This particular seminar has been prepared with a Prosthodontic approach in mind.

1. 1
Good Morning
-Karishma
1st year Postgraduate student
Department of Prosthodontics

2. 2
Muscles Of Facial Expression

3. Face as a whole is an index of the
mind, the facial muscles the
messenger of emotions.
3

4. Contents
4
 Introduction
 Muscle Physiology
 Development
 Topographical classification
 Detailed anatomy of each muscle
 Origin; Insertion; Vascular Supply; Innervation & Action

5. Contents
5
 Summary of facial expressions
 Applied aspects
 Bibliography

6. Introduction
6
 Facial musles also known as the ‘mimetic muscles’,
represent remants 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.

7. Muscle Physiology
7

8. 8

9. Development
9

10. Topographical Grouping of Muscles
of Facial expression
10

11. Muscles of
Facial
expression
Of the
Scalp
Of the
Auricle
Of the
Eyelids
Of the
Nose
Around
the
Mouth
Of the
Neck
11

12. 12
Muscles of Scalp
Occipitofrontalis Temporoparietralis

13. Occipitofrontalis
13
Occipital
2 bellies
Frontal
 Origin
•Occipital Bellies :- Lateral 2/3
rd of the highest Nuchal line &
Mastoid process of the temporal
bone.
•Frontal Bellies :- No bony
attachment, Fibers blend with
adjacent muscles.

14. Occipitofrontalis
14
 Insertion Galea Aponeurotica / Epicranial Aponeurosis.
 Vascular Supply Superficial temporal , Opthalmic ,
Posterior
Auricular and occipital arteries
 Innervation Frontal – Posterior Auricular branch of
Facial
nerve
Occipital – Temporal Branch of Facial Nerve.

15. 15
Action Raises the eyebrows
Wrinkles the forehead
Expresses Surprise.

16. Temporoparietalis
16
Lies between the anterior and superior auricular muscles.

17. 17
Muscles of
the eyelid
Orbicularis
Oculi
Corrugator
Supercilli
Levator
Palpebrae
Superioris

18. Orbicularis Oculi
18
 Broad, flat, elliptical muscle that surrounds the
circumference of the orbit & spreads into the
adjacent regions of the eyelids.
3 Parts
Orbital Lacrimal
Palpebral

19. Orbicularis Oculi
19
 Origin
 Orbital part – Medial part of the medial palpebral ligament
 Palpebral part – Lateral part of the medial palpebral ligament
 Lacrimal part – Lacrimal fascia & lacrimal bone
 Insertion
 Orbital part – Concentric rings return to
 the point of origin
 Palpebral part – Lateral palpebral ligament
 Lacrimal part – Upper & lower eyelids

20. Orbicularis Oculi
20
 Vascular Supply Branches of facial , superficial
temporal,
maxillary , ophthalmic arteries.
 Innervation Temporal and zygomatic branches of
facial
nerve.

21. 21
 Action
Orbital part – Closes lid tightly , protects from bright light
Palpebral part – Closes lid gently , blinking
Lacrimal part – Dilates lacrimal sac , supports the lower lid

22. Corrugator Supercilli
22
Origin:- Medial end of
Superciliary Arch.
Insertion:- Skin of mid
eyebrow
Vascular Supply:-
Superficial temporal & Opthalmic
Arteries
Innervation:- Temporal
branch of facial nerve.

23. 23
Action:- Vertical lines
in the forehead ;
Frowning

24. Levator Palpebrae Superioris
24
• A Triangular extraoccular
Muscle.
• Origin:- Lesser Wing of
Sphenoid, just above the
Optic foramen.
 Insertion:- Skin of the upper eyelid, as well as the
superior tarsal plate.

25. Levator Palpebrae Superioris
25
 Vascular Supply:- Opthalmic Artery.
 Innervation:- Occulomotor Nerve.
 Action:- Elevates the upper eyelid.

26. 26
Muscles of
the nose
Procerus Nasalis
Compressor
Naris
Dilator Naris
Depressor
Septi

27. Procerus
27
Origin:- It arises by
tendenious fibers from
the fascia covering the
lower part of the nasal
bone & upper part of
the lateral nasal
cartilage.
Insertion:- Into the
skin of the lower part
of the forehead
between the two
eyebrows.

28. Procerus
28
 Vascular supply:- Branches of Facial Artery
 Innervation:- Temporal & Lower zygomatic branches of
facial nerve.

29. 29
Actions:- Transverse
wrinkles over the bridge of
nose , helps to reduce the
glare of bright light.
Expresses Frowning.

30. Nasalis
30
Transverse part (Compressor Naris)
 Consists of
Alar part (Dilator Naris)
 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.

