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MD3002 > Anatomy: Oral Cavity and Pharynx > Flashcards

Anatomy: Oral Cavity and Pharynx Flashcards

1
Q

List the components of the GI tract and accessory digestive organs.

A
  • Pharynx
  • Oesophagus
  • Stomach
  • Small intestine (duodenum, jejunum, ileum)
  • Large intestine (caecum, vermiform appendix, ascending colon, transverse colon, descending colon)
  • Rectum and anal canal

Accessory digestive organs

  • Oral cavity (teeth, tongue, salivary glands)
  • Pancreas
  • Gall bladder
  • Liver
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2
Q

Identify the main mechanical processes the digestive system is responsible for.

A

1) Ingestion
2) Mastication
3) Deglutition (swallowing)
4) Propulsion (peristalsis + segmentation)
5) Mechanical digestion
6) Chemical digestion
7) Absorption
8) Defecation

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3
Q

Identify the boundaries of the oral cavity.

A

Lips, cheeks, and palatoglossal folds (palatoglossal arches, anterior pillars of the fauces).

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4
Q

Define oral cavity proper.

A

Portion of the oral cavity located internal to the teeth.

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5
Q

Identify the boundaries of the vestibule of the oral cavity.

A

Externally: between the lips and the cheeks
Internally: between the gums and the teeth

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6
Q

What are the primary, and secondary functions of the oral cavity ?

A

PRIMARY: Ingestion + production of saliva (to wet the food and start digestions of carbs) + mastication and deglutition

SECONDARY: Immune system (tonsils)

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7
Q

What are the anatomical components of the cheeks ?

A
  • Skin
  • Buccinator muscle
  • Buccal (Bichat’s) fat pad
  • Mucous membrane
  • Buccopharyngeal fascia
  • Buccal glands
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8
Q

What is the significance of buccal (bichat’s) fat pad in children’s cheeks ?

A

Buccal fat pads are thought to enhance the sucking capacities of infants

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9
Q

Identify the origin and insertion of buccinator muscle.

A

Origin: mandible, maxilla, pterygomandibular raphe
Insertion: fibers of the orbicularis oris

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10
Q

Define the modiolus. Where can this be felt ?

A

Point of cross-over between buccinator and orbicularis oris.
Can be felt just lateral to the angle of the mouth.

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11
Q

What muscles provide continuity between the oral cavity and the pharynx ?

A

Buccinator attaches notably to the pterygomandibular raphe, where it fuses with the superior pharyngeal constrictor.

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12
Q

Identify the internal and external covering of the lips.

A

Internally, lips are covered by oral mucosa

Externally, lips are covered by skin

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13
Q

Describe the main features of the zone between the skin and the mucous membrane, in the lips.

A

Vermillion zone of the lips

  • Poorly keratinised
  • Richly vascularised
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14
Q

Identify the structure which connects the lips to the adjacent gum.

A

Median labial frenum

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15
Q

Identify the location of any glands located in the lips.

A

Small labial glands located between the muscle tissue and the oral mucosa, opening into the oral vestibule.

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16
Q

Explain the significance of the dense innervation of the lips.

A

Sensitivity to light touch

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17
Q

What is the anatomical function of the palate ?

A

Separate nasal and oral cavities.

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18
Q

Identify the components of the palate.

A
  • Hard palate (anterior 2/3), made of palatine process of the maxilla + horizontal plate of palatine bone
  • Soft palate (attached to posterior border of hard palate), made of mucosal glands + mucosal membrane + aponeurosis (periosteum + tendon of tensor veli palatini))
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19
Q

Identify the main foramina of the palate.

A 
Incisive foramen (nasopalatine nerve)
Greater palatine foramen (greater palatine nerve)
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20
Q

Describe the anatomical relations of the soft palate to surrounding structures.

A
  • Attached to the posterior border of the HARD PALATE
  • Continuous at the sides with the lateral wall of the PHARYNX
  • Forms the superior and lateral margins of the ISTHMUS FAUCIUM
  • In midline of the posterior projection, UVULA
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21
Q

Identify a possible abnormality in the hard/soft palate of newborns.

