5. INTRODUCTION
FACE
Forehead is
common to both
face & scalp.
6. FACIAL MUSCLES
Orbital margins & eyelids
External nose & nostrils
Lips, cheeks & mouth
Pinna
Scalp
Cervical skin
Muscles of facial
expressions
7. Specificity of facial muscles
These muscles are different from other muscle
organization in having lack of deep membranous
fascia beneath the skin of face.
Many small slips of muscles, which are attached to the
facial skeleton are inserted directly into skin
(subcutaneously).
8. Importance of arrangement
Primary & secondary function
SPHINCTOR &
DILATOR OF
FACIAL
ORIFICES V/S
Facial
expression
10. Morphologically they represents the remnants of
‘panniculus carnosus’
Which is a continuous subcutaneous muscle sheet seen in some
animals & all of which are inserted into the skin.
24. Actions –
1. Sphincter of orbital fissure
2. Ocular reflex
3. Accommodate the amount of light entering into eye
4. Controls drainage of tears
25. Corrugator
supercilii
Pyramidal muscle
Located at the medial end of eyebrow
Deep to frontalis
Blood supply – superficial temporal
opthalmic artery
Action –
1. Draws the eyebrow medially
2. Frowning Nerve supply – temporal branch
3. Vertical strip on supranasal strip of forehead
26. Levator palpebrae superioris
Triangular muscle
Arises from lesser wing of sphenoid, infront of optic foramen
But separated by superior rectus
27. Blood supply –
Directly by opthalmic artery
Indirectly by supraorbital branch
Nerve supply –
CN III
Sympathetic pluxes around CN III
Actions –
1. Elevates upper eyelid
2. Linked to superior rectus by check ligament
3. Increased sympathetic activity – widened palpebral apparatus
4. Lesion of sympathetic pluxes - ptosis
28. Procerus
Pyramidal muscle
Close to
Origin – periosteum over lower part of nasal bone
perichondrium over lateral nasal cartilage
aponeurosis of transverse nasalis
Insertion – glabellar skin over lower part of forehead between the eyebrows
29. Action –
1. Draws the eyebrow medially & forms transverse wrinkles on lower part of
forehead
2. Frowning & concentration
3. Reduces the glare of sunlight
Blood supply – branches of facial
artery
Nerve supply – temporal branch
zygomatic branch
30. procerus
Nasalis Transverse
2 parts – part
1. Transverse component / compressor naris
2. Alar part / pars alaris/ dilator naris posterior Alar part
Depressor septi
Attached to skin & posterioir part of mobile septum
Blood supply – branches of facial artery
infraorbital branch of maxillary artery
Nerve supply – buccal branch
zygomatic branch
Actions –
Compression of naris
Widening of naris & elongation of nose
Active immediately before inspiration
31. •Primary dilator of nostril
•Prevents the closure of nasal wall during
Dilator Naris Anterior inspiration
32.
33. Depressor Septi
Absent or rudimentary.
Depressor septi
Blood supply – superior labial branch of facial artery
Nerve supply – buccal & zygomatic branches
Actions –
1. Pulls the nasal columella, septum & tip of nose downward
2. With alar part of nasalis – widens the nasal apperture causing nose to dip
on smiling.
35. Blood supply – superior labial branch of facial artery
Nerve supply – buccal & zygomatic branches
36. Actions –
Lateral slip -
1. Raises & evert the upper lip.
2. Raises, deepens & increases the curvature of top of nasolabial fold.
Medial slip -
1. Pulls the lateral crus superiorly
2. Along with depressor septi – secondary dilator of nose
44. Blood supply – superior labial branch of facial artery
Nerve supply – buccal& zygomatic branches
Actions –
1. Elevates & everts the upper lip
2. Modifies the nasolabial furrow
3. Along with LLSAN & LLS – curls the upper lip in smiling
4. Expressions - smugness (too obviously pleased with oneself)
- contempt ( very low opinion)
- disdain ( to be too proud)
46. Blood supply – superior labial branch of facial artery
infraorbital branch of maxillary artery
Nerve supply – buccal& zygomatic branches
Actions –
1. Raises the angle of mouth on smiling
2. Contributes to depth & contour of nasolabial furrow
54. Blood supply – inferior labial branch of facial artery
mental branch of maxillary artery
Nerve supply – lower buccal & marginal mandibular
Actions –
1. Draws the angle of mouth downward
2. Expressions – sorrow
55. Buccinator
Muscle of cheek
Quadrilateral
Between maxilla & mandible
3 parts-
1. Upper fibers
2. Middle fibbers
3. Lower fibers
Posterior part
Anterior part
56.
