Head and Neck Muscles

Reflexes

Lecture 8
Objectives

1. Identify the parts of the skeletal muscle and action of the skeletal
muscle.
2. Compare and contrast the origin and insertion of muscles.
3. Compare and contrast tendons vs. ligaments and aponeuroses.
4. Identify types of movements skeletal muscles perform.
5. Identify the muscles of facial expression and muscles of
mastication, their origin, insertion, action and innervations.
1. Identify the parts of the skeletal muscle and action
of the skeletal muscle.
Skeletal muscle mostly consists of skeletal muscular
tissue and connective tissue proper. In the skeletal
muscle these two tissues are organized in a very special
order, where the bundles skeletal muscle fibers are
wrapped in the membranes of connective tissue:
endomysium, perimysium, epimysium and deep
fascia. At the ends of the muscle these layers of
connective tissue do not end; instead they are fused
together to make tendons (or aponeuroses), which in
their turn strongly attached to the bones, other
muscles or other body parts.
When the muscular fibers contract within muscle they
pull connective tissue, which is pulling the tendon that
pulls the bone (or another organ attached to the
tendon). When muscular fibers relax the elasticity of
connective tissue returns the muscle to the initial
position.
2. Compare and contrast the origin and insertion of muscles.

Origin and insertion of the muscle are the sites where connective tissue attaches muscle to the
bone.
Insertion is usually more moveable part; normally insertion is pulled toward origin rather than
vice versa. It is usually only one insertion, while it can be few origins (heads; e.g. two heads of
the biceps bracii). Origin is usually more proximal than insertion and can be wider than
insertion.

3. Compare and contrast tendons vs. ligaments and aponeuroses.

Stripes or sheets of connective tissue that attach skeletal muscles to bones are usually referred
as tendons. Aponeuroses attach muscle to muscle. Ligaments attach bone to bone. Ligament
may be also referred to other attachments; e.g. visceral organs to the abdominal wall, or to
each other.
4. Identify types of movements
skeletal muscles perform.
Most of the skeletal muscles are
attached to the bones and move
the bones that they are attached
to. To move the bone muscle must
bypass at least one joint. When
describing the movement
anatomists usually name the joint
or the bone, which is moving and
the type of movement which
occurs in this joint; e.g. flexion of
elbow, or flexion of ulna (forearm).
Muscles that have the same action
are called synergists; e.g. biceps
and brachioradialis both flex the
elbow. Muscles that perform
opposite movements are called
antagonists; biceps and triceps.
5. Identify the muscles of facial
expression and muscles of mastication,
their origin, insertion, action and
innervations.

Most of the muscles of facial expression

have their origin on the bones of the skull
and insertion in the skin of the face. When
they contract they move the parts of the
face and give different expressions.
Muscles of facial expression: Galea
aponeurotica (epicranial aponeuroses)
connects frontalis and occipitalis,
orbicularis ocili, levator labii superioris,
zygomaticus major and minor, risorius,
platysma, depressor anguli oris,
sternocleidomastoid, mentalis, depressor
labii inferioris, orbicularis oris,
buccinators, corrugator supercilii, levator
palpebrae superioris, nasalis.
 TABLE 7.3 MAJOR FUNCTIONAL MUSCLES OF FACE AND SCALP
Muscle Origin Insertion Action

Musclea Origin Insertion Main Action(s) Zygomaticus Zygomatic arch Angle of the Elevates angle of the
Major mouth mouth (smile)
Occipitofrontalis
Zygomaticus Zygomatic arch Upper lip Elevates upper lip
Frontal belly Epicranial aponeurosis Skin and Elevates eyebrows and Minor
subcutaneous wrinkles skin of
tissue of eyebrows forehead; retracts scalp
and forehead (indicating surprise or Risorius Fascia (connective tissue) of Angle of the Retracts angle of the
curiosity) the cheek near ear mouth mouth (false smile)

Occipital belly Lateral two thirds of Epicranial Retracts scalp; Depressor anguli Mandible Angle of the Depresses angle of the
superior nuchal line aponeurosis increasing effectiveness oris mouth mouth
of frontal belly

Mentalis Mandible Lower lip Protracts lower lip

Orbicularis Medial orbital margin; Skin around Closes eyelids: palpebral
oculi (orbital medial palpebral margin of orbit; part does so gently; (inferior)
sphincter) ligament; lacrimal bone superior and orbital part tightly
inferior tarsi (winking) All facial muscles are innervated by the facial nerve (CN VII) via its posterior auricular branch or via
(tarsal plates) the temporal, zygomatic, buccal, marginal mandibular, or cervical branches of the parotid plexus.

