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Orbicularis Oris

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161. Bell Palsy

. The facial nerve passes through the stylomastoid foramen in the skull and terminates into the zygomatic, buccal, mandibular, and cervical branches. These nerves serve the muscles of facial expression, which include the frontalis, orbicularis oculi, orbicularis oris, buccinator, and platysma muscles. Other muscles innervated by the facial nerve include the stapedius, stylohyoid, posterior belly of the digastric, occipitalis, and anterior and posterior auricular muscles. All muscles innervated

2014 eMedicine Surgery

162. Lips and Perioral Region Anatomy

corresponds to the depth of the gingivolabial sulcus. Next: Histology From superficial to deep, the layers of the upper and lower lips include the epidermis, subcutaneous tissue, orbicularis oris muscle fibers, and mucosa. In cross-section, the superior and inferior labial arteries can be observed as they course between the orbicularis muscle fibers and the mucosa. The vermilion is composed of nonkeratinized squamous epithelium that covers numerous capillaries, which give the vermilion its characteristic (...) that passes under the mandibular body in an anteromedial direction. The facial artery ascends in a plane deep to the platysma, risorius, and zygomaticus major and minor muscles and superficial to the buccinator and levator anguli oris. This artery branches into an inferior and a superior labial artery, which course beneath the orbicularis oris and anastomose with the contralateral vessel. [ ] The superior labial artery usually branches from the facial artery 1.1 cm lateral (SD 0.43) and 0.9 cm (SD 0.20

2014 eMedicine Surgery

163. Rhytidectomy, Deep Plane Facelift

, dissection in the mid face to separate the malar fat pad and skin complex from the deeper structures is performed above the SMAS. As a result, the nerves innervating the zygomaticus major and minor muscle complex, which enter these muscles from their deep surface, are not injured. To accomplish this goal, the sub-SMAS dissection is stopped in the lower part of the face at a level approximately 1 cm below the zygomatic arch. Identification of the orbicularis oris muscle and the origin of the zygomaticus (...) major and minor muscles is a key part of the operation. Dissection is facilitated into the mid face in a safe plane just above the orbicularis oris and zygomaticus major and minor muscles to the melolabial fold and into the upper lip, if needed. A thick subcutaneous flap is created that contains the malar fat pad attached to the skin and allows for repositioning of the malar fat pad–skin complex in a more youthful posterior-superior direction. Anatomic details relevant to this technique are further

2014 eMedicine Surgery

164. Scar Revision

in the RSTL direction. Often, these scars cross from an oblique lateral to a more horizontal orientation and require a combination of lateral Z-plasty and running W-plasty over the mentum. Scar revision. W-plasty in scar parallel to orbicularis oris. Forehead The underlying frontalis muscle creates unusually prominent forehead RSTLs. These well-defined lines run horizontally in the central forehead, with their lateral ends projecting obliquely inferior over the temple region. Pay particular attention (...) of the cutaneous, or white lip, and the vermilion, or red lip. Key external landmarks include the Cupid’s bow, the philtral columns, the tubercle, the vermilion border, the white roll, and the red line. The white roll is the ridge formed by the insertion of the orbicularis oculi just superior to the vermilion border. The red line of the vermilion is the transition between the wet and dry mucosal lining of the lip. The lip can be further divided into three aesthetic units: the lateral upper lip, the medial

2014 eMedicine Surgery

165. Head and Neck Cancer: Reconstruction

covers the reconstruction of specific anatomical entities of the head and neck. Previous Next: Reconstruction of Lip Defects The lower lip is the site of more than 90% of cancers of the lips, as it receives more ultraviolet exposure than the upper lip. Anatomy The lips are formed of 3 layers: skin, muscle (orbicularis oris), and mucosa. The vermilion (“red lip”), which is formed of modified mucosa, is the myocutaneous junction; it includes the “white line” where the skin meets the vermilion (...) lip tissue transfer Restoration of orbicularis oris No commissure violation Cross-lip flap Second surgery Relative microstomia Temporary denervation Trap-door deformity as scar appears thickened Vascular compromise Vermillion notching Lip asymmetry Scarring extension beyond sublabial crease Estlander 1/2-1/3 lip defects involving oral commissure Maintain motor/sensory competence of lip One stage Scar can be hidden in skin crease No mouth closure Requires commissuroplasty Commissure violation

