Lecture 14 - Oral Cavity And Pharynx

Question 1

How many teeth does a normal adult have?

Answer 1

32

Question 2

What are the teeth each quadrant of the oral cavity contains?

Answer 2

Medial incisor
Lateral incisor
Canine
2 pre molars
3 molars with last one being the wisdom tooth

Question 3

What is the vestibule?

Answer 3

Space between the lips/cheeks and gums/teeth

Question 4

What are the roof, floor, posterior and the cheek boundaries of the oral cavity proper?

Answer 4

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

Question 5

What arch forms part of teh posterior boundary of the oral cavity proper?

Answer 5

Palatoglossal arch

Question 6

What is the arch found in the pharynx called?

Answer 6

Palatopharyngeal arch

Question 7

What is the relative position of the Palatoglossal arch compared to the palatopharyngeal arch?

Answer 7

Palatoglossal arch anterior to the palatopharyngeal arch

Palatopharyngeal arch posterior

Question 8

How many intrinsic muscles of the tongue are there?

Answer 8

4 pairs of intrinsic tongue muscles

Question 9

What are the 4 pairs of intrinsic tongue muscles innervated by?

Answer 9

Hypoglossal nerve (XII)

Question 10

What are the 4 extrinsic tongue muscles?

Answer 10

Genioglossus
Hyoglossus
Styloglossus
Palatoglossus

Question 11

What is the main innervation to all the extrinsic tongue muscles?

Answer 11

Hypoglossal nerve (XII)

Question 12

What is the extrinsic tongue muscle that is not innervated by the Hypoglossal nerve (XII)?

What is it innervated by?

Answer 12

Palatoglossus

Vagus nerve (X)

Question 13

What are all of the extrinsic tongue muscles?

What are all their innervation?

Answer 13

Genioglossus = Hypoglossal (XII)

Hyoglossus = Hypoglossal (XII)

Styloglossus = Hypoglossal (XII)

Palatoglossus = Vagus (X)

Question 14

Where does Genioglossus originate from?

Answer 14

Chin
Genio means chin
Inserts tongue

Question 15

Where does the Styloglossus originate from?

Answer 15

Styloid process

Inserts on tongue

Question 16

Where des Palatoglossus originated from?

Answer 16

Either side of palate

Question 17

What nerve supplies sensation to the anterior 2/3 of the tongue?

What nerve supplies taste to the anterior 2/3 of the tongue?

Answer 17

Sensory = Trigeminal (Vc lingual branch of mandibular division)

Taste = Facial (VII Chorda tympani branch)

Question 18

What nerve supplies sensation to the posterior 1/3 of the tongue?

What nerve supplies taste to the posterior 1/3 of the tongue?

Answer 18

Sensation and taste both from the GLOSSOPHARYNGEAL (IX)

Question 19

Go to last slide and label the extrinsic tongue muscles on image 1:

Answer 19

Blue = genioglossus
Green = Hyoglossus
Purple = Styloglossus

Question 20

Go to last slide and label the extrinsic tongue muscles on image 2:

Answer 20

1 = Styloglossus
2 = Hyoglossus
3 = genioglossus
4 = palatoglossus

Question 21

What are the 3 different salivary glands?

Answer 21

Submandibular glands
Parotid glands
Sublingual glands

Question 22

Which salivary gland are stones most likely to form in?

Answer 22

Submandibular salivary glands

Question 23

What are the ducts called which allow the submandibular salivary glands to secrete saliva into the oral cavity?

Answer 23

Whartons duct

Remember South West (SW)
Submandibular Wharton’s ducts

Question 24

Where are Whartons ducts located?

Answer 24

Base of lingual frenulum (under tongue)

Question 25

What part of the neck is the submandibular salivary gland located in?

Answer 25

Submandibular triangle which is made by the digastric muscle (In the anterior neck triangle)

Question 26

Go to the last slide and label image 3:

Answer 26

1 = anterior belly of digastric muscle 2= posterior belly of digastric muscle

Question 27

Go to the last slide and label image 4:

Answer 27

1 = parotid gland 2 = submandibular 3 = sublingual Salivary glands

Question 28

Go to the last slide and label image 5:

Answer 28

1 = whartons duct

Question 29

What duct does the parotid gland secrete into the oral cavity proper through?

