Lecture 12: Oral and Nasal Cavities, Pharynx & Pterygopalatine Fossa Flashcards
What is the major arterial supply to the posterior 2/3 of the nasal cavity?
-
Sphenopalatine artery, through its 2 major branches:
1) Posterior Lateral Nasal artery
2) Posterior Septal artery
Label this
The parotid duct pierces what muscle and drains into the mouth where?
- Pierces the Buccinator M.
- Drains into mouth opposite the crown of the 2nd upper molar
Which nerve is the Submandibular duct in close relationship to?
- The lingual nerve spirals around the submandibular duct from superior-lateral to inferior-medial
- Looking in floor out mouth the duct sits on top of the nerve
What is the dental formula for adults and how does it work?
In each set, incisors (I) are indicated first, canines (C) second, premolars (P) third, and finally molars (M), giving I:C:P:M.
- Formula 2-1-2-3 for upper teeth indicates 2 incisors, 1 canine, 2 premolars, and 3 molars on one side of the upper mouth
What is the dental formula for children’s (decidous) teeth?
- 2-1-0-2
- 2 incisors, 1 canine, 0 pre-molars, 2 molars on each side of the top and bottom
What provides the GSA and SVA fibers to the anterior 2/3 of tongue; and what is each of the nerves responsible for?
- Lingual nerve from Trigeminal (V): supplies the GSA fibers for pain, temp., touch
- Chorda Tympani from Facial (VII) supplies the SVA fibers for taste
*Chorda Tympani from Facial n. travels with the Lingual n. to the tongue
What supplies the GVA and SVA fibers to the posterior 1/3 of tongue?
Glossopharyngeal (IX) is responsible for both the GVA and SVA (taste) fibers.
The tonsillar fossa region of the tongue is innervated by what nerve?
- Glossopharyngeal (IX) nerve
- Arises from endoderm of 2nd pharyngeal arch
All the extrinsic and intrinsic muscles of the tongue are innervated by; what is the one exception and its innervation?
- ALL tongue muscles = hypoglossal (CN XII)
- Except! Palatoglossus is innervated by CN X
Unilateral hypoglossal palsy results in what; which way does tongue deviate and why?
- Paralysis, atrophy, and fasciculations of the intrinsic muscles of tongue
- When protruded, the normal genioglossus deviates the tongue toward the affected side!
*BILATERAL paralysis may cause airway obstruction (dyspnea), dysarthria, and dysphagia
The tongue is supplied by which artery and branch?
Lingual artery and its terminal branch, the profunda lingual artery
Which vein drains the tongue and into where?
Lingual vein drans into IJV or facial vein
Lymphatics from the tongue primarily drain to where?
-
Deep Cervical LN’s:
1) Jugulodigastric
2) Jugulo-omohyoid
What is the innervation and action of Tensor Veli Palatini muscle?
- Innervated by small branch of Mandibular n. (V3)
- Tense the palate and opens the auditory tube (depressurizes middle ear)
What is the innervation and action of Levator Veli Palatini muscle?
- Innervated by CN X, pharyngeal plexus
- Elevates the soft palate
Paralysis of the Tensor Veli Palatini or Levator Veli Palatini muscles will lead to?
Muscles of the non-paralyzed side will pull or deviate the uvula TOWARD the normal side
What is the blood supply and innervation like to the palate, including hard and soft palate?
- Greater palatine nerve and artery supply hard palate
- Lesser palatine nerve and artery supply soft palate
- Nasopalatine nerve supplies anterior 1/3 of hard palate
*The greater and lesser palatine arteries are branches off the descending palatine artery, which is one of the last branches off the Maxillary artery!
Which ganglion do the nerves supplying the palate arise from; and which nerve is the main one innervating the palate?
- Sensory nerves of the palate are branches of the Maxillary nerve (V2), which branch from the:
- Sphenopalatine Ganglion
What muscles are critical for closing off the pharyngeal isthmus and separating the nasopharynx from the oropharynx?
