Pharynx, Nasal Cavity, Oral Cavity Flashcards
Nasal vestibule, respiratory region, and olfactory region
Vestibule - hair to catch particulates
Respiratory region- neurovascular supply & warmth
Olfactory region - lined by olfactory epithelium
4 air channels of the nasal cavity
- Inferior nasal meatus between inferior concha & nasal floor
- Middle nasal meatus: between inferior and middle concha
- Superior nasal meatus: between middle and superior concha
- Spheno-ethmoidal recess: between superior concha and nasal roof
The sphenopalatine foramen connects the nasal cavity to the …
The incisive canal connects the nasal cavity to the…
The foramen cecum connects the nasal cavity to…
Sphenopalatine foramen –> Pterygopalatine fossa
Incisive canal -> oral cavity
Foramen caecum -> emissary vein
What nerves give sensation in the anterior nasal cavity and external superior nose?
Anteiror & posterior ethmoidal nerves, which are branches off the ophthalmic nerve [V1].
Anterior ethmoidal terminate as external nasal nerve, giving sensation to the external skin of the superior nerve.
What goes through the sphenopalatine foramen? What does it do?
Maxillary nerve [V2] goes through and ultimately provides sensation to the posterior nasal cavity. Branches:
- Posterior superior lateral nasal nerves
- Posterior superior medial nasal nerves
- Nasopalatine n
- Posterior inferior nasal nerves
What separates the nasal cavity from the oral cavity? from the cranial cavity?
Separation from oral cavity - hard palate
Separation from cranial cavity - frontal, ethmoid, sphenoid bones
the superior and middle concha are part of what bone?
Ethmoid bone
Parasympathetic fibers for the nasal cavity come from
Facial nerve (CN7) joins branches of V2 in the pterygopalatine fossa (synapsing in the ptergopalatine ganglion) innervate the glands of the nasal cavity & sinus glands.
Sympathetics in the nasal cavity come from ___, synapse in ___ and then postgnagliionic fibers reach the NC along blood vessels or by joining V2
Come from T1
Synapse in superior sympathetic ganglion
The ICA supplies blood to the nose via ____
The ECA supplies blood to the nose via ____
ICA:
- ophthalmic artery –> anterior & posterior ethmoidal arteries
ECA:
- maxillary artery –> sphenopalatine artery
- facial artery –> superior labial artery
Nasal cavity venous drainage
- Drain into cavernous sinus & pterygoid plexus posteriorly
- Facial vein & nasal vein anteriorly
- Emissary veins (allow for infection)
Nasal lymphatic drainage
- Anterior: Submandibular and submental lymph nodes
- Posterior: Retropharyngeal and anterior deep cervical nodes
Posterior ethmoidal sinus drains into the
Superior meatus
Anterior ethmoidal sinus, maxillary sinus, and frontal sinus drain into the
Middle meatus
Nasolacrimal duct drains into
inferior meatus
Sphenoid sinus drains into
sphenoethmoidal recess
Innervation of the frontal sinus
Supraorbital nerve from ophthalmic n (V1)
Maxillary sinuses open near the top in the center of the semilunar hiatus. What is their innervation?
Infraorbital and alveolar branches of the maxillary nerve (V2)
Ethmoid cells fill the ethmoidal labyrinth on each side.
- Anterior ethmoid cells open into the ___ or ___.
- Middle ethmoid cells open onto the ___ or the ___
- Posterior ethmoid cells open onto the _____
- The anterior & posterior are innervated by ___ and ___ from ___ and __ by way of branches from the __ ganglion
Anterior ethmoid cells open into the ethmoidal infundibulum or frontal nasal duct.
Middle ethmoid cells open onto the ethmoidal bulla or the lateral wall of nasal cavity above the bulla
Posterior ethmoid cells open onto the lateral wall of superior nasal meatus
The anterior & posterior are innervated by anterior** and **posterior ethmoidal branches of nasociliary n from V1 and V2 by way of branches from the pterygopalatine ganglion
Sphenoid sinuses open onto the roof of the nasal cavity on the posterior wall of the ____
What is their innervation?
