The aim of this study is to identify the branches of the facial nerve to the corrugator supercilii muscle(CSM), upper orbicularis oculi muscle(OOM) and procerus muscle(PM), and to elucidate the relation between the course of facial nerve and the superficial landmark of face. Furthermore, this study is also aimed to present anatomical information which is attributed to the treatment of the glabellar frowning wrinkles using selective neurectomy. Cadaver dissection was done on 19 hemifaces to investigate the distribution of the temporal branch of the facial nerve and its entering into the CSM. Twenty hemifaces of cadavers were dissected to investigate the pattern of the temporal branch of the facial nerve to the upper OOM, and the course of facial nerve into the OOM at three different sagittal/vertical planes through the lateral canthus, midpalpebral fissure, and medial canthus, respectively. Twenty-three hemifaces of cadavers were dissected for the investigation of nerve innervation to PM, and identification of the main trunk of the facial nerve and the buccal branches to the nasal bridge. A crossing point between buccal branch and the intercanthal line, and the entering point of the buccal branch into the PM were measured. 1. The temporal branch of the facial nerve contained 2 to 4 smaller branches on the zygomatic arch, and they were furtherly divided into 4 to 7 thin rami at the position 2.8 to 25 mm above the point 10mm lateral to the supraorbital notch. A plexus mainly from the inferior ramus, partially from the middle ramus entered into the CSM in the supraorbital area. 2. The ramifying point of the temporal branch was continued to the circular hazardous zone with a 10mm diameter, and its center was 7.5cm away from the lateral canthus at angle of minus 15 degrees. The highest level of the those rami that entered OOM on the X-axis and Y-axis from lateral canthus was +2.51+/-0.23cm, +2.70+/-0.35cm, and the lowest was +2.68+/-0.32cm, 0cm, respectively. The uppermost ramus on the Y-axis from lateral canthus, midpalpebral fissure, and medial canthus was +3.47 +/-0.27cm, +3.49+/-0.45cm, and +2.97+/-0.35cm, and the lowest ramus was +1.62+/-0.12cm, +1.82+/-0.17cm, and +1.63+/-0.22 cm, respectively. 3.The PM was innervated by the buccal branch of the facial nerve, which coursed infraorbitally. The buccal branch crossed the intercanthal line(nasion to the medial canthus) at approximately lateral one third. The nerve entrance was within a circle with a diameter of 5mm and the location of its center was 9.1mm lateral and 10.4mm superior from nasion. The present study shows the identification of nerve innervation to CSM, OOM and PM, and the relation between the course of facial nerve and the superficial landmark of face. We elucidated especially the course and entering point of buccal branch of the facial nerve to procerus muscle for the first time. We confirm that selective cutting of buccal branch of the facial nerve is essential to the treatment of the glabellar frowning lines. Furthermore, the anatomic knowledge from this study might be contributive to improve the efficacy of selective neurectomy and minimize the injury of facial nerve during surgical procedure of the face.
Cadaver ; Facial Muscles ; Facial Nerve* ; Muscles* ; Zygoma

The malaris muscle has long been described as one of the facial muscles. Numerous studies have attempted to define and examine the malaris muscle owing to its clinical implications related to the facial aesthetic concept. In the anatomical context, however, the concept of the malaris muscle remains ambiguous. This review article proposes a reconsideration of the malaris muscle. The article focuses on the anatomical concept of the malaris muscle from previous studies to the current studies as well as the conceptual changes in the malaris muscle. To improve understanding of the role of the malaris muscle in the facial aesthetic aspects, here the article reviews the role of the malaris muscle in facial aging appearance and discusses the practical clinical applications surrounding this aging gradation.
Aging ; Facial Muscles

It is the aim of this study to determine the effects of facial denervation on physiological properties of facial muscles and facial bones in growing rabbits. Experimental animals of fifty two Oryctolagus cuniculus rabbits were employed. Unilateral dissection of facial nerve was carried out on twelve rabbits, bilateral dissection of facial nerve was made on another twelve rabbits and the other twenty rabbits were on unilateral dissection of facial nerve for the histochemical analyses. Six rabbits on the bilateral surgical sham operations and six rabbits of non-intervention served the control groups. EMG records of the orbicularis oris, buccinator and masseter muscles as well as lateral and dorsoventral cephalometric films were taken and analyzed at 0, I, 2, 5 and 8 weeks respectively. The orbicularis oris, buccinator and masseter muscles of both sides were removed from the animals of the histochemistry group and muscle fibers were classified on the basis of histochemical staining for alpha-GPD, NADH-D and myosin ATPase. EMG activities of orbicularis oris and buccinator muscles were vanished immediately after denervation. Recovery of activities were detected one week after denervation in buccinator and five weeks in orbicularis oris muscles. Histochemical properties of masseter muscles remained as fast glycolytic through the experimental period. Orbicularis oris muscle fibers showed the gradual diminution of size and ratio of the slow oxidative fibers accompanied with atrophy, phagocytosis and vacuolation as well as the augmentation of fast oxidative glycolytic fibers. The buccinator muscle manifested the augmentation of fast oxidative glycolytic fibers at five weeks of experiment. Visual changes in morphology of craniofacial area were not evident, however it variety of subtle changes were apparent from statistical analysis of cephalometric measurements. It is concluded facial nerve regulates the physiological properties of facial muscles and interrelation between the function of the facial muscles and changes of facial bones would be in some degrees.
Animals ; Atrophy ; Denervation* ; Facial Bones ; Facial Muscles* ; Facial Nerve ; Masseter Muscle ; Muscles ; Myosins ; Phagocytosis ; Rabbits*

