Oral cavity and Esophagus Flashcards
What is the extent of the oral cavity?
Lips to oropharyngeal isthmus
What is the structure of the lips?
Orbicularis oris muscle covered by skin and mucus membrane
What is the innervation of the lips?
Upper lip - CNV2
Lower lip - CNV3
What is the lymphatic drainage of the lips?
Upper and lateral lower to submandibular lymph nodes
Medial lower lip to submental lymph nodes
What are the parts that come together to form the hard palate?
Palatine processes of maxilla and the horizontal plates of palatine bones
What is the palatoglossal arch?
Where the soft palate continues with the tongue
What with the palatopharyngeal arch?
Where the soft palate continues with the pharynx
Where is the tonsillar fossa located?
Between the palatoglossal and palatopharyngeal arches
What are the 5 muscles of the soft palate?
Tensor veli palatini
Levator veli palatini
Palatoglossus
Palatopharyngeus
Musculus uvulae
What is the innervation of the tensor veli palatinin?
Nerve to medial pterygoid via otic ganglion - branch of CNV3
What is the majority of the soft palate muscles innervated by?
Pharyngeal branch of CNX via pharyngeal plexus
What is the arterial supply of the palate?
Greater and lesser palatine from descending palatine from maxillary artery
Ascending palatine from facial artery
What are the veins of the palate?
Corresponding to arteries
Tributaries to pterygoid venous plexus
What is the sensory innervation of the gingiva, mucous membrane and hard palate glands of the oral cavity?
Greater palatine nerve from CNV2
What is the sensory innervation of the soft palate?
Lesser palatine nerve from CNV2 that pass through pterygopalatine ganglion
What is the afferent and efferent limbs of the gag reflex?
Afferent - CNIX - glossopharyngeal
Efferent - CNX - Vagus
What way will the uvula deviate if the pharyngeal plexus is injured?
To the opposite side
What are the actions of the tongue?
Mastication
Taste
Deglutition
Articulation
Oral cleansing
What causes the cobblestone appearance of the root of the tongue?
Lingual tonsil
What are the 5 divisions of the tongue?
Root
Body
Apex
Inferior surface
Dorsal surface
What is the terminal sulcus?
V shaped groove separating anterior 2/3 of tongue from post 1/3
Where is the foramen cecum located?
Apex of the terminal sulcus
What is the foramen cecum?
Proximal part of thyroglossal duct
What are the 4 types of lingual papillae?
Vallate
Foliate
Filiform
Fungiform
Where do the submandibular ducts open?
Base of the lingual frenulum
What are the 4 extrinsic muscles of the tongue?
Palatoglossus
Genioglossus
Styloglossus
Hyoglossus
What are the 4 intrinsic muscles of the tongue?
Superior longitudinal
Inferior longitudinal
Transverse
Vertical
What are the actions of the genioglossus muscle?
Depresses tongue medially
protrusion and retraction
Deviates side to side
What are the actions of the hyoglossus muscle?
Depresses tongue laterally
Retrusion
What are the actions of the styloglossus?
Retrusion
Elevates sides
What are the actions of the palatoglossus?
Elevates posterior tongue
Depresses soft palate
Constrict isthmus of fauces a ligament of the throat
What are the actions of superior longitudinal muscle?
Curls tongue upward
Retrusion
What are the actions of the inferior longitudinal muscle?
Curls tongue downward
Retrusion
What is the action of the transverse muscle of the tongue?
Narrows and protudes
What is the action of the vertical muscle of the tongue?
Flattens and broadens
What is the motor innervation of the palatoglossus muscle?
CNX through pharyngeal plexus
What is the motor innervation for the majority of tongue muscles?
CNXII - hypoglossal
What innervates general sensation of the anterior 2/3 of the tongue?
Lingual nerve branch of CNV3
What innervates taste sensation of the anterior 2/3 of the tongue?
Chorda tympani branch of CNVII
What is the sensory innervation of the posterior 1/3 of the tongue?
CN IX
What is the sensory innervation for the small area in front of the epiglottis?
CN X - internal laryngeal nerve
What will the position of the tongue be with an injury to to the hypoglossal nerve (CNXII)?
It will deviate toward the paralyzed/injured side
What is the lymphatic drainage of the posterior 1/3 of the tongue?
Superior deep cervical nodes bilaterally
What is the lymphatic drainage of the medial anterior 2/3 of the tongue?
Inferior deep cervical nodes bilaterally
What is the lymphatic drainage of the lateral anterior 2/3 of the tongue?
Submandibular nodes
What is the lymphatic drainage of the apex and frenulum of the tongue?
Submental nodes
What are the salivary glands?
Parotid glands
Submandibular glands
Sublingual glands
What are the functions of saliva?
Keeps mouth mucous membrane moist
Lubricates food during mastication
Begins digestion of starches
Intrinsic mouth wash
Prevention of tooth decay
Ability to taste
What is the parotid sheath derived from?
Investing layer of deep cervical fascia
What structures pass through the parotid gland?
