Levator Anguli Research Articles

Coyotes can do 'puppy dog eyes' too: comparing interspecific variation in Canis facial expression muscles.

Facial expressions are critical for non-verbal communication. The Canis genus epitomizes the interplay between behaviour and morphology in the evolution of non-verbal communication. Recent work suggests that the levator anguli oculi medialis (LAOM) muscle is unique to dogs (Canis familiaris) within the Canis genus and evolved due to domestication. The LAOM raises the inner eyebrows, resulting in the 'puppy dog eyes' expression. Here, we test whether the LAOM is a derived trait in dogs by (i) examining the facial expression muscles of a closely related and ancestral wild Canis species, the coyote (C. latrans) and (ii) comparing our results with other Canis and canid taxa. We discover that coyotes have a well-developed LAOM like dogs, which differs from the modified/absent LAOM in grey wolves. Our findings challenge the hypothesis that the LAOM developed due to domestication. We suggest that the LAOM is a basal trait that was lost in grey wolves. Additionally, we find inter- and intraspecific variations in the size of the muscles of the outer ear, forehead, lips and rostrum, indicating potential adaptations related to sensory perception, communication and individual-level functional variations within canids. Together, this research expands our knowledge of facial expressions, their evolution and their role in communication.

Nerve entry points in the mimic musculature of the horse head.

Facial expressions are important in pain recognition in horses, but current observation-based pain scales remain subjective. A promising technique to quantitatively measure subtle changes in expression patterns, including changes invisible to the human eye, is surface electromyography (sEMG). To achieve high-quality and reliable sEMG signals, unilateral placement of bipolar electrodes is required in relation to the motor endplates (MEP). We aimed to localize the nerve entry points (NEPs; where the nerve branch first pierced the muscle belly) and the direction of the terminal nerve endings to estimate MEP locations of the innervating nerves in five equine facial muscles involved in pain expression. Three cadaveric Dutch Warmblood horse heads were dissected to identify the NEPs in the musculi caninus, levator anguli oculi medialis, nasolabialis, masseter and zygomaticus. These points were marked with pins and measured in relation to a reference line between two anatomical landmarks near the origin and insertion of the respective muscle. Relative distances were calculated from the most caudally situated landmark. NEPs were located at 33%-38% (caninus), 69%-86% (levator anguli oculi medialis) and 0%-18% (zygomaticus) from the caudal landmark. The nasolabialis showed two innervations zones. Its NEPs were located at 47%-72% (dorsal muscle branch) and 52%-91% (ventral branch). All terminal nerve endings were found to run in rostral direction. The masseter showed numerous NEPs diffusely spread within the muscle belly. Therefore, calculation of relative positions was not performed. These results could form the basis for feasibility studies and standardization of bipolar electrode positioning invivo to measure facial muscle activity patterns in horses.

Raising an Eye at Facial Muscle Morphology in Canids.

The evolution of facial muscles in dogs has been linked to human preferential selection of dogs whose faces appear to communicate information and emotion. Dogs who convey, especially with their eyes, a sense of perceived helplessness can elicit a caregiving response from humans. However, the facial muscles used to generate such expressions may not be uniquely present in all dogs, but rather specifically cultivated among various taxa and individuals. In a preliminary, qualitative gross anatomical evaluation of 10 canid specimens of various species, we find that the presence of two facial muscles previously implicated in human-directed canine communication, the levator anguli occuli medialis (LAOM) and the retractor anguli occuli lateralis (RAOL), was not unique to domesticated dogs (Canis familiaris). Our results suggest that these aspects of facial musculature do not necessarily reflect selection via human domestication and breeding. In addition to quantitatively evaluating more and other members of the Canidae family, future directions should include analyses of the impact of superficial facial features on canine communication and interspecies communication between dogs and humans.

Adaptations to sociality in the mimetic and auricular musculature of the African wild dog (Lycaon pictus).

