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Face and Related Structures Anatomy Orthopedic Assessment III – Head, Spine, and Trunk with Lab PET 5609C.

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Presentation on theme: "Face and Related Structures Anatomy Orthopedic Assessment III – Head, Spine, and Trunk with Lab PET 5609C."— Presentation transcript:

1 Face and Related Structures Anatomy Orthopedic Assessment III – Head, Spine, and Trunk with Lab PET 5609C

2 Clinical Anatomy Facial Bones: Facial Bones: Vomer Vomer Inferior Nasal Concha Inferior Nasal Concha Nasal bone Nasal bone Maxilla Maxilla Mandible Mandible Palatine bone Palatine bone Zygomatic bone Zygomatic bone Lacrimal bone Lacrimal bone Hyoid (may or may not be included) Hyoid (may or may not be included) "Virgil Can Not Make My Pet Zebra Laugh" "Virgil Can Not Make My Pet Zebra Laugh"

3 Clinical Anatomy

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6 Facial Bones: Facial Bones: Palatine Bone: Palatine Bone: Irregular shaped bone posterior to the maxilla Irregular shaped bone posterior to the maxilla Forms part of the nasal cavity, the eye socket, and the hard palate Forms part of the nasal cavity, the eye socket, and the hard palate

7 Clinical Anatomy Hyoid Bone: Hyoid Bone: Location – in the human neck Location – in the human neck Only bone in the skeleton not articulated to any other bone Only bone in the skeleton not articulated to any other bone Supported by the muscles of the neck and in turn supports the root of the tongue Supported by the muscles of the neck and in turn supports the root of the tongue Shaped like a horseshoe Shaped like a horseshoe

8 Clinical Anatomy Temporomandibular Joint: (TMJ) Temporomandibular Joint: (TMJ) Type – Synovial Joint Type – Synovial Joint Articulation between mandibular condylar process and temporal bone Articulation between mandibular condylar process and temporal bone Articular disc separates the 2 bones Articular disc separates the 2 bones Concave on both superior and inferior surfaces allowing for smooth articulation between 2 bones Concave on both superior and inferior surfaces allowing for smooth articulation between 2 bones Disc injury – locking/catching with opening and closing of mouth Disc injury – locking/catching with opening and closing of mouth Mandibular condyle glides forward as mouth opens Mandibular condyle glides forward as mouth opens Actions/Purpose: Actions/Purpose: Speaking Speaking Mastication Mastication

9 Clinical Anatomy

10 Ear: Ear: Focuses/converts acoustical energy into an electrical signal for interpretation by brain Focuses/converts acoustical energy into an electrical signal for interpretation by brain Parts: Parts: External Ear External Ear Middle Ear Middle Ear Inner Ear Inner Ear

11 Clinical Anatomy External Ear: External Ear: Auricle (Pinna): Auricle (Pinna): Cartilaginous tissue Cartilaginous tissue Acts as a funnel - collecting/focusing sound waves into the external auditory meatus to be passed on to middle ear Acts as a funnel - collecting/focusing sound waves into the external auditory meatus to be passed on to middle ear Ear Canal: Ear Canal: Tube running from the outer ear to the middle ear Tube running from the outer ear to the middle ear Extends from the pinna to the eardrum (26 mm in length and 7 mm in diameter) Extends from the pinna to the eardrum (26 mm in length and 7 mm in diameter)

12 Clinical Anatomy Middle Ear: Middle Ear: Tympanic Membrane – Eardrum: Tympanic Membrane – Eardrum: Outer barrier of middle ear Outer barrier of middle ear Made of thin connective tissue membrane Made of thin connective tissue membrane Skin on the outside Skin on the outside Mucosa on internal surface Mucosa on internal surface Acts as microphone Acts as microphone Sound waves strike tympanic membrane causing vibration Sound waves strike tympanic membrane causing vibration Vibrations transferred to auditory ossicles (malleus, incus, stapes) Vibrations transferred to auditory ossicles (malleus, incus, stapes)

13 Clinical Anatomy Middle Ear: Middle Ear: Auditory Ossicles: Auditory Ossicles: Malleus Malleus Incus Incus Stapes Stapes Note: 3 smallest bones in human body Note: 3 smallest bones in human body Role: Transmit sounds to cochlea Role: Transmit sounds to cochlea

