MUSCLES OF HEAD, NECK & FACE APPLIED CLINICAL SIGNIFICANCE

Introduction

Although bone provide leverage & form the frame work of the body, they cannot move the body by them selves. Motion result from alternating contraction & relaxation of muscles Muscles constitute the 40-50% of body weight. Our muscular strength reflects the prime function of muscle. Defination- Muscle is contractile tissue which brings about movements.

Embryology of muscles:

Myogenesis is the development of muscles . Myogenesis is first manifested by the expression of myogenic regulatory factor (MRF) including Myo D1 MyF5, MRF-4,herculin / Myf6,MyHCs ,& myogenin.

Embrylogy of muscles

head mesoderm i.e. somitomeres & segmented (somatic) mesoderm i.e. somites. The unsegmented muscle progenitor have interaction with neural crest cells & develops the extraocular & pharyngeal arch muscles. Segmented mesoderm develops the neck,tongue laryngeal & diaphragmatic muscles .

Development of muscles:

Craniofacial voluntary muscles develop from paraxial mesoderm that condenses rostrally as incompletly segmented somitomeres & segmented somites. The myomers of the somitomers & myotomes of the somites form primitive muscle cells termed myoblast. Myoblast divide & fuse to form multinucleated myotubes that cease further mitosis & thus become myocytes (muscle fibre) Most muscle fibre develop before birth but increase in number & size in early infancy.

Histology of muscle:

Muscles tissue is made of basically of cells that are called myocytes. Muocytes are elongated in one direction & also called as muscle fibres. Histologically muscles tissue are of three typesA) Skeletal muscle B) Smooth muscle C)Cardiac muscle

Skeletal muscle:

Present mainly in the limbs & in relation to the body walls. Under electron microscope these muscles shows transeverse striations & also called as striated muscles. These are voluntary muscles . Made up of long cylindrical fibres .Longest fibre 30cm. Diameter varies between 10 to 60 microm. They have hundreds of nuclei along their length.

Skeletal Muscle

Nuclei are elongated & lie along the periphery of the fibres. After staining with haematoxyline the striations are seen as alternate dark & light bands .

Dark bands are called as Abands . Light bands are called as I-bands .
Middle of each I-band there is thin dark line called Z-line.

Skeletal muscles

The centre of A-band is traversed by light band called H-band. Centre of H-band is thin dark line calledM-band. The part of myofibril situated between two Z-bands is called sarcomere.

Smooth muscle:

Also called as non-striated,involuntary or plain muscle. Present mainly in the viscera. Made up of long spindle shaped cells(myocytes) Nucleus is oval,elongated & lies in the central part of cells. Length varies from 50-500 micrometers. Seen in the part of hollow viscera including the stomach,intestine,urinary bladder,uterus.Also in walls of artery,vein,bronchi,duct of several glands.Some smooth muscles present in orbit in the upper eye lid.

Cardiac muscles:

Present exclusively in heart & is called as cardiac muscle. It resemble smooth muscle in that they are involuntary & resemble striated musclein that the fibres of cardiac also show transeverse striations Has inherent rhythmic contracticity.

Function of muscles:

Through sustained contraction & relaxation the muscle tissue has four key function1) Motion-Movement Walking,running,& in localised movements such as grasping a pencil or nodding a head. 2) Movements of substance within the bodyCardiac muscle contraction pump blood to all part of body tissue. Smooth muscle contraction-movement of food through gastrointestinal tract. Skeletal muscle contraction promotes the flow of lymph & return of venous blood to heart.

Function of muscles:

3)Stabilizing body position & regulating organ volume. -Skeletal muscle maintain the body in stable position. 4)Thermogenesis (Generating heat)Skeletal muscle contracts to perform work, a by product is heat. Heat is used to mantain body temperature . Muscle contraction are generate about 85% of all body heat.

Classification of muscles of head,neck,face1)Muscles of scalp-

2)Muscles of eye3)Muscles of ear-

Muscles of Facial Expressions

4)Muscles of nose5)Muscles around mouth-

6)Muscles that move mandible-

Classification of Muscles of head,neck,face

7) Muscles of neck 8)Muscles of the oral cavity

1)Muscles of eye

A) Extraocular muscles

A)Voluntary muscles -Superior rectus -Inferior rectus -Medial rectus -Lateral rectus -Superior oblique -Inferior oblique B)Involuntary muscles -Superior tarsal muscles -Inferior tarsal muscles -Orbitalis.

B)Muscles of eyelid -Orbicularis oculi -Corrugator supercilli -Levator palpebrae superioris.

