Oral Cavity Flashcards

The tongue papillae is discussed in details in the histology of the oral cavity.

1
Q

The oral cavity (commonly called mouth) represents the first part of the digestive tube, serving as the entrance of the alimentary canal and initiating the digestive process by salivation and propulsion of the alimentary bolus into the pharynx. State other functions of the oral cavity.

A
  1. Secondary respiratory conduit.
  2. Site of sound modification for the production of sound.
  3. A chemosensory organ.
  4. [Diagram: Anatomy of Oral Cavity]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

State the extents of the oral cavity.

A

Anteriorly: at the lips (through the oral fissure to the face)
Posteriorly: oropharyngeal isthmus/isthmus of the fauces
[Diagram]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The oral cavity is divided into 2 parts by the upper and lower dental arches (formed by the teeth and their bony scaffolding). Name them.

A

☞ Vestibule of the mouth
☞ Oral cavity proper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What forms the:
(a) roof of the oral cavity?
(b) lateral walls of the oral cavity?
(c) floor of the oral cavity?

A

(a) palate
(b) cheeks
(c) diaphragma oris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The vestibule is bound externally by the lips and the cheeks, and internally by the gums and teeth. The entire vestibule is lined by mucous membrane except the teeth. When the mouth is closed, the vestibule communicates on each side with the oral cavity proper through a small gap behind the 3rd molar tooth and ramus of mandible called ______________________.

A

retromolar region
[Figure 1]
[Figure 2] [Figure 3] [Figure 4]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the clinical significance of the gap located in the back of the lower vestibule [retromolar space]?

A

instrumentation during dental procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Lips
They are musculofibrous folds that surround the oral fissure (aperture). There are the external (skin) and internal (mucous membrane) surfaces of the lips. Click on the image in the Answer section to appreciate some of the parts of the lips.

A

[Image]

Further notes:
☞ The red hue on the vermillion zone is due to rich vascular bed visible through the thin moist epithelium.
☞ The internal aspect of each lip is connected to the corresponding gum by a median fold of the mucous membrane called frenulum of the lip.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List the structures in the lip from superficial to deep.

A
  1. Skin.
  2. Superficial fascia.
  3. Orbicularis oris muscle.
  4. Submucosa containing mucous glands.
  5. Mucous membrane.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the blood supply and lymphatic drainage of the lips.

A

Blood Supply
Each lip is supplied by labial branches of facial artery. Each lip has an arterial arch formed by the end-on anastomosis between labial branches of the facial arteries. When this arterial arch is cut, blood spurts from both ends with equal force. The veins correspond to the arteries and drain into the facial vein.

Lymphatics
☞ The lymphatics from the central part of the lower lip drain into submental lymph nodes.
☞ The lymphatics from lateral parts of lower lip and whole of upper lip drain into submandibular lymph nodes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the nerve supply of the lips.

A

☞ The lips have rich sensory supply from trigeminal nerve.
☞ The upper lip is supplied by labial branches of the infraorbital nerve (a branch of the maxillary division) and lower lip by the mental nerve (a branch of the inferior alveolar nerve, which is a branch of the posterior division of the mandibular division).
☞ The red portions of lip are highly sensitive and represented by a large area in the sensory cortex of cerebral hemisphere.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List the 7 layers of the cheek from superficial to deep.

A
  1. Skin.
  2. Superficial fascia containing some muscles of facial expression, viz. zygomaticus major, risorius.
  3. Buccal pad of fat.
  4. Buccopharyngeal fascia.
  5. Buccinator muscle between the alveolar processes of both jaws.
  6. Submucosa containing buccal (mucus) glands.
  7. Mucus membrane.

Further notes:
☞ The last five layers of the cheek are pierced by the parotid duct.
☞ The lymphatics from the cheek drain into the submandibular and preauricular lymph nodes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The gums are composed of fibrous tissue covered with a smooth vascular mucous membrane. They envelop the alveolar processes of the jaws and the necks of the teeth. At the necks of the teeth, the fibrous tissue of gum becomes continuous with the periodontal membrane, which attaches the teeth to their sockets. The gum/gingiva has 3 parts. Name them.

