Face is the most prominent part of the body Facial muscles also known as the ‘mimetic muscles’, represent remnants of the ‘Panniculus Carnosus’ ,continuous subcutaneous muscle sheet seen in some animals. Facial Musculature are the only somatic muscles in the body attached on one side to the bone and the other side to the skin; thus specialized for expression

1. MUSCLES OF FACIAL
EXPRESSION
Dr Nikhil V Suresh
First Year PG
Department of Public Health Dentistry

2. CONTENT

4. Introduction
 Face is the most prominent part of the body
 Facial muscles also known as the ‘mimetic muscles’,
represent remnants of the ‘Panniculus Carnosus’
,continuous subcutaneous muscle sheet seen in
some animals.
 Facial Musculature are the only somatic muscles in
the body attached on one side to the bone and the
other side to the skin; thus specialized for expression

5. FACE
Boundaries of face:
•Superiorly -hair line
• Inferiorly - the chin
and the base of
mandible
• Laterally- on each
side of auricle.

6. Layers of the face
1. Skin
2. Subcutaneous
tissue/superficial
areolar tissue
3. Superficial fascia
4. Loose areolar tissue
5. Periosteum

7.  The superficial fascia has different designations in
different regions of the scalp, temple, face, and neck.
1. In the forehead-galea aponeurosis.
2. In the temple-temporoparietal fascia .
3. In the midface-superficial muscular aponeurotic
system (SMAS).
4. In the neck- as fascial sleeve for the platysma muscle
 Deep fascia is absent in face

8. Facial bones
 Facial
skeleton
consists of :
 2 unpaired
bones and
 6 paired
bones

9. Facial bones
 Facial
skeleton
consists of :
 2 unpaired
bones and
 6 paired
bones

10. Paired bones:
 Maxilla
 Palatine bone
 Zygomatic bone
 Lacrimal bone
 Nasal bone
 Inferior nasal conchae

11. Unpaired facial bones:
 Mandible
 Vomer

12. Unpaired facial bones:
 Mandible
 Vomer

13. Development of muscles of facial expression
 They develop
from mesoderm
of 2nd brachial
arch
 So they are
supplied by
Cranial nerve VII

14. CLASSIFICATION

15. Muscles of
facial
expression
Topographically
Functionally

16. Functionally
They are the regulator of 3 openings
opening
sphincter
Dilator
Palpebral fissure Oral fissure Nostrils
Compressor naris
Orbicularis oris
Orbicularis oculi
1.Dilator naris
2.Depressor septi
3.Medial slip of
levator labii
superioris alaque
nasi
1.Levator
palpebral
superioris
2.Occipitofrontalis
All muscles of
mouth,except
mentalis

17. Topographically
Muscles of
scalp
Muscles of
eyelids
Muscles of
nose
Muscles
around
mouth
Muscles
of auricle
1. Occipitofron
talis
1. orbicularis
oculi
2. levator
palpebral
surerioris
3. corrugator
spercilii
1. Procerus
2. Compressor
naris
3. Dilator naris
4. Depressor septi
1. Orbicularis oris
2. Levator labi superioris aleque nasi
3. Levator labi superioris
4. Levator anguli oris
5. Zygomaticus major
6. Zygomaticus minor
7. Depressor labi inferioris
8. Depressor anguli oris
9. Risorius
10. Mentalis
11. Buccinators
1. Auricularis anterior
2. Auricularis posterior
3. Auricularis superior
Muscles
of neck
1. platysma

18. Muscles of scalp/ Epicranial group
Occipitofrontalis
 The occipitofrontalis muscle
comprises of two main sections.
These sections include
1. Occipital belly -located
posteriorly
2. frontal belly - located anteriorly.
The frontal belly is the major
contributor to facial expression

19.  Occipital Belly:
 Origin-they are small and separate and origin from
lateral two-third of superior nuchal line
 Insertion- into epicranial aponeurosis
 Frontal belly:
 Origin- arises from skin of forehead
 Insertion- into epicranial aponeurosis

20. Innervations
 Frontalis: temporal
branches of the facial
nerve (VII)
 Occipitalis: posterior
auricular branch of the
facial nerve (VII)
Arterial supply
 Frontalis: Supraorbital
and Supratrochlear
artery
 Occipitalis: Occipital
artery.

