MUSCLES OF FACIAL

EXPRESSION

PRESENTED BY : Dr. TV NAGA SAI SUMA

1st M.D.S STUDENT
DEPT. OF PAEDODONTICS & PREVENTIVE DENTISTRY
 CONTENTS
1. Introduction
2. Embryology
3. Classification of facial muscles
4. Nerve supply of the face
5. Clinical anatomy
6. Clinical Considerations
7. Bell’s Palsy in Children-A Pedodontist’s Perspective
8. Impact of dental implants on facial expression- A brief note
9. Conclusion
10. References
 Introduction:

• The Facial muscles are a group of

subcutaneous muscles innervated by
the facial nerve that bring about facial
expression.
• All the muscles of facial expression
are not attached to any bone but are
inserted to the skin.
• They also act as sphincters and
dilators of the orifices of the face
• Facial muscles develop from second
pharyngeal arch.
 Embryology:

■ Embryologically, all the muscles of facial expression develop from the mesoderm of
the second branchial arch, hence innervated by facial nerve.
 Classification:

1. Morphologically.
2. Topographically.
3. Functionally.
 Morphological classification:

• Morphologically they represents the remnants of ‘panniculus carnosus’ which is a

continuous subcutaneous muscle sheet seen in some animals & all of which are inserted
into the skin.
 Topographic classification:
6 GROUPS :

1. MUSCLES OF SCALP/ EPICRANIAL GROUP: occipitofrontalis

2. MUSCLES OF AURICLE:
-Auricularis superior - Auricularis posterior - Auricularis anterior (these are vestigial
muscles)

3.MUSCLES OF EYELID:

-orbicularis oculi - levator palpebrae superioris -corrugator spercilii

4. MUSCLES OF NOSE:

- Procerus - Compressor naris - Dilator naris - Depressor septi alequae nasi

5. MUSCLES ARROUND THE MOUTH:
- Orbicularis oris - Mentalis
- buccinator - Risorius.
- Levator labii superioris alaeque nasi
- Zygomaticus major
- Levator labii superioris
- Levator anguli oris
- Zygomaticus minor
- Depressor anguli oris
- Depressor labii inferioris
6. MUSCLES OF NECK – platysma.
 Click icon to add picture
Muscles of scalp:

Occipitofrontalis.
-Frontal Belly: From ant. Part of Galea
aponeurotica to Skin on lower part of
forehead. Wrinkles forehead; Raises
eyebrows

-Occipital belly: From lateral 2/3rd of

Superior nuchal line inserted into epi
cranial aponeurosis. Draws scalp
backward.
OCCIPITOFRONTALIS
FRONTALIS :
OCCIPITALIS:
 Muscles of Eyelid:
1. Corrugator supercilli:

• From medial end of Supra orbital

ridge into the skin of mid-Eyebrow.
Pierced by supra orbital & supra
trochlear nerves.
CORRUGATOR SUPERCILLI
• Contraction of this muscle causes
vertical grooves or furrows in the
glabellar skin and imparts an angry
expression..
 Muscles of Eyelid:
2. Orbicularis oculi:
a. Orbital part:
From Medial part of medial palpebral
ligament and adjoining bone into the
Concentric rings that return to the
point of origin.
Protects eye from bright light
Closes lids tightly;
 Muscles of Eyelid:

2. Orbicularis oculi:

b. Palpebral part: From Lateral part of

medial palpebral ligament. into the
Lateral palpebral raphe

Closes lids gently; blinking

 Muscles of Eyelid:
2. Orbicularis oculi:
c. Lacrimal part:
From Lacrimal fascia and lacrimal
bone into the Upper and lower eyelids.

Dilates lacrimal sac; directs lacrimal

puncta into lacus lacrimalis; supports
the lower lid.
 Muscles of nose:

1. Procerus:

From Fascia and skin medial to the

eyebrow to the fascia and skin over the
nasal bone. Causes transverse wrinkles.

2. Compressor naris:
From maxilla just lateral to the nose to
aponeurosis across the dorsum of nose.
Compresses the nasal aperture.
PROCERUS MUSCLE:
 Muscles of nose:
3. Dilator naris:
From maxilla over the lateral incisor to
alar cartilage of the nose.
Dilates the nasal aperture.
4. Depressor septi:
From maxilla over central incisor to
nasal septum.
Pulls the nose inferiorly.
 Muscles of neck:
1. Platysma :

From Upper parts of pectoral and

deltoid fasciae, Fibres run upwards
and medially, to the base of the
mandible.
Draws up the skin of the superior chest
and neck. 

