Muscles of facial expression

Muscles of face bring about different types of facial expressions, hence the name muscles of facial expression, the actions of many of them are implied by their names.

CHARACTERISTICS:

  1. Lie in superficial fascia and inserted into the skin.
  2. Morphological, they represent subcutaneous muscle of lower animals, called panniculus carnosus.
  3. Embryologically, develop from mesoderm of 2nd pharyngeal arch, hence supplied by facial nerve
  4. Functionally, perform all important functions of non-verbal communication in addition to closing and opening of orifices.

MUSCLES AROUND THE ORIFICE OF EYE

🔹️Orbicularis oculi

Consists of three parts:

  1. Orbital part: arises from medial palpebral ligament, frontal process of maxilla and adjoining part of frontal bone. Fibres form complete elliptical loops around the eyes.

It closes the eye tightly during intense sunlight and also for winking.

2. Palpebral part: arises from medial palpebral ligament and sweeps laterally over the upper and lower eyelids to be inserted into lateral palpebral ligament.

It closes the eyelids gently as in sleep or in blinking.

3. Lacrimal part: arises from posterior lacrimal crest and lacrimal fascia and passes laterally in front of tarsal plates of both eyelids to be inserted into lateral palpebral range.

It dilates the lacrimal sac , thus helping in the drainage of lacrimal fluid.

🔹️Corrugator supervision

It arises from medial end of superciliary arch, passes laterally and upwards to be inserted into the skin of eyebrow.

It drags the eyebrow medially and downwards producing vertical wrinkles on the the forehead.

🔹️Frontalis

It elevates the eyebrows and produces transverse wrinkles on the forehead.

🔹️Levator palpebra superioris

It elevates the upper eyelid.

MUSCLES AROUND NASAL CAVITY

🔹️Procerus

Arises from nasal bone, passes upwards to be inserted into the skin of lower part of the forehead.

It produces transverse wrinkles across the bridge of the nose.

🔹️Nasalis

Consists of 2 parts:

  1. Compressor naris: arises from maxilla close to nasal notch, passes upwards and medially to form aponeurosis across the bridge of the nose.

It compresses the nasal aperture.

2. Dilator naris: arises from maxilla for the margin of nasal notch and inserted into the lateral part Ala of nose.

Dilates the anterior nasal apertures.

🔹️DEPRESSOR SEPTI

It arises incisive fossa of the maxilla and is inserted into the lower mobile part of the nasal septum.

It fixes the nasal septum to allow dilation of anterior nasal aperture by dilator naris.

MUSCLES AROUND MOUTH

🔹️Orbicularis Oris

It has extrinsic and intrinsic portions. The major extrinsic portion is composed of interlacing fibres of the muscles which converge around the mouth for their insertion into the lips. The fibres of buccinator converge towards modulus and form chiasma.

The intrinsic portion consists of fibres running obliquely between the skin and mucous membranes of lips, incisive slips, which pass laterally into lips and interlace with fibres of peripheral part of orbicularis oris.

🔹️Nine muscles which converge around the mouth

  1. Levator labii superioris alaeque nasii: arises from frontal process of maxilla, inserted into Ala of nose. Elevates upper lip and dilates the nostrils.
  2. Levator labii superioris: arises from maxilla just above infraorbital frames and inserted into upper lip. Elevates upper lip.
  3. Levator anguli oris: arises from maxilla below infraorbital foramen, inserted into angle of mouth. Raises the angle of mouth.
  4. Zygomaticus minor: arises from zygomatic bone, inserted into upper lip. Elevates upper lip.
  5. Zygomaticus major: arises from zygomatic bone, inserted into angle of mouth. Draws angle of mouth upward and laterally.
  6. Depressor labii inferioris: arises from anterior oblique line of mandible, inserted into lower lip. Draws lower lip downward and laterally.
  7. Depressor anguli oris: arises from posterior part of oblique line of mandible, inserted into angle of mouth.
  8. Risorius: arises from parotid fascia, inserted into angle of mouth. Retracts angle of mouth gently.
  9. Buccinator: arises from outer surface of alveolar process of maxilla, pterygomandibular raphe, outer surface of alveolar process of mandible. It flattens the cheek and helps in blowing the cheek.

Muscle of chin: Mentalis

Arises from incisive fossa of mandible, inserted into lower lip.

It puckers the chin and protrudes the lower lip.

REFERENCE:

Vishram Singh: Textbook of Anatomy

ANAESTHESIA – LOCAL AND GENERAL WITH BRAND NAMES AND COMPANY MANUFACTURER

Anaesthetics – local & genral
….
1.Bupivacaine

Used as

👉 Percutaneous infiltration anaesthesia ,

👉 peripheral nerve block

👉Sympathetic nerve block
,
👉retrobulbar block ,

👉Cadual block

👉Lumbar epidural block

Brand names.

🙏Buloc by celon
Inj – 0.25 % & in 0.5 % ( 20ml )
.
🙏Bupivan by Sun pharma
Inj :- 0.25% (20ml)
0.5% ( 20ml )
0.5% ( 4ml )
.
🙏 Marcain by AHPL
Inj:- 0.5 % ( 20ml )
Inj :- 1 % ( 2ml )
.