A
  1. Free part (free gingiva), which surrounds the neck of tooth like a collar.
  2. Attached part (attached gingiva), which is firmly attached to the alveolar process.
  3. Interdental part (interdental gingiva), which is the extension of the attached gingiva between the teeth.
  4. [Image]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

The oral cavity proper has a roof and a floor. Posteriorly the oral cavity communicates with the oropharynx through oropharyngeal isthmus (also called isthmus of fauces). Boundaries of the oropharyngeal isthmus?

A

Superiorly: Soft palate
Inferiorly: Dorsal surface of the pharyngeal part of tongue
Laterally (on each side): Palatoglossal arches

[Diagram]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Necessities of the palatoglossal arches?

A

The approximation of these arches shuts off the mouth from oropharynx and is essential to deglutition.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Click on Answer to view a diagram showing the floor of the oral cavity. Appreciate the lingual frenulum, sublingual papilla and sublingual fold.

A

[Diagram 1] [Diagram 2]

Further notes:
☞ The sublingual papilla is the opening of the submandibular duct. Where is the parotid papilla located?
☞ Many structures in the oral cavity are termed by their relationship to the tongue, palate, cheeks, and lips. The structures closest to the tongue are termed ‘lingual’. Those closest to the palate are termed ‘palatal’. Those closest to the cheeks are termed ‘buccal’. And those closest to the lips are termed ‘labial’.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Ludwig’s angina?

A

Ludwig’s angina is a cellulitis of the floor of the mouth, usually due to infection from a carious molar tooth, causing inflammatory edema of the floor of the mouth. It spreads to the submandibular and submental regions producing diffuse swelling in these regions also. The tongue is pushed upwards due to edema of the floor of the mouth, resulting in difficulty in swallowing.

[Diagram]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

The paralingual space is found in the floor of the mouth. State its boundaries.

A

mylohyoid muscle, lateral margin of the tongue, hyoid bone, and oral mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

State the contents of the paralingual space. What is its clinical significance?

A
  1. Sublingual gland.
  2. Lingual nerve.
  3. Submandibular duct.
  4. Deep lingual vein.
  5. Lingual artery.
  6. Lymph nodes.

The mylohyoid line divides the floor of the mouth into a submandibular space below and a paralingual space above the line.

[11 minute video: Dissection of Paralingual Space]

Clinical significance: spread of infections to other spaces that it communicates with, tumours affecting structures there, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

(a) The posterior part of the tongue forms the ________________ wall of the oropharynx.
(b) The tongue is separated from the teeth by a deep ________________ sulcus, which is filled by palatoglossal fold/arch posterior to the last molar tooth.

A

(a) anterior
(b) alveololingual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Features on the oral part of tongue?
Features on the pharyngeal part of tongue?

A

Features on the oral part of tongue:
1. A median furrow, representing the bilateral origin of the tongue.
2. Large number of papillae.

Features on the pharyngeal part of tongue:
1. A large number of lymphoid follicles, which together constitute the lingual tonsil.
2. A large number of mucus and serous glands.

Note:
The furring or coating of tongue bears no relation to digestive disturbances as generally thought, but is usually due to smoking, respiratory tract infection, fever, or oral infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Click on Answer to view linked images and diagrams the of topography of the tongue.

A

[1] [2] [3] [4] [5] [6]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

The musculature of tongue consists of intrinsic and extrinsic muscles.
List the intrinsic muscles of the tongue, stating the locations and actions.

A
  1. Superior longitudinal
    Location: Beneath the mucous membrane.
    Actions:
    ☞ Shortens the tongue
    ☞ Makes the dorsum concave
  2. Inferior longitudinal
    Location: Close to inferior surface between genioglossus and hyoglossus
    Actions:
    ☞ Shortens the tongue
    ☞ Makes the dorsum convex
  3. Transverse
    Location: Extends from median septum to the margin
    Action: Makes the tongue narrow and elongated
  4. Vertical
    Location: At the border of the anterior part of the tongue
    Action: Make the tongue broad and flattened.
  5. [Diagram] [Diagram 2]
  6. [3-minute Video]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Genioglossus
1. Origin
2. Insertion
3. Action

A
  1. Origin: Superior genial tubercle
  2. Insertion:
    ☞ Whole of the tongue (fibres radiate from the tip to the base)
    ☞ Hyoid bone (lowest fibres)
  3. Action: Protrusion of tongue
  4. [Diagram]

Note: The extrinsic muscles of the tongue of both sides act together for example genioglossus muscle of both sides, etc.