2014 eMedicine Surgery

166. Forehead Anatomy

supercilii 6. Orbicularis oculi 7. Nasalis 8. Levator labii superioris 9. Levator anguli oris 10. Levator labii superioris alaeque nasi 11. Orbicularis oris 12. Mentalis 13. Depressor labii inferioris 14. Depressor anguli oris 15. Platysma 16. Masseter 17. Zygomaticus major 18. Zygomaticus minor 19. Temporalis 20. Lateral pterygoid 21. Medial pterygoid 22. Buccinator Frontalis muscle The paired frontalis muscles are the primary elevators of the brow. The vertically orientated muscle fibers offer no true (...) of the temporal fat pad. Plast Reconstr Surg . 1989 Feb. 83(2):265-71. . Media Gallery Skull. Facial muscles: 1. Galea aponeurotica 2. Frontalis 3. Procerus 4. Depressor supercilii 5. Corrugator supercilii 6. Orbicularis oculi 7. Nasalis 8. Levator labii superioris 9. Levator anguli oris 10. Levator labii superioris alaeque nasi 11. Orbicularis oris 12. Mentalis 13. Depressor labii inferioris 14. Depressor anguli oris 15. Platysma 16. Masseter 17. Zygomaticus major 18. Zygomaticus minor 19. Temporalis 20

2014 eMedicine Surgery

167. Facial Nerve Embryology

, mandibular, and cervical branches are deeper. Multiple facial muscles appear at this time as well, including the zygomaticus major and minor, depressor anguli oris, buccinators, and frontalis. Week 8 (32-49 mm) A sulcus develops around the facial nerve that is the beginning of the fallopian canal. The orbicularis oris, levator anguli oris, and orbicularis oculi muscles appear. Week 9 (50-60 mm) Auricularis anterior, corrugator supercilii, occipital and mandibular platysma, and levator labii superioris

2014 eMedicine Surgery

168. Facial Nerve Paralysis, Static Reconstruction

be aesthetically and functionally problematic. Static suspension of the commissure can reestablish symmetry and enhance oral competence. The sling involves suspension of autologous or alloplastic materials from the orbicularis oris muscle to either the zygomatic arch or the orbital rim. [ ] Sundry surgical approaches and incisions are used in facial suspension. A standard rhytidectomy incision and dissection provide excellent exposure to the entire hemiface. Moreover, exposure of the oral commissure can (...) for normal orbicularis oris and lip from the contralateral unaffected side. The lip resection should be achieved with a full-thickness V or W wedge. As much as one third of both the upper and lower lip can be excised and closed primarily. The goal of this rotation and transfer of normal tissue is to reestablish a dynamic sphincter. Cheiloplasty can improve speech, eating, commissure competence, and appearance. Illustrative case The case illustrated below depicts a patient with facial nerve paralysis

2014 eMedicine Surgery

169. Facial Nerve Anatomy

Elevates corners of mouth Buccal Zygomaticus minor Elevates upper lip Levator labii superioris Elevates upper lip and midportion nasolabial fold Levator labii superioris alaeque nasi Elevates medial nasolabial fold and nasal ala Risorius Aids smile with lateral pull Buccinator Pulls corner of mouth backward and compresses cheek Levator anguli oris Pulls angles of mouth upward and toward midline Orbicularis Closes and compresses lips Nasalis, dilator naris Flares nostrils Nasalis, compressor naris (...) nasolabial fold and nasal ala Risorius Aids smile with lateral pull Buccinator Pulls corner of mouth backward and compresses cheek Levator anguli oris Pulls angles of mouth upward and toward midline Orbicularis Closes and compresses lips Nasalis, dilator naris Flares nostrils Nasalis, compressor naris Compresses nostrils Buccal and marginal mandibular Depressor anguli oris Pulls corner of mouth downward Depressor labii inferioris Pulls lower lip downward Marginal mandibular Mentalis Pulls skin of chin

