15. Anatomy of the Oral Cavity, Tongue & Pharynx Flashcards
What are the 2 arches in the oral cavity called and what is found between them?
Palatoglossal arch and palatopharyngeal arch
- Palatine tonsils between them
What is the fauces?
Opening between oral cavity and oropharynx
- palatoglossal arch forms the anterior pillars
- palatopharyngeal arch forms the posterior pillars
Which muscles form the arches in the oral cavity?
- Palatoglossal arch by palatoglossus
- Palatopharyngeal arch by palatopharyngeal muscle
What is the uvula?
An end of the soft palate
What is the space between the teeth/gums and the lips called?
Vestibule
What is the lingual frenulum?
Small fold of mucous membrane extending from the floor of the mouth to the midline of the underside of the tongue
What are the 2 categories of the muscles of the tongue?
Intrinsic and extrinsic muscles
How many maximum teeth do we have?
32
What is the innervation of the intrinsic muscles of the tongue?
Hypoglossal nerve
What are the intrinsic muscles?
4 paired muscles: • sup longitudinal • inf longitudinal • transverse • vertical
what does intrinsic and extrinsic mean in relation to tongue muscles?
intrinsic - not attached to any other structures apart from other intrinsic muscles
extrinsic - arise from other structures and inert into tongue
What are the extrinsic muscles of the tongue and what is their innervation?
Genioglossus, Hyoglossus, Styloglossus:
• Motor innervation (hypoglossal nerve)
Palatoglossus:
• Motor innervation (Vagus nerve)
Where do the extrinsic muscles of the tongue originate from?
- Genioglossus from mental protuberance
- Hypoglossus from the hyoid bone
- Styloglosusu from the styloid process of temporal bone
- Palatoglossus from the hard/soft palate
What is the general and special sensory innervation to the tongue?
Anterior 2/3: • Sensation -trigeminal (V3, lingual nerve) • Taste -facial (chorda tympani) Posterior 1/3: • Sensation and taste- glossopharyngeal
What is the duct of the submandibular gland and where does it open in the oral cavity?
Whartons duct, opening at each side of the frenulum of the tongue at the base of the tongue
Where are the submandibular glands found?
in submandibular/digastric triangle - underneath mandible - between anterior and posterior belly of digastric
What are the boundaries of the parotid gland?
- Superior: zygomatic arch
- Posterior: SCM
- Anterior: masseter
What is the duct of the parotid gland and where does it open into the oral cavity?
Stensen duct, in the vestibule, in the region of the pre-molars
What is the duct of the sublingual gland and where does it open into the oral cavity?
Has lots of entries into the oral cavity
Where is the sublingual gland found?
underneath the tongue
describe the sublingual gland
- Smallest and most diffuse of the major salivary glands
* 8-20 excretory ducts per gland
How much of saliva is produced by each gland?
submandibular = 60%
parotid =
sublingual = 3-5%
What are salivary gland stones called and in which gland do they mostly occur in?
Sialolithiasis, submandibular gland
What are the symptoms of salivary gland stones?
- Pain in gland
- Swelling
- Infection
What stimulates the symptoms of sialithiasis?
thinking of eating, smelling food, eating
How is a salivary gland stones diagnosed?
History, x-ray, sialogram
What causes salivary gland stones?
Dehydration, reduced salivary flow
What are the symptoms of tonsillitis?
- Sore throat
- Pain/difficulty swallowing
- fever
- Bad breath
Which lymph nodes swell in tonsillitis?
Cervical lymph nodes
What are the causes of tonsillitis?
- Viral causes (most common)
* Bacterial causes (up to 40% of cases) - Strep pyogenes
What is peritonsillar abscess and what is it also called?
Inflammation of tissue surrounding the tonsil
- also called Quinsy
What are the symptoms of peritonsillar abscess?
- Severe throat pain
- Fever
- Bad breath
- Drooling
- Difficulty opening mouth
What causes peritonsillar abscess?
- Can follow on from an untreated or partially treated tonsillitis
- Can arise on its own - Aerobic and anaerobic bacteria
What is the difference between position of the uvula in tonsilitis and peritonsillar abscess?
- Usually central (not displaced) in tonsillitis
- Displaced in peritonsillar abscess
What are the boundaries of the nasopharynx and what does it contain??
Base of skull to upper border of soft palate
• Posterior (C1, C2)
• Anterior (nasal cavity)
• inferior (tip of uvula)
- Contains pharyngeal (adenoid) tonsil and opening of Eustachian tube
What are the 3 parts of the pharynx?
nasopharynx
oropharynx
laryngopharynx
What are the signs/symptoms of enlarged adenoids?
- Block ET - Recurrent/persistent middle ear infections
- Snoring/sleep apnoea
- Sleeping with mouth open
- Chronic sinusitis - Sore throat
- Nasal tone to voice
What are the boundaries of the oropharynx and what does it contain?
Soft palate to epiglottis • Anterior (oral cavity) • Posterior (C2, C3) • superior (tip of uvula) • inferior (upper border of epiglottis)
- contains the palatine tonsils
What are the boundaries of the laryngopharynx and what does it contain?
