Topography of facial arteries and veins
The main vessels of this region are the facial artery (a. facialis) and the facial vein (v. facialis). The projection line of these vessels on the skin runs from the point of intersection of the anterior border of the masseter muscle with the lower border of the mandible in an upward direction directly to the medial angle of the eye.
Unlike the vein, the facial artery has a strongly tortuous course. Maximum tortuosity is observed near the origins of the labial arteries. The initial segment of the artery lies deep in the subcutaneous adipose tissue of the buccal region, while its terminal branch (the angular vein — *Wait, angular artery*) runs between the facial muscles.
The arterial bed of the face forms a rich network of anastomoses:
- With the transverse facial artery (a. transversa faciei), which belongs to the external carotid artery system.
- With the buccal and supraorbital arteries.
- With branches of the ophthalmic artery, connecting the basins of the external and internal carotid arteries.
Venous network and intracranial anastomoses
The origin of the facial vein is the angular vein (v. angularis). The most important topographic and clinical feature of the facial venous system is the connections of the superficial and deep veins with the cavernous sinus (sinus cavernosus) of the dura mater.
Key anastomoses of the facial vein:
- At the medial angle of the eye: connects with the nasofrontal vein (v. nasofrontalis). This vein is the origin of the superior ophthalmic vein (v. ophthalmica superior), which empties directly into the cavernous sinus.
- At the level of the nasal ala (or lower): an anastomosis is located connecting the facial vein with the deep pterygoid venous plexus (plexus venosus pterygoideus).
Clinical significance: When facial vein thrombosis develops, there is a high probability of retrograde blood flow. Infected thrombi can enter the sinus cavernosus, which carries a serious risk of severe intracranial complications.
Neurovascular bundles of the face
Important complexes consisting of arteries, veins, and nerves emerging from the bony canals of the skull are located on the face.
Infraorbital neurovascular bundle Emerges through the infraorbital foramen (foramen infraorbitale) into the loose tissue of the canine fossa (fossa canina).
- Infraorbital artery (a. infraorbitalis): a branch of the maxillary artery. Passes through the inferior orbital fissure into the orbital cavity, then runs along the infraorbital canal and emerges into the fossa canina.
- Infraorbital vein: drains blood into the inferior ophthalmic vein or into the pterygoid venous plexus.
- Infraorbital nerve (n. infraorbitalis): the terminal branch of the maxillary nerve (n. maxillaris, II branch of the trigeminal nerve — $CN V_2$). Provides innervation to the skin below the eyes, the skin and mucosa of the upper lip, as well as the upper jaw and upper teeth.
Mental neurovascular bundle Emerges from the mental foramen (foramen mentale) of the mandible and lies directly on the periosteum.
- Mental artery (a. mentalis): branches off from the inferior alveolar artery (from the a. maxillaris system).
- Corresponding vein: serves as the origin of the inferior alveolar vein, which goes into the deep parts of the face.
- Mental nerve (n. mentalis): the terminal branch of the inferior alveolar nerve (n. alveolaris inferior, III branch of the trigeminal nerve — $CN V_3$). Innervates the skin and mucosa of the lower lip.
Briefly: answers to topical questions
What branches does the facial artery give off on the face?
The facial artery gives off the ascending palatal, submental, and angular arteries.
- Ascending palatal artery (a. palatina ascendens) — a branch of the facial artery, supplies the palatine tonsil.
- Submental artery (a. submentalis) — branches from the facial artery in the region of the submandibular gland.
- Angular artery (a. angularis) — the terminal branch, runs in the space between the facial muscles toward the medial angle of the eye.
Where does the facial vein drain?
The facial vein drains into the internal jugular vein (v. jugularis interna).
It pierces the anterior wall of the common fascial sheath of the neurovascular bundle and empties into the internal jugular vein. The common facial vein may also empty into the internal jugular vein and obstruct surgical access to the external carotid artery.
The pathway of infection to the brain can be remembered by the chain: Angular vein → Nasofrontal vein → Superior ophthalmic vein → Cavernous sinus.
Class and exam questions
The projection line is drawn from the intersection of the anterior border of the masseter muscle with the lower border of the mandible upward and diagonally toward the medial angle of the eye.
The projection line of these vessels runs from the point of intersection of the anterior border of the masseter muscle with the lower border of the mandible in an upward direction toward the medial angle of the eye.
What is the main visual difference between the facial artery and the corresponding vein?
Unlike the vein, the facial artery has a pronounced tortuous course. It is especially tortuous at the sites where the labial arteries branch off.
Why can facial vein thrombosis be life-threatening?
Due to the presence of anastomoses near the nasal ala and the medial angle of the eye. In thrombosis, retrograde blood flow into the cavernous sinus of the dura mater is possible, which causes severe intracranial complications.
What is included in the infraorbital neurovascular bundle?
Infraorbital artery (branch of the maxillary), infraorbital vein, and infraorbital nerve (second branch of the trigeminal nerve). The bundle emerges from the infraorbital foramen into the region of the canine fossa.
What else to study on this topic
- Topography and functions of the pterygoid venous plexus (plexus venosus pterygoideus).
- Branching and blood supply zones of the maxillary artery (a. maxillaris).
- The system of the internal jugular and retromandibular veins on the face and neck.
- Innervation zones of the second and third branches of the trigeminal nerve.
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