Oral Cavity, Tongue And Pharynx Flashcards

1
Q

What are the hard and soft palates?

A

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

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2
Q

Which two arches bind the soft palate to the tongue and pharynx? What’s between them?

A

The palatoglossal arch anteriorly and the palatopharyngeal arch posteriorly

Between arches are the palatine tonsils on each side

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3
Q

What is too short when a person is ‘tongue tied’? What’s either side of this structure?

A

Lingual frenulum connects floor of mouth to tongue

Can be snipped if not feeding properly

Submandibular ducts either side

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4
Q

What’s the area called between lips/ gums and teeth?

A

Vestibule

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5
Q

The mouth is split into 4 quadrants, name the tether from lateral to medial in one quadrant

A

2 molars
3 pre-molars
1 canine
2 incisors

Overall 32 teeth

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6
Q

What are the muscles of the tongue (split into two categories)? What innervates them?

A
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

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7
Q

What innervates the tongue to provide general sensory and taste?

A

Anterior 2/3:
Sensory - trigeminal V3
Taste - facial N

Posterior 1/3:
Sensation and taste - glossopharyngeal

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8
Q

Where are each of the salivary ducts located and how do they release saliva to the oral cavity?

A

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

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9
Q

What is a sialolithiasis? What are the symptoms? How do you diagnose?

A

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)

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10
Q

What is tonsillitis, what are the symptoms , causes?

A

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

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11
Q

What is a peritonsillar abscess/ quinsy? Symptoms?

A

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

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12
Q

Boundaries of the nasopharynx and contents

A

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)

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13
Q

What can enlarged adenoids cause?

A

Block Eustachian tube - recurrent/ persistent middle ear infections

Snoring- sleep apnoea

Sleeping with mouth open

Chronic sinusitis (sore throat)

Nasal tone to voice

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14
Q

What are the boundaries of the oropharynx? Contents?

A

Roof - soft palate
Floor - epiglottis
Anterior - oral cavity
Posterior - C2, C3

Contains - palatine tonsils

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15
Q

What are the boundaries of the laryngopharynx/ hypopharynx? Contents?

A

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)

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16
Q

Which 3 longitudinal muscles elevate the pharynx and larynx during swallowing, where is each located and what is their innervation?

A

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)

17
Q

Which three circular muscles constrict the walls of the pharynx during swallowing, where is each found and what is their innervation?

A

Superior pharyngeal constrictor - origin pterygomandibular raphe

Middle PC - origin hyoid bone

Inferior PC - 2 parts:

  1. Thyropharyngeal (origin thyroid cartilage)
  2. Cricopharyngeal (origin cricoid cartilage)
  • innervation to all vagus N (10)
18
Q

What is Zenker’s diverticulum? Symptoms

A

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

19
Q

Overview of nerve innervation of pharynx

A

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)

20
Q

What are the three stages of swallowing? state whether they are voluntary or not and how long each stage takes.

A
  • 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

21
Q

State what happens in stage one of swallowing & innervation

A

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
22
Q

State what happens in stage two of swallowing and innervation

A

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

23
Q

State what happens in stage three of swallowing and innervation

A

Oesophageal

Upper striated muscle of oesophagus (10)

Lower smooth muscle

LOS opens

24
Q

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

A

Stroke -

Could get neurological dysphagia

30% post stroke deaths due to pneumonia (aspiration pneumonia)

25
Q

Signs and symptoms of dysphasia

A

Usual symptoms:

Coughing
Choking 
Sialorrhoea (drooling) 
Recurrent pneumonia 
Change in voice/ speech (wet voice)
Nasal regurgitation
26
Q

Signs of cranial nerves 9 and 10 pathology. Possible causes

A

Absent gag

Uvula deviated away from lesion

Dysphasia
Taste impairment
Loss sensation oropharynx

Caused: medullary infarct, jugular foramen fracture, lesion

27
Q

Signs of cranial nerve 12 pathology

A

Wasted tongue

Stick tongue out- deviate towards lesion

Fasiculations (twitching)