1. Face and Related Structures Anatomy
Orthopedic Assessment III – Head, Spine, and Trunk with Lab
PET 5609C

2. Clinical Anatomy Facial Bones:
Vomer
Inferior Nasal Concha
Nasal bone
Maxilla
Mandible
Palatine bone
Zygomatic bone
Lacrimal bone
Hyoid (may or may not be included)
"Virgil Can Not Make My Pet Zebra Laugh"

3. Clinical Anatomy

6. Clinical Anatomy Facial Bones: Palatine Bone:
Irregular shaped bone posterior to the maxilla
Forms part of the nasal cavity, the eye socket, and the hard palate

7. Clinical Anatomy Hyoid Bone: Location – in the human neck
Only bone in the skeleton not articulated to any other bone
Supported by the muscles of the neck and in turn supports the root of the tongue
Shaped like a horseshoe

8. Clinical Anatomy Temporomandibular Joint: (TMJ) Type – Synovial Joint
Articulation between mandibular condylar process and temporal bone
Articular disc separates the 2 bones
Concave on both superior and inferior surfaces allowing for smooth articulation between 2 bones
Disc injury – locking/catching with opening and closing of mouth
Mandibular condyle glides forward as mouth opens
Actions/Purpose:
Speaking
Mastication

9. Clinical Anatomy

10. Clinical Anatomy
Ear:
Focuses/converts acoustical energy into an electrical signal for interpretation by brain
Parts:
External Ear
Middle Ear
Inner Ear

11. Clinical Anatomy External Ear: Auricle (Pinna): Ear Canal:
Cartilaginous tissue
Acts as a funnel - collecting/focusing sound waves into the external auditory meatus to be passed on to middle ear
Ear Canal:
Tube running from the outer ear to the middle ear
Extends from the pinna to the eardrum (26 mm in length and 7 mm in diameter)

12. Clinical Anatomy Middle Ear: Tympanic Membrane – Eardrum:
Outer barrier of middle ear
Made of thin connective tissue membrane
Skin on the outside
Mucosa on internal surface
Acts as microphone
Sound waves strike tympanic membrane causing vibration
Vibrations transferred to auditory ossicles (malleus, incus, stapes)

13. Clinical Anatomy Middle Ear: Auditory Ossicles: Malleus Incus Stapes
Note: 3 smallest bones in human body
Role: Transmit sounds to cochlea

15. Clinical Anatomy Eustachian Tube: Links the pharynx to the middle ear
Regulates pressure in middle ear
Normally closed
Can open (air enters) to equalize the pressure between the middle ear and the atmosphere
Pressure equalized – Small Pop
Flying/Driving in mountains
Yawning/swallowing can pull on muscles in the neck – tube opens
Without ET, air could not escape from the ear, isolating the middle ear from atmosphere
Ear susceptible to damage

16. Clinical Anatomy Inner Ear: Cochlea and Semicircular Canal
Bony structure (coiled shape) – moves (↑, ↓) in response to acoustic signals
Semicircular Canal: Fluid filled with thousands of fine hair cells (motion sensors) to detect signal → electrical impulses (Vestibulocochlear Nerve)
Balance, Upright posture (head and body)

18. Clinical Anatomy Nose: Nasal cartilage
Nostrils: external nasal openings (air enters → inferior, middle and superior concha → pharynx → trachea → lungs)
Mucosal Cells:
Warms/humidifies cool, dry air
Mucus production

19. Clinical Anatomy Throat: Larynx: Contains vocal cords
Located between pharynx and trachea
Covered superiorly by thyroid cartilage (Adam’s Apple); inferiorly by cricoid cartilage

20. Clinical Anatomy Mouth:
Oral Vestibule – anterior most portion of mouth
Area from lips to teeth
Oral Cavity – past teeth leading to trachea
Tongue – skeletal muscle
Primary organ of taste
Manipulates food (chewing/swallowing)
Covered with papillae (small, rough-like projections) and taste buds

21. Bicuspids (premolars)
Clinical Anatomy
Teeth Classification and Function:
Type
Number
Function
Incisors 4
Cutting
Cuspids (canines) 2
Tearing
Bicuspids (premolars)
Crushing and grinding
Molars 6

22. Clinical Anatomy Tooth Anatomy: Root: Neck Crown:
Anchored by cementum and small ligaments
Neck
Crown:
Dentin
Enamel
Core of tooth:
Pulp chamber
Nerves and Blood vessels

23. Clinical Anatomy Muscles of Mastication:
Masseter → closes mouth/aids in biting
O: Superficial portion: Zygomatic process of maxilla; anterior 2/3 of zygomatic arch. Profundus portion: Posterior 1/3 of zygomatic arch
I: Superficial: Inferior ½ of lateral ramus (mandible) Profundus portion: Superior ½ of ramus, coronoid process of mandible
N: Trigeminal

24. Muscles of Expression:
Action
Origin
Insertion
Innervation
Buccinator
Depresses the cheeks
Alveolar process of maxilla and mandible
Angle of mouth
Facial
Depressor Anguli Oris
Draws angle of mouth downward
Oblique line of mandible
Depressor Labii Inferioris
Lowers the mouth
Lower lip
Digastric
Opens mouth
Inferior border of mandible
Superior aspect of hyoid bone
Trigeminal
Geniohyoid
Median ridge of mandible
Body of hyoid bone
Ansa Cervicalis
Levator Anguli Oris
Raises each side of mouth
Just superior to canine teeth

