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Muscles of Facial

Expression
Dr. Sriharsha Vadapalli
PG Student
Dept. of Prosthodontics

Over view

Introduction
Classification
Individual muscles
Clinical significance.

INTRODUCTION
The facial muscles are in the subcutaneous tissue
of anterior and posterior scalp, face, and neck.
Most muscles attach to bone on one side and soft
tissue on another side, and produce their effects
by pulling the skin.
One of the greatest early workers in muscle
physiology(1806-1875) is Duchenne, he wrote a
book called physiology of motion in French. In
1949 E.B. KAPLAN translated it into English.
Detailed and extensive studies on these muscles
done by Huber(1931) and Lightoller(1925).

Primary functions:
Regulate the size of the apertures.
Expression of emotions.
Articulation for speech.

Embryology: All the muscles of facial


expression develop from mesoderm and
second pharyngeal arches.
A subcutaneous muscular sheet forms
during embryonic development, that
spread over face and neck carrying
branches of facial nerve with it to supply
all the muscles formed from the arch.
Because of common origin facial muscles
are fused and their fibers are intermingled.

Nerve Supply:
Sensory nerve- Trigeminal nerve.
Motor nerve - Facial nerve. The
branches are,
Temporal
Zygomatic
Buccal
Marginal mandibular
cervical

Blood Supply: arterial supply:


1) Facial artery: this is the chief artery of face and
arises from external carotid artery. It divides into
the following branches.
Superior labial
Inferior labial
Lateral nasal
2) Transverse facial artery, branch of superficial
temporal artery.
3) Small arteries that accompany the cutaneous
branches of trigeminal nerve.
4) Terminal part of supratrochlear and supra orbital
arteries.

Venous supply:
1) Facial vein
2) Retromandibular vein
3) Supratrochlear vein.
4) Supraorbital vein.
5) Tributaries of superficial temporal vein.
6) Tributaries of pterygoid plexus of veins.
(Infraorbital, Buccal, and Mental veins)

Lymphatics:
Preauricular lymph nodes.
Submandibular lymph nodes.
Submental lymph nodes.

Classification:

Muscles of face can be broadly divided into (21)

Muscles of Scalp, Forehead, Eyebrows, Nose and opening of the Eye: (7)

Occipito Frontalis, Procerus, Corrugator Supercilii, Levator Palpebrae


Superioris,
Orbicularis Occulii, Nasalis, Depressor Septii.

Muscles of Mouth, Lips, and Cheeks: (14)


These can be divided into
Evertors, Elevators, Retractors of the upper lip (6)
Levator Labii Superioris Alaque Nasii, Levator Labii Superioris, Levator angulii
Oris,
Zygomaticus major and minor. Incisivus Superioris.

Depressors, Evertors, Retractors of the Lower LIP: (6)


Depressor Angulii Oris, Depressor Labii Inferioris, Risorius, Platysma, Mentalis.
Incisivus Inferioris.

Orbicularis Oris. Sphincter around mouth.


Buccinator- cheek muscle.

Occipito Frontalis.
Frontal belly:
Origin: Epicranial aponeurosis
Insertion: Skin and sub cutaneous tissue of eyebrows and fore
head.
Action: Elevates the eyebrows and wrinkles the skin of fore
head, protracts the scalp.
(Surprise and Curiosity)

Occipital belly:
Origin: Lateral2/3rds of superior Nuchal line
Insertion: Epicranial Aponeurosis.

Action: Retracts Scalp; Increasing effectiveness of frontal


belly.

Corrugator Supercilii:
Origin: Medial end of Superciliary Arch.
Insertion: Skin superior to mid supraorbital margin and
superciliary arch.
Action: Draws eye brows medially and inferiorly, creating
vertical wrinkles above nose.
(Demonstrating concern and worry)

3. Levator Palpebrae Superioris.


Origin: Inferior surface lesser wing of
sphenoid
Insertion:
- Medial margin attaches to
Medial Palpebral ligament.
-Lateral margin attaches to
whitnalls tubercle on zygomatic bone.
-Central part inserts to skin of
upper eyelid, anterior surface of superior
tarsus,
Superior conjuctival fornix.
Action:
- Elevates the eyelids.

4..Procerus:
Origin: Fascia covering the nasal bone.
Insertion: Skin between Eyebrows
Action: Depresses medial end of eyebrow,
acts during Frowning

5.Nasalis:
Origin Anterior surface of maxilla near nasal
notch
Insertion: into the alar cartilage and continues
over the bridge of the nose with opposite muscle.
Action: - Compress the nasal aperture below the
bridge of the nose.
-Alar part dilates the anterior nasal
aperture.

