve passes through the mandibular foramen into the mandibular canal.
Its terminal branch, called the mental nerve, exits the mandibular canal through the mental foramen and supplies the skin of the chin, the mandible, and the lower lip.Cervical spinal nerves also provide a small part of the sensory innervation to the face, through the anterior and posterior rami of the C2 and C3 cervical spinal nerves.

Cervical spinal nerves6:07–7:35

The great auricular nerve arises from the anterior rami of C2 and C3 spinal nerves, and travels towards the face across the sternocleidomastoid muscle.
It provides sensory innervation to the skin of the angle of the mandible and the inferior part of the ear. The lesser occipital nerve arises from the anterior ramus of the C2 spinal nerve, and travels along the posterior border of the sternocleidomastoid muscle.
It reaches the face posterior to the auricle and supplies the skin of the scalp posterior to the ear. The greater occipital nerve arises from the posterior ramus of the C2 spinal nerve and passes between the axis and the obliquus capitis inferior muscle.
It pierces the trapezius muscle and emerges to supply the skin of the occipital part of the scalp. The last branch is the third occipital nerve which arises from the posterior ramus of the C3 spinal nerve.
It pierces the trapezius muscle and travels to the occipital region to supply the skin of the lower occipital and the suboccipital regions.Before we move on, let’s take a short break.

Quiz7:35–7:50

Can you recall what area of the face is innervated by the maxillary nerve?Now, motor innervation of the face is a bit more straightforward.

Motor innervation - Facial nerve7:50–10:04

All muscles of facial expression are innervated by the seventh cranial nerve, known as the facial nerve. The facial nerve exits the cranium through the stylomastoid foramen, and provides a posterior auricular branch which innervates the auricularis posterior and occipital belly of the occipitofrontalis muscle.
It then travels anteriorly and enters the parotid gland, where it forms the parotid plexus. This plexus gives rise to the temporal, the zygomatic, the buccal, the marginal mandibular, and the cervical branches of the facial nerve.
Remember, To Zanzibar By Motor Car! The temporal branch runs across the zygomatic arch and innervates the frontal belly of the occipitofrontalis, corrugator supercilii, and the superior part of the orbicularis oculi muscle.
The zygomatic branch runs inferior to the eye and innervates the inferior part of the orbicularis oculi muscle and the muscles of the nose; procerus, nasalis and the levator labii superioris alaeque nasi.
The buccal branch runs horizontally and innervates the muscles of the upper lip, mouth and cheek, which are the risorius, levator anguli oris, zygomaticus major, zygomaticus minor, levator labii superioris, orbicularis oris,and the buccinator.
The marginal mandibular branch runs along the inferior border of the mandible and innervates the muscles of the lower lip and chin; the depressor anguli oris, depressor labii inferioris, and mentalis muscle.
Lastly, the cervical branch travels posterior to the mandible and innervates the platysma. Now let’s move on to the arteries of the face and scalp.

Vascular supply10:04–10:45

The majority of the blood supply to the face is provided by direct and indirect branches of the external carotid artery.
Direct branches include the facial artery, the superficial temporal artery, the occipital artery, and the posterior auricular artery.
The indirect branch of the external carotid artery is the mental artery. The rest of the face is supplied by two branches of the ophthalmic artery, which is a branch of the internal carotid artery, called the supraorbital and supratrochlear arteries.

Facial artery10:45–11:47

The facial artery runs through the neck, deep to the platysma, and appears at the inferior border of the mandible. It curves around the mandible, anterior to the masseter, and then runs across the face, lateral to the lips and nose.
Then, it travels deep to the risorius, zygomaticus major, and zygomaticus minor muscles to reach the medial angle of the eye called the canthus, where it terminates as the angular artery.
Along its path, the facial artery gives branches to the upper and the lower lips called the superior and the inferior labial arteries.
These branches travel superior and inferior to the mouth and anastomose at the midline with the same arteries on the other side of the face.
At the nose, the facial artery also gives rise to the lateral nasal artery which supplies the lateral surface of the nose.
The superficial temporal artery is one of two terminal branches of the external carotid artery. From the neck, the external carotid artery courses posterior to the ramus of the mandible and passes through the parotid gland, where it gives rise to the posterior auricular artery.

