GUIDED BY: DR.

VIRAJ PATIL PRESENTED BY: EKTHA PAI T

PROFESSOR I MDS

DEPARTMENT OF PROSTHODONTICS ,CROWN AND BRIDGE AND

IMPLANTOLOGY
 Introduction
 Development
 Features of facial muscles
 Classification
 The importance of facial expression is often far more of a key to
the individual than spoken words.

 Preservation of these expressions is necessarily the responsibility

of the dentist charged with the prosthodontic treatment of the
patient.

 It is culminated by recognizing that any true concept of

aesthetics must be based on an understanding of the related
functional anatomy if the prosthesis is to become a harmonious
part of it.
 Definition: The facial muscles are a group of striated skeletal
muscles supplied by the facial nerve (VII) that control facial
expressions.

 Also known as mimetic muscles.

 Develops from the mesoderm of the 2nd branchial arch.

 3rd to 8th week of intrauterine life.

 Supplied by facial nerve.

 Most muscles originate from bone or fascia.

 Insert into the skin hence asserting direct actions on the skin

producing facial expressions.

 Morphologically they represent best remnants of “panniculus

carnosus”.
 Muscles of scalp
1. Occipitofrontalis
 Muscles of eye
1. Orbicularis oculi
2. Corrugator supercilli
3. Levator palpebrae superioris
 Muscles of nose
1. Procerus
2. Compressor naris
3. Dilator naris
4. Depressor septi
 Muscles of auricle (vestigeal)
1. Auricularis anterior
2. Auricularis posterior
3. Auricularis superior
 Muscles around the mouth
1. Orbicularis oris
2. Levator labii superioris alaequae nasi
3. Levator labii superioris
4. Levator anguli oris
5. Zygomaticus major
6. Zygomaticus minor
7. Depressor anguli oris
8. Depressor labii inferioris
9. Mentalis
10. Risorus
11. Buccinator
 Muscles of the neck
1. Platysma
 2 Bellies– occipital and frontal

 Origin:
1. Occipital belly- lateral 2/3rd of highest nuchal line and mastoid
process of temporal bone.

2. Frontal belly- no bony attachment

 Insertion : Galea aponeurotica/ Epicranial aponeurosis

 Vascular supply: ophthalmic, superficial temporal , posterior

auricular and occipital arteries.

 Innervation:
 1) Frontal- temporal branch of VII

 2) Occipital- posterior auricular branch of VII

 Action:
 3 Parts- orbital , palpebral and lacrimal

1) ORBITAL PART-

 Origin: Nasal part of frontal bone, frontal process of maxilla,

medial palpebral ligament between them.

 Insertion: Concentric rings return to the point of origin.

 Action: Close lids tightly, wrinkling, protects eye from bright

light.
2) PALPEBRAL PART:

 Origin: lateral part of medial palpebral ligament.

 Insertion: lateral palpebral raphae

 Action: Closes lids gently during blinking and sleeping.

3)LACRIMAL PART:

 Origin: Lacrimal fascia and posterior lacrimal crest, forms

sheath for lacrimal sac.

 Insertion: Passes laterally in front of tarsal plates of eyelids to

the lateral palpebral raphae.

 Actions: Dilates the lacrimal sac for sucking of lacrimal fluid

into the sac, directs lacrimal puncta into lacus lacrimalis;
supports the lower eyelid.

 Nerve supply : temporal and zygomatic branch of VII

 Small pyramid muscle.

 Origin : Medial end of supercilliary arch.

 Insertion: Skin of mid eyebrow.

 Action:

 1) Vertical lines in forehead as in frowning

 2) Moves eyebrow medially and protects from sunlight.

 Nerve supply: Temporal branch of VII.

 A small pyramid muscle.

 Origin: Nasal bone and upper part of lateral nasal cartilage.

 Insertion: Skin of the forehead between the eyebrows and on the

bridge of the nose.

 Actions:

 Causes transverse wrinkles on the bridge of the nose.

