Cheeks

Cheeks (Latin: buccae) are a part of the human face and the digestive system. It is the area between the eyes and the jawline. Cheeks are complex anatomical structures made of many muscle fibers, blood vessels, fat cells, minor glands, and other tissue. As an anatomical structure, cheeks have several functions. They take part in eating, talking, and creating facial expressions.

Cheek anatomy

The base of the cheeks are formed by the fibers from the buccinator muscle covered by the buccopharyngeal fascia. The superior border defines the eye, but on the lateral side is the ear. On the medial side is the nose, but the inferior border goes along the jawline. 

Three skull bones shape the bony frame of cheek anatomy. The upper bony part is formed by the maxilla and zygomatic bone. The medial area is also formed by the maxilla, while the inferior part - by the mandible. The term cheekbones is often used to describe the zygomatic arch, mostly formed by the temporal process of the zygomatic bone and partly - by the zygomatic process of the temporal bone, participating in forming the cheeks’ bony frame.

The wedge-shaped parotid gland (the largest salivary gland) on each side also helps to form the cheek and give it fullness. The parotid gland is located next to the ear. The ducts of the parotid glands go through the cheeks. In the oral cavity, the buccal mucosa opposite the second large molar tooth presents the parotid duct’s papilla. The duct opens through it and secrets saliva, helping in the digestion process and moistening the oral cavity.

Cheek fat pads

The cheeks contain buccal fat pads that lie on the buccinator muscle’s outer surface close to the superficial skin layer. New-born babies have very well-developed fat pads in their cheeks, but they become smaller as years go. The cheek fat pads help to give fullness to the cheeks and affect the shape of the face. The size and shape of fat pads vary in individuals and ethnic groups related to eating habits and genetics. Cheek fat pads can indicate the level of nutrition as, for example, in malnutrition, they are not well visible. Loss of cheek fullness can also be an indicator of underlying diseases.

There are also several smaller cheek fat pads that come together, participating in forming the cheeks. Below the eyes are the infraorbital fat, and right under it are the medial cheek fat pads. From the lateral sides of the nose or the ala of the nose goes the nasolabial fat. The middle contains the middle cheek fat, but close to the ear is the lateral- temporal cheek fat pads. Along the jawline close to the mouth go superior and inferior jowl fats. In the lateral region, next to the ear, lies lateral- temporal cheek fat pads. Healthcare professionals can remove cheek fat pads during plastic surgeries; they are also commonly used in face reconstruction surgeries or congenital disability repairing surgeries.

Cheek muscles

The subcutaneous cheek tissue contains many muscle fibers that participate in forming the cheeks. The biggest cheek muscles are the masseter and the buccinator

The buccinator muscle is the primary muscle involved in cheek compression. The masseter muscle is located in the lateral part of each cheek. It goes from the zygomatic bone to the mandible next to the ear, helping in the chewing process. The buccinator muscle lies deep within each cheek, forming its middle part. It goes from the lateral area of the alveolar arches of the mandible and maxilla to the angle of the mouth. It connects with the muscle fibers of orbicularis oris that also help to form the cheeks. Dilators and elevators (levators) of the oral opening and both zygomatic muscles are also located in the cheeks. Mostly, the zygomatic major is responsible for smiling. The levator labii superioris aleaque nasi forms the medial part of the cheeks going along the nose’s sides. Next to it locates the levator labii superioris. It also forms the medial region. The zygomaticus major and minor, levator anguli oris muscle fibers form the middle part of the cheeks going from the zygomatic bone to the corner of the mouth. Inferior to them lies the risorius muscle. The lower part of orbicularis oculi participates in forming the superior border of the cheeks.

Cheek dimples

Some people have dimples in both or only one side of the cheeks. Dimples develop due to different variations of the zygomatic major muscle. People who have dimples have separated zygomatic muscles. It divides into two parts, forming two separate bundles. The split is known as the duplication or bifurcation of the zygomatic major, and skin movement over it results in dimples, for example, when smiling. The zygomatic muscle goes from zygomatic bone to the corner of the mouth. In the case of a separated zygomatic major, one bundle connects at the corner of the mouth, but the other one a little bit below it.

