THE FACE. 49 



THE REGION OF THE CHEEK. 



In this region we may include the parts limited above by the zygoma, in front 

 by the eye, nose, and mouth, below by the lower edge of the lower jaw, and behind 

 by the ear. The soft parts of the cheek are supported by the malar and superior 

 and inferior maxillary bones. Between the skin and the buccinator muscle, the 

 hollow beneath and in front of the malar bone and masseter muscle is filled with fat, 

 sometimes called the sucking pad or cushion. In disease this fat disappears, hence 

 the hollow cheek of invalids. The muscles of expression are superficial to this fat 

 and have their insertion in the skin. Swelling occurs readily from contusions and 

 inflammations because the tissues of the cheek are lax. Inflammations may either 

 start in the skin, which is quite prone to disease, or may be the result of inflammation 

 of some surrounding structure, as the parotid gland, the roots of the teeth, the 

 lachrymal sac, eyelids, etc. 



The skin of the cheek contains numerous sebaceous and sweat glands. It is a 

 favorite site for the pustular eruptions of infancy and childhood, the acne of youth, 



Ophthalmic vein Nasal branch of ophthalmic 



Angular artery. \ / Frontal branch of ophthalmic 



Lateral nasal 



Superior coronary 



Inferior coronary 

 Inferior labial 



Facial artery 



Facial vein 

 FIG. 58. The facial artery and its branches. 



and the non-malignant as well as the cancerous ulcers of the aged. It is also the 

 seat of noma or cancrum oris. This starts on the mouth surface as a gangrenous 

 stomatitis and implicates the cheek, causing death or great disfigurement owing 

 to the loss of cheek substance. Facial carbuncle or malignant pustule occurs on the 

 cheek, or sometimes on the lips. It is very fatal. 



Wounds and contusions of the cheeks are common, and, as the blood supply is 

 abundant, bleeding is free and healing prompt. On account of the insertion of 

 the muscles into the skin, gaping is quite marked. 



The malar bone is the most prominent bone of the cheek. It is such a 

 strong bone and so strongly supported that fracture of it, as well as that of the 

 zygoma, is rare. It may be broken by direct violence, as being hit with a stone, etc. 

 It is extremely difficult and often impossible to restore the fractured parts to their 

 original level, therefore deformity following fracture is of frequent occurrence. 

 The fracture may involve thfc margin of the orbit and cause an effusion of blood 

 into the orbit, pushing the eye forward. A fracture of the zygoma, if very much 

 depressed, may interfere with the use of the temporal muscle below, necessitating 

 operation. This occurrence is, however, rare. 



