Functional Muscle Testing of Facial Muscles.pdf
- 1. Functional Muscle Testing of Facial Muscles MUSCLES OF THE FACE Muscle Tested: a. Frontalis (Frontal belly) 1) Origin: epicranial Aponeurosis below the coronal suture. 2) Insertion: Fibers are continuous medially with those of procerus; intermediate fibers blend with corrugator and orbicularis oculi. 3) Nerve Supply: Temporal branches of facial nerve.
- 3. b. Corrugator supercilii 1) Origin: Medial end of superciliary arch 2) Insertion: Deep surface of skin above middle of orbital arch 3) Nerve Supply: Temporal and zygomatic branches of facial
- 4. c. Procerus 1) Origin: Fascia covering lower part of nasal bone and upper part of lateral nasal cartilage 2) Insertion: Skin over lower forehead, between eyebrows. 3) Nerve Supply: Buccal branches of facial nerve.
- 5. d. Nasalis 1) Origin: Transverse part: (compressor) Maxilla, above and lateral to incisive fossa. Alar part: from the maxilla over the lateral incisor Insertion: Transverse part: Thin aponeurosis continuous with muscle of opposite side. on the bridge of the nose, and with the aponeurosis of the procerus muscle Alar part: (dilator) Greater alar cartilage 2) Nerve Supply: Buccal branches of facial nerve.
- 6. Test Procedures In the testing of the face muscles, positioning is not a factor, and, with the exception of the muscles of mastication, only very fine movements are involved. Grades which may be used are: zero, if no contraction can be elicited; trace, for minimal muscle contraction; fair, for performance of the movement with difficulty; and normal, for completion of the movement with case and control. Resistance may be given in the tests for the muscles of mastication. Occipitofrontalis (frontal belly): Command: raise eyebrows, forming horizontal wrinkles in forehead (expression of surprise)Relax. Corrugator Supercilii: Command: draws eyebrows medially and downward, forming vertical wrinkles between brows (frowning) -- - -- Relax.
- 7. Procerus: Command: Lift lateral borders of nostrils, forming diagonal wrinkles along bridge of nose (expression of distaste). Nasalis: Command: Dilate nostrils alar part of nasalis followed by compression (transverse portion) ----------------------------------------------------Relax.
- 8. MUSCLES OF THE EYE Muscle Tested: a. Orbicularis oculi 1) Origin: Orbital part: a. Nasal part of frontal bone b. Frontal process of maxilla in front of lacrimal groove c. Anterior surface and borders of medial palpebral ligament Palpebral part: Bifurcation of medial palpebral ligament Lacrimal part (tensor tarsi): Posterior crest and adjacent part of lacrimal bone 2) Insertion: Orbital part: the fibers are directed laterally, forming a broad and thin layer, which occupies the eyelids or palpebræ, surrounds the circumference of the orbit, and spreads over the temple, and downward on the cheek. Palpebral orbicularis: lateral palpebral raphe at the outer canthus (corner) of the eye.
- 9. 3) Nerve Supply: Temporal and zygomatic branches of facial nerve. b. Levator palpebrae superioris 1) Origin: Inferior surface of small wing of sphenoid, above and in front of optic foramen 2) Insertion: the skin of the upper eyelid, as well as the superior tarsal plate 3) Nerve Supply: Oculomotor nerve.