2)Muscles of the Ear

Muscles of Auricle A)Extrinsic muscles 1)Auricularis anterior 2)Auricularis superior 3)Auricularis posterior B)Intrinsic muscles 1)Helicis major & minor 2)Tragicus 3)Antitragicus 4) Transeverse auriculae 5)Obliquus auriculae

Muscles of tympanic cavity1)Tensor tympani 2)Stapedius

3)Muscles of the Nose

Procerus Nasalis Compressor naris Dilator naris Depressor septi

4)Muscles around Mouth Orbicularis oris Levator labii superioris Levator anguli oris Zygomaticus minor Zygomaticus major Depressor anguli oris Depressor labii inferioris Mentalis Risorius Buccinator

5)Muscles that move mandible

Temporalis Masseter Medial pterygoid Lateral pterygoid

6)Muscles of neck A) Superficial muscles of neck 1)Platysma 2)Sternocleidomastoid muscles 3)Trapezius B)Deep muscles of neck 1)Suboccipital muscles 1)Rectus capitis posterior major 2)Rectus capitis posterior minor 3)Obliques capitis superior 4)Obliques capitis inferior.

6)Deep muscles of neck (contd)

2)Hyoid muscles 1)Suprahyoid muscles -Digastric -Stylohyoid -Mylohyoid -Geniohyoid 2)Infrahyoid muscles -Sternohyoid -Sternothyroid

-Thyrohyoid -Omohyoid

7)Muscles of the oral cavity 1)Muscles of the floor of mouth 1)Mylohyoid 2)Geniohyoid 2)Muscles of the tongue A)Extrinsic muscles B)Intrinsic muscles -Genioglossus -Bilateral superior & -Hyoglossus inferior longitudinal -Styloglossus - Transeverse -Palatoglossus -Verticle

7)Muscles of the oral cavity

3)Muscles of soft palate 1)Levator veli palatini 2)Tensor veli palatini 3)Musculus uvulae 4)Palatoglossus 5)Palatopharyngeus

7)Muscles of the oral cavity

4)Muscles of pharynx 1)Constrictor muscles -Superior constrictor -Middle constrictor -Inferior constrictor 2)Salpingopharyngeus 3)Stylopharyngeus 4)Palatopharyngeus

5)Muscles of Larynx Muscles of larynx divided into extrinsic & intrinsic muscles. Intrinsic muscles-Situated on the lateral & posterior aspect of the larynx. Lateral aspect muscles Posterior muscles 1)Cricothyroid 1)Posterior crico2)Lateral cricoarytenoid arytenoid 3)Thyroarytenoid 2)Transeverse 4)Vocalis arytenoid 5)Thyroepiglotticus 3)Oblique arytenoid 6)Aryepiglotticus

5)Muscles of Larynx

Extrinsic musclesThese are the muscles passing between the larynx & other structure & include all infrahyoid muscles. -Sternohyoid -Sternothyroid -Thyrohyoid - Omohyoid

1)Muscles of the scalpEpicraniousThis muscle is divisible into two portionThe frontalis over the frontal bone & occipitalis over the occipital bone. 1)FrontalisOrigin - Galia aponeurotica Insertion- Skin superior to supraorbital margin Action - Draws scalp anteriorly,elevates eyebrows,& wrinkles eyebrows horizontally. Nerve supply- Facial nerve.

Muscles of scalp- 2) Occipitalis-

Origin- Occipital bone & mastoid part of temporal bone.

Insertion- Galia aponeurotica. Action -Draws scalp posteriorly. Innervation- Facial nerve. Blood supply of muscles of

scalp- Branches of Superficial

temporal Ophthalmic,post auricular & occipital artery.

Muscles of scalp-

Occipitalis-

Frontalis

2)Muscles of the eyeA)Muscles of the eye lid1)Orbicularis oculi-

Origin-Medial wall of orbit.

Insertion-Circular path around orbit. Action- Closes eye. Nerve supply - Facial nerve.

Muscles of the eyelids

2) Corrugator superciliiOrigin-Medial end of superciliarry arch of frontal bone. Insertion-Skin of eyebrow. Action- Draws eyebrows inferiorly as in frowning.

Innervation-Facial nerve.

Muscles of eyelids3) Levator palpebrae superiorisOrigin-Roof of orbit.

Insertion-Skin of upper eyelid.

Action Elevates upper eyelid. Innervation-Oculomotor nerve.

B)Extraocular muscles--

Voluntary muscles-

Muscles of eyelidsExtraocular voluntary muscle

1)Superior rectusOrigin-Tendinous ring attach to bony orbit around optic foramen. Insertion-Superior & central part of eyeball. Action-Rolls eyeball superiorly. Innervation- Oculomotor nerve. 2)Inferior rectusInsertion-Inferior & central part of eyeball. Action- Rolls eyeball inferiorly. Innervation- Oculomotor nerve.