21. Actions:
 Elevates eyebrows and
horizontal wrinkles of
forehead
 Surprise and frightening

22. Muscles around Eye
 Consists of 3 muscles:
1. Orbicularis oculi
2. Corrugator supercili
3. Levator palpebrae
superioris

23. Orbicularis oculi:
 3 parts
1. Orbital part(outer
around orbit) –
Origin- from medial part of
medial palpebral
ligament and adjoining
bone. –
Insertion- form concentric
rings, return to point of
origin
Action –closes the lids tightly,
wrinkling

24. Palpebral part(Inner in
eyelid)
 Origin-from lateral
part of medial
palpebral ligament –
 Insertion- into lateral
palpebral raphe
 Action-closes the lids
gently, blinking

25. Lacrimal part(Small,
posterior to lacrimal
sac)
 Origin- from lacrimal
fascia& lacrimal bone
 Insertion- into lateral
palperal raphae
 Action-dilate lacrimal
sac, support lower eye
lid

26. Innervation Temporal
and zygomatic
branches of facial
nerve.
Contraction of entire
muscle-crow feet
appearance

27. Corrugator supercillii
 Origin- superciliary
arch
 Insertion: skin of the
eyebrow
 Innervation:- Temporal
branch of facial nerve

28. Action :
 produces vertical
wrinkles of the
forehead
 frowning
 as an expression
of annoyance
 Draws eyebrows
medially

29. Levator palpabrae superioris
 Its a triangular muscle
 Origin: lesser wing of
sphenoid bone
 Insertion : upper eyelid
 Function : lid elevation
 Innervation:-
Occulomotor Nerve.

30. Action :
 Elevates upper eyelid
 Ptosis –damage to
muscle or nerve lesion
of CN III causes ptosis

32. Muscles of Nose
 Procerus
 Nasalis
Compressor naris
Dilator naris
 Depressor septi

33. Procerus
 Pyramidal muscle
 Origin – nasal bone and
lateral nasal cartilage
 Insertion – glabellar skin
over lower part of
forehead between the
eyebrows
 Innervation:- Temporal &
Lower zygomatic branches
of facial nerve.

34.  Action :
 pulls down the medial
end of the eyebrow
 wrinkles the skin of the
nose transversely
in Frowning &
concentration
 Reduces the glare of
sunlight

35. Nasalis
 Nasalis
Compressor naris
(transverse part)
Dilator naris
(Alar part)
Origin:-
Compressor Naris:- Arises
from the maxilla just lateral to the
nasal notch
Dilator Naris:- Arises from the
Maxilla; below & medial to the
transverse part.

36.  Insertion:-
 Compressor Naris:- The
muscle fibres pass upward &
medially to expand into a thin
aponeurosis. At the bridge of
the nose, the paired muscle
merges with each other as
well as the aponeurosis of the
procerus.
 Dilator Naris:- Partly merges
with the compressor Naris & is
attached to the cartilagenous
Ala Nasi.

37.  Action:-
 Compressor
naris(transverse):-
Compresses the nasal
aperture.
 Dilator naris(alar):-
Widening the anterior
nasal aperture. Deep
inspiration.
 Innervation:- Buccal &
Zygomatic branch of the
Facial nerve

38. Depressor septi
 Origin – Maxilla above
the central incisor.
 Insertion – Mobile
part of the nasal
septum.
 Innervation:- Buccal
branch of facial nerve

39. Action:-
 Pulls the nasal
columella, septum &
tip of nose downward
 With alar part of
nasalis – widens the
nasal aperture causing
nose to dip on smiling.

