Facial muscles Flashcards
where are the facial muscles embedded
in the the superficial facial
what kind of motor units does the facial muscle make
small motor units
proprioceptive feedback in the facial muscles
limited peripheral proprioceptive feedback.
few if any muscle receptors
Absence of joints and joint receptors
face muscle attach where
Muscles generally attached to bones of the skull and the skin.
relationship between facial orifices and facial muscles
Generally facial muscles surround facial orifices
(eyes, mouth, nostrils).
Functions of the face muscles
Protective and Facial expressions
Facial expressions general importance
convey mood during communication
protective function of the facial muscles
sphincters and dilators for facial orifices.
facial nerve motor component
Muscles of facial expression, Platysma, stylohyoid, digastric
Stapedius muscle of middle ear
facial nerve visceral component
Salivary glands
Lacrimal gland
Taste sensation of anterior 2/3 of the tongue
facial nerve sensory component
Sensation, small area around ear (post. Auricular)
the facial nerve does not do what in the face
Opening the eye (CN III)
Facial sensation and mastication (CN V – trigeminal)
Frontalis is the frontal belly of what
Occipitofrontalis muscle
Frontalis is part of what part of the head
Part of scalp
No bone attachment
Frontalis main action
Elevates the eyebrows
Wrinkles forehead
Orbicularis Oculi
Encircles the eye
Eye closure
Encourages flow of tears
Corrugator Supercilli
Knits eyebrows together
Levator Palpebrae Superioris
Not muscle of facial expression
Opening of the eyes
Not CN VII (CN III)
Elevates upper eyelid – continuously active
Nasalis
Compresses and flares the nostril
Draws the nostril down
Procerus
Draws the medial part of the eyebrow inferiorly
Wrinkling of the nose -VB
Orbicularis Oris
Encircles the mouth
Oral sphincter
Lip protrusion, compression, and puckering
Levator labii superioris alaeque nasi
Elevates alar cartilage of nose and upper lip
Levator labii superioris
Raises and everts the upper lip
Levator anguli oris
Elevates the corner of the mouth
Zygomaticus major and minor
Pulls mouth corners upward and outward
Smile
Risorius
Pulls mouth corners upward and outward (backward)
Smile - controlled, passport
Depressor labii inferioris
Draws lips inferiorly and laterally
Depressor anguli oris
Depresses corner of the mouth
Mentalis
Raise and protrude lower lip
Pout
Buccinator
Aids mastication and swallowing
Press the cheeks against the molar teeth during chewing
Whistling and sucking
Platysma
Tenses the skin of neck
Draws the corners of the mouth inferiorly
Assist depressing mandible
Facial expressions provide information about
basic and complex emotions
Cognitive activity, (perplexed, concentrating, or bored
Temperament and personality traits such as hostility, sociability or shyness
Truthfulness, leakage of concealed emotions, and lies
presence of a physical condition (anxiety, depression, Parkinson’s)
Education facial expression
Teacher’s expressions influence whether the pupils learn
Criminal Justice System
facial expression
help establish or detract crediblity
Business Matters
facial expression
important in negotiations and making personal decisions
Leadership Roles
facial expression
leaders’ expressions regarding important matters can influence citizen and other leaders
Recognizing Anger
Eyebrows are lowered and pulled together to form wrinkles in the skin of the forehead (glabella)
Tensed and straightened lower eyelids, with tension in lips and mouth.
Raised upper eyelids causing a glaring look.
Pressed lips with a slight pushing up of the chin boss.
Recognizing Happiness
Narrowing of the eyelids
Crow’s feet wrinkling at the corners of the eyes,
Raised outer and upper area of the cheeks
Lips parted in a smile with teeth showing
Recognizing Sadness
Eyebrows are lowered and pulled together to form wrinkles in the skin of the forehead (glabella)
Tensed lower eyelids, with tension in lips and mouth.
Widened, and depressed lips, with a slight push up of the chin boss.
Recognizing Disgust
Wrinkling of nose
Elevated lips
Eyebrows may be drawn close to each other
Head turned away from the noxious or disgusting stimulus.