Extraocular voluntary muscles of eye

3)Lateral rectusInsertion-Lateral side of eyeball. Action-Rolls eyeball laterally. Innervation- Abducence nerve. 4)Medial rectusInsertion-Medial side of eyeball. Action- Rolls eyeball medially. Innervation- Oculomotor nerve.

Extraocular voluntary muscles of eye5) Superior obliqueInsertion- Eyeball between superior & lateral recti.

Action- Directs cornea inferiorly & laterally.

Innervation- Trochlear nerve.

6)Inferior obliqueOrigin-Maxilla (anterior orbital belly).

Insertion-Eyeball between inferior & lateral recti.

Action- Directs cornea superiorly & laterally. Innervation- Oculomotor nerve.

3) Muscles of ear a)Muscles of auricles

They aredivided into Extrinsic & Intrinsic muscles. 1)Extrinsic muscles- They areAuricularis anterior Auricularis superior Auricularis posterior

Extrinsic auricular muscles (contd)

Origin- Epicranial aponeurosis & mastoid part of temporal bone. Insertion- Spine of helix & ponticulas on the eminentia conchae. Innervation- Auricularis anterior & superior are supplied by temporal branch of facial nerve. A. posterior is supplied by posterior auricular branch of facial nerve. Action-Draws the auricle forward,upward & superiorly.

Muscles of nose

1) ProcerusOrigin-Lower part of the nasal bone. Insertion-Skin over the lower part of the forehead between the eyebrows. Blood supply-Facial artery. Innervation- Temporal & lower zygomatic branches the facial nerve. Action-Draws down the medial angle of the eyebrows & produce transverse wrinkles over the bridge of nose. -Active in frowning & concentration.

Muscles of nose2) NasalisOrigin-Has two parts, transverse part (compressor naris)& alar part(dilator naris) Arises from the maxilla.lateral to nasal notch. Insertion-Aponeurosis of bridge & ala of nose. Blood supply-Facial artery. Innervation-Buccal & zygomatic branch of facial nerve. Action-Compress the nasal aperture.Draws ala downward & laterally.

Muscles of nose3) Depressor septiOften regarded as part of dilator naris. Origin-Maxilla above the central incisor tooth. Insertion- Mobile part of nasal septum. It is immediately deep to the mucous membrane of the upper lip. Blood supply-Superior labial branch of the facial artery. Innervation-Buccal & zygomatic branch of facial nerve. Action- Helps the alar part of nasalis to widen nasal aperture.

Muscles around mouth1)Orbicularis oris

Origin-Muscle fibre surrounding opening of mouth. Insertion-Skin at corner of mouth. Innervation-Facial nerve. Action- Closes lips,compresses lips against teeth,protrudes lips & shapes lips during speech.

Muscles around the mouth

2)Levator labii superiorisOrigin-Superior to infraorbital foramen of maxilla. Insertion-Skin at angle of mouth & orbicularis oris. Innervation-Facial nerve. Action Elevates uppe lip.

3)Zygomaticus major

Origin-Zygomatic bone. Insertion-Skin at angle of mouth & Orbicularis oris. Innervation-Facial nerve.

Action-Draws angle of mouth upward & outward as in smiling & laughing.

4)Zygomaticus minorOrigin- Lateral surface of zygomatico maxillary suture. Insertion- Skin at angle of mouth & orbicularis oris muscle. Innervation-Zygomatic & buccal branch of facial nerve. Action-Elevates upper lips exposing maxillary teeth.Helps deepening & elevating nasolabial furrow.

5)Risorious

Origin-Fascia over parotid gland. Insertion-Skin at angle of mouth. Innervation-Facial nerve. Action-Draws angle of mouth laterally.

6)Platysma

Origin-Fascia over deltoid & pectoralis major muscle. Insertion-Mandible,muscles around angle of mouth & skin of lower face. Innervation- Facial nerve. Action-Draws outer part of lower lip inferiorly & posteriorly.as in pouting & depress mandible.

7)BuccinatorOrigin-Alveolar process of maxilla & mandible & pterygomandibular raphe. Insertion-Orbicularis oris. Innervation-Facial nerve. Action-Major cheek muscle. Compresses cheek as in blowing air out of mouth.Helps in sucking

8)Depressor labii inferioris

Origin-Mandible. Insertion-Skin of lower lip. Innervation-Facial nerve. Action-Depress lower lip. 9) MentalisOrigin-Mandible. Insertion-Skin of chin. Innervation-Facial nerve. Action- Elevates & protrudes lower lip.Pulls skin of chin up.

