Lectures 19, 20, 21 Oral Cavity and Related structures Flashcards
Name the two components of oral cavity
Vestibule & Oral Cavity Proper
Vestibule is behind _____ & _____ & in front of teeth and gums. The part of the vestibule adjacent to lips is _____ ______, that adjacent to cheeks is _____ _____. Together these form a horseshoe shaped troughs called the ______.
lips, cheeks, labial sulcus, buccal sulcus, fornix
Describe the anterolateral boundary of oral cavity proper
Alveolar/dental arches of mandible & maxilla
Describe the posterior boundary of oral cavity proper
Oropharangeal isthmus is a space bounded laterally by palatoglossal folds (extend from soft palate to posterolateral tongue). Folds contain palatoglossal muscle. Palatopharangeal folds are behind palatoglossal folds with the palatine tonsils in between. Palatopharyngeal folds extend from palate to thyroid (cartilage) lamina & contain palatopharangeal muscle.
Describe the roof boundary in the oral cavity proper
Hard palate (palatine process of maxilla & horizontal plate of palatine bone) & soft palate
Describe the floor boundary of the oral cavity proper
Tongue, alveolar lingual sulcus (under tongue), mylohyoid muscle
T/F - Palatoglossal folds are behind palatopharangeal folds with the palatine tonsils in between.
False, palatopharyngeal folds are behind palatoglossal folds
T/F - Palatoglossal folds extend from palate to thyroid (cartilage) lamina and contain palatopharangeal muscle
False, its palatopharyngeal folds that extend from palate to thyroid lamina
T/F - the line of contact between lips is oral fissure/fissure
True
T/F - Labial commisure forms angle of mouth (usually near first premolar)
True
T/F - the order for lips goes from lips -> vermillion border -> mucosa
True
T/F - Much of the substance of the lip is muscle
True
List the muscles of the lip
Orbicularis oris, mentalis, levator labii superioris etc.
T/F - labial salivary glands are superior to muscle
False, they are deep
______ are fibrous bands in vestibule connecting lips to gums.
Frenulae
Median labial frenulae include the larger ___________________ connecting upper lip & gingiva, smaller _______________ connecting lower lip & gingiva. There may also be lateral frenulae, often rudimentary, adjacent to canines or premolars e.g. _______________.
Superior labial frenulum, inferior labial frenulum, buccal frenulum.
Central part of upper lip has a groove - ______
philtrum
________ sulcus - nose to corners of lips
labionasal/nasolabial
________ ________ - horizontal indentation beneath lower lip
Labiomental sulcus/labial groove
__________ - corner of lip to lower border of mandible
Labiomarginal sulcus
_________ - a vertical Y shaped fissure on the chin in both soft tissue & underlying bone. The fissure marks the site of fusion of the mandibular processes which fuse very early in embryonic life. This fusion is less complete if there is cleft. Thought to be a single gene with cleft dominant.
Chin cleft/ cleft chin
________ - an indentation lateral to corner of lip, usually only visible when the individual smiles ( a series of dissections has indicated that this may be due to bifid zygomaticus major)
Cheek dimple
Name blood supply to lips
- Superior & inferior labial arteries (from facial artery)
- superior and inferior labial veins (to facial vein).
Name innervation of lips
- Sensory- upper lip - infraorbital nerve, lower lip - mental nerve,
- motor - facial nerve - buccal and marginal mandibular branches
(Cheeks) skin & mucosa with muscle in between (______, _______, ________, _________) & fat (buccal fat pad)
buccinator, risorius, zygomaticus major, platysma
(Cheeks) mucosa contains ________ ________ ______ _______ mostly deep to buccinator. There are also 4-5 molar glands which are superficial to buccinator & along parotid duct.
small buccal salivary glands
Cheeks have sebaceous glands called _____ _____.
Fordyce spots.
(Gingivae) T/F - fibrous mucosa overlying and loosely attached to alveolar bone.
False, it is firmly attached
(Gingivae) T/F - contains melanocytes which are active in all individuals
False, they are only active in heavily pigmented individuals.
T/F the tongue is partly oral and partly pharyngeal in position - tongue fills oral cavity when mouth is closed.
True
T/F - root of tongue is where internal muscles attach tongue to surrounding structures (hyoid, mandible, styloid processes, soft palate and pharynx.)
