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FINALS General Anatomy pt. 2 > PAROTID FOSSA AND GLAND > Flashcards

PAROTID FOSSA AND GLAND Flashcards

1
Q

Largest of all the major salivary glands, which weighs approximately 25 g

A

PAROTID FOSSA AND GLAND

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2
Q

Responsible for 20% to 25% of saliva formed & entirely serous in secretion

A

PAROTID FOSSA AND GLAND

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3
Q

Pyramidal in shape, with up to 5 processes (or extensions)

A

PAROTID FOSSA AND GLAND

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4
Q

______ is extremely tough and derived from the deep cervical fascia

A

Gland’s capsule

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5
Q

Approximately 75% or more of parotid gland overlies the ______ muscle; the rest is ______

A

masseter, retromandibular

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6
Q

Facial nerve enters the parotid fossa by passing between the stylohyoid muscle and the posterior belly of the digastric muscle, splits gland into “______ lobe” and “______ lobe” connected by an isthmus

A

superficial, deep

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7
Q

______ lobe lies adjacent to lateral pharyngeal space. Tumors are observed as swellings in the ______

A

Deep, oropharynx

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8
Q

______ artery parallels the parotid duct slightly superior to the duct

A

Transverse facial

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9
Q

______ and ______ branches of the facial nerve form an anastomosing loop superficial to the parotid duct

A

Buccal, zygomatic

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10
Q

BORDERS AND STUCTURES

Anterior

A

Masseter muscle
Ramus of mandible

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11
Q

BORDERS AND STUCTURES

Anteriomedial

A

Medial pterygoid muscle
Stylomandibular fascia

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12
Q

BORDERS AND STUCTURES

Medial

A

Styloid proces superomedially
Traanvese process of atlas inferomedially

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13
Q

BORDERS AND STUCTURES

Posteromedial

A

Stylohyoid muscle
Posterior belly of digastric muscle

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14
Q

BORDERS AND STUCTURES

Posterior

A

Mastoid process of temporal bone
Sternocleidomastoid muscle

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15
Q

BORDERS AND STUCTURES

Lateral

A

Investing layer of deep cervical fascia Helping form tthe capsule

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16
Q

BORDERS AND STUCTURES

Superior

A

External acoustic meatus
Condylar head of the mandible articulating the glenoid fossa

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17
Q

BORDERS AND STUCTURES

Inferior

A

Angular tract of Eisler between angle of mandible and strenocleidomastoid muscle

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18
Q

Largest of all the major salivary glands

A

PAROTID GLAND

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19
Q

Pyramidal shape & serous in secretion

A

PAROTID GLAND

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20
Q

Capsule is fom deep cervical fascia

A

PAROTID GLAND

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21
Q

Upto 5 processes or extensions

A

PAROTID GLAND

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22
Q

also called Stensen’s Duct and 5 cm in length

A

PAROTID DUCT

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23
Q

Forms within deep lobe and passes from anterior border of gland across masseter superficially, through buccinator into oral cavity opposite the 2nd maxillary molar

A

PAROTID DUCT

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24
Q

______ tissue follows parotid duct

A

Accessory parotid

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25
Q

branches of the EXTERNAL CAROTID ARTERY

A

Posterior auricular artery
Maxillary artery
Superficial temporal artery
Transverse facial artery

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26
Q

WHAT VEIN?

  • Superficial to eexternal carotid artery
  • Formed by the following union:
    Superficil temporal vein (small transverse facial v. drains)
    Maxillary vein
  • Exits inferiorportion of parotid gland and divides into:
    Anterior division (joins facial v. forms common facial v.)
    Posterior division (joins posterior auricular v. forms
    external jugular v.)
A

RETROMANDIBULAR VEIN

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27
Q

WHAT NERVE?

• Exits in stylomastoid foramen
• Gives rise to posterior auricular nerve
• Passes between stylohyoid muscle and posterior belly of digastric muscle to enter partotid fossa
• Muscular branches innervate stylohyoid m., posterior belly of digastric m., auricularis m.

Inside the fossa, nerve splits parotid gland into:
• Superficial lobe
• Deep lobe - adjacent to lateral pharyngeal space

Within gland, nerve divides into:
• Temporofcial Trunk
• Cervicofacial Trunk
These forms a loop anterior to gland, superficial the parotid duct

A

FACIAL NERVE

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28
Q

Five (5) Major Branches of facial nerve

A

Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical

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29
Q

______ nerve does not provide innervation to parotid gland

A

Facial

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30
Q

______ and ______ branches of facial nerve form anastomosing loop superficial to parotid duct.

A

Buccal, zygomatic

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31
Q

5 ARTERIAL SUPPLY OF THE PAROTID GLAND

A

External carotid, Posterior auricular, Maxillary, Superficial temporal, Transverse facial

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32
Q

WHAT ARTERY?