A

Epstein’s pearls: clusters of white spots in the midline at the junction of soft and hard palate (small cysts)

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22
Q

Describe the relation between the uvula and the lateral walls.

A

Two arches extend between the uvula and the lateral walls:

  • Anteriorly, palatoglossal arch (anterior pillar) → palatoglossus muscle
  • Posteriorly, palatopharyngeal arch (posterior pillar) → palatopharyngeus muscle
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23
Q

Identify the structure found between the palatoglossal and palatopharyngeal arches, and explain its significance.

A
  • Tonsilar fossa is formed between the palatopharnygeal and palatoglossal arches.
  • Houses palatine tonsls
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24
Q

Identify the main muscles of the soft palate. Identify the main action of each.

A
  • Palatopharyngeus
  • Palatoglossus
  • Levator veli palatini: Raises soft palate
  • Tensor veli palatini: Tenses soft palate + Opens pharyngotympanic tube
  • Uvula
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25
Q

Identify the main muscles of mastication. Which of these opens the mouth ? Identify the innervation of each.

A

Medial pterygoid
Lateral pterygoid (opens the mouth)
Masseter
Temporalis

All are innervated by the mandibular division of the trigeminal nerve (CN5)

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26
Q

Identify the main components of the floor of the mouth. What is the function of this floor ?

A

Muscular diaphragm made of mylohyoid muscle, extending between the mandible and the hyoid bone.
Floor acts as support for tongue.

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27
Q

Identify a possible source of infection spread in the mouth area.

A

Fascial plane in the floor of the mouth.

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28
Q

What are the main functions of the tongue ?

A

Mastication
Deglutition
Taste
Speech

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29
Q

Describe the histological appearance of the tongue.

A

Striated muscle, covered with mucous membrane

Furry appearance, due to papillae (grip food, and house taste buds)

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30
Q

Identify the main groups of muscle in the tongue. Identify the main attachments, function, and innervation of each group.

A

1) EXTRINSIC muscles
- Attach tongue to the styloid process and soft palate above, and to the mandible and hyoid bone below
- Alter position of the tongue
- Innervated by hypoglosseal nerve (CN-XII) except for palatoglossus (pharygeal plexus, CN-X)

2) INTRINSIC muscles
- Confined to the tongue, not attached to bone
- Alter shape of the tongue
- Innervated by hypoglosseal nerve (CN-XII)

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31
Q

Identify the extrinsic muscles of the tongue, and define their role.

A

Palatoglossus (draws the tongue upwards and backgrounds)
Styloglossus (draws the tongue upwards and backgrounds)
Hypoglossus (draws the sides downwards)
Genioglossus (propels the tongue forwards)

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32
Q

Identify the intrinsic muscles of the tongue, and define their role.

A
  • Vertical fibers
  • Longitudinal fibers (superior and inferior)
  • Transverse fibers
33
Q

Identify the main parts of the tongue, anatomically. How are these separated ?

A
  • Root of the tongue (posterior 1/3, lingual tonsils)
  • Body of the tongue (anterior 2/3)

V-shaped sulcus terminalis separates the two

34
Q

Define foramen caecum, in the context of the tongue.

A

Small pit at the apex of the sulcus terminalis

Embryological remnant of the upper end of the thryglossal duct (the thyroid gland develops from this duct)

35
Q

Identify the papillae of the tongue, including their role.

A
  • Vallate (circumvallate) papillae (biggest): taste receptor
  • Foliate papillae: taste receptor
  • Fungiform papillae: taste receptor

-Filiform papillae: gripping and manipulating food

36
Q

Identify the main tonsils found in the pharynx, stating their exact location. Define crypt in the context of these tonsils.

A

Palatine and lingual tonsils, in the mucosa of the pharynx

Crypts are pockets that occur naturally in the tonsils.

37
Q

Explain what possible risk is present during surgical removal of the palatine tonsils.

A

The bed of the palatine tonsils (tonsillar fossa) is highly vascular.
Bleeding from the tonsillar branches of the palatine artery may therefore be a problem during surgical removal

38
Q

Describe Waldeyer’s ring.