 Frowning and concentration.

 Reduces glare of bright light

 Nerve supply: Temporal and zygomatic branch of VII.

 Origin: Maxilla just lateral to the nose.

 Insertion: Aponeurosis across the dorsum of the nose.

 Action: Nasal apperture compressed.

 Nerve supply : Buccal and zygomatic branch of VII.

 Origin: Maxilla over the lateral incisor.

 Insertion: Alar cartilage of the nose.

 Action: Nasal apperture dilated (anger)

 Nerve supply: Buccal and zygomatic branch of VII

 Origin: Maxilla over the central incisor.

 Insertion: Lower mobile part of the nasal septi.

 Action: Nose pulled inferiorly.

 Nerve supply: Buccal and zygomatic branch of VII.

 Include the orbicularis oris and buccinator muscles and a group

of lower and upper oral muscles that move the lips and cheek.

 Many of these muscles intersect just lateral to the corner of the

mouth on each side at a structure termed the modiolus.

 Muscles that encircle the mouth.

 Origin-

 Superior midline of maxilla

 Inferior midline of mandible

 Buccinator and muscles acting on the lip.

 Insertion- Into lips and angle of the mouth.

 Action - Closing and pursing of the mouth (whistling)

 Nerve supply- Lower buccal and mandibular marginal branches

of the facial nerve.

ACCESSORY MUSCLES OF ORBICULARIS ORIS:

1. Incisive labii superioris

2. Incisive labii inferioris

 Thin quadrilateral muscle between the maxilla and the
mandible.
 Origin-
 Posterior part of maxilla and mandible opposite molar teeth.
 Middle fibres from pterygomandibular raphe
 Insertion-
 Lips, blending with fibres from orbicularis oris.
 Its fibres converge towards the modiolus near the angle of the
mouth.
 Fibres:
 Highest fibres- Maxillary fibres
 Central fibres- Pterygomandibular fibres
 Lowest fibres- Mandibular fibres
 Central fibres of the buccinator cross so that lower fibres
enter the upper lip and the upper fibres enter the lower
lip.

 The highest and lowest fibres of the buccinator do not

cross and enter the upper and lower lips, respectively.
 Actions-

 Flattens the cheek against gums and teeth

 Prevents accumulation of food in the vestibule

 Puffing of mouth

 Forceful expulsion of air from the cheeks (whistling)

 Nerve supply- lower buccal branch of VII

The muscles of the lower group consists of the:

1. Depressor anguli oris

2. Depressor labii inferioris

3. Mentalis
 Quadrilateral muscle

 Origin- Oblique line of the mandible between the symphysis

menti and mental foramen

 Insertion- Medially into skin and mucosa of the lower lip

 Actions-

 Depresses the lower lip laterally in mastication

 contributes to the expression of irony, sorrow, melancholy

and doubt

 Nerve supply- Mandibular branch of VII

 Origin- Mental tubercle and oblique line of mandible
inferiolateral to depressor labii inferioris

 Insertion- Into modiolus

 Action-

 Depress angle of the mouth

 Lateral opening of the mouth

 Sadness

 Nerve supply- Mandibular branches of the facial nerve

 Origin- incisive fossa of mandible

 Insertion- into skin of the chin.

 Actions-

 Raises lower lip, mental tissues, mentolabial sulcus, base of

lower lip

 Helps in protruding and everting lower lip during drinking

 Wrinkles the skin of the chin (doubt or disdain)

 Nerve supply- mandibular branch of VII

The muscles of the upper group of oral muscles consists of:

1. Risorus

2. Zygomaticus major

3. Zygomaticus minor

4. Levator labii superioris

5. Levator labii superioris alaeque nasi

6. Levator anguli oris

 Origin- Masseteric fascia

 Insertion- Modiolus

 Action- Grinning

 Nerve supply- Buccal branch of VII

 Origin- From the posterior aspect of lateral surface of zygomatic

bone.

 Insertion- Skin at the angle of the mouth.

