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Neuro Exam III > 4-1 Oral Cavity and Submandibular Regions > Flashcards

4-1 Oral Cavity and Submandibular Regions Flashcards

1
Q

What is the proximal-most portion of the GI tract?

A

Oral cavity

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2
Q

What are some major structures in the oral cavity?

A

Contains the teeth, tongue, gingivae, and openings of all three salivary glands

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3
Q

Where does the parotid duct open?

A

Parotid duct opens into the vestibule opposite the upper 2nd molar, in the vestibule

A.Vestibule

  1. Space between the lips/cheeks and teeth.
  2. Opens externally at the oral fissure between lips.
  3. Muscles of facial expression control shape/size of oral fissure.
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4
Q

What are the lips? What covers them internally and externally?

A

A.Musculofasical skin folds (upper, lower)

  1. Externally – covered by thin skin
  2. Internally – covered by mucus membrane.
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5
Q

What muscles of facial expression are attached to the lips? What are their actions?

A
  1. Muscles of facial expression allow for mobility to control size, shape of oral fissure.
    a. Orbicularis oris – closes lips/mouth
    b. Levator labii superioris – elevates upper lip
    c. Levator anguli oris – elevates upper lip; widens mouth
    d. Zygomaticus major and minor – elevates upper lip; main smile muscles
    e. Risorius – stretches lips laterally; wide smile
    f. Levator labii superioris alaeque nasi – elevates upper lip; flares nostrils
    g. Depressor anguli oris – depresses lower lip; frown
    h. Depressor labii inferioris – depresses lower lip; frown, pout
    i. Mentalis – protrudes lower lip
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6
Q

What is the innervation for the upper and lower lip?

A

A.Innervation

  1. Upper lip – V2 via infraorbital branches
  2. Lower lip – V3 via mental and buccal branches
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7
Q

What is the lymphatic drainage for the lips?

A

A.Lymphatic drainage

  1. Submental lymph nodes – medial part of lower lip
  2. Submandibular lymph nodes – all other regions
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8
Q

How many teeth are typically present? What types? When do they appear?

A

A.32 permanent teeth; 16 deciduous (baby teeth)

  1. Incisors (4), canine (2), premolars (4), molars (6)
  2. Typically appear around 6-8 years of age
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9
Q

What is the gingivae?

A

A.Gingivae = mucus membrane and fibrous tissue attached to the alveolar processes of the mandible and maxilla bones; also attached to neck of teeth.

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10
Q

What is the innervation of teeth - upper versus lower arcade?

A

A.Innervation of teeth

  1. Maxillary teeth – superior alveolar branches of V2
  2. Mandibular teeth – inferior alveolar branches of V3
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11
Q

What is the innervation of the gingivae? Upper versus lower portions?

A

Innervation of gingivae

  1. Maxillary gingivae
    a. Palatine portion
  2. Nasopalatine n (V2)
  3. Greater palatine n (V2)

b Vestibular portion

1.Superior alveolar branches of V2

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12
Q

What, specifically, is the innervation for the mandibular teeth?

A
  1. Mandibular teeth – inferior alveolar branches of V3
    a. Internal portion
  2. Lingual n (V3)
    b. External portion
  3. Buccal n (V3)
  4. Inferior alveolar n, mental branch (V3)
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13
Q

What is the drainage for most teeth? What are the 2 exceptions?

A

A.Lymphatic drainage

  1. Most lymph drainage is to submandibular lymph nodes
  2. Exception: mandibular incisors drain to submental lymph nodes.
  3. Exception: 3rd maxillary molars drain directly to superior deep cervical lymph nodes.
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14
Q

What is the body and the root of the tongue?

A

Body

Anterior 2/3rds of tongue; ends anteriorly at apex, mobile

Root

Posterior 1/3 of tongue
Anchored to mandible, hyoid, and styloid process.

Epiglottic portion

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15
Q

What is the terminal sulcus on the tongue? What does it separate? What embryonic structure is it derived from?

A
  1. Terminal sulcus
    a. V-shaped groove on dorsum of tongue
    b. Separates root from body
    c. Represents embryonic site of oropharyngeal membrane.
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16
Q

What are 8 examples of external structures of the tongue?

A
  1. Terminal sulcus
  2. Foramen cecum – remnant of thyroglossal duct
  3. Median sulcus
  4. Median and lateral glossoepiglottic folds
  5. Epiglottic valleculae
  6. Papillae – vallate, filiform (no taste buds), fungiform, foliate
  7. Lingual tonsils
  8. Frenulum of the tongue
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17
Q

What are the intrinsic muscles of the tongue? What do they do?