Recognizing Fear
Raised eyebrows
Jaw may be dropped
Lips widened or drawn downwards
Recognizing Pain
Cheek-raising, upper lip raising, lip-corner pulling, lips parting, mouth opening and eye closure or blinking” – Craig and Patrick, 1985
“….involving brow lowering, skin drawn tightly around the eyes, and a horizontally stretched open mouth with deepening of the nasolabial furrow
Bell’s Palsy
Most common cause of facial paralysis (50%)
Unilateral facial paralysis
Risk Factors for bells palsy
3X higher during pregnancy (3rd trimester & early postpartum period)
Hypertension
Diabetes
Etiology for bells palsy
Mostly viral
Vascular origin such as ischemia of facial nerve
Fluid retention
Immune-mediated inflammatory response to some vaccines (however this data is uncertain)
Compression due to a tumor or neoplasm
example of a virus that cause bells palsy
Herpes Simplex, influenza
Vascular origin of bells is a high risk with what disea
Diabetes Mellitus
when do we see fluid retention that is related to bells
pregnancy & pre-eclampsia
Mechanism of Bell’s palsy
Compression of the facial nerve in the narrowest part of the canal (labyrinthine portion) due to inflammation
what type of onset does Bell’s Palsy have
Sudden onset
hours, peak facial muscle weakness or paralysis seen within 48-72 hrs
Bell’s Palsy recovery time
Complete recovery within 1-3 months in more than 85% of those affected
Bell’s Palsy relapse
7 to 15% have relapses
Bell’s Palsy long recovery
1/3 of individuals may have late recovery (9 months) or incomplete recovery
Bell’s Palsy recovery is based on what
how badly the nerve was impacted
Risk factors for incomplete recovery in Bell’s Palsy
older age, DM, BP, pregnancy, genetic predisposition, no sign of recovery in first month
Bell’s Palsy those who do not recovery have what
tightness, contracture, twitching and/or synkinesis
Bell’s Palsy - Synkinesis
moving together
Voluntary movement of one facial muscle is accompanied by an involuntary movement of another muscle
Due to abnormal facial nerve fiber regrowth.
E.g., ocular-oral movement.
This occurs when there is fiber regrowth that is not very organized
Bell’s Palsy- Inability to smile, raise eyebrows, etc (facial muscle weakness)
yes
Bell’s Palsy- Drooling
yes
Bell’s Palsy-Increased wrinkles
no – no wrinkles form because of decreased use of muscle in the face
Bell’s Palsy- Feel their face
yes
trigeminal nerve - V
Bell’s Palsy- Change in taste (distorted)
maybe – depending on what part of the canal is affected this can affect the taste
Bell’s Palsy- Hyperacusis
maybe
Bell’s Palsy- Decreased tearing
maybe – the facial nerve gives out branch to lacrimal gland
Bell’s Palsy- Increased tearing (crocodile tears)
maybe - new fibers my lead to excess tear formation
Bell’s Palsy- Decrease in saliva
maybe
Bell’s Palsy- Jaw muscle weakness
no – the facial nerve does not supply the muscle of the mandible
Hyperacusis
a disorder in loudness perception
Bell’s Palsy- What would you expect to see?
Eating
Drinking
Speaking
Dry eye and mouth
Decreased eye protection
Compromised Oral Hygiene
Psychological impact – Depression/Anxiety
Bell’s Palsy - Differential Diagnosis
Lyme Disease
Guillain Barre Syndrome
Sjogren’ syndrome
Tumors in the parotid gland
Herpes Zoster infection
Bell’s Palsy - Common treatments, most effective
Glucocorticoids
Bell’s Palsy - Common treatments, eyes
most effective - Adequate eye care (eye lubrication or ointment) to prevent corneal abrasions and dryness.
Bell’s Palsy - Common treatments, minimal benefits
Anti-viral therapy (evidence shows little to no benefit when combined with glucocorticoids vs glucocorticoids alone)
Facial exercise or retraining with/or without EMG feedback.
Surgical decompression is not recommended.
Facial plastic surgery to improve facial symmetry for those with contractures and residual paralysis.
