11 - Oral Cavity Flashcards
Facial a. supplies most of the
superficial structures of oral (buccal) cavity
Oral Cavity roof
hard and soft pallate
Oral cavity floor
Tongue (dorsum of the tongue) & sublingual region = floor
Oral cavity walls
Teeth & gums (gingiva) = anterior/lateral walls
Palatoglossal arches
oral cavityposterior/lateral walls
Palatopharyngeal arches
The oral cavity is continuous with the .
oropharynx
Palatine aponeurosis
From tensor veli palatini m.
& palatoglossus m.)
Levator veli palatini m.
innervation
CN X Vagus via pharyngeal branch to pharyngeal plexus
Levator veli palatini m. function
Function: Only muscle to elevate the soft palate above the neutral position
Levator veli palatini m. Clinically the Levator is tested by asking the patient to
say “ah” (CN X test)
If the muscle on each side is functioning normally, the palate elevates evenly in the midline.
If one side is not functioning, the palate deviates away from the abnormal side
Palate: Vascular Supply
Descending palatine a. Greater Palatine a. Lesser Palatine a. Ascending Palatine a Palatine a
Palate venous drainage via
Pterygoid & Pharyngeal plexuses
Descending palatine a.
gives rise to
Greater & Lesser Palatine aa
Descending palatine a.
descends
thru palatine canal
Greater Palatine a.
supplies
anterior palate
Greater Palatine a.
passes through
greater palatine foramen
Lesser Palatine a.
supplies
posterior palate
Lesser Palatine a.
passes through
lesser palatine foramen
Ascending Palatine a.
branch of facial a.
Palatine a. -
br. of Ascending Pharyngeal a.
Soft Palate: Motor N. Supply
Mandibular n. (CN V3)
Vagus n. (CN X)
Mandibular n. (CN V3)
soft palate supplies
Supplies Tensor veli palatini m.
Vagus n. (CN X) supplies
soft palate
Supplies Levator veli palatini mm., Palatoglossus mm., Palatopharyngeus mm., Musculus uvulae, Salpingopharyngeus mm.* (via pharyngeal plexus)
Tonsillectomy
Palatine tonsils may be removed
Heavy bleeding may occur from aa
During tonsillectomy,
Bleeding from
paratonsillar v. also common
-Venous drainage from tonsillar bed region
-Venous drainage from
tonsillar bed region, Venous drainage to the pterygoid plexus and facial vein.
CN IX lies on
lateral pharyngeal wall
Vulnerable to injury because lateral wall is thin
Oral Cavity: Lingual N.
Br. CN V3
Lingual n. Emerges between
lat. & med. pterygoid mm
Oral Cavity: Submandibular Ganglion at level of
3rd molar
Submandibular Ganglion Suspended from
Lingual n. by 2 or more short n. brs.
Submandibular ganglion - Relays
p-symp. Fibers from chorda tympani (CNVII)
Submandibular Ganglion - These fibers travel to
submandibular and sublingual glands
Submandibular ganglion - Symp. Fibers to glands are from
external carotid plexus
Oral Cavity: Hypoglossal N (CN XII) - Deep to
post. belly digastric and stylohyoid mm.
Oral Cavity: Hypoglossal N (CN XII) - Runs anterior between
submandibular gland and hyoglossus m.
Oral Cavity: Hypoglossal N (CN XII) - Inferior to
lingual n.
Oral Cavity: Hypoglossal N (CN XII) - Superior to
mylohyoid m.
Hypoglossal n. CN XII Ends in
posterior tongue to provide motor innervation
Oral Cavity: Glossopharyngeal N (CN IX) - Runs lateral to
stylopharyngeus m. to enter pharynx
Oral Cavity: Glossopharyngeal N (CN IX) - Between
superior & middle constrictor mm.
Oral Cavity: Glossopharyngeal N (CN IX) - Continues =]
anteriorly thru tonsillar region
Oral Cavity: Glossopharyngeal N (CN IX) - Ends in
posterior tongue to receive sensory innervation
Muscles of tongue
Palatoglossus m. Styloglossus m. Hyoglossus m. Genioglossus m. Intrinsic mm.