Source: The bifurcation of the common carotid a. (at vertebral level C3)
Course :
- Ascends superiorly posterior to the mandible and deep to the posterior belly of the digastric m. and the stylohyoid m. to enter the parotid gland
- Within the parotid gland, it gives branches to the gland and the posterior auricular a.
- Then branches into the superficial temporal and maxillary aa. within the gland
- The transverse facial a. arises from the superficial temporal a. within the gland

A

External carotid

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33
Q

WHAT ARTERY?

Source: External carotid a. within the parotid gland
Course :
- Passes superiorly between the mastoid process and cartilage of the ear

A

Posterior auricular

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34
Q

WHAT ARTERY?

Source: The 2 terminal branches of the external carotid a. within the parotid gland
Course :
- Begins posterior to the neck of the mandible and travels anteromedially between the sphenomandibular lig. and the ramus of the mandible
- On exiting the parotid gland, passes either superficial or deep to the lateral pterygoid muscle

A

Maxillary

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35
Q

WHAT ARTERY?

Source: The 2 terminal branches of the external carotid a. within the parotid gland
Course :
- Begins posterior to the neck of the mandible and travels superiorly as a continuation of the external carotid
- Joined by the auriculotemporal n.

A

Superficial temporal

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36
Q

WHAT ARTERY?

Source: Superficial temporal a. before it exits the parotid gland
Course :
- Passes transversely to exit the gland
- Passes immediately superior to the parotid duct across the masseter m. and face

A

Transverse facial

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37
Q

2 SENSORY NERVES OF THE PAROTID

A

Auriculotemporal, Great auricular

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38
Q

WHAT NERVE?

Source: Mandibular division of the trigeminal n.
Course:
- Often arises as 2 roots surrounding the middle meningeal a. that unite
- Passes inferior to the lateral pterygoid toward the neck of the mandible
- Passes posterior to the neck of the mandible to ascend with the superficial temporal a.
- Provides sensory fibers to the parotid gland

A

Auriculotemporal

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39
Q

WHAT NERVE?

Source: The cervical plexus formed by contributions of C2 and C3 ventral rami
Course:
- After passing posterior to the midpoint of the sternocleidomastoid, it ascends along the sternocleidomastoid m., dividing into anterior and posterior branches
- The anterior branch continues along the superficial aspect of the inferior part of the parotid gland
- Helps supply parotid capsule

A

Great auricular

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40
Q

ANATOMIC PATHWAY FOR PARASYMPATHETICS OF THE PAROTID GLAND

CELL BODY?

Type of Neuron : Preganglionic neuron
Characteristics of Cell Body: A collection of nerve cell bodies located in the medulla
Course of the Neuron:
- Preganglionic parasympathetic fibers arise from the inferior salivatory nucleus in the medulla
- These fibers travel through the glossopharyngeal n. (IX) and exit the jugular foramen
- Gives rise to the tympanic branch of IX, which reenters the skull through the tympanic canaliculus
- Tympanic branch of IX forms the tympanic plexus along the promontory of the ear
- The plexus re-forms as the lesser petrosal n., typically exiting the foramen ovale to enter the infratemporal fossa
- Lesser petrosal n . joins the otic ganglion

A

Name of Cell Body: Inferior salivatory nucleus

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41
Q

ANATOMIC PATHWAY FOR PARASYMPATHETICS OF THE PAROTID GLAND

CELL BODY?

Type of Neuron : Postganglionic neuron
Characteristics of Cell Body: A collection of nerve cell bodies located inferior to the foramen ovale medial to the mandibular division of the trigeminal n.
Course of the Neuron:
- Postganglionic parasympathetic fibers arise in the otic ganglion
- These fibers travel to the auriculotemporal branch of the trigeminal n.
- Auriculotemporal n . travels to the parotid gland and the Postganglionic parasympathetic fibers innervate the parotid gland

A

Name of Cell Body: Otic ganglion

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42
Q

ANATOMIC PATHWAY FOR PARASYMPATHETICS OF THE PAROTID GLAND

CELL BODY?

Type of Neuron : Preganglionic neuron
Characteristics of Cell Body: Collection of nerve cell bodies located in the lateral horn nucleus of the spinal cord between spinal segments T1 and T3 (and possibly T4)
Course of the Neuron:
- Arise from the intermediolateral horn nuclei from T1 and T3(4)
- Travel through the ventral root of the spinal cord to the spinal nerve
- Enter the sympathetic chain through white rami
- Once in the sympathetic chain, the preganglionic fibers for the eye will ascend and synapse with postganglionic fibers in the superior cervical ganglion

A

Name of Cell Body: Intermediolateral horn nucleus

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43
Q

ANATOMIC PATHWAY FOR PARASYMPATHETICS OF THE PAROTID GLAND

CELL BODY?