10)Depressor anguli orisIt is a superficial muscle of lower lip. Origin-From the mental tubercle & oblique line of the mandible. Insertion-It converges into a narrow fasciculus & fibres get mixed with orbicularis oris & risorius. Innervation-Facial nerve. Action-Draws the angle of mouth downwards & laterally in opening the mouth & in expressing the sadness.

Muscles that move mandible Also called as muscles of mastication. Moves the mandible during mastication & speech. Develop from the mesoderm of the first branchial arch & are supplied by mandibular nerve. Muscles of mastication are : 1) Masseter 2)Temporalis 3) Lateral pterygoid 4)Medial pterygoid.

Muscles of mastication1)Massetor Origin-It consist of three layers a) Superficial layer-It is longest. Arise from the maxillary process of the zygomatic bone & from the anterior 2/3rd of the inferior border of the zygomatic arch. b) Middle layer-Medial aspect of anterior 2/3rd of the zygomatic arch c) Deep layer- Arise from the deep surface of the zygomatic arch.

Masseter (continue)

Insertion-Angle & ramus of mandible. Innervation- Masseteric nerve. Blood supply- Masseteric artery branch of maxillary artery. Action-Elevates mandible as in closing mouth; Assists in side to side movement of mandible & protracts mandible.

2)TemporalisOrigin-Temporal & frontal bone. Insertion-Coronoid process & ramus of the mandible. Innervation-Mandibular division of the trigeminal nerve. Blood supply-Middle & deep temporal arteries. Action-Elevates & retract the mandible ; Assists in side to side movements of the mandible.

3)Medial pterygoid This is a rectangular muscle. It has superficial & deep head. OriginSuperficial head-Tuberosity of maxilla & adjoining bone Deep head-Medial surface of lateral pterygoid plate & adjoining part of palatine bone.

Medial pterygoid

Insertion-Medial surface of angle & adjoining part of ramus of mandible. Innervation-Mandibular division of trigeminal nerve. Blood supply-Branch of maxillary artery. Action-Elevates & protracts mandible.Moves mandible sideto side.

4) Lateral pterygoidOrigin- Has two parts of head. Upper head-arise from infratemporal space & part of greater wing of sphenoid bone. Lower head-arise from lateral surface of lateral pterygoid plate. Insertion-Pterygoid fovea on the anterior surface of neck of mandible. Anterior margin of the articular disc & capsule of TMJ.

Lateral pterygoid muscleInnervation-Mandibular division of trigeminal nerve. Blood supply-Maxilary artery. Action- Protracts mandible. -Opens mouth -Moves mandible from side to side.

7)Muscles of neck A)Superficial muscles

1)Sternocleidomastoid muscles-

Origin-Arise by two heads Sternal head-Upper part of anterior surface of menubrium sterni Clavicular head-Superior border & anterior surface of medial 1/3rd of clavicle. InsertionSternal head- Tip of mastoid process & superior nuchal line. Clavicular head- Superior nuchal line in line with sterno-occipitalis fibres.

1)Sternocleidomastoid muscleNerve supply-Spinal part of accessory nerve. Blood supply- superior thyroid artery & occipital artery. ActionActing singly it tilts the head towards shoulder of the same side Rotates the head so as to carry the face towards the opposite side. Helps in flexion & contralateral rotation of the head. - Both muscles acting together moves the face forwards,helps in protraction.

2)Trapezius It is a triangular muscle. Origin-Medial 1/3rd of superior nuchal line. -External occipital protuberance. -Ligamentum nuchae -Spine of the 7th cervicle & all the 12 thoracic vertebrae.

2)Trapezius

Insertion-

-Uper fibres to lateral half of posterior surface of clavicle. -Middle fibres to medial border of acromian & upper lip of spine of scapula. -Lower fibres to the tubercle at the root of spine of scapula.

Nerve supply-Spinal part of accessory nerve is motor to the muscle. -Branches from the cervical plexus (C3 & C4) proprioceptive in function. Action-Rotation of the scapula is produced by the upper fibre . - Both trapezius muscles brace back & shrug the shoulders & extend the neck.

2)Trapezius-

B)Deep muscles oof neckSuboccipital muscles

1)Rectus capitis posterior majorOrigin-Spine of axis. Insertion-Lateral part of area below the inferior nuchal line. Nerve supply- Suboccipital nerve. Action-Turns the face to the same side.Extend the head.

Suboccipital muscles2)Rectus capitis posterior minor

Origin-Posterior tubercle of atlas. Insertion-Medial part of area below the inferior nuchal line. Nerve supply-Sub occipital nerve. Action-Mainly postural. -Extend the head.