6. Depressor Septii:
Origin: Incisive fossa on the anterior
surface of the maxilla.
Insertion: Nasal septum
Action: Dilatation of anterior nasal
aperture

7. Orbicularis Occulii:
it has 3 parts. Palpebral,
Orbital, Lacrimal.
Origin: Medial Palpebral ligament, adjoining
frontal bone, and frontal process of maxilla,
lacrimal fascia and crest of lacrimal bone.
Insertion: subcutaneous tissue of eyebrow,
Lateral Palpebral raphae.
Action: it causes closure of eyelids both
voluntarily or while blinking.
-Aids in transport of lacrimal fluid by dilating
lacrimal sac.

Injury to facial nerve, causes paralysis of


facial muscles(Bells Palsy). Loss of muscle
tone in Orbicularis Occulii causes inferior
eyelid to Evert and fall away from eyeball.
As a result lacrimal fluid does not spread
on cornea preventing lubrication,
hydration and causes flushing of surface of
cornea. This results in corneal ulceration
and impairment of vision.

Evertors, Elevators, Retractors of the upper lip


(5):

8.Levator Labii Superioris Alaque Nasii:


Origin: Lateral surface of frontal process of
maxilla.
Insertion: forms two thin slips which attach on
Ala of the nose,-Skin of upper lip.
Action:
Elevates and Evert the upper lip and
dilates the nostril.

9.Levator Labii Superioris:


Origin: Anterior surface of maxilla, close to infra orbital foramen.
Insertion: lateral surface of skin and subcutaneous tissue of
upper lip.
Action: Elevates and Everts the upper lip.

10.Levator Anguli Oris: ( caninus)


Origin: Below the infra orbital foramen, in the
canine fossa of Maxilla.
Insertion: Angle of the mouth.
Action: Raises the angle of the mouth.

11.Zygomaticus Major:
Origin: Zygomatic Bone
Insertion: Angle of the mouth.
Action: Pulls the angle of the mouth upwards and
laterally.

Action of zygomatici muscles in


elevating corners of the mouth for
smiling produces nasolabial sulcus.
Many older patients wants to have
nasolabial sulcus obliterated because ,
it becomes a wrinkle as the skin loses
resilience.
The removal of nasolabial sulcus can be
done by thickening of the denture base
under the fold, but excess thickening
gives an artificial look.

12.Zygomaticus Minor:
Origin: Zygomatic Bone
Insertion: Skin of upper lip in lateral part.
Action: -Elevates and Everts the upper lip,Increases Nasiolabial furrow.

Depressors, Evertors, Retractors of the Lower LIP:


(5)

13.Depressor Angulii Oris:


Origin: Posterior part of oblique line of mandible.
Insertion: Angle of Mouth.
Action: Pulls the angle of the mouth downwards
and laterally.

14.Depressor Labii Inferioris:


Origin: Oblique line of Mandible.
Insertion: Skin of Lower Lip.
Action: Pulls the Lower lip downwards and
laterally.

15.Risorius:
Origin: Parotid Fascia.
Insertion: Angle of the Mouth.
Action: Pulls angle of mouth downwards and
laterally.

16.Mentalis:

Origin: Incisive Fossa.

Insertion: Skin of Chin.

Action: Puckers the Chin.

The origin of this muscle is above the


level of lower fornix.
Thus the shallow the lower vestibule,
on contraction, This muscle is capable
of dislodging lower denture, when the
ridge in anterior region is the same
height as the fornix of the vestibule.
The level of attachment of this
muscle to the alveolar ridge, dictates
the extension of flange of the lower
denture. Surgical repositioning of this
muscle is sometimes advisable.

17.Platysma:
Origin: Fascia over the anterior surface of deltoid
and pectoralis major up to 2nd rib
Insertion: Lower border of body of mandible, and
few fibers to angle of mouth.
Action: Depresses the mandible and pulls the
angle of the mouth downwards
and laterally.
Its contraction mainly aids in venous return.

18.Buccinator:
Main muscle of entire cheek.
It is covered by Buccopharyngeal membrane.
It is not a muscle of facial expression.
It does not possess the facial-sheath.

