Viscerocranium:

- lacrimal
- maxilla
- zygomatic
- vomer
- inferior nasal conchae
- mandible

- Facial bones not shown — palatine

Muscles of facial expression:

- develop from 2nd pharyngeal arch + innervated by facial nerve
- insertions into dermis of skin + origins from facial skeleton or fascia
- located on the scalp, face, neck
- superficial
- change facial expression by moving skin
- muscle groups:
- scalp
- eyes (orbital group)
- nostrils (nasal group)
- mouth (oral group)
- cheek
- neck

Orbital group:
Orbital group Action Innervation

Palpebral part close eyelids gently

(fibres originate from medial

palpebral ligament)
Obicularis oculi
orbital part wrinkles eyelid + forehead
close eyelid tightly Facial Nerve (CN VII)
(ring encircling orbital
orifice)

Corrugator supercilii draw eyebrow medially +

downwards
form wrinkles on forehead

Nasal group:
Nasal group Action Innervation

transverse part compress nares

Nasalis draw alar cartilage down
Alar part
+ laterally open nostril

draw medial border of

eyebrows down to Facial Nerve (CN VII)
Procerus
produce transverse
wrinkles of bridge

pull nose inferiorly +

Depressor septi nasi assist alar part open
nares
Oral group
Muscles of lips:
- speech + facial expression to convey feelings
- singing + whistling
Oral group Group Action Innervation

raise upper lip; help form

Levator labii nasolibial furrow (furrow
superioris between nose + mouth during
sadness)

zygomaticus
raise upper lip
minor Upper group:
elevators
zygomaticus
retractor, evertors raise corner mouth + laterally
major
of lip
levator anguli raise corner of mouth; help
oris form nasolibial furrow

levator labii
superioris raise upper lip + flare nostrils
alaeque nasi

raise + protrude lower lip as it

mentalis Facial nerve
wrinkles skin on chin
(CNVII)
depressor labii
Lower group: depress lower lip + laterally
inferioris
depressor,
depressor anguli retractor, evertors depress corner of mouth +
oris of lip laterally

retract corner of mouth:

risorius???
laterally + upward

sphincter of - fibres from buccinator (deep)

orbicularis oris closes + purse lips
mouth + lip muscles (superficially)

press cheek against teeth; O: pterygomandibular raphe +

compresses distended cheeks post maxilla/ mandible
buccinator muscle of cheek
blowing + sucking; keep bolus I: blends with obicularis oris
of food between teeth when
chewing

Other muscle Action Innervation

groups

frontal belly elevate eyebrows - move scalp on head

(skin of wrinkles forehead Facial Nerve
eyebrows) (CNVII):
- temporal
occipital belly draw scalp back
Occipitofrontalis branch
(superior - post belly
(muscle of scalp)
nuchal line
post
occipital bone)
auricular
galea branch
aponeurotica

(move lower lip, - thin sheet of muscle in

corner of mouth superficial fascia of neck
down)
Platysma (muscle of
depress mandible +
neck)
angle of mouth

tense skin over

inferior face + neck
Innervation: Facial nerve
- innervate muscles of facial expression
- muscular branches: muscles
- temporal: frontal
- zygomatic: zygomaticus major
- buccal: buccinator
- mandibular: mentalis
- cervical: platysma

Scalp:
- 5 layers
- anteiror: extend from superciliary arches
- posterior: external occipital protuberance

- S: skin
- C: connective tissue (dense)
- fibrofatty layer attaching skin to aponeurosis
- many arteries + veins form anastomosing network
- A: aponeurosis (occipitofrontalis)
- occipitofrontalis muscle
- L: loose areolar connective tissue
- connect aponeurosis to periosteum of skull
- contain emissary veins that connect superficial veins of scalp to diploic veins of skull with dural
venous sinuses
- P: pericranium:
- periosteum covering bones of skull

Muscles of mastication:
 Muscle O I Action Innervation
mastication
Masseter - zygomatic arch - lateral aspect elevation mandible mandibular division
- maxillary process ramus (V3) of trigeminal
zygomatic bone - angle of mandible nerve