Suboccipital muscle. 3)Obliquus capitis superiorOrigin-Transeverse process of atlas. Insertion-Lateral area between the nuchal line. Nerve supply-Suboccipital nerve. Action-Mainly postural - Extend the head. -Laterally flex the . head.

Suboccipital muscles4)Obliques capitis inferioris

Origin-Spine of axis. Insertion-Transverse process of atlas. Nerve supply-Suboccipital nerve. Action-Mainly postural -Turns face to the same side.

Muscles of neck Suprahyoid muscles

1) Digastric musclesOrigin Anterior belly- From digastric fossa of mandible Posterior belly- From mastoid notch of temporal bone Insertion- Both heads meet at intermediate tendon & held by a fibrous pulley to the hyoid bone.

Muscles of neck Suprahyoid musclesDigastricNerve supplyAnterior belly- Nerve to mylohyoid which is branch of mandibular nerve. Posterior belly- Facial nerve. ActionDepress mandible when mouth is open widely or against resistance ,it is secondary to lateral pterygoid. Elevates hyoid bone.

Suprahyoid muscles2) StylohyoidOrigin- Posterior surface of styloid process. Insertion- Junction of body & greater cornu of hyoid bone. Nerve supply- Facial nerve. Action- Pulls hyoid bone upwards & backwards With other hyoid muscles it fixes the hyoid bone.

Suprahyoid muscles of neck3) MylohyoidFlat triangular muscles two mylohyoid muscles form the floor of mouth cavity deep to anterior belly of digastric. Origin- Mylohyoid line of mandible. InsertionPosterior fibres- Body of hyoid bone Middle & anterior fibre- median raphe between mandible & hyoid bone.

Suprahyoid muscles3)Mylohyoid

Nerve supply- Nerve to mylohyoid. Action1) Elevates floor of mouth in first stage of deglutition. Helps in depression of mandible & elevation of hyoid bone.

Suprahyoid muscles4) Geniohyoid Origin- Inferior mental spine (genial tubercle). Insertion- Anterior surface of body of hyoid bone. Nerve supply C1 through hypoglossal nerve. Action Elevates hyoid bone May depress mandible when hyoid is fixed.

Deep Muscles of neckInfrahyoid muscles

1)SternohyoidOrigin-Posterior surface of menubrium sterni. Adjoining part of clavicle & posterior sternoclavicular ligament. Insertion-Medial part of lower border of hyoid bone.

1)Sternohyoid (contd)
Innervation- Ansa cervicalis. ActionDepress the hyoid bone following its elevation.during swallowing & during vocal movements.

Infrahyoid muscles2)Sternothyroid
It lies deep to the sternohyoid. Origina)Posterior surface of menubrium sterni. b)Adjoining part of first costal cartilage Insertion Oblique line on the lamina of the thyroid cartilage.

Infrahyoid muscles2)Sternothyroid Nerve supplyAnsa cervicalis. Action Depress the larynx after it has been elevated in swallowing & in vocal movements.

Infrahyoid muscles3)Thyrohyoid muscle

It lies deep to the sternohyoid. Origin-Oblique line of thyroid cartilage. InsertionLower border of the body & the greater cornu of the hyoid bone.

Infrahyoid muscles3)Thyrohyoid muscleNerve supply- Supplied by C1 through hypoglossal nerve. Action-Depress the hyoid bone. - Elevates the larynx when the hyoid is fixed by the suprahyoid muscle.

Infrahyoid muscles4)Omohyoid

It has an inferior belly,a common tendon & a superior belly. It arises by the inferior belly & is inserted through the superior belly. Origin-a)Upper border of scapula near the suprascapular notch. B) Adjoining part of suprascapular ligament.

Infrahyoid muscles4)Omohyoid

Insertion-Lower border of body of hyoid bone lateral to the sternohyoid. Nerve supply-Superior belly by superior root of ansa cervicalis & inferior belly by ansa cervicalis. Action-Depress the hyoid bone following its elevation during swallowing or in vocal movements.

Muscles of larynxMuscles of larynx are divided into extrinsic & intrinsic muscles. Extrinsic muscle- Include all infrahyoid muscles. Intrinsic muscles-These are situated on the lateral & posterior aspect of the larynx. Lateral muscles1)Cricothyroid 2)Lateral cricoarytenoid 3)Thyroarytenoid 4)Vocalis 5)Thyroepiglotticus

Muscles of larynx

1)CricothyroidOrigin- Arise from the front & sides of external surface of cricoid arch. Insertion- Lower border of lamina & anterior border of the inferior horn of thyroid cartilage. Only intrinsic muscle found on the external surface of larynx.