Superficial temporal artery11:47–13:04

After this final branch it terminates as the superficial temporal artery which courses between the temporomandibular joint and the ear, travelling upwards to supply the lateral scalp.
The superficial temporal artery also gives rise to the transverse facial artery, which passes through the parotid gland to supply the lateral face.
The occipital artery, arises from the external carotid artery superior to the facial artery, and travels posteriorly, reaching the occipital region to supply the scalp posterior to the vertex.
The posterior auricular artery is a small branch off the external carotid artery that runs between the ear and the styloid process to supply the auricle and the scalp posterior to the ear.Now, the mental artery is an indirect branch from the external carotid artery.

Mental artery13:04–13:31

First, the external carotid artery gives off the maxillary artery, which then gives off the inferior alveolar artery. The inferior alveolar artery passes through the mental foramen of the mandible and emerges as the mental artery to supply the muscles and skin of the chin.Finally, let’s look at the supraorbital and the supratrochlear arteries, which are the only two branches that do not arise from the external carotid artery.

Supraorbital and supratrochlear arteries13:31–14:04

These branches are from the ophthalmic artery, which is a branch of the internal carotid artery. The supraorbital and the supratrochlear arteries follow the nerves of the same name and end in the forehead to supply the muscles and the skin of the forehead and the anterior scalp.Ok, that was quite a bit of information.

Quiz14:04–14:25

Let’s take a break here and review. Can you identify the arteries that supply the face on this image?Now let’s move on to the veins of the face and scalp.

Venous drainage14:25–15:55

Blood is drained by superficial veins, which form many anastomoses with each other, deeper veins, a dural venous sinus, and venous plexus.
All facial veins are valveless, which allows blood to move in any direction, meaning if a vessel is compressed, blood can drain through a different path.
Facial veins usually follow the arteries they are named after. The supratrochlear and the supraorbital veins merge at the root of the nose to form the angular vein, which descends to the inferior orbital margin and becomes a major vein of the face called the facial vein.
The facial vein follows the facial artery to the inferior border of the mandible and receives blood from smaller veins along the way.
Posterior to the mandible, the superficial temporal and the maxillary veins merge into the retromandibular vein, which divides into an anterior and posterior branch.
The anterior branch merges with the facial vein to form the common facial vein, which drains into the internal jugular vein.
The posterior branch unites with the posterior auricular vein and forms the external jugular vein.Last but not least, let’s discuss the lymphatic drainage of the face.

Lymphatic drainage15:55–16:54

Lymph from the face drains into the superficial ring of lymph nodes in the neck and lower face. The submental lymph nodes receive lymph from the central part of the lower lip and the chin.
The submandibular lymph nodes receive lymph from the upper lip and lateral parts of the lower lip. Lymph from the lateral part of the face drains to the superficial parotid lymph nodes.
Lymph from the nasal cavity drains into the deep parotid nodes. From the superficial lymph nodes, lymph runs to the deep cervical lymph nodes and then drains to the jugular lymphatic trunk, which joins the thoracic duct and flows into the internal jugular vein on the left side, or flows directly into the brachiocephalic vein on the right side.
Alright, as a quick recap… The trigeminal nerve provides almost all sensory innervation to the face, through its three major branches: the ophthalmic nerve, the maxillary nerve and the mandibular nerve.

Review16:54–19:12

Branches of the ophthalmic nerve supply the sensory innervation for the part of the scalp anterior to the vertex, forehead, upper eyelids, and roof of the nose.
Branches of the maxillary nerve supply the skin of the anterior part of the temporal region, skin over the zygomatic bone, lower eyelid, cheek, side of the nose, nasal septum, and upper lip.
Branches of the mandibular nerve supply the skin of the posterior temporal region, skin anterior to the ear, skin over the body of the mandible, and skin of the lower lip and chin.
A small part of the sensory innervation of the face comes from branches of the anterior and posterior rami of the C2 to C3 cervical spinal nerves.
Motor innervation for the muscles of the face is provided by the facial nerve via its six branches; the posterior auricular, temporal, zygomatic, buccal, marginal mandibular and cervical branch.
The majority of the blood supply to the face is provided by the facial artery, superficial temporal artery, occipital artery, posterior auricular artery, or mental artery which are direct or indirect branches of the external carotid artery.
The supraorbital and the supratrochlear arteries arise as the terminal branches of the ophthalmic artery, which is a branch of the internal carotid artery.
Blood from the face is drained by superficial veins, which follow the arteries they are named after. Lymph from the face drains into the superficial lymph nodes which include: the submental, the submandibular, and the parotid lymph nodes.