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Head and neck > Lecture 18- The oral cavity and the pharynx > Flashcards

Lecture 18- The oral cavity and the pharynx Flashcards

1
Q

what separates the nasal cavity from the oral cavity

A

the hard and soft palate

  • Tip of soft palate= uvula
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2
Q

tip of the soft palate is the

A

uvula

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3
Q

how many teeth do we have

A

32

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4
Q

area between the lips and teeth

A

vestibule

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5
Q

where do the tonsils sit

A
  • Palatoglossal and palatopharyngeal arches (Mc Donalds signs)
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6
Q

the tongue has

A

intrinsic and extrinsc muscles

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7
Q

intrinsic muscles of the tongue

A
  • not attached to other muscles except other intrinsic muscles
    • 4 pair muscles
      • Longitudinal (superior and inferior)
      • Transverse
      • Vertical
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8
Q
A
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9
Q

motor innervation of the itnrinsic muscles

A

hypoglossal enrve (CN XII)

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10
Q

extrinsic muscles

A
  • arise from other structures and insert into tongue
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11
Q

extrinsic muscles

A
  • Genioglossus
  • Hyoglossus
  • Styloglossus
  • Palatoglossus
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12
Q

Styloglossus

A
  • Motor innervation: hypoglossal nerve
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13
Q

palatoglossus

A
  • Motor innervation (vagus nerve)
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14
Q

anatomy of the extrinsic muscles

A
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15
Q

sensory supply of the tongue (anterior 2/3)

A
  • Sensation- trigeminal (V3)
  • Taste- facial
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16
Q

posterior 1/3 of the tongue

A
  • Sensation and tase- glossopharyngeal
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17
Q

how many pairs of salivary glands

A

3

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18
Q

salivary glands

A
  • parotid
  • submandibular
  • sublingual
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19
Q
A
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20
Q

where does the parotid lie

A
  • Lies anterior to the SCM and ear
  • Behind the masseter and zygomatic arch
  • Duct opens up in the upper region of the oral cavity- Stenson’s duct (near upper 2nd molar)
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21
Q

submandibular gland

A
  • Most of saliva (60%)
  • Sits under the mandibular in the submandibular triangle
  • Saliva exits the Wharton’s ducts
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22
Q
  • Sublingual
A
  • Under the tongue
  • Produce 3-5% of saliva
  • Smallest and most diffuse of the majority salivary glands
  • 8-20 excretory ducts per gland
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23
Q

Salivary gland stones (sialolithiasis) most commonly found in the

A

submandibular - whartons ducts

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24
Q

causes of salivary stones

A
  • Dehydration, reduced salivary flow
  • Most stoned less than 1cm
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25
Q
  • Symptoms (eating) of sialothiasis
A
  • Pain in gland
  • Swelling
  • Infection
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26
Q

diagnosis of sialolithiasis

A
  • Diagnosis
    • History
    • X-ray
    • Sialogram- contrast dye injected into gland
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27
Q

what is tonsilitis

A

inflammation of the palatine tonsils

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28
Q

Symptoms of tonislitis

A
  • Fever
  • Sore throat
  • Pain/difficulty swallowing
  • Cervical lymph nodes
  • Bad breath
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29
Q

tonsilitis causes

A
  • Viral causes (most common)
  • Bacterial causes (up to 40% of cases)
    • Strep pyogenes
    • White spots
  • Can be bacterial secondary to viral tonisilittis
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30
Q

Peritonsillar abscess

A

Diff to tonsilitis

  • Affects tissue around the tonsil
  • If its unilateral (quinsy)à will deviate the uvula towards the swelling
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31
Q

Symptoms of peritonsilar abscess

A
  • Severe throat pain
  • Fever
  • Bad breath
  • Drooling
  • Difficulty opening mouth
32
Q

when can peritonsillar abscesses occur

A

Severe throat pain

Fever

Bad breath

Drooling

Difficulty opening mouth

33
Q

the pharynx can be split in 3

A

(all exist behind various structures)

  • Nasopharynx
    • Behind nasal cavity
  • Oropharynx
    • Behind oral cavity
  • Laryngopharynx
    • Behind larynx
34
Q

the nasopharynx is the

A

upper pharynx- pink part

35
Q

where is the nasopharynx found

A
  • Behind the nasal cavity
36
Q

borders of the nasopharynx

A
  • Base of skull- upper border
  • C1,C2- posterior border
  • Nasal cavity- anterior border
37
Q

the nasopharynx contains the

A
  • Pharyngeal tonsil e.g. adenoids
38
Q

Pharyngeal tonsil (adenoid)- clinical correlates

*

A
  • Enlarged pharyngeal tonsils
    • Block eustachian tube (recurrent/persistent middle ear infection
    • Snoring/sleep apnoea
    • Sleeping with mouth open
    • Chronic sinusitis
      • Sore throat
    • Nasal tone to voice
39
Q

the oropharynx- middle pharynx

A
  • Yellow part on photo
  • Starts where the nasopharynx end
40
Q

borders of the orpharynx

A
  • Soft palate to epiglottis
  • Anterior- oral cavity
  • Posterior (C2,C3)
41
Q

oropharynx contains the

A

palatine tonsils

42
Q
A
43
Q

coronal view of the pharynx

A
44
Q

the laryngopharynx

A

lower pharynx

45
Q
A
46
Q

borders of the laryngopharynx

A
  • Oropharynx to oesophagus
  • Epiglottis to cricoid cartilage
    • Anterior- larynx
    • Posterior (C4, C5, C6)
47
Q

laryngopharynx contains

A
  • Piriform fossa
48
Q

piriform fossa

A
  • Epiglottis (flap on right photo) acts as a director of flow of fluid and water into the piriform fossa into the oesophagus instead of the trachea
49
Q

General overview of muscle arrangements of the pharynx

A

3- longitudinal muscles

Stylopharyngeus

Palatopharyngeus

Salpingopharyngeaus

They act to shorten and widen the pharynx, and elevate the larynx during swallowing.

