BIOMED 5 Flashcards
Mouth + tongue + jaw, laryngectomy
What are the 2 parts of the mouth?
Oral vestibule
Oral cavity proper
What is in the oral vestibule?
The sulci between the cheeks (or lips) and the teeth
What is the lining mucosa?
Varies in colour + shape
Translucent/ seethrough
If less translucent, more involved in chewing
What are the 6 parts of the oral cavity proper?
Vermillion border (lips)
Uvula
Palatoglossal arch
Palatopharyngeal arch
Soft palate
Palatine tonsil
What is normal anatomical variation of the uvula?
Some don’t have
Some are split
What are 3 key clinical issues from the mouth?
Oral thrush (fungal infection)
Poor oral hygiene and aspiration pneumonia risk
Radiotherapy changes (mucosa stripped/inflamed = less saliva = harder to eat)
What are the 7 features on the dorsal surface of the tongue?
Which papillae contain taste buds?
Circumvallate
Fungiform
Which papillae doesn’t contain taste buds?
Filiform
What are the 4 features on the ventral surface of the tongue?
Lining mucosa
Lingual veins
Lingual frenulum
Sublingual papillae
What is the lingual frenulum
Attaches tongue to floor of mouth
What does the sublingual papillae contain?
Opening of Wharton’s ducts
What occurs if the lingual frenulum is too short? When is this picked up and resolved?
Ankyloglossia (tongue-tie)
Usually picked up after birth → surgically resolved
What are the 2 sets of muscles of the tongue?
Extrinsic
- attach to tongue + skull
- change position of tongue
Intrinsic
- both attachments within the tongue
- change shape of tongue
What are the 4 extrinsic muscles of the tongue, and which cranial nerves are they innervated by?
What does the extrinsic palatoglossus muscle do?
Elevates posterior tongue / depresses soft palate
What does the extrinsic styloglossus muscle do?
Retracts tongue + elevates sides of tongue
What does the extrinsic genioglossus muscle do?
Wide range of actions: protrudes, flatten
What does the extrinsic hyoglossus muscle do?
Depresses tongue + depresses sides of tongue
What are the 4 intrinsic muscles of the tongue, and which cranial nerve are they innervated by?
What does the intrinsic superior longitudinal muscle do?
Shortens tongue
Curls apex upwards
What does the intrinsic inferior longitudinal muscle do?
Shortens tongue
Curls apex downwards
What does the intrinsic transverse muscle do?
Narrows + lengthens tongue
What does the intrinsic veritical muscle do?
Broadens + flattens tongue
Which cranial nerve is responsible for motor innervation of the tongue?
Hypoglossal (XII)
Which cranial nerves are responsible for sensory innervation of the tongue?
What are 2 key clinical issues from the tongue?
Glossectomy
Neurological events
What are 3 features of the hard palate?
Alveolar ridge
Rugae
oral masticatory mucosa
What is the hard / soft palate made of?
Hard = bone
Soft = muscle
What are the 7 muscles of the soft palate?
Auditory tube
Levator veli palatini
Tensor veli palatini
Palatoglossus
Palatopharyngeus
Uvula
Pterygoid hamulus
What does the levator veli palatini do?
Elevates soft palate
What does the tensor veli palatini do?
Tenses soft palate
What do the palatoglossus and palatopharyngeus do?
Depresses soft palate
Which cranial nerves are the muscles of the soft palate innervated by?
Vagus (X)
Except tensor veli palatini by a branch of V3
What does the auditory tube do?
Drains secretion from middle ear
What are 3 key clinical issues from the palate?
Cleft lip & palate
Velopalatal insufficiency (VPI): soft palate not strong enough to open/close → bolus through nose
Palatal resection: middle ear infection → conductive hearing loss
What are the anatomical features of the mandible?
Projections of bones…
Coronoid process
Condylar process: head + neck
Ramus
Body
Angle
What does the ramus of the mandible do?
Where masseter muscle attaches
What does the body of the mandible do?
Houses lower dentition
What is the temporomandibular joint (TMJ) formed by?
Underside of temporal bone + head of mandibular condyle
When is the condyle stable/unstable?
Stable = in glenoid
Unstable = on articular eminence
What are the movements the temporomandibular joint can do?
Rotate, axis through condyle
Slide so head of condyle moves from glenoid cavity on to articular eminence
What is the purpose of the articular disc on the temporomandibular joint?
Fibrocartilage
Attaches lateral pterygoid muscle to posterior aspect of joint
Shock absorber: pulled forward by lateral pterygoid to pack space when head of condyle is on articular eminence, stabilises joint
Is the articular disc essential?
No
- if removed, joint still functions
- if perforated in old age, joint still functions
What are the 3 main ligaments of the temporomandibular joint?
Temporomandibular/lateral
Stylomandibular
Sphenomandibular
How is the range of movement of the temporomandibular joint defined?
Pain
What are 3 key clinical issues from the temporomandibular joint?
TMJ dysfunction, from over tightening of jaw
Abscess/infection
Trismus (limited ROM)
What are the 2 pairs of muscles of mastication?
