oral cavity, salivary glands and pharynx Flashcards
what is the oral cavity?
oral vestibule + oral cavity proper (largely occupied by the tongue)
oral cavity proper is deep to the teeth
where is the vestibule?
this is the space between the lips/cheeks and the teeth/gums.
what are the 2 types of oral mucosa and what is the difference?
lining mucosa = stratified squamous epithelium
masticatory mucosa = keratinised stratified squamous epithelium (hard palate, attached gingival, dorsal tongue)
what are the 5 muscles of the soft palate?
- palaptoglossus
- palaptopharyngeus
- tensor veli palatini
- levator veli palatini
- musculus uvulae
what is the posterior border of the oral cavity?
Oropharyngeal isthmus
what are the functions of the oral cavity?
- ingestion
- chewing and swallowing (first phase)
- speech
- taste
what are the boundries of the oral cavity and what occopies it?
- anterolateral boundry
- roof
- floor
- The oral cavity os occupied by the anterior of the tongue
anterolateral boundry = teeth/gums
roof= hard palate
floor of mouth = mucosa and muscle
what marks the transition from skin to labial mucosa of the lips?
what is it continous with?
- the vermillion border
- it will be continous with the oral mucosa
what is the function of obicularis oris?
closes the lips to narrow the oral opening.
innervation and blood supply of the buccinator?
innervation = buccal branches of the facial nerve
blood supply = buccal artery (branches of the maxillary artery)
What is the buccinator muscle continuous with?
continous with the orbicularis oris
function of buccinator muscle?
- pulls the cheeks inwards to prevent the accumulation of food in that area
- aids in chewing and controlling of bollus
innervation of the upper lip?
infraorbital nerve
branch of maxillary nerve
innervation of lower lip?
mental nerve
branch of mandibular nerve
what attaches to the lingula of the mandible?
spehnomandibular ligament
wat goes through the mandibular canal?
inferior alveolar nerve and vessels
what attaches to the mylohyoid line?
the mylohyoid muscle
this muscle creates the floor of the mouth
what are the 4 main muscles of mastication?
- masseter
- temporalis
- medial pterygoid
- lateral pterygoid
what nerve will supply all 4 muscles of mastication?
CN V3
mandibular nerve
function of masseter?
function = elevates mandible
function and attachments of the temporlis?
function = elevates and retracts the mandible
function of medial pterygoid?
elevation and lateral movement of mandible
function of lateral pterygoid?
depression, protrusion and lateral movement
how many teeth do we have and how are they divided?
32 teeth
- divided into 4 quadrants of 8
- right, left, maxillary and mandibular
what teeth/how many do we have in each quadrant?
- two incisors
- one canine
- two premolars
- three molars
how many teeth do kids have and how are the teeth split?
- 20 teeth
- two incisors
- one canine
- two molars
per quadrant
what are the 6 key milestones for loss of baby teeth?
1- first baby tooth by 6 months
2- complete baby teeth by around 2 years
3- first adult molar by six years
4- lose first baby tooth (6-8 years (usually a lower central incisor) )
5- all baby teeth replaced by 12 years
6- third molar (wisdom tooth) very variable
upper teeth innervation?
supplied by the:
- anterior, middle and posterior superior alveolar nerve
- this is a branch of maxillary division
from trigeminal nerve branches
lower teeth innervation
supplied by the:
- inferior alveolar nerve
- from mandibular division
from trigeminal nerve branches
what is gingivae?
The gingiva, also known as the gums, is the pink-colored keratinized mucosa that surrounds and protects the teeth
innervation of upper gingivae?
supplied by:
- upper palatal from nasopalatine and greater palatine nerves
branch of the trigeminal nerve
innervation of lower gingivae?
supplied by the:
- lingual nerve
- buccal nerve
- mental nerve
branches of the mandibular nerve CN V3
from superficial to deep, what are the layers of the cheeks?
- skin
- buccal fat pad
- buccopharyngeal fascia
- buccinator muscle
- minor salivary gland
- oral mucosa
cheeks are continous with the lips
function of the buccal fat pad?
- aids sucking in infants
- aids the function of the muscles of mastication
innervation of the cheeks:
medial aspect?
lateral aspect?
medial = infraorbital CN V2
lateral = buccal nerve CN V3 (lateral to the buccinator)
function of palate?
what are the 2 types of palate?
- the palate will seperate the oral and nasal cavities
- we have hard palate and soft palate
where will you find hard palate?
what is ot covered in?
- anteriorly
- on the bone of maxillae (palatine process) and palatine bones (horizontal plate)
- covered by masticatory mucosa with minor salivary glands
where will you find soft palate?
what is is made by and covered in?
- more posterioly
- made by muscles and membranes
- covered in oral epithelium
function of the tongue?