PLATYSMA -
 Muscles around lips:

1.Orbicularis oris:

From buccinator muscle to angle of

mouth (upper lip) and mandible
(lower lip).

Closes lips; protrudes lips. puckering,

whistling 

ORBICULARIS ORIS: WHISTLING.

 Muscles around lips:

2. Buccinator ( whistling muscle ): From

alveolar process of maxilla and mandible
In
region of molars & pterygomandibular
ligament.

Pierced by

 Parotid duct

 Buccal branch of mandibular nerve.

Presses the cheek against teeth, prevents
accumulation of food in the vestibule.
BUCCINATOR MECHANISM:

Maintaining arch form & teeth

position.

CONCEPT OF NEUTRAL ZONE

 Muscles around lips:

3. Levator labii superioris alaeque nasi:

From the frontal process of maxilla to

the upper lip & alar cartilage of the
nose.

Lifts the upper lip & dilates the nostril.

 Muscles around lips:
4. Zygomaticus major:
From lateral surface of zygomatic bone
to the skin at the angle of mouth.
Pulls the angle upwards & laterally.
5. Levator labii superioris:
From infraorbital margin of maxilla to
the skin of upper lateral half of the
upper lip.
Elevates the upper lip, forms nasolabial
groove.
LEVATOR LABII
SUPERIORIS - SADNESS ZYGOMATICUS MAJOR - SMILE
 Muscles around lips:

6. Levator anguli oris:

From the maxilla just below the infra

orbital foramen to skin of angle of
mouth.

Elevates the angle of mouth, forms

the nasolabial groove.
 Muscles around lips:
7. Zygomaticus minor:

From the anterior aspect of lateral surface of

zygomatic bone to the upper lip medial to its
angle.

Elevates the upper lip.

8. Depressor anguli oris:

From the oblique line of mandible to the skin at

angle of mouth & fuses with orbicularis oris.

Draws the angle of mouth downwards &

laterally.
 Click icon to add picture
Muscles around lips:
9. Depressor labii inferioris :
From oblique line of mandible to lower
lip at midline.
Draws lower lip downwards.
10. Mentalis :
From the mandible inferior to incisor
teeth to the skin of chin.
Elevates & protrudes lower lip.
11. Risorius: From the fascia on the
masseter muscle to the skin at angle of
mouth. Retracts angle of mouth.
RISORIUS:
 MODIOLUS:

It is a compact, mobile fibrovascular structure present at about 1.25 cm lateral to the

angle of the mouth opposite the upper second premolar tooth.
 Motor Nerve Supply of the Face:
• The facial nerve is the motor nerve of the face. Its five terminal branches,
temporal, zygomatic, buccal, marginal mandibular and cervical emerge from
the parotid gland and diverge to supply the various facial muscles as follows.

• Temporal—frontalis, auricular muscles, orbicularis oculi

• Zygomatic—Orbicularis oculi

• Buccal—muscles of the cheek and upper lip

• Marginal mandibular—muscles of lower lip.

• Cervical—platysma.
5 TERMINAL BRANCHES OF FACIAL NERVE
 Sensory Nerve Supply of the Face:

• The trigeminal nerve through its three branches is the chief sensory nerve of
the face

• The skin over the angle of the jaw and over the parotid gland is supplied by
the great auricular nerve.
 CLINICAL ANATOMY:
•In infra nuclear lesions of the facial nerve,
known as Bell's palsy, the whole of the face
of the same side gets paralysed. The face
becomes asymmetrical and is drawn up to
the normal side. The affected side is
motionless. Wrinkles disappear from the
forehead. The eye cannot be closed. Any
attempt to smile draws the mouth to the
normal side. During mastication, food
accumulates between the teeth and the
cheek. Articulation of labialis is impaired. BELL’S PALSY
• In supra nuclear lesions of the
facial nerve; usually a part of
hemiplegia, only the lower part of
the opposite side of face is
paralysed.

