9: Anatomy 3 - salivary glands, tongue, palate & pharynx

Question 1

Which part of the pharynx lies posterior to the oral cavity?

Answer 1

Oropharynx

Question 2

Is the hard palate anterior or posterior?

Answer 2

Anterior to soft palate

Question 3

Which structures form the hard palate?

Answer 3

Palatine process of the maxilla

Palatine bone

Question 4

What are three muscles which make up the floor of the mouth?

Answer 4

Mylohyoid

Geniohyoid

Anterior belly of digastric muscle

Question 5

Which bone is found inferior to the oral cavity and floats freely?

Answer 5

Hyoid bone

Question 6

Which surface of the tongue is the underside?

Answer 6

Ventral surface

Question 7

Which veins can be seen on the ventral surface of the tongue?

Answer 7

Lingual veins

Question 8

Which folds are found under the tongue?

Answer 8

Sublingual folds

Question 9

What are the three pairs of major salivary glands?

Answer 9

Parotid glands

Sublingual glands

Submandibular glands

Question 10

Which salivary gland is found just anterior and inferior to the ear?

Answer 10

Parotid gland

Question 11

Which duct drains the parotid gland?

Where does it emerge?

Answer 11

Parotid duct

Buccal mucosa

Question 12

Which salivary gland is found on the floor of the mouth?

Answer 12

Sublingual gland

Question 13

Where do the sublingual glands drain?

Answer 13

Sublingual folds

Question 14

What is found between the sublingual folds?

What drains here?

Answer 14

Sublingual caruncle

Submandibular glands via the submandibular ducts, which is quite confusing

Question 15

What is the structure which links the ventral surface of the tongue to the floor of the mouth?

Answer 15

Frenulum

Question 16

Which muscle of mastication is the parotid gland superficial to?

Answer 16

Masseter

Question 17

Which cranial nerves innervate the

a) parotid gland
b) submandibular and sublingual glands?

Answer 17

a) CN IX - glossopharyngeal nerve

b) CN VII - facial nerve

Question 18

Which salivary glands are innervated by

a) CN VII
b) CN IX?

Answer 18

a) Submandibular and sublingual glands (remember that facial nerve also does the lacrimal glands)

b) Parotid glands

Question 19

How does CN VII supply the submandibular and sublingual glands?

What does it hitch a ride with?

Answer 19

Chorda tympani

CN V₃ - lingual nerve branch

Question 20

Where does CN IX synapse before supplying the parotid gland?

Answer 20

Otic ganglion

Question 21

Which kind of muscle is the tongue made up of?

Answer 21

Skeletal muscle

Question 22

Which cranial nerves supply the general sensory fibres for:

a) anterior 2/3rds of tongue
b) posterior 1/3rd?

Answer 22

a) CN V₃

b) CN IX

Question 23

Which structure in the tongue did the thyroid gland descend through during development?

Answer 23

Thyroglossal duct

via the foramen caecum

Question 24

What is the foramen caecum?

Answer 24

Hole in the tongue where the thyroid descended during development

Question 25

Through which tube did the **thyroid gland** descend during development?

Answer 25

**Thyroglossal duct**

Question 26

Which direction does the **larynx** move in during swallowing?

Answer 26

**UP** then **DOWN**

Question 27

Which direction do the **thyroid gland and its remnants** move during swallowing? Why?

Answer 27

**UP** then **DOWN** They're attached to the larynx

Question 28

What are the four **intrinsic muscles of the tongue**?

Answer 28

**Palatoglossus** **Styloglossus** **Hyoglossus** **Genioglossus**

Question 29

What is the function of the extrinsic muscles of the tongue?

Answer 29

**Change position of tongue during** mastication swallowing speech

Question 30

What is the motor supply to the extrinsic muscles of the tongue? What is the exception?

Answer 30

**CN XII** - hypoglossal nerve **Palatoglossus** is innervated by **CN VII**

Question 31

Which muscles a) **modify the SHAPE of the tongue** b) **modify the POSITION of the tongue**?

Answer 31

**a) Intrinsic muscles** **b) Extrinsic muscles**

Question 32

Which **cranial nerve** supplies **MOST** of the muscles of the tongue?

Answer 32

**CN XII** Hypoglossal nerve

Question 33

Where in the brain does **CN XII** emerge from?

Answer 33

**Medulla oblongata**

Question 34

Through which hole in the ___ cranial fossa does **CN XII** pass?

Answer 34

**posterior cranial fossa** **hypoglossal canal**

Question 35

Which **bone** is the **hypoglossal canal** found in?

Answer 35

**Occipital bone**

Question 36

How do you test **CN XII**?

Answer 36

**Ask patient to stick their tongue out**

Question 37

Which artery supplies the **tongue**?

Answer 37

**Lingual artery**

Question 38

Which important artery does the **lingual artery** arise from?

Answer 38

**EXTERNAL carotid artery**

Question 39

Which part of the **lingual artery** does **CN XII** pass lateral to?

Answer 39

**Loop of the lingual artery**

Question 40

Which nerve passes **lateral** to the loop of the **lingual artery**?

Answer 40

**CN XII** Hypoglossal nerve

Question 41

Which tonsils are found on the lateral parts of the oral cavity, to either side of the **uvula**?

Answer 41

**Palatine tonsils**

Question 42

What structure lies between the **right and left palatine tonsils**?

Answer 42

**Uvula**

Question 43

What is the proper name for the gums?

Answer 43

**Gingivae**

Question 44

Which border of the lips is repaired by **plastic surgeons** when damaged?

Answer 44

**Vermillion border**

Question 45

Which bones form the majority of the **hard palate**?

Answer 45

**Palatine process** of the **maxilla** ## Footnote **Palatine bones**

Question 46

Which hole is found just **posterior** to the **front** **4 incisors**?