 Action- Retracts and elevate the angle of the mouth upwards and

laterally as in smiling.

 Nerve supply- Buccal branch of VII

 Origin- From lateral surface of the zygomatic bone immediately

behind zygomaticomaxillary suture

 Insertion- Descends medially and inserted in upper lip

 Action-

 Elevates upper lip

 Curl upper lip in smiling

 Nerve supply- Buccal branch of facial nerve

 Origin- canine fossa
 Insertion – into modiolus lateral to the angle
of the mandible
 Actions- raises the angle of mouth
-deepen the furrow between the nose
and the corner of the mouth during sadness
 Nerve supply- Buccal branch of facial nerve.
 Origin- Upper part of frontal process of
maxilla
 Insertion- medial slip in greater alar cartilage
of nose &skin
- lateral slip blends with levator labii
superioris & orbicularis oculi
 Action- medial slip dilates the nostrils
- lateral slip raises and everts the
upper lip
- increases curvature of nasolabial
sulcus
 Nerve supply- Buccal branch of facial nerve.
 Origin- from maxilla & zygomatic bone above
infraorbital foramen.
 Insertion- into upper lip b/w levator labii
superioris alaquae nasi & zygomaticus minor.
 Action- raises & everts upper lip.
- modifies nasolabial furrow & deepens
expression of sadness and seriousness.
 Nerve supply – buccal branch of facial nerve.
 They are vestigial muscles.
 Three types- anterior, superior and posterior
auricular muscles.
 The anterior muscle is anterolateral and pulls
the ear upward and forward.
 The superior muscle elevates the ear.
 The posterior muscles retracts and elevates
the ear.
 Origin- upper part of the pectoral and
deltoid fasciae
 Insertion- lower border of body of mandible.
- lateral half of lower lip
- modiolus
 Actions – 1) depresses mandible
2) pulls the angle of the mouth
downwards as in horror or surprise.
 Nerve supply- cervical branch of VII
A point at the corner of the mouth where 8
muscles meet.
 Muscles attached to modiolus:
1. Zygomaticus
2. Levator labii superioris
3. Levator anguli oris
4. Orbicularis oris
5. Depressor anguli oris
6. Depressor labii inferioris
7. Buccinator
8. risorius
 Modiolus- “ hub of wheel” in latin.
 Location- corner of the mouth.
 Action- unseats the lower denture and
sometimes upper denture too. This may
occur when the arch form is too wide and
restricts the movement of the modiolus.
 Contraction of the muscle press the corner of
the mouth against premolars so that the
occlusal table is closed in front. The food
crushed by the premolars and molars does
not escape at the corners of the mouth
unless VII nerve is damaged as in Bell’s Palsy.
 Lower denture should be made narrow in
premolar region so that pressure from the
modiolus can be taken by upper denture
which due to its greater retention and
resistance to lateral movements is able to
withstand it.
 Muscles form a V-shaped strap that press
against the bicuspid region.
 Denture will be unstable when bicuspid
region is too wide.
 Provides support and mobility to the cheek.
 Pulls corner of the mouth laterally and
posteriorly.
 Participates in deglutition. Middle fibres are
most active and their function is to control
food bolus during mastication.
 Accessory muscle of mastication.
 Size of buccal vestibule varies with
contraction of buccinator.
 Its action does not directly dislodge the
denture because muscle fibres contract in a
line parallel to the plane of occlusion.
 It determines the vertical height of the
distobuccal flange of maxillary denture.
 Buccal vestibule width and length are mainly
dependent on buccal shelf and buccinator.
 The action of masseter on buccinator while
making impression helps to record the
masseteric notch on the distobuccal area of
mandibular impressions.
 One of the limiting factor of distal extension
of mandibular impression is buccinator
muscle which crosses from the buccal to the
palatal as it attaches to the
pterygomandibular raphe.
 If the impression is extended on to the
ramus, the buccinator muscle would be
impinged between the hard denture borders
& sharp internal ridge.
 It would cause soreness and also limit the
fuction of the buccinator muscle.
 Anterior sphincter of oral cavity. Forms bulk
of the lips.
 Rests on labial flange and teeth of the
denture.
 Careful border molding required because it is
easy to overextend the impression as muscle
runs horizontally.
 Superior border of lower lip- supported by
incisal 3rd of maxillary anterior teeth.
 Loss of teeth- loss of function of orbicularis
oris- unsupported muscles do not produce
normal facial expressions.
 During contraction there is considerable
pressure on the labial surface of the teeth.
 Thus in poorly formed alveolar ridges the
lower denture is likely to be raised from the
ridge in front and pushed backwards.
 These forces can be counteracted by forward
pressure from the tongue or by carrying the
heels of lower denture up the ascending
rami.
 Itis an active vertical muscle so careful
border molding is required.
 The bottom of the sulcus is lifted when the
mentalis muscle contracts and the depth of
the vestibule is reduced.
 Excessive activity results in short flange
which may not provide seal for the denture.
 Originates near to the crest of the ridge and
extends down and below the alveololabial
sulcus.
 Its contraction can reduce the denture
space.
 Presence beneath the mucous membrane
might present problems associated with
flange extension and denture retention.
 The caninus/ levator anguli oris muscle attaches
