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Chika- SF2 > Oral Cavity- Wilson > Flashcards

Oral Cavity- Wilson Flashcards

1
Q

The mouth is divided into what two parts?

A
  • vestibule

- oral cavity proper

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2
Q

What are the lateral and medial boundaries of the the vestibule?

A

the slit-like space between the lips/cheeks and teeth

lateral: lips and cheek
medial: teeth

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3
Q

The vestibule and oral cavity proper communicate through what space? How is this important clinically?

A

retromolar space

you can insert a feeding tube for liquids or ground up solids through the retromolar space for nursing patients who are not able to open their jaw for one reason or another (jaw is wired shut) i.e trismus, spasms of muscles of mastication

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4
Q

What are the boundaries of the retromolar space?

A

space between the maxillary/mandibular molars and ramus of the mandible

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5
Q

What are the two skeletal muscles derived from the same branchial arch that make up the lips and cheeks?

A

anteriorly lip is the orbicularis oris

laterally cheeks is the buccinator

2nd branchial arch

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6
Q

Between the mucous membrane and the muscles (buccinator and orbicularis oris) we have minor salivary glands which are important. Why?

A

-the entire oral cavity is covered with very small microscopic salivary glands and unlike the parotid gland this is just a grouping of salivary glands deep to the mucosa and thus will refer to the salivary glands related to the cheek as the buccal salivary glands and related to the lips as the labial salivary glands

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7
Q

What is the vermilion border?

A
  • the thin part of the skin covering the lips (where you put lipstick on)
  • important not just cosmetically but clinically because they turn blue when a patient is hypoxic
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8
Q

What are the 3 skeletal muscles that surround the entry into the digestive system?

A
  • superior pharyngeal constrictor
  • buccinator
  • orbicularis oris

These 3 muscles form a large muscular sphincter around the entrance to the oral tube.

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9
Q

What do the muscle fibers of the superior pharyngeal constrictor run into and the fibers of the buccinator originate from?

A

pterygomandibular raphe

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10
Q

What is the function of the lips and cheek during chewing? What happens to the chewing process if there is a lesion to CN VII?

A

your teeth are coming down on the solid food and you’re mixing this material with saliva making the material you’re chewing very slippery, so the material will naturally slide out laterally or medially

the function of the buccinator and tongue is to trap the food between the occlusive surfaces making chewing much more efficient so food will not escape while you compress, chew, and grind up the food

If there is a lesion in the buccinator or a nerve block paralysing the buccinator, when you chew, food will squirt out into the vestibule (like a squirrel saving up food for the winter time).

During chewing, food is kept between the occlusal surfaces by the buccinator and tongue. Food accumulates in the vestibule and may dribble out the corner of the mouth during chewing following lesions to CN VII.

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11
Q

What is the function of the buccal fat pad in newborns?

A

Outside of the buccinator is the buccal fat pad.

In newborns, the buccal fat pad is well developed and gives babies “fat cheeks”.

They need it for SUCKLING as newborns have not really developed the muscles of body yet and there is not a really a bone supporting the cheeks.

Fat pad gives rigidity to the cheeks so as the child will be nursed and developing a vacuum in the oral cavity, the oral cavity will not collapse (is not sucked inwardly).

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12
Q

What are “sunken cheeks” and what are clinical condition attributed to it?

A

A common appearance where instead of the fat pad being thick with fat it can be cannibalised/metabolised when the body needs extra energy and nutrients.

The buccal fat pad becomes a source of food during these conditions which include:

  • starvation
  • anorexia nervosa
  • chronic disease (eg. cancer)
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13
Q

One of the most important features of the vestibule is the opening of the parotid duct. Why?

A

The parotid duct opens into the vestibule opposite the 2nd maxillary molar as its location.