Cheek microanatomy

From the outside, the cheeks are covered by skin, but from the inside - mucosa. The cheek microanatomy is very similar to that of other parts of the oral cavity.

Unlike the other parts, the cheeks contain a lot of muscle fibers and adipose (fat) tissue. Also, cheek skin includes a massive amount of thick elastic fibers creating an elastic fiber network. The mucosa contains minor buccal salivary glands, mostly in the areas of maxilla and mandible. Around the duct of the parotid gland, the minor buccal glands are slightly larger than in other cheek areas. They are known as molar glands because their ducts open next to the last molar teeth. 

The skin part of the cheeks are lined by stratified squamous keratinized epithelium, but the mucous part  - by stratified squamous non-keratinized epithelium. 

Inside the mucosa’s midline, where both upper and lower teeth connect, mucus sebaceous glands are located and they are similar to sebaceous glands found in the skin. They appear as yellow, or yellowish-grey spots called Fordyce spots. Epithelium of this area has slight signs of keratinization. 

The cheeks contain a lot of blood vessels and capillaries. During blushing, one can easily see the blood vessels of the cheeks manifesting as red-colored cheeks. It happens because of the widening of blood vessels - a process called vasodilation. It increases the perfusion leading to a higher amount of blood in capillaries.

Neurovascular supply of cheeks

Arterial supply

The main arterial supply for structures in the cheeks is provided by the facial and transverse facial arteries. The transverse artery is the terminal branch of the superficial temporal artery. The superficial temporal and facial arteries are branches of the external carotid artery. 

The medial cheek part receives blood from the angular artery, which is the terminal branch of the facial artery. 

The infraorbital and buccal arteries from the maxillary artery (terminal branch of external carotid artery) provide the upper and middle part of the cheeks with arterial blood supply. 

The zygomatico-orbital artery may also provide the upper part with arterial blood supply.

Venous drainage

Venous drainage of the cheeks is provided by the facial vein draining in the internal jugular vein, which flows in the brachiocephalic vein.

Lymphatic drainage

Lymph from the lateral and superior areas of the cheeks drains via the preauricular lymph nodes. While from the inferior and medial areas - via the submandibular lymph nodes

Lymph from the left cheek’s lymph nodes eventually drains into the thoracic duct, while from the right cheek - into the right lymphatic duct.

Innervation

Muscle innervation is provided by branches arising from the facial nerve (CN VII). The buccal branch innervates both zygomatic muscles, the levator labii superioris, risorius, buccinator, and orbicularis oris muscles. The zygomatic branch also innervates the zygomatic muscles.

Skin and mucosa of the cheeks receive sensory innervation from the trigeminal nerve branches - mandibular (CN V3) and maxillary (CN V2) nerves. To be more precise, the buccal nerve arising from the mandibular nerve innervates the skin and mucosa of the cheeks. Also, the infraorbital nerve and the zygomaticofacial branch from the zygomatic nerve (branch of the maxillary nerve) innervate cheeks. 

The masseteric nerve is a motor branch arising from the mandibular nerve and it innervates the masseter muscle.

Cheek functions

Several cheek functions are known providing normal physiology. All cheek structures take part in the digestion process, talking, and creating different facial expressions.

Cheeks help in both digestion processes - mechanical and chemical. The mastication muscles help to provide mechanical digestion. Cheek muscles help open the mouth to get the food and chew it in the oral cavity. And chemical food procession is aided by saliva secreted from the parotid gland.

Talking and facial expression making are also provided by various cheek muscles, except the masseter and buccinator muscles. As mentioned before, the masseter aids in mastication, while the buccinator help to hold the food in the oral cavity while it is being chewed.

Changes in visual appearance

Multiple conditions can affect the appearance of the cheeks. The outer aspect of the cheeks is visible to everyone, so changes in normal cheek anatomy and visual appearance can impact a person’s social life and mental health. 