A
  1. Intrinsic muscles (alter the shape of the tongue)
    a. Longitudinal (shorten; retract tongue; also can curl tongue)
    b. Vertical (flatten; broaden tongue)
    c. Transverse (narrow; elongate tongue)
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18
Q

What are the extrinsic muscles of the tongue?

A

Genioglossus

Hyoglossus

Styloglossus

Palatoglossus

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19
Q

What is the action and innervation of genioglossus?

A

Innervation – hypoglossal n.

Function –

acting bilaterally - protrudes tongue;

acting unilaterally – pushes tongue to opposite side

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20
Q

What is the action and innervation for hyoglossus?

A

Innervation – hypoglossal n.

Function – retracts; depresses tongue

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21
Q

What is the action and innervation for styloglossus?

A

Innervation – hypoglossal n.

Function – retracts; elevates tongue

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22
Q

What is the action and innervation for palatoglossus?

A

Innervation – vagus n
Function – pulls tongue and soft palate together during swallowing

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23
Q

What is the motor innervation for the tongue?

A

1.Hypoglossal nerve – GSE to all muscles except palatoglossus

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24
Q

How is the Vagus nerve involved in innervation to the tongue?

A

1.Vagus nerve – SVE to palatoglossus

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25
Q

What happens with a hypoglossal nerve lesion?

A

1.CLINICAL CORRELATION – Hypoglossal Nerve Lesion. When patient is asked to protrude tongue, tongue will deviate toward affected (paralyzed) side because functioning genioglossus muscle pushes tongue contralaterally.

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26
Q

What provides basic sensory innervation to the tongue? What is GSA, GVA?

A
  1. Anterior 2/3
    a. General sensory (GSA) – lingual branch of V3
  2. Posterior 1/3
    a. General sensory (GVA) – Glossopharyngeal n.
  3. Epiglottic region
    a. General sensory (GVA) – internal laryngeal branch of vagus nerve
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27
Q

What provides SVA to the tongue?

A

1.Anterior 2/3

Taste (SVA) – Facial nerve via chorda tympani

  1. Posterior 1/3
    a. Taste (SVA) – Glossopharyngeal n.
  2. Epiglottic region
    a. Taste (SVA) – superior laryngeal branch of vagus nerve
28
Q

What artery supplies the tongue? What do it’s branches supply?

A
  1. Lingual artery – branch of external carotid artery
    a. Dorsal lingual a. (posterior tongue/palatine tonsil)
    b. Sublingual a. (floor of mouth)
    c. Deep lingual a. (anterior tongue)
29
Q

What veins drain the tongue?

A
  1. Lingual veins – drain tongue and floor of oral cavity directly to internal jugular vein.
  2. Venae comitantes hypoglossi – drain floor of oral cavity and parallel course of hypoglossal nerve to end in the common facial vein.
30
Q

What lymph nodes does the tongue drain to? What parts of the tongue drain where?

A

A.Lymphatic drainage

  1. Posterior 1/3 – superior deep cervical lymph nodes (bilateral)
  2. Anterior 2/3
    a. Lateral sides – submandibular nodes (ipsilateral)
    b. Middle – inferior deep cervical nodes (bilateral)
    c. Apex – submental nodes (the medial portion draining bilaterally)
31
Q

What are the tonsils, in a general sense? Name the 4 types.

A

I.Tonsils

A.Masses of lymphoid tissue situated in the nasopharynx, oropharynx, and oral cavity.

Includes:

  1. Lingual
  2. Pharyngeal
  3. Palatine
  4. Tubal
32
Q

What are the locations of the 4 tonsils?

A
  1. Lingual tonsils – located deep to mucosa of posterior 1/3 of tongue.
  2. Pharyngeal tonsils – located within pharyngeal recess of nasopharynx.
  3. Palatine tonsils – located at opening of oropharynx; between palatoglossal and palatopharyngeal arches.
  4. Tubal – located at opening of auditory tube.
33
Q

What is Waldeyer’s ring?

A

These 4 groups form a defensive ring of lymphoid tissue referred to as the pharyngeal lymphoid ring or Waldeyer’s ring.

34
Q

What are adenoids? What can be problematic with them?

A

A.CLINICAL CORRELATION – lymph nodes can become englarged and occlude surrounding structures (fauces, opening to auditory tube; nasopharynx). When pharyngeal tonsils are inflamed they are referred to as adenoids.

