Orbital Group

The orbital group of facial muscles contains two muscles associated with the eye socket.
These muscles control the movements of the eyelids, important in protecting the cornea from
damage. They are both innervated by the facial nerve.
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Fig 1.0 Posterior view of the orbital muscles of facial expression

Orbicularis Oculi

This muscle surrounds the eye socket and extends into the eyelid. It can be functionally split
into two parts; the outer orbital part and inner palpebral part.

Actions: The palpebral part of the muscle performs gentle closure of the eyelid,
whereas the orbital portion closes more forcefully.

Innervation: Facial nerve.

Corrugator Supercilii
The corrugator supercilii is a much smaller muscle, and is located posteriorly to the
obicularis oculi muscle.

Attachments: It originates from the superciliary arch, running in an superolateral

direction. It inserts into the skin of the eyebrow.

Actions: It acts to draw the eyebrows together, creating vertical wrinkles on the
bridge of the nose.

Innervation: Facial nerve.

Clinical Relevance: Paralysis to the Orbital Muscles

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Fig 1.1 Drooping of the lower eyelid, ectropion.

If the facial nerve becomes damaged, the orbital muscles will cease to function. As they are
the only muscles that can close the eyelids, this has some serious clinical consequences.
1. The eye cannot shut this can cause the cornea to dry out. This is known as
exposure keratitis.
2. The lower eyelid droops, called ectropion. Lacrimal fluid pools in the lower eyelid,
and cannot be spread across the surface of the eye. This can result in a failure to
remove debris, and ulceration of the corneal surface.
The test for facial nerve palsy involves raising the eyebrows and closing the eyelids

Nasal Group

The nasal group of facial muscles are associated with movements of the nose, and the skin
around it. There are three muscles in this group, and they are all innervated by the facial
nerve. They serve little importance in humans.
Nasalis
The nasalis is the largest of the nasal muscles. It is split into two parts; transverse and alar.

Attachments: Both portions of the muscle originate from the maxilla. The transverse
part attaches to an aponeurosis across the dorsum of the nose. The alar portion of the
muscle attaches to the alar cartilage of the nasal skeleton.

Actions: The two parts have opposing functions. The transverse part compresses the
nares, and the alar part opens the nares.

Innervation: Facial nerve.

Procerus
The procerus is the most superior of the nasal muscles. It also lies superficially to the other
muscles of facial expression.

Attachments: It originates from the nasal bone, inserting into the lower medial
forehead.

Actions: Contraction of this muscle pulls the eyebrows downward to produce

transverse wrinkles over the nose.

Innervation: Facial nerve.

Depressor Septi Nasi

This muscle assists the alar part of the nasali in opening the nostrils.

Attachments: It runs from the maxilla (above the medial incisor tooth) to the nasal
septum.

Actions: It pulls the nose inferiorly, opening the nares.

Innervation: Facial nerve.

Oral Group
These are the most important group of the facial expressors the are responsible for
movements of the mouth and lips. Such movements are required in singing and whistling,

and add emphasis to vocal communication. The oral group of muscles consists of the
orbicularis oris, buccinator, and various smaller muscles.
Orbicularis Oris
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Fig 1.2 The main oral muscles of facial expression. Note how the fibers of buccinator and
obicularis oris blend together
The fibres of the orbicularis oris enclose the opening to the oral cavity.

Attachments: Arises from the maxilla and from the other muscles of the cheek. It
inserts into the skin and mucous membranes of the lips.

Action: Purses the lips.

Innervation: Facial nerve.

Buccinator
This muscle is located between the mandible and maxilla, deep to the other muscles of the
face.

Attachments: It originates from the maxilla and mandible. The fibres run in an
inferomedial medial direction, blending with the orbicularis oris and the skin of the
lips.

Actions: The buccinator pulls the cheek inwards against the teeth, preventing
accumulation of food in that area.

Innervation: Facial nerve.

Other Oral Muscles

There are other muscles that act of the lips and mouth. Anatomically, they can be divided into
upper and lower groups:

The lower group contains the depressor anguli oris, depressor labii inferioris and the
mentalis.

The upper group contains the risorius, zygomaticus major, zygomaticus minor,
levator labii superioris, levator labii superioris alaeque nasi and levator anguli oris.

Five main divisions of the facial nerve and the muscles they control:

1) temporal

The frontalis muscle of the forehead lifts the eyebrows.

The anterior and superior auricular muscles which move the ear forward
and superiorly.

The Corrugator muscle on the brow, draws the eyebrow downward and
medially, producing the vertical wrinkle on the forehead at the bridge of
the nose.

The procerus pulls the skin between the eyebrows downward, assists in
flaring the nostrils and helps create an angry expression.

The temporal branches assist the zygomatic branches of the facial nerve
with the obicularis oculi, which closes the eyelids and contracts the skin
around the eyes.

2) zygomatic

The zygomaticus major elevates the corners of the mouth for smiling.

3) buccal

The zyomaticus minor, levator labii elevate the upper lip.

The levator labii superioris alaeque nasi dilates the nostril and
elevates the upper lip, enabling one to snarl.

The risorius and levator angulii oris are muscles that assist in smiling.

The orbicularis encircles the mouth, closes and puckers the lips and is
sometimes called the kissing muscle.

The nasalis compresses the bridge of the nose and the nostrils.

The buccal branches also assist the mandibular branches in pulling the
mouth downwards for a frown, by the depressor anguli oris, and pulling
the lower lip down with the depressor labii inferioris.

4) mandibular

The mentalis pulls the skin on the chin upwards.

5) cervical

This division supplies the platysma muscle of the neck, also a frowning
muscle.