Muscles of Larynx. 2)Lateral cricoarytenoidOrigin- Upper border of posterior part of cricoid arch. Insertion- Anterior surface of muscular process of arytenoid. 3)ThyroarytenoidOrigin- Inner surface of lower part of thyroid lamina. Insertion- Anterolateral surface of arytenoid.

Muscles of larynx.
4)VocalisIt is portion of thyroarytenoid that is adjecent to the vocal ligament. Origin- Thyroid angle & some fibre from the vocal ligaments. Insertion- Some fibre insert into vocal ligament & vocal process of arytenoid. 5)Thyroepiglotticus- It is formed by some superior fibres of the thyroarytenoid .

Muscles of larynx

Posterior muscles They are three in no. 1)Posterior cricoarytenoidOrigin- Posterior surface of lamina of cricoid cartilage. Insertion- Posterior aspect of muscular process of arytenoid cartilage.

Muscles of Larynx 2)Transverse arytenoid-It is unpaired muscles connecting lateral margin & muscular process of two arytenoids. 3)Oblique arytenoidsOrigin- Posterior aspect of the muscular process of arytenoid. Insertion- Apex of the opposite arytenoid.

Muscles of Larynx Nerve supply There are three laryngeal nerves which are branches of the vagus nerve. 1)Recurrent Laryngeal Nerve 2)External Laryngeal Nerve 3)Internal Laryngeal Nerve.

Muscles of Larynx

Nerve Supply-All the intrinsic & extrinsic muscles of the larynx are supplied by Recurrent laryngeal nerve except cricothyroid which is supplied by External laryngeal nerve. -Mucous membrane of the larynx above the vocal fold is supplied by internal laryngeal nerve while below the vocal fold is supplied by recurrent laryngeal nerve.

Muscles of Larynx

Blood SupplySuperior laryngeal by branch of superior thyroid artery. Inferior laryngeal by branch of inferior thyroid artery.

Muscles of Larynx

ActionsA) Muscles which open the glottis- Posterior cricoarytenoid. B) Muscles which closes the glottis-Lateral cricoarytenoid -Transverse arytenoid -Cricothyroids -Thyroarytenoids

Muscles of Larynx

ActionC)Muscles which tense the vocal cordCricothyroids. D)Muscles which relax the vocal cords -Thyroarytenoids & Vocalis. E)Muscles which close the inlet of larynx -Oblique arytenoid & Aryepiglotticus. F) Muscles which open the inlet of larynx-Thyroepiglotticus.

Muscles of pharynx

They are divided intoOuter circular layer Superior constrictor Middle constrictor Inferior constrictor.

Inner longitudinal layer-Palatopharyngeus -Salpingopharyngeus - Stylopharyngeus

Muscles of pharynxSuperior constrictor Origin- From above downwards it has continous origin from-Lower half of posterior edge of medial pterygoid plate. -Posterior margin of the pterygomandibular raphe. -Posterior end of mylohyoid line on the inner aspect of mandible. -Mucous membrane of the margin of tongue.

Muscles of pharynx

Superior constrictorInsertion-Pharyngeal tubercle on the basilar part of the occipital bone. -The rest of the fibres fan out backwards & medially to get attached to the median fibrous pharyngeal raphe.

Muscles of pharynx 2) Middle constrictor- It is a fan shaped muscles. Origin- It has V-shaped origin - Lower part of stylohyoid ligament - Lesser cornu of the hyoid bone. - Whole length of the greater cornu. Insertion-Median pharyngeal raphe by running backwards.

Muscles of pharynxInferior constrictor Origin-It is fan shaped superiorly but tubular inferinferiorly-Oblique line on the thyroid cartilage. -Fibrous arch over the crocothyroid muscle Insertion- posterior median raphe.

Muscles of pharynxB)Inner longitudinal layer 1)Palatopharyngeus Origin- Posterior edge of the hard palate & the palatine aponeurosis. Insertion-Pharyngeal musculature & pharyngeal raphe. -Postero-lateral border of the thyroid cartilage

Muscles of pharynx

2)Salpingopharyngeus Origin- Lower border of the cartilagenous part of the auditary tube Insertion- Musculature of the mid pharynx. -Posterolateral border of the thyroid cartilage.

Muscles of pharynx3)Stylopharyngeus Origin-Medial side of the base of the styloid proces. Insertion- Posterolateral border of the thyroid cartilage. -Its fibres mingle with those of middle constrictor.

