Significant Differences in Sympathetic Nerve Fiber Density Among the Facial Skin Nerves: A Histologic Study Using...

Sympathetic nerve fibers in the skin nerves are connected with vasomotor, thermoregulatory, sensory input modulatory, and immunologic events; however, to our knowledge, no histological information is available for skin nerves in the human face. Using specimens from 17 donated cadavers (mean age, 86 years), we measured a sectional area of tyrosine hydroxylase (TH)-positive fibers in (1) the frontal nerve (V1), (2) the infraorbital nerve (V2), (3) the mental nerve (V3), (4) the greater auricular nerve (C2), (5) the auriculotemporal nerve (ATN), and (6) the zygomatic branch of the facial nerve (VII). The V1, V2, and V3 were obtained at their entrances to the subcutaneous tissue from the bony canal or notch. The V1, C2, ATN, and/or VII usually contained abundant TH-positive fibers (almost 3%-8% of the nerve sectional area), whereas the V2 and V3 consistently carried few TH-positive fibers (<1%). The difference between these two groups was quite significant (P < 0.001). Thus, from the superior cervical ganglion, the sympathetic nerve fibers reached the forehead through the frontal nerve trunk, whereas artery-bounded fibers came to the cheek, nose, and mouth. The sympathetic palsy caused by trigeminal nerve involvement is mainly characterized by the symptoms seen in the distribution of the ophthalmic division of the trigeminal nerve, such as in Horner's syndrome. It suggests that the forehead and the other facial areas are representative parts of those different sympathetic innervations that could be useful for evaluating the sympathetic function of the face in various diseases. Anat Rec, 299:1054-1059, 2016. © 2016 Wiley Periodicals, Inc.