24
Q

Hyoglossus
1. Origin
2. Insertion
3. Actions

A
  1. Origin: greater cornu and adjacent part of the body of hyoid [Diagram: hyoid bone]
  2. Insertion: side of tongue (posterior half) between styloglossus laterally and inferior longitudinal muscle medially.
  3. Actions:
    ☞ Depresses the sides of the tongue
    ☞ Makes the dorsal surface convex
  4. [Diagram]
25
Q

Styloglossus
1. Origin
2. Insertion
3. Action

A
  1. Origin: Tip of styloid process and adjacent part of the stylohyoid ligament
  2. Insertion: Side of tongue (whole length), interdigitating posteriorly with the fibres of hyoglossus
  3. Action: Elevates and retracts the tongue
  4. [Diagram]
26
Q

Palatoglossus
1. Origin
2. Insertion
3. Actions

A
  1. Origin: Oral surface (inferior surface) of palatine aponeurosis of palate
  2. Insertion: Side of tongue (at the junction of its oral and pharyngeal parts)
  3. Actions:
    ☞ Pulls up the root of the tongue
    ☞ Approximates palatoglossal arches to close the oropharyngeal isthmus
  4. [Diagram 1] [Diagram 2]

Note:
The right and left palatoglossus muscles create ridges in the lateral pharyngeal wall, referred to as the palatoglossal arches (anterior faucial pillars). These pillars separate the oral cavity and the oropharynx — the muscle functions as an antagonist to the levator veli palatini muscle.

The levator veli palatini is a muscle of the soft palate. Its primary function is to elevate the soft palate during swallowing, helping to prevent food from entering the nasopharynx. It is innervated by the pharyngeal branch of the vagus nerve.

27
Q

What muscles produce the following movements of tongue:
1. Protrusion (most important movement)
2. Retraction
3. Depression
4. Elevation (of posterior one-third)
5. Changes in shape

A
  1. Protrusion (most important movement): Genioglossus muscles (of both side acting together)
  2. Retraction: Styloglossus muscles (of both sides acting together)
  3. Depression: Hyoglossus muscles (of both sides acting together)
  4. Elevation (of posterior one-third): Palatoglossus muscles (of both sides acting together)
  5. Changes in shape: Intrinsic muscles
28
Q

Which is the safety muscle of the tongue? Why is it called this?

A

Genioglossus.
Reason: The two genioglossi form the bulk of the tongue and are responsible for the protrusion of the tongue. If these muscles are paralyzed, the tongue will fall back into the oropharynx and obstruct the air passage causing choking and death. For the same reason during anesthesia, the tongue is pulled forwards to clear the air passage.

29
Q

The genioglossi are commonly used for clinical testing of the hypoglossal nerve. Explain.

A

The muscles of both sides acting together protrude the tongue whereas one muscle acting alone deviates the tongue to the opposite side. Therefore, when patient is asked to protrude his tongue, the tongue deviates to the paralyzed side (i.e., the side of lesion of the hypoglossal nerve).

30
Q

State the arterial supply of the tongue.

A
  1. Branches of lingual artery (chief artery of tongue); the deep lingual arteries to the anterior part [they are from which part of the lingual artery?] and dorsal lingual arteries [from which part of the lingual artery?] to the posterior part.
  2. Tonsillar branch of the facial artery
  3. Ascending pharyngeal artery
  4. [Video: lingual artery]: starts from 3:23
  5. [Diagram]: cervical and facial branches of the facial artery

Further notes:
The deep lingual artery anastomoses with its fellow of the opposite side near the tip of the tongue. It is the only significant anastomoses across the midline of the tongue.

31
Q

State the venous drainage of the tongue.

A

(a) Deep lingual vein is the principal vein of the tongue and is visible on the inferior surface of the tongue near the median plane through thin mucous membrane in life. [Diagram]
(b) Venae comitantes accompanying the lingual artery. They are joined by dorsal lingual veins.
(c) Venae comitantes accompanying the hypoglossal nerve.
[Diagram]

These veins unite at the posterior border of the hyoglossus to form the lingual vein, which drains into either common facial vein or internal jugular vein.

32
Q

Describe the lymphatic drainage of the tongue.