A

♦ Tonsils form a lymphatic ring around the openings of the respiratory and GI tracts.
♦ Specifically, from top to bottom, pharyngeal, tubal, palatine, lingual tonsils.
♦ The first two surround the nasal cavity, the last two surround the oral cavity.

39
Q

Describe the main roles of the salivary glands.

A

1) Lubrication and binding of the masticated food
2) Solubilisation of dry food
3) Digestion of carbs (alpha-amylase)
4) Oral hygiene

40
Q

How are salivary glands innervated ?

A

Parasympathetic secretomotor fibers from the facial (CN-VII) and glossopharyngeal nerves (CN-IX).

41
Q

Identify the main groups of salivary glands. What type of gland is each of these ?

A

Parotid (serous gland)
Sublingual (mucous glands)
Submandibular (mixed serous and mucous)

42
Q

PAROTID GLAND

  • Location
  • Duct, including location of the duct
  • Other anatomical significance
A

PAROTID

  • Location: lies in retromandibular fossa (below the external acoustic meatus, behind the ramus of the mandible)
  • Duct: Parotid duct, aka Stensen’s duct, crosses masseter superficially then pierces buccinator and opens into oral vestibule (opposite the second maxillary molar tooth)
  • Other anatomical significance: Terminal branching of facial nerve and external carotid takes place in carotid gland
43
Q

Define Koplik’s spots.

A

“Small white spots on the inside of cheeks, sign of measles infection.”

44
Q

SUBLINGUAL GLANDS

  • Location
  • Duct, including location
A

SUBLINGUAL GLANDS

  • Location: Above mylohyoid muscle, beneath the mucous membrane of the floor of the mouth.
  • Duct: 8-20 separate ducts that open into floor of the mouth, along the sublingual fold
45
Q

SUBMANDIBULAR GLAND

  • Location
  • Duct, including location
A

SUBMANDIBULAR GLAND

  • Location: beneath the lower border of the body of the mandible. Deep and superficial parts in relation to the mylohyoid muscle.
  • Duct: empties into oral cavity at sublingual papillae
46
Q

Give an example of clinical significance of submandibular duct.

A

Submandibular duct is the most common site for sialothiasis (calcified mass or sialolith forms within a salivary gland following the stagnation of saliva)

47
Q

Identify important anatomical landmarks in the mandible, and the use of each.

A

♦ Sublingual fossa → sublingual gland
♦ Submandibular fossa → submandibular gland
♦ Retromolar fossa → attachment for pterygomandibular raphe
♦ Mandibular foramen → Mandibular canal → Mental foramen: for the inferior alveolar nerve → mental nerve to mandibular teeth
♦ Mylohyoid line → attachment for mylohyoid muscle
♦ Lingula → attachment for sphenomandibular ligament

48
Q

Identify the main groups of teeth.

A

Right/Left
Maxillary/Mandibular

Each region has 
3x molars
2x premolars
1x canine
2x incisors
49
Q

How many teeth do we have in total ?

A

32

50
Q

Identify the deciduous teeth.

A

2x incisor (central and lateral)
1x canine
2x molar

in each region

51
Q

What are the limits of the pharynx ?

A

Base of the skill and lower border of the cricoid cartillage (upper margin of C6 vertebra)

52
Q

What is the role of the pharynx ?

A

Conducting food to the oesophagus and air to the lungs

53
Q

What are the main parts of the pharynx ? Give the location of each.

A

1) Nasopharynx (epipharynx), posterior to the nasal cavity (opens into it by choana)
2) Oropharynx, posterior to the oral cavity (opens into it by oropharyngral isthmus)
3) Laryngeopharynx, at the level of the larynx (opens into trachea via laryngeal inlet)

54
Q

Identify and describe the folds found in the nasopharynx.

A

Salpingopharyngeal and Salpingopalatine folds, formed by Salpingopharyngeus and Salpingopalatine muscles running between torus tubarius and pharynx and palate.

55
Q

Where is the pharyngeal recess found ? What is its clinical relevance ?