Origin: -outer surface of alveolar process of


maxilla and mandible opposite the 3
molar teeth.
-Pterygomandibular raphae
Insertion: Upper fibers insert into upper lip,
lower fibers insert into lower lip while
intermediate fibers decussate
to upper and lower lips.
Action: - Flattens the cheek against the
gums and teeth, which helps during
mastication.

-Helps in blowing out air through


mouth.

- participates in deglutition.

It runs from the corner of the mouth, and passing


along the outer surface of maxilla and mandible,
until it reaches the ramus, where it passes to the
lingual surface to join superior constrictor of
pharynx, and Pterygomandibular raphae.
Two Buccinator muscles and the Orbicularis
oris forms a functional unit that depends
on position of dental arches and labial
contours of the mucosa or the denture base
for effective action.

In extreme cases of resorption of residual


ridge, Mylohyoid and Buccinator cover the
bone from 1st molar to retromolarpad.
The action of this muscle does not
dislodges the denture, because the fibers
run parallel to plane of occlusion.

But run perpendicular to masseter,


when masseter is activated it pushes
the Buccinator medially against
denture in Retromolarpad area.
This is a dislodging force, so denture
base should be contoured to
accommodate insertion between these
two muscles.
The contour in the denture base is
termed as masseter groove.

The position of the attachment of


buccinator in upper jaw determines
the vertical height of the distobuccal
flange of upper denture.

In senile individuals, patients with


facial paralysis, and individuals with
reduced tone of Buccinator cheeks
will collapse, and caught between the
teeth.

19. Orbicularis Oris:


Origin: Extrinsic part: surrounds Facial muscles.
Intrinsic part: Incisive fossa of maxilla
and
Mandible.
Insertion: fibers intermingle and surround the
orifice of the mouth and attach to angle
of the mouth and skin of lips.
Action: -Closure of lips.
-Compresses lip against gums and teeth
which helps in mastication.
-Protrusion of lips.

The muscles that merge into Orbicularis oris are


the

Zygomaticus,
Quadrates Labii Superioris,
caninus or Levator angulii oris,
Mentalis,
Quadrates Labii Inferioris,
Triangularis or Depressor Anguli oris,
Buccinator and
Risorius.

It is the muscle of the lips, it is sphincter like


and attaching to the maxillae along a median
line under the nose by means of a band of
fibrous connective tissue known as maxillary
labial frenum, and mandible on median plane
by means of mandibular labial frenum.

The marginal portion of muscle adjacent to


the oral fissure acts less forcefully against
the labial surface of the anterior teeth than
does its peripheral portion. This permits
more natural anterior position of the teeth,
especially when labiolingual inclination keeps
the neck of the tooth nearer the ridge.
The superior border of lower lip is supported
by incisal third of upper anteriors, if not so,
lower lip will be caught between anteriors
during occlusion.

Three factors affect the face in repositioning


the Orbicularis oris with complete dentures.
Thickness of labial flanges of both the dentures.
Anteroposterior position of anterior teeth
Amount of separation between the mandible
and maxilla.

The upper lip is supported by the 6


upper anterior teeth. and lower lip is
supported by labial surfaces of lower
anteriors. And not by the denture
flange.
When teeth are in occlusion, the
superior border of the lower lip is
supported by the incisal third of the
maxillary anterior teeth. So lower
teeth should extend up to mentolabial
sulcus

If this were not so, the lower lip is


caught between the U/l anterior teeth
during occlusal contact.

Angle of the mouth are easily


irritated if the lips are stretched
taught when impression tray is
inserted

If the jaws are closed too far, or


dental arches are located too far
posteriorly, the upward and backward
positioning of the O.oris will cause
movement of its merging muscles
nearer to their origins.

this causes sagging of merging


muscles at rest. This causes dropping
of the corners of the mouth. With a
resultant senile edentulous
expression, and causes atrophy of
muscle fibers.
If the mouth has been edentulous for
a long time, with considerable
resorption of ridges, the borders
need to be thick to restore the
position of the muscles.

20&21) Incisivus Labii Inferioris, and


Superioris ,
are small muscles , arises from the
maxillary and mandibular alveolar
processes.
Then course laterally and blend with the
orbicularis oris muscle.

It is doubtful that , contraction of


these muscles alone will dislodge the
dentures.
However their presence beneath the
mucous membrane might present
problems associated with flange
extension and denture retention.

Modiolus: (in Latin means hub of a wheel) .


The bundle of tissues 1cm lateral to the corner of mouth
called Modiolus or muscular node.
It represents the origin, insertion or decussation of many
fibers from various muscles of facial expression. The
muscles form the Modiolus are:

The Zygomaticus major.