The parotid duct if you are not good at chewing or don’t have appropriate proprioceptive feedback of your muscles, sometimes when you chew because the buccinator keeps the food so close to the occlusive surfaces, sometimes you end up biting your cheeks when chewing.

orifice/opening of parotid duct is the parotid papillae

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14
Q

The mucosal lining of the vestibule as well as the oral cavity proper has a direct relationship to the teeth. Explain.

A

Gingivae cover the alveolar bone surrounding the teeth. There are two types:

  • attached: gingiva very closely attached to the teeth and periodontal ligament that holds the teeth in the socket; pale appearance
  • loose (free-alveolar mucosa): free gingiva
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15
Q

What is gingivitis?

A
  • inflammation of the attached gingiva
  • it could become more advanced in its diseased states where you have acute necrotizing ulcerative gingivitis (ANUG)
  • it can be a condition that provides a chronic state of the inflammation to the body ( a lot of argument if chronic inflammation has deleterious effects on the heart and other parts of the body)
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16
Q

What is periodontal disease?

A
  • a more more advanced state of gingivitis
  • similar to gingivitis except that the inflammatory process is now invading the alveolar bone
  • alveolar bone surrounds the teeth and holds the teeth in place
  • you start to get a BONE INFECTION with this periodontal disease
  • you end up getting a receding gum line; gums retract and teeth can fall out becoming unstable
  • this is one of the major reasons (leading cause) why people lose their teeth
  • pseudomembrane over inflammation, very painful, stress, lack of sleep
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17
Q

Why is periodontal disease the major cause of tooth loss? What is the relationship between periodontal

A
  • attached gingiva to the teeth becomes inflamed you get gingivitis; if the gingivitis becomes chronic the inflammatory infection can invade the surrounding alveolar bone
  • as soon as you get an infection in the alveolar bone, you have periodontal disease
  • you get absorption of bone away from the infection and thus receding of gums to a point where the teeth has nothing holding it in place
  • now you see the gingiva follows the bone it has a proper relationship with bone

-the inflammatory process has direct contact to the bone and thus the bone remains chronically infected; you get further reabsorption of bone with eventually loss of teeth

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18
Q

What is the anterior, lateral, and posterior boundaries of the oral cavity proper?

A
  • teeth is the both the anterior and lateral boundary of the teeth
  • palatoglossal arch is the posterior boundary

remember teeth was the medial border of the vestibule

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19
Q

What is the palatoglossal arch and why is it important?

A

the arch that goes from the soft palate to the tongue

you connect the fold from the right-left hand side and you have an arch

this is the boundary where we distinguish oral cavity proper and oropharynx

-it is important for the gag reflex

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20
Q

The palatoglossal arch separates oral cavity from oropharynx, the region of the gag reflex.

A

The linea terminalis or sulcus terminalis is the line on the tongue separating the oral cavity from the oropharynx.

The palatoglossal muscle is deep to the palatoglossal fold.

everything anterior to those landmarks is oral cavity and everything posterior to them is oropharynx; this region receives sensory information which is carried back to the brain through CN IV to invoke a gag reflex (swallowing nothing) or the peristaltic wave (if you’re swallowing during the pharyngeal or involuntary phase of swallowing)

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21
Q

What is the roof of the oral cavity proper? What is its surface topography?

A
  • hard palate forms the roof of the oral cavity (soft palate is really in the oropharynx)
  • incisive papilla: is the location where the nasopalatine nerves/arteries enter to the oral cavity
  • median raphe: where the palatine shelves fuse to prevent a cleft palate
  • rugae: hard ridges on the front part of the hard palate that gives you a good hold of the food you’re trying to eat
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22
Q

What forms the floor of the oral cavity proper?

A

mylohyoid muscle
-it separates the oral cavity from the neck

the floor is NOT the tongue (don’t get this question wrong!!!)

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23
Q

What are the triangular spaces inferior to the mylohyoid muscle? Why are they important?