35
Q

What is the function of the salivary glands? What does saliva do?

A

A.Secrete salivary fluid into oral cavity which functions to: begin process of digestion, lubricate food, prevent tooth decay, moisten oral cavity.

36
Q

Where are the sublingual glands? Where do they open?

A

A.Sublingual glands

Lie in floor of oral cavity; covered with oral mucosa.
Forms sublingual fold on floor of mouth.
Open into oral cavity via several small ducts on sublingual fold.

37
Q

Where is the submandibular gland? Where does it empty? What is it’s relationship with the lingual nerve?

A

A.Submandibular glands

Superficial portion lies within submandibular triangle of neck; deep to mandible; superficial to mylohyoid muscle.
Deep portion of gland wraps around the posterior border of the mylohyoid to pass between it and the hyoglossus muscle.

Submandibular (Wharton’s) duct courses anteriorly from deep part of gland (between mylohyoid and hyoglossus) to open in floor of the mouth on the sublingual caruncle.

NOTE: The lingual nerve wraps around the submandibular duct as they course forward.

38
Q

What is the course of the preganglionic parasympathetic innervation to the parotid gland? Which nerve carries these fibers?

A

A.Innervation of Parotid Gland

  1. Parasympathetic
    a. Preganglionic (glossopharyngeal nerve)
  2. Location of cell bodies – salivatory nucleus within brainstem
  3. Preganglionic fibers travel with the glossopharyngeal nerve (CN IX).
  4. CN IX exits at jugular foramen and immediately gives a tympanic branch.
  5. The tympanic nerve then enters the middle ear via the tympanic canaliculus.
  6. Travels through the middle ear and then reforms as the lesser petrosal nerve.
  7. Lesser petrosal nerve exits middle ear via hiatus for the lesser petrosal nerve; nerve is now in the middle cranial fossa and exits via the foramen ovale.
  8. Lesser petrosal n is now in infratemporal fossa and synapses in otic ganglion.
39
Q

What is the course of the postganglionic parasympathetic innervation to the parotid gland? What nerve(s) carry these fibers?

A

a. Postganglionic (distribute with V3)
1. Location of cell bodies – otic ganglion
2. Postganglionic fibers travel with the auriculotemporal branch of V3.

40
Q

Where are the preganglionic and postganglionic cell bodies that provide sympathetic innervation to the parotid gland?

A
  1. Sympathetic
    a. Preganglionic cell bodies located in the spinal cord at levels T1-T4.
    b. Postganglionic cell bodies located in superior cervical sympathetic ganglion.
41
Q

What nerve distributes sympathetic innervation to the parotid? What is its function?

A

a. Postganglionic fibers travel with external carotid nerve to parotid tissue.
b. Function: vasomotor

42
Q

Where is the submandibular ganglion? What cell bodies does it contain? What does it provide innervation for?

A

A.Innervation of sublingual and submandibular glands

  1. Submandibular ganglion
    a. Ganglion suspended from lingual nerve within posterior floor of oral cavity.
    b. Contains the cell bodies of postganglionic parasympathetic fibers.
    c. Provides innervation for the submandibular and sublingual glands
43
Q

What is the origin and course of the preganglionic cell bodies and fibers for parasympathetic innervation to the sublingual and submandibular glands?

A
  1. Parasympathetic
    a. Preganglionic (facial nerve)
  2. Location of cell bodies – salivatory nucleus within brainstem
  3. Preganglionic fibers travel with the facial nerve (CN VII).
  4. CN VII courses along the posterior wall of the middle ear and gives rise to the chorda tympani n.
  5. The chorda tympani n. then exits the middle ear through the petrotympanic hiatus to enter the infratemporal fossa.
  6. Here, chorda tympani joins the lingual nerve.
  7. The chorda tympani portion of the lingual nerve synapses in the submandibular ganglion.
44
Q

What is the origin and course of the postganglionic parasympathetic innervation to the submandibular and sublingual glands? What is the function?

A

a. Postganglionic
1. Location of cell bodies – submandibular ganglion
2. Postganglionic fibers travel with the lingual branch of V3.
b. Function: secretomotor; stimulate salivation

45
Q

What is the origin and course of sympathetic innervation to submandibular and sublingual glands?

A
  1. Sympathetic
    a. Preganglionic cell bodies located in the spinal cord at levels T1-T4.
    b. Postganglionic cell bodies located in superior cervical sympathetic ganglion.
    c. Postganglionic fibers travel with external carotid nerve to the gland tissue.
    d. Function: vasomotor
46
Q

What are the contents of the submandibular region?