Facial nerve
Retromandibular vein
External carotid artery
What is the anatomical location of the parotid gland?
Between mandible, styloid process and mastoid process bilaterally
What is the locations of the submandibular gland?
Lies along body of mandible
What is the location of the sublingual gland?
Lies in floor of mouth between mandible and genioglossus muscle
What is the secretomotor nerve supply of the parotid gland starting from the pons?
Inferior salivatory nucleus in pons
Glossopharyngeal N
Tympanic nerve
Tympanic plexus
Lesser petrosal nerve
Otic ganglion
Auriculotemporal nerve
Parotid gland
What is the nerve supply of the submandibular and sublingual glands starting at the pons?
Superior salivary nucleus in pons
Facial nerve
Chorda tympani
Submandibular ganglion
To glands
With what viral disease can you see parotiditis?
Mumps
What is the extent of the pharynx?
Base of cranium to cricoid cartilage at C6 level
What are the 3 subdivisions of the pharynx?
Nasopharynx
Oropharynx
Laryngopharynx/hypopharynx
What are the boundaries of the oropharynx?
Soft palate
Base of tongue
Palatoglossal and palatopharyngeal arches
What is the extent of the laryngopharynx?
Tip of epiglottis to cricoid cartilage
What part of the pharynx is continuous with the epiglottis?
Laryngopharynx
What is the piriform fossa?
Small depression on either side of laryngopharyngeal cavity
What lies anterior to the layngopharynx?
Larynx
What structure is related to the piriform fossa?
Branches of internal laryngeal and recurrent laryngeal nerves lie deep to the fossa
What are the external layer of muscles of the phaynx?
Superior pharyngeal constrictor
Middle pharyngeal constrictor
Inferior pharyngeal constrictor
What are the internal layer of muscles of the pharynx?
Palatopharyngeus
Salpingopharyngeus
Stylopharyngeus
What is the innervation of the stylopharyngeus muscle?
CNIX - glossopharyngeal
What are the majority of the pharynx muscles innervated by?
Pharyngeal branch of vagus nerve and pharyngeal plexus?
What muscles of the pharynx are also innervated by the external and recurrent laryngeal nerves?
Middle pharyngeal constrictor
Inferior pharyngeal constrictor
What is the sensory innervation of the pharynx?
Anterior and superior nasopharynx by CNV2
Rest is by pharyngeal plexus from glossopharyngeal nerve
What makes up the pharyngeal tonsillar ring of Waldeyer?
Lingual tonsil
Palatine tonsils
Tubal tonsils
Pharyngeal tonsils
What are the arteries that supply the palatine tonsils?
Branches of facial artery
-Tonsillar artery
-Ascending palatine
Descending palatine branch of maxillary artery
Lingual and ascending pharyngeal branches of external carotid
What can be injured to cause bleeding during tonsillectomy?
External palatine vein that drains into facial vein
What is the typical length of the esophagus?
25 cm
At what level is the esophageal hiatus of the diaphragm?
T10
Where does the thoracic part of the esophagus lie?
Between the two pleural cavities - called the mediastinum
What is located anterior to the esophagus in the lower mediastinum?
Left atrium of heart
What are the constrictions of the esophagus?
Cervical constriction/pharyngoesophageal sphincter
2 Thoracic/broncho-aortic constriction
Diaphragmatic constriction
What causes the cervical constriction and what is its distance?
Cricopharyngeus muscle
15 cm from incisor teeth
What causes the two thoracic constrictions and what are their distances?
Crossing of aorta - 22.5 cm
Crossing of left main bronchus - 27.5 cm
At what distance does the esophagus pass through the diaphragm?
40 cm
What is a tracheo-esophageal fistula?
Birth defect where partitioning of trachea and esophagus failed
What is the most common type of tracheoesophageal fistula?
Upper part of esophagus ends in blind pouch and lower part connects to trachea
What is the most common complaint seen in esophageal cancer?
Dysphagia
What area of the esophagus is related to the portosystemic shunt?
Lower end
What is the portosystemic shunt?
Abdominal part drains from portal venous system and thoracic part drains from systemic venous circulation
What can form esophageal varices?
When the portosystemic shunt is dilated
What are the three types of oral mucosa divided by location?
Masticatory mucosa
Specialized mucosa
Lining mucosa
Where would you find the masticatory mucosa?
Gingiva and hard palate
What is the epithelium of the masticatory mucosa?
Stratified squamous keratinized/parakeratinized
Where would you find the specialized oral mucosa and what does it contain?
Dorsal surface of tongue
Lingual papillae
Where would you find the lining oral mucosa?
Rest of oral cavity
What is the epithelium of the lining oral mucosa?
Stratified squamous non-keratinized
What are the three regions of the lip?
Cutaneous region
Vermillion region
Oral mucosa region/vestibular aspect
What characterizes the cutaneous region of the lip?
Thin skin with hair follicles, sebaceous glands, and sweat glands
Stratified squamous epithelium
What characterizes the vermillion region of the lip?