Type of Neuron : Postganglionic neuron
Characteristics of Cell Body: Collection of nerve cell bodies located in the superior cervical ganglion, which is located at the base of the skull
Course of the Neuron:
- Arise in the superior cervical ganglion
- Postganglionic fibers will follow the external carotid a.
- Branches from the external carotid follow the arteries that supply the parotid gland

A

Name of Cell Body: Superior cervical ganglion

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44
Q

______ - Unilateral facial paralysis from facial nerve (cranial nerve VII) damage

Causes
- Approximately 80% of cases have unclear ______
- Evidence suggests ______ infection as a cause.
(When the virus becomes active at the facial nerve, if the inflammation is in the bony facial canal, limited room for expansion results in nerve compression)

A

Bell’s Palsy, etiology, herpes simplex virus (HSV-1)

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45
Q

______ infections have also been linked to Bell’s palsy.
In some cases of ______, bacteria may enter the facial canal, and any resulting inflammatory response could compress the facial nerve

A

Bacterial, otitis media

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46
Q

______ can result from dental procedures if inferior alveolar nerve block anesthetic is improperly administered in the ______ fossa; signs and symptoms disappear when the anesthetic effects wear off.

A

Temporary Bell’s palsy, parotid

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47
Q

Bell’s Palsy

Prognosis

• Mild cases produce a facial nerve ______; the prognosis for complete recovery is very good, usually within ______ weeks
• In more moderate cases, an ______ may occur, producing wallerian degeneration; full recovery may take ______ months
• In a small percentage of cases, function is never completely recovered.

A

neurapraxia, 2 to 3, axonotmesis, 2 to 3

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48
Q

Bell’s Palsy
Sites of lesions and their manifestations

1.______ and/or ______. All symptoms of 2, 3, and 4, plus deafness due to involvement of ______ cranial nerve.

  1. ______. All symptoms of 3 and 4, plus pain behind ear. ______ of tympanum and of external auditory meatus may occur.
  2. ______. All symptoms of 4, plus loss of taste in anterior tongue and decreased salivation on affected side due to chorda tympani involvement. ______ due to effect on nerve branch to stapedius muscle.
  3. Below ______ (parotid gland tumor, trauma) Facial paralysis (mouth draws to opposite side; on affected side, patient unable to close eye or wrinkle forehead; food collects between teeth and cheek due to paralysis of buccinator muscle).
A

Intracranial, internal auditory meatus, 8th

Geniculate ganglion, Herpes

Facial canal, Hyperacusia

stylomastoid foramen

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49
Q

______
-a rare neurological condition that causes you to sweat excessively while eating or thinking about food.

Caused by regeneration of the auriculotemporal autonomic bers in an abnormal fashion, innervating the sweat glands near the parotid gland after a parotidectomy
• Symptoms: sweating and redness in the distribution of the auriculotemporal nerve during eating
• Diagnosis is via ______ test—creates a dark spot over the gustatory sweating area.
• Treatments include ______ (severing the parasympathetic component) and the ______ (Robinul)

A

Frey’s Syndrome, Minor’s starch iodine, tympanic neurectomy, topical anticholinergic glycopyrrolate

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50
Q

Tumors of the Parotid Gland

  • 80% of parotid tumors are ______.
  • The most common benign tumor is a ______, which, if present for many years, can convert to a highly malignant carcinoma
  • When these extend through the capsule, they must be removed to reduce recurrence • Because of the proximity, these tumors can extend into the ______ space
A

benign, pleomorphic adenoma, lateral pharyngeal

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51
Q

Tumors of the Parotid Gland

  • Removal of the tumor with its surrounding capsule and tissue is important to obtain a low recurrence rate
  • Histologically, ______ have extensions through the tumor capsule into adjacent tissue, so simple ______ would allow recurrence from tumor cells left behind.
A

pleomorphic adenomas, enucleation

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52
Q

______/______
An in ammation of the parotid glands that typically is caused by a bacterial or viral infection

A

Parotitis, Mumps

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53
Q

______/______
Can also be caused by other diseases, such as Sjögren’s syndrome, tuberculosis, and human immunodeficiency virus (HIV) infection
• Pain on mandibular movement is the result of the compression of the deep lobe of the gland by the mandibular ramus

A

Parotitis/Mumps

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54
Q

2 types of Parotitis/Mumps

A

BACTERIAL PAROTITIS, VIRAL PAROTITIS

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55
Q

what type of Parotitis/Mumps?

  • Less common since the introduction of antibiotics, proper hydration, and better oral hygiene
  • Mortality rate in the early 19th century was as high as 70% to 80%
  • Most cases now seen in patients on anticholinergic medication, especially the elderly, because it inhibits the salivary ow, which makes it easier for the bacteria to be transported in retrograde fashion along the parotid duct into the gland, where they may settle to cause an infection
A

BACTERIAL PAROTITIS

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56
Q

what type of Parotitis/Mumps?

