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HNNS > HNS29 Oral Cavity, Submandibular And Sublingual Glands > Flashcards

HNS29 Oral Cavity, Submandibular And Sublingual Glands Flashcards

1
Q

Oral cavity bony framework

A
  1. Maxilla
  2. Palatine bone (hard palate)
  3. Mandible

Maxilla, Mandible: with alveolar process for teeth attachment

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2
Q

Oral cavity boundaries

A
  1. Roof:
    - Hard palate (soft palate is in pharynx)
  2. Floor:
    - Mylohyoid muscle (attach between mandible and hyoid)
  3. Side walls:
    - Buccinator muscle (CN7)
    —> superior attachment: Maxilla (alveolar process)
    —> **Pterygomaxillary ligament (extend from **Maxillary tuberosity to **Hamulus of medial pterygoid plate)
    —> extend downward
    —> **    Pterygomandibular raphe (interdigitate with superior constrictor of pharynx, behind 3rd molar of mandible)
    —> **links Pterygoid process to Mandible
    —> insert into superior to posterior end of **    Mylohyoid line
    —> muscle continue to form **External oblique line of Mandible (up to 1st lower molar)
    —> anterior fuse with **    Orbicularis oris muscle
  4. Anterior:
    - Oral fissure
  5. Posterior:
    - Oropharynx
    - separated from oropharynx by Anterior pillar of fauces (Palatoglossal arch)

Oropharyngeal fauces: bounded by Anterior pillar + Posterior pillar (Palatopharyngeal arch)

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3
Q

Oral cavity division

A
  1. Oral cavity proper
    - space medial / posterior to teeth
  2. Vestibule
    - space between teeth/gum and cheek
    - parotid duct opening is next to second upper molar each side
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4
Q

Sensory supply of oral cavity

A

CNV2

  • Roof (Hard palate): Greater palatine nerve (posterior) + Nasopalatine nerve (anterior)
  • Upper teeth: Superior alveolar nerve

CNV3

  • Floor: Lingual nerve
  • Cheek: Buccal nerve
  • Lower teeth, chin: Inferior alveolar nerve

(Oropharynx: Pharyngeal plexus (CN9,10))

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5
Q

Hard palate bone components

A
  1. Maxilla (anterior)
    - palatal processes
  2. Palatine bone (posterior)
    - horizontal plates

Fissure in between: Palatomaxillary suture

  1. Premaxilla
    - fuse with hard palate during development —> problem with fusing —> cleft palate —> but cleft palate rarely separates premaxilla into 2 halves at the middle (usually right / left side)
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6
Q

Hard palate foramen

A
  1. Incisive foramen
    - communication between nasal region and oral region
    - **Nasopalatine nerve (from nasal cavity to oral cavity)
    - **    Greater palatine artery (from oral cavity into nasal cavity —> anastomoses with Sphenopalatine artery)
  2. Greater palatine foramen
    - between palatine and maxilla on hard palate
    - Greater palatine artery
    - Anterior palatine nerve (    Greater palatine nerve)
  3. Lesser palatine foramen
    - perforate palatine bone
    - Middle + Posterior palatine nerve (soft palate) (***Lesser palatine nerve)
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7
Q

Hard palate blood supply

A

Greater palatine artery:

Greater palatine artery (branch of Maxillary artery)
—> Greater palatine canal (with Anterior palatine nerve)
—> Greater palatine foramen
—> passes around hard palate
—> Incisive foramen
—> Nasal cavity (anastomoses with Sphenopalatine artery)

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8
Q

Hard palate nerve supply

A
  1. Anterior palatine nerve (from CNV2 —> Pterygopalatine ganglion)
    - from Greater palatine foramen up to Incisive foramen
  2. Nasopalatine nerve (from CNV2 —> Pterygopalatine ganglion)
    - crosses nasal roof —> descend on nasal septum —> through Incisive foramen —> supply hard palate anterior to incisive foramen
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9
Q

***Soft palate

A

Aponeurosis (of tensor veli palatini) acted upon by 5 pairs of muscles

  1. Tensor veli palatini (CNV3)
  2. Levator veli palatini
  3. Palatopharyngeus muscle
  4. Palatoglossus muscle
  5. Muscular uvulae
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10
Q
  1. Tensor veli palatini (CNV3)
A