Levator angulii oris.
Incisivus superious.
Buccinator.
Depressor angulii oris.
Incisivus inferiors.
Risorius
Orbicularis oris muscles

This bundle is very active and act as a movable


attachment to aid the Orbicularis oris and
Buccinator muscles in their functions associated
with mastication, speech, and deglutition.
The other muscles listed above, act to stabilize this
mass in various positions. This action tends to
draw Modiolus medially, and hence exerts forces
against teeth or denture flanges in the premolar
area.
Denture that is wide in premolar area will
therefore tend to be displaced from its tissue seat.

If thumb is placed inside the corner of the


mouth,and finger on outside of the
prominence, and then lip and cheeks are
contracted, the modiolus feels like a knot.

The modiolus becomes fixed every time
the buccinator muscle contracts,
which is a natural accompaniment of
all chewing efforts.
The contraction of modiolus presses
the corner of the mouth against the
premolars, so the occlusal table is
closed in front.

Food is crushed by the premolars and


molars and does not escape the
corner of the mouth. Unless seventh
nerve damage has occurred.
A good reminder of this observation
is drooling that frequently occurs
when a patient with an inferior nerve
block attempts to drink.

Clinical significance of facial muscles:


Muscles of face do not insert into the bone and
need support from the teeth for proper support.
If these muscles are not properly supported,
either by natural substitute or by artificial teeth,
none of facial expressions appears normal.

Lack of support allows sagging of muscles,


stretching inhibits normal contraction of these
muscles.

They depend on the vertical dimension of the


face, as determined by the occlusion of teeth in
order that they may be neither stretched nor
permitted to sag.
These factors affect the function, appearance of
complete denture prosthesis, also to comfort of

Forces exerted by these muscles against


labial,buccal surfaces, and peripheral borders of
dentures will obviously affect their dentures.
Interplay of forces between tongue and cheek in
placing and maintaining food on occlusal surfaces
of teeth, that teeth should be placed in ideal
position in neutral zone.

The memory pattern of facial expression


developed within neuromuscular system
when patient had natural teeth is continued
or reinforced, when all these muscles are
correctly supported by the complete
dentures.

Summary: The normal facial expression ,


and proper tone of the skin of the face
depend on the position and function of the
facial muscles.
These muscles can function physiologically
only when the dentist has positioned and
shaped the dental arches correctly and has
given the mandible a favorable vertical
position.
In addition dentures themselves must have
a pleasing and natural appearance in
patients mouth, A condition that is
dependent on arranging the artificial teeth
in a plan that simulates the nature.

Paralysis of buccinator and orbicularis oris


accumulates the food in oral vestibule
during chewing, and requires continuous
removal of food with help of finger. Saliva
dribble out through lips and patient will have
a sad look when face is relaxed.

ial expressions and concerned muscles:


Expression

Changes in skin of face

Muscles involved

Surprise

-Transverse wrinkles of forehead


-Transverse wrinkles at bridge of nose

-Frontalis
-Procerus

Frowning

-Vertical wrinkles of fore head

-Corrugator Supercilii

Anger

-dilatation of anterior nasal aperture


-Depression of lower part of nasal
septum.

-Dilator naris
-Depressor Septii

Laughing, Smiling

-Angle of mouth is drawn upwards


and laterally.

Zygomaticus major

Sadness

Angle of the mouth drawn


downwards and laterally

Depressor angulii Oris

Sorrow and grief

Accentuation of Nasiolabial furrow


with elevation and eversion of upper
lip

-Levator Labii Superioris


-Levator Anguli Oris

Grinning

Retraction of angle of mouth

Risorius

Disdain/Doubt

Puckering of skin over chin with


protrusion of lower lip

Mentalis

Whistling

Pressing the cheek against gum with


pursing of mouth with small opening

Buccinator

Summary
All the muscles of facial expression
are developed from single bronchial
arch, thus they share single nerve
and blood supply.
Each muscle has got its own
importance.
Knowing the prosthodontic
significance of these muscles help us
in daily practice.

Bibliography:
B.D. Chaurasias human anatomy 3rd
edition.
Essentials of complete denture
Prosthodontics Sheldon Winkler ,Second
Edition.
Complete denture Prosthodontics, John .J.
sharry, third edition.
Text book of complete denture, Rahn, fifth
Edition.
Prosthodontic treatment for edentulous
patient, Zarb-Bolender, 12th Edition.