- 11. Rectus superior: Origin: Upper part of fibrous ring surrounding optic foramen on upper, medial and lower margins Insertion: Into sclera about 6 mm behind cornea, on superior aspect of eyeball Nerve Supply: Oculomotor nerve Rectus inferior Origin: Lower part of fibrous ring surrounding optic foramen on upper, medial and lower margins Insertion: Into sclera about 6 mmbehind cornea, on inferior aspectof eyeball Nerve Supply: Oculomotor nerve Rectus medialis: Origin: Medial part of fibrous ring surrounding optic foramen on upper, medial and lower margins Insertion: Into sclera on medial aspect of eyeball, farther forward than recti superior and inferior. Nerve Supply: Oculomotor nerve
- 12. Rectus lateralis: Origin: Two heads from lateral parts of bands surrounding optic foramen and adjoining part of orbital fissure Insertion: Into sclera on lateral aspect of eyeball, farther forward than recti superior and inferior Nerve Supply: Abducent nerve Superior oblique 1) Origin: Above margin of optic foramen, from body of sphenoid. 2) Insertion: superolateral aspect of the eyeball; thus muscle pulls in a forward, upward and medial direction. Abducts, depresses, internally rotates eyeball 3) Nerve Supply: Trochlear nerve
- 13. Superior oblique
- 14. Inferior oblique: Origin: Orbital surface of maxilla, lateral to lacrimal groove. Insertion: Passes lateralward, backward and upward to insert into inferolateral aspect of eyeball (deep to lateral rectus muscle) This muscle : Abducts, elevates, externally rotates eyeball Nerve Supply: Oculomotor nerve
- 16. Test Procedures: Orbicularis oculi Command: Close your eyes tightly ------------ Relax. Levator palpebrae superioris Command: Lift your upper eyelids completely as eyes are turned upward ------------- Relax. Inferior oblique (right) and superior rectus (left) Command: move your eyes in a direction upward and to the right--------------- Relax Superior oblique (left) and inferior rectus (right) Command: move your eyes in a direction downward and to the left --------------- Relax. The rectus medialis and rectus lateralis may be tested by movement of the eyes horizontally to the right and left. (Not illustrated. )
- 18. MUSCLES OF THE MOUTH Muscle Tested: a. Orbicularis oris: 1) Origin: a. Fibers derived from other facial muscles, principally Buccinator, Levator anguli oris, and Depressor anguli oris. b. Proper fibers of lips, from under surface of skin c. Fibers attached to maxilla and septum of nose above and to mandible below. 2) Insertion: a. Intermingling of transverse and oblique fibers
- 19. comprising muscle b. Mucous membrane lining mouth cavity c. Decussation of some fibers of Buccinator at corner of mouth; Levator anguli oris fibers pass below, and Depressor anguli oris fibers pass, above mouth 3) Nerve Supply: Buccal branches of facial nerve. b. Zygomaticus minor: 1) Origin: (Anterior part of) Lateral aspect of zygomatic bone Insertion: - Upper lip between angular head and Levator anguli oris - Upper lip at corner of mouth 2) Nerve Supply: Buccal branches of facial nerve.
- 20. Levator anguli oris: Origin: Canine fossa of maxilla,immediately below infraorbital foramen Insertion: Angle of mouth,intermingling with zygomaticus, depressor anguli oris and orbicularis Nerve Supply: Buccal branches of facial nerve.
- 21. Zygomaticus major: Origin: Zygomatic bone anterior to zygomaticotemporal suture. Insertion: Angle of mouth,intermingling with levator and depressor anguli oris and orbicularis oris Nerve Supply: Buccal branches of facial nerve.
- 22. Risorius: Origin: Fascia over Masseter; muscle passes laterally superficial to Platysma Insertion: Skin at angle of mouth Nerve Supply: Mandibular and buccal branches of facial
- 23. Buccinator Origin: Outer surfaces of alveolar processes of maxilla above and mandible below aPterygomandibular raphe Insertion: blends with muscles of upper lip Nerve Supply: Buccal branches of facial
- 24. Depressor anguli oris Origin: Oblique line of mandible. Insertion: Angle of mouth Nerve Supply: Mandible and buccal branches of facial nerve.
- 25. Depressor labii inferioris Origin: Oblique line of mandible, between symphysis and mental foramen Insertion: Skin of lower lip, blending with orbicularis oris and opposite depressor labii inferioris Nerve Supply: Buccal branches of facial nerve.
- 26. Mentalis 1) Origin: Incisive fossa of mandible 2) Insertion: skin of chin 3) Nerve Supply: Mandibular and buccal branches of facial nerve.
- 27. Platysma 1) Origin: Fascia over superior pectoralis major and deltoideus muscles 2) Insertion: Base of mandible; skin of cheek and lower lip; angle of mouth; orbicularis oris 3) Nerve Supply: Cervical branch of facial nerve.
- 28. Test Procedure: Orbicularis Oris Command: Approximate and compress your lips ----- Relax. Zygomaticus Minor Command: Protrude your upper lip----------Relax. Levator Anguli Oris: Command: Lift your upper border of lip on one side without raising lateral angle of mouth (sneering) ------ Relax.
- 29. Zygomaticus Major: Command: Raise your lateral angle of mouth upward and lateralward (smiling)--Relax. Risorius: Command: Approximate your lips and draw your corners of mouth lateralward (grimacing)Relax. Buccinator Command: Approximate your lips and compress your cheeks(blowing)--------Relax. Depressor Labii Inferior: Command: Protrude your lower lip (pouting) ----- Relax. Depressor Anguli Oris and Platysma: Command: Draw your corners of mouth downward strongly ----------------Relax.
