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MET1 > Anatomy: Mouth to Oesophagus > Flashcards

Anatomy: Mouth to Oesophagus Flashcards

1
Q

What is the first part of the digestive system and what are its three major functions?

A

The oral cavity is the first part of the digestive system. It has three major functions:

  • Digestion: receives food, preparing it for digestion in the stomach and small intestine.
  • Communication: modifies the sound produced in the larynx to create a range of sounds.
  • Breathing: acts as an air inlet in addition to the nasal cavity
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2
Q

What structures are housed by the oral cavity?

A

The oral cavity houses a number of structures, which include the teeth, the tongue and associated structures such as the salivary glands.

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3
Q

What is the oral cavity proper?

A

This is the space located inside the teeth. It is occupied mostly by the tongue.

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4
Q

Where does each salivary gland drain to?

A

Parotid - upper second molar
Sublingual - sublingual folds
Submandibular - either side of frenulum

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5
Q

How would you test the hypoglossal nerve in the tongue?

A

Ask patient to stick their tongue out, and see if it sticks out straight or if it tends towards one side, or if one side of the tongue seems wasted.

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6
Q

What is the vestibule?

A

This is the space between the cheeks and the teeth.

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7
Q

What is the hard palate?

A

The hard palate (along with the soft palate) make up the roof of the oral cavity.

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8
Q

What is the frenulum?

A

The tongue is attached to the floor of the oral cavity by a fold of mucosa called the frenulum.

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9
Q

What is the soft palate?

A

The soft palate (along with the hard palate) makes up the roof of the oral cavity.

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10
Q

What is the uvula?

A

The uvula is the midline extension of mucosa of the soft palate.

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11
Q

What are the palatine tonsils?

A

The palatine tonsils are found between two arches of mucosa that project down from the soft palate.

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12
Q

What is the palatopharyngeal arch?

A

The palatopharyngeal arch lies posterior to the palatine tonsils.

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13
Q

What is the palatoglossal arch?

A

The palatoglossal arch lies anterior to the palatine tonsils.

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14
Q

What are the parotid glands?

A

The parotid glands are large salivary glands which lie just in front of each ear, in the parotid region.

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15
Q

What is the parotid region bound by?

A

The parotid region is bounded by the zygomatic arch (superiorly), inferior border of the mandible (inferiorly), masseter muscle (anteriorly) and external ear and sternocleidomastoid (posteriorly).

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16
Q

What is the parotid duct and where is it located?

A

The parotid duct secretes saliva into the oral cavity. The duct arises from the anterior surface of the gland, pierces the buccinator and opens out into the oral cavity near the second upper molar.

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17
Q

What are the sublingual glands?

A

The sublingual glands are almond-shaped and lie on the floor of the oral cavity. underneath the tongue. The sublingual glands form a shallow groove on the medial surface of the mandible known as the sublingual fossa.

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18
Q

Where are the sublingual glands located?

A

They open with separate ducts on the sublingual fold (plica sublingualis), a fold of mucous membrane between the tongue and the body of the mandible.

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19
Q

What are the sublingual ducts and where are they located?

A

Secretions drain into the oral cavity by minor sublingual ducts, each opening out onto the sublingual folds. Each sublingual fold extends from a posterolateral position and traverses anteriorly to join the sublingual papillae at the midline, either side of the lingual frenulum.

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20
Q

What are the submandibular glands?

A

The submandibular glands are bilateral salivary glands located in the face. Their mixed serous and mucous secretions are important for the lubrication of food during mastication to enable effective swallowing and aid digestion.

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21
Q

Where are the submandibular glands located and what do they look like?

A

Located in the submandibular triangle, the submandibular glands are a pair of elongate, flattened “hook-like” glands.

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22
Q

What are the submandibular glands and where are they located?

A

Secretions from the submandibular glands travel into the oral cavity via the submandibular duct. The duct opens on a small sublingual papilla (caruncle) at the base of the lingual frenulum bilaterally.

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23
Q

What are the salivary glands innervated by, and in which way?

A

The salivary glands are innervated by cranial nerves. The glands receive both sensory supply and motor innervation. The motor innervation increases saliva production and is therefore termed secretomotor supply.

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24
Q

Is secretomotor supply to the salivary glands sympathetic or parasympathetic?

A

Parasympathetic

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25
Q

Which glands are parasympathetically innervated by the facial nerve?

A

Sublingual gland

Submandibular gland

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26
Q

Which glands are parasympathetically innervated by the glossopharyngeal nerve?

A

Parotid gland

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27
Q

Which cranial nerve does not innervate the Parotid gland but is closely associated to the gland?

A

Facial nerve

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28
Q

Due to multiple salivary calculi (stones) in the submandibular duct, the submandibular gland of a 45-year-old individual was surgically removed. What major artery directly related to the gland was of special concern to the surgeon?

