Head & Neck II: Nasal & Oral Cavities Flashcards
What are apart of the external nose?
Cartilage:
- Lateral Cartilage (2)
- Septal Cartilage
- Alar Cartilage (2) (means wings - paired)
Bones:
- Nasal Part of Frontal Bone
- Nasal Bones
- Frontal Process of Maxilla
When nose breaks what is it normally?
cartilage
What are the bones of the Nasal Cavity? Apart of the Medial Wall.
- Ethmoid Bone (cribriform plate)
- Sphenoid Bone
- Vomer
- Palatine Bone
- Maxilla
- Septal Cartilage
- Nasal Septum
- Nasal Bone
- Frontal Bone
What are the bones of the Nasal Cavity? Apart of the Lateral Wall.
- Ethmoid Bone
- Superior Nasal Concha (means seashell)
- Middle Nasal Concha
- Sphenoid Bone
- Palatine Bone
- Inferior Nasal Concha (independant bone)
- Maxilla
- Nasal Bone
- Frontal Bone
What overlies bone & cartilage of the nasal cavity?
Nasal mucosa
- produce mucous & help catch things (like dirt, allergens, dust, etc.)
What are the other nasal cavity passages for air to flow?
- Superior Nasal Meatus (below Superior Nasal Concha)
- Middle Nasal Meatus (below Middle Nasal Concha)
- Inferior Nasal Meatus (below Inferior Nasal Concha)
Nasal Atrium
Nasal Vestibule
Nare
What are the 2 areas of the nasal cavity & what are their functions?
- Respiratory Area: Inferior 2/3 of nasal mucosa
Function: warms & moistens air
- Olfactory Area: Superior 1/3 of nasal mucosa
Function: smell
Arterial blood supply for the nasal cavity derives from the:
i. External carotid artery – maxillary a.
ii. Internal carotid artery – ophthalmic a.
What is the Kisselbach’s Area?
- Site of anastomosis on the ANTEROINFERIOR part of the NASAL SEPTUM
- Common site for origin of EPISTAXIS (nosebleeds)
- b/c v. vascularized
What are the 2 general sensory innerventions?
- Ophthalmic Branch of Trigeminal Nerve (CN V1) (anterosuperior part of lateral wall & nasal septum)
- Maxillary Branch of Trigeminal Nerve (CN V2) (posteroinferior lateral wall & nasal septum)
Which is the special sensory innervation?
Olfaction
Function:
Mediates sense of smell
Location of OLFACTORY MUCOSA (the rest is respiratory)
Receptors in OLFACTORY EPITHELIUM –> OLFACTORY NERVES (pass through cribriform plate) –> Synapse on OLFACTORY BULB –> axons of olfactory bulb from OLFACTORY TRACT (conveys impulses to brain)
How does the Olfaction (special sensory innervation) work?
- Olfactory Nerves
- Synapse at Olfactory Bulb
- Olfactory Tract - take info back to brain
Paranasal Sinuses:
Air-filled extensions of the respiratory part of the nasal cavity
- also lined with mucosa
Paired:
- Frontal
- Ethmoid
- Sphenoid
- Maxillary - largest
Which Paranasal Sinus is the largest?
Maxillary
What are the functions of the Paranasal Sinuses?
- Voice resonation (how voice gets projected in & goes out
- Warm and humidify air
- Decrease skull weight
Which are the Frontal Sinuses? What is the drainage?
- Opening of frontonasal duct
- Semilunar hiatus
Drainage:
FRONTONASAL DUCT –> SEMILUNAR HIATUS (in MIDDLE MEATUS)
Which are the Ethmoidal Sinuses? What is the drainage?
Drainage:
Anterior –> SEMILUNAR HIATUS (in MIDDLE MEATUS)
Middle –> form ETHMOID BULLA –> middle meatus
Posterior –> SUPERIOR MEATUS
Which are the Sphenoidal Sinuses? What is the drainage?
Drainage: Spheno-ethmoidal recess
(most posterior)
Which are the Maxillary Sinuses? What is the drainage?
- Roof of maxillary sinus is floor of orbit
- Floor is alveolar part of maxilla
Drainage:
MAXILLARY OSTIUM –> SEMILUNAR HIATUS (in middle meatus)
What is the Nasolacrimal duct drainage?
Drainage:
LACRIMAL GLAND –> tears –> NASOLACRIMAL DUCT –> inferior meatus
What is the drainage site of the Frontal sinus?
semilunar hiatus (middle meatus)
What is the drainage site of the Arterior Ethmoid Cells sinus?
semilunar hiatus (middle meatus)
What is the drainage site of the Middle Ethmoid Cells sinus?
middle meatus
What is the drainage site of the Posterior ethmoid sinus?
superior meatus
What is the drainage site of the Sphenoid sinus?
spheno-ethmoidal recess
What is the drainage site of the Maxillary sinus?
semilunar hiatus (middle meatus)
What is the drainage site of the Nasolacrimal duct?