Levator Veli Palatini and Tensor Veli Palatini
What is the 2 main sources of blood supply to the palatine tonsil?
1) Tonsilar artery of the Facial a.
2) Palatine branch of the Ascending Pharyngeal a.
What nerve is closely related to the floor of the tonsilar fossa?
Glossopharyngeal nerve
*He mentioned surgeons bagging this nerve by accident when removing the tonsils
Fractures of the nose frequently occur at what junction?
Junction between the septal cartilage and the ethmoid and vomer
Where is the Sphenoethmoidal Recess and why is it relevant?
- Postero-superior to superior concha
- Sphenoidal sinus drians into the sphenoethmoidal recess
What important structures/openings found in the Superior Concha and Meatus?
- Openings for the posterior ethmoial air cells
- Sphenopalaine Foramen
What important structures and openings found in the Middle Meatus?
- Ethmoidal bulla
- Hiatus Semiluniaris
- Openings for the: Maxillary, Ethmoidal and Frontal Sinuses
The opening for the maxillary sinus is located where?
- Posterior 1/3 of the hiatus semilunaris
The frontal and anterior ethmoidal sinuses drain into the ______, which is located in the anterosuperior portion of the _________.
- Drain into the ethmoidal infundibulum
- Hiatus semilunaris
What are the 2 openings for the frontal sinus?
1) Ethmoidal infundibulum
2) Frontal Recess
Where is the opening for the nasolacrimal duct?
Inferior meatus
What is the blood supply for the posterior 2/3 of the nasal cavity and what supplies the anterior 1/3?
Posterior 2/3: the sphenopalatine artery with the posterior lateral and posterior septal branches
Anterior 1/3: the anterior and posterior ethmoidal as. branches of the opthalmic artery
Most nasal hemorrhages or (epitaxis) occurs at the junction of what?
- Septal branches of the superior labial and sphenopalatine arteries
- Clinically this region is referred to as: Kiesselbach’s area
Where are the Olfactory neurons found in the nasal cavity and what type of fibers are they?
- Embedded in the olfactory epithelium
- SVA fibers
What supplies the innervation to the posterior 2/3 and anterior 1/3 of nasal cavity?
Posterior 2/3: branches of the sphenopalatine (pterygopalatine) ganglion
Anterior 1/3: the anterior ethmoidal nerve, a branch of the nasociliary nerve (V1)
Which nerve innervates the mucosa of the gingiva and hard palate adjacent the upper incisors?
- Nasopalatine nerve, a branch of the sphenopalatine (pterygopalatine) ganglion
What is the Salpingopharyngeal Fold and what muscle forms it?
- Mucosal fold that extends between the posterior part of the torus and pharyngeal wall
- Formed by the underlying salpingopharyngeus muscle.
What neurovasculature is found within the sphenopalatine fossa?
- Short Maxillary nerve (V2) enters via foramen rotundum and exits via the inferior orbital fissure
- Sphenopalatine artery the terminal branch of the Maxillary artery
What are the branches of the Pterygopalatine Ganglion?
- Vidian nerve formed by merging of deep petrosal and great petrosal nerves
- Lesser and Greater Palatine nerves
- Nasopalatine nerve
What does the roof of the Maxillary Sinus form; why is this clinically significant, what’s found here?
- Forms the floor of the orbit
- Floor of the orbit is where the infraorbital nerve lies in the infraorbital canal
- Blows to the eyeball can herniate orbital contents into maxillary sinus and entrap the maxillary nerve: will have numbness in the cheek of affected side
What are the relationships of the sphenoidal sinus, posterior, superior, anterior, inferior, and lateral? (*He really stressed this!)
Posterior: pons and basilar artery
SUPERIOR: PITUITARY GLAND!
Anterior: nasal cavity
Inferior: nasopharynx
LATERAL: INTERNAL CAROTID, V1, CAVERNOUS SINUS
Which sinus is frequently used as a surgical approach to its surrounding structures?
- Maxillary sinus
- Transmaxillary approach!