• The upper part with the frontalis

and orbicularis oculi escapes due to
its bilateral representation in the
cerebral cortex.
SYNDROMES ASSOCIATED WITH FACIAL NERVE LESION:

MOBIUS
SYNDROME: Rare
congenital disorder.
Lack of facial
expression.

FACIAL NERVE
LESIONS

RAMSAY HUNT
MELKERSSON- SYNDROME facial paralysis+
ROSENTHAL SYNDROME pain in ear+ vesicles in auditory
= cheilitis granulomatosa canal.
+facial paralysis+lingua
plicata. ( reactivation of latent HZV
Infection)
 OTHER ASSOCIATED CONDITIONS:
• Lyme Disease

• Sarcoidosis

• Tetanus

• Facial neuroma

• Amyloidosis

• Myasthenia Gravis

• Multiple sclerosis
CLINICAL CONSIDERATIONS :

• TRANSIENT FACIAL PARALYSIS:

Produced by the deposition of local

anesthetic into the body of the parotid gland,
blocking the VII Cranial nerve ( facial nerve ),
a motor nerve to the muscles of facial
expression.
Hence, care must be taken during
administration of Inferior alveolar nerve block.
 BELL’S PALSY IN CHILDREN-A PEDODONTIST’S
PERSPECTIVE
• Bell’s palsy is the most common cause of PFP in childhood, and proper management of
BP is essential for paediatricians, otolaryngologists and general practitioners

• Acute idiopathic peripheral facial paralysis (PFP) or Bell’s palsy (BP), can be seen in all
age groups.

• In general, its frequency is considered to be 20-30/100,000. It is also the most common

cause of unilateral facial paralysis and constitutes 60-75% of paralysis of the facial
nerve. Nine percent of the patients have a previous history of paralysis. Bilateral
paralysis is observed in 0.3 % of the patients.
■ According to Abdulhalim Aysel Et al. , during the first consultation and evaluation of
treatment outcomes, the House-Brackmann (HB) facial nerve grading system was
used to identify the degree of paralysis.
Grade Appearance Forehead Eye Mouth
■ Grade Appearance Forehead Eye Mouth
1 Normal Normal Normal Normal

2. Slight weakness
 MANAGEMENT OF CHILD PATIENT WITH BELL’S PALSY:

The treatment for patients with Bell’s Palsy includes,

 oral or intravenous methyl prednisolone (1 mg/kg/day) at tapered doses for 14 days.
 Further, antiviral therapy will be included for the treatment of patients with a positive recent upper
respiratory tract infection history or positive serologic test results for aforementioned viruses.
DENTAL IMPLANTS – ITS IMPACT ON FACIAL
MUSCULATURE :
• Carl E .Misch stated that implant prosthesis allows the muscle function and
improves the muscle tonicity of the facial musculature.
• Implant related prosthesis are positioned in relation to esthetics, function & speech.
• The implant prosthesis is stable and retentive without the efforts of facial
musculature.
 CONCLUSION

• The Muscles of Facial Expression has its significance in both functional and aesthetic

point of view.

• Any dysfunction or the derangement will eventually lead to complication. Early

detection and management of facial paralysis in children will result in uneventful

recovery with minimum complications.

• In addition to functional problems there is also a psychological aspect. The child tends

to be withdrawn and may have serious emotional problems with reduction in dietary

and fluid intake, hence reducing the quality of life in such patients.
 REFERENCES:
1. B.D. Chourasia's human anatomy 4th edition vol. 3 The Head & Neck.

2. Gray’s Anatomy 40th edition.

3. Hand book of local anaesthesia by Stanley F Malamed 6th Edition.

4. Dental implant prosthetics Second edition , by Carl E. Misch

5. B Uday Kumar Chowdary, Sunitha B, Ravindar Puppala, Manoj Kumar

Mallela, Balaji Kethineni and E Hanmanth Reddy; Bell’s Palsy in Children-A

Pedodontist’s Perspective; Indian Journal of Mednodent and Allied Sciences

Vol. 2, No. 1, February 2014, pp- 49-53.

6. Abdulhalim Aysel1 , Togay Müderris2 , Fatih Yılmaz1 , Taşkın Tokat1 , Aynur Aliyeva,

Özgür Özdemir Şimşek3 , Enver Altaş, Paediatric Bell’s palsy: prognostic factors and

treatment outcomes ,The Turkish Journal of Paediatrics 2020; 62: 1021-1027

THANK YOU