Oral Cavity, Tongue And Pharynx Flashcards
What are the hard and soft palates?
Hard - front of roof of mouth, made from 2 bones: palatine process of maxilla anteriorly and the horizontal plate of palatine bone posteriorly
Soft - back of roof off mouth, 5 muscles and connective tissue - end with uvula
Which two arches bind the soft palate to the tongue and pharynx? What’s between them?
The palatoglossal arch anteriorly and the palatopharyngeal arch posteriorly
Between arches are the palatine tonsils on each side
What is too short when a person is ‘tongue tied’? What’s either side of this structure?
Lingual frenulum connects floor of mouth to tongue
Can be snipped if not feeding properly
Submandibular ducts either side
What’s the area called between lips/ gums and teeth?
Vestibule
The mouth is split into 4 quadrants, name the tether from lateral to medial in one quadrant
2 molars
3 pre-molars
1 canine
2 incisors
Overall 32 teeth
What are the muscles of the tongue (split into two categories)? What innervates them?
Intrinsic: 4 paired muscles 1superior longitudinal 1 inferior longitudinal 1 vertical 1 transverse On each side motor innervation - hypoglossal N
Extrinsic: Genioglossus (from mandible) Hypoglossus (from hyoid) Styloglossus (from styloid process temporal) Motor innervation- hypoglossal N
& palatoglossus (from palates)
Motor innervation - vagus N
What innervates the tongue to provide general sensory and taste?
Anterior 2/3:
Sensory - trigeminal V3
Taste - facial N
Posterior 1/3:
Sensation and taste - glossopharyngeal
Where are each of the salivary ducts located and how do they release saliva to the oral cavity?
Submandibular - pairs either side at around angle of jaw -> wharton duct -> each side of lingual frenulum
Parotid gland -in front of ears either side -> stensen duct -> near 2nd pre-molar
Sublingual - (smallest and most diffuse, 3-5% of saliva) - under tongue -> 8- 20 excretory ducts ‘ducts of Rivinus’ -> adjacent to incisors
What is a sialolithiasis? What are the symptoms? How do you diagnose?
Salivary gland stone - most in submandibular glands, most less then 1cm diameter
❌ dehydration (reduced salivary flow), eating/ thinking about food stimulates pain in gland, welling -> infection
History, X- ray, sialogram (inject dye-> x-ray)
What is tonsillitis, what are the symptoms , causes?
Inflammation of the palatine tonsils between arches, normally tucked away but visible when inflamed.
❌fever, sore throat, pain/ dysphasia, cervical LNs enlarged, bad breath
viral causes most common, bacterial 40% e.g. strep pyogenes
What is a peritonsillar abscess/ quinsy? Symptoms?
Pus filled pocket forms near tonsils Due to infection behind tonsils usually from untreated/ partially treated strep throat/ tonsillitis or can arise on its own from bacterial infection
❌ fever, bad breath, drooling, difficulty opening mouth, hot potato voice, deviated uvula away
Boundaries of the nasopharynx and contents
Roof - base of skull
Floor- upper border soft palate
Posterior- C1, C2
Anterior - nasal cavity
Contains - pharyngeal tonsil/ adenoid (starts near end of nasal septum)
What can enlarged adenoids cause?
Block Eustachian tube - recurrent/ persistent middle ear infections
Snoring- sleep apnoea
Sleeping with mouth open
Chronic sinusitis (sore throat)
Nasal tone to voice
What are the boundaries of the oropharynx? Contents?
Roof - soft palate
Floor - epiglottis
Anterior - oral cavity
Posterior - C2, C3
Contains - palatine tonsils
What are the boundaries of the laryngopharynx/ hypopharynx? Contents?
Roof - oropharynx
Floor - oesophagus
anterior - larynx incl epiglottis and cricoid cartilage
Posterior - C4, C5, C6
Contains- piriform fossa (either side vocal cords and aeroepiglottis folds, epiglottis just anterior)
Which 3 longitudinal muscles elevate the pharynx and larynx during swallowing, where is each located and what is their innervation?
Stylopharyngeus - temporal styloid process -> posterior thyroid cartilage
- glossopharyngeal N (9)
Palatopharyngeus - hard palate -> posterior thyroid cartilage
- pharyngeal branch vagus N (10)
Salpinopharyngeus - cartilaginous Eustachian tube -> merges palatopharyngeus -> TC
- pharyngeal branch vagus (10)
Which three circular muscles constrict the walls of the pharynx during swallowing, where is each found and what is their innervation?
Superior pharyngeal constrictor - origin pterygomandibular raphe
Middle PC - origin hyoid bone
Inferior PC - 2 parts:
- Thyropharyngeal (origin thyroid cartilage)
- Cricopharyngeal (origin cricoid cartilage)
- innervation to all vagus N (10)
What is Zenker’s diverticulum? Symptoms
Pharyngeal ouch that forms at junction of oesophagus and laryngopharynx ‘Killian’s dehiscence’. Arises in weakness between two parts of the inferior constrictor.
Probably due: failure UOS to relax, and normal timing swallowing, higher pressure in laryngopharynx, food material collects in pouch/ disrupts swallowing
❌ bad breath, regurgitation food, occasional choking fluids, dysphasia
Overview of nerve innervation of pharynx
Pharyngeal plexus - mainly surface of middle constrictor muscle
- vagus, glossopharyngeal, cervical sympathetic N
Motor - CNX innervates all muscles bar stylopharyngeus (glossopharyngeal N 9)
Sensory - nasopharynx (maxillary 2), oropharynx (glossopharyngeal), laryngopharynx (vagus)
What are the three stages of swallowing? state whether they are voluntary or not and how long each stage takes.
- voluntary Stage 1 oral 0-7.4 secs
Stage 2 pharyngeal - involuntary 7.4-7.6 = 0.2secs
Stage 3 oesophageal - involuntary 7.6 onwards
State what happens in stage one of swallowing & innervation
Oral stage
Preparatory phase
-Make bolus
Transit phase
-bolus compressed against palate -> pushed into oropharynx by tongue & soft palate
- hypoglossal N (12) muscles of tongue
State what happens in stage two of swallowing and innervation
Pharyngeal
Tongue against hard palate (food can’t re-enter mouth) CN12
Soft palate elevated (seal off nasopharynx) tensor palatini CNV3, levator palatini CNX
Suprahyoid (V3, 7, 12) & longitudinal muscles (9, 10) shorten -> pharynx widens & shortens to receive bolus, larynx elevated & sealed off by vocal cords adduction
Epiglottis closes over larynx
Bolus moves through pharynx sequential contraction constrictors
Relaxation UOS
State what happens in stage three of swallowing and innervation
Oesophageal
Upper striated muscle of oesophagus (10)
Lower smooth muscle
LOS opens
What could the following presentation be a sign of: 78yro lady with left sided facial weakness, slurred speech, left limb weakness & hypertensive. What should you worry about
Stroke -
Could get neurological dysphagia
30% post stroke deaths due to pneumonia (aspiration pneumonia)
Signs and symptoms of dysphasia
Usual symptoms:
Coughing Choking Sialorrhoea (drooling) Recurrent pneumonia Change in voice/ speech (wet voice) Nasal regurgitation
Signs of cranial nerves 9 and 10 pathology. Possible causes
Absent gag
Uvula deviated away from lesion
Dysphasia
Taste impairment
Loss sensation oropharynx
Caused: medullary infarct, jugular foramen fracture, lesion
Signs of cranial nerve 12 pathology
Wasted tongue
Stick tongue out- deviate towards lesion
Fasiculations (twitching)