Answer 29

Stensen duct Think PS (Parotid drains through Stensen duct)

Question 30

How does the Stensen duct from the parotid gland travel?

Answer 30

Passes through masseter Pierces the Buccinator Opens near upper 2nd molar

Question 31

Go to the last slide and label the image 6:

Answer 31

Yellow = parotid gland + Stensen duct Blue = Sternocleidomastoid Red = masseter Green = Buccinator

Question 32

How do the sublingual slaivary glands drain into the oral cavity?

Answer 32

Via minor sublingual ducts

Question 33

What is sialolithiasis?

Answer 33

Salivary gland stones/calculi

Question 34

Why do the majority of salivary gland stones/calculi form in the submandibular glands?

Answer 34

Conc of Ca2+ in the saliva here the highest

Question 35

What are the symptoms of Sialolithiasis?

Answer 35

Pain in gland Swelling Infection All stimulated by eating

Question 36

How is Sialolithiasis diagnosed?

Answer 36

History X-ray Sialogram (radioopaque dye injected)

Question 37

What is tonsillitis?

Answer 37

Inflammation of the palatine tonsils

Question 38

Where do the palatine tonsils lie?

Answer 38

Between the 2 arches Between the Palatoglossal and the Palatopharyngeal arches

Question 39

What are some signs/symptoms of tonsillitis?

Answer 39

Fever Sore throat Painful/difficulty swallowing Cervical lymphadenopathy Bad breath

Question 40

What is the most common cause of tonsillitis?

Answer 40

Viral

Question 41

What is the normal causative organism if a tonsillitis is a bacterial cause? ((Normally viral)

Answer 41

Beta haemolytic strep pyogenes

Question 42

What is the uvula and extension of?

Answer 42

Soft palate

Question 43

What can you see on examination of the oral cavity to indicate tonsillitis?

Answer 43

Uvula unaffected Swollen palatine tonsils often with exudate

Question 44

What often causes peritonsilar abcesses?

Answer 44

Tonsillitis

Question 45

What is an alternate name for a peritonsillar abcesses?

Answer 45

Quinsy

Question 46

How does a peritonsillar abscess present?

Answer 46

Sevre throat pain Fever Bad breath Drooling Difficulty opening mouth

Question 47

What usually happens to the uvula in a peritonsilar abcesses?

Answer 47

Uvula deviates

Question 48

Where does the pharynx exist?

Answer 48

Behind the 3 other cavities

Question 49

What are the 3 pharyngeal cavities?

Answer 49

Nasopharynx Oropharynx Laryngopharynx

Question 50

What are the borders of the nasopharynx?

Answer 50

Anterior = nasal cavity Posterior = C1 and C2 vertebra Roof = base of skull + soft palate

Question 51

What are the contents of the nasopharynx?

Answer 51

Pharyngeal/adenoid tonsils Opening of the Eustachian/pharyngotympanic tube

Question 52

What issues can enlarged pharyngeal/adenoid tonsils cause? (Nasopharynx)

Answer 52

Block Eustachian tube causing recurrent/persistent middle ear infections Snoring/sleep apnoea Sleeping with mouth open Chronic sinusitis Nasal tone to voice

Question 53

What are the boundaries of the oropharynx?

Answer 53

Anterior = oral cavity Posterior = C2 and C3 vertebrae

Question 54

What are the contents of the oropharynx?

Answer 54

Palatine tonsils

Question 55

What structures are the palatine tonsils located between?

Answer 55

Palatoglossal and Palatopharyngeal arches

Question 56

Go to slide 7 and label the image:

Answer 56

1 = Palatoglossal arch 2 = palatopharyngeal arch 3 = enlarged uvula 4 = tonsilar (palatine) hypertrophy

Question 57

What are the boundaries of the Laryngopharynx?

Answer 57

Anterior = larynx ( from epiglottis to cricoid cartilage) Posterior = C4,C5 and C6 vertebra The Laryngopharynx is continous with the oesophagus

Question 58

What does the Laryngopharynx contain?

Answer 58

Piriform fossae

Question 59

What are the piriform fossae in the Laryngopharynx?

Answer 59

Holes that funnel food and water into the oesophagus when the epiglottis has closed of the trachea

Question 60

What are the 2 types of muscles in the pharynx?