beneath the maxillary buccal frenum &
triangular / depressor anguli oris attaches
beneath the mandibular buccal frenum.
 The border of the impression should be
functionally molded to fit the depth & width of
the frenum when it is in function.
 Orbicularis oris pulls the buccal frenum forward
& buccinator pulls it backward.
 Inadequate provision for the flange distal to the
buccal notch causes dislodgement of the denture
when patient smiles.
 Lip movements are controlled by the muscular
activity affecting the corners of the mouth.
 The five types of movements which occur in the
lip area are- elevation, depression, retraction,
compression and protrusion.
 With the elevation of the upper lips and the
retraction of the corners of the mouth, the lips
are drawn against the teeth.
 Excessive labial placement of teeth orbicularis
oris stretched modioli pulled anteriorly
stretching effect on lips dislodgeing forces on
maxillary denture.
 Ifthere is lack of maxillary lip support and
teeth are set on the crest of the alveolar
ridge, there is a downward cast to the smile
which is similar to expressions of grief.
 Increase or decrease in vertical dimension of
occlusion can also cause strained
maxillomandibular relationships which result
in damaging effects on residual ridges and
distortion of facial features.
 GPT 8 DEFINITION: “The potential space between
the lips and the cheeks on one side and the
tongue on the other; that area or position where
the forces between the tongue and cheeks or
lips are equal.”
 In this area, during function, the forces of the
tongue pressing outward are neutralized by the
forces of the cheeks and lips pressing inwards.
 Since these forces are developed through
muscular contractions during different functions
of the mouth they vary in magnitude and
direction in different individuals and different
periods of life.
A soft material that can be molded by the
action of the tongue, cheek, and lips is used
to establish the neutral zone.
 Ensure the patient is sitting upright with the
head supported. This allows the actions of
swallowing and speaking to be more natural.
 Insert the upper wax try in denture ensuring
that the upper lip is supported, the incisal
and occlusal planes are correct and the
functional width of the sulcus is restored.
 Reinsert the base plate and modify the
occlusal stops so that the correct VD-O is
achieved.
 With the base plate out of the mouth place
the correct volume of a high viscosity mix of
tissue conditioner an the superstructure.
 Manipulate this to form an approximate rim
and insert the plate into the mouth. The
volume should be controlled so that the sulci
are not distorted.
 Instruct the patient to perform repeated actions:
1. Swallow
2. Take frequent sips of water.
3. Talk out loud
4. Pronounce the vowels and count 60-70
5. Smile (zygomaticus)
6. Grin(risorius)
7. Wet their lips
8. Purse their lips (triangularis/orbicularis oris)
 These actions will mould the material by
muscle activity.
 After 10 mins, when the impression has set,
remove the plate and proceed to the
laboratory stage.
 Bell’s
palsy
 Myasthenia gravis
 Congenital syndrome-
 Moebius syndrome
 Melkersson Rosenthal Syndrome
 Defined as an idiopathic paresis or paralysis
of facial nerve of sudden onset.
 It is a common, acute, benign neurological
disorder, characterized by sudden, isolated
peripheral facial nerve paralysis.
 Lower motor neuron disorder.
 Various and unknown etiology.
 Infections, vascular conditions, nerve
entrapment & viral etiology are common.
 Facial weakness.
 Inability to whistle, smile or grimace.
 Hyperacusis
 Loss of taste in the anterior 2/3rd of the tongue
due to involvement of chorda tympani.
 Pain near the mastoid area.
 Difficulty with articulation.
 Food accumulation in the labial & buccal
vestibule.
 Consequently the lower denture is constantly
dislodged towards the paralysed side and rotates
medially during any activity involving the lips.
 Face drawn to the normal side.
 Facial creases, nasolabial fold- disappear.
 Forehead unfurrows and corner of the mouth
droops.
 Eyelids will not close, lower lid sag.
 Tear production decreases, but appears to
tear excessively as loss of eyelid control.
 Positive Hitselberger sign
 Positive Bell’s sign
 Symptomatic:
 Lubricating eye drops
 Massage the affected muscles
 Medication:
 Prednisone 60-80mg/day in 4 divided doses for 5
days, then taper over 5-7 days.
 Acyclovir if the etiology is viral.
 Autoimmune disease
 Auto antibodies to acetylecholine receptors
are seen.
 Profound weakness of the muscles.
 Diplopia, ptosis, drooping of the corners of
the mouth.
 Sorrowful appearance.
 Difficulty in mastication, deglutition, speech
and protrusive movements of the tongue.
 Multiple short early morning appointments must
be scheduled.
 This allowes the better dental care to be
undertaken with the advantage of greater
muscular strength typically noted during morning
hours.
 Difficulty in lying way back in the dental chair-
upright position must be governed to avoid
closing the throat or regurgitating fluids.
 Implant supported prostheses may be preferable
over tissue supported prosthesis. This is due to
the fact that higher bite forces are generated
with the former.
 Extremely rare congenital neurological
disorder.
 Characterized by facial paralysis and inability
to move the eyes from side to side.
 Usually born with complete facial paralysis
and cannot close their eyes or form facial
expressions.

