Oral And Nasal Cavities, Sinuses, And Pterygopalatine Fossa Flashcards
What is the shallow midline sulcus between nose and upper lip?
Philtrum
What is the portion of lips that is due to thin epithelium and extensive underlying capillary network?
Red margin
What are the midline folds of mucosa which extend between inside of lips to gingivae?
Upper and lower labial frenulae
Describe lymph drainage of lips
Directly into submental and submandibular (pericervical) lymph nodes
Then into deep cervical nodes
What is the recess between cheeks and gums?
Vestibule
Describe the histology of the skin of the cheek
Keratinzed stratified squamous epithelium
What innervates the skin and mucosa of the cheek?
Buccinator nerve (V)
What innervates the buccinator muslce?
Facial nerve (VII)
What pierces the buccinator muscle?
Parotid duct
Where is the orifice of the parotid duct?
Loacted on inner cheek opposite crown of second upper molar
What is the histology of the mucosa of the cheek?
Non-keratinized stratified squamous epithelium
What are formed by mucosa which is firmly attached to underlying alveolar portion of maxilla and mandible by dense fibrous connective tissue?
Gingivae (gums)
What is the midline mucosal fold that extends between floor of mouth to inferior surface of tongue?
Frenulum of tongue
What is a small ridge of mucosa which located bilaterally on floor of mouth?
Sublingual fold or plica
Has numerous small openings for sublingual ducts along crest
What is located at the antero-medial end of the sublingual fold?
Sublingual caruncle or papilla
Where does the orifice of submandibular duct open?
Apex of sublingual caruncle
The lingual nerve spirals from superior-lateral to inferior-medial around what?
Submandibular (Wharton’s) duct
Describe relationships of submandibular duct to other structures
Submandibular duct will be above lingual nerve
Sublingual gland will be lateral to submandibular duct
Describe where the hypoglossal nerve enters in the sublingual region
Hypoglossal nerve enters more posterior and deeper than lingual n/submand duct/sublingual gland
It is closely adherent to hypoglossus muscle
Describe the relationship of the sublingual gland to other structures in the floor of the mouth
Sublingual gland is flattened between mandible and genioglossus/geniohyoid musles
Sublingual gland rests on superior surface of mylohyoid
Submandibular duct crosses medial side of sublingual gland
Lateral side is relatively free of nerves and vessels
Describe ducts of sublingual gland
12 small sublingual duct (Bartholin’s) per side
They have minute opening along crest of sublingual fold
What is the blood supply of the sublingual gland?
Sublingual branch of lingual artery
Describe parasympathetic innervation to sublingual gland
Preganglionic parasympathetic fibers from superior salivatory nucleus exit brainstem with facial nerve (VII)
Travel through chorda tympani
Join with lingual nerve before terminating in submandibular ganglion
Postgangionic parasympathetic fibers from submandibular ganglion distribute numerous short branches to sublingual gland
Describe sympathetic innervation to sublingual gland
Postganglionic sympathetic fibers originate in superior cervical ganglion
They reach the sublingual gland by coursing in external carotid and facial plexuses in adventitia of respective arteries
They can also reach the sublingual gland via sublingual plexus which courses in adventitia of sublingual branch of lingual artery
Summarize innervation of tongue
Anterior 2/3: V (GSA) and VII (SVA)
Posterior 1/3: IX (GVA and SVA)
Intrinsic muscles: XII (GSE)
Describe sulcus terminalis
V-shaped furrow which extends from foramen cecum (at midline apex) to palatoglossal folds (laterally)
Hypoglossal nerve innervates all extrinsic and intrinsic muscles of the tongue except for what? What innervates this one?
Palatoglossus
Vagus via pharyngeal plexus
What extends from lateral corner of nose to angle of mouth? Clinical reference?
Nasolabial sulcus
Unilateral diminution or absence of sulcus may indicate neurological disorder
Describe paralysis of the tongue
Unilateral hypoglossal palsy results in paralysis, atrophy, and fasciculations of intrinsic muscles of the tongue
When protruded, normal gengioglossus deviates tongue towards affected side
Bilateral paralysis may cause airway obstruction (dyspnea), dysarthria, and dysphagia
Describe lymphatic drainage of the tongue
Drain into deep cervical lymph nodes
- jugulodigastric
- juguloomohyoid
What innervates the tensor veli palatini muscle?
Mandibular nerve (V)
What innervates the levator veli palatini muscle?
Vagus (X) via the pharyngeal plexus
Describe paralysis of the tensor or levator palate
Allows muscles on non-paralyzed side to pull or deviate the uvula towards the normal side
What gives rise to the greater and lesser palatine arteries?
Descending palatine artery (branch of sphenopalatine artery)
What is the intrinsic muslce of the soft palate that forms part of the midline uvula? Innervation?
Muscularis uvulae muscle
Vagus (X)
What is the frequent bleeder during a tonsillectomy?
Tonsillar vein
Describe lymphatic drainage from palatine tonsil
Directly into jugulodigastric (tonsillar) nodes
What make up the upper portion of the nose?
Frontal, maxillae, and nasal bones
What make up the lower portion of the nose?
Septal and alar cartilages
What make up the nasal septum?
Septal cartilage
Perpendicular plate of ethmoid
Vomer
Where do fractures of the nose frequently occur?
At junction between septal cartilage and ethmoid & vomer bones.
Cartilaginous fragments may telescope posteriorly
What is the respiratory region of the nasal cavity covered by?