PURPOSE: The purpose of this study was to examine the effects of a facial muscle exercise program including facial massage on the facial muscle function, subjective symptoms related to paralysis and depression in patients with facial palsy. METHODS: This study was a quasi-experimental research with a non-equivalent control group non-synchronized design. Participants were 70 patients with facial palsy (experimental group 35, control group 35). For the experimental group, the facial muscular exercise program including facial massage was performed 20 minutes a day, 3 times a week for two weeks. Data were analyzed using descriptive statistics, χ²-test, Fisher's exact test and independent sample t-test with the SPSS 18.0 program. RESULTS: Facial muscular function of the experimental group improved significantly compared to the control group. There was no significant difference in symptoms related to paralysis between the experimental group and control group. The level of depression in the experimental group was significantly lower than the control group. CONCLUSION: Results suggest that a facial muscle exercise program including facial massage is an effective nursing intervention to improve facial muscle function and decrease depression in patients with facial palsy.
Depression ; Facial Muscles* ; Facial Paralysis* ; Humans ; Massage* ; Nursing ; Paralysis

The management of facial paralysis is one of the most complex areas of reconstructive surgery. Given the wide variety of functional and cosmetic deficits in the facial paralysis patient, the reconstructive surgeon requires a thorough understanding of the surgical techniques available to treat this condition. This review article will focus on surgical management of facial paralysis and the treatment options available for acute facial paralysis (<3 weeks duration), intermediate duration facial paralysis (3 weeks to 2 yr) and chronic facial paralysis (>2 yr). For acute facial paralysis, the main surgical therapies are facial nerve decompression and facial nerve repair. For facial paralysis of intermediate duration, nerve transfer procedures are appropriate. For chronic facial paralysis, treatment typically requires regional or free muscle transfer. Static techniques of facial reanimation can be used for acute, intermediate, or chronic facial paralysis as these techniques are often important adjuncts to the overall management strategy.
Cosmetics ; Decompression ; Facial Nerve ; Facial Paralysis ; Humans ; Muscles ; Nerve Transfer

PURPOSE: Blepharoptosis can result from either congenital or acquired causes. Blow out fracture or facial bone fracture including blow out fracture can be one of the causes. Authors experienced 3 cases of severe blepharoptosis after blow out fracture treated only with observation after reduction of associated fracture. METHODS: Reconstruction of orbital wall was conducted on all cases diagnosed as blow out fracture using 3 dimensional computed tomography, and conservative treatment was done on accompanying severe blepharoptosis. RESULTS: At the time of injury, all cases showed severe blepharoptosis requiring frontalis muscle transfer for correction. But blepharoptosis was recovered in an average of 18 weeks without any surgical procedure except reconstruction of orbital wall. CONCLUSION: Once Blepharoptosis occurred after blow out fracture, thorough evaluation must be done at first. If definitive cause of blepahroptisis cannot be found as authors' cases, injury of oculomotor nerve may result in blepharoptosis. So, as for blepharoptosis after blow out fracture, conservative treatment following reconstruction of fractured orbital wall can be one of good management.
Blepharoptosis ; Facial Bones ; Muscles ; Oculomotor Nerve ; Orbit

OBJECTIVETo study on the anatomical layers and depth of Yifeng (TE 17) so as to provide anatomical basis for clinical treatment.

METHODSFifteen fresh adult corpse samples, 10 males and 5 females, were randomly taken for investigating the anatomical structures and nerve-blood vessel relationship at the acupoint area of Yifeng (TE 17) with layer anatomical method layer by layer.

RESULTSAnterior of Yifeng (TE 17) is posterior border of condylion, the part backward is the aponeurosis of sternocleidomastoid muscle and anterior border of papillary. Structures of this point are skin, subcutaneous fascia, the posterior border of parotid, venous plexus of infratemporal fossa in turn. And the superficial layer of the point are the branches of great auricular nerve and external jugular vein. The structures of the deep layer are occipital artery, branches of upper jaw's artery and vein, pterygoid venous plexus and facial nerve, mandibular nerve. The average dangerous depth is (35.52 +/- 6.31) mm.

CONCLUSIONThere are important nerves and blood vessels around Yifeng (TE 17), which should be noted in acupuncture.

