Face and Related
Structures Anatomy
Orthopedic Assessment III – Head,
Spine, and Trunk with Lab
PET 5609C
Clinical Anatomy
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Facial Bones:
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Vomer
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Inferior Nasal Concha
Nasal bone
Maxilla
Mandible
Palatine bone
Zygomatic bone
Lacrimal bone
Hyoid (may or may not be
included)
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"Virgil Can Not Make My Pet
Zebra Laugh"
Clinical Anatomy
Clinical Anatomy
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Facial Bones:
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Palatine Bone:
Irregular shaped
bone posterior to the
maxilla
 Forms part of the
nasal cavity, the eye
socket, and the hard
palate
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Clinical Anatomy
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Hyoid Bone:
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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
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Temporomandibular Joint: (TMJ)
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Type – Synovial Joint
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Articulation between mandibular condylar process and temporal
bone
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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:
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Speaking
Mastication
Clinical Anatomy
Clinical Anatomy
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Ear:
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Focuses/converts
acoustical energy
into an electrical
signal for
interpretation by
brain
Parts:
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External Ear
Middle Ear
Inner Ear
Clinical Anatomy
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External Ear:
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Auricle (Pinna):
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Cartilaginous tissue
Acts as a funnel collecting/focusing sound
waves into the external
auditory meatus to be passed
on to middle ear
Ear Canal:
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Tube running from the outer
ear to the middle ear
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Extends from the pinna to
the eardrum (26 mm in
length and 7 mm in
diameter)
Clinical Anatomy
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Middle Ear:
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Tympanic Membrane –
Eardrum:
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Outer barrier of middle ear
Made of thin connective
tissue membrane
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Skin on the outside
Mucosa on internal surface
Acts as microphone
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Sound waves strike
tympanic membrane
causing vibration
Vibrations transferred to
auditory ossicles (malleus,
incus, stapes)
Clinical Anatomy
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Middle Ear:
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Auditory Ossicles:
Malleus
 Incus
 Stapes
 Note: 3 smallest
bones in human body
 Role: Transmit
sounds to cochlea
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Clinical Anatomy
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Eustachian Tube:
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Links the pharynx to the middle ear
Regulates pressure in middle ear
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Normally closed
Can open (air enters) to equalize
the pressure between the middle
ear and the atmosphere
Pressure equalized – Small Pop
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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
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Ear susceptible to damage
Clinical Anatomy
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Inner Ear:
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Cochlea and Semicircular
Canal
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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
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Nose:
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Nasal cartilage
Nostrils: external nasal
openings (air enters →
inferior, middle and
superior concha →
pharynx → trachea →
lungs)
Mucosal Cells:
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Warms/humidifies cool,
dry air
Mucus production
Clinical Anatomy
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Throat:
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Larynx:
Contains vocal cords
 Located between
pharynx and trachea
 Covered superiorly by
thyroid cartilage
(Adam’s Apple);
inferiorly by cricoid
cartilage
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Clinical Anatomy
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Mouth:
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Oral Vestibule – anterior
most portion of mouth
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Area from lips to teeth
Oral Cavity – past teeth
leading to trachea
Tongue – skeletal muscle
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Primary organ of taste
Manipulates food
(chewing/swallowing)
Covered with papillae
(small, rough-like
projections) and taste buds
Clinical Anatomy
Teeth Classification and Function:
Type
Number
Function
Incisors
4
Cutting
Cuspids
(canines)
2
Tearing
Bicuspids
(premolars)
4
Crushing and
grinding
Molars
6
Crushing and
grinding
Clinical Anatomy
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Tooth Anatomy:
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Root:
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Anchored by cementum
and small ligaments
Neck
Crown:
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Dentin
Enamel
Core of tooth:
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Pulp chamber
 Nerves and Blood
vessels
Clinical Anatomy
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Muscles of Mastication:
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Masseter → closes
mouth/aids in biting
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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
Muscles of Expression:
Muscle
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
Angle of mouth Facial
Depressor Labii Lowers the
Inferioris
mouth
Oblique line of
mandible
Lower lip
Facial
Digastric
Opens mouth
Inferior border
of mandible
Superior aspect
of hyoid bone
Trigeminal
Geniohyoid
Opens mouth
Median ridge
of mandible
Body of hyoid
bone
Ansa Cervicalis
Levator Anguli
Oris
Raises each
side of mouth
Just superior to
canine teeth
Angle of mouth Facial
Muscles of Expression:
Muscle
Action
Origin
Insertion
Innervation
Mentalis
Elevates the
Incisive fossa
Point of the
skin of the chin of the mandible mandible
Facial
Mylohyoid
Opens the
mouth
Inferior border Superior aspect
of the mandible of hyoid bone
Trigeminal
Orbicularis
Oris
“Puckers” the
lips
Originates off
of the muscles
surrounding
the mouth
Skin
Facial
surrounding the
lips
Procerus
Wrinkles the
nose
Lower portion
of the nasal
bone; Lateral
nasal cartilage
Lower portion
of the forehead
between the
eyebrow
Facial
Temporalis
Aids in biting
Temporal fossa
Coronoid
process and
ramus of
mandible
Trigeminal
Zygomaticus
Major
Smiling
Zygomatic
bone
Angle of mouth Facial
Clinical Anatomy
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Bell’s Palsy:
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Inhibition of facial nerve
(cranial nerve VII) →
inability to control facial
muscles (resultant flaccidity)
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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)
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Infection or Virus
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).