Orbicularis Medial maxilla and Mucous Tonus closes mouth;

oris (oral mandible; deep surface membrane of lips phasic contraction
sphincter) of peri-oral skin; angle compresses and
of mouth protrudes lips (kissing)
or resists distension
(when blowing)

Buccinator Mandible, alveolar Angle of mouth Presses cheek against

(cheek processes of maxilla (modiolus); molar teeth; works with
muscle) and mandible, orbicularis oris tongue to keep food
pterygomandibular between occlusal
raphe surfaces of teeth and
out of oral vestibule;
resists distension (when
blowing)

Platysma Subcutaneous tissue of Base of mandible; Depresses mandible

infraclavicular and skin of cheek and (against resistance);
supraclavicular regions lower lip; angle of tenses skin of inferior
mouth; orbicularis face and neck
oris
Muscles of mastication:
masseter, temporalis, pterygoid medial and pterygoid lateral.
Muscle Origin Insertion Main Action(s)

Masseter Zygomatic arch Angle of the mandible Bilateral - elevates and protracts
mandible, unilateral – turns jaw contra-
laterally

Temporalis Temporal bone Coronoid process of the Elevates mandible

mandible

Pterygoid Pterygoid pcs of Medial surface of Elevates and protracts mandible

medial sphenoid mandibular angle and Unilateral - side to side
ramus

Pterigoid Pterygoid pcs of Mandibular condyle Depresses and protracts mandible

lateral sphenoid Unilateral - side to side

All muscles of mastication are innervated by the mandibular branch of trigeminal (CN V) nerve.
Genioglossus Posterior mental Ventral surface of the Bilateral- depresses and
protuberance of the tongue protrudes the tongue
mandible Unilateral – turns the tip
of the tongue contra-
laterally

Hyoglossus Hyoid Lateral and ventral Depresses the tongue

surface of the tongue

Styloglossus Styloid pcs. Dorsolateral surface Elevates back of the

of the tongue tongue

Palatoglossus Soft palate Lateral surface of the Elevates root of the

tongue tongue, closes pharynx

First three muscles are supplied by the Hypoglossal nerve (CN XII).
Palatoglossus is supplied by the Vagus nerve (CN X).
 Sternocleidomastoid
muscle moves the
head.

Muscle Origin Insertion Main Action(s)

Sternocleidomastoid Manubrium of the sternum Mastoid pcs Bilateral- flexes cervical vertebrae and
Medial clavicle extends head
Unilateral – flexes the neck laterally
and rotates face to contralateral side

Sternocleidomastoid muscle receives motor signals from the Accessory (spinal accessory) nerve (CN XI). Sensations from this muscle perceived via cervical plexus.
Reflexes
 Reflexes

Objectives
1. Describe the steps in a neural reflex
2. Classify the types of reflexes and explain the
functions of each.
A reflex is a specific motor reaction to a specific stimulus.
A reflex arc is the pathway followed by nerve impulses that
produce a reflex. An ideal reflex arc consists of 5 steps:
1) receptor, 2) afferent fiber, 3) interneuron(s),
4) efferent fiber and 5) effector.
1. Receptors convert external or internal stimulus (e.g. light, heat,
pressure, chemical changes) into the action potentials.
2. Afferent (sensory) fibers transmit these signals to the
interneurons in CNS.
3. Interneurons integrate and process the signals; it may be one or
few interneurons or no interneuron at all.
4. Motor fibers transfer the AP from CNS to the effector.
5. Effectors (e.g. skeletal muscles, smooth muscles, glands) perform
the response.
2. Classify the types of reflexes and explain the functions of each.

Reflexes can be classified by the site of processing: e.g. spinal, brain stem, cerebral, etc.
Spinal reflexes are processed at the level of the spinal cord. This allows the faster motor
reaction because the motor neuron is activated without sending signals to the brain and back.
Although, the brain still receives the signal while the motor reaction is occurring: e.g. myotatic
stretch reflexes.
Brain reflexes are processed at the level of the brain. Their absence indicates brain death; e.g.
pupillary, pharyngeal, cough reflexes. Cough reflex is coughing in response to irritation of the
airway linings. Pupillary reflex is a contraction of the pupil in response to the light. Pharyngeal
reflex is a contraction of pharyngeal constrictor muscle in response to touching the back of the
pharynx.

