Before we start the lecture the doctor said a note he didnt mention it in previous lectures which is : The innervation

for : * geniohyoid muscle ( suprahyoid muscle ) * thyrohyoid muscle ( infrahyoid muscle ) The inervation for these muscles is c1 via hypoglossal nerve ** What do we mean by this ? We mean that a branch from first cervical spinal nerve ( c1) will inervate these muscles , however this nerve is so weak and tiny so it can`t reach it`s destination to these 2 muscles directly so it needs to be attached or traveled with another stronger nerve which is the hypoglossal nerve ( cranial nerve number 12) so c1 branch will go up and travel within the fascial covering or the fascial sheath of hypoglossal nerve .. All the way until it reach these muscles then c1 will leave the sheath of the hypoglossal nerve to go and innervate these 2 muscles .

** So what do we mean by c1 via hypoglossal nerve ? The muscles are innervated by a branch of c1 that travels by hypoglossal nerve .. ** Today we will speak about a new topic which is the face When we talk about the soft tissues of the head we first go to the anterior aspect of the head which we refer to it the face .. So in anatomical definition of the face : its the anterior aspect of the head with the following borders ( boundaries ) anterior to the ears ( auricles )

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from the forehead superiorly to the chin inferiorly which is the mental area

The shape of the face is determined by underlying facial bones ( 14 bones .. part of the skull ) the shape of these bones , how they calcified & produce there shap will determine the shape of your face . In the face there is some thing very important which is NO deep fascia there .. so the layers will be

skin superficial fascia ( fat layer ) muscles and bones so that`s why when the face injurys during face laceration , the injured area lead to be far away from each other (two sides of injury) they just distinct far away from each other . Because when usually there is a deep fascia it will keep the soft tissues ( the injured ones whish are the skin or the superficial fascia ) close to each other so the healing can easily happened ..However in the face they will stay far away from each other ( not thing will close them ) thats why the healing in the face usually ends with scaring ( connective tissue forms there to produce a scar ) To prevent scar formation we need a careful suturing for the injured area . * What are there in the face ? _ arteries , veins , nerves and specific structures which are the muscles

These muscles we refer to them as the facial expression muscles .. They are distinct kind of skeletal muscles because they related more in moving the skin not the bone In another muscles like muscles of mastication or upper limb , they have attached from bone to bone so when they contract they move the bone ,
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while the muscles in the face have one attachment to the bone and the another attachment is to the skin So when they contract they move the skin producing the face expression as when you are happy , sad and so on .. ( express the feeling ) In addition to these muscles you will find distinct muscles for mastication these muscles of mastication are 4 in number .. two from outside you can find them in the face and two inside of the ramus of the mandible 2 in the face region ( outside of the mandible ) 2 deep to the mandible ( in infra temporal fossa which is an area below to temporal bone ) The two ones in the face you can see them we refer to them as the : 1- Masseter(in the outer surface of the ramus of the mandible to the zygomatic arch ) 2- temporalis( part of it ( anterior half of temporalis which located anterior to the ear extended into the face ) So we have two muscles of mastication we can find them in the face the anterior part of temporalis ( largest one of mastication ) masseter muscle

Why do we call it muscle of mastication ? ( chewing ) Because they are responsible in moving the mandible at the TMJ ( lateral movement , elevation and depression of the mandible ) which will help in masticating the food ..

What else there is in the face ?? * VAN ( arteries , veins and nerves ) 1- vein ( the main vein is the facial nerve ) 2- artery ( facial artery which arise from anterior external carotid artery )

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3- nerves

* for sensation * motor inervation ( for the muscle of the facial expression )

** the motor nerve is cranial nerve ( number 7 ) which is the facial nerve ( that`s why we call it facial because it goes to the face and give motor inervation to the muscle of fasial expression ) .. **The another one is responsible for sensation which is the trigeminal nerve , tri mean three, so it have three branches * ophthalmic branch * maxillary branch * mandibular branch ** So if we mention any muscle of the face expression what`s the inervation ? It`s the facial nerve ** And if we mention any muscle of mastication the inervation will be mandibular branch of trigeminal nerve Starting with the muscles 1- temporalis muscle ( the largest one of mastication ) 2- masseter muscle ( strongest muscle of mastication ) Both of these muscles are responsible in elevating the mandible as when you pit in your tooth .

