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MBBS II HNNS > L29 – The Oral Cavity, Submandibular, Sublingual Glands > Flashcards

L29 – The Oral Cavity, Submandibular, Sublingual Glands Flashcards

1
Q

3 bones that form the oral cavity?

A
  • Palatine bone
  • Maxilla
  • Mandible
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2
Q

Define the roof, floor and side walls of the oral cavity?

A

Roof = hard palate (soft palate is in pharynx, not in oral cavity)

Floor = mylohyoid muscle (thin, inserts to hyoid bone)

Side walls = buccinator muscle (wraps around mouth)

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3
Q

Precise origin and attachment of Buccinator muscle?

A

Origin:

  1. Maxilla (parallel to alveolar cavitis)
  2. Pterygomaxillary ligament&raquo_space; extend from maxillary tuberosity to hamulus&raquo_space; form Pterygomandibular raphe

Insertion:
1. Pterygomandibular raphe ends at Buccinator Crest&raquo_space; Continue to external oblique line of mandible, up to first lower molar

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4
Q

Anterior and posterior opening of the oral cavity?

A

Anterior: • Opens into oral fissure

Posterior: • Opens into oropharynx

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5
Q

What separates oral cavity from the oropharynx?

A

Fauces:

  • Anterior pillar of the fauces = palatoglossal arch
  • Posterior pillar = palatopharyngeal arch

2 pillars surround the palatine tonsils

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6
Q

Define the 2 spaces of the oral cavity?

A

• Oral cavity proper: space medial or posterior to teeth

• Vestibule: space between teeth/gum and cheek
Contains Opening of parotid duct (salivary gland) opposite second upper molar

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7
Q

Describe the sensory nerve supply of the oral cavity? Floor, cheek, upper and lower teeth, gum?

A

All by trigeminal nerve:
V2 (maxillary), V3 (mandibular):

  • Roof: Anterior palatine [V2], nasopalatine nerves [V2]
  • Floor: lingual nerve [V3]
  • Cheek: buccal nerve [V3]
  • Upper Teeth = Ant-, Middle-, Post- Superior alveolar nerve [V2]
  • Lower teeth = Inferior alveolar nerve [V3]
  • Upper gum = Nasopalatine and Anterior palatine nerve [V2]
  • Lower gum = Lingual, Buccal, Inf. Alvoelar nerve [V3]
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8
Q

Define the bony components of the hard palate?

A

 Anterior = maxilla (palatal processes)

 Posterior = palatine bone: horizontal plates

Anterior and posterior parts divided by Palatomaxillary fissure

 Premaxilla: cleft palate rarely separates the 2 halves of premaxilla

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9
Q

List the foramina in the oral cavity?

A

Incisive foramen in the Premaxilla

Greater and Lesser palatine foramen in the palatine region (posterior)

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10
Q

List the structures that go through the foramina in the oral cavity?

A

Incisive foramen = Nasopalatine nerve [V2] + sphenopalatine artery

Greater palatine foramen:
- For greater palatine artery and anterior palatine nerve

Several lesser palatine foramina:

  • Perforate palatine bone itself
  • For middle, posterior palatine nerves
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11
Q

Name the arterial supply of the hard palate.

A

Greater palatine artery= branch of the descending palatine artery (a terminal branch of the maxillary artery)

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12
Q

Tract of greater palatine artery?

A

maxillary artery

> accompanies greater palatine nerve

> down greater palatine canal

> emerges from greater palatine foramen

> passes around palate

> enters incisive foramen

> passes up into the nose

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13
Q

Name of arterial supply to soft palate?

A

Lesser palatine artery

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14
Q

Nerve supply of the hard palate?

A
  • anterior palatine nerve (from pterygopalatine ganglion), From greater palatine foramen up to incisive foramen
  • nasopalatine nerve (from pterygopalatine ganglion), crosses nasal roof, descend on nasal septum, through incisive foramen, supplies hard palate anterior to incisive foramen
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15
Q

What forms the soft palate?

A

An aponeurosis of tensor veli palatini

acted upon by 5 pairs of muscles

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16
Q

List the muscles that act on the soft palate?