Stratified squamous epithelium
Supported by CT containing blood vessels that provide red color
No glands
What characterizes the oral mucosa region of the lip?
Lining oral mucosa
Minor salivary glands
What are the characteristics of filiform papillae?
Most numerous
Conical shape
No taste buds
Keratinized stratified squamous epithelium
What are the characteristics of fungiform papillae?
More numerous near apex of tongue
Mushroom-shaped
Few taste buds on free surface
Nonkeratinized stratified squamous epithelium
What are the characteristics of foliate papillae?
Posterolateral aspect of anterior 2/3 of tongue
Shallow furrows
Taste buds for first 2 years of life
Secretion of glands of von Ebner released into furrows
What are the characteristics of Circumvallate papillae?
Just anterior to terminal sulcus
Numerous taste buds
Surrounded by deep furrow
Where do the glands of von Ebner release their secretions?
Into furrow of foliate papillae
Into deep furrow surrounding circumvallate papillae
What part of the tongue has lingual papillae?
Dorsal surface of tongue anterior to terminal sulcus
How do taste buds appear in staining?
Oval, pale
Extend through epithelium
The microvilli of what cells project through the taste pore?
Gustatory cells
What is the basic secretory unit of the salivary glands?
Salivon
What does the salivon consist of?
Acinus
Intercalated duct
Excretory duct
What are the characteristics of acini?
Spherical
Myoepithelial cells present at base
What are the types of secretion in acini?
Serous - protein secreting
Mucous - mucin secreting
Mixed
What is the drainage of the secretion from acinus?
Into intercalated duct which merges with striated duct and then into excretory duct
What is the epithelium of the intercalated duct of the salivary gland?
Simple cuboidal
What is the epithelium of the excretory duct of the salivary gland?
Stratified cuboidal/columnar epithelium
surrounded by CT
What gives the striated duct of the salivary gland its striated appearance?
Numerous basal membrane infoldings containing mitochondria
What type of acini is found in the parotid glands?
Only serous acini
What are the histological characteristics of the parotid glands?
Dark serous acini
White adipose tissue
What are the histological characteristics of the submandibular glands?
Predominantly dark serous acini with some lighter mucous acini mixed in
Evident striated ducts
What type of acini is found in the submandibular glands?
Mixed, but predominantly serous
What type of acini is found in the sublingual glands?
Mixed, but primarily mucous
What are the histological characteristics of the sublingual glands?
Predominantly lighter mucous acini with some dark serous acini
Whitish ducts
What are the 4 general layers of the GI tract?
Mucosa
Submucosa
Muscularis Propria
Serosa or adventitia
What are the three divisions of the GI tract’s mucosa layer?
Epithelium
Lamina propria
Muscularis mucosa
In what layer of the GI tract is the Meissner’s plexus found?
Submucosa
In what layer of the GI tract is the Auerbach’s/Meyenteric plexus found?
Muscularis propria between the circular and longitudinal muscle
What are the two types of muscle in the muscularis propria layer of the GI tract?
Circular
Longitudinal
What are the characteristics of the lamina propria of the GI tract?
Loose CT
Rich in blood vessels, lymphatics, lymphocytes, and smooth muscle cells
Often contains small glands
What are the characteristics of the muscularis mucosa of the GI tract?
Thin layer of smooth muscle
Separates mucosa from submucosa
Allows local movements of mucosa
What are the characteristics of the submucosa of the GI tract?
CT with larger blood and lymph vessels
Contain submucoal/Meissner plexus
May contain glands and lymphoid tissue
What type of nerves make up the Meissner plexus?
Autonomic
What are the actions of the musclaris propria layer of the GI tract?
Contraction that mixes and propels luminal contents forward through the GI tract
What are the characteristics of the adventitia?
Thin sheet of loose CT
Rich in blood vessels, lymphatics, and adipose tissue
Continuous with surrounding tissues
What are the characteristics of the serosa?
Thin sheet of loose CT
Rich in blood vessels, lymphatics, and adipose tissue
Covered with simple squamous epithelium called mesothelium
Not continuous with surrounding tissues
What makes up the ENS?
Meissner’s plexus
Myenteric plexus
How is the ENS affected in Hirchsprung disease?
Part or all of the plexuses are absent or injured
What type of epithelium is the mucosa of the esophagus?
Nonkeratinized stratified squamous
Where are the esophageal glands located and what is their function?
Submucosa
Secrete mucus to lubricate and protect the mucosa
What part of the esophagus has only striated muscle?
Superior 1/3
What part of the esophagus has mixed striated and smooth muscle?
Middle 1/3
What part of the esophagus has only smooth muscle?
Inferior 1/3
What forms the outer layer of the esophagus?
Adventitia in thoracic cavity
Serosa in abdominal cavity
What happens to the epithelium at the esophagogastric junction?
Abrupt change from nonkeratinized stratified squamous to simple columnar
Where are the esophageal cardiac glands located and what is their function?
In mucosa of the esophagus near the stomach
Secrete additional neutral mucus to protect esophagus from regurgitated gastric contents