The muscle of facial expression Distinct or Special group of muscles you have to know their main characteristic
1- located within the superficial fascia of the face because there is no

deep fascia in the face .. why ? because you know that the deep facia usually cover the muscle to protect it . why these muscles don`t need a deep fascia ? because they have to be attached to the skin . if you

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have a deep fascia you need to separate them from the skin , they need to be attached to the skin to move it .
2- attached to bony part from one side and to skin in another side to

move it
3- They have no tendons .. specially in skin area .. why ? because there is

no bone there So the bone is a hard tissue whereas the muscle is a soft tissue ..in order for a muscle to attached to hard tissue you need an intermediary which is the tendon ( dense regular connective tissue ) .. But when you have soft tissue ( muscle ) with another soft one ( skin) you don`t need a tendon 4- they are inervated by facial nerve

MAIN MUSCLE OF FACIAL EXPRESSION

(you need to know these muscles in the lab, not in the theoretical exam, these muscles more important in the practical exam ) 1- Occipito-frontalis muscle -(From its name) it is ascending from occipital bone through an intermediate tendon (but these tendon consider as apenuroses more than tendon) then go all the way anteriorly to the frontal bone. So it is attaching to superior nuchal line of the occipital bone, and its frontal belly attaches to the skin over the eyebrows, so when these muscle contracts: it will elevate the eyebrows up, produce the folding in your forehead. 2-Orbicularis oculi muscle (Orbicular: from orbit)

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So, this muscle surrounds the orbital area, and it is going around the eyeball. When it contracts, it will lead to closing your eye. 3-Orbicularis oris muscle These muscle also has orbital shape but it surrounds the mouth (oris=oral cavity) And it is responsible for closing the mouth (compresses the lips together) 4-Nasalis muscle (From its name = it is located in the nose) This muscle is 2 parts: A) One responsible for dilating the nasal opening = dilator naris (Naris means anterior opening of the nasal cavity) B) Another one responsible for compressing the nasal opening = compressor nasi 5- Zygomaticus muscle attaches to the zygomatic bone descend down to the upper lips, there is a large one below zygomaticus major, and one above zygomaticus minor. 6- the most important one is the buccinator muscle it is the main muscle of the cheek, and it is the muscle that keep your cheek tight, preventing its folding specially during chewing, so you will not injure your cheek. (In other word, it compresses cheeks and lips against teeth). Also it is responsible for the movement of the cheek, like when you are using an instrument, whistling, smiling, and chewing. SO, IT IS THE MAIN MUSCLE OF THE CHEEK

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Levator=elev

7- now , we have 2 groups of muscle related to the lips (levator&depressors) levator= elevate the lips up ***LEVATOR A) levator labii superioris muscle <<< elevate the lips superiorly . B) Levator anguli oris muscle <<< elevate the angle of the mouth. ***DEPRESSOR A)Depressor labii inferioris<<< depress the lower lips down. B) Depressor anguli oris <<< depress the angle of the mouth down. There is another very tiny &small muscle (part of it comes from levator labii, and another part comes from nasalis muscle) so that it is dilating the alae of the nose. it has the LONGEST NAME <<< levator labii superioris alaeque nasi muscle 8- platysma muscle consedered one of the muscle of the neck region but it is also depressing the angle of the mouth ,so that it is consedered one of the muscle of the facial expression . 9- aurcular muscle those muscle are related to the auricle *one anterior to the auricle= anterior auricularis. *one posterior to the auricle=posterior auricularis. *one superior to the auricle= superior auricularis. depressor=depressed your lips down

ate
-labii=lips -superioris= superiorly __________ _ -anguli=relat ed to the angle. oris= related to

Alae of the nose: the prominent part of the lower lateral aspect of the nose.

(some people have the ability to move those muscle , so they have the ability to move their ears ) WHAT IS THE INNERVATION FOR ALL THESE GROUP OF MUSCLE ?? FACIAL NERVE

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Facial nerve
since it is the main motor supply to the face, that means ,it is the main motor innervation to the muscle of facial expression . the facial nerve originats in the brain (C7) within posterior cranial fossa between the pons and medulla oblingata in the brain , then it will enter the skull through internal auditory meatus ( THESE IS THE FIRST STORY ) . then it will pass insid the peterous part of temporal bone within the posterior wall of middle ear , all the way anteriorly until its reach an opening there (to go outside the skull) , we called these opening stylomastoid foramen (THESE IS THE SECOND STORY ) . then after it leaves the peterous part of temporal bone through stylomastoid foramen ,it will descend down into the face ( AND THESE IS THE THIRD STORY) . Once it leaves stylomastoid foramen ,it will give a motor branch which will go behind the auricl <<< posterior auricular nerve . post auricular nerve will give motor innervation to occipital part of occipito-frontalis muscle & posterior auricularis muscle .

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So this is the third part of facial nerve >> it exits the skull throw stylomastoid foramen Once it leaves there it gives a motor branch . Motor facia gives a motor branch that goes behind the Auricle >>>> ( posterior Auricular nerve) since it motor its main function is to provide innervations to the occipitalis part of occipitfrontalis muscle and to posterior auricularis . So it goes from stylomastoid foramen >> firstly it gives the posterior auricular nerve that gives innervation to occipitalis and posterior auricular nerve . Then the nerve moves down forward > then enters the parotid gland which is the largest salaivary gland in your body .

