The blood vessels 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.
Vaccular nevi 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 nmvus 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 nmvus, 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 aim 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 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 doulottrour, 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 more especially the infra-orbitar. Neuralgia of the lower part of the face seems, however, in some instances to follow the course of those branches of the cervical plexus which proceed toward this region. Division of the nerves, though it sometimes checks, seldom cures this painful affection, for the divided nerves spee dily reunite, and the complaint returns ; and this takes place even after a portion of the nerve has been removed. Spasmodic affections of the face are connected with the branches of the portio dura: both nerves are of course sub ject to palsy.
The cellular tissue of the face is abundant, vascular, mingled generally with more or less fat, and in some places, as on the eyelids, is so lax as to be peculiarly liable to infiltration with fluids. Sometimes it becomes emphyse matous, in cases of wounds of the frontal sinuses and larynx. It is easily affected by erysipelas, and is the common scat of abscesses, which, however, as there is no fascia to confine the matter, rarely attain any considerable size, but soon make their way towards the surface of the skin. When, indeed, the pus forms on the
forehead between the muscles and the pericra nium, or beneath the fascia covering the parotid gland, or beneath that investing the masseter and posterior part of the buccinator muscles, the matter being more confined is longer in arriving at the surface, and is productive of more pain than in the former instance. En cysted tumours are not unfrequently formed in this structure of the face.
The skin of the face, from its vascularity and the almost homogeneous mass which it forms with the subjacent tissues, readily unites after incised wounds, and hence the success which has attended the attempts at reparation of some parts of this region, such as the nose, cheek, and lips ; the extensibility of the skin also favours such operations. Punctured and con tused wounds of the face are apt to produce erysipelas when they affect those parts where the cellular tissue is most dense, as on the nose and the prominence of the cheek. Abscesses are the more common result where the cellular tissue is looser. The skin of the face becomes swollen and thickened in some complaints which attack it, such as scrofula, which produ ces enlargement of the lips and nose, and ele phantiasis, cancer, and a few other diseases which affect it more permanently. It is sub ject also to freckles, stains, and discolorations of various kinds, enlargement, inflammation, and induration of its follicles; to a variety of cutaneous eruptions; to ulcerations from scro fula, scirrhus, lupus, &c. which frequently make great ravages not only in the soft parts of the face, but even in the bones; to tubercles, warts, tumours, and anomalous growths of various kinds; and finally to boils. Its vas cularity renders it more liable than in other parts of the body to receive the impression of small-pox pustules. Like the bones, the soft parts of the face are subject to congenital mal formation. 1. Its apertures may be closed more or less firmly ; this happens with the eye lids, nostrils, and lips. 2. There may be de feels of growth, as fissures in the lips, or hare lip, which may be single or double, and exist alone or in combination with fissures of the palate. The fissure may vary in depth, some times, in the upper lip, extending into one of the nostrils, and at others only affecting the border of the lip. Congenital cleft of the lower lip is very rare, and is never combined with fissure of the bone. The nose is sometimes fissured, presenting no cartilaginous septum, and but one large orifice or nostril. Occasion ally a congenital fissure has been observed in the cheek. The abnormal conditions of the teeth, the orbits and their contents, of the lachrymal apparatus, and of the cavities of the nose and mouth, will be found under the seve ral articles on these subjects.