Answer 60

3 outer longitudinal muscles 3 inner circular muscles

Question 61

What are the 3 longitudinal muscles of the laryngopharynx?

Answer 61

Stylopharyngeus Palatopharyngeus Salpingopharyngeus

Question 62

What is the function of the 3 longitudinal pharyngeal muscles? What are the 3 longitudinal muscles?

Answer 62

Elevate pharynx and larynx during swallowing Stylopharyngeus Palatopharygeus Salpingopharyngeus

Question 63

Where do all of the longitudinal pharyngeal muscles insert? (Stylopharyngeus, palatopharyngeus and Salpingopharyngeus)

Answer 63

Posterior aspect of thyroid cartilage

Question 64

What is the innervation of the 3 longitudinal muscles of the pharynx?

Answer 64

All vagus (X) except Stylopharyngeus = Glossopharyngeal (IX) Stylopharyngeus = Glossopharyngeal (IX) Palatopharyngeus = Vagus (X) Salpingopharyngeus = Vagus (X)

Question 65

What are the origins of all the 3 outer longitudinal muscles?

Answer 65

Stylopharyngeus = Styloid process of temporal bone Palatopharyngeus = hard palate Salpingopharyngeus = from opening of Eustachian tube

Question 66

What are the 3 inner circular pharyngeal muscles?

Answer 66

Superior pharyngeal constrictor Middle pharyngeal constrictor Inferior pharyngeal constrictor

Question 67

What is the function of the 3 circular muscles of the pharynx/pharyngeal constrictors?

Answer 67

Constrict walls of the pharynx when swallowing

Question 68

What is the origin of the superior pharyngeal constrictor?

Answer 68

Pterygomandibular raphe which is in the mouth

Question 69

What is the origin of the middle pharyngeal constrictor?

Answer 69

Hyoid bone

Question 70

What is the origin of the inferior pharyngeal constrictor?

Answer 70

Has 2 parts to it Thyropharngeal = thyroid cartilage Cricopharyngeal = cricoid cartilage

Question 71

What is the clinical significance of the inferior pharyngeal constrictor?

Answer 71

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

Question 72

What is the innervation to all of the pharyngeal constrictors?

Answer 72

Vagus nerve (X)

Question 73

Go to the last slide and label image 8:

Answer 73

1 = superior constrictor 2 = middle constrictor 3 = inferior constrictor 4 = oesophagus

Question 74

Where does a pharyngeal pouch/ posteromedial (false) diverticulum form?

Answer 74

Weakness between the 2 parts f the inferior constrictor

Question 75

What are the symptoms of a pharyngeal pouch/posteromedial false diverticulum?

Answer 75

Bad breath Regurgitation of food Choking on fluids Difficulty swallowing

Question 76

What usually causes the pharyngeal pouch?

Answer 76

Failure of the upper oesophageal sphincter to relax or abnormal timing of swallowing So anything increasing the pressure in the Laryngopharynx

Question 77

What are the 3 phases of swallowing ?

Answer 77

Oral Pharyngeal Oesophageal

Question 78

What happens in stage 1 oral phase of swallowing?

Answer 78

Bolus made Bolus compressed against plate and pushed into oropharynx by tongue and soft palate

Question 79

What happens in stage 2 pharyngeal phase of swallowing?

Answer 79

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

Question 80

What happens in stage 3 oesophageal phase of swallowing?

Answer 80

Upper striated muscle of oesophagus and Lower smooth muscle contract

Question 81

How does the type of Dysphagia in stroke patients and patients with a mass in their oesophagus present differently?

Answer 81

Stroke = hard to swallow liquids (poor coordination) Mass = solids harder to swallow

Question 82

What are some common symptoms of Dysphagia?

Answer 82

Coughing and choking Sialorrhoea Recurrent pneumonia Chang invoice/speech Nasal regurgitation (soft palate not raising)

Question 83

What is affected if Glossopharyngeal and vagus nerve damage occurs?

Answer 83

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

Question 84

What can damage cranial nerves IX and X?

Answer 84

Medullary infarct Jugular foramen issue

Question 85

What can happen with a Hypoglossal nerve (XII) damage?

Answer 85

Wasted tongue Lick your wounds, tongue deviates to damaged side, since other muscle is functional