41. Muscles around mouth
Elevators, evertors & retractors of
upper lip
Depressors, evertors & retractors of
lower lip
Orbicularis oris
Buccinator

42. Elevators, evertors & retractors of upper lip
Levator Labii Superioris Alaque Nasi
Levator Labi Superioris
Levator Anguli Oris
Zygomaticus Major
Zygomaticus Minor
Risorius

43. Levator Labii Superioris Alaque Nasi
 Origin:- Upper part of
the frontal process of
maxilla
 Insertion:- ala of the
nose by one slip and To
skin of upper lip by
another slip
 Innervation:- Zygomatic
and buccal branches of
facial nerve.

44.  Action:
 Raises & everts the upper lip.
 Dilates the nostril

45. Levator Labii Superioris
 Origin:- Maxilla &
Zygomatic bone above
the infra orbital foramen.
 Insertion:- Muscular
substance of upper lip.
 Innervation:- Zygomatic
& buccal branches of
facial nerve

46.  Action :
 Raises upper lip
 Helps form nasolabial
furrow in sadness

47. Levator Anguli Oris(caninus)
 It is intermingle with
other muscles .Extends
further into skin of
lower lip up to midline
 Origin:- Canine fossa of
the maxilla.
 Insertion:- Into & below
the angle of the mouth.
 Innervation:- Zygomatic
& Buccal branches of
the facial nerve

48.  Actions:
 Raises the angle of
mouth
 Accentuates the
nasolabial furrow
 Expression of sadness
 Bilateral contraction of
this muscle causes a
typical “Dracula”
expression which
exposes canines of both
the sides

49. Zygomaticus Major
 Origin:- Zygomatic
bone behind
zygomatico-temporal
suture.
 Insertion:- Angle of the
mouth.
 Innervation:-
Zygomatic & Buccal
branches of facial
nerve

50.  Action :-
 Draws the angle of the
mouth upwards &
laterally as in
laughing/Smiling.
 Spasm- risus
sardonicus

51. Zygomaticus minor
 Small muscle
 Its located between
levator labii superioris
and zygomaticus major
muscle
 Origin:- Lateral surface of
zygomatic bone infront of
the zygomaticomaxillary
suture.
 Insertion:- Muscular
substances of upper lip.
 Innervation:- Zygomatic
& Buccal branches of
facial nerve

52.  Action:-
 Elevates & curls
the upper lip as in
contempt,
smugness or
disdain.

53. Risorius
 Origin:- Massetric
Fascia
 Insertion:- Skin of
the angle of the
mouth
 Innervation:- The
buccal branch of the
facial nerve

54.  Action :
 Contraction of its fibres
pulls the corner of the
mouth laterally and
upwards

55. Depressors, evertors & retractors of lower lip
Depressor labi inferioris
Depressor anguli oris
Mentalis

56. Depressor labi inferioris
 Origin:- Oblique line of
the mandible between
the symphysis menti and
mental foramen.
 Insertion:- Into the skin &
mucosa of the lower lip.
 Innervation- marginal
mandibular branch of
facial nerve

57.  Action:-
 Draws the lower lip
downwards & laterally
 Assists in eversion of
lower lip.

58. Depressor anguli oris
 Origin:- Mental
tubercle of mandible
and its continuation,
the oblique line.
 Insertion:- Angle of the
mouth.
 Innervation- marginal
mandibular branch of
facial nerve

59.  Action:- Draws the
angle of mouth
downwards and
laterally in opening
mouth.
 Expresses Grief

60. Mentalis
 Its conical in shape
 Origin:- Incisive fossa of
the mandible.
 Insertion:- Skin of the
chin
 Innervation:- Mandibular
branch of facial nerve

61.  Action:-
 Raises the lower lip
 wrinkling the skin of the
chin as in doubt
 Protrudes the lower lip in
drinking

62. Orbicularis oris
 Its the muscle that
surrounds the mouth
entirely
 There are 4 parts: 2 in
left(upper and lower) and 2
in right(upper and lower)
 Each of the 4 parts anchor to
the modiolus on that side
 At the midline the fibres
from each side interlaces
with each other thereby
attaching into each other

63. Origin: -
 Some fibres originate near the
midline from the maxilla
superiorly and mandible
inferiorly
 Other fibres from the buccinator
in the cheek and other muscles
acting on the lips
Insertion: -
 It inserts into the angle of mouth
and mucous membrane of the
lips.