Muscles of PharynxNerve supply- All the muscles of pharynx are supplied by pharyngeal plexus except Stylopharyngeus which is supplied by the glossopharyngeal nerve. Action-1) The constrictor of pharynx by a descending wave of contraction propel the bolus of food downwards. 2) The Stylopharyngeus & Palatopharyngeus due to their attachment to the thyroid cartilage lift up the larynx during swallowing. 3)Salpingopharyngeus & palatopharyngeus- Open the auditory tube during swallowing to equalise the pressure on the two sides of the tympanic membrane.

Muscles of tongue-

A middle fibrous septum divides the tongue into right & left halves.Each half contains 4 intrinsic & 4 extrinsic muscles. Extrinsic musclesIntrinsic muscles Genioglossus- Superior Hyoglossuslongitudinal Styloglossus- Inferior Palatoglossuslongitudinal

-Transverse & vertical

Muscles of tongueExtrinsic muscles

GenioglossusIt is a fan shaped muscles which form the main bulk of tongue. Origin- Upper genial tubercle of mandible. Insertion- Upper fibres are inserted in to the tip,the middle fibres into the dorsum & lower fibres into the hyoid bone.

Muscles of tongueExtrinsic musclesNerve supply-Supplied by hypoglossal nerve. ActionUpper fibres retract the tip, middle fibres depress the tongue & lower fibres pull the posterior part of tongue forwards & thus protrude the tongue from mouth.

Muscles of tongueExtrinsic muscles

2)HyoglossusOrigin- Whole length of greater cornu & lateral part of body of hyoid bone. Insertion- Side of tongue between styloglossus & inferior longitudinal muscle of tongue. Nerve supply- Hypoglossal nerve. Action- Depress the tongue makes dorsum convex , retract the protruded tongue.

Muscles of tongueExtrinsic muscles

3) StyloglossusOrigin- Arise from the tip & adjecent part of the anterior surface of the styloid process as well as from the upper end of the stylohyoid ligament. Insertion- Side of the tongue intermingling with the fibres of the hyoglossus.

Muscles of tongueExtrinsic muscles

3) StyloglossusNerve supply- Hypoglossal nerve. Action- During swallowing it pulls the tongue upwards & backwards. 4) Palatoglossus- Described in muscles of soft palate.

Muscles of tongueIntrinsic muscles

They occupy the upper part of tongue & are attached to the squamous fibrous layer & to the median fibrous septum. They alter the shape of the tongue. 1) Superior longitudinal muscleLies beneath the mucous membrane It shortens the tongue & makes its dorsum concave.

Intrinsic muscles of tongue

2) Inferior longitudinal muscleIt is a narrow band lying close to the inferior surface of the tongue between genioglossus & hyoglossus. It shortens the tongue & makes its dorsum convex. 3) Transverse muscleExtend from the median septum to the margins. It makes the tongue narrow & elongated.

Intrinsic Muscles of tongue

4) Vertical musclesMuscle is found at the borders of the anterior part of the tongue. It makes the tongue broad & flattened.

Muscles of soft palate

1)Tensor veli palatiniOriginLateral side of auditory tube Adjoining part of base of skul. InsertionPosterior border of the hard palate. Inferior surface of the palate behind the palatine crest.

Muscles of soft palate. Tensor veli palatini

ActionTightens the soft palate, chiefly the anterior part. Opens the auditory tube to equalize air pressure between the middle ear & nasopharynx.

Muscles of soft palate2)Levator veli palatini

Origin- Inferior aspect of auditory tube. Inferior surface of petrous temporal bone. Insertion- Upper surface of palatine aponeurosis. Action- Elevates the soft palate & closes the pharyngeal isthmus. Opens the auditory tube.

Muscles of soft palate3)Musculus uvulae

This is a longitudinal strip placed on one side of median plane,within the palatine aponeurosis. Origin-Posterior nasal spine & palatine aponeurosis. Insertion- Mucous membrane of uvula. Action- Pulls up the uvula.

Muscles of soft palate

4) PalatoglossusOrigin- Oral surface of palatine aponeurosis Insertion- Side of the tongue at the junction of its oral & pharyngeal parts. Action- Pulls up the root of tongue. Approximates the palatoglossal arches & thus closes the oropharyngeal isthmus.

Muscles of soft palate.

Nerve supplyAll the muscles of soft palate except tensor veli palatini are supplied by pharyngeal plexus. Fibres of this plexus are derived from cranial part of accessory nerve through vagus. Tensor veli palatini is supplied by mandibular nerve.

Applied anatomy

1) Diseases of muscles1) Primary myopathies- It is limited to or predominant in musclesA) Dystrophies- It is primarily, progressive degenerative, non contagious disorder of unknown etiology manifested by weakness & wasting away of voluntary muscles. B) MyotoniasAre failure of muscle relaxation after cessation of voluntary contraction. Are of following types.