A
  • Tensor veli palatini
  • Levator veli palatini
  • Palatopharyngeus muscle
  • Palatoglossus muscle
  • Musculus uvulae
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17
Q

Origin and attachment of the tensor veli palatini?

A

Origin = outside the pharynx: basicranium and lateral cartilaginous part of eustachian tube

Insertion = Fibers converge to base of pterygoid hamulus, turns flat and hooks around the hamulus to get inside pharynx&raquo_space; turns into aponeurosis (soft palate)

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18
Q

Action of tensor veli palatini? Nerve supply?

A
  • tenses up the aponeurosis so that other muscles can act on it
  • pulls open the cartilaginous part of Eustachian tube
  • mandibular nerve (CNV3), via nerve to medial pterygoid
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19
Q

Origin and attachment of Levator veli palatini?

A

Origin = Inside pharyngobasilar fascia (medial cartilaginous part of eustachian tube + quadrate area on petrous part of temporal bone)

> > form V-shape sling

Insertion = nasal surface of the palatine aponeurosis

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20
Q

Action of levator veli palatini? Nerve supply?

A

pull soft palate backwards and upwards, shutting nasopharynx from oropharynx (i.e. swallowing)

pharyngeal plexus (CNX)

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21
Q

Origin and attachment of palatopharyngeus muscle?

A

Origin: arises by 2 heads from the horizontal plate of palatine bone + back of palatine aponeurosis

Arches over the lateral margin of palatine aponeurosis, forms posterior pillar of fauces (PALATOPHARYNGEAL ARCH)

Insert: posterior border of thyroid cartilage and cornua

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22
Q

Action and attachment of palatopharyngeus muscle? Nerve supply?

A

Actions: • elevates larynx and pharynx • depresses soft palate

Nerve supply: pharyngeal plexus (CNX)

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23
Q

Origin and insertion of palatoglossus muscle?

A

Origin = undersurface of palatine aponeurosis

Insertion: Interdigitate with styloglossus &raquo_space; forms anterior pillar of fauces (Palatoglossal arch)

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24
Q

Action and nerve supply of palatoglossus muscle?

A

Actions:
• sphincteric at oropharyngeal isthmus
• raises tongue

Nerve supply: pharyngeal plexus (CNX)

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25
Q

Origin and insertion of musculus uvulae?

A

Origin = Posterior nasal spine + palatine aponeurosis

Insertion = Mucous membrane of uvula

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26
Q

Action and nerve supply of musculus uvulae?

A

Actions:
• shape the uvula
• draws up the uvula ipsilateral side

Nerve supply: pharyngeal plexus (CNX)

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27
Q

Proportions of tongue in the oral cavity and oropharynx?

A
  • anterior 2/3: in oral cavity

* posterior 1/3: in oropharynx

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28
Q

How are tongue papillae formed? List the papillae in the anterior and posterior tongue?

A

Mucous membrane projections

Anterior 2/3:
Filliform
Fungiform
Foliate

Boundary between anterior and posterior = Vallate papillae (V-shape) + Sulcus terminalis

Posterior 1/3:
No papilla

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29
Q

What structures divide the anterior and posterior tongue?

A

Sulcus terminalis

Vallate papillae
no papilla posterior to the vallate papillae

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30
Q

Explain the nodular appearance of posterior tongue?

A

Rough due to:

 Mucous, serous glands

 Aggregation of lymphatic tissue (lingual tonsil = part of Waldeyer’s ring)

31
Q

Compare the functions of the anterior and posterior tongue?

A

Anterior = Prehensile (can grasp), for mastication (e.g. dig out food from vestibule)

Posterior = Smooth for swallowing, not mastication

32
Q

Location and embryonic origin of the foramen caecum?

A
  • behind the apex of vallate papillae

* remnant of thyroglossal duct

33
Q

Glands exist in both the anterior and posterior portions of the tongue. T or F?

A

False

No glands on the dorsum in the anterior portion, only in posterior

34
Q

Compare the shape and function of the tongue papillae?

A
  • filiform (conical), furry appearance, NO taste buds, somatosensory
  • fungiform (mushroomshaped), visible as red dots, contains taste buds
  • foliate, on posterolateral border of the tongue, bear serous glands and taste buds
  • vallate, 8-12 in number, anterior to foramen cecum and sulcus terminalis, contains taste buds
35
Q

Innervation of the vallate papillae?