31. Nasalis
31
Insertion:-
Compressor Naris:- The muscle fibers 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
attatched to the cartilagenous Ala Nasi.

32. Nasalis
32
 Vascular Supply:- Braches of Facial Artery ; Maxillary
artery.
 Innervation:- Buccal & Zygomatic branch of the Facial
nerve.
 Action:-
Transverse:- Compresses the nasal apeture.
Alar:- Widening the anterior nasal apeture.
Deep inspiration.

33. Depressor Septi
33
 Origin – Maxilla above
the central incisor.
 Insertion – Mobile part
of the nasal septum.
 Vascular supply – Facial
 artery.
 Innervation:- Buccal branch of
facial nerve

34. 34
Action:- Pulls the nasal
septum downwards , with
nasalis widens the nasal
aperture.

35. 35
Elevators, evertors & retractors
of upper lip
Depressors, evertors &
retractors of lower lip.
Orbicularis Oris
Buccinator
Muscles around the Mouth.

36. 36
Elevators, evertors & retractors
of upper lip
Levator Labii Superioris Alaque Nasi
Levator Labi Superioris
Levator Anguli Oris
Zygomaticus Major
Zygomaticus Minor
Risorius

37. Levator Labii superioris Alaque
Nasi
37
Origin:- Upper part of the frontal process
of maxilla
Insertion:- Alar cartilage
of nose and skin over it; some fibers
into lateral part of upper lip.
Vascular Supply:- Facial and maxillary artery.
Innervation:- Zygomatic and buccal branches of facial
nerve.
Action:- Raises & everts the upper lip.
Dilates the nostril

38. Levator Labii Superioris
38
Origin:- Maxilla & Zygomatic
bone above the infra orbital
foramen.
Insertion:- Muscular
substance of upper lip.
Vascular Supply:- Facial &
maxillary artery.
Innervation:- Zygomatic &
buccal branches of facial nerve.
Action:- Everts the upper lip.

39. Levator Anguli Oris (Caninus)
39
Origin:- Canine fossa of the maxilla.
Insertion:- Into & below the angle
of the mouth.
Vascular supply:- Facial &
Maxillary artery.
Innervation:- Zygomatic & Buccal
branches of the facial nerve.

40. 40
Action:- Raises the angle of the mouth during sadness
Contributes to depth & contour of nasolabial furrow.

41. Zygomaticus Major
41
Origin:- Zygomatic bone in front
of zygomatico-temporal suture.
Insertion:- Angle of the mouth.
Vasuclar supply:- Facial artery.
Innervation:- Zygomatic &
Buccal branches of facial nerve.

42. 42
Action:- Draws the angle of the mouth upwards & laterally as in
laughing/Smiling.

43. Zygomaticus Minor
43
Origin:- Lateral surface of zygomatic
bone behind the zygomaticomaxillary
suture.
Insertion:- Muscular substances of
upper lip.
Vascular supply:- Facial artery.
Innervation:- Zygomatic & Buccal
branches of facial nerve.

44. 44
Action:- Elevates & curls the
upper lip as in contempt,
smugness or disdain.

45. Risorius
45
Origin:- Massetric Fascia
Insertion:- Skin of the angle
of the mouth
Vascular supply:- Facial
artery
Innervation:- The buccal
branch of the facial nerve

46. 46
Action:- Pulls the angle of the mouth laterally as
in grinning

47. Depressors, evertors & retractors
of lower lip.
47
Depressor Labii
Inferioris
Depressor anguli oris
Mentalis

48. Depressor Labii Inferioris
48
Origin:- Oblique line of the
mandible betweenthe symphysis
menti and mental foramen.
Insertion:- Into the skin &
mucosa of the lower lip.
Action:- Draws the lower lip
downwards & laterally ;
Assists in eversion of lower lip.

49. Depressor Anguli Oris
(Triangularis)
49
Origin:- Mental tubercle of
mandible and its continuation, the
oblique line.
Insertion:- Angle of the
mouth.
Action:- Draws the angle of
mouth downwards and laterally in
opening mouth.
Expresses Grief.

50. Mentalis
50
Origin:- Incisive fossa of the
mandible.
Insertion:- Skin of the chin.
Vascular supply:- Facial &
Maxillary artery.
Innervation:- Mandibular branch
of facial nerve.

51. 51
Action:- Raises the lower lip, wrinkling the skin of the
chin as in doubt

52. Orbicularis Oris
52
Extrinsic Part
Comprises of
Intrinsic Part
Extrinsic part – Consists of fibers of other
muscles which converge on the lips.
Intrinsic part – within the lip consists 3
types of fibers
Radiating Circular Antero- Posterior

53. Orbicularis Oris
53
 Vascular supply –Facial artery.
Maxillary artery.
Superficial temporal artery.
 Innervation:- Buccal & Mandiublar branches of facial
nerve.

