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Face and Related Structures Anatomy

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Presentation on theme: "Face and Related Structures Anatomy"— Presentation transcript:

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

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

3 Clinical Anatomy



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

7 Clinical Anatomy Hyoid Bone: Location – in the human neck
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 Shaped like a horseshoe

8 Clinical Anatomy Temporomandibular Joint: (TMJ) Type – Synovial Joint
Articulation between mandibular condylar process and temporal bone Articular disc separates the 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 Mandibular condyle glides forward as mouth opens Actions/Purpose: Speaking Mastication

9 Clinical Anatomy

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

11 Clinical Anatomy External Ear: Auricle (Pinna): Ear Canal:
Cartilaginous tissue Acts as a funnel - collecting/focusing sound waves into the external auditory meatus to be passed on to middle ear Ear Canal: 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)

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

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


15 Clinical Anatomy Eustachian Tube: Links the pharynx to the middle ear
Regulates pressure in middle ear Normally closed Can open (air enters) to equalize the pressure between the middle ear and the atmosphere Pressure equalized – Small Pop Flying/Driving in mountains 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 Ear susceptible to damage

16 Clinical Anatomy Inner Ear: Cochlea and Semicircular Canal
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) Balance, Upright posture (head and body)


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

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

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

21 Bicuspids (premolars)
Clinical Anatomy Teeth Classification and Function: Type Number Function Incisors 4 Cutting Cuspids (canines) 2 Tearing Bicuspids (premolars) Crushing and grinding Molars 6

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

23 Clinical Anatomy Muscles of Mastication:
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 I: Superficial: Inferior ½ of lateral ramus (mandible) Profundus portion: Superior ½ of ramus, coronoid process of mandible N: Trigeminal

24 Muscles of Expression:
Action Origin Insertion 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 Depressor Labii Inferioris Lowers the mouth Lower lip Digastric Opens mouth Inferior border of mandible Superior aspect of hyoid bone Trigeminal Geniohyoid Median ridge of mandible Body of hyoid bone Ansa Cervicalis Levator Anguli Oris Raises each side of mouth Just superior to canine teeth

25 Muscles of Expression:
Action Origin Insertion 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 Procerus Wrinkles the nose Lower portion of the nasal bone; Lateral nasal cartilage Lower portion of the forehead between the eyebrow Temporalis Aids in biting Temporal fossa Coronoid process and ramus of mandible Zygomaticus Major Smiling Zygomatic bone Angle of mouth


27 Clinical Anatomy Bell’s Palsy:
Inhibition of facial nerve (cranial nerve VII) → inability to control facial muscles (resultant flaccidity) 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 Cause: Inflammation of facial nerve (resultant pinching) 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: Location of Pain:
Pressure/pain in middle or inner ear → infection or tympanic membrane rupture Otitis Externa (Swimmer’s Ear) → chronic pain/itching Activity and MOI: Blunt trauma Slapping blow → tympanic membrane rupture Middle ear infections → URI (inflamed mucus membranes that block eustachian tubes) Other Symptoms: Tinnitus (ringing in ear) Dizziness

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

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

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

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

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

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

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

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

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

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

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

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

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