50
Q

3 longitudinal muscles

A

elevate pharynx and larynx during swallowing

  • Stylopharyngeus
  • Palatopharyngeus
  • Salpingopharygeus
51
Q

Stylopharyngeus

A
  • Originates from the styloid process and goes down to the posterior border of the thyroid cartilage
  • Innervation- glossopharyngeal nerve (CN IX)
52
Q

Palatopharyngeus

A
  • Originates from the hard palate and extends down to the attach to the posterior border of the thyroid gland
  • Pharyngeal branch of vagus (CN X)
53
Q

Salpingopharyngeaus

A
  • Originates from the cartilaginous part of ET- merges with the palatopharyngeus
  • Pharyngeal branch of vagus (CN X)
54
Q

pharngeal constrictors

A

X3 circular (more semi-circular) muscles all insert on the pharyngeal raphe)

  • Constrict walls of pharynx when swallowing
55
Q

what are the 3 circular muscles

A
  • Superior pharyngeal constrictor
    • Origin – pterygomandibular raphe
  • Middle pharyngeal constrictor
    • Origin- hyoid bone
  • Inferior
    • 2 parts
      • Thyropharyngeal (origin- thyroid cartilage)
      • Cricopharyngeal (origin- cricoid cartilage
  • All supplies by the vagus nerve
56
Q

what do pharngeal constrictures and the pharngeal raphe loop like

A
57
Q

Pterygomandibular raphe

A
58
Q

3 forms of innervation of the pharynx

A
  • pharyngeal plexus
  • motor
  • sensory
59
Q
  • Pharyngeal plexus
A
  • Located mainly on surface of middle constrictor muscle
  • Vagus, glossopharyngeal and cervical sympathetic nerve
60
Q
  • Motor
A
  • CNX -Vagus innervates all muscles
    • Except stylopharyngeus (glossopharyngeal nerve (CN IX)
61
Q
  • Sensory
A
  • Nasopharynx (maxillary nerve CN V2)
  • Oropharynx ( glossopharyngeal nerve CN IX)
  • Laryngopharynx (vagus nerve CNX)
62
Q

Clinical correlates with pharyngeal

A
  • Caused by a posteromedial (false diverticulum)à arises in weakness between the 2 parts of the inferior constrictor (Killians dehiscence)
63
Q

false diverticulum in killians dehiscence is probably caused by

A
  • Failure of UOS to relax
  • Abnormal timing of swallowing
    • Essentially there is a higher pressure in laryngopharynx
      • Weakness in inferior constrictor muscle produces outpouching
64
Q

stage sof swallowing

A

oral

pharngeal

oesophageal

65
Q

outline the oral stage of swallowing (stage 1)

A
  • voluntary
  • prepatory phase- making the bolus
  • transit phase- bolus compressed agaisnt palate nad pushed into oropharynx by tongue and soft palate
66
Q

which nerve is associated with the oral stage

A

hypoglossal CNXII- muscles of the tongue

67
Q

outline the pharyngeal phase of swallowing

A
  • involuntary
  • tongue positioned against the hard palate (food cannot re-enter mouth (CN XII)
  • soft palate elevated sealing off nasopharnx
    • opens ET tubule
  • suprahyoud and longituidnal muscles shorten
    • pharynx widwns and shortens to receive bolus
    • larymx elevated and sealed off by vocal folds
  • epiglottis closes over larynx (result of elevated hyoid)
  • bolus moves throguh pharynx by sequential contraction of constrictors
  • relaxation of the UOS
68
Q
A
69
Q

pharangeal phase is

A

dangerous- shared airway sapce

  • Need to protect airway
    • By shortening longitudinal muscles- elevate larynx and pharynxà widening it
    • Closure of epiglottis (sealing the airway)
70
Q

Oesophageal phase

A
  • involuntary
  • uppder strated muscle of oesophagus (CNX)
  • lower smooth muscle
  • LOS covered in GI unit
71
Q

dysphagia

A

problems swallowing

Neurological conditions makes swallowing liquids harder (solid= more due to obstruction)

72
Q

Signs and symptoms of dysphagia

A
  • Coughing and chocking
  • Sialorrhea (drooling)
  • Recurrent pneumonia
  • Change in voice/speech (wet voice)
  • Nasal regurgitation
73
Q

causess of dysphagia

A
  • Stroke
  • Progressive neurological disease
  • Parkinson’s/MS
  • COPD
  • Dementia
  • 30% of post stroke death are due to pneumonia
    • E.g. aspiration pneumonia
74
Q

dysphagia interventions

A

Fluids are thickened

75
Q

1) cranial nerve problems with dysphagia realted to which CN

A

Intervention

  • Fluids are thickened
  • Absent gag
  • Uvula deviated away from lesion (Lower Motor Neurone lesion)
  • More subtle
    • Dysphagia
    • Taste impairment (posterior tongue IX)
    • Loss of sensation oropharynx
76
Q

Injury to IX/V caused by

A

Medullary infarct, jugular foramen issues (fracture)

77
Q

2) Cranial nerve problems in this area

*

A

XII- hypoglossal

  • Wasted tongue
  • Stick tongue out- tongue may deviated
    • Damage to nerve itself (LMN)- points to side of the lesion (tongue never lies)
    • Muscle wasting
    • Fasciculations

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