Myotonias

1) Dystrophic myotoniaAtrophy of facial muscle is characteristics feature of this disease. Consist of ptosis of eyelids & atrophy of the masseter & sternocleidomastoid muscles. This gives characteristics appearance to the patient called myopathic facies & swan neck.

Myotonias

2) Congenital myotoniaCharacterised by muscular hypertrophy. Spasm of extraocular muscle lead to convergent strabismus. There is prolong spasm of the muscles of face, neck,chest & there may be respiratory embarrasment 3)Acquired myotoniaCharacterised by repeated,rapid, painless, irregular, non rhythmic, uncontrollable, unilateral contraction of facial muscles. 4) Hypotonias Reduction or absence of tonus in

2)MyastheniasMyasthenia is an abnormal weakness & fatigue in muscle following activity. Myasthenia gravisA chronic disease characterised by progressive weakness of skeletal muscl. Muscles of mestication & facial expression are involved in this disease. 3)Myositis- Refers to an inflamation of muscle tissue & is entirely nonspecific since a lot many bacteria, viral, fungal, parasitic infection as well as certain physical & chemical injuries, may give rise to this condition.

Atrophy of musclesIt refers to the decrease in size of the individual muscle fibres. Hypertrophy of musclesIt refers to an increase in size of individual muscle fibres .

Few common facial expression & muscles producing it. Smiling & laughing- Zygomaticus major. Sadness Levator labii superioris & levator anguli oris. Grief Depressor anguli oris. Anger Dilator naris & depressor septi. Frowning Corrugator supercilli & procerus. Horror, terror & fight-Platysma. Surprise- Frontalis Doubt-Mentalis Grinning Risorius.

Bell`s palsy

In infranuclear lesion of facial nerve,the whole of the face is paralysed. The affected side is motion less. Wrinkles disappear from the forehead. In supranuclear lesion of the facial nerve, only lower part of the face is paralysed. The upper part is escapes due to its bilateral representation in the cerebral cortex.

Tetany

Hypoparathyroidism results in hypocalcaemia leading to increased neuromuscular irritability causing muscular spasm & convulsion also called Tetany.

Muscles of masticationClinical testing of muscle sof mastication & their motor innervations is done by asking the patient to clench his teeth & then palpating the temporalis & masseter which has gone into contraction. If one masseter is paralysed due to injury to mandibular nerve, the jaw deviates to the paralysed side, on opening the mouth. Muscle spasm of masseter& lateral pterygoid locks the jaw. Temporalis

Muscles of eye

Thrombosis of the cavernous sinus with involvement of the 3rd ,4th & 6th cranial nerve results in paralysis of the extraocular muscles both voluntary & involuntary. Oculomotor nerve paralysis results in Lateral strabismus due to unopposed action of superior oblique, & lateral rectus, rotating eyeball laterally. Dilated & fixed pupil due to paralysis of sphincter pupillae & ciliaris. Dropping of the upper eyelid- due to paralysis of the levator palpebrae.

Muscles of eye

Slight prominance of the eyeball (proptosis) due to relaxation of all the paralysed muscle. Nystagmus- Is characterised by involuntary, rhythmical, oscillatory movements of the eye. This is due to incoordination of the ocular muscles. Abducent nerve injury leads to medial strabismus of eye. Loss of accomodation & light reflex is due to paralysis of constrictor pupellae.

Muscles of neck

Spasm of the muscle is one of the cause of flexion deformity of the neck known as worg neck or torticollis. In this condition ear lies close to the tip of the shoulder of the same side & the chin is rotated to the opposite side. Sternocleidomastoid- Paralysis causes difficulty in turning of the face to the opposite side. Trapezius- when trapezius is paralysed the patient is unable to shrug his shoulder against resistance.

Muscle of tongue

Lesions involving the hypoglossal nerve resuts in an ipsilateral paralysis & wasting of the tongue muscles. Tongue protrudes to the opposite side. Genioglossus- It is the main tongue muscle used in clinical testing of the hypoglossal nerve. Only muscle which protrudes the tongue forwards , when the patient is asked to do so. Genioglossus projects the tongue to the paralysed side.

Pain of muscular origin

Muscle pain emanates from the skeletal muscles, tendons & fascia. Muscle pain is usually felt as nonpulsatile, varible aching sensation with boring quality.. Myofacial pain arises from hypersensitive areas in muscles called trigger points.

Reference Grays Anatomy-39th edition Clinical Anatomy 7th edition by Snell. Anatomy Regional & Clinical By A.Halim Oral & Maxillo facial Surgery- By Laskin. Bell`s Orofacial Pain 5th edition.