Welcome to this tutorial on the Neural

Control of Facial Expressions. I've got two learning objectives for you
in this tutorial. I want you to be able to discuss the
control of facial expression by upper motor neurons in the cerebral cortex.
And then I want you to use that knowledge to predict patterns of facial weakness
that might follow lesions of the cerebral cortex, the internal capsule or the
facial
nerve itself. So, in order to begin this tutorial, I
want to introduce a relatively common clinical phenomenon.
And that is, that a lesion involving the distribution of the middle cerebral
artery, such as a stroke or hemorrhage, often results in contralateral facial
weakness. But that weakness is typically limited to
just the lower part of the face. So the question is why is this weakness
restricted in this way to just lower part of the facial muscles?
And in order to explain this phenomenon, we need to learn something about how the
muscles of facial expression are governed by different neurons in this cerebral
cortex. So, before we get there, lets just remind
ourselves that some the more peripheral components of this.
So let's consider a couple of study questions.
First of all, what cranial nerve innervates the muscles of facial
expression? So think for just a moment and record your
responses. Secondly, where would you find the
relevant motor nucleus? Now, if you checked your references or
hopefully you knew from your studies earlier, that the facial motor nucleus is
both responsible for supplying muscles of facial expression via craneal nerve
seven.
Then you got the answer to the first one. But now, what I want you to reinforce is
where in the brain would you find that facial motor nucleus?
Is it in the thalamus, the midbrain, the pons or the medula oblongata?
Now that we know that the facial motor nucleus is found in the pons, let's
actually go find it in our Digital Atlas to the brain stem in Sylvius 4.
So I've just opened our launcher window in Sylvius 4, and, I will select from
brainstem cross-sectional Atlas all structures and this will open up.
A collection of sections that are fully segmented and annotated that will allow us
to find the facial motor nucleus. So, now that you know where to look, it
shouldn't be too difficult to actually find it.
So first, let's select a section through the pons and I can do that simply by
pulling down this slider in our navigational window to the left to about
the region of the middle of the pons. And so, now, we have a section that is
present and I'll make it just a little bit larger for us.
And as we mouse over structures, we see that the structures light up as do labels.
And I want to draw your attention to this central region of the brainstem.
This is what we refer to as the tegmentum, it's the part of the brain stem between
the ventricular system up above, and the specialized white matter and gray matter
structures that we find down below in various divisions of the brainstem.
So that tegmentum is the core, that's where we find our cranial nerve nuclei.
That's the part of the brain stem that's most like the spinal cord, where we have
nuclei for sensation and for motor control.
Now, the facial nucleus, it's one of the motor nuclei that innervate muscles that
have a particular embryological derivation.
They come from the pharyngeal arches and that's significant, because this tells us
where to look for the nucleus that grew out the axons that supply those muscles.
And in this case, we're concerned with the muscles of facial expression, cranial
nerve VII, the facial nerve, and the facial motor nucleus.
Now, these neurons in embryological development migrate to a somewhat lateral
and intermediate position in the tegmentum of the brainstem.
And for the facial motor nucleus, we find it right here.
So, now in yellow, we have our facial motor nucleus.
Now, one might think that these axons would simply take a straight shot out and
exit the ventrolateral aspect of the junction between the pons and the medulla.
But in fact, the course of these axons reflects this embryological migration of
the motor neurons that I just mentioned. So this nucleus migrated from a more
dorsal position, and as the neurons moved, they elongated their axons.
So the axons from the facial motor nucleus actually wrap around and form this band
of
nerve root that wraps around the abducens nucleus.
So, the abducens nucleus makes a bit of a protrusion at the base of the fourth
ventricle and on top of that nucleus are these axons of the facial nerve that form
a little bit of a hill on top of that protrusion.
So, we call this the facial colliculus. If we're looking down at the floor of the
ventricle, we'd see these two little humps here and that reflects the course of the
facial nerve. And then from here, the facial nerve
projects towards this angle here between the pons, the medulla just below, and
then, the cerebellum out to the lateral aspect.
So there is the facial motor nucleus. This is the structure that is in question
in this tutorial. So let's continue on now and talk more
about the way that upper motor neurons provide input to this structure.
Okay. Well I'm going to introduce the brain to
you again using this brain model. And, I want to draw your attention to that
part of the motor cortex that is involved in governing the facial expression.
So what we're looking at here is the lateral surface, the right hemisphere of
course, and all of these red lines are meant to illustrate blood vessels that
supply this surface of the brain. In fact, these would all be branches of
the middle cerebral artery. Now, the motor cortex is found in the
banks of the precentral gyrus, which is located right here.
Of course, the central sulcus, being this space just posterior to that precentral
gyrus, which runs all the way from the longitudinal fissure in the dorsal midline
to the lateral fissure here between the frontal parietal and temporal lobes.
Now, if you viewed my tutorial where I put my fingers on an actual human brain, you
get the idea that the central sulcus is found roughly near the middle of the
hemisphere. And as I'm putting my fingers down over
the central sulcus, now, my middle finger would be representing the precentral
gyrus
and my index finger representing the postcentral gyrus with the space between
my fingers representing the central sulcus.