Styloglossus m.
Styloid process to tongue
Hyoglossus m.
Hyoid bone to tongue
Genioglossus m.
Genoid tubercle of mandible to tongue
Intrinsic mm.
Vertical, transverse & long fibers
Clinical Notes: Genioglossus m. - Paired mm. fused in
midline that serves to protrude tongue
Clinical Notes: Genioglossus m. - Unilateral paralysis of CN XII affects
straight protrusion
Intact side protrudes more than affected side
Results in deviation of tongue toward paralyzed side
Clinical Notes: Genioglossus m. - Bilateral paralysis results in
inability to protrude tongue
Tongue falls back & may occlude airway (suffocation)
CN XII test:
ask patient to ‘stick out their tongue’
Oral Cavity: Arterial Supply
Facial a
Maxillary a.
lingual a.
Accompanying vv. provide venous drainage to IJV
Facial a.
supplies most of superficial structures
Maxillary a.
supplies buccinator m.
Lingual a.
supplies most of deeper structures
3 brs. to tongue region
Dorsal Lingual a., Deep lingual a., & Sublingual a.
Oral Cavity: Tongue: special sensory
Chorda tympani n. (CNVII)
Glossopharyngeal n. (CN IX)
Vagus
Chorda tympani n. (CNVII)
Taste of anterior 2/3
Fibers travel with lingual n.
Glossopharyngeal n. (CN IX)
Taste from posterior 1/3 tongue
Vagus n.
Vagus (CN X)
Taste from root of tongue and epiglottis
Oral Cavity: Tongue: general sensory
Lingual n. (CNV3
Glossopharyngeal n. (CN IX)
Vagus (CN X)
Lingual n. (CNV3)
Sensory of anterior 2/3 tongue
Glossopharyngeal n. (CN IX)
Sensory of posterior 1/3 tongue
Vagus (CN X)
Sensory of root of tongue and epiglottis
Ant. Supr. Alveolar a. –
br. of Infraorbital a.
Mid. Supr. Alveolar a. –
br. of Infraorbital a. (When it exists as a separate br.)
Post. Supr. Alveolar a. –
br. of Maxillary a.
Inferior Alveolar a. –
br. of Maxillary a.
An epithelial membrane consists of an
epithelial tissue bound to an underlying connective tissue layer.
The three types of epithelial membranes are:
1) Cutaneous Membranes
2) Mucous Membranes *
3) Serous Membranes
The primary epithelium of the oral cavity is
nonkeratinized stratified squamous epithelium; has a stratum basale, stratum spinosum, and a stratum superficiale.
primary epithelium of the oral cavity -
This is found covering the soft palate, lips, cheeks, inferior surface of tongue, and the floor of the mouth; part of lining mucosa.
In certain areas of the oral cavity have a special
keratinized stratified squamous epithelium (i.e., parakaratinized); specifically the hard palate, gingiva (gums) and the dorsum of the tongue; part of masticatory mucosa.
Sensory Receptor Organ
taste buds
Cells of Taste Bud
Neuroepithelial (or Sensory or Gustatory or Gustatory Receptor or Taste) Cells, Supporting Cells, and Basal Cells.
Apical Foramen –
opening at the base of the tooth into the pulp cavity; allows entrance and exit of blood vessels, lymphatics, and nerves to the pulp cavity.