The African wild dog (Lycaon pictus) is a highly social canid that engages in sophisticated, coordinated group hunting tactics to procure large game. It is one of the most effective hunters of the African savannah, due to its highly developed communication methods. It also has large, mobile ears which enhance its auditory capabilities while hunting and assist with thermoregulation. Recent research suggested that certain muscles of facial expression, particularly those involved with expressive eyebrow movement, evolved solely in domestic dogs (Canis familiaris) to facilitate communication with their human owners. However, it is unclear whether highly social wild canid species may also employ similar expressive eye communication. We performed detailed dissections of an adult male L. pictus to evaluate and describe its mimetic and auricular musculature. Overall, L. pictus has well-developed facial and ear muscles. Musculi levator anguli oculi medialis (LAOM) and retractor anguli oculi lateralis (RAOL), mimetic muscles of hypothesized importance in domestic dog-human non-verbal communication, are enlarged in L. pictus, comparable in size to those of domestic dogs, as is m. orbicularis oculi. This morphology suggests that ocular facial expressions contribute to within-pack communication in wild dogs and are not unique to domestic dogs. The auricular muscles of L. pictus are well-developed, supporting greater leverage and fine manipulation of its large, mobile ears. These muscular adaptations facilitate the highly social ecology of African wild dogs and challenge current interpretations about the unique nature of domestic dog facial expressions.

Analysis of the kinetics of the eyelids of little owl Athene noctua

AbstractThis study gives a comprehensive description of eyelids movement in little owl and discusses the impact of some surrounding conditions in their kinetic performance. The present study used the video's recording technique to record the kinetic activity of eyelids, besides the anatomical and histological studies of the eyelid's structure. The fundamental eyelid movements can be uniquely and reliably characterized by their anatomical relationship that was confirmed via video recording for their kinetic activity. The levator palpebrae muscle is considered a main generating motor for the upper eyelid; in the little owl, this muscle splits into multiple directions and is distinguished from the levator palpebrae superioris (Lps) and the levator anguli oculi (Lao) muscle. That anatomical pattern of insertion increases the movement of the upper lid. On the other side, the contraction of depressor palpebrae inferioris (Dpi) muscle and the active upward forces of levator palpebrae muscle help in increasing the opening of the eye's fissure. However, the closure process is produced from the passive downward forces and relaxation of the levator palpebrae superioris (Lps), levator anguli oculi (Lao), and depressor palpebrae inferioris muscle, as well as the contraction of retractor anguli oculi lateralis (Raol) and medialis (Raom) muscle. The present results also recorded that nictitating membrane's (Nm) movement is reversely proportionate to the level of kinetic of other eyelids. The mobility of Nm in little owl occurs under the effect of artificial external stress. These anatomical data and sequence video recordings have confirmed that the upper eyelid moves more compared to other eyelids. The authors also suggest that the mobility of eyelids may get stimulated through external pressure force of some surrounding structure like the periorbital sheet. Also, the histological study exhibited that the structure of two eyelids is very similar in the little owl and the variability is showing in the number of cell layers that forms their epithelium of skin and palpebral surfaces, the distribution of pigment granules, and degree of keratinization on their surface. That variability in the histological characters of eyelids may counteract the abrasive forces occurring during the opening and closing processes.

African Wild Dogs (Lycaon pictus) Show Adaptations to Sociality and Hypercarnivory in Their Cranial Musculature