A
  • Pharyngeal recess is found in behind the auditory tube (Fossa of Rosenmuller)
  • Clinical relevance: most common site of craniopharyngioma + when attempting to put a catheter in the auditory tube, may instead enter pharyngeal recess in which case if pharynx is pierced, catheter could enter internal carotid artery
56
Q

Where does the anterior lobe of the pituitary develop from ?

A

From Rathke’s pouch

57
Q

Identify all the significant structures in the pharynx.

A
  • Choana, oropharyngeal isthmus, laryngeal inlet
  • Torus levatorius (produced by levator veli palatini)
  • Salpingopharyngeal fold
  • Soft palate and uvula
  • Palatine and lingual tonsils
  • Palatopharyngeal fold
  • Piriform fossa: between the quadrangular membrane of the larynx and the side wall of the pharynx
58
Q

Identify the muscles in the pharynx.

A

1) Circular muscles (constrictor muscles)
• Superior, middle, and inferior pharyngeal constrictors

2) Longitudinal muscles (levator muscles)
• Stylopharyngeus
• Palatopharyngeus
• Salpingopharyngeus

59
Q

Define the Sinus of Morgagni.

A

Space between the base of the skull and upper free border of superior constrictor, closed by pharyngobasilar fascia.

60
Q

What is the significance of the pharyngobasilar fascia.

A

It holds the nasopharynx open.

61
Q

Identify the origin and insertion of all the pharyngeal constrictor muscles + of the pharyngobasilar fascia.

A

♠ Pharyngobasila fascia attaches to medial pterygoid plate, internal to the attachment of the Superior pharyngeal constrictor
♠ Superior pharyngeal constrictor attaches to the pterygoid hamulus and pterygomandibular raphe with the buccinator
♠ Middle pharyngeal constrictor attaches to the hyoid bone and stylohyoid ligament
♠ Inferior pharyngeal constrictor attaches to the oblique line of the thyroid cartilage, the cricoid cartilage

NOTE: All constrictors insert on Pharyngeal raphe, which attaches to Pharyngeal tubercle

62
Q

Define Killian’s dehiscence and explain its clinical significance.

A

-The inferior-most region of the inferior constrictor muscle, where the superior pharyngeal constrictor ends is a weak area known as Killian’s dehiscence

-Pharyngoesophageal diverticulum
(Zenker’s diverticulum) is more likely to occur here

63
Q

Define Passavant’s Ridge, and its role.

A
  • Passavant’s Rdige (=Palatopharyngeal sphincter) is a mucosal ridge caused by superior pharyngeal constrictor or the palatopharyngeus, it encircles the posterior and lateral walls of the nasopharynx
  • During swallowing it touches to the soft palate and isolates the oropharynx from nasopharynx
64
Q

Where do elevator muscles of the pharynx originate from ?

A

Elevator muscles of the pharynx originate from the skull to fan out into the inner surface of the pharynx.

65
Q

Explain the role of Palatopharyngeus.

A

− elevates the pharynx and larynx
− draws the soft palate downwards
− brings the palatopharyngeal arch
backwards (separates the oral cavity from the pharynx)

66
Q

Explain the role of Salpingopharyngeus.

A

− Opens the auditory tube during

swallowing

67
Q

Describe the attachments of Salpingopharyngeus and Stylopharyngeus.

A

Stylopharyngeus extends from the styloid process to pass between the superior and middle pharyngeal constrictors and fan into the internal pharyngeal surface.

Salpingopharyngeus descends into the pharynx from the torus tubarius

68
Q

What is the possible result of lack of coordination between pharyngeal constrictors and cricopharyngeal sphincter ?

A

Hypopharyngeal diverticulum through Killian’s dehiscence

69
Q

Identify the main structures going through the gaps/gateways of the pharynx.

A

1) Pharyngobasilar fascia pierced by auditory tube, levator veli palatini, tensor veli palatini
2) Oropharyngeal triangle: stylopharyngeus muscle, glossopharyngeus nerve and stylohyoid ligament
3) Thyrohyoid membrane pierced by internal branch of superior laryngeal nerve with superior laryngeal vessels (sensation to larynx above the vocal folds)
4) Recurrent laryngeal nerve (motor to intrinsic laryngeal muscles except CT) with inferior laryngeal vessels

70
Q

Describe the arterial supply of the pharynx.