Reflexes can be classified by the number of synapses in the reflex arch:

polysynaptic vs. monosynaptic. Polysynaptic reflexes involve more than one
synapse. They are often complex and take a longer time. Monosynaptic reflexes
involve just one synapse. There are no interneurons involved and processing
occurs in the motor neuron. These reflexes are the most simple and fastest.
Myotatic stretch reflexes are an example of a spinal
monosynaptic reflex. A stretch reflex is the contraction of
the muscle in response to the stretching of the muscle
spindles. Muscle spindles are receptors inside the muscle
that lie parallel to muscle fibers. When a muscle spindle is
stretched the sensory neuron sends the signal to the motor
neuron in the ventral horn of the spinal cord which in turn
sends the signal back to the muscle and the muscle
contracts. Stretch reflexes are very important to maintain
posture and balance. For the testing purposes the myotatic
stretch reflexes can be checked by brisk taping of the
tendon of the corresponding muscle: knee jerk reflex
(patellar ligament) , ankle jerk reflex (Achilles tendon),
biceps reflex (biceps tendon), brachioradialis reflex, etc.
Hyporeflexia – absent or low response to tapping (weak reflexes) usually indicate the damage of
the motor neuron within the reflex arc (lower neuron damage).
Hyperreflexia – repeating or too strong response to tapping indicates damage to the descending
tracts of the corticospinal pathway (upper neuron damage).
The Golgi tendon organ, which is
another receptor, is attached between
the muscle and the tendon. When
muscle contracts Golgi tendon organ
sends the signal to the spinal cord and
synapses on an inhibitory interneuron.
The inhibitory interneuron synapses on
an alpha motor neuron which goes to
an antagonist muscle and causes
relaxation of the antagonist.
Information is also conveyed from
these receptors to the cerebellum and
cortex.
Reflexes can be classified by their development: innate vs. acquired. Inborn or innate reflexes
are involuntary and unlearned. Withdraw reflex is pulling your body part away from pain (e.g.
hand away from a hot surface when touched). Palatine reflex is a swallowing in response to
stimulation of the palate. Grasp reflex is a flexion of the fingers (grasping) in response to
stimulation of the palm (in infants). Rooting reflex; when an infant's cheek is stroked, the baby
responds by turning his or her head in the direction of the touch and opening their mouth for
feeding.
Learned or acquired reflexes are often complex, learned motor patterns acquired during the
lifetime; e.g. walking on two extremities, biking, swimming, driving the car, reading, writing,
speech, languages, following the traffic rules, etc.
Reflexes can be classified by the effector organs: somatic vs. autonomic (visceral). Somatic Reflexes: involve
contractions of the skeletal muscles. Examples: Knee Jerk reflex, biking. Babinski's reflex dorsiflexion of the big toe
results from firmly stroking the lateral outer margin of the sole. In adults positive Babinski is a sign of the lesions in
the cortex or in the pyramidal tract, although it is a normal reflex in infants till one year old.
Autonomic or visceral reflexes: involve glands, smooth and cardiac muscles, and generally are not consciously
perceived. The main integrating centers for most autonomic reflexes are located in the hypothalamus and brain
stem. Some autonomic reflexes, e.g. for urination and defecation, have integrating centers in the spinal cord.
Examples: peristaltic reflex, when a portion of the intestine is full (stretched and irritated), the area just proximal
contracts and the area just distal relaxes, blood pressure regulation, pupil constriction or dilation, etc.
The steps of the visceral reflex
arch are essentially the same as
somatic, but visceral (autonomic)
has two neurons in the motor
branch: preganglionic and
postganglionic; while somatic
reflex has only one neuron in the
motor branch.
To perform Babinski’s test, the sole of the foot
must be firmly stroked on the lateral side in
the direction from heel to toes as it shown in
the image.
A and B normal adult plantar reflex causes a Positive Babinski’s is normal in babies. Positive Babinski’s after age 2
flexion of the hallux and toes ( Negative is a sign of damage to the nerve paths connecting the spinal cord and
Babinski’s sign). the brain (the corticospinal tract).
C is positive Babinski’s sign, when the big toe Underlying causes of positive Babinski’s test may be head trauma,
moves toward the dorsum of the foot and the stroke, meningitis, multiple sclerosis, brain tumor etc. A Babinski's
other toes fan out in response to the foot reflex can occur on one side or on both sides of the body. Patients
stroke. with positive Babinski’s may complain of poor coordination and
muscle spasms or weakness.
Cranial Nerves
Lecture 7
Objectives

1. List twelve pairs of cranial nerves.

2. Explain functions and types of the twelve pairs of
cranial nerves.
3. Identify location and function of each cranial nerve
and discuss clinical applications of cranial nerve
impairments.
1. List twelve pairs of cranial nerves.