Swallowing: First Stage

The first stage of swallowing is voluntary. It begins with the selective separation of the
masticated food into a specific bolus. This task is accomplished primarily by the tongue. The
bolus is positioned on the dorsum of the tongue and then pressed lightly against the intact
hard palate. The tip of the tongue rests on the hard palate anteriorly, just behind the incisors.
The lips are sealed, and the teeth are brought together; this essentially dams off the anterior
oral cavity. The presence of the bolus pressed against the mucosa of the intact hard palate
initiates a reflex wave of contraction of the tongue that pushes the bolus backward. As the
bolus reaches the back of the tongue and with the soft palate now occluding against the
nasopharynx, the bolus is transferred into the pharynx.
Swallowing: Second Stage

When the bolus has reached the pharynx, a peristaltic wave caused by the contracture of the
pharyngeal constrictor muscles carries it down the pharynx. To prevent regurgitation into the
nasal cavity, the soft palate must rise and touch the posterior pharyngeal wall, thereby sealing
off the nasal cavity. Simultaneously, the epiglottis must block the pharyngeal airway to the
trachea to prevent the food from going into the larynx or the trachea and ending up in the
lungs. This process of walling off potential openings keeps the food moving down the
esophagus. During this stage of swallowing, the pharyngeal muscular activity opens the
pharyngeal orifices of the eustachian tubes, which would otherwise be closed.
Swallowing: Third Stage

The third stage of swallowing describes the passing of the bolus through the length of the
esophagus and into the stomach. Rapid peristaltic waves carry the bolus through the
esophagus. As the bolus reaches the lower esophagus, the sphincter relaxes, thereby allowing
for the entrance of the bolus into the stomach. Interestingly, in the upper portion of the
esophagus, the muscles are mainly voluntary and can also be used to return the bolus into the
mouth when necessary for more complete mastication. In the lower section of the esophagus,
the muscles are entirely involuntary.
Evaluation of Swallowing

When a complaint about swallowing is registered, a special evaluation may be required. Such
an evaluation should consist of a complete medical history, a detailed description of the
complaint, and a physical examination of the peripheral deglutitory motor and sensory
system, including trial swallows under observation. Diagnostic studiesincluding
videofluorography, manometry, electromyography, and fiber-optic endoscopyare indicated
in selected cases.
Mastication Mechanism

Mastication is defined as the act of chewing food (Fig. 8-2). It represents the initial stage of
digestion. During mastication, the food bolus is broken down into small particles for ease of
swallowing. For most, it is considered an enjoyable activity that involves the senses of taste,
touch, and smell. It is a complex function that requires the involvement of the muscles, the
teeth, and the periodontal supportive structures. It also requires functioning
temporomandibular joints and jaws, and it makes use of the lips, the cheeks, the tongue, the
palate, and the salivary glands. It is an activity that is usually automatic and often taken for
granted, although it can be easily brought into voluntary (i.e., conscious) control. It is also
susceptible to pathologic conditions and damaging habits. Furthermore, modifications of this
system (i.e., compensatory patterns) will be introduced when component parts are not in
proper working order (e.g., in the presence of dentofacial deformity with malocclusion).
Mengunyah terdiri dari beberapa tahap, yaitu tahap membuka
mandibula, tahap menutup mandibula dan tahap berkontaknya gigi
antagonis satu sama lain atau kontak gigi dengan bolus makanan,

dimana setiap tahap mengunyah berakhir 0,5 sampai 1,2 detik

(Andriyani, 2001).

More specific terms for Stomatognathic Diseases:

Jaw Diseases

Mouth Diseases

Pharyngeal Diseases

Temporomandibular Joint Disorders

Tooth Diseases

Stomatognathic System Abnormalities

Bagian-Bagian Sistem Stogmatognatik Sistem stomatognati terdiri atas: a.

Gigi a. Mahkota b. Akar b. Jaringan gigi a. Email b. Dentin c. Pulpa c. Jaringan
periodontal a. Gingival b. Ligament periodontal c. Sementum d. Tulang alveolar
d. Membrane mukosa e. Palatum f. TMJ a. Kondilus b. Fossa c. Disk g. Saliva a.
Sekresi saliva b. Flow saliva h. Inervasi i. Vaskularisasi j. Otot-otot mastikasi

MANIFESTASI KLINIS TMD

Pada kepala
* Head pain, headache
* Forehead
Temples
Migraine
Sinus type
Shooting pain up back of head
Hair and scalp painful to touch

Telinga
Seperti ada suara berdesis, berdengugn, berdering
* Penurunan pendengaran
* Nyeri telinga, tanpa infeksi
* Clogged itchy ears
Vertigo, pusing

Mata
Nyeri di belakang mata
Bloodshot eyes
* May bulge out
* Sensitive terhadap sinar matahari

Mulut
Rasa tidak nyaman
* Keterbatasan membuka mulutTidak dapat membuka mulut perlahan
* Deviasi rahang ke salah satu sisi saat membuka mulut
* Mulut terkunci saat membuka atau menutup
* Tidak dapat menemukan oklusi/ bite
Gigi
Clinching, grinding saat malam
* Looseness and soreness of back teeth

Leher
* Keterbatasan mobilitas, kekakuan
* Nyeri/ sakit leher
* Otot terasa lelah
* Sakit pada pundak dan punggung
* Baal dan atau nyeri pada lengan dan jari

Tenggorokan
* Kesulitan menelan
* Laryngitis
* Sakit tenggorokan (tanpa adanya infeksi)
* Perubahan suara yang tidak biasa
* Frequent coughing (batuk berulang), constant clearing of throat
* Merasa adanya benda asing pada tenggorokan

JAW
* Clicking, popping jaw joints
* Grating sound
* Nyeri pada otot pipi
* Gerakan rahang dan lidah tidak terkontrol