57. Blood supply – branches from facial artery
branches from maxillary artery
Nerve supply – branches from facial nerve
Actions –
1. Compresses the cheek against the gums
2. When cheek are distended with air the buccinator expel it
between lips – important for playing wind instruments.
Buccinator – Latin : trumpeter
trumpet – a brass musical wind instrument
with a high clear tone.
66. Blood supply – superior labial branch of facial artery
mental branch of maxillary artery
Nerve supply – buccal branch of facial nerve
Actions –
Pulls the corner of mouth laterally in grinning & laughing.
67. Platysma
Origin – from pactoral & deltoid fascia
Insertion – lower border of body of mandible & skin over the lower neck
Muscle of neck & contributes to orbicularis oris complex
3 parts
1. Mandibular
2. Labial
3. Modiolar
69. Blood supply –
1. facial artery
2. occipital artery
3. posterior auricular artery
4. subclavian artery
They form a rich network
within platysma &
account for the viability
of various skin flaps
raised during neck
dissection.
70. Blood supply – superior labial branch of facial artery
mental branch of maxillary artery
Nerve supply – buccal branch of facial nerve
greater auricular nerve
transverse cutaneous nerve of neck
Actions –
1. Release pressure of skin on the subjacent vein
2. Depresses the mandible forcefully
3. Pull the angle of mouth downward
4. Depresses & wrinkles the skin of lower face &
mouth
5. Tenses the skin of neck
73. Cleft lip cases -
Nasal septum deviated to non-cleft side
due to absence of correct insertion of
transverse muscle of nose &
orbicularis oris on medial aspect of
cleft onto the tissue around the anterior
nasal spine , nasal septum & most
important contralateral muscle.
3 functional groups of facial muscles
displaced inferiorly
83. Mangement of facial palsy -
1. Reanastomosis of facial nerve stem – some voluntary & emotional
expressions.
2. Adams transplanted –
anterior fibers of masseter – on both lips
Requires 2-3 months
temporalis muscle fiber – eyelids
for function properly
part of frontalis – to other side
3. Adour et al transplanted
masseter – facial muscles – successful
best result by – stripping fascia from masseter & suture the
paralyzed muscles on its raw surface.
84. Examination of facial muscle
Frontalis
Dilators of mouth
Orbicularis oculi
Buccinator
90. Wrinkle lines
The direction in which facial skin tension is greatest varies regionally. Skin tension
lines which follow the furrows formed when the skin is relaxed are known as
‘relaxed skin tension lines’ (Borges & Alexander 1962). In the living face, these
lines frequently (but not always) coincide with wrinkle lines and can therefore act as
a guide in planning elective incisions.
A, Distribution of relaxed skin tension lines (Kraissl's lines) lateral view. B, Anterior view.
91. When lesions on the face such as scars, pigmented lesions and
skin cancers are excised, the dimensions of these lesions often
require excision as an ellipse, so that the resulting defect can be
closed as a straight line.
If the resulting scar is to be aesthetically acceptable it is
important to make the long axis of the ellipse parallel to the
natural relaxed skin tension lines, so that the scar will look like
a natural skin crease.
96. RESOURCES
TEXT BOOK –
1. B.D. Chaurassia’s human anatomy 4th edition vol. 3 The Head & Neck.
2. Gray’s Anatomy 40th edition.
3. Botulinum Neurotoxin For Head & Neck Disorder – by Blitzer , Benson & Guss.
4. Surgical Approaches To Facial Skeleton 2nd Edition – by Edward Ellis & Michael F.
Zide
The vestibulo-ocular reflex (VOR) is a reflexeye movement that stabilizes images on the retina during head movement by producing an eye movement in the direction opposite to head movement, thus preserving the image on the center of the visual field. For example, when the head moves to the right, the eyes move to the left, and vice versa. Since slight head movement is present all the time, the VOR is very important for stabilizing vision: patients whose VOR is impaired find it difficult to read using print, because they cannot stabilize the eyes during small head tremors. The VOR does not depend on visual input and works even in total darkness or when the eyes are closed. However, in the presence of light, the fixation reflex is also added to the movement.[1]