2014 eMedicine Surgery

170. Facial Nerve Paralysis, Dynamic Reconstruction

as to expressions of sadness, anger, and sorrow. The lower lip is animated by interactions of the orbicularis oris, depressor labii inferioris, depressor anguli oris, mentalis, and platysma. Terzis described a technique to improve this type of smile by transfer either of the anterior belly of the digastric tenor or of the platysma. [ ] Other authors argue that this symmetrical smile could be achieved with less invasive approaches, including or myectomy of the depressor labii inferioris. Regional muscle (...) , spontaneous facial movements Oral competence and eyelid closure with corneal protection Absence or limitation of synkinesis and mass movement Limitations of surgery The facial nerve innervates a total of 23 paired muscles and the orbicular oris, but only 18 of these muscles, working in a delicate balance, produce facial animation and expression. No current reconstructive stratagem can reproduce every facial expression and movement. The patient and the surgeon should thoroughly discuss the patient's

2014 eMedicine Surgery

171. Facial Nerve Paralysis

Pyramidalis The zygomatic division innervates the following muscles: Zygomaticus major [ ] Zygomaticus minor Elevator ala nasi Levator labii superioris Caninus Depressor septi Compressor nasi Dilatator naris muscles The buccal division gives off fibers to innervate the buccinator and superior part of the orbicularis oris muscle. Mandibular division innervations are found in the following muscles: Risorius Quadratus labii inferioris Triangularis Mentalis Lower parts of the orbicularis oris The cervical (...) , with occasional use of tests for salivation, tearing, and taste; these are the first steps in determining the site of injury. Physical examination findings reveal affected facial musculature movement. Tests for facial innervation include the following: Forehead wrinkling (frontalis muscle) Eye closure (orbicularis oculi muscle) Wide smile Whistling Blowing (eg, buccinator muscle, orbicularis oris muscle, zygomatic muscle) During the patient's initial consultation, evaluate general muscle status (latissimus

2014 eMedicine Surgery

172. Lip Reconstruction

, which can be further divided into 3 components: cutaneous, vermilion, and mucosal (see image below).The cross-sectional anatomy of the lips consists of the epidermal, dermal, subcutaneous, muscular (orbicularis oris), submucosal, and mucosal layers. Neurovascular, lymphatic, and glandular structures mainly run between the muscular and submucosal layers. At the vermilion, a rich neural and vascular plexus lies beneath a layer of specialized squamous epithelium, making the vermilion highly sensate (...) of mouth medially Zygomaticus major Zygomatic arch Modiolus at angle of the mouth Buccal branch of facial nerve (VII) Elevates and draws laterally the angle of the mouth Zygomaticus minor Lateral infraorbital margin Lateral skin and muscle of upper lip Buccal branch of facial nerve (VII) Elevates and everts upper lip Depressors Depressor labii inferioris Mandible below mental foramen along oblique line Orbicularis oris and skin of lower lip Mandibular branch of facial nerve (VII) Depresses

2014 eMedicine Surgery

173. Bites, Human (Treatment)

may be reconstructed with mucosal advancement flaps. Wounds measuring up to a third of the length of the lip may be closed by using a wedge or chevron excision and approximating the 2 cut edges. [ ] Perform muscular reapproximation of the orbicularis oris with interrupted, buried, absorbable sutures to assure continuity of the sphincteric muscular ring. Small (< 1.5 cm 2 ) lip segments have been successfully replanted as composite grafts when a segment of lip has been amputated and is available

2014 eMedicine Emergency Medicine

174. Birth Trauma (Diagnosis)

of the facial muscles, unilateral absence of the orbicularis oris muscle, and intracranial hemorrhage. Management and recovery Most infants begin to recover in the first week, but full resolution may take several months. Palsy that is due to trauma usually resolves or improves, whereas palsy that persists is often due to absence of the nerve. Management consists of protecting the open eye with patches and synthetic tears (methylcellulose drops) every 4 hours. Consultation with a neurologist and a surgeon