  • Known as mumps
  • Causative virus is a paramyxovirus that infects different body parts, notably the parotid glands
  • Usually is spread through saliva, coughing, and sneezing
  • Parotid glands typically swell and become very painful
  • With the introduction of mumps vaccination in the 1970s, now rare in most developed nation
A

VIRAL PAROTITIS

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57
Q

______ “dry mouth”

  • Dry mouth is a symptom that increases the affected person’s susceptibility to dental caries
  • Can be caused by any medication that reduces salivary outflow (antihistamines, antidepressants, chemotherapy agents, antihypertensive, and analgesics, as well as by therapeutic irradiation)
  • Occurs in disease processes such as depression, stress,
    endocrine disorders, Sjögren’s syndrome, and improper
    nutrition
  • Can lead to the formation of ______, calculi that form in the duct or gland, although they are more commonly associated with infections of the submandibular gland than of the parotid gland and duct
A

Xerostomia, sialoliths

58
Q

______: a communication between the skin and the parotid gland or duct that may lead to the formation of a sialocele, a cyst filled with a collection of mucoid saliva in the tissues surrounding the gland

A

Parotid fistula

59
Q

______ and _______
Causes:
- Trauma during surgery
May also be caused by:
- Section or injury of the duct or 1 of its branches during operation for cancer of the cheek or face.
- Removal of parotid tumors, especially those of the accessory lobe
- Primary or secondary malignant tumors that ulcerate the skin
- Incision and drainage for acute bacterial parotitis
- Ulceration and infection associated with large salivary calculi
-may develop after a mastoid or fenestration operation
- Congenital
- Infection (actinomycosis, tuberculosis, syphilis, cancrum oris)

A

Fistulas, Sialoceles

60
Q

Fistulas and Sialoceles
Treatment
- Fistulas that lead directly into the ______ cavity need no treatment
- Fistulas on the ______ may or may not need surgical intervention
- ______ are useful agents to diminish the salivation during treatment
- Sialoceles often resolve with ______ or ______ and normally do not require drain placement
- Injury to the parotid gland or duct should be repaired to prevent formation of fistulas and sialoceles.

A

oral, skin, Anticholinergics, aspiration, compression

61
Q

Fistulas and Sialoceles
COMMON REPAIRS
- Repair of the duct using a ______
- ______ of the duct
- Creating a fistula from the duct into the oral cavity

A

stent, Ligation

62
Q

Muscular structure in oral cavity

A

TONGUE

63
Q

2 parts of TONGUE

A

Oral (Presulcal)
Pharyngeal (Postsulcal)

64
Q

movable part, anterior 2/3 of tongue

A

Oral (Presulcal)

65
Q

non-movable part, posterior 1/3 of tongue

A

Pharyngeal (Postsulcal)

66
Q

V-shaped groove
Separates oral part from pharyngeal part

A

Sulcus Terminalis

67
Q

Initial development site of thyroid gland
Located tip (angle) of V

A

Foramen Cecum

68
Q

Separates tongue into halves

A

Median Fibrous Septum

69
Q

FUNCTIONS of the tongue

A

MASTICATION
TASTE
TALKING
DEGLUTITION

70
Q

MUSCLE TYPES (tongue)

  • ______: Moves tongues as an anatomic structure
  • ______: Change the tongue’s shape
A

EXTRINSIC, INTRINSIC

71
Q

The tongue is typically pink and covered with numerous small bumps called ______.

A

papillae

72
Q

Changes in color or texture may reflect health problems such as:
- ______
- ______
- ______

A

Leukoplakia
Squamous cell carcinoma
Nutritional deficiencies

73
Q

An unusual appearance of the tongue may represent a benign condition:
- ______ tongue
- ______ tongue
- ______ tongue

A

Fissured, Black hairy, Geographic

74
Q
  • The ______ part of the tongue is also known as anterior 2/3 of the tongue
  • Develops from the 2 lateral lingual swellings and tuberculum impar of the 1st pharyngeal arch — this mucosa is innervated by the nerve of the 1st arch, which is the ______ nerve (lingual n.)
  • Has a ______ and a ______ surface
A

oral, trigeminal, dorsal, ventral

75
Q

WHAT SURFACE OF THE ORAL PART?

  • Mucosa is keratinized stratified squamous epithelium
  • Bounded posteriorly by sulcus terminalis
A

DORSAL

76
Q

WHAT SURFACE OF THE ORAL PART?

  • Mucosa is nonkeratinized stratifies squamous epithelium
A

VENTRAL

77
Q

STRUCTURES DORSAL SURFACE

A

Median Sulcus
Glands
PAPILLAE

78
Q

STRUCTURES VENTRAL SURFACE

A

Lingual frenulum
Plica fimbriata
Deep lingual veins
Sublingual papilla

79
Q

WHAT STRUCTURE?

  • Groove that travels anteriorly in midline
  • Represents location of median septum divides tongue in halves
  • Septum thicker posteriorly and thinner anteriorly
A

Median Sulcus

80
Q

WHAT STRUCTURE?

  • Numerous mucous and serous glands on dorsal surface
A

Glands

81
Q

FOUR TYPES OF PAPILLAE

A

Filiform
Fungiform
Foliate
Circumvallate

82
Q

WHAT TYPE OF PAPILLAE?

  • Lack taste buds
  • Most numerous type
  • Have thick keratin on epithelium
A

Filiform

83
Q

WHAT TYPE OF PAPILLAE?

  • Have taste buds that receive innervation from the facial nerve (chorda tympani branch)
  • Scattered throughout the dorsum of the oral part
  • Lack keratin on the epithelium
A

Fungiform

84
Q

WHAT TYPE OF PAPILLAE?