A

submandibular and submental spaces are inferior to the mylohyoid muscle
-they are important in terms of spreading infections from the oral cavity (potential spaces that could fill up with hemorrhage, abscess, fluid)

-submandibular triangle is where you find the submandibular gland

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24
Q

Why is the mylohyoid line significant?

A
  • it is partition separating the neck and oral cavity proper
  • the roots of the mandibular dental arch teeth don’t extend pass or near the mylohyoid line but found ABOVE it
  • the molar teeth however do have roots that extend beyond the mylohyoid line
  • the insertion of the mylohyoid is an important watershed in the spread of oral infections
  • if you have an dentoalveolar abscess, the abscess will form above the mylohyoid line and if it tracts (moves from one location to another) it can open up right into the sublingual space (space btw the mucosal membrane of the floor of the mouth of the mylohyoid muscle)
  • these spaces communicate!!! if you have an infection in one space it can spread to the other
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25
Q

What separates these 3 fascial spaces?

  • sublingual space
  • submental space
  • submental space
A

-mylohyoid muscle which attaches to the mylohyoid line

separates these spaces

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26
Q

If you have caries of a molar (roots of the molars are longer and extend below the mylohyoid line) and develop dentoalveolar abscess at the root of the molar, where will the infection travel if it were to drain?

A

if the abscess drains itself the infection will go into the neck into the submandibular triangle and eventually into the submental triangle.

27
Q

IMPORTANT TO UNDERSTAND ABOUT THE SPACES UNDER THE MYLOHYOID

A

if you get an infection in the submandibular space and because the fascia is just a single fascial plane the infection can also spread to the sublingual space

28
Q

What is Ludwig’s angina?

A

BILATERAL infection in the sublingual, submandibular, and submental spaces (all three spaces are swollen)

  • may result in an embarrassed airway that leads to asphyxiation and death
  • it is BILATERAL infection found in 3 spaces which pushes the tongue back into the throat leading to an embarrassed airway AKA tongue is blocking breathing
29
Q

Describe the surface topography of the floor of the mouth.

A
  • tongue
  • lingual frenulum: mucosal fold from tongue to floor of the mouth controls movement of the tongue
  • sublingual papilla: location where the submandibular duct releases saliva into the oral cavity
  • sublingual ridge: a U-shaped ridge where find the sublingual gland is deep to this ridge; provides saliva to the floor of the mouth

Ask the pt to open his/her mouth and place gauze under the tongue and tell them to lift the tongue up; you may get a squirt of saliva so you don’t want to get too close; let the saliva ejaculate and them continue examination

30
Q

What is the excellent site for drug absorption in oral cavity?

A

the floor of the mouth

if you need to absorb drugs quickly, place the drugs here and it will reach the bloodstream quickly

placing nitroglycerin under the tongue of a pt who may be having a heart attack (transient ischemic attack)

31
Q

What is ankyloglossia (tongue-tied)?

A

remember that movement of the tongue is anchored to the lingual frenulum

  • if the lingual frenulum is congenital short, the movement of the tongue is reduced tongue so if a person tries to speak quickly their tongue cannot move freely and they become tongue tied
  • if the lingual frenulum is too short , the tongue cannot be pushed up to the hard palate

Treatment: take scissors and cut the lingual frenulum to free the tongue so it can move around properly

32
Q

What is sialolithiasis?

A

salivary stones (in the sublingual papilla in the pic)

saliva has a lot of salts and slats can precipitate out and become hard (stones)

-stones can block salivation and produce halitosis

when a person eats, they try to produce lots of saliva but it is blocked due to the salivary stone

33
Q

What are the contents of the floor of the mouth?

A
  • lingual nerve coming from infratemporal fossa: follow that to the tongue and this stage the lingual nerve would have GSA (coming back from pain,temp, proprioception from the tongue) SVA (facial nerve for taste) , GVE (facial for salivation)
  • sublingual gland which is underneath the sublingual ridge
  • submandibular duct runs on top of the lingual nerve “looking like a cross); the duct is always above
34
Q

What are the structures in the floor of the mouth that is lateral and medial to the hyoglossus?

