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Anatomy - Head, neck and spine > Biting, chewing and swallowing - oral cavity > Flashcards

Biting, chewing and swallowing - oral cavity Flashcards

1
Q

Name two fold of tissue which contain the palatine tonsil between them

A

palatopharyngeal fold

palatoglossal fold

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2
Q

How can damage to the back of the pharynx spread infection?

A

Can spread infection into the thoracic cavity

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3
Q

What are the 2 types of palates in the mouth

A

Hard and soft

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4
Q

Which palate is the uvula part of?

A

soft

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5
Q

What does deviation of the uvula suggest?

A

dysfunction of the vagus on the opposite side

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6
Q

Where does the oesophagus open in relation to the airway?

A

posterior to the airway

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7
Q

What happens during swallowing to prevent food going down the trachea?

A

The larynx is raised and the epiglottis retroflects to cover the airway.

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8
Q

What is the use of the hard palate?

A

The hard palate is bone – this is useful in mastication. When you chew food, pushing it against the hard palate helps to break it down before swallowing

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9
Q

What is the importance of the piriform fossa in the laryngopharynx?

A

Food can get caught here (particularly fish bones).

This area has a very sensitive innervation so this is very painful. You sometimes have to use forceps to try and extract fish bones.

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10
Q

What are the constrictor muscles of the larynx and their innervation?

A

Within the pharynx are the superior, middle and inferior constrictor muscles
They allow pushing of food downwards into the GI tract – sequential contraction
Sensory IX, X supply to the pharyngeal plexus
Motor activity is largely due to X innervation (XI as well)

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11
Q

What is the process of swallowing?

A
  • Lift and retract the tongue (controlled by the styloglossus and intrinsic)
  • Bolus is moved into the oropharynx (contraction of palatoglossus)
  • Elevate the soft palate (levator muscles) – this closes off the nasopharynx (stops food going into nose)
  • Raise the larynx, to close off the epiglottis – stops food going into the airway
  • Peristaltic wave of constrictor muscles (superior, middle and inferior constrictors) – moves bolus down
  • Relax cricopharyngeus (UOS) -> this opens the oesophagus to allow passage for food
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12
Q

How many pairs of salivary glands are there and what are they?

A

3 - parotid, submandibular, sublingual

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13
Q

What kind of saliva does each salivary gland produce?

A

parotid - thin, serous
submandibular - serous
sublingual - mucous

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14
Q

Where do each of the salivary glands get input from?

A

Parotid - cranial nerve 9

Submandibular - cranial nerve 7

Sublingual - cranial nerve 7

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15
Q

How does saliva pass from the parotid gland to the mouth and where?

A

Via the parotid duct and opens next to the second upper molar

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16
Q

What are the muscles of the tongue?

A

Styloglossus - helps retract tongue

Hyoglossus

Genioglossus - from tongue to mandible, contraction helps prortrude tongue

Intrinsic muscles

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17
Q

Which is the only motor nerve supplying the tongue?

A

The hypoglossal

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18
Q

How can you test for the hypoglossal nerve?

A

The genioglossus contracts on either side and if there is deviation of one side of the tongue it means that the same side of hypoglossal is affected

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19
Q

What does the lingual nerve (branch of v3 - trigeminal mandibular branch) do?

A

Has mixed cranial components and supplies the tongue with touch sensation and taste perception
Trigeminal and facial fibres (chorda tympani ) are all together in the lingual nerve (multifunctional nerve)

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20
Q

Which nerve provides sensation to the anterior two third of the tongue?

A

V3 - trigeminal

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21
Q

Which nerve supplies the taste fibres to the anterior two thirds of the tongue?

A

facial nerve - chorda tympani

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22
Q

Where is taste perception processed?

A

The nucleus solitaries in the brainstem

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23
Q

Which nerve provides sensation and taste to the posterior third of the tongue?

A

glossopharyngeal - little also from the vagus

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24
Q

What are the muscles of mastication (superficial) and their locations?

A

Masseter - from the zygomatic arch to lateral surface of ramus and angle of mandible (side and the corner)

Temporalis - from temporal fossa to coronoid process of mandible

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25
Q

What are the muscles of mastication (deep) and their locations?

A

Lateral pterygoid - connects from sphenoid/lateral pterygoid plate to neck of mandible

Medial pterygoid - lateral pterygoid plate/maxilla/palate to angle of mandible

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26
Q

Name another muscle of mastication and its location

A

Buccinator - between maxilla and mandible

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27
Q

What is the temporal fossa?

A

shallow depression on the side of the skull

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28
Q

What is the zygomatic arch?

A

cheek bone

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29
Q

What innervates the superficial muscles of mastication?

A

mandibular division of the trigeminal

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30
Q

What innervates the deep muscles of mastication?

A

mandibular division of the trigeminal

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31
Q

What innervates the buccinator muscle?

A

Facial nerve - bucal branch

32
Q

What does masseter do?

A

Elevates the mandible and allows forced closure of mouth

33
Q

What does the temporalis do?

A

Elevates and retracts the mandible

34
Q

What does lateral pterygoid do?