  • Have taste buds that receive taste innervation from the facial nerve (chorda tympani branch)
  • Are located on the side s of the tongue in 4 to 5 folds
    immediately anterior to the palatoglossal fold
  • Lack keratin on the epithelium
A

Foliate

85
Q

WHAT TYPE OF PAPILLAE?

  • Have taste buds that receive taste innervation from the glossopharyngeal nerve
  • Generally a nonkeratinized epithelium
  • Lie in a row immediately anterior to the sulcus terrminalis
A

Circumvallate

86
Q

WHAT STRUCTURE?

  • A midline fold of tissue
  • Connects the ventral surface of the tongue to the floor of the oral cavity
A

Lingual frenulum

87
Q

WHAT STRUCTURE?

  • Fimbriated folds
  • Lateral to the lingual frenulum
A

Plica fimbriata

88
Q

WHAT STRUCTURE?

  • Can be observed through the mucosa between the plica mbriata and the lingual frenulum
A

Deep lingual veins

89
Q

WHAT STRUCTURE?

  • A swelling on both sides of the lingual frenulum at the
    tongue base
  • Marks the entrance of saliva from the submandibular
    glands into the oral cavity
  • Continuous with the sublingual folds overlying the sublingual glands on the floor of the oral cavity
A

Sublingual papilla

90
Q
  • The ______ part of the tongue is also known as the posterior 1/3 of the tongue
  • Develops from the hypobranchial eminence of the 3rd pharyngeal arch—thus mucosa is innervated by the nerve of the 3rd arch (the glossopharyngeal nerve)
  • The area immediately posterior to the palatoglossal folds (also called the anterior pillar of the fauces) is the ______
  • Has a ______ surface only and does not possess any papilla
A

pharyngeal, oropharynx, dorsal

91
Q

WHAT SURFACE OF THE PHARYNGEAL PART?

  • Mucosa is non-keratinized stratified squamous epithelium
A

DORSAL

92
Q

Structures of PHARYNGEAL PART

A

Lingual tonsils, Glossoepiglottic folds

93
Q

WHAT STRUCTURE?

  • Large nodules of lymphatic tissue
  • Cover the pharyngeal surface of tongue
A

Lingual tonsils

94
Q

WHAT STRUCTURE?

  • Mucous membrane of nonkeratinized stratified squamous epithelium from the pharyngeal part and lateral wall of pharynx that reflects onto the anterior epiglottis, forming:
    Median glossoepiglottic fold
    2 lateral glossoepiglottic folds
    Median glossoepiglottic fold is bordered by depression on each side:
    Vallecula
    Connect the posterior portion of the pharyngeal part of the tongue with the epiglottis of the larynx
A

Glossoepiglottic folds

95
Q

EXTRINSIC MUSCLES OF THE TONGUE

A

genioglossus,
hyoglossus,
styloglossus,
palatoglossus

96
Q

______ muscles originate from structures outside the tongue and are inserted into the tongue.

These muscles protrude, retract, depress, and elevate the tongue.

A

Extrinsic

97
Q
  • These thick fan-shaped muscles contribute significantly to the tongue structure.
  • They occur bilaterally, separated by the midline septum.
  • Originate from superior mental spines on the posterior surface of the mandibular symphysis, just above these muscles from the inferior mental spines.
  • From this point, muscles expand posteriorly and superiorly.
  • Inferior fibers attach to the hyoid bone while remaining fibers spread out superiorly to blend with intrinsic muscles along the entire tongue length
A

Genioglossus

98
Q

The ______ muscles:
■ depress the central part of the tongue, and
■ protrude the anterior part of the tongue out of the oral fissure (i.e.,stick the tongue out).
Like most muscles of the tongue, these muscles are innervated by the ______.

A

genioglossus, hypoglossal nerves [XII]

99
Q
  • Asking a patient to “stick your tongue out” can be used as a test for the ______.
  • If the nerves are functioning normally, the tongue should protrude evenly in the midline.
  • If the nerve on one side is not fully functional, the tip of the tongue will point to that side.
A

hypoglossal nerves [XII]

100
Q
  • Thin quadrangular muscles lateral to the genioglossus
    muscles
  • It originates from the greater horn and adjacent body of the hyoid bone.
  • Passes between superior and middle constrictor muscles
    through the gap (oropharyngeal triangle).
  • Inserts into the tongue lateral to genioglossus and medial to styloglossus.
  • depresses the tongue and is innervated by the hypoglossal nerve [XII]
A

Hyoglossus

101
Q

IMPORTANT LANDMARK:
■ The ______ artery from the external carotid artery in the neck enters the tongue deep to the hyoglossus, between the hyoglossus and genioglossus.
■ The ______ and ______ nerve (branch of the mandibular nerve [V3]), from the neck and infratemporal fossa of the head, respectively, enter the tongue on the external surface of the hyoglossus.