A

Facial artery

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29
Q

Where does the parotid duct open into the mouth?

A

Upper second molar

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30
Q

Why is the tongue a remarkable structure?

A

Not only is it required for licking, swallowing, breathing and talking, it is also responsible for taste. It has a complex pattern of development, which means that its sensory and motor nerve supplies are quite complicated.

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31
Q

What is the root of the tongue?

A

The posterior 1/3 of the tongue is called the root. It is covered in a mucosa that is derived from endoderm.

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32
Q

What is the body of the tongue?

A

The anterior 2/3 of the tongue is known as the body. Its mucosa is derived from ectoderm.

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33
Q

What is the sulcus terminalis?

A

The sulcus terminalis is a V-shaped line in between the body and the root of the tongue.

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34
Q

What is the median sulcus?

A

The tongue develops as two longitudinal ridges that join at the midline and form a longitudinal line running down the centre of the tongue. This is the median sulcus.

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35
Q

What is the foramen caecum?

A

The foramen caecum occurs where the sulcus terminalis and the median sulcus meet. It is a closed pit and a remnant of embryological development.

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36
Q

What are papillae?

A

Papillae are small nipple-like structures covering the surface of the tongue that give it its rough appearance. Click on the images below to discover the different types of papillae.

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37
Q

What are the fungiform papillae?

A

Fungiform (mushroom-shaped) papillae tend to be concentrated around the margin of the tongue. Most of the fungiform papillae have taste buds.

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38
Q

What are the filiform papillae?

A

Filiform (thread-like) papillae are small projections of the mucosa that end in one or more points. These are thought to increase the surface area of the tongue.

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39
Q

What are circumvallate papillae?

A

Circumvallate papillae (numbering around 8-12) are large papillae located anterior to the sulcus terminalis. These papillae have taste buds in the medial walls of the clefts.

40
Q

Which of the papillae have taste buds?

A

Fungiform

Circumvallate

41
Q

What are the two sets of muscles related to the tongue?

A

Those found entirely within in the tongue itself are called intrinsic muscles and those originating external to the tongue are extrinsic.

42
Q

Where are the intrinsic muscles of the tongue?

A

The intrinsic muscles of the tongue originate and insert within the tongue itself.

43
Q

How do the intrinsic muscles alter the shape of the tongue?

A

They alter the shape of the tongue by:

  • lengthening and shortening it
  • curling and uncurling both the apex and the edges
  • flattening and rounding the surface
44
Q

What are the four intrinsic muscles of the tongue?

A

1- Superior longitudinal muscles
The most superficial of the intrinsic muscles. Found just deep to the superior surface of the tongue.
2 - Inferior longitudinal muscles
The inferior longitudinal muscles are sandwiched in between two of the extrinsic muscles.
3 and 4 - Transverse and vertical muscles
The transverse and vertical muscles appear in the middle of the tongue. The vertical muscle connects the two longitudinal muscles and the transverse attaches to the mucous membranes at the side of the tongue.

45
Q

What are the different extrinsic muscles of the tongue?

A 
- Palatoglossus
Elevates the posterior aspect of the tongue
Supplied by CN X
- Styloglossus
Retracts (pulls back) and elevates the tongue
Supplied by CN XII
- Genioglossus
Different fibres:
Protrude and depress the tongue and draw the tip back and down
Supplied by CN XII
- Hyoglossus
Depresses and retracts the tongue
Supplied by CN XII
46
Q

Where are the extrinsic muscles located?

A

The extrinsic muscles originate from outside of the tongue and insert into the tongue.

47
Q

What motor nerve supplies the tongue?

A

The motor nerve supply to ALL of the muscles of the tongue EXCEPT for palatoglossus is the HYPOGLOSSAL NERVE (CN XII).
Palatoglossus is supplied by VAGUS NERVE (CN X).

48
Q

What are the two types of sensory nerve supply in the tongue?

A

It has both general sensory nerve supply (pain, temp, touch) and special sensory supply (taste).

49
Q

Which nerves convey the general and special senses in the different parts of the tongue?

A
  • Somatic (general) sensation from the anterior 2/3 is carried by the LINGUAL branch of the TRIGEMINAL nerve (CN V3)
  • Taste (special) sensation from the anterior 2/3 is carried by CHORDAE TYMPANI of the FACIAL nerve (CN VII)
  • Somatic (general) and special (taste) sensation from the posterior 1/3 is carried by the GLOSSOPHARYNGEAL nerve (CN IX)
50
Q

Which nerves supply the motor function of the tongue?

A

Hypoglossal nerve

51
Q

Which nerves supply the sensory anterior 2/3 of the tongue?

A

Trigeminal nerve

Facial nerve

52
Q

Which nerves supply the sensory posterior 1/3 of the tongue?