Temporalis - bone of temporal - coronoid process elevation + retraction

fossa mandible of mandible
- temporal fascia - ant margin ramus
mandible

Medial pterygoid - tuberosity of - medial surface of elevation + side to

maxilla mandible near side movement
- medial aspect of angle mandible
lateral pterygoid
plate

Lateral pterygoid - roof of infra - head of mandible protracting mandible

temporal fossa to fully open mouth
- lateral surface of
lateral pterygoid
plate

- Insert: mandible
- act on temporomandibular joint

- muscles assisting mastication: depress jaw (suprahyoids)

- digastric
- jeniohyoid
- mylohyoid

- fixed by infra hyoid muscles:

- thyrohyoid
- sternothyroid
- sternohyoid
- omohyoid

Parotid Gland:
- largest of 3 salivary glands
- type of saliva: serous
- large + irregular shape
- encapsulated by part of deep cervical fascia

- anteriorly: ramus of mandible

- posteriorly: mastoid process + sternocleidomastoid
- superficially: extend anteriorly halfway across masseter muscle
- deep: granular lobes extend into deep spaces between mandible + adj structures

- Parotid duct:
1. emerge from anterior aspect gland
2. pass forward over masseter
3. turns medially at anterior border of ramus
4. pierce through buccal fat pad + buccinator muscle to reach oral cavity
5. parotid duct open into oral cavity near second upper molar tooth

- Innervation:
 - PNS:
- Preganglionic fibres: via glossopharyngeal nerve synapse in otic ganglion
- Postganglionic fibres: from otic ganglion (associated with V3) to parotid gland via
auriculotemporal nerve
- Action: stimulation produce thin watery saliva
- SNS:
- fibres to parotid gland arise from cervical sympathetic ganglia
- fibres vasomotor in action + thought to reduce secretion / thicken saliva
- Sensory:
- auriculotemporal nerve: branch mandibular nerve V3 (exit skull via foramen ovale)
- great auricular nerve

- Important relationships: structures pass through gland

- Facial nerve:
- exit skull via stylomastoid foramen —> parotid gland
- divide into 5 motor branches in gland: temporal, zygomatic, buccal, maginal,
mandibular, cervical
- emerge into face from anteromedial surface
- clinical: difficult to remove parotid gland surgically
- external carotid artery:
- (superiorly to give off posterior auricular artery)
- gland: divide to 2 terminal branches — maxillary + superficial temporal artery
- maxillary artery —> pass horizontally, deep to mandible
- superficial temporal artery —> continues superiorly to give transverse facial artery
- Posterior facial/ retromandibular vein:
- formed by superficial temporal + maxillary vein uniting in gland
- divide into ant + post branches below inferior border of gland

Vascular supply of face:

Arterial:
- face + scalp
- from ECA (mainly) + ICA

Facial artery:
- Path:
1. branch from: external carotid artery
2. curve around inferior border mandible (palpated); anterior to masseter —> facial artery enter
face
3. run superficially + medially
4. give branches to upper + lower lips + side of nose
5. terminate: angular artery (medial canthus of eye)
- deep to: platysma, risorius, zygomaticus major/minor
- superficial to: buccinator, levator anguli oris, levator labii superioris
- Branches:
- angular artery (terminate) —> superior part of cheek + inferior eyelid
- inferior labial —> lower lip
- superior labial —> upper lip + nasal septum + ala
- lateral nasal —> dorsum + ala

Superficial temporal artery: terminal

- ECA terminal branch
- divide into anterior + posterior branches
- —> skin over frontal + temporal region of scalp
- branches:
- transverse facial artery:
- cross face in transverse direction (superficial to masseter)
- —> parotid gland + duct, masseter, overlying skin)

Maxillary artery: terminal

- ECA terminal branch
- branches:
- infrorbital artery:
- enter face: infraorbital foramen
- —> lower eyelid, upper lid
- buccal artery:
- enter face: superficial surface buccinator muscle
- mental artery:
- enter face: mental foramen
- —> muscles + skin chin

Ophthalmic artery: terminal

- ICA terminal branch
- branches:
- supraorbital artery —> muscles + skin of forehead and scalp
- supratrochlear artery —> muscles + skin of scalp

Occipital + posterior auricular arteries:

- posterior aspect external carotid artery
- occipital —> scalp at back of head
- posterior auricular —> auricle + scalp posterior to auricle