So that part of the motor cortex that governs our voluntary control of the
facial muscles is found out here where my fingertip is located in the inferior
segment of the lateral precentral gyrus. So about the fingertip region of my middle
finger is where we would find this relative part of the neural cortex.
So, here we are, the inferior segment of the precentral gyrus.
This is governing the movements of the contralateral face.
Now, I need to be more specific than that in order to answer this clinical
conundrum. What was discovered in recent years, is
that these upper motor neurons that are otherwise representing the face are
actually governing the movements of just the lower part of the contralateral face.
So as, as illustrated in this brain model, this is the region of cortex, that when
damaged by that middle cerebral artery infarction is responsible for the weakness
of the contralateral lower face. Now, what about the cortical
representation of the upper part of the face?
Well, we used to think that it was represented likewise here in the lateral
part of the precentral gyrus. We now know from studies done in non-human
primates, that the control of the upper part of the face seems to be governed by a
region along the mid-sagittal surface of the brain.
So as I take this brain model apart, show you the medial face of the right
hemisphere. I'll draw your attention to a region in
the banks of the cingulate sulcus that's found right about here just in front of
our paracentral lobule. So in the banks of this cingulate sulcus
is a division of the medial premotor cortex, that we call the cingulate motor
area. And it's this part of the premotor cortex
that governs the movements of the upper part of the face.
Now, one explanation to this clinical conundrum is that the upper part of the
face is spared, simply because, the medial face of the hemisphere is not supplied
by
the middle cerebral artery at all, it's supplied by the anterior cerebral artery.
But there's another anatomical fact that also works in favor of preservation of the
upper part of the face and that is that the cingulate motor area found here,
innervates the facial motor nucleus on both sides of the midline of the pons.
So there's bilateral innervation from upper motor neurons here down to the
relevant cranial nerve nuclei, the facial motor nucleus, in this case.
So let's look at a figure from our text, from the box found in Chapter 17 of
Neuroscience, Fifth edition box a. So this figure provides in schematic form
what we've been talking about. So I'll first draw your attention to the
representation of the face and the, in this case, the right primary motor cortex.
So, we find upper motor neurons that send their axons to the white matter of the
hemisphere through the internal capsule between the thalamus and the basal ganglia
into the brainstem through the cerebral peduncle.
And into the pons and as these axions enter the pons, they cross the midline and
synapse preferentially on those lower motor neurons that govern the lower part
of the face as is illustrated here in this middle picture.
So, this explains the contralateral bias in the governance of these motor neurons
that integrate the lower face. Now, I'll draw your attention next to the
cingulate motor regions, which are found here along the midline of the hemisphere
in the banks of the cingulate sulcus. These neurons project down to the more
dorsal columns of motor neurons in the facial motor nucleus that innervate the
upper part of the face. And the additional anatomical fact is
depicted here in this figure. And that is, that the facial neurons that
govern the upper face receivebilateral input from the cingulate motor regions in
each hemisphere. So, this, together, with the differential
distribution of these upper motor neurons explains why the upper part of the face
is
spared with the middle cerebral artery infarction.
In fact, it's quite difficult to have a lesion in the brain that produces motor
weakness in the upper part of the face, because of this bilateral pattern of
innervation. So even a unilateral stroke involving the
interior cerebral artery is likely to have spared motor control for the upper face.
Now, also shown in this figure, just for completion is what would happen with
lesions that are deeper and more peripheral than a stroke involving the
cortex. So notice, for example, the region
illustrated by this letter B. This would be a stroke involving the white
matter of the internal capsule and such a stroke would affect the input from the
precentral gyrus to the contralateral facial motor nucleus replicating the
impact of the stroke that one would see with a middle cerebral artery infarction
out here to the cortex. There would be sparing of the upper motor
neurons because of the bilateral innervation coming from the cingulate
motor area. If one had a lesion to the facial nerve
itself or a pathological process, such as what happens in Bell's palsy, one would
expect a distribution of weakness that would cover both the upper and the lower
regions of the face. So in a clinical practice during a
neurological exam, it's always important to test motor function in, individually
for the lower part of the face and the upper part of the face.
And this can be done by asking a patient to show their teeth, to check the lower
muscle tone, and to have them raise their eyebrows often against a little bit of
manual resistance. So that the clinician can feel and see the
strength of the muscles that are governing the upper part of the face.
Now, there's some consequence for this anatomy, with respect to how we understand
the facial expressions that are so important to us as people.
We read so much into the human face. We can interpret intention.
We can appreciate emotion as we observe the movement of the facial muscles.
And if you're like me things get a little bit strange when you're sitting in front
of a camera as I am now. Especially, if I'm in a portrait studio
getting my picture taken by a photographer.
We're often asked to smile in those circumstances.
And somehow the smile typically is just not so authentic, is it?
At least for myself, I have a terrible time in that circumstance trying to
produce what looks like a compelling smile.
What ends up is what looks like a fake smile or a contrived smile.
