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.