Lecture 14 - Oral Cavity And Pharynx Flashcards
How many teeth does a normal adult have?
32
What are the teeth each quadrant of the oral cavity contains?
Medial incisor
Lateral incisor
Canine
2 pre molars
3 molars with last one being the wisdom tooth
What is the vestibule?
Space between the lips/cheeks and gums/teeth
What are the roof, floor, posterior and the cheek boundaries of the oral cavity proper?
Roof = hard palate (anterior) then soft palate (posterior)
Floor = mylohyoid muscles, geniohyoid muscles, tongue, salivary glands + ducts
Cheek = Buccinator muscle
Posterior = uvula, palatine tonsil, roof of tongue and lingual tonsils
What arch forms part of teh posterior boundary of the oral cavity proper?
Palatoglossal arch
What is the arch found in the pharynx called?
Palatopharyngeal arch
What is the relative position of the Palatoglossal arch compared to the palatopharyngeal arch?
Palatoglossal arch anterior to the palatopharyngeal arch
Palatopharyngeal arch posterior
How many intrinsic muscles of the tongue are there?
4 pairs of intrinsic tongue muscles
What are the 4 pairs of intrinsic tongue muscles innervated by?
Hypoglossal nerve (XII)
What are the 4 extrinsic tongue muscles?
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus
What is the main innervation to all the extrinsic tongue muscles?
Hypoglossal nerve (XII)
What is the extrinsic tongue muscle that is not innervated by the Hypoglossal nerve (XII)?
What is it innervated by?
Palatoglossus
Vagus nerve (X)
What are all of the extrinsic tongue muscles?
What are all their innervation?
Genioglossus = Hypoglossal (XII)
Hyoglossus = Hypoglossal (XII)
Styloglossus = Hypoglossal (XII)
Palatoglossus = Vagus (X)
Where does Genioglossus originate from?
Chin
Genio means chin
Inserts tongue
Where does the Styloglossus originate from?
Styloid process
Inserts on tongue
Where des Palatoglossus originated from?
Either side of palate
What nerve supplies sensation to the anterior 2/3 of the tongue?
What nerve supplies taste to the anterior 2/3 of the tongue?
Sensory = Trigeminal (Vc lingual branch of mandibular division)
Taste = Facial (VII Chorda tympani branch)
What nerve supplies sensation to the posterior 1/3 of the tongue?
What nerve supplies taste to the posterior 1/3 of the tongue?
Sensation and taste both from the GLOSSOPHARYNGEAL (IX)
Go to last slide and label the extrinsic tongue muscles on image 1:
Blue = genioglossus
Green = Hyoglossus
Purple = Styloglossus
Go to last slide and label the extrinsic tongue muscles on image 2:
1 = Styloglossus
2 = Hyoglossus
3 = genioglossus
4 = palatoglossus
What are the 3 different salivary glands?
Submandibular glands
Parotid glands
Sublingual glands
Which salivary gland are stones most likely to form in?
Submandibular salivary glands
What are the ducts called which allow the submandibular salivary glands to secrete saliva into the oral cavity?
Whartons duct
Remember South West (SW)
Submandibular Wharton’s ducts
Where are Whartons ducts located?
Base of lingual frenulum (under tongue)
What part of the neck is the submandibular salivary gland located in?
Submandibular triangle which is made by the digastric muscle
(In the anterior neck triangle)
Go to the last slide and label image 3:
1 = anterior belly of digastric muscle
2= posterior belly of digastric muscle
Go to the last slide and label image 4:
1 = parotid gland
2 = submandibular
3 = sublingual
Salivary glands
Go to the last slide and label image 5:
1 = whartons duct
What duct does the parotid gland secrete into the oral cavity proper through?
Stensen duct
Think PS (Parotid drains through Stensen duct)
How does the Stensen duct from the parotid gland travel?
Passes through masseter
Pierces the Buccinator
Opens near upper 2nd molar
Go to the last slide and label the image 6:
Yellow = parotid gland + Stensen duct
Blue = Sternocleidomastoid
Red = masseter
Green = Buccinator
How do the sublingual slaivary glands drain into the oral cavity?
Via minor sublingual ducts
What is sialolithiasis?
Salivary gland stones/calculi
Why do the majority of salivary gland stones/calculi form in the submandibular glands?
Conc of Ca2+ in the saliva here the highest
What are the symptoms of Sialolithiasis?
Pain in gland
Swelling
Infection
All stimulated by eating
How is Sialolithiasis diagnosed?
History
X-ray
Sialogram (radioopaque dye injected)
What is tonsillitis?
Inflammation of the palatine tonsils
Where do the palatine tonsils lie?
Between the 2 arches
Between the Palatoglossal and the Palatopharyngeal arches
What are some signs/symptoms of tonsillitis?
Fever
Sore throat
Painful/difficulty swallowing
Cervical lymphadenopathy
Bad breath
What is the most common cause of tonsillitis?
Viral
What is the normal causative organism if a tonsillitis is a bacterial cause?
((Normally viral)
Beta haemolytic strep pyogenes
What is the uvula and extension of?
Soft palate
What can you see on examination of the oral cavity to indicate tonsillitis?
Uvula unaffected
Swollen palatine tonsils often with exudate
What often causes peritonsilar abcesses?
Tonsillitis
What is an alternate name for a peritonsillar abcesses?
Quinsy
How does a peritonsillar abscess present?
Sevre throat pain
Fever
Bad breath
Drooling
Difficulty opening mouth
What usually happens to the uvula in a peritonsilar abcesses?
Uvula deviates
Where does the pharynx exist?
Behind the 3 other cavities
What are the 3 pharyngeal cavities?