- speech
- taste
- mastication
- swallowing
describe the structure of the tongue?
muscular, mucosa lined organ
- kertinsed on dorsum
- specialised papillae for taste
describe the position of the tongue in the oral cavity?
how is either part distinguished?
body = anterior 2/3rds - horizontal in oral cavity
root = posterior 1/3rd- vertical in oral cavity
they are distinguished from each other by sulcus terminalis (this is important for demarking the nerve supply
the tongue has many different strictures on it, describe filiform papillae?
filiform papillae:
- found on the naterior 2/3rds dorsum
- kertinised
- not chemosensory
- for gripping food
- it has an underermined mechanoreceptive role
the tongue has many different strictures on it, describe fungiform papillae?
fungiform papillae:
- found on the anterior 2/3rds dorsum
- not keratinised
- houses taste buds
- highest density will be found anteriorly
where will you find taste buds and what do taste buds have?
taste buds will be found in fungiform papillae, they will have multiple chemosensory receptors. (CN V7)
describe the osition and function of the:
- foliate papillae
- circumvallate papillae
- foliate papillae = lateral borders posteriorly
- circumvallate papillae = relatively large dome shaped papillae, found aterior to the terminal sulcus
function:
they are both chemosensory, CN IX- they will mediate taste
palatoglossus:
function
attachments
function:
- depresses palate
- moves the palatoglossal arch medially
- elevates back of the tongue
attachments:
- from the inferior part of the palatine aponeurosis to the lateral aspect of tongue
ANTERIOR PILLAR OF FAUCES
Palatopharyngeus:
function
attachments
function:
- depresses palate
- elevates pharynx
- moves palatopharyngeal folds medially
attachments:
- from the superior part of palatine aponeurosis to the lateral pharyngeal wall
POSTERIOR PILLAR OF FAUCES
tensor veli palatini:
attachments?
functions?
function:
- tenses the soft palate, opening the pharyngotympanic tube
attachments:
- scaphoid fossa and spine of the sphenoid bone, pharyngotympanic tube to the palatine aponeurosis
levator veli palatini?
functions
attachments
function:
- elevates soft palate
attachments:
- petrous temporal bone and pharyngotympanic tube to the superior surface of the palatine aponeurosis
musculus uvulae:
function
attachments
function:
- elevates and retract the uvula
attachments:
- posterior nasal spine to mucosa of uvula.
all the muscles of the soft palate will be innervated by what nerve?
what is the exception?
- pharyngeal plexus (CN X)
- except tensor veli palatini (CN V3)
describe the arterial supply to the soft palate?
SUPPLIED BY BRANCHES OF THE EXTERNAL CAROTID:
maxillary - greater and lesser palatine
facial - ascending palatine
ascending pharyngeal - palatine
how many intrinsic and extrinsic muscles does the tongue have?
it has 4 of each
what are the 4 intrinsic muscles of the tongue?
what is their over all function?
function:
- change shape of the tongue
- superior and inferior longitudinal
- transverse
- vertical
what are the 4 extrinsic muscles of the tongue?
what is the over all function?
function:
- change position of the tongue
- palatoglossus
- hyoglossus
- genioglossus
- styloglossus
what are the individual functions of the extrinsic muscles of the tongue?
- palatoglossus = elevate
- hyoglossus = depress
- genioglossus = protrude
- sytyloglossus = retrude
what are all of the intrinsic and extrinsic muscles of the tongue innervated by?
what is the only exception?
all innervated by the CN XII hypoglossal EXCEPT palatoglossal (which is supplied by the vagus nerve)
describe the diagram of the different areas of sensory nerve supply of the tongue ?
describe the arterial supply to the tongue?
suppl to the tongue is from the external carotid artery via the lingual artery.
- this gives off dorsal and deep lingual branches.
- the tongue is highly vascularised.
describe the venous supply of the tongue?
it has 2 main veins
sublingual vein… drains into vena comitans following CN XII … drains into internal jugular
the dorsal and deep lingual veins… drain into the internal jugular vein
why can sublingual medications be given?
because there is a rich vascular drainge close to the mucosal surface
describe the lympathic drainge of the tongue?
- posteriorly
- medially
- anteriorly
- bilateral drainge at the midline that goes into the superior deep cervical lymph nodes posteriorly.
- medially to the inferior deep cervical lymmph nodes
- anteriorly to submandibular lymph nodes/ submental lymph nodes
where will the deep cervical lymph nodes drain into?
venous angle between the subclavian and the internal jugular
what are the 2 main muscles of the floor of the mouth?
- mylohyoid
- geniohyoid
mylohyoid:
innervation
function
innervation:
- CN V3 (MANDIBULAR NERVE)
function:
- can depress the mandible when the hyoid is fixed.
geniohyoid:
attachments
innervation
function
attachments:
- inferior mental spines to hyoid bone
innervation:
- C1 via the hypoglossal nerve
function:
- can depress the madnible when the hyoid is fixed.
what are the 3 bilateral pairs of major glands?