A

♣ Upper pharynx: branches of the external carotid artery

♣ Lower pharynx: branches of the inferior thyroid artery of thyrocervical trunk of subclavian artery

71
Q

Describe the veinous and lymphatic drainage of the pharynx.

A

Venous drainage by the pterygoid plexus but essentially converges on the facial and internal jugular veins

Lymph drainage includes retropharyngeal, paratracheal and infrahyoid nodes → on the deep cervical nodes
Palatine tonsils drain to the jugulodigastric

72
Q

What is the clinical significance of jugulodigastric lymph nodes ?

A

Palpable if inflamed

73
Q

Describe the motor innervation of the pharynx and salivary glands.

A
  • Stylopharyngeus is the only pharyngeal muscle supplied by the glossopharyngeal nerve (CN-IX)
  • All other pharyngeal elevators and constrictors are supplied by the vagus (CN-X)

• Visceral efferents (Parasympathetic secretomotor) are via vagus (CN-X) and facial (CN-VII) nerves

74
Q

Describe the location of the pharyngeal plexus, as well as some of the nerves it includes.

A

The pharyngeal plexus lies on the external pharyngeal wall and includes branches of CN-IX, CN-X and cervical sympathetics

75
Q

Describe the sensory innervation of the pharynx.

A

Nasopharynx: Maxillary (CN-V2) division of trigeminal nerve

Oropharynx, palatine tonsils, inferior surface of soft palate and posterior 1/3 of the tongue: Glossopharyngeus (CN-IX)

Laryngopharynx, vallecula and epiglottis: Vagus (CN-X)

76
Q

Where may pain be referred, from the Oropharynx, palatine tonsils, inferior surface of soft palate and posterior 1/3 of the tongue (all supplied by glossopharyngeus) ?

A

Pain may be referred to the middle ear

77
Q

What are the requirements of chewing, and how are these achieved ?

A

1) Food needs to be kept between the occlusal surfaces of the molar teeth
→ Buccalis muscle, together with the tongue

2) The oropharyngeal isthmus must be closed
− Soft palate is pulled down
→ Palatoglossus and palatopharyngeus

− Tongue is drawn slightly upwards
→ Palatoglossus and palatopharyngeus

− Palatoglossal and palatopharyngeal
arches move medially like curtains

78
Q

Describe the main steps in swallowing, as well as each muscle involved.

A
  1. The bolus is pushed towards the back of the oral cavity by raising the tip and body of the tongue upwards towards the palate:
    → mylohyoid and intrinsic tongue muscles
  2. The palatoglossal and palatopharyngeal arches relax and move laterally
  3. The tongue is pulled upwards and backwards to tip the bolus through the
    oropharyngeal isthmus and into the pharynx:
    → Styloglossus
  4. The soft palate is stretched and elevated:
    → Tensor veli palatini, levator veli
    palatini
  5. Elevated soft palate and Passavant’s ridge separate the nasopharynx from the oropharynx:
    → Superior pharyngeal constrictor
  6. The pharynx (and larynx) is elevated by the pharyngeal elevators:
    → stylopharyngeus, salpingopharyngeus and palatopharyngeus as well as stylohyoid and digastric
  7. Laryngeal inlet is closed:
    → Tongue, Aryepiglottic and thyroepiglottic muscles
  8. Bolus is pushed towards the oesophagus:
    → Pharyngeal constrictors (contract involuntarily from superior to inferior)

NOTE: The inferior pharyngeal constrictor has a lower circular part around the
upper oesophagus that is known as cricopharyngeal sphincter, which prevents air being drawn into the stomach during inhalation

79
Q

Describe the major differences in oral cavity, pharynx and larynx anatomy of infants and adults.

A

In infants:

  • Omega shaped epiglottis
  • Tongue with a central groove
  • Fat pads for generation of intra- oral suction
  • Close proximity of the soft palate and epiglottis (until ~6mth)
  • Elevated larynx that is tucked up under the epiglottis

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