Origin:
- arise from basicranium and **lateral part of Cartilaginous part of Eustachian tube (outside of pharynx)
—> fibres converge towards base of pterygoid hamulus
—> flat tendon
—> **hooks around hamulus
—> go inside pharynx
—> becomes aponeurosis

Actions (拉開Eustachian tube):

  1. ***Tenses up aponeurosis —> so other muscles can act on it
  2. ***Pulls open cartilaginous part of Eustachian tube

Nerve supply:
- CNV3 (via nerve to medial pterygoid)

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11
Q
  1. Levator veli palatini (V shape)
A

Origin:
- inside Pharyngobasilar fascia
- from quadrate area on petrous part of temporal bone
- from **medial part of Cartilaginous part of Eustachian tube
—> round belly runs towards, medially, downwards (V-shaped sling)
—> insert onto **nasal (upper) surface of Palatine aponeurosis

Actions (扯起soft palate):
- Pull soft palate backwards + upwards
—> ***shutting nasopharynx from oropharynx (during swallowing)

Nerve supply:
- Pharyngeal plexus (CN10)

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12
Q
  1. Palatopharyngeus muscle (Inverted V)
A

Origin:
- 2 heads
- from horizontal plate of palatine bone
- from **back of Palatine aponeurosis
—> arches over lateral margin of Palatine aponeurosis
—> form **Posterior pillar of fauces
—> insert into ***Posterior border of Thyroid cartilage and Cornua

Actions (扯起pharynx):

  1. ***Depresses soft palate
  2. ***Elevates larynx and pharynx

Nerve supply:
- Pharyngeal plexus (CN10)

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13
Q
  1. Palatoglossus muscle
A

Origin:
- arises from **undersurface of Palatine aponeurosis
—> passes down to interdigitate with **Styloglossus (lateral tongue muscle)
—> form ***Anterior pillar of fauces

Actions:

  1. Sphincter of oropharyngeal fauces
  2. ***Raises tongue

Nerve supply:
- Pharyngeal plexus (CN10)

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14
Q
  1. Muscular uvulae
A

Origin:
- arises from posterior nasal spine and palatine aponeurosis
—> insert into mucous membrane of uvula

Actions:

  1. Shape the uvula
  2. ***Pull up uvula ipsilateral side

Nerve supply:
- Pharyngeal plexus (CN10)

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15
Q

Tongue

A
  • Mass of muscle
  • Contain mucous + serous glands
  • Covered with mucous membrane

Divided into:

  1. Anterior 2/3: Oral cavity
  2. Posterior 1/3: Oropharynx
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16
Q

Anterior 2/3 tongue

A
  • Thick fibrous mucous membrane (***Rough)
  • Small projections: ***Papillae
    —> Filiform
    —> Fungiform
    —> Foliate
  • ***NO glands on dorsum (upper surface)
  • Prehencile (grabbing), for ***mastication
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17
Q

Posterior 1/3 tongue

A
  • in Oropharynx, NOT in mouth
  • bound by **Sulcus terminalis (後d) / **Vallate papillae (前d)
  • NO papilla posterior to Vallate papillae
  • Mucous membrane: Nodular appearance because of **mucous and serous glands + **Lingual tonsil (part of Waldeyer’s ring)
  • **Smooth, for **swallowing
  • ***Foramen caecum (just behind apex of Vallate papillae) —> remnant of thyroglossal duct (descend of thyroid gland)
18
Q

***4 Lingual papillae

A 
Anterior 2/3:
1. Filiform
- conical
- fur appearance
- ***no taste buds
(- somatosensory receptor: detect texture in food)
  1. Fungiform
    - mushroom-shaped
    - visible as red dots
    - taste buds
  2. Foliate
    - posterolateral border of tongue (側面)
    - serous glands
    - taste buds

Posterior 1/3:

  1. Vallate (雖然係anterior 度, 但係當posterior tongue, ∵ innervated by ***CN9)
    - V-shape
    - 8-12 in number
    - immediately in front of Foramen caecum and Sulcus terminalis
    - taste buds
19
Q