Oropharynx to oesophagus
Epiglottis to cricoid cartilage
• Anterior (larynx)
• Posterior (C4,C5,C6)
- Contains Piriform fossa
What is the piriform fossa?
Recesses on either side of the of the laryngeal orifice.
What happens to divert food away from trachea?
epiglottis comes over and covers respiratory tract, diverting food down piriform fossa and into oesophagus
What are the 3 longitudinal muscles of the pharynx and what is their function?
elevate pharynx and larynx during swallowing:
• Stylopharyngeus
• Palatopharyngeus
• Salpingopharngeus
What are the attachments and innervation of the palatopharyngeus?
- originate from Hard palate
- insert into posterior border of thyroid cartilage
- Pharyngeal branch of vagus (CN X)
What are the attachments and innervation of the salpingopharyngeus?
- originates from Cartilaginous part of ET
- merges with palatopharyngeus
- Pharyngeal branch of vagus (CN X)
What are the attachments and innervation of the stylopharyngeus?
- originate from Styloid process
- insert into posterior border of thyroid cartilage
- Glossopharyngeal nerve (CN IX)
What are the 3 circular muscles of the pharynx and what is their function?
- Superior pharyngeal constrictor
- Middle pharyngeal constrictor
- Inferior pharyngeal constrictor,
What are the origins of the circular muscles?
Superior pharyngeal constrictor
- Origin -Pterygomandibular raphe
Middle pharyngeal constrictor
- Origin- Hyoid bone
Inferior pharyngeal constrictor, Has 2 parts
- Thyropharyngeal (origin- thyroid cartilage)
- Cricopharyngeal (origin-cricoid cartilage)
What is the insertion and innervation of the pharyngeal constrictor muscles?
- Insert onto the pharyngeal raphe
- innervated by the vagus nerve
What abnormality can arise due to the 2 parts of the inferior contrictor muscle?
Pharyngeal pouch (Zenker’s diverticulum)
What are the sings/symptoms of pharyngeal pouch?
70 year old man presents with • Bad breath • Regurgitation of food • Occasional choking on fluids • General difficulty swallowing
What is the area of the inferior constrictor where the pouch can form called?
Killian’s dehiscence
- A posteromedial (false) diverticulum
- Arises in weakness between the two parts of the inferior constrictor
Why does a pharyngeal pouch form?
Essentially there is a higher pressure in laryngopharynx:
• Failure of the UOS to relax
• Abnormal timing of swallowing
• Weakness in Inferior constrictor muscle produces outpouching
What are the symptoms in pharyngeal pouch related to?
Symptoms related to food material collecting in pouch or disruption of swallow
What is the pharyngeal plexus?
- Located mainly on surface of middle constrictor muscle
* Vagus, glossopharyngeal and cervical sympathetic nerves
What is motor innervation to the pharynx?
- CN X innervates all muscles
* Except stylopharyngeus (Glossopharygeal nerve (CN IX)
What is sensory innervation to the pharynx?
- Naospharynx (maxillary nerve CN V2)
- Oropharynx (glossopharyngeal nerve CN IX)
- Laryngopharynx (vagus nerve (CN X)
What are the 3 phases of swallowing?
oral, pharyngeal, esophageal
Describe the oral phase of swallowing
- Voluntary
- Preparatory phase - Making bolus
- Transit phase - Bolus compressed against palate and pushed into oropharynx by tongue and soft palate
Describe the pharyngeal phase of swallowing.
• Involuntary
• Tongue positioned against hard palate (food cannot re-enter mouth) (CN XII)
• Soft palate elevated sealing off nasopharynx (tensor palatini CN V3, levator palatini CN X)
- Opens ET tube
• Suprahyoid (CN V3, CN VII, CN XII) and longitudinal muscles shorten (CN IX, CN X)
- Pharynx widens and shortens to receive bolus
- Larynx elevated and sealed off by vocal folds
• Epiglottis closes over larynx (result of elevated hyoid)
• Bolus moves through pharynx by sequential contraction of constrictors
• Relaxation of UOS
Describe the oesophageal phase of swallowing.
• Involuntary Peristalsis: - Upper striated muscle of oesophagus (CN X) - Lower smooth muscle • LOS relaxes
What are the sings/symptoms of dysphagia? (5)
- Coughing & choking
- Sialorrhoea (drooling)
- Recurrent pneumonia
- Change in voice/speech (wet voice)
- Nasal regurgitation
What are the signs/symptoms o f a IX/X lesion?
Obvious things
• Absent gag
• Uvula deviated away from lesion (LMN)
Bit more subtle
• Dysphagia
• Taste impairment (posterior tongue)
• Loss of sensation oropharynx
What can cause a lesion in CN IX/X?
medullary infarct, jugular foramen issue (fracture)
What are the signs/symptoms of a XII lesion?
- Wasted tongue
- Stick tongue out- tongue may deviate
- Damage to nerve itself (LMN) -point to side of lesion
- Muscle wasting
- Fasiculations
https://quizlet.com/gb/452646946/session-8-anatomy-of-the-oral-cavity-and-pharynx-flash-cards/
(aspiration) pneumonia due to issues with swallowing (dysphagia)
