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MMT Face

This document provides information about manual muscle testing of the facial muscles. It discusses the facial nerve and its motor innervation of the facial expression muscles. It describes the seven main groups of facial muscles - occipitofrontalis, orbital, nasal, oral, and neck groups. For each muscle, it indicates its function and involvement in facial expressions. It also provides details on grading facial muscle strength from 0-5 during manual muscle testing. Common causes of facial paralysis like Bell's Palsy and central lesions are outlined.

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Ravneet singh
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785 views35 pages

MMT Face

This document provides information about manual muscle testing of the facial muscles. It discusses the facial nerve and its motor innervation of the facial expression muscles. It describes the seven main groups of facial muscles - occipitofrontalis, orbital, nasal, oral, and neck groups. For each muscle, it indicates its function and involvement in facial expressions. It also provides details on grading facial muscle strength from 0-5 during manual muscle testing. Common causes of facial paralysis like Bell's Palsy and central lesions are outlined.

Uploaded by

Ravneet singh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Examination methods in Rehabilitation, 5.10.

2020

Manual
muscle testing

Facial
muscles (2)

Mgr. Veronika Mrkvicová (physiotherapist)


Introduction
• Facial muscles
• MMT, grading
• Facial nerve
• Facial paralysis
Facial Nerve
• Most of the facial nerve is comprised
of motor innervation of the muscles
of facial expression

In addition, it subserves several other functions including:


• taste perception from the anterior two-thirds of the tongue
• perception of cutaneous stimuli in the external auditory canal
and over part of the pinna and mastoid region
• innervation of the stapedius muscle in the middle ear
• innervation of the lacrimal gland and two of the salivary
glands (the submaxillary and submandibular)
Facial expression
• The most prominent deficit noted by patients
with facial nerve damage is weakness of muscles
of facial expression

• Careful observation of the patient's face during


conversation and at rest almost always reveals
facial weakness

• Additionally, the face may "droop" on the side of


damage due to the effects of gravity
Facial nerve: test
The nerve can be further tested by functional activities:
• having the patient close their eyes and lips tightly
• having the patient grimace (show their teeth)
• having the patient look up (elevating the eyebrows
and creasing the forehead)
• having the patient fill their cheeks with air with their
lips tightly pursed. If one or both sides of the face are
weak, s/he will have difficulty holding the air in
Bell´s palsy
• The most common cause of facial weakness, an idiopathic
condition that may result from viral infection-induced
inflammatory swelling of the facial nerve in its canal

• Since the canal is very long and tight, swelling can put pressure
on the nerve, resulting in damage either by direct effects or by
impairing blood flow in the nerve

• In some cases, facial palsy is produced by a very clear viral


infection with Herpes Zoster, often associated with ear pain
and vesicles on the tympanic membrane

• Lyme disease also has a predisposition to produce facial palsy,


sometimes bilateral
Bell´s palsy
• The characteristic of peripheral facial palsy is that it involves the entire
side of the face, including weakness of the forehead muscles as well as
those around the eye and mouth

• This is because fibers to all of these regions of the face are packed
together in the facial canal

• Most cases of uncomplicated Bell's palsy recover quite well

• In its most severe form, infarction of the nerve may occur with a
prolonged and not infrequently incomplete process of regeneration

• This is more common when a longer course of the nerve is affected,


accompanied by ageusia (loss of taste) and hyperacusis
Bell´s palsy
Central paralysis
• Corticobulbar (pyramidal) projections from the motor cortex
(precentral gyrus) through the genu of the internal capsule
are the major pathway for voluntary facial movement

• The cerebral cortical projections to the facial motor neurons


innervating the upper face are essentially bilateral (i.e., each
cortical hemisphere provides innervation to both sides)

• Therefore, unilateral lesions (such as a stroke affecting one


hemisphere or the internal capsule) will not produce
weakness of the upper face muscles
Central paralysis
• On the other hand, facial motor neurons that
innervate the muscles of the lower face receive input
largely from the contralateral hemisphere (i.e., the right
hemisphere activates motor neurons of the left facial nucleus, and vice-
versa)

• Therefore, a lesion involving the right motor cortex


(e.g., carotid-middle cerebral arterial system occlusion and hemispheric
infarction) causes a weakness of voluntary left lower
facial movement that is especially noticeable while
the patient is talking, grimacing (usually elicited by
asking the patient to bare their teeth or gums), or
resting
Central paralysis
• The corner of the mouth droops and there may
be some widening of the palpebral fissure (eye)

• On the other hand, the forehead is normally


creased when a person raises their eyebrows or
looks toward the ceiling

• This distinguishes the "supranuclear" weakness of


the face from the weakness of the whole side of
the face due to damage of the peripheral facial
nerve, as seen with Bell's palsy.
Peripheral vs. central lesion
Manual muscle test - grading
• 5 Normal contraction of the muscle, no assymetry
compared to healthy side
• 4 Nearly normal contraction, little assymetry
compared to healthy side
• 3 Contraction of the muscle in one half compared to
healthy side
• 2 Contraction of the muscle in one quarter
compared to healthy side
• 1 Trace of muscle contraction can be seen/palpated
• 0 The muscle demonstrates no palpable muscle
contraction
Muscles of facial expression
Occiptofrontalis group
• The occiptofrontalis, or scalp, group consists
of the frontalis and occipitalis
• These muscles provide movement of the
eyebrows, forehead, and scalp
M. occipitofrontalis
Raises forehead, pulls scalp backward
Orbital group
The orbital group consists of:
• orbicularis oculi
• corrugator supercilii

These muscles provide movement of the eyelid


and periorbital skin
M. corrugator supercilii
Draws eyebrow medially
M. orbicularis oculi
Closes eyelid
Nasal group
The nasal group consists of:
• Procerus
• Nasalis

These muscles provide movement of the nose


and perinasal skin
M. procerus
M. nasalis

M. nasalis

M. procerus
Oral Group
The oral group consists of:
• obicularis oris
• depressor anguli oris, levator anguli oris
• zygomaticus major et minor
• levator labii sup., levator labii sup. alaeque nasi
• risorius
• depressor labii inferioris
• mentalis
• buccinator

These muscles provide movement of the lips


M. levator labii superioris alaeque nasi

Raises upper lip


and widens nostril
M. buccinator

Moves “bolus” of food


M. zygomaticus major et minor

Raises angle of mouth


M. risorius

Smile widely
M. risorius, m. depressor labii inferioris
M. levator labii superioris
M. depressor labii inferioris

Lowers lower lip


M. orbicularis oris
Closes or purses lips
M. depressor anguli oris
M. mentalis
Raises chin, protrudes lower lip, and
decreases depth of lower vestibule
Neck group
• The neck group consists of the platysma
• It provides movement of the skin of the neck
M. platysma

Raises skin of neck and


lowers corner of mouth
Thank you for attention 

The Seven Universal Facial Expressions of Emotion

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