I – Olfactory IX – Glossopharyngeal
II – Optic X – Vagus
III –Oculomotor XI – Accessory (Spinal Accessory)
IV – Trochlear XII – Hypoglossal
V – Trigeminal
VI – Abducens
VII – Facial
VIII – Vestibulocochlear
 2. Explain functions and types of twelve pairs of cranial nerves.
Cranial nerves, like spinal nerves, contain sensory or motor fibers, or a combination of these fibers. Cranial nerves innervate
muscles or glands or carry impulses from sensory receptors. They are called cranial nerves because they emerge from foramina
or fissures in the cranium and are covered by tubular sheaths derived from the cranial meninges. Cranial nerves carry one or
more of the following five main functional components:
Motor (efferent) fibers
1. Motor fibers innervating voluntary (striated) muscle: Somatic motor (general somatic efferent) axons innervate the striated
muscles in the orbit, tongue, and external muscles of the neck (sternocleidomastoid and trapezius) as well as striated muscles
of the face, palate, pharynx, and larynx. The muscles of the face, palate, pharynx, and larynx are derived from the pharyngea l
arches and their somatic motor innervation is CN III, IV, VI, VII, IX, XI, & XII.
2. Motor fibers involved in innervating glands and involuntary (smooth) muscle (e.g., in viscera and blood vessels). These
include visceral motor (general visceral efferent) axons that constitute the cranial outflow of the parasympathetic division of
the autonomic nervous system. The presynaptic (preganglionic) fibers that emerge from the brain synapse outside the central
nervous system in a parasympathetic ganglion. The postsynaptic (postganglionic) fibers innervate glands and smooth muscle
throughout the body: CN III, VII, IX, & X.
Sensory (afferent) fibers
3. Fibers conveying sensation from the viscera. These include visceral sensory (general visceral afferent) fibers conveying
information from the carotid body and sinus, pharynx, larynx, trachea, bronchi, lungs, heart, and gastrointestinal tract: CN X.
4. Fibers transmitting general sensation (e.g., touch, pressure, heat, cold) from the skin and mucous membranes. These inclu de
somatic (general) sensory fibers: mainly CN V, but also CN VII, IX, & X).
5. Fibers transmitting unique (special) sensation. These include special sensory fibers conveying taste and smell and those
serving the special senses of smell (I), vision (II), hearing, and balance (VIII), taste (VII, IX and X).
 Olfactory Nerve: (CN I)

Anosmia – loss of smell .

Causes and risk factors:
aging, trauma,
inflammation of mucosa
due to infection or allergy,
neurogenic disorders (MS,
schizophrenia, epilepsy),
smoking, sniffing cocaine.

Rhinorrhea, a leakage of
the fluid through the nose
from the subarachnoid
space. Rhinorrhea may
result from skull base
fracture.
 Optic nerve (CN II)
The optic nerve passes through the optic
canal (optic foramen) to enter the middle
cranial fossa, where it forms the optic
chiasm. Here, fibers from the nasal
(medial) half of each retina decussate in the
chiasm and join uncrossed fibers from the
temporal (lateral) half of the retina to form
the optic tract. Thus, fibers from the right
halves of both retinas form the right optic
tract, and those from the left halves form
the left optic tract. The decussation of
nerve fibers in the chiasm results in the
right optic tract conveying impulses from
the left visual field and vice versa.
 Most fibers in the optic tracts terminate in the lateral
geniculate bodies (nuclei) of the thalamus. From these
nuclei, axons are relayed to the visual cortices of the
occipital lobes of the brain.
Demyelinating Diseases and the Optic Nerve
Because the optic nerves are actually CNS tracts, the myelin
sheath that surrounds the fibers from the point at which
they penetrate the sclera is formed by oligodendrocytes
rather than by Schwann cells. Consequently, the optic
nerves are susceptible to the effects of demyelinating
diseases of the CNS, such as multiple sclerosis (MS).
The visual field (VF) is what is seen by a person with both
eyes wide open and looking straight ahead.
VF seen by right eye only (with left closed) is different from
VF seen by left eye only
Visual field defects may result from a large number of
neurologic diseases. It is clinically important to be able to
link the defect to a likely location of the lesion.