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15 Clinical Anatomy Eustachian Tube: Eustachian Tube: Links the pharynx to the middle ear Links the pharynx to the middle ear Regulates pressure in middle ear Regulates pressure in middle ear Normally closed Normally closed Can open (air enters) to equalize the pressure between the middle ear and the atmosphere Can open (air enters) to equalize the pressure between the middle ear and the atmosphere Pressure equalized – Small Pop Pressure equalized – Small Pop Flying/Driving in mountains Flying/Driving in mountains Yawning/swallowing can pull on muscles in the neck – tube opens Yawning/swallowing can pull on muscles in the neck – tube opens Without ET, air could not escape from the ear, isolating the middle ear from atmosphere Without ET, air could not escape from the ear, isolating the middle ear from atmosphere Ear susceptible to damage Ear susceptible to damage

16 Clinical Anatomy Inner Ear: Inner Ear: Cochlea and Semicircular Canal Cochlea and Semicircular Canal Bony structure (coiled shape) – moves ( ↑, ↓) in response to acoustic signals Bony structure (coiled shape) – moves ( ↑, ↓) in response to acoustic signals Semicircular Canal: Fluid filled with thousands of fine hair cells (motion sensors) to detect signal → electrical impulses (Vestibulocochlear Nerve) Semicircular Canal: Fluid filled with thousands of fine hair cells (motion sensors) to detect signal → electrical impulses (Vestibulocochlear Nerve) Balance, Upright posture (head and body) Balance, Upright posture (head and body)

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18 Clinical Anatomy Nose: Nose: Nasal cartilage Nasal cartilage Nostrils: external nasal openings (air enters → inferior, middle and superior concha → pharynx → trachea → lungs) Nostrils: external nasal openings (air enters → inferior, middle and superior concha → pharynx → trachea → lungs) Mucosal Cells: Mucosal Cells: Warms/humidifies cool, dry air Warms/humidifies cool, dry air Mucus production Mucus production

19 Clinical Anatomy Throat: Throat: Larynx: Larynx: Contains vocal cords Contains vocal cords Located between pharynx and trachea Located between pharynx and trachea Covered superiorly by thyroid cartilage (Adam’s Apple); inferiorly by cricoid cartilage Covered superiorly by thyroid cartilage (Adam’s Apple); inferiorly by cricoid cartilage

20 Clinical Anatomy Mouth: Mouth: Oral Vestibule – anterior most portion of mouth Oral Vestibule – anterior most portion of mouth Area from lips to teeth Area from lips to teeth Oral Cavity – past teeth leading to trachea Oral Cavity – past teeth leading to trachea Tongue – skeletal muscle Tongue – skeletal muscle Primary organ of taste Primary organ of taste Manipulates food (chewing/swallowing) Manipulates food (chewing/swallowing) Covered with papillae (small, rough-like projections) and taste buds Covered with papillae (small, rough-like projections) and taste buds

21 Clinical Anatomy TypeNumberFunctionIncisors4Cutting Cuspids (canines) 2Tearing Bicuspids (premolars) 4 Crushing and grinding Molars6 Teeth Classification and Function:

22 Clinical Anatomy Tooth Anatomy: Tooth Anatomy: Root: Root: Anchored by cementum and small ligaments Anchored by cementum and small ligaments Neck Neck Crown: Crown: Dentin Dentin Enamel Enamel Core of tooth: Core of tooth: Pulp chamber Pulp chamber Nerves and Blood vessels Nerves and Blood vessels

23 Clinical Anatomy Muscles of Mastication: Muscles of Mastication: Masseter → closes mouth/aids in biting Masseter → closes mouth/aids in biting O: Superficial portion: Zygomatic process of maxilla; anterior 2/3 of zygomatic arch. Profundus portion: Posterior 1/3 of zygomatic arch O: Superficial portion: Zygomatic process of maxilla; anterior 2/3 of zygomatic arch. Profundus portion: Posterior 1/3 of zygomatic arch I: Superficial: Inferior ½ of lateral ramus (mandible) Profundus portion: Superior ½ of ramus, coronoid process of mandible I: Superficial: Inferior ½ of lateral ramus (mandible) Profundus portion: Superior ½ of ramus, coronoid process of mandible N: Trigeminal N: Trigeminal