Posterior ethmoidal branch of V1 and maxillary [V2] by way of branches from the pterygopalatine ganglion
An autonomic pathway from the CNS to the mucous membrane of the inferior nasal concha would include which ganglia?
Pterygopalatine ganglion
Parasympathetics provide secretomotor fibers to the glands in the mucosa of the nasal cavity and paranasal sinuses. Preganglionic parasympathetic fibers synapse with postganglionic ones in the pterygopalatine ganglia.
You push a curved probe through the inferior aspect of the maxillary sinus. What space/cavity might you see the tip of the probe in?
Oral cavity.
A child puts a rock up her nose and affects the drainage of the inferior nasal meatus. What symptom is most likely to occur?
Tearing of the ipsilateral eye.
Nasolacrimal duct from the orbit empties into the inferior nasal meatus. The ipsilateral eye’s tears cannot drain inferiorly and teasr will exude over the lower eyelid.
What makes up the floor of the oral cavity? What’s the innervation?
Mylohoid and geniohyoid muscles
What bones make up the hard palate?
Anteriorly, the palatine process of the maxilla
Posteriorly, the horizontal plate of palatine bone
Buccinator muscle runs from pterygomandibular raphe, alveolar part of mandible, and alveolar process of maxilla to blend with the orbicularis oris muscle & modiolus. Holds cheek against alveolar arches and keeps food between the teeth durign mastication. What innervates the buccinator muscle?
Facial n (CN7)
Tensor veli palatini vs Levator veli palatini - function & innervation
Tensor veli palatini tenses the soft palate to open the pharyngotympanic tube; innervated by mandibular n (V3)
Levator veli palatini elevates the soft palate; innervated by vagus
Function of soft palate
Valve that can close the orpharyngeal isthmus using the uvula and separate the nasopharynx from the oropharynx
Palatopharyngeus, musculus uvulae, and palatoglossus are all innervated by ____. What is each of their functions?
All innervated by vagus
Palatopharyngeus:
- Elevate the pharynx
- Depress the soft palate
- Move the palatopharyngeal arch toward midline
Musculus uvulae: elevates & retracts uvula; thicken central region of soft palate
Palatoglossus
- Elevate the back of tongue
- Move palatoglossal arch toard midline
- Depress the palate
Name the arteries of the oral cavity
Greater & lesser palatine arteries
Ascending palatine artery coming off the facial artery
Palatine branch of ascending pharyngeal artery
Veins of the palate ultimately drain into the ___ or ___.
Lymphatics drain into the ___ nodes.
Veins ultimately drain into the pterygoid plexus or veins associated with the palatine tonsil
Lymphatics drain into the deep cervical nodes
Innervation of the palate
- Sensory?
- Parasympathetics - what nerve and what ganglion?
- Sympathetics?
- Sensory innervation: maxillary n
- Parasympathetics: greater petrosal n from pterygopalatine ganglion (distributed with CN2)
- Sympathetics: T1 > sympathetic trunk > superior cervical ganglion; also deep petrosal nerve from pterygopalatine ganglion
Dental anesthesia targets what nerve?
**Inferior alveolar nerve (from V3) innervates bottom (mandibular) teeth and lip
- Note that the lingual nerve is close by, so tongue will also be numb
Superior alveolar nerve (from V2) innervates the top (maxillary) teeth
Where do you insert the needle for dental anesthesia?
Needle in the pterygomandibular raphe to reach the ptergyomandibular space
The oral part of the tongue (anterior 2/3) is separated from the pharyngeal part (posterior 1/3) by the ____.