Answer 46

**Incisive foramen**

Question 47

Which plates, found at the back of the hard palate, serve as attachment for important muscles of mastication?

Answer 47

**Medial** and **lateral pterygoid plates**

Question 48

Which bone do the **medial** and **lateral pterygoid plates** belong to?

Answer 48

**Sphenoid bone**

Question 49

What are the two important muscles of the **soft palate**?

Answer 49

Right and left... ## Footnote **LEVATOR VELI PALATINI** **TENSOR VELI PALATINI**

Question 50

What do the **levator veli palatini** muscles do? Why is this useful?

Answer 50

**Lift the soft palate upwards** Stops food from entering the nasopharynx

Question 51

What do the **tensor veli palatini** muscles do? What's useful about this?

Answer 51

**Tense the soft palate** Helps levator veli palatini to raise the soft palate

Question 52

Which **cranial nerve** supplies a) **levator veli palatini** b) **tensor veli palatini**?

Answer 52

**a) CN X** **b) CN V₃**

Question 53

Which muscles of the soft palate are supplied by a) **CN V₃** b) **CN X**?

Answer 53

**a) Tensor veli palatini** **b) Levator veli palatini**

Question 54

Which part of the oral/nasal cavity closes off the nasopharynx to stop food from entering it? Which part of the larynx closes off the respiratory tract to stop aspiration of stuff?

Answer 54

**Soft palate** (posterior) ## Footnote **Epiglottis**

Question 55

How do you test the muscles of the soft palate? Which cranial nerves are you testing?

Answer 55

**Ask patient to say AAAAH** **CN V₃** and **CN X**

Question 56

What happens if nothing is wrong when you test a) **CN XII** b) **CN V₃** and **CN X**?

Answer 56

**a) Tongue remains in midline** **b) Uvula remains in midline**

Question 57

What happens if there's nerve damage when you test **a) CN V₃** and **CN X** **b) CN XII**?

Answer 57

**a) Uvula deviates AWAY from damaged side** (because muscles still work on the opposite side) **b) Tongue droops ON damaged side** (because muscles aren't working)

Question 58

What are the two types of muscle found in the **pharynx**?

Answer 58

**Circular muscles** **Longitudinal muscles**

Question 59

What are the three **circular muscles** of the pharynx?

Answer 59

**Superior, middle and inferior constrictor muscles**

Question 60

What type of muscle makes up the **constrictor** **muscles** of the pharynx?

Answer 60

**Skeletal muscle**

Question 61

Which cranial nerve innervates virtually all of the muscles of the pharynx? What is the exception?

Answer 61

**CN X** **Stylopharyngeus**, one of the longitudinal muscles, which is **CN IX** (glossopharyngeal)

Question 62

Where do all of the **constrictor muscles** of the pharynx insert?

Answer 62

**Midline raphe**

Question 63

What is another name for the **upper oesophageal sphincter**?

Answer 63

**Cricopharyngeus**

Question 64

Apart from the **circular muscles**, which other muscles do the pharynx?

Answer 64

**Longitudinal muscles**

Question 65

Which type of pharyngeal muscle are **stylopharyngeus, palatopharyngeus** and **salpingopharyngeus**? Which cranial nerves innervate them?

Answer 65

**Longitudinal muscle** Palatopharyngeus, salpingopharyngeus are both CN X like the rest **Stylopharyngeus** is CN IX

Question 66

What is the **origin of stylopharyngeus**?

Answer 66

**Styloid process of the temporal bone**

Question 67

What is the **origin** of **palatopharyngeus**?

Answer 67

**Hard palate**

Question 68

What is the origin of **salpingopharyngeus**?

Answer 68

**Eustachian tube** just to make things confusing

Question 69

What is the common insertion of **stylopharyngeus, palatopharyngeus** and **salpingopharyngeus**?

Answer 69

**Posterior border of thyroid cartilage**

Question 70

Looking at the **pharynx** from the back, what are the openings into the nasal cavity called?

Answer 70

**Choana**

Question 71

What is the ring of lymphoid tissue, found in the pharynx, called?

Answer 71

**Waldeyer's ring**

Question 72

The tonsils are all examples of **\_\_\_** tissue.

Answer 72

**lymphoid**

Question 73

Where do all the **salivary lymphatics** drain? Which area of the neck is this structure found in?

Answer 73

**Deep cervical lymph nodes** Carotid sheathe

Question 74

Which lymph nodes should you examine in an OSCE?

Answer 74

**Submental** **Submandibular** **Pre-auricular** **Post-auricular** **Occipital** **Anterior and posterior triangles**

Question 75

When you palpate the **pre-auricular** and **post-auricular areas**, what are you actually feeling?

Answer 75

**Anteriorly:** parotid lymph nodes **Posteriorly:** mastoid lymph nodes

Question 76

When you palpate the **anterior and posterior triangles** of the neck, what are you feeling for?

Answer 76

**Superficial and deep cervical nodes**

Question 77

What are two common causes of lymph node enlargement?

Answer 77

**Infection** **Malignancy**

Question 78

What are some differences between **infected** and **cancerous** lymph nodes in terms of a) **pain** b) **texture** c) **mobility** d) **reaction to antibiotics**?

Answer 78

**a)** Infected nodes are **painless**, cancerous nodes are **painful** **b)** Infected nodes are **soft and smooth**, cancerous nodes and **hard and irregular** **c)** Infected nodes are mobile, cancerous nodes are **fixed** to structures **d)** Infected nodes clear up, cancerous nodes don't

Question 79

Why do you need to examine **both sides** in a lymph node exam?

Answer 79

**Because lymph node drainage often crosses over and by doing one side only you may miss something**