9.1 The Oral Cavity & Pharynx Flashcards
Label the diagram
IMPORTANT
What are the different types of muscles of the tongue?
4 paired intrinsic
4 extrinsic muscles
What innervates the 4 pairs of intrinsic muscles?
Hypoglossal
(superior and inferior longitudinals + transverse and vertical)
What are the 4 extrinsic muscles?
Genioglossus
Hypoglossus
Styloglossus
-innervated by hypoglossal
Palatoglossus
-innervated by vagus
Describe the sensory innervation of the tongue
Anterior 2/3 tongue
-Sensation by Vc
-Taste chorda tympani
Posterior 1/3 tongue
-Sensation and taste glossopharyngeal
Where do you find submandibular salivary glands?
Submandibular triangle underneath the mandible
What duct releases saliva from the submandibular duct?
Whartons duct, underside of the tongue, either side of the lingual frenulum
What are the borders of the parotid gland?
Anterior-Masseter
Posterior- SCM
Superior- Zygomatic arch
What duct releases saliva from the parotid gland?
Stensen duct, next to molars
What proportion of saliva do the sublingual glands produce?
Only 3-5% of saliva
Smallest
8-20 excretory ducts per gland
Underneath the tongue
What is a sialolithiasis?
Salivary gland stone
Where are most sialolithiases found?
Submandibular glands, has the most calcium in its saliva
Why do we get sialolithiases?
Dehydration, reduced salivary flow
How large are sialolithiases
Most less than 1cm in diameter
What are some symptoms of sialolithiases?
Pain in gland
Swelling
Infection
Diagnose with history, x-ray and sialogram (radiopaque dye into duct then x-ray it)
What is tonsillitis?
Inflammation of the palatine tonsils (between the palatoglossal arch and palatopharyngeal arch)
What are the symptoms of tonsillitis?
Sore throat (EXTREMELY SORE, unbarable)
Pain/difficulty swallowing
Bad breath
What causes tonsillitis?
Viral cause most common, refrain from antibiotic use
Bacterial causes (up to 40%), steptococcus pyogenes, causes white exudate on tonsils
Is the uvula position affected in tonsilitis?
No, should be central
How does a peritonsillar abcess (quinsy) happen?
Can follow on from untreated/ partially treated tonsilitis
Can arise on its own, aerobic or anaerobic bacteria
What symptoms do you have in peritonsillar abcesses?
Severe throat pain
Fever
Bad breath
Drooling
Difficulty opening mouth
Is the uvula affected in peritonsillar abscesses?
Yes, pushed to opposite side by affected tonsil
What are the boundaries of the nasopharynx?
Base of skull to upper border of soft palate
-Posterior C1,2
-Anterior nasal cavity
What does the nasopharynx contain?
Pharyngeal tonsils (adenoids)
What happens if you have enlarged pharyngeal tonsils?
Can block ET, leads to:
* Recurrent 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?
Soft palate to epiglottis
-Anterior (oral cavity)
-Posterior C2,3
-Superior soft palate
-Inferior epiglottis
What does the oropharynx contain?
Palatine tonsils between the palatoglossal and palatopharyngeal arches
What are the borders of the laryngopharynx?
-Anterior larynx
-Posterior C4,5,6
-Superior epiglottis
-Inferior cricoid cartilage
What does the laryngopharynx contain?
Piriform fossae, either side of the larynx
What do the piriform fossae do?
Form recesses allowing fluid to collect here and drain into the pharynx rather than enter the larynx
What are the 3 longitudinal muscles?
Stylopharyngeus
Palatopharyngeus
Salpingopharyngeus
What do the longitudinal muscles of the pharynx do?
Elevates the pharynx and larynx while swallowing
Shortens distance food travels to oesophagus by elevating the pharynx
What is the origin and insertion of the stylopharyngeus?
Styloid process (temporal bone)
Posterior border of the thyroid cartilage
Innervated by CNIX
What is the origin and insertion of palatopharyngeus?
Hard palate
Posterior border of thyroid cartilage
Pharyngeal branch of vagus CNX
What is the origin and insertion of salpingopharyngeus?
Cartilaginous part of ET
Merges with pataltopharyngeus
Pharyngeal branch of vagus CNX
What are the 3 circular pharyngeal muscles and what do they do?
Superior, middle and inferior (two parts thyro and cricopharyngeal parts)
Constrict walls of pharynx when swallowing
What is Killian’s dehiscence? (pharyngeal pouch)
Weakness between the thyropharyngeal and cricopharyngeal part of the inferior pharyngeal constrictor, posteromedial (false) diverticulum
Causes a lump in the back of the neck, bad breath, regurgitation of food, choking on fluids and dysphagia
Due to failure of UOS to relax, abnormal timing of swallowing causing high pressure in the laryngopharynx
Where do pharyngeal constrictors attach?
Pharyngeal raphe, fuse at the back
What is the origin of the superior pharyngeal constrictor?
Pterygomandibular raphe (oral cavity)
What is the origin of the middle pharyngeal constrictor?
Hyoid bone
What is the origin of the inferior pharyngeal constrictor?
Thyropharyngeal portion from thyroid cartilage
Cricopharyngeal portion from cricoid cartilage
What innervates the pharyngeal constrictors?
CNX
What is the pharyngeal plexus?
Collection of vagus, glossopharyngeal and cervical sympathetic nerves
Found mainly on surface of middle constrictor muscle
What is the motor supply to the pharynx?
CNX innervates all muscles except for stylopharyngeus CNIX
What is the sensory innervation to the pharynx?
Nasopharynx (Maxillary nerve CNVb)
Oropharynx (glossopharyngeal CNIX)
Laryngopharynx (vagus CNX)
What are the causes of dysphagia?
Progressive neurological disease - parkinsons, MS
COPD
Dementia
Why is dysphagia so dangerous following a stroke?
Aspiration pneumonia - patients inhale food, bacteria grows causing pneumonia
What are some signs and symptoms of dysphagia?
Coughing/choking
Sialorrhoea - drooling unable to swallow saliva
Recurrent pneumonia
Change in voice/speech
Nasal regurgitation