54. 54
Action:- Varying kind of movements
of lips like pouting , pursing , twisting.

55. Buccinator
55
Known as the ‘Whistling muscle
Upper fibers
3 types of fibers Middle fibers
Lower fibers
Origin:-
Upper Fibers:- Outer surface of alveolar
process of upper molar teeth
Middle Fibers:- From
Pterygomandibular Raphe
Lower Fibers:- Mandible , opposite the
molar teeth

56. Buccinator
56
Insertion:-
Upper Fibers;- Upper Lip
Lower Fibers:- Lower Lip
Middle fibers:- Decussate
Upper part into lower lip and vice versa.
Vascular supply:- Maxillary
artery.
Innervation:- Buccal branch of
Facial Nerve

57. 57
Action:- Flattens the cheek against the gums & teeth during
mastication &
prevents accumulation food in the vestibule.
Whistling
Blowing

58. Muscle of the neck
Platysma
58
Origin:- Upper parts of pectoral and deltoid fasciae. Fibres run
upwards and medially.
Insertion:-
Anterior fibers:- Base of the Mandible.
Posterior fibers:- Skin of the lower face & lip and may be
continuous with risorius.

59. Platysma
59
 Vascular Supply:- Facial artery.
 Innervation:- Cervical Branch of Facial nerve.

60. 60
Action:- Pulls the angle of the mouth downwards as in horror.

61. 61
Summary of Muscles used for
Facial Expression.

62. Zygomaticus Major - Smiling &
Laughing
62

63. Levator Anguli Oris & Levator
Labii Superioris - Sadness
63

64. Depressor Anguli Oris- Grief
64

65. Dilator Naris & Depressor Septi -
Anger
65

66. Corrugator Supercilli & Procerus
- Frowning
66

67. Frontalis - Surprise
67

68. Platysma - Horror, Terror, Fright
68

69. Mentalis - Doubt
69

70. Risorius – Grinning
70

71. Zygomaticus Minor - Contempt
71

72. Orbicularis Oris – Closing of the
mouth
72

73. Buccinator & Orbicularis Oris -
Whistling
73

74. 74
Applied Anatomy
Modiolus
Myasthenia Gravis
Bell’s Palsy
Congenital Syndromes :- Moebius Syndrome
Melkerson Rosenthal Syndrome

75. Modiolus
75
 Also known as ‘muscular node’
 Chiasma of facial muscles
 Located lateral and slightly superior
to angle of the mouth.
 Muscles Fibers attached are:-
• Buccinator
• Zygomaticus Major
• Orbicularis Oris
• Risorius
• Levator Labii Superioris
• Levator Labii Inferioris
• Levator Anguli Oris
• Depressor Anguli Oris

76. Modiolus
76
 The denture base must be contoured to allow the
modiolus to function freely.
 The labial flanges of the maxillary denture frequently
need to be reduced latero-medially in the area of the
modiolus.
 The mandibular denture in the premolar region
should have shortened & narrow flange.

77. Myasthenia Gravis
77
The term ‘ myasthenia gravis , stems
from the Greek word, ‘mys’ meaning
muscle & ‘asthenia’ meaning
weakness.
Autoimmune Disease
Auto antibodies to acetylcholine
receptors are seen.
Profound weakness of muscles.
Diplopia, ptosis, drooping of the
corners of the mouth
Sorrowful appearance.

78. Dental approach of patients with
Myasthenia Gravis
78
 Patient has difficulty in mastication, deglutition , speech &
protrusive movements of the tongue.
 Multiple short early-morning appointments should be
scheduled.
 This allows the dental or oral surgical care to be undertaken
with the advantage of greater muscular strength typically
noted during the morning hours. *8
 The patient usually finds it more difficult to lie way back in the
dental chair. It may help to be more upright to avoid closing
the throat or regurgitating fluids.*8
 Implant-supported prostheses may be preferable over tissue-
supported prostheses. This recommendation stems from the
fact that higher bite forces are generated with implant-
supported prostheses. *8

79. Bell’s Palsy
79
 Charles Bell in 1821 first described Bell’s Palsy.
 It is Common, acute, benign neurological disorder,
characterized by sudden, isolated peripheral facial nerve
paralysis.
 Lower Motor Neuron Disorder.
 Various and unknown etiology
 However infections, vascular condition, nerve entrapment
& viral etiology are the common ones.

80. Bell’s Palsy- Signs & Symptoms
80
Facial weakness.
Patient is unable to whistle ,
smile or grimace.
Hypersensitivity of sound (
Hyperacusis)
Loss of taste/metallic taste (Due
to involvement of Chorda
Tympani).