- parotid
- submandibular
- sublingual
function of saliva?
- it facilitates oral processes
- solubilises the food
- lubricate oral function
- amylase digests carbs
- many other proteins within the saliva have defence and protective function
what are vert common signs of disease related to the mouth?
- dry mouth
- hyposalivation
- xerostomia (a feeling of dryness in the presense of adequate salivary flow)
- altered taste (this can be a side effect of medication or secondary to infection and some GI conditions)
what are the very serious signs of oral cancer?
- ## any oral lesion persisting longer than three weeks
smoking and alcohol and big risk factors
Parotid Gland:
- type pf secretion
- location
- what divides within it
- serous secretion (no mucin)
- located within the retromandibular fossa, anteroinferior to the ear, within investing fascia.
- the facial nerve will divide within the gland BUT IT DOES NOT INNERVATE IT
- the superficial temporal and maxillary vessels unite/divide within it.
largest major gland
what is the secretomotor innervation for the parotid gland
- innervation comes from the glossopharyngeal nerve via the tympanic nerve
- this goes through the tympanic plexus
- this comes out as the lesser petrosal nerve
- synapses in the otic ganglion
- post synaptic neurons reach the parotid gland via the auricotemporal nerve
from CN IX = glossopharyngeal
sensory innervation to the parotid gland?
comes from the auricotemporal nerve and great auricular nerve C2/3
what will the parotid gland empty into?
- empties lateral to the maxillary second molar
submandibular gland:
- what muscle is it related too?
- what is it prone to?
- what are its secretions like?
- what does it open up into?
- innervation?
- wraps around the mylohyoid
- prone to silaothiasis (stones within the gland)
- mixed seromucos secretions
- opens into sublingual papillae
- supplied by the facial artery via submental branches
- CN VII via chorda tympani (joining the lingual nerve)
sublingual gland:
- what muscle is it related too?
- where does it drain into?
- what are its secretions like?
- innervation?
- above mylohyoid, below the mucus membrane
- there are multiple short branches that open into the sublingual folds
-MUCOUS GLAND - submental and sublingual artery branches
- innervation (same as submandibualar) CN VII via chorda tympani joining the lingual nerve
what is the pharynx?
what are its borders?
what are its 3 divisions?
function?
the pharynx is a fibromuscular tube from the base of the skull to the lower border of the cricoid (C6)
nasopharynx
oropharynx
laryngopharynx.
conveying air to the trachae and food/liquids to esophagus
what are the 3 constrictor and 3 longitudinal muscles of the pharynx?
constrictor:
- superior constrictor
- middle constrictor
- inferior constrictor
longitudinal:
- stylopharyngeus
- palatopharyngeus
- salpingopharyngeus
what makes up Waldeyer’s ring?
- pharyngeal tonsil
- 2 bilateral tubal tonsil
- 2 bilateral paltine tonsil
- lingual tonsil
ring of tonsil tissue around entrance to resp/digestrive tract
nasopharynx:
- anterior communication?
- innervation
- anterior communication = nasal cavities via concha
- anterior innervation = CN V2 pharyngeal branch
oropharynx:
communicates with?
innervation?
- communicates with oral cavity vi oropharyngeal isthmus
- sensory innervation from CN IX via the pharyngeal plexus
- valeculae between posterolateral tongue and epiglottis (this is a common place for foreign bodies to get stuck)
laryngopharynx:
communicates with?
innervation?
- communicates with larynx via the laryngeal inlet
- sensory innervation from CN X via pharyngeal plexus
- the piriform fossae between pharyngeal wall and quandrangular membrane is a common place for foregn bodies to get stuck like fish bones.
what is the insertion of all of the pharyngeal constrictor muscles?
what are they all supplied by?
- they all insertet onto the pharyngeal raphe
- they are all supplied by the CN x
CN X = vagus nerve
stylopharyngeus:
attachments?
innervation?
function?
attachments= styloid process to pharyngeal walls
innervation = CN IX
function = elevates pharynx
CN IX= glosspharyngeal nerve
palaptopharyngeus:
attachments?
innervation?
function?
attachments:
- palatine aponeurosis to pharyngeal walls
innervation:
- CN X (vagus nerve)
function:
- elevates pharynx and closes the oropharyngeal isthmus
salpingopharyngeus:
attachments?
innervation?
function?
attachments:
- pharyngotympanic tube to pharyngeal walls
innervation:
- supplied by CN X (vagus nerve)
function:
- elevates pharynx
the pharynx has 3 muscular functions, what are the 3 functions using the:
- elevators
- constrictors
- cricopharyngeal sphincter
- the elevators will raise the pharynx superiorly to receive bolus (this makes it shorten and widen)
- the constrictors act in an involuntary co=ordinated fashion to propel the bolus towards the esosphagus
- the cricopharyngeal sphincter prevents air entering oesophagus during breathing.
what can a lack of co-ordination of constrictors cause?
it can cause pharyngoeosophageal diverticulum via Killian’s dehiscence (this is a relatively weak part of the pharynx)
where do the potential spaces arise?