African wild dogs (Lycaon pictus) are highly social canids that live in large, hierarchical packs and engage in coordinated hunts. Recent research has suggested that enlarged muscles associated with expressive movement of the eyes and eyebrows may have evolved in domestic dogs (Canis familiaris) to facilitate interspecies communication with their human owners. In L. pictus, communication is reported to occur predominantly through vocalization with reduced reliance on facial expressions; however, the mimic muscles in L. pictus have never been described and evaluated. L. pictus is also hypercarnivorous with the highest documented bite force quotient of any mammalian carnivore. It has large, mobile ears, which enhance its auditory capabilities while hunting and assist with thermoregulation.We performed detailed dissections of the muscles of facial expression, mastication, and auricular movement in an adult male L. pictus,and conducted diffusible iodine‐based contrast‐enhanced computed tomographic (diceCT) scans of the head. Musculus levator anguli oculi medialis (LAOM) and retractor anguli oculi lateralis (RAOL), muscles of hypothesized importance in domestic dog‐human non‐verbal communication, are enlarged in L. pictus, suggesting that ocular expressions represent a significant component of communication. LAOM exhibits an intricate relationship with adjacent orbital musculature including partial fusion along its borders with mm. orbicularis oculi and frontalis. Muscles that draw the angles of the mouth caudally (e.g., m. zygomaticus major) are expanded. Numerous ramifying branches of CN VII and CN V2 course across the face to provide extensive sensory and motor innervation. These findings indicate that facial expression musculature of African wild dogs is well‐equipped for non‐verbal communication and that the same adaptations argued to facilitate communication between domestic dogs and humans may also facilitate intraspecific communication in L. pictus.Muscles of mastication are especially enlarged in L. pictus, with multiple bellies of mm. masseter and temporalis separated by deep layers of thick intermuscular fascia and with expanded insertions onto the mandible. Musculus digastricus is composed of a single, large belly without intervening tendon, and it receives its innervation exclusively from CN V3. These enlargements reflect increased masticatory capabilities in L. pictus, which enable its powerful bite force and hypercarnivorous diet. Auricular muscles are also well‐developed, supporting greater leverage and fine manipulation of its large, mobile ears. Musculus frontoscutularis is well‐developed and distinctly separable from m. frontalis, suggesting greater leverage of the auricle via attachments to the scutiform cartilage. The intrinsic ear muscles differ in pattern and orientation from all other published canids, demonstrating unique muscular control over rotation and fine manipulation of the auricle. Taken together, these morphological patterns illustrate that specific adaptations in the cranial musculature of L. pictus facilitate its ecological habits.

How puppy dog eyes evolved

Companion Animals![Figure][1] Humans selected for dogs' expressive eyebrows. PHOTO: SARAH BICKEL Dogs are adorable. We are often amazed at just how humanlike their facial expressions can be when they gaze into our eyes. Kaminski et al. provide an evolutionary explanation for how “puppy dog eyes” came to be, by comparing the facial muscles of dogs with their closest living relatives, wolves. As dogs became domesticated thousands of years ago and began to form bonds with humans, both their anatomy and behavior developed as a result of selection for favorable traits. Dogs (but not wolves) harbor the levator anguli oculi medialis muscle, which is responsible for raising the inner eyebrow. This allows dogs to produce eyebrow movements that are more frequent and expressive than those of wolves, in turn giving dogs an evolutionary advantage with humans, who instinctively respond more positively. Proc. Natl. Acad. Sci. U.S.A. 10.1073/pnas.1820653116 (2019). [1]: pending:yes

Evolution of facial muscle anatomy in dogs

Domestication shaped wolves into dogs and transformed both their behavior and their anatomy. Here we show that, in only 33,000 y, domestication transformed the facial muscle anatomy of dogs specifically for facial communication with humans. Based on dissections of dog and wolf heads, we show that the levator anguli oculi medialis, a muscle responsible for raising the inner eyebrow intensely, is uniformly present in dogs but not in wolves. Behavioral data, collected from dogs and wolves, show that dogs produce the eyebrow movement significantly more often and with higher intensity than wolves do, with highest-intensity movements produced exclusively by dogs. Interestingly, this movement increases paedomorphism and resembles an expression that humans produce when sad, so its production in dogs may trigger a nurturing response in humans. We hypothesize that dogs with expressive eyebrows had a selection advantage and that "puppy dog eyes" are the result of selection based on humans' preferences.

Facial motor and non-motor disabilities in patients with central facial paresis: a prospective cohort study.