Objective: To investigate the characteristics of electromyography (EMG) signals and the starting threshold voltages of the orbicularis oris muscles (OOM) in healthy rhesus monkeys under different muscle movement conditions. Methods: The EMG signals and the starting threshold voltages at different time points in 4 healthy rhesus monkeys were acquired and recorded with EMG device and evoked potentiometer. The voltage amplitude variation of EMG signals was analyzed, and the voltage amplitude range of EMG signals at the beginning of OOM contraction was established. The data were statistically analyzed by one-way ANOVA. Results: The EMG of OOM in healthy monkeys in the quiet, natural and continuous mouth-closed state was linear and relatively stable, and the absolute value fluctuated between 15 and 50 μV. The EMG waveform increased rapidly during the natural lip contraction movement, and its amplitude fluctuated greatly, with the highest absolute value of the peak value reaching hundreds of microvolts. The amplitude of EMG induced by continuous mouth closure was more than thousands of microvolts. There was no significant difference in EMG amplitudes of OOM in the healthy rhesus monkey under quiet and continuous lip closure at different time points (P>0.05). There was no significant difference in threshold voltages in the state of natural lip contraction of bilateral OOM at different time points (average range: 57.17-57.47 μV) in the healthy rhesus monkeys (P>0.05). There was no significant difference in threshold voltages of OOM induced by bilateral OOM at different time points(average range: 55.38-55.99 μV) in the healthy rhesus monkeys(P>0.05). There were significant differences in the absolute values of EMG amplitudes of OOM between the three lip movement modes: (30.67±8.72) μV in quiet and natural continuous lip closure (475.12±54.72) μV in natural lip contraction, and (921.22±312.79) μV in the induced persistent lip closure, with t values of -8.48, -9.35 and -5.01 respectively, all P<0.001. Conclusions: The EMG signals of OOM show different characteristics under different muscle movement conditions, which can be used as a basis for computer to judge and recognize the movement conditions of OOM. The upper limits of the EMG threshold voltage values of OOM under different motion states are 55-60 μV.
Animals ; Lip ; Macaca mulatta ; Facial Muscles ; Electromyography

BACKGROUND: This study was undertaken to evaluate the diagnostic sensitivity of several muscles in repetitive nerve stimulation test (RNST) for myasthenia gravis (MG) patients. MATERIALS AND METHODS: The study population consisted of 39 MG patients classified by modified Ossermann's classification. Using Stalberg's method, RNST was systematically performed in facial (orbicularis oculi and nasalis) and upper extremity (flexor carpi ulnaris, abductor digiti quinti and anconeus) muscles. RESULTS: The significant electrodecremental response of RNST were noted in orbicularis oculi (58.9%), nasalis (51.3%), flexor carpi ulnaris (42%), anconeus (41%) and abductor digiti quinti muscles (27%). Among the 3 muscles of upper extremity (abductor digiti quinti, flexor carpi ulnaris and anconeus), the positive electrodecremental response of anconeus muscles was significantly higher than other two muscles (p<0.05) in type IIa, IIb and there were no statistical differences of the positive electrodecremental response between orbicularis oculi and nasalis muscles. The facial muscles showed more prominent decremental responses than upper extremity muscles in type I MG(p<0.05). In type IIa MG patients, there were no significant statistical differences between facial and upper extremity muscles but significant statistical differences among upper extremity muscles. In type IIb MG patients, there were no significant statistical differences in all tested muscles in spite of the increased positive electrodecremental response of RNST. CONCLUSION: On the basis of this study, RNST would be initially performed for the orbicularis or nasalis in type I MG and for the anconeus in type IIa or IIb MG.
Classification ; Facial Muscles ; Humans ; Muscles* ; Myasthenia Gravis* ; Upper Extremity

PURPOSE: To compare the size of the masseter and lateral pterygoid muscle between the affected and the unaffected side of the patients who have the chief complaints of the mandibular asymmetry. MATERIALS AND METHODS: Twenty two patients (male: 4, female: 18, average age: 21.3 year-old) were radiographed using posterior-anterior (P-A) cephalography and computed tomography (CT). On P-A cephalography, the degree of deviation was determined by the distance from the mentum to the vertical reference line through the crista galli and the anterior nasal spine. On the scanned tracing papers of the maximum cross-sectional area of the masseter and lateral pterygoid muscle using axial CT images, the pixel number was measured. The ratio of the affected : unaffected sides were obtained. For the masseter and lateral pterygoid muscle, the relationship between the muscular volume and degree of skeletal hypoplasia was studied. RESULTS: The half cases showed no skeletal asymmetry. The lateral pterygoid muscle of the affected side was larger significantly than unaffected side (p.0.05). However, there was no significant difference between two sides in the cases of skeletal asymmetry. There was only significant difference in the cases without skeletal asymmetry (p.0.05). CONCLUSIONS: To some extent, the slight mandibular hypoplasia could affect the growth of some masticatory muscles.
Chin ; Facial Asymmetry ; Female ; Humans ; Masticatory Muscles* ; Pterygoid Muscles ; Spine