Oral Cavity/Pharynx Flashcards
Palate
skeletal muscle over hard (anterior 2/3) and soft (post 1/3) palates
uvula extends inferior to soft palate, helps elevate to close off oropharynx in swallowing
fauces--> opening b/t oral cavity and oropharynx
bounded by paired
muscular folds:
glossopalatine arch
(anterior)
pharyngopalatine arch
(posterior)
Where are palatine tonsils located?
Between glossopalatine arch and pharyngopalatine arch
What are removed during tonsillectomy?
Palatine tonsils
Can damage CN IX or ICA if tortuous b/c both are lateral to tonsils
Tongue Histo/Anatomy
skeletal muscle covered with lightly keritanized stratified squamous epithelium
compress partially digested food against palate–> bolus
inferior surface attached by lingual frenulum
papillae on superior surface
lingual tonsils on posterior surface
Salivary Glands
produce and secrete saliva to digest
increased during mealtime (1-1.5L / day)
submandibular>parotid>sublingual
Neural Control of Saliva
CN IX parasympathetic stimulate parotid
CN VII parasympathetic stimulate submandibular and sublingual
Sympathetic cervical ganglia–>mucus secretion in lungs (beta receptor)
Parotid Gland
CN IX stimulation
Anterior inferior to ears
Largest salivary gland–> 25-30% saliva through parotid gland to oral cavity, opens into oral vestibule (space b/t cheek and gums) next to 2nd upper molar
–>serous secretion
Submandibular Gland
inferior to body of mandible
most saliva (60-70%)
duct from each gland–> papilla in floor of mouth lateral to lingual frenulum
–> mucous and serous secretion
Sublingual Gland
inferior to tongue, internal to oral cavity mucosa
multiple tiny glands that open to inferior surface of oral cavity (post to submandibular gland papilla)
–> mucous mainly, some serous secretion
Saliva
moistens food, help turn into bolus
moistens and cleans oral cavity
1st step–> breakdown carbs via amylase
ABX (lysozyme) inhibits bacterial growth in oral cavity
–> dissolved material activate taste receptors
Teeth- overview
mechanical digestion
exposed crown, constricted neck, 1+ roots anchored to jaw (dental alveoli) via periodontal ligaments–> gomphosis joint
alveoli (bone) in maxilla and mandible
Teeth- infant vs adult
Infant: deciduous teeth b/t 6-30 months
lost, replaced by 32
permanent
Anterior appear 1st
3rd molars in late teens–> wisdom teeth, can be impacted (no space in alveoli)
Teeth-types
Infant: upper teeth overview central incisor (2)- 7 to 9 mo. lateral incisor (2)- 9 to 11 mo. canine (2)- 18-20 mo. 1st molar (2)- 14 to 16 mo. 2nd molar (2)- 24 to 30 mo.
Adult: upper teeth overview central incisor 7-8 yrs lateral incisor 8-9 yrs canine 11-12 yrs 1st premolar 10-11 yrs 2nd premolar 10-12 yrs 1st molar 607 yrs 2nd molar 12-13 yrs 3rd molar 17-25 yrs
Describe the look of each tooth type
central: flat
lateral: pointed
canine: 2 roots, indented
molar: typical tooth, multiple
roots, deeply indented
premolar: bicuspids
Anatomy of Swallowing
1: voluntary
bolus compressed against
palate, pushed into
oropharynx by tongue and
soft palate muscles
2: involuntary and rapid
soft palate elevated to seal
off nasopharynx
pharyx widens and shortens to receive bolus suprahyoid muscles and longitudinal pharyngeal muscles contract to elevate larynx
3: involuntary
sequential contraction of
all 3 pharyngeal
constrictor muscles moves
bolus to esophagus
Tensor veli palatini vs Levator veli palatini muscles
Tensor veli palatini: CN V3 tenses soft palate, acts on Eustachian tube (pharyngotympanic tube) to depressurize middle ear
Levator veli palatini: CN X-
pharyngeal plexus
elevates tensed palate, also
acts on Eustachian tube
PARALYSIS–> reflux of oral components into nasal cavity or Eustachian tube dysfunction
N/A/L of teeth
Superior (CN V2) and Inferior (CN V3) alveolar nerves create dental plexus that supply teeth
Superior and inferior alveolar arteries (maxillary A) supply teeth
Lymph–> submandibular lymph nodes
Sublingual gland innervation pathway
Presynaptic parasympathetic secretomotor fibers on chorda tympani (CN VII) to lingual nerve (CN V3)–> synapse in submandibular ganglion–> go to gland along with postsynaptic sympathetic fibers from superior cervical ganglion
–> SAME AS SUBMANDIBULAR
Submandibular gland innervation pathway
Presynaptic parasympathetic secretomotor fibers on chorda tympani (CN VII) to lingual nerve (CN V3)–> synapse in submandibular ganglion–> go to gland along with postsynaptic sympathetic fibers from superior cervical ganglion
–> SAME AS SUBLINGUAL
Submandibular-Nerve relationships
- Lingual N goes beneath submandibular duct and terminates as several medial branches
