Oral Cavity Flashcards
What is the roof of the oral cavity?
Hard (maxilla and palatine bones) and soft palate
What is the floor of the oral cavity?
Mylohyoid muscle
What is the lateral boundary of the oral canal?
Buccinator muscle
What is the posterior boundary of the oral cavity?
Palatoglossal arch and sulcus terminalis on tongue
What is the vestibule of the oral cavity?
The space between teeth and mucosa (gingiva) of cheeks and lips
What primordia forms the primitive oral and nasal cavities?
Stomodeum
What is the frontonasal process?
An embryonic primordia that is the swelling produced by the growing forebrain and overlying mesenchyme and surface ectoderm
What is a nasal placode?
Ectodermal thickenings on the frontonasal process that invaginates to form nasal pits that break through into the roof of the stomodeum
What structures flank the nasal pits of embryos?
Medial and lateral nasal swellings
How is the roof of the stomodeum formed?
The frontonasal process intervenes between the maxillary process
How are the nasolacrimal ducts formed?
The ectodermal groove between the maxillary processes invaginates to form the ducts
How are the primitive choanae (nostrils) and nasal septum formed?
Nasal pits (from nasal placodes) break through the stomodeum
What do lateral nasal swellings form?
Alae (lower lateral part of the nose) of the nose lateral to the nostrils
What do medial nasal swellings form?
Intermaxillary segment that gives rise to the middle of the external nose, middle portion of upper lip (philtrum), and primary palate
What is the median palatine process?
The primary palate that forms from the intermaxillary segment
How is the secondary palate forms?
It forms behind the primary palate in the 6th week when the lateral palatine processes from the maxillary part of arch 1 fuse together in midline
What primordia does the tongue develop from?
Post-otic somites
What nerve supplies the intrinsic and extrinsic muscles of the tongue?
Hypoglossal nerve (except for palatoglossus - vagus nerve)
What muscle is the only protractor of the tongue?
Genioglossus
What is the nerve that innervates the region of the tongue labeled A? What does it do?
Vagus nerve - visceral sensory and taste
What is the nerve that innervates the region of the tongue labeled B?
Glossopharyngeal nerve (IX)
What is the nerve that innervates the region of the tongue labeled C?
Lingual nerve (V)
What is the nerve that innervates the region of the tongue labeled D?
Facial nerve (VII)
What is the nerve that innervates the region of the tongue labeled E?
Hypoglossal nerve (XII)
What is the nerve that innervates the region of the tongue labeled F? What is the muscle?
Vagus nerve, palatoglossus
What is the innervation of the lining of the oral cavity?
V3 (lingual and buccal nerves)
What nerve provides taste to the lining of the oral cavity?
Facial enrve (VII)
What is the innervation of most of the pharynx?
IX (glossopharyngeal nerve)
What innervates the lining of the laryngopharynx and larynx?
Vagus nerve (X)
What is the complete pathway of parasymapthetic innervation to the parotid gland?
Glossopharyngeal nerve (IX) –> tympanic nerve –> tympanic plexus (middle ear) –> lesser petrosal nerve –> synapse in otic ganglion –> auriculotemporal branch of V3 –> parotid gland
What is the complete pathway of parasympathetics to the submandibular and sublingual glands?
Facial nerve (VII) –> chorda tympani –> lingual branch of V3 –> synapse in submandibular ganglion –> direct branches into submandibular gland OR rejoin the lingual nerve to the sublingual gland
A cleft lip results from a failure of fusion of what two embryonic primordia?
a) lateral palatine processes
b) maxillary and mandibular arches
c) maxillary arch and frontonasal process
d) left and right maxillary arches
e) lateral palatine process and nasal septum
c) maxillary arch and frontonasal process
- (a) would result in a cleft of secondary palate*
- (b) would result in a cheek defect*
- (d) these structures do not touch each other*
- (e) would result in cleft of secondary palate*
A patient’s submandibular salivary gland swells when eating meals. Where would you look for a possible blockage of its duct?
a) by the lower second molars
b) lingual frenulum
c) plica sublingualis
d) labial frenulum
e) foramen cecum
b) lingual frenulum
Lack of secretion of the parotid gland might be due to dysfunction of which of the following nerves?
a) tympanic
b) lingual
c) chorda tympani
d) greater petrosal
e) hypoglossal
a) tympanic
the tympanic branch of IX is in the parotid pathway
What nerve is the sensory limb of the gag reflex?
a) mandibular
b) chorda tympani
c) vagus
d) hypoglossal
e) glossopharyngeal
e) glossopharyngeal
* IX is sensory to the posterior 1/3 of tongue and pharynx in general*
What muscle keeps the tongue from falling back into the pharynx in an unconscious person?
a) palatoglossus
b) hypoglossus
c) genioglossus
d) styloglossus
e) longitudinal intrinsic fibers
c) genioglossus
pulls the tongue forward
What are common non-genetic etiologies of cleft lip/palate?
Maternal disease/exposures: anticonvulsant medication, retinoic acid medications, folic acid antagonists/deficiency, corticosteroids, alcohol/tobacco ingestion, maternal diabetes
What are some syndromes that are often associated with cleft lip/palate?
Stickler syndrome (also associated with eye problems, hearing loss, joint problems)
Van der Woude Syndrome (lower lip pits)
Down Syndrome
22q11 deletion (DiGeorge - absent thymus)
Goldenhar Syndrome
CHARGE syndrome
Pierre Robin sequence
What disease is associated with cleft palate/lip and lower lip pits?
Van der Woude Syndrome
What is CHARGE syndrome?
C - Coloboma
H - Heart anomalies
A - atresia (choanal)
R - retarded development of CNS
G - genitourinary anomalies
E - Ear anomalies
What is sialadenitis?