  1. Halothane
    Inhalation anesthesia

👉 used in Induction & maintenance of general anaesthesia
.
🙏Fluothane by AhPL
I:vap :- 100% in ( 200 , 250 , 30, 50 ml ) soln
.
3.Isoflurane
Inhalation anaesthesia

👉 Induction & maintenance of general anaesthesia
.
🙏 Forane by abbott
Inhalant :- 100% in ( 100, 250 ml )

🙏Isorane by AhPL
I:sol :- 5mg/5ml in ( 100,250,30 ml )
.

  1. Ketamine
    Intramuscular
    & Intravenous anesthesia


.
,🙏Ketam by sun
Inj 10mg/ ml (10ml )
Inj 50mg / ml ( 2ml )
.
🙏Ketmin by Themis medicare
Inj 50mg /ml ( 10 ml )
Inj 50 mg/ ml ( 2ml )
.
🙏Ketsia by celon
Inj 100mg ( 2ml )
Inj 500mg ( 10ml )

Abbreviation
I sol :- inhalation solution
Ivap :- inhalation vapour

  1. Lidocaine ( used as )
    Epidural
    👉 as Epidural anesthesia
    Injection
    👉Pulp dilatation during phaco-emulsification cataract surgery
    Intraspinal
    👉Spinal anaesthesia
    as Intravenous
    👉Intravenous regional anaesthesia
    Parenteral
    👉 Sympathetic nerve block
    👉 Peripheral Nerve Block
    👉 Percutaneous infiltration anaesthesia
    Urethral
    👉Surface anesthesia
    Mouth / throat
    👉Surface anesthesia
    as for Opthalmic region
    👉Surface anesthesia
    Rectal & topical / cutaneous
    .
    Company names


    ..

🙏Gesican 2% gelly by AHPL ( 30ml )

🙏Lidopatch by zydus cadila
T:patch- 5%

🙏Xylocaine by AstraZeneca
T:sol:- 2% 100ml
Oint :- 5% w/w ( 20mg )
Jelly :- 2% w/w ( 30mg )
..

🙏Xylocard 2 % by AstraZeneca
Inj (21.3mg/ml ) 50ml soln
.

🙏 Xylocaine viscous by astra zeneca
T:sol :- 21.3mg/ml ( 100ml )

🙏 Xylocaine topical 4% by AstraZeneca
T:sol :- 42.7mg/ml ( 30ml )

🙏Nummet by icpa
Spy :- 15% w/w ( 100g )

.
Some Combinations
Lidocaine + epinephrine

🙏 Lignosafe by stedman
( Lignocaine hcl 21.3mg & adrenaline 0.0125mg/ml )
Inj in 30ml

🙏 Xylocaine with adrenaline 2% by AstraZeneca
( Lidocaine hcl 21.3mg , adrenaline 0.005mg , nacl 6mg /ml )
Inj 30ml
.

Some other combination
🙏 Xylocaine 5% heavy ( lignocaine hcl 53.3mg/ml , Dextrose 75mg ) inj in 2ml
.

& Xylocaine soln ( same dosage as above ) T:Sol 100ml by AstraZeneca

🙏 Xylocaine spray by AstraZeneca
( Lidocaine hcl 100mg , ethanol 28.29% ) 500ml
.
🙏Xicaine by icpa
( Lignocaine 2 percent , adrenaline 0.022mg) inj 30ml
&
( Lignocaine hcl 2% , adrenaline 0.009 mg ) inj 30ml
.
🙏Asthesia by unichem
( Lidocaine 2.5% w/w , prilocaine 2.5% )
CRM (15,30,5 )g
.
Abbreviation
Crm :- cream
Tsol :- topical solution

HAIRY TONGUE

INTRODUCTION

Black hairy tongue is a harmless temporary oral condition. It gives the tongue black and flurry appearance.

This is a condition of defective desquamation of the filiform papillae.

OTHER NAMES-

black tongue, lingua villosa nigra.

ETIOLOGY-

Usually unknown but below are some of the causes-

  • A soft diet: A lack of stimulation for abrasion to the surface of the tongue can prevent sufficient shedding of the papillae.
  • Poor oral hygiene: This can cause a buildup of bacteria or yeast, contributing to hairy tongue.
  • Certain substances: Tobacco use, as well as excessive consumption of alcohol, coffee or tea, for example.
  • Dehydration or dry mouth: Lack of moisture in the mouth can make a person more prone to having hairy tongue.
  • Certain medications: These include some treatments for stomach acid reflux.
  • Oral hygiene products: Certain types of mouthwash, such as those containing peroxide. 

CLINICAL FEATURES

Age: occurs at any age

Sex: No gender predilection is seen but seen mostly in males than in females.

Site: dorsal surface and the lateral surface of the tongue.

CLINICAL PRESENTATION

  • Usually Asymptmatic.
  • Patient may present black discoloration of the tongue, although the color may be brown, tan, green, yellow or white.
  • hairy or furry appearance of the tongue.
  • Altered taste or metallic taste in your mouth.
  • Bad breath (halitosis)
  • Gagging or tickling sensation, if the overgrowth of the papillae is excessive.

HISTOLOGIC FEATURES

Elongated filiform papillae with mild hyperkeratosis and occasional inflammatory cells

Debris accumulation among the papillae and candida pseudohyphae may be seen.

TREATMENT

Recommended to maintain a good oral hygiene, use of mouth wash, regular brushing