A

Glassopharyngeal nerve (even though it exists in the anterior portion of tongue)

36
Q

Divide the tongue muscles into groups.

A

4 intrinsic:

  • Superior longitudinal fibers
  • Inferior longitudinal f.
  • Transverse f.
  • Vertical f.

4 extrinsic:

  • Genioglossus
  • Hyoglossus
  • Styloglossus
  • Palatoglossus
37
Q

Describe the organization of intrinsic tongue muscles?

A

 Wholly within the tongue
 Not attached to bones
 Fibres in 3 planes perpendicular to each other

38
Q

Describe the location of inferior longitudinal fibers in relation to extrinsic muscles of tongue?

A

alongside genioglossus, medial to hyoglossus

39
Q

Describe the location of transverse fibers in the tongue?

A

originate from midline fibrous septum, inserts onto the sides

40
Q

Describe the location of the vertical fibers in the tongue?

A

originate from mucous membrane of dorsum, insert onto the sides of lower part

41
Q

Nerve supply of 4 extrinsic muscles of the tongue?

A

All supplied by hypoglossal (XII),

except palatoglossus (by pharyngeal plexus [CN X]; forms anterior pillar of fauces)

42
Q

Extrinsic tongue muscles and their direction of attachment in the oral cavity?

A
  • front: to mandible (genioglossus)
  • down: to hyoid bone (hyoglossus)
  • back: to styloid process of temporal bone (styloglossus)
  • up: to soft palate (anterior pillar of fauces) (palatoglossus)
43
Q

Origin, insertion and nerve supply of Genioglossus muscle?

A

Origin: • superior genial tubercle

Fibres radiate widely

Insertion: • the mucous membrane of dorsum of the tongue, lowest fibres go to hyoid (not to confuse with the geniohyoid muscle)

Nerve supply: • CNXII

44
Q

Origin, insertion and nerve supply of Hyoglossus muscle?

A

Origin:
• body and the length of greater horn of hyoid

Extends as a quadrilateral sheet on the side of the tongue

Insertion:
• Interdigitate with styloglossus, and attaches to side of tongue

Nerve supply: • CNXII

45
Q

Origin, insertion and nerve supply of palatoglossus muscle?

A

• from surface of palatal aponeurosis to side of tongue&raquo_space; anterior pillar of fauces

CN X, pharyngeal plexus

46
Q

Origin, insertion and nerve supply of styloglossus muscle?

A
  • from styloid process to side of tongue

* CNXII

47
Q

Compare the overall action of the intrinsic and extrinsic muscles of the tongue?

A

Shape = altered by intrinsic muscles

Position = altered by extrinsic muscles

48
Q

Action of genioglossus, styloglossus and hyoglossus muscles on the tongue?

A
  • Genioglossus = protrude tongue
  • Styloglossus = Retract
    Hyoglossus = Draw sides downwards
49
Q

Intrinsic muscles involved in narrowing and convex the dorsum of tongue?

A

Transverse fibers

50
Q

Intrinsic muscles involved in flattening and elongating the dorsum of tongue?

A

transverse + vertical fibers

51
Q

Intrinsic and extrinsic muscles involved in protruding the dorsum of tongue?

A

transverse + vertical + genioglossus (lowest fibres)

52
Q

Direction of tongue deviation is the hypoglossal nerve is damaged? Deviation of uvula if the vagus nerve is damaged?

A

Hypoglossal nerve palsy: tongue deviates to weaker/ injured side: injured side muscle weakness cannot oppose normal side

Uvula deviation to contralateral side: i.e. right vagus cut = only left side is contracted/ shortened

53
Q

What is the frenulum of tongue? Location, attachment?

A

Mucous membrane fold extending from the floor of the mouth to the midline of the inferior aspect of the tongue

54
Q

Describe the sequence of muscle contraction in swallowing?

A

1) Food is masticated in oral cavity
2) Conscious decision is made to swallow: Tongue pulled up, back = pushes food bolus into back of oral cavity

3) Swallowing reflex takes over:
- Bolus of food enters pharynx, receptors in pharynx trigger reflex
- raise soft palate to temporarily close off nasopharynx from oropharynx
- pharyngeal muscles constrict in sequence
- push bolus into esophagus
- esophageal muscles drive bolus down by peristalsis

55
Q

Arterial supply of tongue?

