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anatomy - head,neck,spine > oral cavity > Flashcards

oral cavity Flashcards

1
Q

what can impact on normal swallowing

A

trauma to brain //
stroke //
degenerative disease

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2
Q

describe inspection of the buckle cavity

A

depress the tongue - using wooden tongue depressors //
see 2 folds of tissue - palatopharyngeal fold from the palate to the pharynx //
anterior to this have a palatoglossal fold from the palate to the tongue // between these folds is the palatine tonsil // see the posterior wall of the pharynx - in the oral cavity this is the oropharynx // see the uvula - this is part of the soft palate

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3
Q

what nerve is responsible for the gag response

A

CN 9

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4
Q

describe the palatine tonsil in infection

A

speckled/swollen

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5
Q

describe a lolly pop injury

A

the stick gets stuck in the back of the pharynx // this can be infected which passes down into the thoracic cavity because of the fascial components in the head and neck

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6
Q

what are drs looking for when they ask you to open your mouth and say ahh

A

quick test of CN 10 - levator palatine muscles lift the soft palate and mainly receive innervation from the vagus - soft palate rises see if uvula is rising in the midline, if deviating - suggesting there is a problem with CN10. it will deviate away from the side with the lesion

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7
Q

what are the 3 components of the pharynx *

A

the nasopharynx - back of nose down to uvula //
oropharynx - see through the mouth //
laryngopharynx - in relation to the larynx

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8
Q

what does the epiglottis do when you swallow

A

it retroflexes over the airway to stop food going down the airway. this happens by raising the larynx

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9
Q

describe the hard palate *

A

anterior// made of bone//

useful for chewing - break down food before swallowed

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10
Q

describe the soft palate *

A

anterior // uvula hanging down on the midline

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11
Q

where relatively is the oesophagus *

A

posterior to the airway opening

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12
Q

describe the piriform fossa *

A

in the laryngopharynx /
either side of larynx /
area where food can get caught/
very sensitive innervation so very painful

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13
Q

where are the constrictor muscles *

A

3 on each side of pharynx - joined at back by pharyngeal raphe //
muscles fan out posteriorly from their attachment to bones and ligaments anteriorly

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14
Q

what is the role of the constrictor muscles *

A

push food into upper GI / sequential contractions push food down

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15
Q

what are the 3 groups of constrictors *

A

superior

middle and inferior constrictors

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16
Q

what is the innervation of the constrictors *

A

V sensitive - glossopharyngeal nd vagus supply the pharyngeal plexus (sensory plexus for the pharynx)//
motor is the vagus - a few fibres from accessory nevre

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17
Q

stages of swallowing *

A

lift and retract the tongue - intrinsic muscles (in the tongue), styloglossus (from styloid process to the tongue - when contracts helps to lift and retract) //
move the bolus into the oropharynx - palatoglossus muscle //
close off into the nasopharynx by raising the soft palate (levator muscles) //
larynx anteriorly is raised - close epiglottis //
peristaltic wave from constrictor muscles move food down pharynx // cricopharyngeus (muscle at top of oesophagus relax to allow food into the top of the oesophagus)

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18
Q

name the 3 pairs of salivary glands *

A

parotid
submandibular
sublingual

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19
Q

describe the parotid salivary gland *

A

largest pair of salivary glands /
just in front of the ear / produce largely serous, thin saliva - passes through parotid duct opening next to the upper second molar - this moves anteriorly piercing the cheek through the buccinator muscle /
PNS is from CN 9 glossopharyngeal

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20
Q

describe the submandibular gland *

A

hook shaped / submandibular duct emerges from the medial side of the deep part of the gland in the oral cavity - passes forward to open on a sublingual caruncle beside the base of the frenulum of the tongue mainly serous thin saliva / innervation is CN 7 facial via the chorda tympani

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21
Q

describe the sublingual salivary glands *

A

just under tongue / drains into the oral cavity via various small ducts, open onto the crest of the sublingual fold. Occasionally anterior of gland is drained by the major sublingual duct that opens together with submandibular duct on sublingual caruncle // mucus saliva - doesn’t have to go as far, but can get blockages / innervated by PNS CN 7 facial via the chorda tympani