64.  Action:-
 Varying kind of movements of
lips like pouting , pursing ,
twisting.
 Contraction narrows the
mouth and closes the lips

65. Buccinator
 Its the muscle of cheek
 Known as the ‘Whistling
muscle
 Its a quadrilateral shaped
muscle
 Its pierced by: Parotid duct,
Buccal branch of
mandibular nerve

66. Upper
fibers
Middle
fibers
Lower
fibers

67. Origin:-
 Upper Fibers:- Outer surface of
alveolar process of upper molar
teeth
 Middle Fibers:- From
Pterygomandibular Raphe
 Lower Fibers:- Mandible , opposite
the molar teeth
Insertion:-
 Upper Fibers;- Upper Lip
 Middle fibers:- Decussate Upper
part into lower lip and vice versa
 Lower Fibers:- Lower Lip
Innervation:-
Buccal branch of Facial Nerve

68. Relations:-
 Lateral aspect-related to
the ramus of mandible,
muscle of mastication
(masseter and medial
pterygoid muscle), the
buccal fat pad, and the
buccopharyngeal fascia.
 Medial aspect- its
covering is the submucosa
and mucosa of the cheek.
 The buccinator muscle is
pierced by the parotid
duct (Stenson's duct)

69. Actions ;-
 Flattens the cheek against
the gingiva & teeth during
mastication
 prevents accumulation
food in the vestibule.
 Whistling
 Blowing

70.  Buccinator mechanism –balance
between the muscles is responsible
for integrity of dental arches and
relationship of teeth to each. Loss of
this balance causes malocclusion
 Inward forces - it balances the
outward forces of tongue
 Hyperactivity –results in narrow
arches and malocclusion
 Paralysis of the buccinator -lead to
difficult mastication as the non-
functioning of this muscle can cause
repeated laceration of the cheek
mucosa.
 Denture stabilization- it grips the
polished surface of the denture

72. Muscles of auricle
Origin:-
 anterior: galea aponeurotica
anterior to ear
 superior: galea aponeurotica
superior to ear
 posterior: mastoid process
Insertion:-
 into epicranial aponeurosius
Innervation :-
 anterior & superior: temporal
branches of facial nerve (VII)
 posterior: posterior auricular
branch of facial nerve

73. Platysma-muscle of neck
Origin :-
 Subcutaneous fascia of
superior chest, the pectoral
and deltoid fascia. The fibres
run upward and medially
Insertion:-
 Anterior fibres to base of
mandible
 Posterior fibres to skin of
lower face and lip
Innervation:-
Cervical branch of facial nerve

74.  Action:-
 Draws up the skin of the superior
chest and neck, creating ridges
of skin of the neck
 Depresses and draws laterally
the lower lip
 depress mandible
 Pulls angle of mouth downwards
 Terror, fright, horror

75. Summary of muscles used for facial expression

76. Zygomaticus major-smiling and laughing

77. Levator Anguli Oris & Levator Labii Superioris -
Sadness

78. Corrugator Supercilli & Procerus - Frowning

79. Frontalis - Surprise

80. Platysma - Horror, Terror, Fright

81. Buccinator & Orbicularis Oris - Whistling

82. Applied Anatomy

83. Facial Nerve
 The facial nerve, CN VII, is
the seventh paired cranial
nerve
 The main trunk of the
nerve, after existing the
skull, continues anteriorly
and inferiorly into the
parotid gland

85. Bell’s palsy
• Charles Bell in 1821 first described Bell’s
Palsy.
• Bell's palsy is a non-progressive
neurological disorder of one of the facial
nerves (7th cranial nerve).
• This disorder is characterized by the
sudden onset of facial paralysis that may
be preceded by a slight fever, pain behind
the ear on the affected side, a stiff neck,
and weakness and/or stiffness on one
side of the face.