A

lingual, hypoglossal nerve [XII], lingual

102
Q
  • These muscles originate from the anterior surface of the styloid processes of the temporal bones.
  • They pass inferiorly and medially through the oropharyngeal triangle, situated between the middle constrictor, superior constrictor, and mylohyoid muscles.
  • Upon reaching the tongue, they blend with the superior margin of the hyoglossus and intrinsic muscles.
  • Functionally, styloglossus muscles retract the tongue and elevate its posterior part.
  • Innervated by the hypoglossal nerves [XII].
A

Styloglossus

103
Q
  • _______ Muscles of the soft palate and the tongue
  • Originate from the undersurface of the palatine aponeurosis.
  • They pass anteroinferiorly to the lateral side of the tongue.
  • Functions include; Elevating the bac of the tongue; Moving the palatoglossal arches of mucosa toward the midline; and Depressing the soft palate.
  • These movements aid in closing the oropharyngeal isthmus, separating the oral cavity from the oropharynx.
  • Unlike other tongue muscles, these muscles are
    innervated by the ______.
A

Palatoglossus, vagus nerves [X]

104
Q

INTRINSIC MUSCLES OF THE TONGUE

A

superior longitudinal,
•inferior longitudinal,
•transverse, and
•vertical muscles of the tongue.

105
Q

The ______ muscles originate and attach to other structures within the tongue.

A

intrinsic

106
Q

The intrinsic muscles alter the shape of the tongue by:
- ______ and ______ it,
- ______ and ______ its apex and edges, and
- ______ and ______ its surface.

A

Lengthening, shortening, Curling, Flattening, rounding

107
Q
  • Origin: The ______ muscle originates from the submucosa of the posterior tongue and the lingual septum.
  • Insertion: It inserts into the apex and anterolateral margins of the tongue.
  • Innervation: The muscle is innervated by the ______.
  • Action: It shortens and curls the tongue’s apex and lateral margins ______, which makes the dorsal surface ______.
  • It is located immediately deep to the mucous membrane of the tongue’s dorsal surface.
A

superior longitudinal, hypoglossal nerve (CN XII), upward, concave

108
Q
  • Origin: The ______ muscle originates from the root of the tongue and the body of the hyoid bone.
  • Insertion: It inserts into the apex of the tongue.
  • Innervation: Innervated by the ______.
  • Action: It shortens and curls the tongue’s apex ______, which makes the dorsal surface ______.
  • Runs the length of the tongue between the hyoglossus and genioglossus.
A

inferior longitudinal, hypoglossal nerve (CN XII), downward, convex

109
Q
  • Origin: The ______ muscle originates from the lingual
    septum.
  • Insertion: Inserts into the lateral margin of the tongue.
  • Innervation: Receives innervation from the ______.
  • Action: Its primary action is to ______ and ______ the tongue.
  • It runs the ______ of the tongue.
A

transverse, hypoglossal nerve (CN XII), narrow, elongate, width

110
Q
  • Origin: The ______ muscle originates from the submucosa of the dorsal surface of the tongue and the genioglossus muscle.
  • Insertion: Inserts into the submucosa of the ventral surface of the tongue.
  • Innervation: Innervated by the ______.
  • Action: Its primary action is to ______ and ______ the tongue.
  • It runs from the ______ to the ______ tongue surface.
A

vertical, hypoglossal nerve (CN XII), broaden, elongate, dorsal, ventral

111
Q

SENSORY NERVE SUPPLY

GENERAL SOMATIC AFFERENT (GSA)

Function:
______, ______, ______
Nerves:
Trigeminal (via lingual), glossopharyngeal, and vagus (via internal laryngeal), to innervate the mucosa

A

Pain, temperature, discriminative touch

112
Q

SENSORY NERVE SUPPLY

SPECIAL VISCERAL AFFERENT (SVA)

Function:
______
Nerves:
Facial (via chorda tympani), glossopharyngeal, and vagus (via internal laryngeal), to innervate the taste buds

A

Taste

113
Q

WHAT NERVE?

Source:Mandibular division of the trigeminal nerve.
Course:
- Passes between the medial pterygoid muscle and the ramus of the mandible to pass obliquely
- Enters the oral cavity lying along the lingual tuberosity of the mandible
- Continues anteriorly and passes onto the lateral surface of the hyoglossus
- Passes from the lateral side inferiorly and medial to the submandibular duct to reach the mucosa of the tongue

GSA - supplied to the epithelium and papillae of the tongue’s anterior 2/3, linguoalveolar ridge, and gingiva on the lingual aspect of the mandibular teeth

A

LINGUAL NERVE

114
Q

WHAT NERVE?

Source: Facial nerve in the tympanic cavity
Course:
- Carries preganglionic parasympathetic fibers to the submandibular ganglion and taste fibers to the anterior 2/3 of the tongue
- Passes anteriorly to enter the tympanic cavity and lies along the tympanic membrane and malleus until exiting the petrotympanic fissure
- Joins the posterior border of the lingual nerve

SVA - from the chorda tympani, it travels to the taste buds in this region

A

CHORDA TYMPANI NERVE

115
Q

WHAT NERVE?