- retrophryngeal from th base of the skull to the posterior mediastinum
- danger space within the prevertebral from the base of the skull to the diapghram.
where will you find buccopharyngeal fascia?
posterior part of the pretrachael fascia is termed buccopharyngeal fascia.
what are the 2 layers of the pharynx fascia?
describe them?
buccopharyngeal - posterior and external
pharyngobasilar fascia - internal (thicker and tougher)
above the superior constrictor, the pharyngobasilar fascia is the majority of the pharyngeal wall. it is reinforced by the pharyngeal raphe.
how many spaces are there within the pharynx?
4
what vessels go through space 1 (between the (above) superior constrictor, below the base of the skull)?
- sinus of morgagni
- tensor and levator palatini
- pharyngotympanic tube
- ascending palatine artery
what vessels move through space 2 (between the superior and middle constricotrs) = oropharyngeal triangle?
- stylopharyngeus
- glossopharyngeus nerve
- stylohyoid ligament
what vessels move through space 3 (between the middle and inferior constrictor)
- internal laryngeal nerve
- superior laryngeal artery and vein
what vessels move through space 4 ( below the inferior constrictor)
- the recurrent laryngeal nerve
- inferior laryngeal artery
describe the infant anatomy of the oral cavity ?
- omega shaped epiglottis
- tongue with a central groove
- fat pads for generation of intraoral suction
- close proximity of the soft palate and epiglottis (until 6 months)
- elevated larynx that is tucked up and under the epiglottis
upper pharynx arterial supply?
- ascending pharyngeal artery (from the ECA)
- ascending palatine and tonsillar branch from the facial artery
lower pharynx arterial supply?
- pharyngeal branch of the inferior thyroid artery (from thyrocervical trunk from subclavian)
describe the venous driange of the pharynx?
happens through the pterygoid venous plexus … into the facial and retromandibular veins … into the internal jugular veins.
describe the lymph draiange of the pharynx?
- retropharyngeal
- paratrachael
- infrahyoid
THEY ALL DRAIN INTO THE DEEP CERVICAL LYMPH NODES
where do the palatine tonsils drain into?
the jugulodigastric node, they will be palpable if inflammed.
what will all pharyngeal muscles be supplied by?
what is the only exception?
all pharyngeal muscles are supplied by the vagus nerve.
EXCEPT
stylopharyngeus which is supplied by the glossopharyngeal nerve.
where does the pharyngeal plexus lie?
the pharyngeal plexus lies on the external pharyngeal wall and includes branches of the vagus nerve and the glossopharyngeal nerve and cervical sympathetics.
describe the motor innervation to the pharynx?
all pharyngeal muscles are supplied by the vagus nerve.
EXCEPT
stylopharyngeus which is supplied by the glossopharyngeal nerve.
the pharyngeal plexus lies on the external pharyngeal wall and includes branches of the vagus nerve and the glossopharyngeal nerve and cervical sympathetics.
visceral efferent (parasympathetic secretomotor) and via vagus and facial nerves.
describe the sensory innervation to the pharynx?
(its divided into 3 parts)
nasopharynx = maxillary and trigeminal nerve
oropharynx, palatine tonsils, inferior surface of soft palate and posterior 1/3rd of the tongue= glossopharyngeal
laryngopharynx, vallecula and epiglottis = vagus nerve
pain may be reffered to middle of ear for glosspharyngeal
what happens to the pharynx during mastication?
what 2 muscles act to do this?
The buccinator and the muscles of the tongue will maintain the bollus between the teeth.
- the oropharyngeal isthmus must be closed
this is helped done by the, due to their actions
the palatoglossus and palatophaaryngeus act to:
- move medially like curtains
- raise posterior tongue
- depress the soft palate
name the suprahyoid muscles?
mylohyoid
digastric
geniohyoid
stylohyoid
stylohyoid:
function?
innervation?
function:
- elevates hyoid
innervation:
- facial nerve
periced by digastric tendon at hyoid insertion
geniohyoid:
function?
innervation?
function:
- elevates hyoid/depress mandible
innervation:
- CI via hyoglossal nerve
mylohyoid:
function?
innervation?
function:
- elevates hyoid, floor of mouth
innervation:
- CN V3 (mandibular)
digastric:
function?
innervation?
function:
- raises hyoid, floor of mouth, depresses mandible
innervation:
posteriorly = facial nerve
anteriorly = V3