Inferior meatus
What is Sinusitis?
Infection/inflammation of PARANASAL SINUSES
MAXILLARY SINUS is most commonly infected due to the superior location of the MAXILLARY OSTIUM
- & drains the least
What are the symptoms & treatment of Sinusitis?
Symptoms:
- Facial pain
- Headache
- Toothache
- Fever
- Nasal congestion
Treatment:
- NSAIDs
- Saline nasal spray
- Neti pots
What are the 4 parts of the Oral Cavity?
- Oral vestibule
- Oral cavity proper
- Roof
- Tongue
Oral vestibule:
space between the cheeks & dental arches
Oral cavity proper:
space posterior & medial to the upper & lower dental arches
- area behind teeth
Roof (of oral cavity):
is formed by the palate & communicates posteriorly with the oropharynx
The ____ fully occupies the oral cavity when the mouth is closed & at rest
tongue
Describe teeth
Set in the dental alveoli (tooth sockets) & used in MASTICATION & ARTICULATION
3 parts:
- Crown
- Neck
- Root
4 types:
- Molar
- Premolar
- Canine
- Incisor
How many teeth do children have?
Children have 20 DECIDUOUS (primary) teeth & 1st tooth usually erupts at 6-8 months of age & the last by 20-24 months of age
How many teeth do adults have?
Adults have 32 PERMANENT (secondary) teeth, which begin to erupt at 6-7 years of age
Describe the 3rd molars
3rd molars “WISDOM TEETH” are the last to erupt, usually entering by the late teens or early twenties
What is the teeth neurovasculature?
SUPERIOR Alveolar N
Sensory Trigeminal nerve Maxillary branch (CN V2)
INFERIOR Alveolar N
Sensory Trigeminal nerve Mandibular branch (CN V3)
SUPERIOR & INFERIOR Alveolar A (from Maxillary A)
(alveolar - refers to teeth)
Describe the hard palate
Anterior 2/3 of the palate that functions as roof of the oral cavity & floor of the nasal cavity
Includes:
- Palatine Process of Maxillae
- Horizontal Plates of the Palatine Bone
Describe the soft palate
Moveable posterior 1/3 of the palate
- b/c made out of various muscles & CT
Formed by the PALATINE APONEUROSIS &
MUSCLES; it is covered by mucosa
Extends postero-inferiorly as a curved free margin from which the UVULA hangs
Describe the palate neurovasculature
- GREATER PALATINE & LESSER PALATINE A (from Maxillary A)
- Sensory nerve fibers from the palate are branches of Trigeminal nerve Maxillary division (CN V2)
What is the tongues job?
Mobile muscular organ that is mainly composed of muscles & covered by mucosa
Assists in mastication, taste, deglutition, articulation, & oral cleansing
Describe the 3 parts of the tongue
ROOT of the tongue: posterior 1/3 that rests on the floor of the mouth
BODY of the tongue: anterior 2/3 of the tongue
APEX: pointed anterior part of the body
What are taste buds?
Lingual Papillae: give the anterior tongue a rough appearance; there are 4 types
- Vallate papillae
- Fungiform papillae
- Foliate papillae
- Filiform papillae
Vallate papillae:
contain taste buds
Fungiform papillae:
mushroom-shaped, contain taste buds
Foliate papillae:
contain taste buds
Filiform papillae:
sensitive to touch
(NO taste buds!)
What are the muscles of the tongue?
Extrinsic muscles ALTER THE POSITION of the tongue
- move it side to side for ex
*All lingual muscles are innervated by the HYPOGLOASSAL N (CN XII) except the PALATOGLOSSUS MUSCLE (CN X)
* Pulls tongue posteriorly and superiorly
What are the 3 lingual (tongue) muscles innervated by the Hypoglossal N (CN XII)?
Styloglossus
- Retracts the tongue
Hyoglossus
- Depresses the tongue
Genioglosus
* Bilaterally depresses tongue & unilaterally deviates tongue to contralateral side
* Pulls tongue anteriorly for PROTRUSION & retracts apex of protruded tongue (only 1 that does this)
What are the Intrinsic muscles of the tongue?
Superior Longitudinal, Transverse, & Vertical M.
- Intrinsic muscles CHANGE THE SHAPE of the tongue
- All intrinsic muscles are innervated by the HYPOGLOSSAL N (CN XII)
Describe Paralysis of Genioglossus
When the genioglossus (only 1 that protrudes the tongue) is paralyzed, the tongue mass has a tendency to SHIFT POSTERIORLY, obstructing the airway & presenting the risk of suffocation.