Source: Arises as a cranial nerve from the medulla oblongata
Course:
- Passes through the jugular foramen with the vagus and accessory nerves. Within the foramen, it passes between the internal carotid artery and the internal jugular vein
- Continues inferiorly and travels posterior to the stylopharyngeus muscle
- Passes anteriorly with the stylopharyngeus m. and travels between the superior and middle constrictor muscles, to be located by the palatine tonsils

GSA - distributed to the epithelium of the tongue’s posterior 1/3, in addition to the fauces
SVA - distributed to the taste buds in the mucous membrane of the tongue’s posterior 1/3 and the circumvallate papilla

A

GLOSSOPHARYNGEAL
NERVE

116
Q

WHAT NERVE?

Source: Superior laryngeal branch of the vagus nerve
Course:
- A series of nerves branch from the vagus in the neck, including the superior laryngeal nerve, which travels inferiorly posterior to the internal carotid artery on the side of the pharynx and divides into the internal and external laryngeal nerves
- Passes inferior to the larynx and passes through the thyrohyoid membrane with the superior laryngeal veins

GSA - distributed to the tongue’s base at the epiglottic region and the mucous membranes of the larynx as far inferiorly as the false vocal folds
SVA - distributed to the taste buds scattered at the base of the tongue at the epiglottic region

A

INTERNAL LARYNGEAL NERVE

117
Q

2 MOTOR INNERVATION

A

HYPOGLOSSAL NERVE
PHARYNGEAL PLEXUS

118
Q

WHAT NERVE?

Source: Arises as a series of rootlets from the medulla oblongata and passes through the hypoglossal canal
Course:
• Travels inferiorly and is located between the internal carotid a. and the internal jugular v.
• Passes anteriorly as it wraps around the occipital a.
• Passes superficial to the external carotic and the loop of the lingual a. in its anterior path
• Passes deep to the posterior belly of the digastric and the stylohyoid m. and lies superficial to the hyoglossus m. with the accompanying vein of the hypoglossal n.
• Passes deep to the mylohyoid m. and continues anteriorly in the genioglossus m.

Muscular branches supply:
• All intrinsic tongue muscles:
• superior longitudinal • transverse muscles o inferior longitudinal
vertical muscles
• Hyoglossus muscle
• Styloglossus muscle
• Genioglossus muscle

A

HYPOGLOSSAL NERVE

119
Q

WHAT NERVE?

Source: Pharyngeal plexus (the motor portion of this plexus is formed by the pharyngeal branch of the vagus n.)
Course:
• Arises from the upper part of the inferior ganglion of the vagus n.
• Lies along the upper border of the middle constrictor m., glossopharyngeal nerve) where it forms the pharyngeal plexus
• Motor branches from the plexus are distributed to the muscles of the pharynx and soft palate (with the
exception of the tensor veli palatini m.)

In the tongue, it innervates:
Palatoglossus muscle

A

PHARYNGEAL PLEXUS

120
Q

7 VASCULAR SUPPLY

A

Lingual Artery
Dorsal lingual Artery
Deep lingual Artery
Sublingual Artery
Submental Artery
Tonsillar Artery
Ascending pharyngeal Artery

121
Q

WHAT ARTERY?

Source: External carotid artery within the carotid triangle
Course:
- passes superiorly and medially (obliquely) toward the greater cornu of the hyoid bone and makes a loop by passing anteriorly and inferiorly while traveling superficial to the middle constrictor m.
- while forming a loop, the artery is crossed superficially by the hypoglossal n.
- passes deep to the posterior belly of the digastric m. and the stylohyoid m. as it travels anteriorly, where it gives off a suprahyoid branch that travels on the superior surface of the hyoid bone, supplying muscles in that area
- lingual a. passes deep to the hyoglossus m. and travels anteriorly between it and the genioglossus m.
- after the dorsal lingual aa., the lingual a. continues to pass anteriorly and gives off the sublingual branch at the anterior border of the hyoglossus

A

Lingual Artery

122
Q

WHAT ARTERY?

Source: Lingual
Course:
- after passing deep to the hyoglossus, 2 to 3 small dorsal lingual aa. are given off at the posterior border of the hyoglossus
- they pass in a superior direction to the posterior 1/3 of the dorsum of the tongue and provide vascular supply to the mucous membrane in this region, the palatoglossal arch, the palatine tonsil, the epiglottis, and the surrounding soft palate

A

Dorsal lingual Artery

123
Q

WHAT ARTERY?

Source: Lingual
Course:
- it is the terminal branch or continuation of the lingual a. once the sublingual a. is given off, travels superiorly to reach the tongue’s ventral surface
- located between the inferior longitudinal m. of the tongue and the mucous membrane , the deep lingual a. is accompanied by branches of the lingual n., and it anastomoses with its counterpart from the other side

A

Deep lingual Artery

124
Q

WHAT ARTERY?