A

Depresses and protracts mandible to the open mouth

35
Q

What does medial pterygoid do?

A

Elevates, protracts and allows lateral movement of mandible for chewing

36
Q

What does buccinator do?

A

Contraction pushes food into the middle of the mouth and aids chewing

37
Q

What does the parotid duct pierce to open into the buccal cavity?

A

buccinator muscle

38
Q

Describe the temporomandibular joint

A

The mandibular fossa of the temporal bone articulates with the head of the mandible
There is an articular disc and the joint capsule between

39
Q

What is the condyloid process?

A

made of condyle and neck

40
Q

What are the 2 actions of the TMJ?

A
  1. WHEN YOU OPEN THE JAW SLIGHTLY, you get a hinge action in the capsular joint between the articular disc and the head of the mandible
  2. WHEN YOU OPEN THE JAW WIDELY, you get a gliding movement up onto the articular tubercle. The capsular joint moves forward slightly.
41
Q

What kind of a joint if TMJ?

A

synovial

42
Q

How can jaw dislocation be treated?

A

The thumbs must be used to push down and back at the molars at the bottom. Patients may bite as reflex

43
Q

What are the 8 branches of the external carotid supplying the face?

A
  • Superior thyroid arteries
  • Ascending pharyngeal arteries
  • Lingual arteries – go to the tongue
  • Facial artery
  • Occipital artery
  • Posterior auricular artery – goes behind the ear
  • Maxillary artery
  • Superficial temporal artery – seen pulsing in the forehead of people when they get upset
44
Q

Where do the carotid arteries emerge and split?

A

Right common carotid originates in the neck from the brachiocephalic trunk; the left from the aortic arch in the thorax.

Split into external and internal carotid arteries at the upper border of the thyroid cartilage (C4)

45
Q

What do internal and external carotids do?

A

External carotid artery brings blood to structures outside the skull (face), and the internal carotid to structures inside the skull, including the brain

46
Q

Describe the pathway of the facial artery and the importance of this

A

Passes round the inferior border of the mandible, before going up to medial canthus (corner) of the eye. This artery has a loop– this allows movement of the facial artery as it goes around the mandible. If it was tight around the mandible it would be ruptured every time you open your mouth

47
Q

Where does the facial nerve emerge from the cranial cavity?
Where does it emerge from at the base of the skull?
What does it pass underneath and where do the 5 branches emerge?

A
  • Internal acoustic meatus
  • The facial nerve passes through the skull (via IAM) and emerges from the stylomastoid foramen at the base of the skull
  • The parotid
  • From the anterior border of the parotid.
48
Q

What kind of nerve is the trigeminal and the mandibular division?

A
  • The trigeminal nerve is sensory
  • It has 3 divisions (3 dermatomes)
  • The mandibular div. has motor activity
49
Q

What are the 3 branches of the mandibular division of the trigeminal nerve and what do they do?

A
  • Inferior alveolar: this is the inferior dental nerve. It comes down and passes into the back of the mandible. Sensory nerve that mediates toothache.
  • Mental nerve: the inferior branch of the inferior alveolar nerve.
  • Lingual nerve: anterior 2/3 of tongue sensation is by V3.
50
Q

How can the 3 branches of the trigeminal be tested for?

A

By testing sensation in the chin -
V1: forehead
V2: cheek
V3: side of face, chin

51
Q

Where does the lingual nerve recieve fibres from?

A

the facial nerve - a small branch called the chorda tympani

52
Q

Where does the chorda tympani emerge and what is its pathway?

A
  • Emerges in the temporal bone and branches off the main facial nerve
  • This branch comes through anteriorly, through the petrotympanic fissure and joins the lingual nerve
  • Information flow is bidirectional – fibres are the parasympathetic outflow to the submandibular ganglion
  • From the submandibular ganglion, post-ganglionic fibres innervate submandibular and sublingual glands
53
Q

What do the different branches of the trigeminal supply sensation to?

A

Ophthalmic division:
Supplies skin from the top of the head to the upper eyelids, and a strip down the median line of the nose. Supplies the very sensitive conjunctiva that covers the inner surfaces of the eyelids, the sclera and is continuous with the corneal epithelium. It also supplies much of the nasal mucosa and the frontal sinus.

The maxillary division:
Supplies the skin of the anterior temple and the middle part of the face as far down as the corners of the mouth. In addition it supplies the upper teeth, lip, gums and the roof of the mouth.

Mandibular division:
Supplies a strip of skin running from the middle part of the temple then anterior to the ear and down to the chin. In addition it supplies the lower teeth, gums and lip, the lining of the cheeks, the floor of the mouth and the anterior two-thirds of the tongue.

54
Q

How would the motor component of the facial nerve be tested?

A

Ask patient to look up at the ceiling (look for creasing of the forehead as frontalis contracts), keep eyes closed against resistance (orbicularis oculis) and bare their teeth (risorius)

55
Q

How is the glossopharyngeal nerve tested for?

A

Stimulation of it by a tongue depressor placed too far back causes the reflex expulsive effort called “gagging

56
Q

Why is it so easy to feel masseter compared to temporalis?