A

Glossopharyngeal nerve

53
Q

What is the pharynx?

A

The pharynx is a muscular tube that connects the nasal and oral cavity to the oesophagus. It extends from the base of the skull to the level of C6.

54
Q

What 3 constrictor muscles does the pharynx consist of? What do these form?

A

It consists of three constrictor muscles; superior, middle and inferior pharyngeal constrictor muscles. All these muscle extend posterio-medially and form the midline pharyngeal raphé.

55
Q

What 3 extrinsic muscles does the pharynx consist of? What is their function?

A

The pharynx consists of three extrinsic muscles; stylopharyngeus, palatopharyngeus and salpingopharyngues muscles.
These muscles act as a group to elevate the larynx, shorten the pharynx and act during swallowing and speaking.

56
Q

What are the three interior parts of the pharynx?

A

Nasopharynx: the area from the base of the skull to the level of the soft palate, lined by ciliated columnar epithelium.
Oropharynx: the area from the soft palate to the base of the tongue, lined by stratified squamous epithelium.
Laryngopharynx: the space above and behind the laryngeal opening, lined by stratified squamous epithelium.

57
Q

What us the Eustachian tube?

A

The Eustachian tube is a tube which connects the middle ear with the pharynx. This is important for equalization of pressures between these spaces. This is necessary for the tympanic membrane (ear drum) to vibrate properly.
When your ears pop this is the Eustachian tube opening.

58
Q

What is the soft palate?

A

The soft palate is a group of muscles. The soft palate elevates during swallowing to prevent food moving into the nasal cavity.

59
Q

What are the structures of the pharynx?

A 
Opening of eustachian tube
Soft palate
Laryngeal inlet
Stylopharyngeus muscle (cut)
Middle pharyngeal constrictor muscle
Uvula
Oral cavity
Epiglottis
Piriform recess
60
Q

What is the stylopharyngeus muscle (cut)?

A

This muscle runs between the styloid process on the base of the skull to the pharynx.

61
Q

What is the uvula?

A

The uvula is the central point of the soft palate. From this angle you can see how it hangs from the posterior edge of the hard palate and can be elevated to prevent food moving into the nasal cavity.

62
Q

What is the oral cavity?

A

Specifically here you are looking at the posterior 1/3 of the tongue.

63
Q

What is the epiglottis?

A

This is a leaf-shaped cartilage covered in a mucous membrane. The epiglottis can be lowered to prevent food entering the larynx (and therefore trachea).

64
Q

What is the piriform recess?

A

This recess is found either side of the laryngeal inlet. Food can become lodged here, with fish bones being the classic example.

65
Q

Which part of the pharynx do you find the opening of the eustachian tube?

A

Nasopharynx

66
Q

Which cranial nerve innervates stylopharyngeus?

A

Glossopharyngeal (IX)
The glossopharyngeal nerve is largely a sensory nerve, but it has a somatic motor branch which innervates the stylopharyngeus muscle.

67
Q

What are the muscles of mastification?

A

The muscles of mastication are attached to the jaw and help with chewing.

68
Q

What are the four muscles of mastification?

A

Temporalis muscle
Masseter muscle
Medial pterygoid
Lateral pterygoid

69
Q

What is the innervation to the muscles of mastification?

A

Mandibular branch (V3) of trigeminal nerve (CNV)

70
Q

What is the infratemporal fossa?

A

The infratemporal fossa is a depression located beneath the temporal bone. It is closely associated with the muscles of mastication. It also forms an important passage for the mandibular nerve.

71
Q

What are the branches of the mandibular nerve?

A

The mandibular nerve has motor branches to the muscles of mastication and two major sensory branches: the inferior alveolar nerve (sensory to lower dentition and chin) and lingual nerve (sensory to anterior 2/3 of the tongue).

72
Q

Which muscle of mastication opens the mouth?

A

Lateral pterygoid
The temporalis, massester and medial pterygoid muscles help close the mouth and the lateral pterygoid opens it, by pulling the head of the mandible and tilting it forward.

73
Q

A 38 year old man complains of progressive weakness when opening and closing his jaw along with difficulty when chewing. You suspect his muscles of mastication may be affected.
What tests would you perform to assess this?

A

Ask to open mouth against resistance

74
Q

What does the hyoid bone do?

A

The hyoid bone does not articulate with any other bones. It moves up and down and together with its attached muscles, the hyoid bone has two important functions: it holds up the tongue, which sits above it, and it holds up the larynx, which hangs below it. It also transmits the force of muscles that help to open the jaw.

75
Q

What are the two groups of muscles that attach to the hyoid bone?

A

The suprahyoid muscles (lie above the hyoid bone) and the infrahyoid muscles (lie below the hyoid bone).

76
Q

What are the different suprahyoid muscles?