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22
Q

innervation of the tongue muscles

A

hypoglossal nerve CN 12 /

except palatoglossus - vagus via palatine branch to pharyngeal plexus

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23
Q

muscles of the tongue

A

styloglossus - originates at the styloid process and inserts at the lateral margin of the tongue - retract and elevate the tongue to move the food into the pharynx /
hyoglossus - from greater horn and adjacent part of body of hyoid bone to lateral surface of tongue - depress the tongue /
genioglossus from superior mental spines to body of hyoid and entire length of tongue, protrude the tongue and depress the centre of tongue /
palatoglossus - inferior surface of palatine aponeurosis to lateral margin of tongue - depress palate, move palatoglossal fold toward midline, elevate the back of tongue
intrinsic muscles in tongue

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24
Q

hwo do you test the hypoglossal nerve

A

stick tongue out, genioglossus contracts on either side, if contracts on one side and not other - tongue deviate towards the lesion

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25
Q

describe the lingual nerve *

A

it has mixed CN components / supply the tongue with touch sensation and nerve fibres involved in taste perception

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26
Q

where is the submandibular ganglion

A

close to salivary gland sitting under tongue

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27
Q

describe the afferent innervation of the tongue *

A

anterior 2/3 sensation is trigeminal nerve, taste fibres from fascial
posterior 1/3 tongue- glossopharyngeal for sensation and taste
a lit bit of innervation from vagus

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28
Q

where do all taste fibres go back to *

A

the nucleus solitaries - this is where taste perception starts its processing

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29
Q

what are the superficial muscles of mastication *

A

masseter - from the zygomatic arch to the lateral surface of ramus and angle of the mandible - elevates the mandible allowing forced closure of the mouth (CN 5)//
temporalis - very thin (difficult to palpate) fan shape, from the temporal fossa to the coronoid process of the mandible, they elevate and retract the jaw (CN 5) //
buccinator - push food to middle of mouth, and muscle of fascial expression (innervation from facial nerve), suck in cheeks - contraction of buccinator

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30
Q

how do you test the mandibular division of the trigeminal nerve motor function *

A

feel mandible - clench teeth - should feel masseter buldge

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31
Q

deeper muscles of mastication *

A

lateral pterygoid muscle - attach to the sphenoid/lateral pterygoid plate to neck of the mandible, depresses and protracts the mandible to open mouth /
medial pterygoid attached to the sphenoid bone lateral pterygoid plate, maxilla and to angle of the mandible. elevates and protracts and allows lateral movement of the mandible for chewing (to some extent the lateral can as well) /
innervated by CN 5

32
Q

describe the temporomandibular joint *

A

it is a synovial joint / head of mandible articulates in the infratemporal fossa (mandibular fossa), capsular joint (joint capsule around it), there is an articular tubercle anteriorly /
open jaw slightly get a hinge action at this joint between articular disk and head of mandible /
open widely - also get gliding movement onto articular tubercle - capsular joint moves forward slightly - if over do it, could get a dislocation into infratubercular fossa where there are nerves and vessels that could be damaged

33
Q

hwo do you put a dislocated jaw back in place

A

put thumbs on back molars at the bottom - push down and back (necessary because of articular tubercle)

34
Q

where does the carotid artery branch *

A

laryngeal prominence /
internal has no branches, goes up through the carotid canal and supplies anterior circulation to the brain /
external has many branches supplying the facial area

35
Q

what are the branches of the external carotid *

A 
superior thyroid /
ascending pharyngeal /
lingual - to tongue /
facial - pass round inferior border of the mandible then up to medial canthus of the eye /
occipital - to back of the head /
posterior auricular - behind the ear /
maxillary /
superficial temporal /
36
Q

why is there a loop in the facial artery *

A

because it goes around the base of the mandible, if it was tight it would rupture every time you opened your mouth

37
Q

what is the branch off the maxillary *

A

middle meningeal artery - pierce base of skull through the foramen spinosum

38
Q

where does the facial nerve exit the cranial cavity *

A

through the internal acoustic meatus

39
Q

where does the facial nerve emerge from *

A

the stylomastoid foramen at the base of the skull

40
Q

describe the path of the facial nerve *

A

passes under the parotid gland (salivary) /

5 branches emerge from the anterior of the parotid

41
Q

what are the branches of the facial nerve *

A

most superiorly is the TEMPORAL BRANCH /

ZYGOMATIC BRANCH / BUCCAL BRANCH to mouth / MANDIBULAR to mandible / CERVICAL BRANCH innervating platysma muscle

42
Q

how would you test facial nerve func *

A

look for creasing in the frontalis muscle when ask person to look up to the ceiling