- Hypoglossal N deep to gland–> digastric muscle
- Facial N (marginal mandibular branch) exits anterior-inferior parotid gland @ angle of jaw and runs inferior to submandibular gland
Lymph drainage of tongue
1) root of tongue drains BL to superior deep cervical LNs
2) medial part of body drains BL to inferior deep cervical LNs
3) BL lateral parts of body drain to submandibular LN on ipsilateral side
4) apex and frenulum (tip and front underside) drain to submental LNs
–> ultimately to deep cervical LN to venous system via jugular venous trunks
Palatine tonsil relationships/drainage
Located between palatoglossal and palatopharyngeal arches
CN IX lateral and posterior to tonsil
Inneravtion via CN V2 and CN IX
Lymph drain into jugulo-digastric (upper) deep cervical lymph nodes
Removed in tonsillectomy d/t tonsillitis
Complication of bacterial tonsillitis is peritonsillar abscess that requires drainage
Lymph drainage of tongue
1) root of tongue drains BL to superior deep cervical LNs
2) medial part of body drains BL to inferior deep cervical LNs
3) BL lateral parts of body drain to submandibular LN on ipsilateral side
4) apex and frenulum (tip and front underside) drain to submental LNs
–> ultimately to deep cervical LN to venous system via jugular venous trunks
Tensor veli palatini M
M of soft palate
scaphoid fossa of medial pterygoid plate, sphenoid bone and cartilage of Eustachian tube–> palatine aponeurosis
CN V3- medial pterygoid nerve via otic ganglion
Tenses soft palate, opens Eustachian tube during swallowing and yawning
Levator veli palatini M
cartilage of Eustachian tube and temporal bone–> palatine aponeurosis
Pharyngeal branch of CN X
Elevates tensed soft palate during swallowing and yawning
Palatoglossus M
palatine aponeurosis–>side of tongue
Pharyngeal branch of CN X
Elevates posterior part of tongue and draws soft palate onto tongue
Extrinsic muscle of tongue
Genioglossus M
Extrinsic muscle of tongue
bulk of tongue: spine of mandible–>dorsum of tongue and hyoid bone
Depress tongue, pull anteriorly for protrusion, retracts tip of tongue, deviate to contralateral side
Styloglossus M
Extrinsic muscle of tongue
styloid process–> posterior sides of tongue
Retrude tongue, curls sides w/ genioglossus to form central canal for swallowing
Hyoglossus M
Extrinsic muscle of tongue
hyoid–>inferior lateral tongue
Depress tongue, pull sides inferiorly, retrude tongue
Genioglossus M
Extrinsic muscle of tongue
CN X
bulk of tongue: spine of mandible–>dorsum of tongue and hyoid bone
Depress tongue, pull anteriorly for protrusion, retracts tip of tongue, deviate to contralateral side
Styloglossus M
Extrinsic muscle of tongue
CN X
styloid process–> posterior sides of tongue
Retrude tongue, curls sides w/ genioglossus to form central canal for swallowing
Hyoglossus M
Extrinsic muscle of tongue
CN X
hyoid–>inferior lateral tongue
Depress tongue, pull sides inferiorly, retrude tongue
Intrinsic Ms of tongue
CN X
superior longitudinal
inferior longitudinal
transverse
vertical
curls tongue, protrudes tongue, flattens and broadens tongue
Superior Pharyngeal Constrictor M
External
pterygoid, mylohyoid, mandible, tongue–> occipital bone
Pharygneal branch of CN X
Constrict walls of pharynx during swallowing
Middle Pharyngeal Constrictor M
External
Stylohyoid L, hyoid–> pharyngeal raphe
Pharyngeal branch of CN X, recurrent laryngeal nerves
Constrict walls of pharynx during swallowing
Inferior Pharyngeal Constrictor M
External
Thyroid cartilage, cricocartilage–> encircles pharyngo-esophageal junction without forming a raphe
Constrict walls of pharynx during swallowing
Salpingopharyngeus M
Internal
Pharyngeal branch of CN X
cartilage of Eustachian tube—>blends with palatopharyngeus on thyroid cartilage, pharynx and espophagus
Elevate larynx, shorten pharynx during swallowing and speaking
Stylopharyngeus M
Internal
CN IX
Styloid process–> thyroid cartilage with palatopharyngeus
Elevate larynx, shorten pharynx during swallowing and speaking
Waldeyer’s lymphatic ring
Palatine tonsils
Pharyngeal (adenoid) tonsils
Lingual tonsils
–> all drain to deep cervical LNs
Pharyngeal plexus
Sensory of oropharynx (CN IX) and laryngopharynx (CN X)
Nasopharynx above Eustachian tube (CN V2)
Gag reflex
More superior–> CN IX
More inferior–> CN X
Inferior Alveolar Nerve Block
branch of CN V3
inject around mandibular foramen
teeth of median plane, skin and mucous of lower lip, gums, skin of chin (d/t supplied by mental N)
–>pterygoid trismus if poorly injected into parotid gland or medial pterygoid M
