Facial Muscles - Upper Group

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (26/07/2020)

Original Editor - Wendy Walker

One Page Owner - Wendy Walker as part of the One Page Project 

Top Contributors - Wendy Walker and Kim Jackson

Description

The muscles of the upper portion of the face can be divided into 2 groups:

  1. Orbital Facial Muscles
  2. Nasal Facial Muscles

We will examine the 2 groups separately.

Orbital Facial Muscles

There are 3 Orbital Facial Muscles:

Occipitofrontalis (often referred to simply as Frontalis)

Orbicularis Oculi

Corrugator Supercilii

Occipitofrontalis

Origin and insertion

Occipitofrontalis is one of the muscles of the scalp. It consists of 2 separate bellies:

  • Occipital part - which originates from occipital bone (lateral part of the upper nuchal line) and from the mastoid aspect of the temporal bone.
  • Frontal part - originates from the superior fibres of the other upper facial muscles (ie. orbicularis oculi, corrugator supercilii and procerus
  • Both parts insert into the galea aponeurotica in the scalp
Nerve and blood supply

Nerve supply is the Facial Nerve (CN VII), with the occipital belly supplied by the posterior auricular branch, and the frontal belly by the temporal branch.

Blood supply of the occipital portion is from the occipital artery, and the frontal segment is supplied by the supraorbital and supratrochlear arteries.

Function

The frontalis portion elevates the eyebrows, which causes the horizontal wrinkles in the forehead.

It also weakly moves the skin of the scalp anteriorly

The occiptal part weakly moves the scalp skin posteriorly.

Clinical Relevance

In facial palsy, paralysis of the frontalis muscle[1] results in lack of ability to raise the ipsilateral eyebrow; it also results in absence of horizontal lines/wrinkles on that side of the forehead. In older patients, there may also be some descent of the affected eyebrow, which as well as producing visible asymmetry of the eyebrows can impact on vision in that eye, if the brow ptosis is sufficient to obscure the upper field of vision. Brown ptosis can also lead to a secondary misdirection of the upper eyelid lashes which can irritate/scratch the eye.

Orbicularis Oculi

Surrounding the eye is the orbicularis oculi[2], a sphincter muscle which consists of 3 sections: the orbital, the palpebral and the lachrymal portions. The fibres are arranged in concentric circles round the upper and lower eyelids. The palpebral fibres form the eyelids.

Origin and Insertion

The fibres originate from the anterior surface of the medial orbital margin, the rim of the eye socket, and the lachrymal sac. They travel laterally, both above and below the eye, to insert into the lateral palpebral raphe. At the peripheral borders of the muscle, the fibres interdigitate (merge in an interlocking fashion) into the bordering muscles, ie. the upper fibres interdigitate with the frontalis and corrugator muscles.

Nerve and blood supply

The muscle is supplied by the seventh cranial nerve, Facial Nerve; the upper fibres by the temporal branch, and the lower fibres by the zygomatic branch.

Function

The action of the orbicularis oculi muscle is to close the eye.

The palpebral fibres, which form the eyelids, are responsible for blinking.

The lachrymal fibres facilitate drainage of tears by helping to empty the lachrymal sac, and the orbital section of the muscle is responsible for providing a tight eye closure/seal[2].

The action of orbicularis oculi muscle helps with distribution of the tear film over the cornea[3].

Clinical relevance

Paralysis of the Orbicularis Oculi muscle results in incomplete closure of the eyelids, and this has a profound effect on the condition of the cornea of the eye. If not managed well, the lack of closure can result in drying out of the cornea, often accompanied by significant pain, scarring of the cornea, and can progress to ulceration, and in extreme cases perforation of the cornea[3][4]. This means that signs of an acute Dry Eye in patients with Facial Palsy should have urgent evaluation by an opthalmic team.

There is further information on general management of the eye on the Dry Eye page.