A
  1. Submandibular gland
  2. Facial artery
  3. CN XII
  4. Suprahyoid muscles
47
Q

What are the names of the suprahyoid muscles?

A

Digastric

Stylohyoid

Mylohoid

Geniohyoid

48
Q

What is the action and innervation of the digastric mm?

A

Innervation – anterior belly (V3); posterior belly (CN VII)

Function – depresses mandible; elevates hyoid

49
Q

What is the action and innervation of the stylohyoid?

A

Innervation – CN VII
Function – elevates and retracts hyoid

50
Q

What is the action and innervation of the mylohoid?

A

Innervation – mylohyoid branch of V3

Function – elevates hyoid and floor of mouth; assists with opening mouth

51
Q

What is the action and innervation of the geniohyoid?

A

Innervation – C1 via hypoglossal

Function – elevates hyoid; when hyoid fixed, opens mouth

52
Q

What arteries supply the submandibular region?

A
  1. Lingual artery – branch of external carotid artery
    a. Dorsal lingual a. (posterior tongue)
    b. Sublingual a. (floor of mouth)
    c. Deep lingual a. (anterior tongue)
53
Q

What veins drain the submandibular regions?

A
  1. Lingual veins – drain directly to internal jugular vein
  2. Venae comitantes hypoglossi – veins which parallel course of hypoglossal nerve and end in the common facial vein.
54
Q

How does sublingual absorption of drugs work?

A

1.CLINICAL CORRELATION – Sublingual Absorption of Drugs – certain drugs (such as nitroglycerin) need rapid absorption. Because the lingual veins drain directly to the IJV, drugs can be placed in the sublingual region (below the tongue on floor of mouth) and rapidly absorbed into the bloodstream.

55
Q

What are the major nerves of the oral cavity?

A

Lingual nerve

Hypoglossal nerve

Glossopharyngeal nerve

Vagus

56
Q

What is the course of the lingual nerve through the oral cavity?

A

a. Enters oral cavity posteriorly from infratemporal fossa.
b. Courses through paralingual space (between hyoglossus and mylohyoid mm.)
c. Wraps around submandibular duct in course.
d. Pierces tongue laterally.

57
Q

What nerve does the lingual nerve originate from? What innervation does it provide directly?

A

a. Branch of V3
a. Provides GSA to floor of mouth and anterior 2/3 of tongue

58
Q

What does the lingual nerve distribute?

A
  1. SVA – via chorda tympani - SVA to anterior 2/3rds of tongue
  2. GVE-P – via chorda tympani - GVE-P (parasympathetic fibers) to submandibular ganglion to be distributed to the submandibular and sublingual glands.
59
Q

What is the course of chorda tympani? Where does it merge with lingual nerve?

A
  1. Chorda tympani (CN VII) nerve
    a. Chorda tympani is a branch of CN VII given off within middle ear.
    b. Chorda tympani n exits middle ear via petrotympanic fissure to enter infratemporal fossa.
    c. Here, it merges with the lingual n (V3) to travel to the oral cavity.
60
Q

What is the course of the hypoglossal nerve?

A
  1. Enters oral cavity from submandibular region.
  2. After passing lateral to the occipital artery, the hypoglossal nerve then enters the paralingual space.
61
Q

What types of innervation does the hypoglossal nerve supply?

A
  1. Provides:
    a. GSE – extrinsic tongue muscles (except palatoglossus)
    b. GSE – intrinsic tongue muscles
62
Q

What is the course of CN IX through the oral cavity?

A
  1. Glossopharyngeal nerve
  2. Enters oral cavity posteriorly from pharyngeal region.
  3. After passing in between the superior and middle constrictor muscles, CN IX travels forward to pierce the tongue posteriorly.
63
Q

What types of innervation does CN IX provide in the oral cavity?

A
  1. Provides:
    a. GVA – posterior 1/3 of tongue
    b. SVA – posterior 1/3 of tongue
64
Q

What is the course of the vagus nerve through the oral cavity?

A
  1. Internal branch of superior laryngeal nerve will enters oral cavity posteriorly from pharyngeal region.
  2. After passing in between the middle and inferior constrictors muscles, the internal laryngeal nerve will ascend to supply the epiglottic region of the tongue
65
Q

What types of innervation will CN X provide to the oral cavity?

A
  1. Provides:
    a. GVA – epiglottic region of tongue
    b. SVA – epiglottic region of tongue

Neuro Exam III (9 decks)

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