25. Muscles of Expression:
Action
Origin
Insertion
Innervation
Mentalis
Elevates the skin of the chin
Incisive fossa of the mandible
Point of the mandible
Facial
Mylohyoid
Opens the mouth
Inferior border of the mandible
Superior aspect of hyoid bone
Trigeminal
Orbicularis Oris
“Puckers” the lips
Originates off of the muscles surrounding the mouth
Skin surrounding the lips
Procerus
Wrinkles the nose
Lower portion of the nasal bone; Lateral nasal cartilage
Lower portion of the forehead between the eyebrow
Temporalis
Aids in biting
Temporal fossa
Coronoid process and ramus of mandible
Zygomaticus Major
Smiling
Zygomatic bone
Angle of mouth

27. Clinical Anatomy Bell’s Palsy:
Inhibition of facial nerve (cranial nerve VII) → inability to control facial muscles (resultant flaccidity)
Most common cause of Acute Facial Nerve Paralysis
Symptoms: weakness on one side of face, facial droop, pain on affected side, headache, loss of taste
Cause: Inflammation of facial nerve (resultant pinching)
Infection or Virus

28. A) Demonstrates inability to raise the left eyebrow or generate wrinkles on the left side of forehead; B) Demonstrates difficulty closing the left eye and inability to raise the left corner of mouth; C) Demonstrates drooping at the left corner of mouth and inability to completely close the left eye. These findings are the result of idiopathic peripheral cranial nerve 7 palsy (Bell's palsy).

29. Clinical Evaluation History Involving the Ear: Location of Pain:
Pressure/pain in middle or inner ear → infection or tympanic membrane rupture
Otitis Externa (Swimmer’s Ear) → chronic pain/itching
Activity and MOI:
Blunt trauma
Slapping blow → tympanic membrane rupture
Middle ear infections → URI (inflamed mucus membranes that block eustachian tubes)
Other Symptoms:
Tinnitus (ringing in ear)
Dizziness

30. Clinical Evaluation History Involving the Nose: Location of Pain
Onset:
Acute
Insidious onset:
Sinusitis – inflammation of paranasal sinuses
URI – acute infection involving nose, sinuses, pharynx or larynx
Activity and MOI:
Direct blow to nasal bone or cartilage
Symptoms:
Pain, bleeding
Medical History:
Past nasal trauma (previous fracture → deformity)

31. Clinical Evaluation History Involving the Throat: Location of Pain:
Trauma → anterior throat pain
Sore throat → pain deep in neck
Onset → acute
Activity and MOI:
Trauma (struck by ball, bat, elbow)
Symptoms:
Inability to speak → crushed larynx, respiratory distress

32. Clinical Evaluation History Involving Maxillofacial Injuries:
Location of Pain
Onset → acute and direct result of trauma
Nonathletic Injuries → dental caries, Bell’s palsy
Activity and MOI:
Trauma (struck by ball, bat, elbow)
Other Symptoms:
Vision impairment, difficulty with eye movements
TMJ impairment

33. Clinical Evaluation Inspection of the Ear: Auricle:
Contusion/lacerations/avulsion
Hematoma within Auricle:
Auricular Hematoma (Cauliflower Ear)
Tympanic Membrane:
Inspection with Otoscope
Shiny, translucent, smooth
Suspected disruption/fluid in membrane → refer!
Periauricular Area:
Battle’s Sign → ecchymosis around mastoid process
Basilar skull fracture

34. Clinical Evaluation Inspection of the Nose: Alignment Epistaxis:
Light → anterior portion
Moderate to Heavy → Posterior
Septum and Mucosa:
Otoscope or penlight
Septum should appear symmetrical/straight
Eyes and Face:
Raccoon eyes → ecchymosis under eyes

35. Clinical Evaluation Inspection of the Throat: Respiration patterns
Thyroid and Cricoid cartilages
Any deformity → medical emergency (airway compromised)

36. Clinical Evaluation Inspection of the Face and Jaw: Bleeding
Ecchymosis:
Periorbital Ecchymosis → fracture to nasal, maxilla, zygomatic bones
Symmetry:
Any deformity/swelling
Muscle tone:
Movement of mouth, eyebrows, forehead

37. Clinical Evaluation Inspection of the Oral Cavity: Lips → lacerations
Teeth
Tongue
Lingual Frenulum
Ask patient to lift the tongue
Gums:
Gingivitis → inflammation of gums

38. Clinical Evaluation Palpation: Palpation: Nasal Bone Nasal Cartilage
Zygoma
Maxilla
TMJ
Periauricular Area
Palpation:
External Ear
Teeth
Mandible
Hyoid Bone
Cricoid and Thyroid Cartilage

39. Clinical Evaluation Palpation of TMJ Joint: External palpation:
Note any clicking/locking of joint
Patient opens/closes mouth
Internal palpation:

40. Clinical Evaluation Functional Testing: Tests for the Ear:
Hearing → Does hearing return quickly?
Balance and Dizziness
Tests for the Nose:
Smell

41. Clinical Evaluation Functional Testing: TMJ involvement:
Opening and Closing Mouth
Normal → mouth can open wide enough to insert 2 knuckles
Inability → Decreased TMJ ROM
Malocclusion:
Any lateral deviation → misalignment of teeth