A

LATERAL:

  • lingual nerve: underneath is the submandibular ganglion; this ganglion will provide PS, secretomotor, and visceromotor innervation to the submandibular and sublingual and minor salivary glands (buccal and lingual salivary glands)
  • CN IX: goes to the back of the tongue to the tonsillar bed and would find it in btw the palatoglossal and palatopharyngeal fold
  • CN XII: forms a loop right above the hyoid bone; find it best by identifying the hyoid bone; provide motor innervation to all the muscle of the tongue
  • submandibular duct: crosses above the lingual nerve in the floor of the mouth

MEDIAL:
-lingual artery

35
Q

What are the parts of the submandibular gland?

A
  • superficial

- deep (finger-like projection that goes around the mylohyoid muscle)

36
Q

What is the landmark in the tongue used for studying the tongue nerves, arteries, and ducts?

A

hyoglossus muscle (a square shaped muscle)

37
Q

What are the structures on the dorsum of the tongue?

A
  • vallecula: cul-de-sac or pouch in the back of the throat that accumulates saliva
  • foramen cecum: the place where the thyroid gland forms; where the thyroglossal duct opens
  • sulcus (linea) terminalis: V- shaped structures that separates the anterior oral cavity from the posterior oropharynx
  • circumvallate papillae: loaded with taste buds; are anterior to the sulcus terminalis; innervated by IX
  • median sulcus:
38
Q

The sulcus terminalis divides the tongue into what parts?

A

body= anterior 2/3 of tongue in the oral cavity proper

root= posterior 1/3 of tongue in the oropharynx

39
Q

What is the innervation of the region of the vallecula?

A

GSA (pain, temp, touch): CN X

SVA (taste): CN X

40
Q

What is the innervation of the root of the tongue?

A

GSA: CN IX
SVA: CN IX

taste buds found on the circumvallate papillae are innervated by CN IX (anterior to the sulcus terminalis)

remember CN IX provides both general sensation that is important for starting the swallowing/gag reflex and taste sensation to the body of the tongue

41
Q

What is the innervation of the body of the tongue?

A

GSA: V3
SVA: CN VII

42
Q

Which cross section of the midbrain are the olives most prominent?

A

open medulla

43
Q

GSA and SVA (taste) fibers run in what tract and terminate in what nucleus? Where is this tract and nucleus located?

A

Solitary tract
Solitary nucleus

both found in the open medulla

44
Q

What are the 3 extrinsic muscles of the tongue? What makes them extrinsic? What are they innervated by?

A

muscles that originate at a location outside of the tongue but insert into the tongue (extrinsic)

  • genioglossus
  • styloglossus
  • hyoglossus
  • palatoglossus: is more properly functions with regards to movements of the soft palate

They are all innervated by CN XII.

45
Q

What is the function of the genioglossus muscle?

A

functions to depress (vertical fibers)and protrude (horizontal fibers) the tongue

46
Q

What is the origin of the genioglossus muscle?

A

-attaches anteriorly to the mandible at the superior mental spine

47
Q

What will happen if the genioglossus muscle is paralyzed or relaxed?

A

If paralyzed, it may fall into the back of the throat and produce choking. You could swallow your tongue and block breathing.

To prevent this you could protrude your jaw anteriorly pulling the tongue out of the oral cavity.

Get a dental application that holds your jaw forward to prevent blockage of breathing.

48
Q

What is the origin and function of the styloglossus muscle?

A

origin: styloid process of the temporal bone
insertion: laterally into root of the tongue
function: retracts and elevates

49
Q

What is the origin and function of the hyoglossus muscle?

A

square shaped tongue muscle

origin: lesser and greater horns of the hyoid bone
insertion: attaches laterally to the root of the tongue

function: retracts and depresses

50
Q

What are the 4 groups of intrinsic tongue muscles? What makes them intrinsic? What are they innervated by?