Clinical Evaluation
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History Involving the Ear:
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Location of Pain:
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Activity and MOI:
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Pressure/pain in middle or inner ear → infection or tympanic
membrane rupture
Otitis Externa (Swimmer’s Ear) → chronic pain/itching
Blunt trauma
Slapping blow → tympanic membrane rupture
Middle ear infections → URI (inflamed mucus membranes that
block eustachian tubes)
Other Symptoms:
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Tinnitus (ringing in ear)
Dizziness
Clinical Evaluation
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History Involving the Nose:
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Location of Pain
Onset:
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Acute
Insidious onset:
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Activity and MOI:
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Direct blow to nasal bone or cartilage
Symptoms:
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Sinusitis – inflammation of paranasal sinuses
URI – acute infection involving nose, sinuses, pharynx or larynx
Pain, bleeding
Medical History:
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Past nasal trauma (previous fracture → deformity)
Clinical Evaluation
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History Involving the Throat:
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Location of Pain:
Trauma → anterior throat pain
 Sore throat → pain deep in neck
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Onset → acute
 Activity and MOI:
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Trauma (struck by ball, bat, elbow)
Symptoms:
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Inability to speak → crushed larynx, respiratory
distress
Clinical Evaluation
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History Involving Maxillofacial Injuries:
Location of Pain
 Onset → acute and direct result of trauma
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Activity and MOI:
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Nonathletic Injuries → dental caries, Bell’s palsy
Trauma (struck by ball, bat, elbow)
Other Symptoms:
Vision impairment, difficulty with eye movements
 TMJ impairment
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Clinical Evaluation
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Inspection of the Ear:
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Auricle:
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Hematoma within Auricle:
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Contusion/lacerations/avulsion
Auricular Hematoma
(Cauliflower Ear)
Tympanic Membrane:
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Inspection with Otoscope
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Shiny, translucent, smooth
 Suspected disruption/fluid
in membrane → refer!
Periauricular Area:
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Battle’s Sign → ecchymosis
around mastoid process
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Basilar skull fracture
Clinical Evaluation
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Inspection of the
Nose:
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Alignment
Epistaxis:
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Light → anterior portion
Moderate to Heavy →
Posterior
Septum and Mucosa:
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Otoscope or penlight
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Septum should appear
symmetrical/straight
Eyes and Face:
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Raccoon eyes →
ecchymosis under eyes
Clinical Evaluation
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Inspection of the Throat:
Respiration patterns
 Thyroid and Cricoid cartilages
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Any deformity → medical emergency (airway
compromised)
Clinical Evaluation
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Inspection of the Face and
Jaw:
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Bleeding
Ecchymosis:
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Symmetry:
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Periorbital Ecchymosis →
fracture to nasal, maxilla,
zygomatic bones
Any deformity/swelling
Muscle tone:
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Movement of mouth,
eyebrows, forehead
Clinical Evaluation
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Inspection of the Oral
Cavity:
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Lips → lacerations
Teeth
Tongue
Lingual Frenulum
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Ask patient to lift the tongue
Gums:
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Gingivitis → inflammation of
gums
Clinical Evaluation
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Palpation:
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Nasal Bone
Nasal Cartilage
Zygoma
Maxilla
TMJ
Periauricular Area
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Palpation:
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External Ear
Teeth
Mandible
Hyoid Bone
Cricoid and Thyroid
Cartilage
Clinical Evaluation
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Palpation of TMJ
Joint:
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External palpation:
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Note any
clicking/locking of
joint
Patient opens/closes
mouth
Internal palpation:
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Patient opens/closes
mouth
Clinical Evaluation
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Functional Testing:
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Tests for the Ear:
Hearing → Does hearing
return quickly?
 Balance and Dizziness
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Tests for the Nose:
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Smell
Clinical Evaluation
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Functional Testing:
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TMJ involvement:
 Opening
and Closing Mouth
 Normal → mouth can open wide enough to insert
2 knuckles
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Inability → Decreased TMJ ROM
 Malocclusion:
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Any lateral deviation → misalignment of teeth