228 



FACE. 



and further from the median line than the 

 artery ; 2. the transverse Jucial vein and some 

 other small branches of the temporal; 3. veins 

 corresponding to the branches of the internal 

 maxillary artery already mentioned ; and, 

 lastly, some veins about the nose and brow, 

 which are connected with the ophthalmic vein 

 within the orbit. Both arteries and veins are 

 imbedded in the adipose tissue, and are often 

 remarkably tortuous, more especially the ar- 

 teries, in old persons. Their trunks and 

 branches open in a direction towards the me- 

 dian line, particularly at the upper part of the 

 face. 



The lymphatics are much more numerous 

 than those of the cranium, and follow prin- 

 cipally the course of the bloodvessels, and 

 terminate in the submaxillary and parotid lym- 

 phatic ganglions ; in their course they traverse 

 some ganglions, which are situated on the buc- 

 cinator. 



The superficial lymphatics arise from all 

 parts of the face, and, accompanying the su- 

 perficial vessels, end in the submaxillary gan- 

 glions; some of them traverse the smaller 

 buccal ganglions. 



The deep lymphatics are situated in the zy- 

 gomatic and pterygo-maxillary fossje ; they 

 also accompany the bloodvessels, and ter- 

 minate in the deep parotid and submaxillary 

 ganglions. 



The lymphatic ganglions of the face are prin- 

 cipally situated along the base of the jaw, and 

 are termed the subaiaxillary ganglions. Others 

 are placed on the jaw and buccinator, in front 

 of the masseter (the buccal ganglions), and 

 follow the facial vessels. Some lymphatic 

 ganglions are situated underneath the zygoma 

 (the zygomatic ganglions) ; and others, more 

 numerous, are placed upon, within, or under- 

 neath the parotid gland, and are termed the 

 parotid ganglions. The deep lymphatics of 

 the orbits, nose, and mouth, will be described 

 with those cavities. 



The nerves itf the face are derived from the 

 three divisions of the fifth and from the portio 

 dura of the seventh cerebral nerves. The 

 branches from the fifth emerge on the face, 

 1 . from the orbit ; these come from the oph- 

 thalmic or first division of the fifth, and are 

 the frontal, the supra-trochlear, the infra- 

 trochlear, and the lachrymal : 2. from the 

 infra-orbitar foramen escape the infra-orbitar 

 nerve, from the second division of the fifth or 

 superior maxillary, and from the same source, 

 emerging from underneath the ramus of the 

 jaw, the buccal nerves : 3. from the mental 

 foramen emerge branches of the inferior den- 

 tal nerve, derived from the third division of 

 the fifth or the inferior maxillary ; and from 

 the same source, piercing the masseter, the 

 masseteric nerves. The portio dura, after turn- 

 ing over the posterior border of the lower jaw, 

 forms a plexus (the pes anserinus) within the 

 parotid gland, and divides into a great num- 

 ber of branches, which are distributed on the 

 face, and which have received various names 

 corresponding to the regions where they run. 

 The branches of the fifth nerve which are dis- 



tributed to the face principally supply the in- 

 teguments, and those of the portio dura the 

 muscles. Some filaments, however, of the 

 fifth, such as the buccal branch, derived from 

 the ganglionous portion, supply muscles; and, 

 on the other hand, some cutaneous twigs are 

 sent from the portio dura of the seventh to the 

 commissure of the lips. Both nerves freely 

 anastomose with each other on the face. For a 

 more particular account of these nerves and of 

 their functions, see FIFTH PAIR OF NERVES, 

 SEVENTH PAIR OF CEREBRAL NERVES, and 

 PHYSIOGNOMY. 



Abnormal conditions of the siift parts of the 

 face. The muscles of the face offer nothing 

 very remarkable in their abnormal conditions ; 

 like others, they become much developed by 

 constant exercise, and on the other hand, when 

 paralytic, they waste and lose both their colour 

 and consistence; their fibres have been ob- 

 served occasionally to have degenerated into a 

 fatty substance, and the trichina, spirulis has 

 also been found among them as among those 

 of other voluntary muscles. 



The bloodvessels of the face are subject to no 

 anomalies in their course which call for notice 

 in this place. It may be remarked, however, 

 that they vary in size in different individuals, 

 and are sometimes superficially and sometimes 

 more deeply situated among the soft parts 

 around ; their tortuosity in old age has already 

 been adverted to. 



Vascular ntevi are not unfrequently found on 

 the face, in some cases deeply situated within 

 the cavities or underneath the bones; in others, 

 and more commonly, they lie superficially in 

 the skin and subcutaneous tissues. They occur 

 of the venous, arterial, or mixed kinds. The 

 first sometimes attain a considerable magni- 

 tude, as I have witnessed in the case of an old 

 woman, in whom such a naevus grew on one 

 cheek and lip, and exceeded in size the whole 

 face. Such swellings are easily compressed, 

 and often produce no other inconvenience than 

 that of their deformity and weight. The arte- 

 rial naevus, however, and more especially when 

 deeply seated, is sometimes a formidable dis- 

 ease, which may involve all the surrounding 

 structures and ultimately prove fatal. The cu- 

 taneous capillaries of the cheeks, and about the 

 tip and ala? of the nose, often become enlarged 

 and varicose, presenting a peculiar appearance, 

 which is not uncommon in hard drinkers. 



The lymphatic glands of the face are particu- 

 larly liable to inflammation, enlargement, and 

 suppuration. In scrofula they often form im- 

 mense swellings along the base of the jaw and 

 about the parotid gland, sometimes remaining 

 permanently enlarged, and sometimes suppura- 

 ting and terminating in abscesses difficult to 

 heal. 



The nerves of the face are liable to be pressed 

 upon and irritated by the enlarged glands and 

 by the tumours in this part of the body. The 

 face is also subject to a most distressing com- 

 plaint, termed tic doulonroiu; which may arise 

 spontaneously or from injury, and which ap- 

 pears to affect particularly, if not exclusively, 

 the branches of the fifth pair of nerves, and 