A

Lingual artery

  • a branch from the anterior surface of external carotid artery
  • passes deep to hyoglossus towards the tip
56
Q

Venous drainage of tongue?

A
  • ranine veins: on undersurface of tongue, to common facial vein&raquo_space; Internal jugular vein
  • lingual vein: to internal jugular vein
57
Q

Summarize all the nerve supplies to the anterior and posterior tongue?

A

1) Anterior 2/3:
 Sensation: lingual nerve (V3)
 Taste + secretomotor: chorda tympani via lingual nerve (CN VII)

2) Posterior 1/3: sensation + taste + secretomotor: glossopharyngeal nerve (IX)

Motor: all intrinsic, extrinsic by hypoglossal nerve (except palatoglossus)

58
Q

Origin, insertion and innervation of mylohyoid muscle at floor of mouth?

A
  • Origin: mylohyoid line (mandible)
  • Insertion: midline raphe, hyoid bone (posterior fibres)
  • Innervation: CNV3
59
Q

2 muscles that form the floor of mouth?

A

Geniohyoid + Mylohyoid

60
Q

Origin, insertion and innervation of geniohyoid muscle at floor of mouth?

A
  • Origin: inferior genial tubercle
  • Insertion: upper border of hyoid bone
  • Lies above mylohyoid, below genioglossus
  • Innervation: C1 via CNXII
61
Q

Location of hyoid bone?

A

Slung between mandible and styloid process by geniohyoid and stylohyoid

Position determined by tonic contraction of diff. muscles

62
Q

List muscles that elevate and depress hyoid?

A

Elevate hyoid:
• geniohyoid, stylohyoid, mylohyoid

Depress hyoid:
• thyrohyoid, omohyoid, sternohyoid, (sternothyroid)

63
Q

List 4 structures Lateral/ superficial to hyoglossus?

LHSS LGS

A

 Lingual nerve (V3)
 Hypoglossal nerve (CN12)

 Submandibular duct

 Stylohyoid muscle

64
Q

List 3 structures deep to hyoglossus?

LHSS LGS

A

 Lingual artery*

 Glossopharyngeal nerve (CN9)

 Stylohyoid ligament

65
Q

Location of superficial part of submandibular gland?

A
  • lies in submandibular fossa
  • superficial to (below) mylohyoid, covered by deep cervical fascia
  • curves around posterior border of mylohyoid
66
Q

Location of deep part of submandibular gland?

A
  • lies in floor of mouth

* between mandible and side of the tongue

67
Q

Tract of submandibular duct?

A
  • leaves the gland at anterior end of deep part
  • runs between sublingual gland and genioglossus
  • opens at sublingual papilla: at sublingual caruncles on either side of frenulum of tongue
68
Q

3 structures that crosses the submandibular gland?

A
  • facial artery: grooves the gland, before turning around inferior border of mandible
  • common facial vein: grooves the gland
  • mandibular branch of facial nerve: crosses the gland
69
Q

Location of sublingual gland?

A
  • lies in front of anterior border of hyoglossus, between mylohyoid and genioglossus
  • lies below the termination/opening of submandibular duct
70
Q

Drainage of sublingual gland?

A

about 15 ducts, half open into submandular duct,

half open directly on sublingual fold and papilla

71
Q

List the permanent teeth number and types?

A 
Permanent teeth: total 32 
• central and lateral incisors 
• canine 
• 2 premolars 
• 3 molars
72
Q

Nerve supply of teeth? (Upper and lower)

A

Upper: • maxillary nerve CNV2

Lower: • mandibular nerve CNV3

73
Q

Submandibular gland nerve supply?

A

secretomotor fibres from chorda tympani

Synapse at submandibular ganglion

Along maxillary artery, then lingual artery

(Sympathetic fibers hitchhike across lingual artery)

74
Q

Nerve supply of sublingual gland?

A

same as submandibular gland (secretomotor fibres from chorda tympani synapse at submandibular ganglion)

MBBS II HNNS (57 decks)

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