2014 eMedicine Pediatrics

175. Birth Trauma (Follow-up)

of the facial muscles, unilateral absence of the orbicularis oris muscle, and intracranial hemorrhage. Management and recovery Most infants begin to recover in the first week, but full resolution may take several months. Palsy that is due to trauma usually resolves or improves, whereas palsy that persists is often due to absence of the nerve. Management consists of protecting the open eye with patches and synthetic tears (methylcellulose drops) every 4 hours. Consultation with a neurologist and a surgeon

2014 eMedicine Pediatrics

176. Birth Trauma (Treatment)

of the facial muscles, unilateral absence of the orbicularis oris muscle, and intracranial hemorrhage. Management and recovery Most infants begin to recover in the first week, but full resolution may take several months. Palsy that is due to trauma usually resolves or improves, whereas palsy that persists is often due to absence of the nerve. Management consists of protecting the open eye with patches and synthetic tears (methylcellulose drops) every 4 hours. Consultation with a neurologist and a surgeon

2014 eMedicine Pediatrics

177. Bell Palsy (Diagnosis)

of the eighth cranial nerve. The facial nerve passes through the stylomastoid foramen in the skull and terminates into the zygomatic, buccal, mandibular, and cervical branches. These nerves serve the muscles of facial expression, which include the frontalis, orbicularis oculi, orbicularis oris, buccinator, and platysma muscles. Other muscles innervated by the facial nerve include the stapedius, stylohyoid, posterior belly of the digastric, occipitalis, and anterior and posterior auricular muscles. All

2014 eMedicine Emergency Medicine

178. Human Bites (Treatment)

may be reconstructed with mucosal advancement flaps. Wounds measuring up to a third of the length of the lip may be closed by using a wedge or chevron excision and approximating the 2 cut edges. [ ] Perform muscular reapproximation of the orbicularis oris with interrupted, buried, absorbable sutures to assure continuity of the sphincteric muscular ring. Small (< 1.5 cm 2 ) lip segments have been successfully replanted as composite grafts when a segment of lip has been amputated and is available

2014 eMedicine.com

179. Dysphagia in Duchenne muscular dystrophy assessed objectively by surface electromyography. (PubMed)

the peak, duration, and relative timing of muscle activity during swallowing of four muscle groups: orbicularis oris, masseter, submental, and infrahyoid. The study included three groups of participants: Nine DMD patients with dysphagia (mean age = 21.7 ± 4.2 years), six DMD patients with preserved swallow function (21.0 ± 3.0 years), and 12 healthy controls (24.8 ± 3.1 years). Dysphagic DMD participants produced significantly higher normalised peak amplitude measurements than the healthy control group (...) for masseter (61.77 vs. 5.07; p ≤ 0.01) and orbicularis oris muscles (71.87 vs. 26.22; p ≤ 0.05). Intrasubject variability for masseter peak amplitude was significantly greater for dysphagic DMD participants than the other groups (16.01 vs. 5.86 vs. 2.18; p ≤ 0.05). There were no differences in timing measurements between groups. Different characteristic sEMG waveforms were observed for the three groups. sEMG provides useful physiological information for the evaluation of swallowing in DMD patients

2013 Dysphagia

180. Marchiafava-Bignami disease mimics motor neuron disease: case report. (Full text)

and dysphagia. On admission, the patient was alert with mild cognitive dysfunction. The facial expression was flat, and there was weakness of the orbicularis oris bilaterally. The patient's speech was slurred, there was difficulty swallowing, and the gag reflex and palate elevation were poor. The jaw jerk reflex was brisk and the snout reflex was positive. Neither tongue atrophy nor fasciculation were found. Bilateral upper and lower limb weakness with increased bilateral upper limb reflexes and Babinski

2013 BMC Neurology PubMed

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