A

Mylohyoid muscle
Anterior belly of digastric muscle
Posterior belly of digastric muscle
Geniohyoid muscle

77
Q

What is the mylohyoid muscle?

A

The mylohyoid muscle is a paired muscle running from the mandible to the hyoid bone, forming the floor of the oral cavity of the mouth.

78
Q

What is the anterior belly of digastric muscle?

A

The anterior belly arises from a depression on the inner side of the lower border of the mandible called the digastric fossa of mandible and passes downward and backward where it meets with the posterior belly.

79
Q

What is the posterior belly of digastric muscle?

A

The posterior belly, longer than the anterior belly, arises from the mastoid process. It runs forward and downward to eventually meet with the anterior belly.

80
Q

What is the geniohyoid muscle?

A

The geniohyoid muscle is a narrow muscle situated superior to the medial border of the mylohyoid muscle.

81
Q

What are the different infrahyoid muscles?

A

Thyrohyoid muscle
Sternothyroid muscle
Sternohyoid muscle
Omohyoid muscle (superior belly)

82
Q

What is the thyrohyoid muscle?

A

This muscle extends between the hyoid bone and thyroid.

83
Q

What is the sternothyroid muscle?

A

This muscle extends between the sternum and thyroid.

84
Q

What is the sternohyoid muscle?

A

The sternohyoid muscle is a thin, narrow muscle attaching the hyoid bone to the sternum.

85
Q

What is the omohyoid muscle (superior belly)?

A

The omohyoid muscle is located in the front of the neck and consists of two bellies separated by an intermediate tendon. It’s superior belly serves as the most lateral member of the infrahyoid muscles, located lateral to both the sternothyroid and thyrohyoid muscles.

86
Q

Which muscles elevate the hyoid bone?

A

Digastric muscle
Geniohyoid muscle
Mylohyoid muscle

87
Q

Which muscles depress the hyoid bone?

A

Omohyoid muscle
Sternohyoid muscle
Sternothyroid muscle
Thyrohyoid muscle

88
Q

What is the oesophagus, where is it located and what is its function?

A

The oesophagus is a muscular tube that begins distal to the PHARYNX at vertebral level C6 and terminates at the STOMACH at vertebral level T10. It functions to convey food and fluids from the mouth and pharynx to the stomach.

89
Q

Where does the oesophagus run through? What is located at the upper and lower ends?

A

The oesophagus is the part of the gastrointestinal tract that runs through the thorax connecting the oral cavity and the pharynx to the stomach. At the upper and lower ends of the oesophagus are sphincters and there are three areas of constriction that occur naturally.

90
Q

What types of muscles are present in the oesophagus? What does this mean for the process of swallowing?

A

There are both skeletal and smooth muscles in the oesophagus which means that the process of swallowing has a voluntary and an involuntary phase. At the proximal end the muscles are skeletal and therefore voluntary. There is a transition from skeletal to smooth muscle as you move distally. There is an inner circular layer - contraction of this muscle increases luminal pressure. There is also an outer longitudinal layer of muscle, contraction of which causes shortening of the oesophagus.

91
Q

What is the motor nerve supply to the oesophagus?

A

Vagus nerve

92
Q

What are constrictions of the oesophagus? Where are the 4 constrictions of the oesphagus?

A 
N #3
There are four normal constrictions of the oesophagus that should not be confused with pathological ones. They are a part of the oesophagus where it narrows, thus items may get lodged or an ingested corrosive substance could move slowly.
The first (cervical) constriction occurs due to the cricoid cartilage and is found at the level of C5/6.
The second (thoracic) constriction is due to the aortic arch and the left main bronchus cross the oesophagus and occurs at the level of T4/5.
The third (abdominal) constriction is located at the oesophageal hiatus in the diaphragm and can be found at vertebral level T10/11.
93
Q

What is a barium swallow used for?

A

A barium swallow is a dedicated test of the pharynx, oesophagus and proximal stomach. It is often used to evaluate the whole path from the lips and oral cavity to the fundus of the stomach.

94
Q

What are the main relations as the oesophagus runs through the neck and thorax?

A
  • Superior thorax
    In the superior aspect of the thorax, note how the oesophagus is sandwiched between the trachea anteriorly and the vertebral body posteriorly.
  • Vertebral level T4/T5
    At the level of the sternal angle (vertebral level T4/T5) the oesophagus sits on the midline with the vertebral body directly posterior.
  • Inferior thorax
    On this section, look at where the oesophagus is in relation to the lung and left atrium.
95
Q

Which structures are lateral to the oesophagus?

A

Thoracic aorta

Recurrent laryngeal nerve

96
Q

Which structures are anterior to the oesophagus?

A

Left atrium
Trachea
Right pulmonary artery

97
Q

Which structures are posterior to the oesophagus?

A

Thoracic duct
Vertebral body
Hemiazygous vein

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