24 Muscle Muscle Action Action Origin Origin Insertion Insertion Innervation Innervation Buccinator Depresses the cheeks Alveolar process of maxilla and mandible Angle of mouth Facial Depressor Anguli Oris Draws angle of mouth downward Oblique line of mandible Angle of mouth Facial Depressor Labii Inferioris Lowers the mouth Oblique line of mandible Lower lip Facial Digastric Opens mouth Inferior border of mandible Superior aspect of hyoid bone Trigeminal Geniohyoid Opens mouth Median ridge of mandible Body of hyoid bone Ansa Cervicalis Levator Anguli Oris Raises each side of mouth Just superior to canine teeth Angle of mouth Facial Muscles of Expression:

25 Muscle Muscle Action Action Origin Origin Insertion Insertion Innervation Innervation Mentalis Elevates the skin of the chin Incisive fossa of the mandible Point of the mandible Facial Mylohyoid Opens the mouth Inferior border of the mandible Superior aspect of hyoid bone Trigeminal Orbicularis Oris “Puckers” the lips Originates off of the muscles surrounding the mouth Skin surrounding the lips Facial Procerus Wrinkles the nose Lower portion of the nasal bone; Lateral nasal cartilage Lower portion of the forehead between the eyebrow Facial Temporalis Aids in biting Temporal fossa Coronoid process and ramus of mandible Trigeminal Zygomaticus Major Smiling Zygomatic bone Angle of mouth Facial Muscles of Expression:

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27 Clinical Anatomy Bell’s Palsy: Bell’s Palsy: Inhibition of facial nerve (cranial nerve VII) → inability to control facial muscles (resultant flaccidity) Inhibition of facial nerve (cranial nerve VII) → inability to control facial muscles (resultant flaccidity) Most common cause of Acute Facial Nerve Paralysis Most common cause of Acute Facial Nerve Paralysis Symptoms: weakness on one side of face, facial droop, pain on affected side, headache, loss of taste Symptoms: weakness on one side of face, facial droop, pain on affected side, headache, loss of taste Cause: Inflammation of facial nerve (resultant pinching) Cause: Inflammation of facial nerve (resultant pinching) Infection or Virus Infection or Virus

28 A) Demonstrates inability to raise the left eyebrow or generate wrinkles on the left side of forehead; B) Demonstrates difficulty closing the left eye and inability to raise the left corner of mouth; C) Demonstrates drooping at the left corner of mouth and inability to completely close the left eye. These findings are the result of idiopathic peripheral cranial nerve 7 palsy (Bell's palsy).

29 Clinical Evaluation History Involving the Ear: History Involving the Ear: Location of Pain: Location of Pain: Pressure/pain in middle or inner ear → infection or tympanic membrane rupture Pressure/pain in middle or inner ear → infection or tympanic membrane rupture Otitis Externa (Swimmer’s Ear) → chronic pain/itching Otitis Externa (Swimmer’s Ear) → chronic pain/itching Activity and MOI: Activity and MOI: Blunt trauma Blunt trauma Slapping blow → tympanic membrane rupture Slapping blow → tympanic membrane rupture Middle ear infections → URI (inflamed mucus membranes that block eustachian tubes) Middle ear infections → URI (inflamed mucus membranes that block eustachian tubes) Other Symptoms: Other Symptoms: Tinnitus (ringing in ear) Tinnitus (ringing in ear) Dizziness Dizziness

30 Clinical Evaluation History Involving the Nose: History Involving the Nose: Location of Pain Location of Pain Onset: Onset: Acute Acute Insidious onset: Insidious onset: Sinusitis – inflammation of paranasal sinuses Sinusitis – inflammation of paranasal sinuses URI – acute infection involving nose, sinuses, pharynx or larynx URI – acute infection involving nose, sinuses, pharynx or larynx Activity and MOI: Activity and MOI: Direct blow to nasal bone or cartilage Direct blow to nasal bone or cartilage Symptoms: Symptoms: Pain, bleeding Pain, bleeding Medical History: Medical History: Past nasal trauma (previous fracture → deformity) Past nasal trauma (previous fracture → deformity)

31 Clinical Evaluation History Involving the Throat: History Involving the Throat: Location of Pain: Location of Pain: Trauma → anterior throat pain Trauma → anterior throat pain Sore throat → pain deep in neck Sore throat → pain deep in neck Onset → acute Onset → acute Activity and MOI: Activity and MOI: Trauma (struck by ball, bat, elbow) Trauma (struck by ball, bat, elbow) Symptoms: Symptoms: Inability to speak → crushed larynx, respiratory distress Inability to speak → crushed larynx, respiratory distress