- 30. Mentalis Command: Draw your tip of chin upward --------- Relax
- 32. Temporalis: 1) Origin: a. Temporal fossa b. Deep surface of temporal fascia 2) Insertion: Medial surface, apex, and anterior border of coronoid process of mandible Nerve Supply: Deep temporal nerves from mandibular nerve. Action: Anterior fibres: Elevates mandible Posterior part: Retracts mandible
- 33. Masseter: Origin : Superficial part: maxillary process of zygomatic bone, Inferior border of zygomatic arch (anterior 2/3) Deep part: deep/inferior surface of zygomatic arch (posterior 1/3) Insertion: Lateral surface of ramus and angle of mandible Nerve Supply: Masseteric nerve from mandibular nerve. Action : Elevates and protrudes mandible
- 34. Pterygoid externus: Origin: Superior head: Infratemporal crest of greater wing of sphenoid bone Inferior head: Lateral surface of lateral pterygoid plate of sphenoid bone Insertion Superior head: Joint capsule of temporomandibular joint Inferior head: Pterygoid fovea on neck of condyloid process of mandible Nerve Supply: External pterygoid nerve from mandibular nerve . Action Bilateral contraction - Protrudes and depresses mandible, stabilizes condylar head during closure; Unilateral contraction - Medial movement (rotation) of mandible
- 35. Pterygoid internus: Origin Superficial part: Tuberosity of maxilla, Pyramidal process of palatine bone Deep part: Medial surface of lateral pterygoid plate of sphenoid bone Insertion Medial surface of ramus and angle of mandible Action Bilateral contraction - Elevates and protrudes mandible Unilateral contraction - Medial movement (rotation) of mandible Innervation Medial pterygoid nerve (of mandibular nerve (CN V3)
- 36. Mylohyoid: Geniohyoid: origin Inferior mental spine (inferior genial tubercle) Insertion Body of the hyoid bone Action Elevates and draws hyoid bone anteriorly; shortens the mouth floor; widens pharynx Innervation Anterior ramus of spinal nerve C1 (via hypoglossal nerve) Origin Mylohyoid line of mandible Insertion Mylohyoid raphe, body of hyoid bone Action Forms floor of oral cavity, elevates hyoid bone and floor of mouth, depresses mandible Innervation Nerve to mylohyoid (of inferior alveolar nerve (CN V3))
- 37. Digastricus: Origin Anterior belly: digastric fossa of mandible Posterior belly: mastoid notch of temporal bone Insertion Body of hyoid bone (via intermediate tendon and its fibrous sling) Action Depresses mandible Elevates hyoid bone during chewing, swallowing Innervation Anterior belly: mylohyoid nerve (of inferior alveolar nerve) (CN V3) Posterior belly: digastric branch of facial nerve (CN VII)
- 38. Stylohyoid: Origins Styloid process of temporal bone Insertions Body of hyoid bone Action Elevates and draws hyoid bone posteriorly Innervation Stylohyoid branch of facial nerve (CN VII)
- 39. Sternohyoid: Origin Manubrium of sternum, medial end of clavicle Insertion Inferior border of body of hyoid bone Action Depresses hyoid bone (from elevated position) Innervation Anterior rami of spinal nerves C1-C3 (via ansa cervicalis)
- 41. Omohyoid: Origin Inferior belly: superior border of scapula near the suprascapular notch Superior belly: intermediate tendon Insertion Inferior belly: intermediate tendon Superior belly: body of hyoid bone Action Depresses and retracts hyoid and larynx Tenses carotid sheath Innervation Anterior rami of spinal nerves C1-C3 (via ansa cervicalis)
- 42. Thyrohyoid muscle Origin Oblique line of thyroid cartilage Insertion Inferior border of body and greater horn of hyoid bone Action Depresses hyoid bone Elevates larynx Innervation Anterior ramus of spinal nerve C1 via hypoglossal nerve (CN XII)
- 43. Sternothyroid muscle rigin Posterior surface of manubrium of sternum, Costal cartilage of rib 1 Insertion Oblique line of thyroid cartilage Action Depress the larynx Innervation Anterior rami of C1-3 (via the ansa cervicalis)
- 44. Test Procedures: Temporalis, Masseter and Pterygoid internus Command: Close your jaws tightly Pterygoid externus and internus (left) Command: Move your mandible laterally and forward to the right Digastric and suprahyoid muscles; (hyoid bond is fixed by Infrahyoid muscles) Command: Depress your mandible