A

The lymphatics emerging from the tongue are grouped into the following four sets:
(1) Apical vessels: They drain the tip and inferior surface of the tongue into submental lymph nodes after piercing the mylohyoid muscle. Their efferents go to the submandibular nodes mainly, some cross the hyoid bone to reach the jugulo-omohyoid nodes.
(2) Marginal vessels: They drain the marginal portions of the anterior two-third of the tongue—unilaterally into submandibular lymph nodes and then to the lower deep cervical lymph nodes, including jugulo-omohyoid.
(3) Central vessels: They drain the central portion of the anterior two-third of the tongue (i.e., area within 0.5 inch on either side of midline). They pass vertically downwards in the midline of the tongue between the genioglossus muscles and then drain bilaterally into the deep cervical lymph nodes.
(4) Basal vessels: They drain the root of the tongue and posterior one-third of the tongue bilaterally into upper deep cervical lymph nodes, including jugulodigastric.
[Diagram]

33
Q

Describe the nerve supply of the tongue. [motor and sensory]

A

Motor supply: All the muscles of tongue (intrinsic and extrinsic) are supplied by the hypoglossal nerve except palatoglossus which is supplied by superior laryngeal branch of CN X.
Sensory supply:
Anterior two-third of the tongue is supplied by:
(a) lingual nerve carrying general sensations, and
(b) chorda tympani nerve carrying special sensations of taste.
Posterior one-third of the tongue is supplied by:
(a) glossopharyngeal nerve, carrying both general and special sensations of taste, and
(b) posteriormost part (base of the tongue), supplied by the internal laryngeal branch of the superior laryngeal nerve carrying special sensations of taste.

34
Q

What is the anatomical basis of the pattern of innervation to the tongue?

A

Different embryological origins of development of the mucosa of tongue (ant. 2/3 from 1st and 2nd branchial arch and posterior 1/3 from largely 3rd and 4th branchial arches) and musculature of tongue from occipital myotomes.

35
Q

The roof of the oral cavity proper has two components, which are?

A

the bony hard palate (anterior four-fifth) and the musculofibrous soft palate (posterior one-fifth).

36
Q

Name the two bones that form the hard palate.

A

Palatine processes of the maxillae
Horizontal plates of the palatine bones
[Diagram]

37
Q

List the features on the inferior surface of the hard palate. If foramina are mentioned, state the contents passing through them.

A

(a) Incisive fossa, into which open the incisive canal/foramen.
Structures passing through the incisive canal:
☞ Terminal parts of the nasopalatine nerve [branch of the maxillary nerve]
☞ Greater palatine vessels [branch of descending palatine artery]
(b) Greater palatine foramen
Structures passing through:
☞ Greater palatine neurovasculature
(c) Lesser palatine foramina
☞ Lesser palatine neurovasculature
(d) Posterior nasal spine.
(e) Palatine crest
(f) Masticatory mucosa. It presents:
transverse masticatory ridges on either side of mid-line, and
palatine raphe, a narrow ridge of mucous membrane extending anteroposteriorly in the midline from a little papilla overlying the incisive fossa.
(g) Intermaxillary suture

[Diagram 1] [Diagram 2] [Image]

Note:
The hard palate is lined by stratified squamous keratinised epithelium.

38
Q

State the arterial supply and venous drainage of the hard palate.

A

Arterial supply: Greater palatine arteries from the 3rd part of maxillary artery. Each artery emerges from greater palatine foramen and passes forwards around the palate (lateral to the nerve) to enter the incisive canal and pass up into the nose.
Venous drainage: The veins of hard palate drain into the pterygoid venous plexus (mainly) and pharyngeal venous plexus.

39
Q

State the nerve supply and lymphatic drainage of the hard palate.

A

Nerve supply: By greater palatine and nasopalatine nerves derived from pterygopalatine ganglion. The greater palatine nerve supplies whole of the palate except anterior part of palate behind incisor teeth (the area of premaxilla), which is supplied by nasopalatine nerves.
Lymphatic drainage: The lymphatics from the palate drain mostly into the upper deep cervical lymph nodes and few into retropharyngeal lymph nodes.

40
Q

The soft palate is a mobile muscular flap, which hangs down from the posterior border of the hard palate into the ____________ cavity like a curtain or velum. It separates the nasopharynx from oropharynx.