 Upper lip retracted due to muscle shrinkage.

 Delayed speech in affected children due to
paralysis of the muscles that move the lips,
soft palate and tongue.
 Microglossia, which occurs in 75% of patients,
as well as tongue weakness or fissured
tongue.
 Swallowing and sucking problems.
 Drooling
 Hypoplastic upper lip.
 Cleft or gothic palate with bifid uvula
 Open bite
 Challenges:
 Small mouth opening
 Speech difficulties
 Compromised neuromuscular controls
 Important deviation from the normal
denture- removal of the facial flange of the
maxillary denture to provide lip competence.
 Teeth arrangement is done in an edge-to-
edge position to allow the lips to be
adequately sealed.
 Rare neurological disorder.
 Characterized by triad of recurring facial
paralysis, recurrent orofacial non-pitting
oedema and fissured toungue.
 Also known as orofacial granulomatosis.
 Face as a whole is an index of the mind, and
the facial muscles are the messenger of
emotions.
 An understanding of the muscles of facial
expression is important for a successful
complete denture construction.
 Success of a prosthodontic treatment is in
direct proportion to the dentist’s knowledge
of functioning anatomy and his application of
this knowledge in construction of prosthesis.
 B.D Chaurasia, Volume 3
 Complete denture prosthodontics- Boucher
 Arthur 0. Rahn , Charles M. Heartwell,
JR,Textbook of complete dentures
 Impressions for complete denture by Bernard
levin