43
Q

what are the 2 branches of V3 - the mandibular branch of the trigeminal nerve *

A

inferior alveolar nerve (inferior dental nerve) - passes into the back of the mandible - sensory nerve for the lower dentition. terminal branch of this is the mental nerve (relates to the mens which is the chin) //
lingual nerve - sensory of the anterior 2/3 of tongue. lingual also receives fibres from the facial nerve from a branch called the corda tympani that has branched off the main facial nerve coming anteriorly through the petro tympanic fissure and joins the lingual nerve

44
Q

how do you test V3 function *

A

test sensation of the chin (mental nerve)

45
Q

describe the function of the lingual nerve *

A

multi-functional /
information flow is bidirectional - fibres are PNS outflow to submandibular ganglion - prosecretory fibres, post ganglionic fibres go to submandibular and sublingual salivaryu glands /
taste fibres for anterior 2/3 of tongue (also in chorda tympani)

46
Q

describe how you would test the sensory function of trigeminal *

A

need to know dermatomes - V1 forehead, V2 cheek, V3 chin //
ophthalmic division supplies the skin from the top of head to upper eyelids and a strip down median line of nose, nasal mucosa, frontal sinus and conjunctiva (sensitive area that covers inner surface of eyelids, the sclera and is continuous with corneal epi) //
maxillary division - skin of anterior temporal and middle part of the face down to the corners of the mouth, upper teeth lip and gum, roof of mouth. //
mandibular division - skin running from middle part of temple, then anterior to the ear to chin, lower teeth, gum, lip, lining of cheeks, floor of the mouth, buccal part of tongue (anterior 2/3) //
test by putting cotton wool in these areas bilaterally and asking where they feel it

47
Q

describe the function of the digastric muscle and its innervation *

A

when mandible is fixed the digastric muscle raises the hyoid bone //
when the hyoid bone is fixed the digastric muscle opens the mouth by lowering the mandible //
innervation - posterior belly facial nerve, anterior = V3 of trigeminal nerve

48
Q

describe the function, location and innervation of the mylohyoid muscle *

A

location - superior to anterior belly of digastric from molar to hyoid.
function - it supports and elevates the floor of the mouth and elevates the hyoid bone
innervation - V3 of trigeminal (mandibular division)

49
Q

describe the function, location and innervation of the pharyngeal constrictors *

A

3 on each side of pharynx walln
function - contract sequentially from top to bottom, as in swallowing, they move a bolus of food
innervation - pharyngeal branch of the vagus

50
Q

numbers of teeth do children and adults have *

A

adults have 32 primary teeth

children have 20 deciduous teeth

51
Q

what is the clinical significance of tonsils *

A

they are lymphoid tissue so are part of the bodies defence system

52
Q

hwo do you test the motor function of the facial nerve *

A

ask them to look up at ceiling (look for creasing of the forehead as the frontalis contracts)//
keep eyes closed against resistance (orbicularis oculis) //
bare their teeth (risorius)

53
Q

how do you test the glossopharyngeal nerve *

A

stimulation of the gag reflex

54
Q

how do you test the hypoglossal nerve *

A

stick out their tongue, this involves the genioglossus and intrinsic muscles of the tongue

55
Q

how do you test the olfactory nerve *

A

with pts eyes closed see if they can identify smells eg orange/vinegar

56
Q

explain the movements of the mandible that occur during mastication *

A

depression - by digastric, geniohyoid, and mylohyoid muscles on both sides - normally assisted by gravity. head of mandible moves onto articular tubercle so lateral pterygoid muscles involved //
elevation - temporalis, masseter, and medial pterygoid muscles - involves movement of the head of the mandible into the mandibular fossa //
protraction - lateral pterygoid muscle with some assistance from medial pterygoid //
retraction - geniohyoid and digastric muscles and by posterior and deep fibres of the temporalis and masseter muscles respectively

57
Q

innervation of the muscles for mastication *

A

all innervated by the mandibular nerve by branches that originate in the infratemporal fossa //
EXCEPT geniohyoid muscle is innervated by C1 spinal nerve

58
Q

describe the boundaries of the oral cavity *

A

roof - hard and soft palates //
floor - soft tissues: muscular diaphragm and tongue //
walls - muscular (cheeks) merge with lips anteriorly forming the oral fissure //
posterior aperture - oropharyngeal isthmus which opens into the oral part off the pharynx

59
Q

what are the roles of the intrinsic muscles of the tongue *

A

they alter the shape and length of tongue by curling and uncurling the apex and edges, and flattening and rounding its surface // working in pairs or alone they contribute to the precision movements involved in speech, eating and swallowing