32 Clinical Evaluation History Involving Maxillofacial Injuries: History Involving Maxillofacial Injuries: Location of Pain Location of Pain Onset → acute and direct result of trauma Onset → acute and direct result of trauma Nonathletic Injuries → dental caries, Bell’s palsy Nonathletic Injuries → dental caries, Bell’s palsy Activity and MOI: Activity and MOI: Trauma (struck by ball, bat, elbow) Trauma (struck by ball, bat, elbow) Other Symptoms: Other Symptoms: Vision impairment, difficulty with eye movements Vision impairment, difficulty with eye movements TMJ impairment TMJ impairment

33 Clinical Evaluation Inspection of the Ear: Inspection of the Ear: Auricle: Auricle: Contusion/lacerations/avulsion Contusion/lacerations/avulsion Hematoma within Auricle: Hematoma within Auricle: Auricular Hematoma (Cauliflower Ear) Auricular Hematoma (Cauliflower Ear) Tympanic Membrane: Tympanic Membrane: Inspection with Otoscope Inspection with Otoscope Shiny, translucent, smooth Shiny, translucent, smooth Suspected disruption/fluid in membrane → refer! Suspected disruption/fluid in membrane → refer! Periauricular Area: Periauricular Area: Battle’s Sign → ecchymosis around mastoid process Battle’s Sign → ecchymosis around mastoid process Basilar skull fracture Basilar skull fracture

34 Clinical Evaluation Inspection of the Nose: Inspection of the Nose: Alignment Alignment Epistaxis: Epistaxis: Light → anterior portion Light → anterior portion Moderate to Heavy → Posterior Moderate to Heavy → Posterior Septum and Mucosa: Septum and Mucosa: Otoscope or penlight Otoscope or penlight Septum should appear symmetrical/straight Septum should appear symmetrical/straight Eyes and Face: Eyes and Face: Raccoon eyes → ecchymosis under eyes Raccoon eyes → ecchymosis under eyes

35 Clinical Evaluation Inspection of the Throat: Inspection of the Throat: Respiration patterns Respiration patterns Thyroid and Cricoid cartilages Thyroid and Cricoid cartilages Any deformity → medical emergency (airway compromised) Any deformity → medical emergency (airway compromised)

36 Clinical Evaluation Inspection of the Face and Jaw: Inspection of the Face and Jaw: Bleeding Bleeding Ecchymosis: Ecchymosis: Periorbital Ecchymosis → fracture to nasal, maxilla, zygomatic bones Periorbital Ecchymosis → fracture to nasal, maxilla, zygomatic bones Symmetry: Symmetry: Any deformity/swelling Any deformity/swelling Muscle tone: Muscle tone: Movement of mouth, eyebrows, forehead Movement of mouth, eyebrows, forehead

37 Clinical Evaluation Inspection of the Oral Cavity: Inspection of the Oral Cavity: Lips → lacerations Lips → lacerations Teeth Teeth Tongue Tongue Lingual Frenulum Lingual Frenulum Ask patient to lift the tongue Ask patient to lift the tongue Gums: Gums: Gingivitis → inflammation of gums Gingivitis → inflammation of gums

38 Clinical Evaluation Palpation: Palpation: Nasal Bone Nasal Bone Nasal Cartilage Nasal Cartilage Zygoma Zygoma Maxilla Maxilla TMJ TMJ Periauricular Area Periauricular Area Palpation: External Ear Teeth Mandible Hyoid Bone Cricoid and Thyroid Cartilage

39 Clinical Evaluation Palpation of TMJ Joint: Palpation of TMJ Joint: External palpation: External palpation: Note any clicking/locking of joint Note any clicking/locking of joint Patient opens/closes mouth Patient opens/closes mouth Internal palpation: Internal palpation: Patient opens/closes mouth Patient opens/closes mouth

40 Clinical Evaluation Functional Testing: Functional Testing: Tests for the Ear: Tests for the Ear: Hearing → Does hearing return quickly? Hearing → Does hearing return quickly? Balance and Dizziness Balance and Dizziness Tests for the Nose: Tests for the Nose: Smell Smell

41 Clinical Evaluation Functional Testing: Functional Testing: TMJ involvement: TMJ involvement: Opening and Closing Mouth Opening and Closing Mouth Normal → mouth can open wide enough to insert 2 knuckles Normal → mouth can open wide enough to insert 2 knuckles Inability → Decreased TMJ ROM Inability → Decreased TMJ ROM Malocclusion: Malocclusion: Any lateral deviation → misalignment of teeth Any lateral deviation → misalignment of teeth


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