81. Bell’s Palsy- Signs & Symptoms
81
 Pain near Mastoid area.
 Difficulty with articulation.
 Food accumulation in the Labial & Buccal Vestibule.
 Consequently the lower denture is constantly dislodged towards the
paralysed side and rotates medially during any activity involving the
lips.*9

82. Bell’s Palsy – Clinical Evaluation
82
 Face drawn to the normal side.
 Facial creases, nasolabial fold- disappear.
 Forehead unfurrows and corner of mouth droops.
 Eyelids will not close, lower lid sag.
 Tear production decreases, but appears to tear excessively as loss of
eye lid control.
 Postive Hitselberger sign:- Decreased sensation along the external
acoustic meatus.
 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.

83. Bell’s Palsy-Treatment
83
 Symptomatic:- Lubricating eye drops
Massage of the affected muscles.
 Medication:- Prednisone 60-80mg/day in 4 divided doses
for 5 days, then taper over 5-7 days.
Acylovir; if a virus is responsible for it.

84. Prosthodontic approach of patients
with Bell’s Palsy
84
 The prosthodontic management of these patients requires a
systematic approach as the clinical features of Bell’s palsy
may interfere with most of the steps such as impression
making, jaw relation, denture retention, and stability. *5
 The poor neuromuscular control is considered to be the main
reason for the poor voluntary movements of the mandible.
Edentulous patients are unable to perform satisfactory
mandibular functional movements as they receive very limited
input signals and proprioception from muscle fibers.*5
 Flat Mandibular occlusal tables were made with lingulaised
occlusion as studies have shown, it has better masticatory
efficiency & prevents lateral movements of the dentures.

85. 85
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 assymetrical
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

86. Moebius Syndrome
86
 Extremely rare congenital neurological
disorder.
 Characterized by facial paralysis and the
inability to move the eyes from side to side.
 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.
 Limb & chest wall abnormalities sometimes
occur with the syndrome.
 Children with Moebius syndrome may have
delayed speech because of paralysis of
muscles that move the lips, soft palate &
tongue.

87. Moebius Syndrome – Oral
Findings*6
87
 Microglossia, which occurs in 75% of patients, as well as
tongue weakness or fissured tongue.
 Swallowing and sucking problems.
 Drooling
 Hypoplastic upper lip
 Cleft or Gothic palate with bifid uvula
 Open bite

88. Prosthodontic approach of
patients with Moebius syndrome
88
 Patients with Moebius syndrome seeking prosthodontic care
present multiple challenges. *6
 Small mouth opening, speech difficulties, and compromised
neuromuscular control present a challenge to successful
restoration.*6
 One particularly important deviation from normal denture
fabrication was the removal of the facial flange of the maxillary
complete denture to provide lip competence. *6
 The setting of the teeth in an edge
to-edge position was also needed to
allow the lips to be adequately
sealed.*6

89. Melkersson Rosenthal Syndrome
89
 Rare neurological disorder.
 Characterized by triad of recurring facial paralysis, recurrent
orofacial non-pitting oedema and fissured tongue.
 Also known as orofacial granulomatosis.

90. Biliography
90
1- B.D. Chaurasia - Volume 3
2- Gray’s Anatomy- 39th Edition
3- Texbook of Embryology – Inderbir Singh
4- Text book of Oral Pathology – Shafer
5- Rajapur A, Mitra N, Prakash VJ, Rah SA, Thumar S. Prosthodontic
Rehabilitation of Patients with Bell’s Palsy: Our Experience. Journal of
International Oral Health : JIOH. 2015;7(Suppl 2):77-81.
6-Mahrous, A. and Thalji, G. (2018), Prosthodontic Management of a Patient
with Moebius Syndrome: A Clinical Report. Journal of Prosthodontics, 27:
299-305. doi:10.1111/jopr.12664

91. Bibliography
91
7- Martone, A. L. (1962). Anatomy of facial expression and its prosthodontic
significance. The Journal of Prosthetic Dentistry, 12(6), 1020–1042.
doi:10.1016/0022-3913(62)90158-0
8- Patil, P. M., Singh, G.,&Patil, S. P. (2012). Dentistry and the myasthenia
gravis patient: a review of the current state of the art. Oral Surgery, Oral
Medicine, Oral Pathology and Oral Radiology, 114(1), e1–e8.
doi:10.1016/j.tripleo.2011.08.023
9- Hodgson, O. (1968). Dentures for the Residual Hemiplegic and the Aged.
the Supportive Roles of Dentist and Speech Therapist. International
Journal of Language&Communication Disorders, 3(2), 189–195.
doi:10.3109/13682826809011459
10- Complete denture prosthodontics – John J Sharry ; 3rd edition
11-Syllabus of Complete Dentures – Charles M Heartwell ; 4th eidtion


92. 92
Thankyou