Corrugator Supercilii

Lying above the orbicularis oculi muscle and below occipitofrontalis, Corrugator Supercilii is a small muscle which is located at the medial end of the eyebrow. The Latin name means "Wrinkler of the Eyebrows": Corrugator from the Latin verb to wrinkle, corrugo, and the Latin word for eyebrow is supercilium, which in the plural becomes supercilii.

Origin and Insertion

It originates from the superciliary arch (a ridge on the frontal bone) and the fibres travel laterally and slightly upward to insert into the deep surface of the skin of the eyebrow.

Nerve and blood supply

It is supplied by the temporal branch of the Facial Nerve. Blood supply comes from the Superficial Temporal Artery and from the Opthalmic Artery.

Function

This muscle pulls the eyebrow downward and medially, producing the vertical lines/wrinkles of the forehead.

Clinical relevance

This muscle acts when producing the facial expressions of sadness and puzzlement; it creates a "frown". It also acts to help shield the eye from strong light.

Nasal Facial Muscles

There are 3 major Nasal Facial Muscles:

  1. Procerus
  2. Nasalis
  3. Depressor Septi Nasi

Procerus

Origin and insertion

Procerus, AKA Pryamidalis Nasi) runs between the nose and the forehead. The term procerus means tall or extended in Latin.

It arises from the superior surface of the nasal bones, and the upper lateral nasal cartilages.

The fibres travel upwards to insert into the skin of the inferomedial forehead, its fibres at this point merge with those of frontalis, in between the 2 eyebrows.

Nerve and blood supply

It derives its nerve supply from the temporal branch of the Facial Nerve.

Blood supply is via the Facial Artery.

Function

This muscle pulls down the medial parts of the eyebrows, causing transverse wrinkles in the skin above the nose and between the eyebrows (this area is sometimes referred to as the glabella area).

Clinical relevance

Contraction of Procerus causes the facial gesture of a frown, along with Corrugator Supercilii. Procerus is responsible for producing horizontal lines over the bridge of the nose. Its main action is involved with facial expressions of sadness, bewilderment or anger.

Nasalis

Origin and insertion

Nasalis is split into two sections: alar (AKA Dilator Naris) and transverse (AKA Compressor Naris).

Both sections of the muscle originate from the frontal part of the maxilla.

  • The fibres of the alar section travel medially to insert into the ipsilateral alar cartilages
  • The transverse fibres insert into an aponeurosis on the dorsum of the nose
Nerve and blood supply

The buccal branch of the Facial Nerve supplies both sections of this muscle.

Blood supply is porvided by the superior labial, septal and lateral nasal branches of the Facial Artery, and the infraorbital branch of the Maxillary Artery.

Function

The two sections of this muscle have opposing actions: the alar section of Nasalis brings about widening of the nostril, and the transverse fibres compress the nostril.

Clinical relevance

Nasalis is an accessory muscle of respiration, being particularly active during deep breathing and times of respiratory distress; it also acts in emotional states such as anger.

Assessment

Treatment

Resources

  1. Bérzin F. Occipitofrontalis muscle: functional analysis revealed by electromyography.  Electromyogr Clin Neurophysiol. 1989;29(6):355‐358.
  2. 2.0 2.1 Tong J, Lopez MJ, Patel BC. Anatomy, Head and Neck, Eye Orbicularis Oculi Muscle. [Updated 2020 Apr 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441907/
  3. 3.0 3.1 Choi Y, Kang HG, Nam YS, Kang JG, Kim IB. Facial Nerve Supply to the Orbicularis Oculi around the Lower Eyelid: Anatomy and Its Clinical Implications.  Plast. Reconstr. Surg. 2017 Aug;140(2):261-271. [PubMed]
  4. Hollander MHJ, Contini M, Pott JW, Vissink A, Schepers RH, Jansma J. Functional outcomes of upper eyelid blepharoplasty: A systematic review.  J Plast Reconstr Aesthet Surg. 2019 Feb;72(2):294-309. [PubMed]