Total relaxation of the genioglossus muscles occurs during GENERAL ANESTHESIA; therefore, the tongue of an anesthetized patient must be prevented from relapsing by INSERTING AN AIRWAY.
Describe the innervation of tongue
- Lingual and Chorda Tympani
- CN IX
- Hypoglossal nerve (CN XII)
- Motor innervation to tongue
- Tongue just anterior to the epiglogs
- General sensation & taste: VAGUS N (CN X)
- except the pallosis
- Posterior 1/3 of the tongue
- General sensation & taste: GLOSSOPHARYNGEAL N (CN IX)
- Anterior 2/3 of the tongue
- General sensation: LINGUAL N (CN V3)
- Taste: CHORDA TYMPANI N (br. of CN VII)
Describe the vasculature of tongue
Supplied by the LINGUAL A, which passes DEEP TO THE HYPOGLOSSUS MUSCLE
LINGUAL VEINS drain the tongue into the internal jugular vein
(medication given under the tongue gets absorbed)
Salivary Gland: Parotid
Secretes SALIVA through the PAROTID DUCT into the oral cavity near the second maxillary molar tooth
Innerva3on:
PARASYMPATHETIC fibers (INCREASE SECRETION) travel from GLOSSOPHARYNGEAL NERVE CN IX
SYMPATHETIC FIBERS (DECREASE SECRETIONS) travel from T1-2 SYMPATHETIC CHAIN
Salivary Gland: Submandibular
Secretes SALIVA through the SUBMANDIBULAR DUCT into the oral cavity under the tongue
Innervation:
PARASYMPATHETIC (INCREASE SECRETIONS) fibers travel via CHORDA TYMPANI (FACIAL NERVE CN VII)
SYPATHETIC FIBERS (DECREASE SECRETIONS) travel from T1-2 SYMPATHETIC CHAIN
Salivary Gland: Sublingual
Secretes SALIVA through many SUBLINGUAL DUCTS into the oral cavity under the tongue
Innervation:
PARASYMPATHETIC (INCREASE SECRETIONS) fibers travel via CHORDA TYMPANI (FACIAL NERVE CN VII)
SYMPATHETIC FIBERS (DECREASE SECRETIONS) travel from T1-2 SYMPATHETIC CHAIN
(exactly like submandible)
What are the 3 parts of the Pharynx?
- Nasopharynx C1
- Oropharynx
- Laryngopharynx
What are the main functions of the Pharynx?
respiration, deglutition (swallowing), protection against foreign bodies, and pressure equalization
What are the Pharynx’s main parts?
- Pharyngotympanic (Eustachian) Tube Opening
*(tubal tonsils can be located pharyngotympanic tube) - Palatoglossal fold
- Pharyngeal tonsils
- Palatine tonsil (in tonsillar sinus)
- Palatopharyngeal fold
When can tonsils be removed?
if too many infections or snoring
What are the 3 Stages of Deglutition?
Stage 1 (voluntary):
* Bolus is pressed against the palate
* Muscles of the SOFT PALATE AND TONGUE push food into the oropharynx
Stage 2 (involuntary):
* SOFT PALATE ELEVATES to seal the nasopharynx from the oropharynx
* Pharynx widens and shortens
* LONGITUDINAL PHARYNGEAL AND SUPRAHYOID MUSCLES elevate the larynx
Stage 3 (involuntary):
* All three PHARYNGEAL CONSTRICTORS forces the food bolus into the esophagus.
What isn’t working properly when food goes down wrong tube while talking/laughing etc.?
soft palate (doesn’t elevate to seal the nasopharynx from the oropharynx)
What are the Pharyngeal Constrictor Muscles?
- Involuntary
- Constrict wall of pharynx during swallowing
- Same innervation: PHARYNGEAL BRANCH OF CN X
- 3 external circular muscles
What are the 3 external circular muscles of the Pharyngeal?
- Superior pharyngeal constrictor
- Middle pharyngeal constrictor
- Inferior pharyngeal constrictor
What are the Internal Longitudinal Muscles of the Pharynx’s function & muscles?
Function: elevate and shorten the pharynx and larynx during swallowing and speaking
3 muscles:
– Palatopharyngeus
(CN X)
– Salpingopharyngeus (CN X)
– Stylopharyngeus (CN IX)
Pharyngeal branches of Vagus n. (CN X)
*MOTOR to most pharyngeal muscles EXCECPT _______
stylopharyngeus
Glossopharyngeal n. (CN IX)
*MOTOR to ______
*SENSORY to all _____
stylopharyngeus
pharyngeal mucosa
What is the Gag Reflex?
- Irritation of pharyngeal mucosa
- Glossopharyngeal n. (CN IX) is the Afferent signal to the BRAIN (MEDULLA)
- Vagus n. (CN X) is the Efferent signal to the PHARYNGEAL MUSCLES
- Gag/vomit reflex