Tongue muscles

A

Midline septum divide tongue into halves

  • 4 Intrinsic
  • 4 Extrinsic
20
Q

Intrinsic tongue muscles

A
  • wholly within tongue
  • no attachment to bones
  • fibres in 3 planes perpendicular to each other
  1. Superior longitudinal fibres (前後)
  2. Inferior longitudinal fibres (前後)
    - alongside Genioglossus
    - medial to Hyoglossus
  3. Transverse fibres (向左右延伸)
    - origin: Midline fibrous septum
    - insertion: 2 Sides of tongue
  4. Vertical fibres (向下延伸)
    - origin: Mucous membrane of dorsum
    - insertion: 2 Sides of Lower part
21
Q

Extrinsic tongue muscles

A
  • ALL supplied by CN12 (except Palatoglossus (Pharyngeal plexus: CN10))
  1. Genioglossus (Genio: chin)
    - front: to mandible
  2. Hyoglossus
    - down: to hyoid bone
  3. Styloglossus
    - back: to styloid process (temporal bone)
  4. Palatoglossus
    - up: to soft palate
22
Q
  1. Genioglossus
A
  • Fibres radiate widely
  • Lateral to midline septum

Origin:
- ***Superior genial tubercle (Mandible)

Insertion:
- ***Mucous membrane (薄膜) of dorsum (upper surface) of tongue, lowest fibres go to hyoid (=/ geniohyoid muscle)

Nerve supply:
- CN12

23
Q
  1. Hyoglossus
A
  • Lateral to Genioglossus

Origin:
- body and length of greater horn of **Hyoid bone
—> extends as quadrilateral sheet on side of tongue
—> insert into **side of tongue (interdigitate with ***Styloglossus)

Nerve supply:
- CN12

24
Q
  1. Palatoglossus
A

Origin:
- arises from **undersurface of palatine aponeurosis
—> passes down to interdigitate with **Styloglossus (lateral tongue muscle)
—> form ***Anterior pillar of fauces

Nerve supply:
- Pharyngeal plexus (CN10)

25
Q
  1. Styloglossus muscles
A
  • most lateral tongue muscle

Origin:
- from **styloid process (temporal bone) to **side of tongue

Nerve supply:
- CN12

26
Q

Movement of tongue

A

Function:
- sucking, prehension of food, chewing, swallowing, speaking, toileting, gestures

  • **Shape —> altered by Intrinsic muscles:
  • transverse: narrow tongue and heaps up dorsum into convexity
  • transverse + vertical: dorsum convexity flattened —> smaller cross-sectional area —> elongate
  • transverse + vertical + genioglossus (lowest fibres) —> protrude tongue
  • **Position —> altered by Extrinsic muscles:
  • Genioglossus: ***Protrude root of tongue (lower fibres)
  • Styloglossus: ***Retract + Elevate tongue
  • Hyoglossus: Draw the side ***downwards
  • Palatoglossus: ***Elevate tongue

Mylohyoid: elevate floor of mouth —> elevate tongue

27
Q

Tongue and Uvula lesion

A

Right CN12 lesion
—> Right genioglossus affected
—> Unopposed left side protrusion
—> Tongue protrude to right side

Right CN10 lesion
—> Right Muscular uvulae affected
—> Unopposed left side contraction
—> Uvula deviate to left side

28
Q

Frenulum of tongue (脷根)

A

Mucous membrane fold extending from floor of mouth
—> midline of inferior tongue

Either side:
Opening of Submandibular and Sublingual gland

29
Q

Tongue and swallowing

A 
Food is masticated
—> forming bolus
—> conscious decision to swallow
—> tongue push bolus backwards into oropharynx
—> trigger swallowing reflex
  1. Soft palate raised (Levator veli palatini) —> temporarily close off nasopharynx from oropharynx
  2. Pharyngeal muscles constrict in sequence —> pushing bolus into esophagus
  3. Larynx elevates —> epiglottis close off larynx
  4. Esophageal muscles drive bolus down by peristalsis
30
Q

Blood supply of tongue

A

Artery:

  1. Lingual artery
    - branch from anterior branch of ***External carotid artery
    - passes deep to Hyoglossus towards tongue tip

Venous drainage:

  1. Deep lingual veins (Ranine veins): undersurface of tongue —> Common facial vein —> Internal jugular vein
  2. Lingual veins —> Internal jugular vein
31
Q

Sensory innervation of tongue

A

Anterior 2/3

  • general sensory: Lingual nerve (CNV3)
  • special sensory: Chorda tympani (CN7) (via Lingual nerve)
  • secretomotor (parasympathetic): Chorda tympani (CN7) (via Lingual nerve)

Posterior 1/3
- general sensory, special sensory, secretomotor (parasympathetic): CN9

32
Q

Floor of mouth

A
  1. Mylohyoid muscle (最底層)
  2. Geniohyoid muscle
  3. Hyoid bone
33
Q
  1. Mylohyoid muscle
A

Origin:
- ***Mylohyoid line (Mandible)

Insertion:

  • Midline raphe
  • ***Hyoid bone (posterior fibres)

Nerve supply:
- ***CNV3

34
Q
  1. Geniohyoid muscle
A
  • Above Mylohyoid
  • Below Genioglossus
  • Important for positioning of hyoid bone —> positioning of larynx

Origin:
- ***Inferior genial tubercle (Mandible) (Genioglossus: Superior genial tubercle)

Insertion:
- upper border of ***Hyoid bone

Nerve supply:
- ***C1 (via CN12) (即係由C1黎 —> hitchhike CN12)

35
Q

***3. Hyoid bone

A
  • U shape
  • Above larynx
  • Slung between Mandible and Styloid process by Geniohyoid (前) and Stylohyoid (後)
  • Important in positioning of larynx
  • **Elevate hyoid:
    1. Geniohyoid (C1 via CN12)
    2. Stylohyoid (CN7)
    3. Mylohyoid (CNV3)
  • **Depress hyoid (Infrahyoid muscles):
    1. Thyrohyoid (Ansa cervicalis)
    2. Omohyoid (Ansa cervicalis)
    3. Sternohyoid (Ansa cervicalis)
    (4. Sternothyroid —> drag entire larynx down) (Ansa cervicalis)
36
Q

***Hyoglossus as landmark

A

Lateral (Superficial) to Hyoglossus:

  1. Lingual nerve (Submandibular ganglion for preganglionic cell from Chorda tympani CN7)
  2. CN12
  3. Submandibular duct
  4. Stylohyoid muscle

Medial to Hyoglossus:

  1. CN9
  2. Lingual artery
  3. Genioglossus
  4. Stylohyoid ligament
37
Q

Submandibular gland

A

Superficial part

  • below / lateral to Mylohyoid
  • lies in Submandibular fossa
  • covered by deep cervical fascia
  • curves around posterior border of Mylohyoid (包住Mylohyoid的後面)

Deep part

  • above / medial Mylohyoid
  • lies in floor of mouth
  • between mandible and side of tongue
  • **Submandibular duct
  • opening at anterior end of deep part —> ***Sublingual papilla
  • runs between Sublingual gland and Genioglossus

Anatomical relationships:

  • Facial artery: grooves the gland (before turning around inferior border of mandible)
  • Common facial vein: grooves the gland
  • CN7 Mandibular branch: crosses the gland
38
Q

Sublingual gland

A
  • in front of Anterior border of Hyoglossus
  • between Mylohyoid and Genioglossus
  • below termination of Submandibular duct
  • about 15 ducts
    —> 1/2 open into Submandibular duct —> Sublingual papilla
    —> 1/2 open directly on Sublingual fold + Sublingual papilla
39
Q

Teeth

A

Deciduous teeth (milk teeth) —> total 20

  • central and lateral incisors
  • canine
  • 2 molars

Permanent teeth —> total 32

  • central and lateral incisors
  • canine
  • 2 premolars
  • 3 molars

Upper: Maxillary teeth
Lower: Mandibular teeth

40
Q

Teeth nerve supply

A

Upper: CNV2 (Superior alveolar nerve: anterior, middle, posterior)

Lower: CNV3 (Inferior alveolar nerve)

41
Q

Dental occlusion

A

Class I: Normal
Class II: Distal occlusion: Maxilla protrude anteriorly
Class III: Mesial occlusion (倒及): Mandible protrude anteriorly

HNNS (58 decks)

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