Although central facial paresis (CFP) is a major symptom of stroke, there is a lack of studies on the motor and non-motor disabilities in stroke patients. A prospective cohort study was performed at admission for inpatient rehabilitation and discharge of post-stroke phase of 112 patients (44% female, median age: 64 years, median Barthel index: 70) with CFP. Motor function was evaluated using House-Brackmann grading, Sunnybrook grading and Stennert Index. Automated action unit (AU) analysis was performed to analyze mimic function in detail. Non-motor function was assessed using the Facial Disability Index (FDI) and the Facial Clinimetric Evaluation (FaCE). Median interval from stroke to rehabilitation was 21 days. Rehabilitation lasted 20 days. House-Brackmann grading was ≥ grade III for 79% at admission. AU activation in the lower face was significantly lower in patients with right hemispheric infarction compared to left hemispheric infarction (all p < 0.05). Median total FDI and FaCE score were 46.5 and 69, respectively. Facial grading and FDI/FaCE scores improved during inpatient rehabilitation (all p < 0.05). There was a significant increase of the activation of AU12 (Zygomaticus major muscle), AU13 (Levator anguli oris muscle), and AU24 (Orbicularis oris muscle) during inpatient rehabilitation (all p < 0.05). Multivariate analysis revealed that activation of AU10 (Levator labii superioris), AU12, AU17 (Depressor labii), and AU 38 (Nasalis) were independent predictors for better quality of life. These results demonstrate that CFP has a significant impact on patient's quality of life. Therapy of CFP with focus on specific AUs should be part of post-stroke rehabilitation.

Anatomical features of the incisivus labii superioris muscle and its relationships with the upper mucolabial fold, labial glands, and modiolar area

The current study examined the incisivus labii superioris muscle (ILS) and its morphologic and spatial relationships with the surrounding structures, especially focusing on the upper mucolabial fold, labial glands, and modiolar area. ILSs were investigated in 52 specimens obtained from formalin-fixed Korean adult cadavers (26 left sides, 26 right sides of the face; 15 men, 11 women; mean age, 70.8 years). ILSs were observed in all specimens (100%). The ILS has an oblique and linear origin from the incisive fossa of the maxilla to the point just medial to the origin of the levator anguli oris muscle (LAO). The arising fibers of the ILS arched and covered the prominent labial glands at the superior margin of the orbicularis oris muscle (OOr). After the ILS coursed laterally along the anterior part of the upper mucolabial fold, it divided into superficial and deep inserting fibers in 48 specimens (92.3%) and it did not divide in 4 specimens (7.7%). The superficial inserting ILS fibers and the ILS fibers that did not divide blended with the medial fibers of the LAO to converge toward the modiolus. The deep inserting fibers of the ILS blended with the lateral deep fibers of the OOr in the 48 specimens (92.3%), and the deep inserting fibers continued to descend to converge toward the modiolus in 20 of those specimens (38.5%). These observations indicate that the ILS may assist to compress the labial glands and the upper oral vestibule, controlling modiolar movements and thereby integrating the movements of the mouth and lips.

IMAGE-BASED SKELETAL MUSCLE COORDINATION: CASE STUDY ON A SUBJECT SPECIFIC FACIAL MIMIC SIMULATION

Facial muscle coordination is a fundamental mechanism for facial mimics and expressions. The understanding of this complex mechanism leads to better diagnosis and treatment of facial disorders like facial palsy or disfigurement. The objective of this work was to use magnetic resonance imaging (MRI) technique to characterize the activation behavior of facial muscles and then simulate their coordination mechanism using a subject specific finite element model. MRI data of lower head of a healthy subject were acquired in neutral and in the pronunciation of the sound [o] positions. Then, a finite element model was derived directly from acquired MRI images in neutral position. Transversely-isotropic, hyperelastic, quasi-incompressible behavior law was implemented for modeling facial muscles. The simulation to produce the pronunciation of the sound [o] was performed by the cumulative coordination between three pairs of facial mimic muscles (Zygomaticus Major (ZM), Levator Labii Superioris (LLS), Levator Anguli Oris (LAO)). Mean displacement amplitude showed a good agreement with a relative deviation of 15% between numerical outcome and MRI-based measurement when all three muscles are involved. This study elucidates, for the first time, the facial muscle coordination using in vivo data leading to improve the model understanding and simulation outcomes.