A
  1. vertical
  2. transverse
  3. longitudinal
    - superficial
    - deep

intrinsic because they originate and insert within the tongue

all skeletal muscles innervated by CN XII

they are best studied with a microscope

they are important in changing the size and shape of the tongue during speech or chewing

51
Q

What tongue muscle is an exception to being innervated by CN XII?

A

palatoglossus muscle is innervated by CN X

52
Q

Describe the pathway of CN XII innervation of tongue muscles.

A

fibers come from the hypoglossal nucleus in the the open medulla and go through the hypoglossal canal to go towards the tongue muscles to innervate the extrinsic and intrinsic tongue muscles (except palatoglossus m.)

53
Q

How do you test for a hypoglossal nerve damage?

A
  • Ask the pt to protrude the tongue
  • When you contract a single genioglossus the direction the muscle is being moved is at an angle (oblique).
  • When you contract both right and left genioglossus the oblique nature is canceled out so the tongue sticks straight out

Genioglossus protrudes and depresses the tongue.

The two action of the genioglossus muscles counteract each other so the tongue protrudes forward.

Unopposed, the intact genioglossus protrudes the tongue to the side of the lesion.

54
Q

If you patient has a hypoglossal nerve lesion, which direction will the tongue deviate?

A

towards the side of the lesion

55
Q

What is spasticity, fasciculation, and wasting of muscles?

A

spasticity: muscles are continuously contracted
fasciculation: spontaneous contraction affecting a small number of muscle fibers, often causing a flicker of movement under the skin
wasting: atrophy of the muscle

56
Q

What are the 3 major salivary glands?

A
  • parotid gland
  • submandibular gland
  • sublingual gland
57
Q

Where is the parotid gland located? What type of saliva does it secrete? Where does it get its secretomotor innervation?

A
  • found in the retromandibular condition btw mandible and the ear
  • largest salivary gland
  • secrete serous fluid
  • CN IX (via lesser petrosal) preganglionic fibers synapse in
  • otic ganglion
  • postganglionic fibers hitchhike with the auriculotemporal nerve to reach parotid gland
58
Q

Where is the submandibular gland located? What type of saliva does it secrete? Where does it get its secretomotor innervation?

A

found btw the floor of the mouth and neck

  • serous and mucous
  • CN VII (chorda tympani)
  • joins the lingual nerve to
  • submandibular ganglion
  • postganglionic fibers innervate the gland
59
Q

Where is the sublingual gland located? What type of saliva does it secrete? Where does it get its secretomotor innervation?

A

found in the floor of the mouth

  • mucous
  • CN VII (chorda tympani)
  • lingual nerve
  • submandibular ganglion
60
Q

Describe the lymphatic drainage of the tongue.

A
  • lateral edge of the tongue will drain into the submandibular nodes IPSILATERALLY
  • central part of the tongue drains BILATERALLY into the deep cervical nodes bypassing the submandibular nodes
  • tip of the tongue drains into the submental nodes (not really ipsilateral or bilateral)
61
Q

Cancers of the tongue will metastasize in what direction?

A

-cancers in the center of the tongue will metastasize bilaterally

in squamous cell carcinoma you can note precancerous leukoplakia

62
Q

Lymphatic drainages from the central part of the lower 1/2 of the oral cavity including the chin, lip, floor of the mouth, and tip of the tongue drain into what nodes?

A

submental nodes receive lymphatic drainage from central part of the lower 1/2 of the oral cavity including the chin, lip, floor of the mouth, and tip of the tongue

63
Q

What parts of the oral cavity does the submandibular node drain?

A
  • palate
  • maxillary teeth
  • upper lip
  • vestibular gingivae
  • floor of the mouth
  • cheek
  • tongue
64
Q

What parts of the oral cavity does the deep cervical node drain?

A
  • mandibular teeth

- tongue

Chika- SF2 (63 decks)

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