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Now within the parotid inside the parotid tissue the facial nerve terminates by dividing into 5 branches you can know them by putting your fingers at the side of your face : 12345going up to the temporal >> temporal branch .(superior aspect) go over the zygomatic bone >> zygomatic branch .(anterior aspect) over the cheek >> buccinator muscle .(anterior aspect) over the mandible >> manibular branch .(anterior aspect) go to the neck >> cervical branch .(lower part of the gland)

So it terminates in the parotid into 5 branches . All of them are motor branches to the muscles of facial expression.

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* How many branches for the facial nerve are there in the face ? 6 branches. * How many branches are within the parotid? 5 branches.

This is very useful that let you know wheres the problem exactly .

So if you have for example a tumor (>> ) in the parotid gland this tumor will make pressure on the 5 facial branches leading to paralysis of these muscles or paresthesia ( facial palsy).

How ever if you look carefully and find that the posterior auricularis and occipitalis are still functioning that indicate thats the tumor below ( within the parotid gland ) so the 5 branches only will affected .

How ever if the tumor was there up within the skull for example within petrous part or within the middle ear >>> the whole six branches will be affected.

1- Temporalis goes up all the way to provide innervation to frontalis muscle , upper half of Orbicularis Oculi >>> this is very important muscle its innervated lower half from zygomatic., and lateral and superior auriculars.

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2- Zygomatic branch > to the lower half of orbicularis oculi to the zygomatic muscles. 3- The buccal branch >> over the buccinator to the cheek so we call it buccal ( adjective to the cheek). Innervate the muscles of the cheek >> buccinator and muscles of the upper limb ( levators lepiae superior and levator angulis oris) and also the upper half of the orbicularis oris. There is another sensory branch >> buccal branch from trigeminal.

Sensation in the face >> trigeminal Motor to the face >> facial

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In the cheek area the motor buccal and the sensory buccal so in any answer in anatomy if you mention buccal nerve you have to follow it with its origin to make specific which one you mean.

Buccal trigeminal >> sensory. Buccal facial >> motor.

4- The mandibular branch to the lower lip muscle ( depressors) and mentalis. 5- Cervical branch >>

A- platysma. B- the two other muscles but not included in facial expression and innervated by this branch >> styloid and posterior belly of digastric (suprahyoid muscles).

Facial palsy:

Injury in facial nerve due to many reasons may be it is just a trauma so you should know which branch is injury in order to know that each branch and which muscle it innervate .

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For example if you look to the injury and you find that there is drop in the lower eyelid >> zygomatic branch.

If you had a drop in the angle of the mouth >> buccal branch to the levators so levator and lips go down . If there is a malignancy, cancer in the parotid gland (mainly 80 % of the tumors for salivary glands in the parotid).

If there is an inflammation in parotid or facial covering of the parotid itself specially if the inflammation was high up in the middle ear >> can make spread and make inflammation in facial nerve. in this case all the facial nerve >> paralysis .

So it is called bells palsy >> Because it will be difficult to identify the cause ( idiopathic) that means when there is a problem high up with in the skull. Signs of injury those are very important: - dropping of the angles of the mouth and lower eyelid. By the action of the gravity because the levator are no longer function so there is a dropping down ( sagging) of the LOWER eyelid and the angle of the mouth in the affected side so if you look to this side the right fascia will affected. Its also will lead to difficulty in blinking , Why you do blinking most of the time ? to replicate the cornea Avascular

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when you have a paralysis in orbicularis oclli your lower eyelid is drop down you cant close it open to the atmosphere , SO ,, the difficulty in blinking will lead to corneal dehydration that lead to Ulcer cornea . Disturbance in taste because of injury in Chorda tympani nerve Facial special sensation nerve . NOTE : SPECIAL SENSE IT HAVE A SPEIAL CRANIAL NERVE AND SPECIAL AREA IN THE BRAIN . the taste sensation in the anterior 2/3 of the tongue carried up by facial nerve Inside the petrous part second part of the facial nerve behind the middle ear facial nerve will give a branch , go through middle ear leaves the anterior aspect , leaving the skull all the way down to go and attached to the lingual nerve ,, to the tongue Lingual nerve is branched from trigeminal nerve General Sensation the branch of the facial nerve give Taste sensation if the problem or the injury is after the middle ear so you dont have a problem with taste sensation .

Facial palsy with taste disturbance = the problem is high up within the skull Facial palsy = down outside the skull

The other nerve that found in the face Trigiminal Nerve * Sensory nerve * have 3 branches * ophthalmic nerve V1 * maxillary nerve V2 * Mandibular V3 sensory and motor ALL MASTICATION and tensors MUCSLES ARE MOTOR SUPPLY BY Madibular nerve . any muscle of facial expression by facial nerve .
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