The effect of a Le Fort I incision on nose and upper lip dynamics: Unraveling the mystery of the "Le Fort I lip".

Postoperative flattening of the upper lip with loss of lip pout and down turning of the corners of the mouth is often seen after Le Fort I surgery. We aim to determine which facial muscles are involved in this phenomenon to update the literature on this subject. In 6 cadavers, a unilateral Le Fort I incision was executed. After removal of the skin, all individual facial muscles were identified and submitted to bilateral tactile traction, comparing incised sides with non-incised sides. All the components of the deep layer of the modiolus alae nasi (transverse part of the nasalis muscle and the myrtiformis muscle) and the deep layer of the midface musculature (levator anguli oris muscle) were transected by the Le Fort I incision. After performing the incision, the majority of the depressor septi nasi is intact. Further, the superficial layer of the midface musculature is intact but it loses tension because of its connection to the deep layer. This study suggests the importance of correctly suturing the deep muscular layers to maintain the 3-dimensional facial contour. Moreover, in this cadaver study, we attempt to predict the functional consequences on the impairment of facial mimics related to the Le Fort I incision.

Levator anguli oris: a cadaver study implicating its role in perioral rejuvenation.

The purpose of this study was to investigate the role of the levator anguli oris in perioral rejuvenation by delineating the detailed anatomy of this muscle and illustrating a new technique to elevate the oral commissure using this muscle. Fresh cadaver dissection was carried out in 9 facial halves specifically examining the anatomy of and surrounding the levator anguli oris. This muscle was identified in each cadaver to coalesce with the zygomaticus major muscle at the modiolus, thus elevating the oral commissure. In 3 facial halves, an intraoral incision from the canine to the modiolus was performed. This allowed easy access to the levator anguli oris muscle for plication and successful elevation of the oral commissure. This procedure could be applied in combination with traditional face lifts to enhance facial rejuvenation or potentially used to reanimate the partially paralyzed face.

DUDAĞIN YENIDEN KONUMLANDIRILMASI VE GINGIVEKTOMI YAPILARAK GUMMY SMILE TEDAVISI BIR OLGU SUNUMU (GUMMY SMILE)

Excessive gingival display can be managed by variety of treatment modalities, depending on specific diagnosis. This case report demonstrates the successful management of excessive gingival display with a lip-repositioning and gingivectomy. A female patient aged 26 years reported with a chief complaint of gummy smile and was treated with this technique performed under local anesthesia with the main objective to reduce gummy smile by limiting the retraction of elevator muscles (e.g., zygomaticus minor, levator anguli, orbicularis oris, and levator labii superioris). The technique is fulfilled by removing a strip of mucosa from maxillary vestibule and creating a partial thickness flap between mucogingival junction and upperlip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display

The relationship between nervus intermedius anatomy, ultrastructure, electrophysiology, and clinical function. Usefulness in cerebellopontine microsurgery

Although previous studies have described the clinical features of the nervus intermedius (NI), no attempt has yet been made to describe the relationship between the ultrastructural and electrophysiological characteristics of the nervus intermedius and its motor competence. In this study, we analyzed the intraoperative electrophysiological response obtained during vestibular schwannoma surgery. The ultrastructure was studied using electron microscopy. Thirty-six consecutive patients underwent microsurgery for vestibular schwannoma with cerebellopontine angle tumors. The patients were extensively monitored intraoperatively. Selective stimulation of the nervus intermedius was attempted in all cases. The patients were then examined postoperatively and followed for a minimum of 1 year. Forty-three isolated human brainstems were analyzed to collect the ultrastructural NI data. We found a correlation between the NI motor responses in the perinasal and perioral regions and the ultrastructure characteristics, with few (0.5 %) but large myelinated motor fibers (diameters >12 μm). Both characteristics are consistent with the clinical observation of transient weakness of the levator anguli oris muscle. These observations indicate a relationship between the intraoperative electrophysiological identification of the NI nervus intermedius and its clinical and ultrastructural characteristics. Identifying the NI in the deformed anatomy of tumors could provide a fixed landmark during cerebellopontine surgery and help prevent damage of the facial nerve.

