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Face and Related Structures Anatomy

Face and Related Structures Anatomy. Orthopedic Assessment III – Head, Spine, and Trunk with Lab PET 5609C. Facial Bones: V omer Inferior Nasal Concha N asal bone M axilla M andible P alatine bone Z ygomatic bone L acrimal bone H yoid (may or may not be included)

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Face and Related Structures Anatomy

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

  2. 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" Clinical Anatomy

  3. Clinical Anatomy

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

  5. 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 Clinical Anatomy

  6. 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

  7. Clinical Anatomy

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

  9. External Ear: Auricle (Pinna): 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) Clinical Anatomy

  10. 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) Clinical Anatomy

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

  12. 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 Clinical Anatomy

  13. 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) Clinical Anatomy

  14. 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 Clinical Anatomy

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

  16. 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 Clinical Anatomy

  17. Clinical Anatomy Teeth Classification and Function:

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

  19. 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 Clinical Anatomy

  20. Muscles of Expression:

  21. Muscles of Expression:

  22. 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 Clinical Anatomy

  23. 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).

  24. 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

  25. 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)

  26. 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

  27. 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

  28. 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 Clinical Evaluation

  29. 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 Clinical Evaluation

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

  31. 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 Clinical Evaluation

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

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

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

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

  36. 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

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