False, external muscles
List the 5 surrounding structures that is attached by external muscles of tongue
hyoid, mandible, styloid processes, soft palate & pharynx
(Tongue) Dorsum (upper surface) with palatine (oral/anterior/presulcal) & pharyngeal (posterior/post sulcal) parts with inconspicuous sulcus terminalis & foramen caecum in between. T/F - the two parts have same embryological origins reflected in their same nerve supplies
False, they have separate embryological origins and separate nerve supplies.
T/F - apex is pointed tip of the tongue
True
List the lingual papillae on the dorsal surface of palatine part of tongue
- Fungiform & filiform lingual papilla
- 7-12 circumvallate/vallate papilla just anterior to sulcus terminalis. Associated with serous glands (von Ebner’s glands)
T/F - on dorsal surface of palatine part of tongue, the midline groove/median sulcus continues into tongue asa horizontally oriented fibrous/lingual septum
False, it is a sagittally oriented fibrous /lingual septum
T/F - there are approximately 10 foliate papillae on each side of palatine part of tongue
False, there are 5.
T/F - taste buds are located on fungiform, vallate & foliate as well as in soft palate and epiglottis and filiform
False, there are none on filiform. Taste buds are also reported on all regions of pharynx and even in upper oesophagus
_________ in midline which is an extension of the lingual septum.
Frenulum
_______ lateral to frenulum
Deep lingual veins
________ (mucosal folds of unknown function) lateral to veins
fimbriated folds
________ run on either side of root. ____________ are small elevations on the sublingual folds on either side of base of frenulum with paired openings of submandibular ducts. Sublingual ducts (several per side) are microscopic and mostly open onto sublingual folds.
Sublingual folds, sublingual papillae/caruncles.
T/F - pharyngeal part of tongue stretches from sulcus terminalis to epiglottis
True
In pharngeal part of tongue _____________________ just anterior to epiglottis
valleculae and median and lateral glossoepiglottic folds
Describe lingual tonsils in mucosa of tongue
Elevations which overlie lymphoid nodules. there are mucous salivary glands in the mucosa between and beneath the lymphatic nodules. Each elevation is formed by a single nodule & has an indentation into which the ducts of adjacent mucous glands empty.
T/F - salivary glands of tongue are mostly serous.
False, mostly mucous or seromucous apart from those associated with the vallate papillae (von Ebners glands) which are serous.
List the 4 intrinsic muscles of the tongue
- superior longitudinal
- inferior longitudinal
- vertical
- transverse
Describe the superior longitudinal intrinsic muscle of the tongue
- fibres run in a sagittal orientation from epiglottis to apex of tongue immediately beneath dorsal mucosa
- turns apex up
Describe the inferior longitudinal intrinsic muscle of the tongue
- in the inferior lateral part of the tongue between hyoglossus and genioglossus and fibres extend from lingual root to apex (tip).
- Apex down
T/F - together the superior and inferior longitudinal intrinsic muscle shortens the tongue together
True
Describe vertical intrinsic muscle of tongue
- fascia between dorsum of tongue to fascia of ventral surface
- fibres are oriented vertically
- flatten and widen tongue
Describe the transverse intrinsic muscle of the tongue
- lingual septum to submucosa of the lateral sides of tongue - woven between the superior longitudinal muscle bundles
- vertical elongation and narrower
List the 4 extrinsic muscles of the tongue
- genioglossus
- hyoglossus
- styloglossus
- palatoglossus
Describe the genioglossus extrinsic muscle
- from superior genial tubercle/mental spine to fascia of dorsal tongue. A few of the most posteroinferior fibres are attached to hyoid.
- bilaterally - protrusion or unilaterally - deviate tongue to contralateral side
Describe the hyoglossus extrinsic muscle
- body and greater horn hyoid to fascia at side of tongue
- depresses sides of tongue, sucking/retraction.
Describe the styloglossus extrinsic muscle
- styloid process to side of tongue - intermingles with hyoglossus
- tongue up & back during swallowing, elevate sides
Describe the palatoglossus extrinsic muscle
- palatal aponeurosis to fascia of lateral tongue
- elevates tongue, narrows isthmus
- actually a palatine muscle rather than tongue - NB different innervation to other extrinsic muscles.
T/F - lingual artery is a branch of internal carotid artery
False, it is a branch of external carotid
T/F - lingual artery passes lateral to posterior border of hyoglossus
False, it passes medial
List the branches of lingual artery
- dorsal lingual
- deep lingual
- sublingual
What does dorsal lingual artery supply?
posterior tongue and tonsil
What does deep lingual artery supply?