Unusual labial glands in snakes of the genusGeophisWagler, 1830 (Serpentes: Dipsadinae)

Geophis belongs to the goo-eating dipsadine assemblage of snakes that are known to feed exclusively on earthworms, snails, and slugs. Although the unusual feeding strategies of the goo-eating dipsadines are well known (but poorly documented), little attention has been paid to their internal anatomy. Here, we describe a new and noteworthy morphological and histochemical condition of the infralabial glands in three species of Geophis (G. brachycephalus, G. nasalis and G. semidoliatus), all earthworm feeders. Their infralabial glands are constituted of two distinct parts: an anterolateral portion composed of mucous and seromucous cells that stretches from the tip of the dentary to the corner of the mouth, and a tubular posteromedial portion that is exclusively seromucous. The anterolateral portion receives fibers of the levator anguli oris muscle that attaches on its posterodorsal extremity while the posteromedial portion extends posteriorly to the corner of the mouth where it receives fibers of the adductor mandibulae externus medialis muscle. Furthermore, the posteromedial portion of the infralabial gland is constituted by large acini filled with secretion that is periodic acid-Schiff positive. These acini release their secretion directly into a large lumen located in the middle of the glandular portion. In the three species examined, the supralabial glands show a traditional configuration, being constituted of mucous and seromucous cells and retaining an enlarged part in its caudal region that resembles a Duvernoy's gland. The presence in Geophis of an expanded lumen in part of the infralabial gland that is compressed by an adjacent muscle suggests a more specialized role for the secretion produced by these glands that may not be related to envenomation but rather to prey transport and mucus control.

Lip repositioning with crown lengthening & gingival depigmentation: a case report

This clinical report describes the successful use of lip repositioning technique for the reduction of excessive gingival display. A 34-year-old female patient reported with a chief complaint of gummy smile. The lip repositioning technique was performed under local anesthesia with the main objective of reducing gummy smile by limiting the retraction of elevator muscles (e.g. zygomaticus minor, levator anguli, orbicularis oris and levator labii superioris). The technique is fulfilled by removing a strip of mucosa from the maxillary buccal vestibule, creating a partial-thickness flap between mucogingival junction and upper lip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display. A scalpel surgery was planned for depigmentation. The entire procedure was explained to the patient and written consent was obtained. A Bard Parker handle with a No.15 blade was used to remove the pigmented layer. When a crown lengthening procedure is planned to increase the length of the available tooth, the biological width needs to be considered and not encroached upon, as this may lead to periodontal breakdown.

New anatomical insight of the levator labii superioris alaeque nasi and the transverse part of the nasalis

The aim of this study was to clarify the morphology and topography of the deep layer of levator labii superioris alaeque nasi muscle (LLSAN) and the transverse part of the nasalis. Anatomical variations in the topographic relationships were also described to understand the function of the LLSAN and the transverse part of the nasalis. Anatomical dissections were performed on 40 specimens of embalmed Korean adult cadavers. The LLSAN was divided into two layers, which were superficial and deep in the levator labii superioris muscle (LLS), respectively. The superficial layer of LLSAN descended on the LLS, and the deep layer was located deep in the LLS. The deep layer of LLSAN originated from the superficial layer of LLSAN and the frontal process of the maxilla. It inserted between the levator anguli oris and the orbicularis oris muscles. This transverse part of the nasalis received some muscle fibers from the superficial layer of LLSAN in 90% (36/40) of specimens. The transverse part of the nasalis originated from the maxilla and ascended, passing posterior to the superficial layer of LLSAN in 65% (26/40) of specimens. However, it originated as two muscle bellies from the maxilla and the upper half of the alar facial crease, respectively, in 35% (14/40) of specimens. These findings will be crucial data to understand the structure and function of the LLSAN and the transverse part of the nasalis.

