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2 - HNA > Oral Cavity, Mandible & Temperomandibular Joint > Flashcards

Oral Cavity, Mandible & Temperomandibular Joint Flashcards

1
Q

What forms the lateral walls of the oral cavity?

A
  • Buccinator: continuous with the superior constrictor at pterygomandibular raphé
    • PMR: pterygoid plate of sphenoid → mandible (posterior to mylohyoid ridge)
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2
Q

What are tonsillar pillars?

A
  1. Palatoglossus - connects palate to tongue
  2. Palatopharyngeus - connects palate to pharynx
  • Lie medial to the PM raphé & dominate the posterior border of the oral cavity
  • Palatine tonsil lie between (hence name)
  • Covered by mucous membrane
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3
Q

Discuss the tongue

A

Occupies the floor of the oral cavity

Anterior 2/3 - oral part:

  • ‘Velvety’ appearance - covered in papillae
    • Mostly filiform
    • Fungiform interspersed, taste buds at base

Posterior 1/3 - pharyngeal part:

  • Nodular due to the underlying lingual tonsils
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4
Q

Sensory innervation of the tongue

A
  • Anterior 2/3: lingual n. (Vc) general sensation, chorda tympani - taste (VII) hitchhikes on lingual
  • Posterior 2/3: glossopharyngeal nerve for both
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5
Q

Intrinsic muscles of the tongue

A

Longitudinal, transverse and vertical fibres

Change the shape of the tongue

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6
Q

Extrinsic muscles of the tongue

A

Change the position of the tongue

  • Genioglossus: protrudes tongue
    • Anterior part of the mandible
  • Hyoglosss: retracts & depresses tongue
    • Hyoid
  • Styloglossus: retracts & elevates tongue
    • Styloid process
  • Palatoglossus: depresses palate
    • Palate
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7
Q

Innervation to the muscles of the tongue

A

XII all except palatoglossus (pharyngeal plexus - X)

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8
Q

Discuss the floor of the oral cavity

A

Mylohyoid (n. to mylohyoid Vc) forms muscular sling

Attach to hyoid, inner surface of mandible & each other at midline raphé, has a free posterior border

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9
Q

Discuss the sublingual glands

A

Lie on the superior surface of mylohyoid & inner surface of the mandible

Open into the sublingual region via many small, short ducts

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10
Q

Discuss the submandibular glands

A

Lies in the submandibular fossa - two lobes

  • Superficial lobe is grooved by the facial artery
    • Separated from parotid by stylomandibular ligament
  • Deep lobe passes around posterior border of mylohyoid with duct
    • Open on papilla beside lingual frenulum
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11
Q

Innervation to the sublingual & submandibular glands

A

Parasympathetic secretomotor from CN VII → chorda tympani → submandibular ganglion

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12
Q

Issues which can arise in the submandibular gland

A
  • Higher concentration of mucus, increasing viscosity/decreasing flow
  • More likely to develop calculi & stasis
    • Duct blockage causes swelling & pain
  • Impacted calculus extracted transorally
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13
Q

Discuss the parotid glands

A
  • Largest salivary gland
  • In the retromandibular region, extending over the lateral surface of mandibular ramus & masseter
  • Duct crosses masseter & pierces buccinator
    • Drains opposite upper 2nd molar
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14
Q

Discuss the innervation of the parotid glands

A
  • Parasympathetic from IX to otic ganglion
    • Via lesser petrosal nerve (from tympanic n)
  • Post-ganglionic branches join auriculotemporal nerve
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15
Q

Discuss conditions of the parotid gland

A
  • Specific viral infection causes mumps
    • Can spread to brain, pancreas & testes
      • Orchitis & sterility in adult males
  • Tumours
    • Benign (pleomorphic adenoma) often asymptomatic
    • Malignant tumours are highly invasive and may involve VII
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16
Q

Describe the palate

A

Roof of the oral cavity, comprised of the soft & hard palates which are continuous with one another

17
Q

Describe the hard palate

A
  • Formed from palatine process of maxilla & horizontal plate of palatine bone
  • Covered in mucous membrane
18
Q

Describe the soft palate

A

Comprised of 5 muscles:

  • Palatoglossus & palatopharyngeus raise the tongue & oropharynx, approximating the palate
    • Control opening of the oropharynx
  • Tensor palati tenses the soft palate
    • Innervated by n. to medial pterygoid (Vc)
  • Levator palati elevates the palate, closing the nasopharynx
  • Muscular uvalae stiffens the uvula
19
Q

Describe the temporomandibular joint

A
  • Articulation of the tubercle on the inferior surface of the temporal bone with head of the mandible
  • Synovial condyloid joint with fibrocartilage on its articular surfaces
  • A fibrocartilaginous disc separates the joint into upper & lower cavities

Exhibits a combination of complexity, close-to-continuous use and a capacity for force & finesse

20
Q

Discuss dislocation of the TMJ

A
  • Dislocate anteriorly when mouth is opened wide
  • Under light anaesthetic, mandible pressed down and back to click into place
21
Q

What are the muscles of mastication?

A
  1. Masseter
  2. Temporalis
  3. Medial pterygoid
  4. Lateral pterygoid
22
Q

Masseter

A
  • Origin: zygomatic process of the maxilla & zygomatic arch
  • Insertion: lateral aspect of ramus, & angle of mandible
  • Action: elevates mandible
23
Q

Temporalis

A
  • Origin: inferior temporal line & temporal fossa
  • Insertion: coronoid process & anterior border of mandibular ramus
  • Action: elevates the manible (posterior fibres retract)
24
Q

Medial pterygoid

A
  • Origin: pterygoid fossa, medial surface of lateral pterygoid plate
  • Insertion: medial surface of mandibular ramus
  • Action: elevates mandible and produces lateral movement
25
Q

Lateral pterygoid

A

Two heads (s) & (i)

  • Origin: infratemporal fossa (s) & lateral surface of the lateral pterygoid plate (i)
  • Insertion: articular capsule & disc of the TMJ (s) & pterygoid fovea on neck of the mandible (i)
  • Action: protrudes and depressed the mandible
    • (s) fibres stabilise TMJ
26
Q

Discuss movement at the TMJ

A

Comprised of two movements:

  • Gliding in upper compartment
  • Hinge movement in lower compartment

NB: never entirely independent - depression/elevation use both equally but protrusion/retraction/grinding mainly gliding

27
Q

Depression of the mandible

A
  • Lateral pterygoids pull condyles forward
  • Digastric & infrahyoid pull the body down

Passive depression assisted by gravity

28
Q

Elevation of the mandible

A
  • Masseter, temporalis, medial pterygoid
29
Q

Protrusion of the mandible

A
  • Both pterygoids
30
Q

Retraction of the mandible

A
  • Posterior fibres of temporalis
31
Q

How are grinding and chewing movements produced?

A
  • Grinding: alternating protrusion/retraction
  • Chewing: mandible moved side-to-side
    • Masseter/temporalis keep mouth closed
32
Q

Discuss mandibular fractures

A
  • 2nd commonest facial bone fracture (1st nasal)
  • Force can transmit removing fracture from site of impact
  • Multiple fractures more common than single site

NB: if fracture strong enough for mandibular fracture, can get c-spine injury: secure airway as priority

2 - HNA (11 decks)

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