Anterior tongue
What does sublingual artery supply?
sublingual gland and floor of mouth
List branches of lingual vein
- dorsal lingual
- deep lingual
- sublingual
T/F - lingual vein is often a tributary of internal jugular
True
What does dorsal lingual vein drain?
dorsum and sides of tongue
What does deep lingual vein drain?
Ventral tongue (seen through ventral mucosa)
What does sublingual vein drain?
Sublingual salivary gland
T/F - tributaries join to form lingual vein deep to hyoglossus and then to external jugular vein
False, internal jugular vein
Describe general sensation innervation of anterior tongue
- General sensation - lingual nerve (v3)
Describe special sensation innervation of anterior tongue
- taste buds (except on vallate papillae) - chorda tympani - branch of facial nerve (CN7) travelling with lingual nerve.
Describe innervation of posterior tongue
- general and special sensation - glossopharyngeal (CN9) and vagus (CN10)
Describe innervation of taste buds of vallate papillae
- glossopharyngeal (vallate papillae arise from posterior tongue precursors & migrate anteriorly during development taking their nerve supply with them.
Describe innervation of intrinsic & extrinsic muscle
migrates into tongue later in development - hypoglossal (except palatoglossus which is supplied by pharyngeal plexus)
Describe innervation of intrinsic salivary glands
parasympathetic supply from chorda tympani
Describe innervation of blood vessels in tongue
(vasomotor) - sympathetic supply from plexuses on lingual arteries
List the lymph drainage of tongue
- superior and inferior deep cervical nodes & submandibular nodes
Describe innervation of maxillary gingivae
- outer/buccal/labial gingivae - maxillary nerve - gingival branches of anterior (over incisors and canines), middle (over premolars) & posterosuperior alveolar branches (over molars).
- inner/lingual/palatine gingivae - greater palatine, nasopalatine
Describe innervation of mandibular gingivae
- outer/buccal/labial - sensory buccal branches of mandibular nerve to level first molar (with contributions from inferior alveolar branches - probably variable - also depends on source consulted), mental nerve (over incisors & canines)
- inner/lingual - lingual
Describe innervation of epiglottis and aryepiglottic folds
Vagus nerve
Describe innervation of soft palate
Facial nerve (but via greater petrosal and lesser palatine nerves, NOT chorda tympani)
T/F - palate separates oral cavity from nasal cavities
True
T/F - hard palate’s transverse ridges rugae posteriorly, smooth anteriorly
False, smooth posteriorly, rugae anteriorly
T/F - soft palate has a midline elevation - raphe (sometimes called a torus if enlarged)
False - hard palate
T/F - Hard palate is made up of palatine process of palatine bone, horizontal plate of maxilla
False - it is made up of palatine process of maxilla, and horizontal plate of palatine bone
T/F - hard palate has an incisive papilla at posterior end of raphe overlying incisive canal
False, it is at anterior end
What is the hamular notch?
hamular notch (pterygomaxillary notch) is the notch between the maxillary tuberosity and hamulus of sphenoid bone. An important landmark when making impressions for dentures (dentures should end at the hamular notch and not extend over hamulus)
(Hard palate) thick mucosa is covered with __________________________ epithelium, tightly bound to periosteum at ______ & on _____. Between these regions, there is a softer submucosa with mainly ______ tissue anteriorly and mainly ______ ______ posteriorly.
Where submucosa is present: - mostly _____ anteriorly
- predominantly ______ ____ posteriorly .
Many (? all) of these ducts empty on each side into a single large duct which then opens into a _____ (an indentation 2-3mm in diameter). ____ are on either side of the raphe approximately at the junction of hard and soft palate.
keratinised stratified squamous, median raphe, gingivae, adipose, mucous glands, adipose, glandular tissue, fovea, fovea
(Soft palate)
____________ epithelium on inferior oral surface with taste buds, _______ ____ on upper nasal surface. Within are ___________ glands, _____ aponeurosis and muscle.
- posterior are _____, _________ arches
- lateral are _______ & _______ raphe
non-keratinized stratified squamous, respiratory mucosa, palatine mucous, palatal, uvula, palatoglossal, hamulus, pterygomandibular
Describe palatine aponeurosis
- a thin fibrous sheet in inferior soft palate,
- attached to posterior hard palate
- thicker anteriorly
- consists of the expanded tendons of tensor palati, other palatine muscles are attached to aponeurosis.