And that's because that forced smile is really a product of our primary motor
cortex out here in the precentral gyrus. The precentral gyrus is ultimately the
motivator of volitional action. So that forced smile, it's really not
reflecting genuine emotion. Often, it's something that we're trying to
contrive for the moment. Now, should we express an actual emotion,
hopefully, it's much more authentic, communicates in a compelling way what's
really going on in our internal state. That kind of smile is what we really want
to capture in our photographs. That's the smile that's motivated by the
cingulate motor area. So if you run across a photograph of a
individual in a magazine or perhaps in your own photo album.
You can tell very readily whether the smile is an authentic smile reflecting
emotion or whether it's what's sometimes called the pyramidal smile which arises
from force of will from the premotor cortex conveyed on.
The pathway parallel to the pyramidal fibers ultimately control the movements
that are expressed via our spinal cord. So, next time you see a persons face,
think about these differential regions of the lateral precentral gyrus and the more
immediate cingulate motor area is they govern the integrated expression of
emotion and other behaviors that we express with our face.
Now, there are some important consequences for understanding the way these upper
motor neurons govern the facial motor nucleus.
There are folks that have strokes involving various pathways in the brain,
of course, and some of them are known to affect either the voluntary expression of
movement involving the face or the emotional expression of movement involving
the face. So, this schematic figure just illustrates
what we've been talking about. There are parallel pathways coming from
motor control centers in the brain that converge upon the facial motor nucleus and
it's neurons that ultimately activate the muscles of facial expression.
We've described those neurons in the precentral gyrus that are associated with
voluntary control over the facial motor nucleus.
And if one should have a stroke involving those upper neurons or the pathway by
which those neurons innervate the contralateral pons.
One can have a condition known as voluntary facial paresis in which is there
is weakness when you ask a patient to execute a voluntary movement involving the
parietal muscles such as showing their teeth.
They may only do so on one side of the face, but if you can get that person to
smile with the authentic smile of emotion, you may find a much more symmetrical
response. And that's because the neural systems
associated with this cingulate motor areas and their bilateral projections to the
pons remain intact. Now, a much more rare condition can be
found for individuals that have some damage.
Often requiring some bilateral injury to the cingulate motor area or their pathways
that connect that part of the brain down to the pons.
So, damage to those pathways would produce the complementary deficit, something
that
we call emotional facial paresis. These would be an individual that, when
told an amusing story, might only express emotion on one side of the face.
However, if you ask those people to raise their eyebrows or show their teeth, they
might do so symmetrically, because the pyramidal pathways from the lateral
precentral gyrus are intact. Okay.
There's one more point to consider before we conclude this tutorial and that has to
do with other cranial motor nuclei that you may be wondering about.
So, what are the cranial motor nuclei that have a significant contralateral bias in
the way upper motor nuerons integrate them.
And I'll give you a principal that will help you understand this.
Essentially, whatever we can do with our cranial muscles that, that are lateralized
that implies a contralateral bias and the way upper motor neurons project to the
relevant lower motor neurons. So some of us can wink with just one eye
or not the other, some of you are able raise just one eyebrow, I can't really do
that really well. I can only control my frontalis muscle,
evidently through some symmetrical input. But if you could only raise one eyebrow,
that would suggest that there is a contralateral bias to the innervation of
those muscles. Okay, so some of you can raise an eyebrow.
Most of us can wink one eye or the other. We can often chew just on one side of our
mouths, can we not? Imagine biting down on a hard nut?
That's a lateralized activity. And finally, we can protrude our tongue
just to one side of our mouth or the other.
This is often something that's done in assessing the integrity of upper motor
neuron pathways to the nucleus that controls the tongue.
We might ask a patient to stick their tongue into just one cheek, something like
that. And you can often put your hand on your
cheek and feel the force of that protrusion.
So these are all examples of lateralized motor functions that we can do with
cranial muscles. And the relevant nuclei then, would be the
trigeminal motor nucleus that allows us to chew just on one side of the mouth, the
facial motor nucleus, as we've been talking about in this tutorial, and the
spinal accessory nucleus. Now, this is the nucleus in the upper part
of the cervical cord that allows us to shrug our shoulders, which we usually do
symmetrically. But of course, it is possible to
fractionate that movement just to one side of the midline or the other.
And then, lastly, the hypoglossal nucleus. Taking them in numerical order, this is
the cranial nerve, nerve XII, that allows us to protrude our tongue.
So these four nuclei are the cranial nerve nuclei that likely have a contralateral
bias in the way upper motor neurons project down to the relevant lower motor
neurons. The other motor nuclei are organized in a
much more symmetrical bilateral fashion. For example, we don't cry out of one eye.
We don't secrete saliva just from one gland by force of will.
So there is coordination across the mid line, either at the level of the cortex
and/or at the level of the brain stem itself.
Well, I hope you've enjoyed this discussion of facial expression.
We'll have much more to say about facial expressions when we talk about emotions
later on in the course. But, for now, I hope this has helped you
understand the way upper motor neurons in the cerebral cortex govern the lower
motor
neurons that are found in the brainstem.