A

pharyngeal

[Image]: uvula, patalopharyngeal arch, palatine tonsils, palatoglossal arch
[Diagram]

41
Q

The soft palate consists of five pairs of muscles. List them. Which of the five is intrinsic?

A
  1. Tensor palati (tensor veli palatini)
  2. Levator palati (levator veli palatini)
  3. Palatoglossus
  4. Palatopharyngeus
  5. Musculus uvulae - intrinsic
  6. [Diagram: Muscles of Soft Palate]
42
Q

Tensor palati (thin triangular muscle)
1. Origin
2. Insertion
3. Actions
4. Innervation

A
  1. Origin: Scaphoid fossa of sphenoid bone; fibrous part of pharyngotympanic tube (lateral side of PTT); spine of sphenoid
  2. Insertion: Muscle descends, converges to form a tendon, which hooks around the pterygoid hamulus and then expands to form the palatine aponeurosis for attachment to:
    * Posterior border of the hard palate
    * Inferior surface of the hard palate behind the palatine crest
  3. Actions:
    ☞ Tenses the soft palate
    ☞ Opens the pharyngotympanic tube
  4. Innervation: Mandibular nerve [V3] via the branch to medial pterygoid muscle
  5. [7-minute video: the veli palatini muscles]
  6. [Diagram]
43
Q

Levator veli palatini/Levator palati
1. Origin
2. Insertion
3. Actions
4. Innervation

A
  1. Origin: (a) Medial aspect of the cartilaginous part of the pharyngotympanic tube
    (b) Adjoining part of the petrous temporal bone (inferior surface of its apex anterior to carotid canal)
  2. Insertion: Superior surface of palatine aponeurosis
  3. Actions:
    ☞ Only muscle to elevate the soft palate above the neutral position to close the pharyngeal isthmus.
    ☞ Opens the pharyngotympanic tube.
  4. Innervation: Vagus nerve [X] via pharyngeal branch to pharyngeal plexus
  5. [7-minute video: the veli palatini muscles]
44
Q

Palatopharyngeus [consists of two fasciculi, which are separated by the levator palati]
1. Origin
2. Insertion
3. Actions
4. Innervation

A
  1. Origin: (a) Anterior fasciculus: from posterior border of the hard palate
    (b) Posterior fasciculus: from superior surface of palatine aponeurosis
  2. Insertion: median fibrous raphe of pharyngeal wall [a connective tissue band along the posterior pharyngeal wall]
  3. Actions:
    ☞ elevates pharynx (during swallowing)
    ☞ moves palatopharyngeal arch toward midline
    ☞ depresses soft palate
  4. Innervation: Vagus nerve [X] via pharyngeal branch to pharyngeal plexus
  5. [Diagram 1] [Diagram 2] [Diagram 3]

Further notes:
As palatopharyngeus descends along the pharyngeal wall from its origin, it forms a notable projection called the palatopharyngeal arch. This arch is located posteriorly to the palatoglossal arch and anteriorly to the palatine tonsil.

45
Q

Musculus uvulae
[a longitudinal muscle strip, one on either side of the median plane within the palatine aponeurosis]
1. Origin
2. Insertion
3. Actions
4. Innervation

A
  1. Origin: Posterior nasal spine of hard palate
  2. Insertion: Connective tissue of uvula
  3. Actions:
    ☞ Elevates and retracts uvula
    ☞ Thickens central region of soft palate
  4. Innervation: Vagus nerve [X] via pharyngeal branch to pharyngeal plexus
46
Q

State the functions/role of the soft palate.

A

(1) Separates the oropharynx from nasopharynx during swallowing so that food does not enter the nose.
(2) Helps to modify the quality of voice, by varying the degree of closure of the pharyngeal isthmus.
(3) Prevents the damage of nasal mucosa during sneezing, by appropriately dividing and directing the blast of air through both nasal and oral cavities.
(4) Prevents the entry of sputum into nose during coughing by directing it into the oral cavity.
[Diagram]: Soft palate

47
Q

What is the clinical picture of a patient with palatal paralysis?

A

The paralysis of the muscles of soft palate (due to lesion of vagus nerve) produces:
☞ nasal regurgitation of liquids,
☞ nasal twang in voice,
☞ flattening of the palatal arch on the side of the lesion,
and
☞ deviation of uvula, opposite to the side of the lesion.