Periodontium consists of
Cementum
Periodontal Ligaments
Alveolar Bone
Gingiva
Salivary Glands are accessory
digestive organs
Major Salivary Glands
produce
& secrete saliva (90%)
3 paired glands
Minor Salivary Glands
numerous in oral submucosa (10%)
named based on location
Salivary Glands: 2 major cell types
serous and mucous cells
Serous cells
polarized, protein-secreting, pyramidal
Seorus cells secretory granules =
zymogen granules
serous cells have
basophilic cytoplasm (RER & free ribosomes)
Mucous cells
produce
hydrophilic glycoprotein mucins
mucous cells are
cuboidal or columnar
Myoepithelial cells
within
basal lamina of secretory unit
myoepithelial cells contracts &
accelerates secretion
myoepithelial cells prevents
distention when lumen fills
Acinus
blind sac composed of secretory cells
Serous acini:
serous cells only; generally spherical
Mucous acini:
mucous cells only; generally tubular
Mixed acini:
both serous & mucous *
in traditional fixation methods: mucous acini appear to have a
cap of serous cells (=serous demilunes); found in sublingual & submandibular glands
Salivon composed of
acinus, intercalated duct, striated duct & excetory duct
Basic unit of salivary gland
Ducts: continuous with salivary acini; 3 segments
Intercalated ducts
Striated ducts
Interlobar or Excretory ducts
Intercalated ducts
from acini; low cuboidal epithelials
modifies serous secretion
Striated ducts
striations = infoldings of basal plasma membrane; simple cuboidal to columnar epithelium
modifies serous secretion
Interlobar or Excretory ducts
simple cuboidal to pseudostratified columnar or stratified cuboidal to stratified columnar; may be nonkeratinized stratified squamous as it approaches the oral epithelium
Parotid Gland
largest
extraoral
long excetory duct = parotid duct (parotid papilla at 2nd molar)
branched acinar (serous)
Submandibular Gland - under
floor of mouth
Submandibular Gland -
Extraoral & Intraoral
Submandibular Gland - have long
excetory duct = submandibular duct (lingual frenulum
Submandibular Gland - have branched
tubuloacinar - (mixed but mostly mucous)
Tonsils
Lymphatic tissue
lymphatic tissues that form a ring around the oropharynx =
Waldeyer’s ring.
Tonsils misc.
paired palatine
pharyngeal (adenoids) in the nasopharynx
lingual
Wharton’s duct
submand. duct
Oropharyngeal isthmus is the
posterior extent of oral cavity - palatoglossal arch
Conae
posterior opening of nasal cavity
Oral fissure line of separation for
v2 and v3 innervation
Orbicularis oris innervated by
CN7
Vermillion borders
color - underlying connective tissue has large deep papillae, bringing vasculature to surface
Uvular muscle only seen in
midline
Palatine tonsils
can regress
tensor veli palatini in fossa between
medial and lateral pterygoid plates. INferior extension hook sunderneath hamulus (inferior extent of medial p. plate)
Seals palate during swallowing.
tendon of tensor veli merges to
aponeurosis in soft palate
Levator veli palatini is
posteiror and medial to tensor
LVP is along long axis of
pharyngotympanic tube
these two lift palate together
.Incisive foramen between
palatine processes - near 4 incisors
Vasculature anastamoses on
nasal cavity side
Nerves anastamose on
oral cavity side
Pterygopalatine ganglion serves
palate and (p-symp) glands
Sympathetics do not
synpase in pterygopalatine ganglion
Fibriated fold - line where
we can see superficial veins and not
Lingual nerve crosses submandibular duct
twice
Submandibular ganglion supplies
p-symp to submand and subling glands
Parakeratinized epithelium
intermediate
Foramen cecum is embryological remnant of
thyroid gland
Filiform are most
numerous, keratinied, cones directed posteriorly - licking ice cream cone, kind of pointy - NO TASTE BUDS
Fungiform
red dots on front, a few taste buds at tip, not very keratinized
Folliate papillae
lateral tongue, lost through adolescence.
Vellate papillae
have large moat filled with salivary secretion (from lingual glands). lateral walls filled with taste buds.
Without liquid to dissolve food,
no taste
Hairy tongue affected
filiform
How many taste buds
10,000, majority on circumvellate
Apex of taste bud have
long microvilli that create hair process to receive chemical stimuli. Carry signal to basal cells that support populations (stem cell layer).
parotid gland predominatey
serous
submand predominately
serous, some mucous
sublingual predominately
mucous, some serous
Striated ducts modify
secretions
Base of tonsil crypts hold
basal cells. Infection in this tissue can perpetuate permanently.
Infection of differentiated layers can be
resolved in a few years