A tightly adherent mucoperiosteum and mucoperichondrium
Where does the the sphenoidal sinus drain into?
Sphenoethmoidal recess
Where is the sphenoethmoidal recess? Sphenopalatine foramen?
Spehnoethmoidal recess: postero-superior to superior concha
Sphenopalatine foramen: posterior to superior concha in submucosa
What forms a bony eminence overlying the middle ethmoidal air cells?
Ethmoidal bulla
What is the crescent-shaped trough located anterior and inferior to ethmoidal bulla?
Hiatus semilunaris
Where do the frontal and anterior ethmoidal sinuses drain into? Where is this?
Ethmoidal infundibulum
Located in anterosuperior portion of hiatus semilunaris
If the frontal sinuses drain through a separate opening besides the ethmoidal infundibulum and is anterior to the hiatus semilunaris, this is called ___
Frontal recess
Where is the nasolacrimal duct?
Located in inferior meatus, posterior to anterior edge of concha
What supplies the posterior 2/3 of the nasal cavity?
Branches of the sphenopalatine artery
What supplies the anterior 1/3 of the nasal cavity?
Anterior ethmoidal artery
What is the importance of Kiesselbach’s area?
This region is where septal branches of superior labial and sphenopalatine arteries meet
The majority of nasal hemorrhages (epistaxis) occurs at this junction
What innervates the posterior 2/3 of the nasal cavity?
Branches of the sphenopalatine/pterygopalatine ganglion
What innervates the anterior 1/3 of the nasal cavity?
Anterior ethmoidal nerve (branch of nasociliary nerve (V))
What branch of the pterygopalatine ganglion courses diagonally beneath septal mucosa and innervates mucosa of gingiva and hard palate in area of upper incisors?
Nasopalatine nerve
Where is the pharyngeal tonsil is located where and is called what when it hypertrophies?
Located in roof of nasopharynx
Called adenoid, which can obstruct auditory tube or nasopharynx
What is the cartilaginous eminence above the opening of the auditory tube?
Tonus tubarius
What is the function of the levator veli palatini?
Elevator of soft palate
What is the function of the tensor veli palatini?
Tenses soft palate and opens auditory tube
What is the mucosal fold located between the anterior part of the torus and palate and contains no underlying muscle?
Salpingopalatine fold
What is the mucosal fold that extends between the posterior part of the torus and pharyngeal wall and is formed by underlying muscle?
Salpingopharyngeal fold
What is located posterior to the torus tubarius and may contain a tubal tonsil?
Pharyngeal recess
What causes many of the facial changes of childhood?
Growth of sinuses and development of dentition
What does the medial wall of the maxillary sinus form?
Lateral wall of nasal cavity
What does the roof of the maxillary sinus form?
Floor of the orbit
What is the maxillary sinus floor a part of, and what forms elevations in the floor? Clinical relevance?
Part of alveolar portion of maxilla
Elevations are formed by first and second molars
Due to close relationship, maxillary sinusitis may be associated with a toothache of first or second molars
What does the posterior wall of maxillary sinus form?
Anterior wall of pterygopalatine fossa and infratemporal fossa
Describe drainage of maxillary sinus
Drains by ciliary action, gravity, and negative pressure into one or more openings into hiatus semilunaris
Describe the transmaxillary approach for surgery
Superior: orbit Inferior: molar teeth of maxilla Posterior: pterygopalatine fossa Infraorbital neurovascular bundle Palatal neurovascular bundle (descending palatine artery, greater & lesser palatine arteries & nerves)
Describe where the anterior, middle, and posterior ethmoidal cells open into
Anterior: into anterior part of hiatus semilunaris
Middle: onto surface of bulla ethmoidalis
Posterior: into superior meatus
What is the frontal sinus regarded as?
Displaced anterior air cells which have invaded frontal bone
What does the frontonasal duct drain into?
Into either ethmoidal infundibulum
Or frontal recess of middle meatus
Describe the sphenoidal sinus
Cube-shaped sinus located in body of sphenoid with extensions into greater wings or pterygoid processes
Drains into sphenoethmoidal recess
What is posterior to sphenoidal sinus?
Pons
Basilar artery
What is superior to the sphenoidal sinus?
Pituitary
What is anterior to sphenoidal sinus?
Nasal cavity
What is inferior to the sphenoidal sinus?
Nasopharynx
What is lateral to the sphenoidal sinus?
Internal carotid
V1
Cavernous sinus
Describe the pterygopalatine (sphenopalatine) ganglion
Attached to maxillary nerve (V2) in fossa
Branches: vidian nerve (nerve of pterygoid canal), lesser & greater palatine nerves, nasopalatine nerve
Describe the vidian nerve (nerve of pterygoid canal)
Formed by merging of deep petrosal and great petrosal nerves
Conveys postganglionic sympathetic, GVE parasympathetic, and GVA to ptergyopalatine ganglion
Describe the lesser and greater palatine nerves
Largest branches of pterygopalatine ganlgion Convey GSA (V2), GVA( VII), GVE parasympathetic, postganglionic sympathetic fibers to mucosa of inferior surface of soft and hard palate, respectively
Describe innervation through pterygopalatine ganglion
Preganglionic (GVE) parasympathetic fibers originate in superior salivatory nucleus and synapse in pterygopalatine ganglion
Postganglionic parasympathetic fibers supply lacrimal gland