60
Q

summarise the anatomy of the tongue *

A

triangular ish shape - blunt apex of the tongue - directed anteriorly and sits behind incisors / oral surface of the tongue is in the horizontal plane, pharyngeal part of tongue curves inferiorly and becomes orientated in the vertical plane / oral and pharyngeal surfaces are separated by the terminal sulcus of the tongue / on the superior oral surface there are papillae increasing surface area, most have taste buds / on inferior oral surface there are mucosal folds / on pharyngeal surface there are nodules of lymphoid tissue and no papillae

61
Q

describe the longitudinal muscles of the pharynx *

A 
function - elevate the pharyngeal wall or in swallowing lift the pharyngeal wall up and over a bolus of food // stylopharyngeus - cylindrical, from the styloid process, descends between superior and middle constrictor muscles, innervated by the glossopharyngeal nerve //
salpingopharyngeus - small muscle, originate from pharyngotympanic tube, descending on and blending into deep surface of the pharyngeal wall, innervated by vagus //
palatopharyngeus - attached to upper surface of palatine aponeurosis, passes posteriorly and inferiorly to blend with the deep muscles of the pharyngeal wall - function: close the oropharyngeal isthmus - innervated by vagus
62
Q

describe the anatomical arrangement of lymphoid tissue in the pharyngeal wall *

A

tonsils //
pharyngeal tonsil - midline on the roof of the nasopharynx //
palatine tonsils - each side of oropharynx //
lingual tonsils - numerous lymphoid tonsils on the posterior 1/3 tongue //
small lymphoid nodules occur in the pharyngotympanic tube near its opening into nasopharynx and on upper surface of the soft palate

63
Q

describe the components of the gag reflex *

A

afferent - CN 9

efferent - CN 10

64
Q

describe the sensory innervation of the oral cavity *

A

general sensory innervation is carried by branches of trigeminal nerve V //
upper parts - V2 /
lower parts - V3
taste - tongue - anterior 2/3 CN7, posterior CN V

65
Q

what are the muscles of the soft palate and what is their innervation *

A

5 on each side // tensor veli palatine and levator veli palatini descend into palate from base of skull //
palatoglossus and palatopharyngeus ascend into the palate from the tongue and pharynx respectively //
musculus uvulae - associated with uvula //
all innervated by vagus, EXCEPT tensor veli palatini - V3

66
Q

function of the soft palate muscles *

A

tensor veli palatini - opens pharyngotympanic tube when soft palate moves in yawning/swallowing //
levator veli palatini - elevate the palate above neutral position and close the pharyngeal isthmus between nasopharynx and oropharynx //
palatopharyngeus - depress the palate and move palatinopharyngeal and palatoglossal arches to midline - help close the oropharyngeal isthmus. also elevates palate in swallowing
palatoglossus - depresses palate, move palatoglossal arches to midline, elevate back of tongue - all help close the oropharyngeal isthmus //
musculus uvulae - elevates and retracts the uvula = thickens central part of soft palate

67
Q

what is the function of general sensation to the tongue *

A

tell you something is present

68
Q

what is the function of special sensation to tongue *

A

taste

69
Q

how many nerves supply special and general sensation to tongue *

A

anterior - 1 nerve for each

posterior - 1 nerve for both functions

70
Q

what are the 2 movements of the temporomandibular joints *

A

hinge /

gliding - back and forward movement

71
Q

describe the movements of the temporomandibular joint *

A

the joint is divided by the articular disk - made of dense cartilage so is flexible /
the lower part of the joint allows the hinge like depression and elevation of the mandible / upper part allows head of mandible to translocate forward (protrusion) onto the articular tubercle and backward (retraction) into the mandibular fossa- this is the gliding movement

72
Q

what would you see in long standing injury to the hypoglossal nerve *

A

wastage

73
Q

what is the vallecula and where is it *

A

an anatomical groove anterior to the epiglottis

74
Q

function of the chorda tympani nerve *

A

carries taste from anterior 2/3 tongue and pns innervation to all salivary glands below the level of the oral fissure

75
Q

what is the innervation of the intrinsic muscles of the tongue *

A

hypoglossal nerve

76
Q

describe the lymphatics of the posterior region of the nasal cavity and paranasal sinuses *

A

drain into upper deep cervical nodes /

some first passes through the retro-pharyngeal nodes

anatomy - head,neck,spine (7 decks)

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