Changes in cheek appearance may be caused by many factors such as diet, various allergies, genetics, stress, lack of sleep, use of cosmetics, hormonal changes, sun exposure, smoking, weather and temperature changes, and many more to follow. 

The skin of the cheeks also changes with aging. Lack of elastic fibers and collagen, inadequate hydration, negative facial expressions can cause wrinkle formation.

Patognomic symptoms

Some of the pathognomic or typical symptoms of various diseases can result in changes in cheek appearance. For example, butterfly or malar rash is a specific symptom in systemic lupus erythematosus. It appears across the cheeks, also including the bridge of the nose. The malar rash is a red or purple facial rash that shapes the form of a butterfly. It looks like a rash from a sunburn.

Acne

The most common diseases affecting cheeks are various skin disorders such as acne. Acne is a skin disease occurring when skin hair follicles become plugged with dead skin cells and oils. It results in inflammation and bacterial infection. 

Acne appears as various-looking comedones such as whiteheads, blackheads, and blisters or pimples. Whiteheads are the plugged pores that are closed, while blackheads are open. Acne can present only with a few small raised skin lesions, or more severe forms can have significant and painful nodules or even cystic lesions. Acne is most commonly seen in teenagers, although it can affect adults as well. Most commonly, adults have lighter acne manifestations as in their teenage years. Acne affects the skin that contains sebaceous glands. Cheeks have them, and the hair follicles have a connection with sebaceous glands. 

Genetics and sebaceous gland overactive secretion can lead to acne. Hormonal changes, poor diet, stress, medications, other underlying diseases such as digestive tract disorders, bad quality cosmetic use can affect acne and make it worse.

Summary on cheeks

What is the anatomical term for cheeks?

The Latin word for cheeks is buccae, so the anatomical term is the buccal region.

Is the cheek a body part?

Yes, the cheek is a body part located on each side of the face. Cheeks help to form the oral cavity, so they are also a part of the digestive system.

Why do we have cheeks?

Cheeks take part in the digestion process, talking, and facial expression making.

What are cheekbones?

The term cheekbones is used for the zygomatic arch. It is formed by the zygomatic bone and the temporal bone that help to form the cheekbone frame.

What bones form the cheeks?

Cheeks are formed by the maxilla, mandible, and zygomatic bones.

Are cheeks muscles?

Although muscles help to form the cheeks, they do not classify as muscles. Cheeks are a part of the digestive system.

What muscles are in your cheeks?

Cheeks contain many facial muscles such as the buccinator, masseter, risorius, and both zygomatic muscles. They also contain three levator muscles - levator labii superioris, levator labii superioris aleque nasi and levator anguli oris muscle. Muscle fibers from orbicularis oris and the lower part of orbicularis oculi muscle also take part in cheek formation.

What muscles compress cheeks?

Mainly cheeks are compressed by the buccinator muscle.

Can facial muscles grow?

Like other muscles of the body, it is possible to gain bigger cheek muscles by exercising.

What causes fat loss in the cheeks?

Fat loss in the cheeks can be caused by several factors such as poor diet or underlying diseases, also regular physical activities.

What is the cheek muscle called?

The main cheek muscles are the buccinator and masseter muscles.

Which muscle is responsible for smiling?

Mostly, the zygomatic major muscle is responsible for smiling.

What causes dimples?

Dimples happen due to different variations of the zygomatic major muscle. People who have dimples have this muscle divided into two parts.

Do cheeks have nerves?

Yes, cheeks do have a lot of nerves. The primary nerves responsible for cheek innervation are the trigeminal nerve and the facial nerve.

What does acne on cheeks mean?

Acne is a skin disease that happens when hair follicles become plugged with dead skin cells and oils. It happens in places in the skin that contain many sebaceous glands. As cheeks have these glands, acne can affect cheeks.

What causes acne?

Acne occurs when skin’s hair follicles become plugged with dead skin cells and oils, resulting in skin inflammation and various looking comedones such as whiteheads, blackheads, and pimples.