Inflammation of major salivary gland due to stasis of secretions in salivary duct
What are risk factors for sialadenitis?
Dehydration (elderly), post-surgical, radiation/chemotherapy, Sjogren’s
What pathogens are associated with sialadenitis?
Staph aureus, strep viridans, strep pyogenes, haemophilus influenzae, e coli, HIV, mumps, influenza, coxsackie
What is Uveparotid fever?
A disease that is an extrapulmonary form of sarcoidosis - associated with uveitis, parotid enlargement, facial nerve dysfunction, sensorineural hearing loss, fever
What is sialolithiasis?
Calculi/stones within salivary duct (mostly in submandibular)
What are risk factors for sialolithiasis?
Gout, smoking
What is the usual cause of sleep apnea in pediatrics?
Hypertrophy of palatine tonsils and adenoids (or lingual tonsils)
What are the symptoms of pediatric obstructive sleep apnea?
Snoring, inflammation, insulin resistance, hypertension, increased cardiac load, attention/behavior issues
What is the likely etiology of generalized pale mucosa?
Anemia, thalassemia
What is the likely etiology of black/brown oral cavity discoloration?
Bismuth and arsenic intoxication
What is the likely etiology of blue-gray gingival margins in the oral cavity?
Lead intoxication
What is the likely etiology of generalized redness of the oral cavity?
Polycythemia vera, hepatic insufficiency
What is the likely etiology of perioral melanotic macules?
Puetz-Jeghers
What is the likely etiology of small yellow spots in the oral cavity?
Fordyce’s disease
What is the likely etiology of black hairy tongue?
Elongated (hypertrophic) filiform papillae
What is the likely etiology of telagiectasias in the oral cavity?
Osler-Weber-Rendu syndrome
What is the likely etiology of diffuse hyperpigmentation of mucosa?
Addison’s disease
What is the presentation of herpetic gingivostomatitis?
Small, painful vesicles with erythematous ulceration and gray eschar
What is the presentation of oral candidiasis?
Sometimes painful white plaque lesions that scrape off and reveal erythematous base and are friable
What is the treatment for herpetic gingivostomatitis?
Acyclovir, valacyclovir
What is the treatment for oral candidiasis?
Topical antifungals, systemic antifungals for severe disease
What is the presentation of necrotizing gingivostomatitis?
Gingival caters/erosions, gray pseudomembranes, halitosis, malaise, fevers, necrosis due to synergistic infection (spirochetes, fusiform rods, anaerobes)
What is the presentation of oral actinomycosis infection?
Invades mucosa due to trauma, poor hygiene, dental infections. Presents as a plapable mass of head/neck with purple skin discolorations with abscesses
What is the presentation of actinomycosis on histology?
Branching gram positive anaerobic bacteria, granulomatous and suppurative appearance, sulfur granules
What is the most common benign lesion of oral cavity?
Squamous papilloma
What is the cause of squamous papilloma?
Human papilloma virus
What is the presentation of erythema multiforme?
Oral (or cutaneous) target lesions with concentric rings, fever, odynophagia, and cervical adenopathy
What is oral pempigus vulgaris?
Painful blisters of oral cavity, pharynx, and desquamitive gingivitis
What are aphthous ulcers?
Most common oral ulcer, can be idiopathic/immunologic/infectious/pharmacologic/nutritional/etc.
When a child has a genetic syndrome associated with cleft palate, what other craniofacial anomalies are common?
Ear malformations, ocular malformations, midfacial hypoplasia (flattened midface), choanal atresia
What factors predispose a patient to infectious parotitis?
Extremes of age, immunodeficiency, dehydration, malnutrition
What systemic diseases can present with oral pigmented/hypopigmented lesions?
Chemical intoxications, blood disorders, puetz jeghers disease, osler-weber-rendu syndrome, addison’s disease, amyloidosis
What organism is responsible for thrush?
Candida albicans
What organism is responsible for oral ulcers?
HSV
What organism is responsible for necrotizing gingivostomatitis?
Borellia Vincentii
What organism is responsible for oral papillomas?
Human papilloma virus
In the newborn nursery, you examine a newborn and identify cleft palate. The mother is pictured below. Upon your questioning, she reports a history of: wearing glasses for vision deficit, cataracts, hearing loss, and joint hyper-flexibility. What syndrome do you expect?
a) 22q11 deletion
b) goldenhar
c) van der woude
d) stickler
D) Stickler
An 83 year old male hospitalized for dehydration develops unilateral parotid swelling and tenderness. You express purulence from the parotid duct. What is the most likely etiology of his parotitis?
a) infectious
b) calculus (stone)
c) Heerfordt’s Disease
d) Sjogren’s
a) infectious
Which of the following choices represents a true statement comparing pediatric and adult OSA?
a) children rarely have increased fasting glucose, insulin resistance, and increased triglycerides
b) behaviorally, children more often have hyperactivity than adults
c) like adults, the common cause of pediatric OSA is obesity
d) the same sleep study scoring system is used in both groups
b) behaviorally, children more often have hyperactivity than adults
If you saw the following 27 year old female in your primary care clinic, you would refer the patient to…
a) gastroenterology to rule out Puetz-Jeghers syndrome and gastrointestinal polyps
b) otolaryngology because erythroplakia carries a 25% risk of malignancy
c) toxicology to rule out lead poisoning
d) infectious disease for treatment of herpes stomatitis
a) gastroenterology to rule out Puetz-Jeghers syndrome and gastrointestinal polyps
In CHARGE syndrome, the “A” stands for atresia of what?
a) anus
b) esophagus
c) duodenum
d) choanae
The most common benign lesion of the oral cavity is caused by…
a) Mumps
b) Syphilis
c) HPV
c) HPV