86.  Lower Motor Neuron
Disorder.
 Various and unknown
etiology
 often associated with viral
infection like Herpes
simplex virus, Epstein barr
virus, Varicella zoster virus
 Bacterial infection like
Borellia burgdofere

87. Signs & Symptoms:
 Facial weakness.
 Absence of nasolabial fold
 Drooping of eyelid
 Drooping of mouth
 Dryness of effected eye or
mouth
 Hypersensitivity of loud noise
 Loss of taste sensation from
anterior 2/3rd of tongue
 Patient is unable to whistle ,
smile or grimace.

88.  Clinical Evaluation:
 Bells’ sign:- Whenever patient
attempts to close the eyelid, the
eyeball rolls upward so that the
pupil is covered and only the
white sclera is visible
 Face drawn to the normal side.
 Postive Hitselberger sign:-
Decreased sensation along the
external acoustic meatus.

89. Grading:
The grading system developed by House and Brackmann categorizes Bell
palsy on a scale of I to VI as follows:
• Grade I: normal facial function
• Grade II: mild dysfunction
• Grade III: moderate dysfunction
• Grade IV: moderately severe dysfunction
• Grade V: severe dysfunction
• Grade VI: total paralysis

90.  Treatment :
 Symptomatic:- Lubricating eye drops Massage of the
affected muscles.
 Medication:-corticosterioids- Prednisolone 60-
80mg/day
 Acylovir; if a virus is responsible for it.

91. Infranuclear Lesion Supranuclear Lesion
•LMN lesion of facial nerve (Bell’s Palsy),
the whole of the face of the same side
gets paralyzed.
• The face becomes asymmetrical and is
drawn up to normal side.
•The affected side is motionless.
•Wrinkles disappear and eye cannot be
closed.
•Peripheral Palsy
•UMN lesions of Facial nerve is usually a
part of hemiplegia.
•Only the lower part of opposite side of
the face is paralyzed.
•The upper part of frontalis and
orbicularis oris escape due to its bilateral
representation in the cerebral cortex.
•Central Palsy

92. Complication of Inferior alveolar nerve block
 Undesirable nerve block:
 Due to proximity of IANB needle
position to the facial nerve and
the parotid
 facial nerve is anesthetised
results in Transient Hemifacial
Paralysis
 Muscles being supplied by the
side of the facial nerve is
affected and cannot contract,
leads to loss of muscle action of
the affected side of the face

93. Melkersson Rosenthal Syndrome
 Rare neurological disorder.
 Characterized by triad of :
1. Recurring facial
paralysis
2. Recurrent orofacial non-
pitting oedema
3. Fissured tongue.
 Also known as orofacial
granulomatosis

94. Moebius Syndrome
 Extremely rare congenital
neurological disorder.
 In most cases, the sixth and
seventh cranial nerves are
congenitally absent
 The absence of these nerves leads
to the characteristic facial
paralysis and other symptoms of
Moebius syndrome.
 Characterized by facial paralysis
and the inability to move the eyes
from side to side.

95.  Most people with Möbius
syndrome are born with
complete facial paralysis and
cannot close their eyes or form
facial expressions.
 Often the upper lip is retracted
due to muscle shrinkage.
 Children with Moebius
syndrome may have delayed
speech because of paralysis of
muscles that move the lips,
soft palate & tongue

96. Conclusion

98. Reference
1. Chaurasia BD. Human anatomy. CBS Publisher;
2004.
2. Gray H. Gray's anatomy. Arcturus Publishing; 2009
Jul 15.
3. Halim A. Human Anatomy: Volume III: Head, Neck
and Brain. IK International Pvt Ltd; 2008 Dec 30.

99. THANK YOU