A

The massater muscle is very superficial. The temporalis is covered by the temporalis fascia so it is harder to feel.

57
Q

What is the importance of the facial nerve?

A

The main motor nerve supplying the muscles of facial expression

58
Q

What is the full number of each teeth in a permanant set?

A

32 – 8 incisors, 4 canines, 8 premolars and 12 molars

59
Q

How does a permanent set of teeth differ from a complete deciduous set?

A

A complete deciduous set has 8 incisors, 4 canines, 4 premolars and 4 molars (20 teeth in total)

60
Q

What is the maxillary artery?

A
  • One of the terminal branches of the external carotid
  • The middle meningeal artery is a branch of the maxillary
  • It goes up to supply the meninges supplying the brain
61
Q

How would the motor function of the mandibular division be tested?

A

Palpate masseter as teeth are clenched

62
Q

How can the olfactory nerve be tested?

A

With the patient’s eyes closed present them with olfactory stimuli to see if they can identify the smell

63
Q

What will loss of taste tell us?

A

Loss of taste over the anterior 2/3 of the tongue indicates a facial nerve deficit whereas taste deficit over the posterior 1/3 indicates a glossopharyngealdeficit.

64
Q

What are the phases of swallowing?

A
  • oral preparatory
  • oral transit
  • pharyngeal 1
  • pharyngeal 2
  • oesophageal
65
Q

What happens in the different phases of swallowing?

A
  1. Food / liquid chewed & formed into a bolus. Bolus held on centre of tongue. Lip, jaw, tongue & palate sensory & motor function needed. V, VII, IX, X, XII VOLUNTARY
  2. Bolus propelled to back of mouth, palate seals entrance to nasal cavity. Lip, jaw, tongue & palate, sensory & motor function needed
    V, VII, IX, X, XII
    VOLUNTARY, AIRWAY OPEN
  3. Triggered when bolus reaches facial arch, palate stays elevated, tongue retracts, to push bolus to pharynx. Tongue, palate & laryngeal sensory & motor function needed, REFLEX, IX, X, XII,
    AIRWAY CLOSED
  4. Bolus propelled through pharynx, tongue, palate & laryngeal sensory & motor function needed
    REFLEX
    IX, X, XII,
    AIRWAY CLOSED by epiglottis, vocal cords & arytenoid action
  5. Oesophagus opens, airway closed, breath held, Bolus propelled through oesophagus, REFLEX
    IX, X,
    Respiration then resumes with an exhalation, to clear any food particles from airway entrance
66
Q

What are the features of normal swallowing?

A
  • Barium transit through mouth takes 1 second
  • Pharyngeal transit takes 1-2 seconds
  • No residue in mouth or the pharynx
  • No spillage from the lips or into the airway
  • Vocal cords adduct to produce voice &; to close airway
  • Saliva is cleared in a single swallow & does not accumulate
  • Water swallowed in < 1 second
  • No residue in pharynx or in trachea
67
Q

How is swallowing impaired in Parkinson’s disease?

A
  • Difficulty initiating swallowing
  • Typical repetitive tongue movements
  • Linked with muscle rigidity, unable to lower the back of the tongue
  • Improve by active range of motion exercises of lips and tongue
68
Q

How is swallowing impaired in excised acoustic neuroma (lower motor neurone disease)?

A
  • Ipsilateral paresis of the pharynx, larynx, tongue
  • Weak bolus propulsion -> pharyngeal & oral residue
  • Failed airway closure
  • To improve: head rotation to direct bolus down strong side of pharynx & ­increase airway closure. Also exercises to ­increase tongue & laryngeal muscle strength for 9 months
69
Q

How is swallowing impaired from a cerebellar haematoma (ataxic - lack of coordination of muscle)?

A
  • Uncoordinated tongue retraction to propel food
  • Delayed airway closure -> food enters airway
  • Delayed & ineffective cough to clear airway - food aspirated to lungs
  • To improve flex neck during swallowing to prevent aspiration. Also exercises to improve swallow speed & strength
70
Q

How is swallowing impaired from severe head injuries?

A
  • Myoclonus from anoxia / brainstem involvement
  • Spastic ++ pharynx and tongue -> reduced movement
  • Infrequent swallow 1 per 17 mins [Norm = 2 per 3mins]
  • Ineffective / weak swallow-> residue in pharynx
  • Ineffective cough -> unable to clear saliva from airway
  • Treatment: long term nil by mouth & tracheostomy
71
Q

Where is swallowing regulated?

A

at cortical & brainstem level

72
Q

Can impairments to swallowing be chronic or short term?

A

yes

73
Q

Which systems are involved in swallowing?

A

oral, pharyngeal, laryngeal & oesophageal components

74
Q

What is the pathway for sneezing?

A

afferent - trigeminal

efferent - phrenic, vagus etc…

75
Q

What is the pathway for gagging?

A

afferent - glossopharyngeal

efferent - vagus to constrictor muscles of larynx

76
Q

What are the five branches of the facial nerve?

A 
Temporal
Zygomatic
Buccal
(Marginal) Mandibular
Cervical

Anatomy - Head, neck and spine (6 decks)

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