Nasopharynx
Oropharynx
Laryngopharynx
What are the borders of the nasopharynx?
Anterior = nasal cavity
Posterior = C1 and C2 vertebra
Roof = base of skull + soft palate
What are the contents of the nasopharynx?
Pharyngeal/adenoid tonsils
Opening of the Eustachian/pharyngotympanic tube
What issues can enlarged pharyngeal/adenoid tonsils cause? (Nasopharynx)
Block Eustachian tube causing recurrent/persistent middle ear infections
Snoring/sleep apnoea
Sleeping with mouth open
Chronic sinusitis
Nasal tone to voice
What are the boundaries of the oropharynx?
Anterior = oral cavity
Posterior = C2 and C3 vertebrae
What are the contents of the oropharynx?
Palatine tonsils
What structures are the palatine tonsils located between?
Palatoglossal and Palatopharyngeal arches
Go to slide 7 and label the image:
1 = Palatoglossal arch
2 = palatopharyngeal arch
3 = enlarged uvula
4 = tonsilar (palatine) hypertrophy
What are the boundaries of the Laryngopharynx?
Anterior = larynx ( from epiglottis to cricoid cartilage)
Posterior = C4,C5 and C6 vertebra
The Laryngopharynx is continous with the oesophagus
What does the Laryngopharynx contain?
Piriform fossae
What are the piriform fossae in the Laryngopharynx?
Holes that funnel food and water into the oesophagus when the epiglottis has closed of the trachea
What are the 2 types of muscles in the pharynx?
3 outer longitudinal muscles
3 inner circular muscles
What are the 3 longitudinal muscles of the laryngopharynx?
Stylopharyngeus
Palatopharyngeus
Salpingopharyngeus
What is the function of the 3 longitudinal pharyngeal muscles?
What are the 3 longitudinal muscles?
Elevate pharynx and larynx during swallowing
Stylopharyngeus
Palatopharygeus
Salpingopharyngeus
Where do all of the longitudinal pharyngeal muscles insert?
(Stylopharyngeus, palatopharyngeus and Salpingopharyngeus)
Posterior aspect of thyroid cartilage
What is the innervation of the 3 longitudinal muscles of the pharynx?
All vagus (X) except Stylopharyngeus = Glossopharyngeal (IX)
Stylopharyngeus = Glossopharyngeal (IX)
Palatopharyngeus = Vagus (X)
Salpingopharyngeus = Vagus (X)
What are the origins of all the 3 outer longitudinal muscles?
Stylopharyngeus = Styloid process of temporal bone
Palatopharyngeus = hard palate
Salpingopharyngeus = from opening of Eustachian tube
What are the 3 inner circular pharyngeal muscles?
Superior pharyngeal constrictor
Middle pharyngeal constrictor
Inferior pharyngeal constrictor
What is the function of the 3 circular muscles of the pharynx/pharyngeal constrictors?
Constrict walls of the pharynx when swallowing
What is the origin of the superior pharyngeal constrictor?
Pterygomandibular raphe which is in the mouth
What is the origin of the middle pharyngeal constrictor?
Hyoid bone
What is the origin of the inferior pharyngeal constrictor?
Has 2 parts to it
Thyropharngeal = thyroid cartilage
Cricopharyngeal = cricoid cartilage
What is the clinical significance of the inferior pharyngeal constrictor?
It has 2 parts to it, the thyropharyngeal part and the cricopharyngeal part
Between these is a point of weakness where herniation can occur called a pharyngeal pouch
What is the innervation to all of the pharyngeal constrictors?
Vagus nerve (X)
Go to the last slide and label image 8:
1 = superior constrictor
2 = middle constrictor
3 = inferior constrictor
4 = oesophagus
Where does a pharyngeal pouch/ posteromedial (false) diverticulum form?
Weakness between the 2 parts f the inferior constrictor
What are the symptoms of a pharyngeal pouch/posteromedial false diverticulum?
Bad breath
Regurgitation of food
Choking on fluids
Difficulty swallowing
What usually causes the pharyngeal pouch?
Failure of the upper oesophageal sphincter to relax or abnormal timing of swallowing
So anything increasing the pressure in the Laryngopharynx
What are the 3 phases of swallowing ?
Oral
Pharyngeal
Oesophageal
What happens in stage 1 oral phase of swallowing?
Bolus made
Bolus compressed against plate and pushed into oropharynx by tongue and soft palate
What happens in stage 2 pharyngeal phase of swallowing?
Tongue positioned against hard palate
Soft plate elevated sealing off nasopharynx
Longitudinal muscles shorten
Pharynx widens and shortens
Larynx elevates a sealed of by vocal cords
Epiglottis closes over larynx
UOS relaxes
What happens in stage 3 oesophageal phase of swallowing?
Upper striated muscle of oesophagus and Lower smooth muscle contract
How does the type of Dysphagia in stroke patients and patients with a mass in their oesophagus present differently?
Stroke = hard to swallow liquids (poor coordination)
Mass = solids harder to swallow
What are some common symptoms of Dysphagia?
Coughing and choking
Sialorrhoea
Recurrent pneumonia
Chang invoice/speech
Nasal regurgitation (soft palate not raising)
What is affected if Glossopharyngeal and vagus nerve damage occurs?
Absent gag
Uvula deviated away from the lesion (supposed to be central, healthy side lifts up but non healthy doesnt)
Dysphagia
Loss of toast on posterior tongue
What can damage cranial nerves IX and X?
Medullary infarct
Jugular foramen issue
What can happen with a Hypoglossal nerve (XII) damage?
Wasted tongue
Lick your wounds, tongue deviates to damaged side, since other muscle is functional