Venous drainage:
- to internal jugular vein (mainly)

- superficial temporal vein unite with maxillary vein —> form retromandibular vein
- retromandibular vein pass through parotid gland —> divide into ant + post divisions:
- anterior division:
- join facial vein to form common facial vein
- common facial vein drain into internal jugular vein
- posterior division:
- joins posterior auricular vein to form + drain to external jugular vein

Lymphatic drainage of scalp + face:

- Lateral aspect face + scalp —> parotid nodes
- lateral part lower lip —> submandibular nodes
- chin + medial part lower lip —> submental nodes
- back of scalp —> occipital
- scalp above ear, auricle, external auditory meatus —> retroauricular (mastoid)

- lymph from all regional nodes eventually same route:

- regional lymph nodes
- deep cervical lymph nodes
- jugular trunk
- thoracic or right lymphatic duct
- IJV or brachiocephalic vein

Innervation:
- sensory: trigeminal nerve
- motor: facial nerve

Tongue:
- muscular structure forming part of floor of oral cavity + part of anterior wall of oropharynx
- mass of skeletal muscle covered by oral mucosa
- muscles from each side tongue meet at midline fibrous septum
- apex of tongue; root of tongue: attached to mandible + hyoid bone
- Oral part: anterior 2/3, horizontal plane
- Pharyngeal part: post 1/3, vertical plane
- terminal sulcus: demarcate oral + pharyngeal part (ant + post parts)
- foramen caecum: remnant of embryological development where epithelium invaginated to form thyroid
gland

- Dorsal/ superior surface:

- numerous papillae:
- Filiform papillae: small cone shaped; sensitive to touch but not taste
- Fungiform papillae: rounder shape + larger than filiform (margin of tongue)
- Vallate papillae: largest; blunt cylindrical invaginations — v shaped ant to terminal
sulcus
- Foliate papillae: linear folds of mucosa on sides near terminal sulcus
- sulcus terminalis
- rough appearance
- specialised mucosa

- Ventral/ inferior surface:

- lingual frenulum: continuous with mucosa covering floor (median fold)
- covered with lining mucosa
- transparent mucous membrane; underlying veins evident
- smooth shine appearance

- Type of tissue underlies mucosa of posterior 1/3 of tongue + responsible for nodular appearance??????

Muscles of tongue:
- all muscles innervated by hypoglossal nerve (XII) except palatoglossus— vague nerve (X)

Intrinsic muscles:
- originate + insert in tongue
- alter shape of tongue:
- shorten + lengthen
- curling + uncurling apex + edges
- flatten + rounding surface
- 4 muscles:
- inferior longitudinal
- superior longitudinal
- transverse
- vertical

Extrinsic muscles:
- originate outside tongue + insert into tongue
- alter position of tongue
Extrinsic
tongue O I Action Innervation
muscles
- Clinical: stick
body of hyoid
superior part tongue out test CN
entire lengths protrude tongue;
Genioglossus mental spines of XII - dysfunction:
of tongue depress centre
mandible tip of tongue point
dorsum
towards

body + greater inferior aspect

Hypoglossal
Hyoglossus horn of hyoid lateral margin depress tongue
Nerve (CN
bone tongue
XII)
- pass between
middle, superior
lateral margin elevate sides?? + constrictor +
styloglossus styloid process
tongue retract tongue mylohyoid muscles
- blend with superior
margin hyoglossus

narrow oropharyngeal
isthmus during
swallowing
inferior surface - muscles of soft
lateral margin - depress soft palate Vagus Nerve
Palatoglossus palatine palate of tongue
tongue - move palatoglossal (CN X)
aponeurosis
fold to midline
- elevate back of
tongue

Tongue Innervation:
Glossopharyngeal nerve:
- general + special (taste) sensation posterior 1/3 tongue

Facial nerve:
- Chorda tympani: special sensation (taste) anterior 2/3 tongue

Hypoglossal nerve:
- motor to all tongue muscles (intrinsic + extrinsic) except palatoglossus

Trigeminal nerve:
- mandibular nerve (v3): general sensation anterior 2/3 tongue; via lingual nerve

Vagus nerve:
- pharyngeal plexus: motor to palatoglossus muscle