Cranial Muscles of the Sulawesi Babirusa (Babyrousa celebensis)

The detailed muscular anatomy of the head of the Sulawesi Babirusa (Babyrousa celebensis) is described for the first time. The results show that the muscular anatomy of the Babyrousa is very similar to the pig genus Sus, despite long geological separation from it. Some differences were noted: the M. parietoauricularis was more clearly separated into two parts in the Babirusa than in the domestic pig; the rostral fibres of the M. levator anguli oculi reached the infraorbital sinus in the Babirusa but only as far as the medial corner of the eye in the domestic pig; the M. palatinus of the Babirusa is paired and did not reach the Os palatinum, unlike its description in the domestic pig and the Platysma pars zygomatica originates from the fascia of the neck in the Babirusa, whereas that of the domestic pig originates largely or entirely from the scapula.

The diagnosis of art: facial nerve palsy in ancient Rome

In the first century BCE, sculptors in Rome broke with the classical Greek tradition of idealized but bland and anonymous sculptured faces and produced individualized portraits from which the subjects could be recognized. These sculpture portraits were stern, brutally realistic and often unbecoming, but they projected the personalities of the subjects and the virtues valued in the Republican period: strength of character, honesty, frugality, hard work and devotion to country. Ugly or unusual features of face or head were not only recorded but highlighted. These sculptures were of imported Greek marble,1 and the sculptors are thought to have been of Greek origin,2 but the exaggerated realism, or verism, was a distinctly Roman innovation and is considered by many art historians to have been one of the Romans' more significant artistic contributions. It has been suggested that the deliberate ugliness of some of these faces may have resulted from the contempt held by Greek sculptors for their Roman sitters.3 Still, the Romans must have liked the portraits, for they commissioned many of them. One of the Roman Republican portraits in the Metropolitan Museum of Art ( Figure 1) shows the signs of right-sided seventh nerve palsy. As a result of weakness of the muscles of expression on the right, the levator anguli oris, zygomaticum, orbicularis oculi and frontalis, the face is asymmetrical. The right corner of the mouth sags, and there is atrophy of the right zygomatic musculature. The right eye is wider than the left, and the furrows of the forehead come to an abrupt end over the right eye with a flattening of the right forehead. Figure 1 Marble portrait of a man. Late 1st century BCE. Metropolitan Museum (21.88.14) The weakness of both lower and upper facial muscles indicates a lesion at the level of the facial nerve or the pons, making a stroke unlikely. We do not know the prevalence of Bell's palsy in Roman times, but today it accounts for 65–70% of all unilateral facial palsy.4 Charles Bell (1774–1842) originally described the condition ‘in a man who developed suppuration anterior to the ear’.5 This may have been an infection of the parotid gland, through which the facial nerve passes. Over the years, however, Bell's palsy has come to refer more specifically to the rather common facial palsy of abrupt onset and limited duration associated in most cases with the herpes simplex virus.4 Recovery is usually complete or nearly complete. The severe and longstanding atrophy of facial musculature in this Roman sculpture weighs against Bell's palsy. There are, of course, many less common causes of unilateral, peripheral facial nerve deficit.6–8 On the right side of the head, above the level of the ear and anterior to it, there appears to be a cutaneous scar ( Figure 2). This man had apparently suffered some sort of head trauma. The scar is above the level of the temporal bone, but it could have been associated with a blow to the head that fractured the right temporal bone. The facial nerve passes through its petrous portion and can be permanently injured by a horizontal fracture of that bone.9 This Roman lived in violent times. Many male citizens did military service and often engaged in hand-to-hand fighting, as they enlarged and defended their vast frontier. There must have been many blows to the head, with more than a few temporal bone fractures, seventh nerve injuries and permanent facial palsies. Figure 2 Detail of Figure 1, showing an apparent scar above and anterior to the right ear The haunting realism of the Roman Republican sculpture portraits allows us some insight into the mindset that created one of the world's largest, most efficient, and longest-lasting empires. It also allows us to speculate about a clinical diagnosis.