2 superficial: masseter + temporalis
2 deep: medial + lateral pterygoid muscles
What cranial nerve are the muscles of mastication supplied by?
Motor branches of V3
What does the temporalis muscle do?
Elevator + retractor of mandible
To what is the temporalis muscle attached?
Lateral aspect of skull
Coronoid process of mandible
What does the masseter muscle do?
Powerful elevator of mandible
To what is the temporalis muscle attached?
Zygomatic arch
Lateral aspect of mandibular ramus
What does the lateral pterygoid muscle do?
Protrudes mandible
What does the medial pterygoid muscle do?
Powerful elevator of mandible
Which muscles are used to depress the mandible?
Suprahyoid + infrahyoid muscles
How do the suprahyoid + infrahyoid muscles depress the mandible?
Contract together
Hyoid bone is stabilised
Suprahyoids pull down on mandible
Lateral pterygoids protrude mandible
What are 3 other muscles involved in mastication that don’t act on the temporomandibular joint?
Buccinator (pushes cheeks out)
Orbicularis oris (keeps lips closed)
Tongue muscles
What do teeth do?
Grind food into cohesive bolus
What is the tooth position of the molars?
Upper molars overhang lower molars by half a tooth
What is the tooth position of the incisors?
Upper incisors project ~2mm in front of lower incisors, and overhang by ~2mm
What is lateral excursion?
When we chew, mandible moves side to side and molars brought into contact
For incision, what must the mandible be?
Depressed sufficiently to open mouth for size of object
Protrude enough to bring incisors into edge-to-edge bite when mandibe elevated
For mastication, what must the mandible be?
Depressed enough to get food between molars
Deviated laterally to bring molars into cuspal contact
What is the range of movement of the jaw?
Extreme ROM only when yawning
Mastication only near limited for large objects eg: apple
What is the range of movements of the jaw needed for speech?
No lateral excursion
opening ~2cm
Protrusion <1cm for lip support (bilabials)
Retraction <1cm (alveolar phonemes + fricatives)
What are 3 key clinical issues from the muscles of mastication?
Mandibulectomy / maxillectomy (part of jaw removed)
Abscess/infection
Neurological events
What % of all cancers is head and neck cancer? How is this changing?
3%
32% increase in incidence since 1990, projected to rise as HPV increases (but vaccines…)
What is the peak age for head and neck cancer?
70-74
Where can head and neck cancer occur?
Upper aerodigestive tract
Salivary glands
Skin
Thyroid
Sarcoma
What is the most common type of head and neck cancer?
Squamous cell carcinoma (SCC)
What are some factors affecting the risk of head and neck cancer?
Tobacco
Alcohol
HPV
… preventable by fruit + veg intake
How are head and neck cancers categorised?
T1-4 (size of tumour)
Nodes present (lymph)
Metastases (spread to other parts, eg lung)
What are signs/symptoms of head and neck cancer?
Enlarged nodes
Dysphonia
Dysphagia
Odynophagia
Non-healing ulcer
What are treatment options for head and neck cancer?
Surgical…
- Trans-oral robotic surgery (TORS)
- Trans-oral laser resection (TOLR)
Chemoradiotherapy (CRT)
Best supportive care to manage symptoms (if not treatable)
What can head and neck cancer impact on?
Speech
Voice
Swallowing
Breathing
Cosmesis
What is a laryngectomy?
Surgical voice box removal
What are 4 indications for someone to have a laryngectomy?
Advanced laryngeal/hypopharyngeal malignancies with invasion of thyroid/cricoid cartilage and extra laryngeal soft tissue
Failed response to primary radiotherapy or chemoradiotherapy
Extensive tumours of histologic entities not suitable for conservative treatment
Have no voice and have chronic aspiration due to palsy of CN IX / X / XI
What are the different types of laryngectomy?
Partial laryngectomy
Total laryngectomy
- primary
- salvage
What is normal anatomy pre-laryngesctomy?
Respiration/EDS shares larynx
Humidification occurs via nose
What is anatomy post-laryngesctomy?
2 distinct systems of respiration + digestion
Altered airway + swallow + communication
Stoma
Neopharynx
After laryngectomy, what are the 4 options for communication?
Oesophageal speech
Artificial larynx
Surgical voice restoration
AAC
What is an artification larynx?
Vibration device, buzz which articulators pick up on
What is tracheoesophageal voice prothesis (surgical voice restoration)?
Puncture and button over stoma
Valve
Redirects airflow
Vibrates for voice
What is oesophageal speech?
Technique to swallow + redirect air
When is AAC used after a laryngectomy?
If no language difficulties
What are the impacts of a laryngectomy on swallowing?
No aspiration risk
Use technique of pharyngeal constriction
Altered muscular contraction and pressure
If other mouth surgeries: pre-stage phase dysphagia
Tissue reconstruction
Radiotherapy
What are the impacts of a laryngectomy on breathing?
Neck breathing
Loss of filtering, warming, humidifying air
Artification humidification (constant filter placed on baseplate, in pic)