[21-second video: Patient with paralysis of muscles of soft palate]: also in the video, notice the deviation of the patient’s uvula to the left

48
Q

State the arterial supply, venous drainage and lymphatic drainage of the soft palate.

A

Arterial supply:
1. Lesser palatine branches of the maxillary artery.
2. Ascending palatine branch of the facial artery.
3. Palatine branches of the ascending pharyngeal artery.

Venous drainage: The venous blood from palate is drained into pharyngeal venous plexus and pterygoid venous plexus.

Lymphatic drainage: The lymphatics from soft palate drain into retropharyngeal and upper deep cervical lymph nodes.

49
Q

Describe the sensory innervation to the soft palate.

A

General sensations from palate are carried by:
Lesser palatine nerves to the maxillary division of trigeminal nerve via pterygopalatine ganglion.
Glossopharyngeal nerve.

Parasympathetic (to glands) and special afferent (taste on soft palate) fibers from a branch of the facial nerve [VII] join the nerves in the pterygopalatine fossa, as do the sympathetics (mainly to blood vessels) ultimately derived from the T1 spinal cord level.

50
Q

Describe the primary gustatory pathway of taste sensations from the:
a) anterior 2/3 of tongue except vallate papillae
b) posterior 1/3 of tongue including vallate papillae

A

a) anterior 2/3 of tongue ⇒ lingual nerve ⇒ chorda tympani nerve ⇒ geniculate ganglion ⇒ nervus intermedius ⇒ upper part of nucleus of tractus solitarius (aka gustatory nucleus)
b) posterior ⅓ of tongue ⇒ terminal branches ⇒ glossopharyngeal nerve ⇒ petrous ganglion (inferior ganglion of glossopharyngeal nerve) ⇒ central processes ⇒ gustatory nucleus

51
Q

Describe the primary gustatory pathway of taste sensations from the:
a) valleculae
b) soft palate

A

a) valleculae ⇒ internal laryngeal branch ⇒ vagus nerve ⇒ nodose ganglion ⇒ central processes ⇒ gustatory nucleus
b) soft palate ⇒ palatine nerves ⇒ greater petrosal nerve ⇒ geniculate ganglion ⇒ nervus intermedius ⇒ gustatory nucleus

Further notes:
Vallecula is a term that means depression in something. The epiglottic vallecula consists of a small mucosa-lined depression (vallecula) located at the base of the tongue just between the folds of the throat on either side of the median glossoepiglottic fold.
[Diagram 1: Epiglottic vallecula] [Diagram 2: Epiglottic vallecula] [Diagram 3: Epiglottic vallecula]

52
Q

Describe the pathway of the second order gustatory axons from the gustatory nucleus (upper part of solitary tract).

A

Second order gustatory axons start from the nucleus of the solitary tract and carry visceral impulses to the hypothalamus and the thalamus through the solitario- hypothalamic and solitariothalamic tracts, respectively. The fibres going to thalamus cross the midline and terminate in the ventral posteromedial nucleus (along with the trigeminal lemniscus). The nucleus of the solitary tract also sends fibres to the reticular formation, the general visceral efferent cranial nerve nuclei and to the autonomic nuclei (in the intermediolateral grey column) of the spinal cord.

53
Q

Describe the pathway of the third order gustatory axons.

A

Third order gustatory axons start from the ventral posteromedial nucleus of thalamus and radiate through the posterior limb of internal capsule to the inferior part of the postcentral gyrus of cerebral cortex and the insula. The ascending fibres ending in the hypothalamus, reach the limbic system, which allow autonomic reactions to taste.

54
Q

State the clinical relevance of the gustatory pathway.

A

Lesions of cranial nerves VII, IX, and X can affect taste sensation and result in ageusia (loss of taste), hypogeusia (decreased taste) or abnormal taste (dysgeusia).

55
Q

What is the gag/pharyngeal reflex? Why is it important?

A

Watch this 1:40 minute video first: [Video]
It is a protective reflex characterized by the elevation of the palate and contraction of the pharyngeal muscles with associated retching and gagging in response to stimulation of the mucous membrane of the oropharynx. It occurs when the palate, tonsil, posterior part of the tongue, or posterior pharyngeal wall are touched by unfamiliar objects such as swab, spatula, etc.

The afferent limb of the reflex is provided by the glossopharyngeal nerve and efferent limb by the vagus nerve.