Source: Lingual
Course:
- the sublingual branch arises at the anterior border of the hyoglossus
- this a. passes anteriorly between the genioglossus and mylohyoid mm. to the sublingual gland and provides vascular supply to the gland and the muscles and mucosa in the area

Typically has 2 branches of significance:
- branch that passes mylohyoid to anastomose with submental a.
- branch that passes deep to the gingiva to anastomose with branch from contralateral side
At this anastomosis, typically 1 branch (although may be multiple branches arises to enter a small lingual foramen superior to the genial tubercles in the posterior midline

A

Sublingual Artery

125
Q

WHAT ARTERY?

Source: A branch of the facial artery from the external carotid a.
Course:
- given off at the submandibular gland, travels anteriorly superficial to the mylohyoid m.
- anastomoses with a branch from the sublingual branch of the lingual a. to help supply the tongue

A

Submental Artery

126
Q

WHAT ARTERY?

Source: A branch of the facial artery from the external carotid artery
Course:
- while ascending superiorly along the lateral side of the pharynx, it passes into and supplies the superior constrictor m. until reaching the palatine tonsil and the root of the tongue

A

Tonsillar Artery

127
Q

WHAT ARTERY?

Source: External carotid artery
Course:
- the smallest branch arising from the external carotid a.
- ascends superiorly between the lateral aspect of the pharynx and the internal carotid a.
- has branches supplying the palatine tonsil that anastomose with tonsillar branch of facial and dorsal lingual branches at the root of the tongue

A

Ascending pharyngeal Artery

128
Q

2 VEINS

A

Lingual Vein
Submental Vein

129
Q

WHAT VEIN?

Course:
- receives tributaries from the deep lingual vv. on the ventral surface, and the dorsal lingual vv. from the dorsal surface
- passes with the lingual a., deep to the hyoglossus m., and ends in the internal jugular v.
- the vena comitans nervi hypoglossi, or accompanying vein of the hypoglossal n., begins at the tongue’s apex and may either join the lingual v. or accompany the hypoglossal n. and enter the common facial v., which empties into the internal jugular

A

Lingual Vein

130
Q

WHAT VEIN?

Course:
- anastomoses with the branches of the lingual v.
- parallels the submental a. on the superficial surface of the mylohyoid m. and ends in the facial v.

A

Submental Vein

131
Q

______: condition in which the lingual frenulum is restricted because of an increase in tissue, leading to reduced tongue mobility
Also known as tongue-tie

A

Ankyloglossia

132
Q

Ankyloglossia
PRESENTATIONS

  • Tongue may not be capable of ______ beyond the incisors
  • Tongue may not be capable of touching the ______
  • Tongue may have a ______ notch at its tip or may appear bilobed on protrusion
A

protrusion, palate, V-shaped

133
Q

Ankyloglossia
COMPLICATIONS

  • Causes problems for babies who ______
  • If the tongue cannot clear the oral cavity of food, ______, ______ disease, and ______ can result
  • If condition is severe, can cause a ______
A

breastfeed, caries, periodontal, halitosis, speech impediment

134
Q

Ankyloglossia

TREATMENT
- If necessary, the lingual frenulum may be cut (______)

A

frenectomy

135
Q

______
- Hypoglossal nerve lesions paralyze the tongue on 1 side
- On protrusion, the tongue deviates to the ipsilateral (same) or contralateral side, depending on the lesion site

A

Hypoglossal Nerve Paralysis

136
Q

Hypoglossal Nerve Paralysis
LOWER MOTOR NEURON LESION
- Lesions to the hypoglossal nerve cause paralysis on the ______ side:
- Tongue deviates to the paralyzed side on ______ (the paralyzed muscles will lag, causing the tip to deviate)
- ______ on the paralyzed side
- ______ occur on the paralyzed side

A

ipsilateral, protrusion, Musculature atrophies, Tongue fasciculations

137
Q

Hypoglossal Nerve Paralysis
UPPER MOTOR NEURON LESION
- Causes paralysis on the ______ side:
- Tongue deviates to the side opposite the lesion
- Musculature atrophies on side opposite the lesion

A

contralateral

138
Q
  • ______ accounts for most cancers of the oral cavity
  • In the tongue, usually located on the anterolateral aspect
  • Alcohol and tobacco use are risk factors
  • ______, such as erythroplasia and leukoplakia, should be identi ed, because early diagnosis and treatment are paramount for long-term survival
  • ______ imaging helps reveal the tumor’s extent and location
  • Staging of the tumor guides prognosis
A

Squamous cell carcinoma, P remalignant lesions, Radiographic

139
Q

Squamous Cell Carcinoma
TREATMENT
- ______ or ______ therapy, or possibly in combination with chemotherapy
- I f lesion is detected early, excision may suffice
- With later tumor stages, a 2nd primary squamous cell carcinoma must be excluded

A

Excision, radiation

140
Q

______: a common premalignant condition of the oral cavity involving the formation of white spots on the mucous membranes of the tongue and inside the mouth
______ is a type observed in persons with compromised immune systems

A

Leukoplakia, Hairy leukoplakia

FINALS General Anatomy pt. 2 (4 decks)

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