Diff types of papillae on tongue
Foramen cecum (this is where the thyroid starts and descends into the neck)
Extrinsic muscles of tongue actions- protursion, retraction, depression, elevation+retraction of posterior third
- Protrusion: genioglossus
- Retraction: styloglossus + hyoglossus
- Depression: hyloglossus
- Elevation + retraction of posterior third: styloglossus + palatoglossus
Intrinsic muscles of the tongue actions-
Superior longitudinal, Inferior longitudinal, transverse, vertical
Superior longitudinal: shortens; curl apex & sides of tongue
Inferior longitudinal: shortens; uncurls apex & turns it downward
Transverse: narrows & elongates tongue
Vertical: flattens & widens tongue
Tongue innervation
- Sensory to anterior 2/3 vs 1/3
- Motor to palatoglossus vs intrinsic muscles, genioglossus, hyoglossus, and styloglossus
- Taste to anterior 2/3 - Chorda tympani (from CN7)
- General sensation to anterior 2/3 - Lingual n (from V3)
- General sensation + taste to posterior 1/3 - Glossopharyngeal n
- Motor to everything except palato glossus - hypoglossal n
- Motor to palatoglossus - vagus n
Hypoglossal nerve damage
Tip of tongue goes deviates to the affected side during protrusionbecause the gnioglossus is weak/paralyzed
Artery to tongue?
Veins to tongue?
Lymphatics of tongue?
- Lingual artery
- Dorsal lingual and deep lingual veins
- Lymphatics
- Pharyngeal part - jugulodigastric node (deep cervical node)
- Oral part
- Directly into deep cervical nodes
- Indirectly through submental & submandibular nodes > deep cervical
- Tip - mylohyoid > submental > jugulomohyoid node of deep cervical chain
Parotid parasympathetic innervation
From fibers that travel in CN IX; joins branch of V3 in infratemporal fossa
What gland lies inferior to the mylohyoid muscle against the submandibular fossa on the medial surface of the mandible? Where does it duct open?
Submandibular gland
Submandibular duct opens near the frenulum of the tongue
What gland is immediatley lateral to the submandibular duct against the medial surface of the mandible in the sublingual fossa?
Sublingual gland
Temporomandibular joint anatomy
What muscles and nerves are responsible for protruding the TMJ?
Lateral and medial pterygoids innervated by mandibular nerve V3
What muscles and nerves are responsible for retracting the TMJ?
Posterior fibers of temporalis V3
Deep part of masseter V3
Geniohyoid C1 via the hypoglossal n
Digastric (anterior - V3, posterior - V2)
____: the posterior opening of the nasal cavity into the nasopharynx
_____: the posterior opening of teh oral cavity into the oropharynx
_____: opening of the larynx into the laryngopharynx
Choanae: the posterior opening of the nasal cavity into the nasopharynx
Oropharyngeal isthmus: the posterior opening of teh oral cavity into the oropharynx
Laryngeal inlet: opening of the larynx into the laryngopharynx
What innervates the constrictor muscles of the pharynx?
Vagus n
Different attachments of the superior, middle , and inferior constrictors
Superior: pterygomandinular raphe; pharyngeal raphe
Middle constrictor: greater & lesser horn of hyloid; stylohyoid ligament
Inferior: cricocartilage; oblique line of thyrocartilage; and the ligament that spans it
Longitudinal muscles of the pharynx - stylopharyngeus, salpingopharyngeus, and palatopharyngeus. What is the function on the pharynx and innervation?
All of them elevate the pharynx
Stylopharyngeus - glosspharyngeal n
Salpingopharyngeus- vagus n
Palatopharyngeus- vagus n
What fascia covers the external side of the muscular wall of teh pharynx?
Buccopharyngeal fascia
What fascia lines the inner surface of the muscular pharyngeal wall?
Pharyngobasilar fascia
Where is the nasopharynx continuous with the oropharynx?
Pharyngeal isthmus
The pharyngeal tonsil is a collection of lymphoid tissue in the mucosa on the roof of the ____
nasopharynx.
Called adenoids when enlarged
The pharyngotympanic tube connects the ___ to the ___, which is connected to the mastoid air cells
Connects the nasopharynx to the middle ear (which is connected to the mastoid ari cells); important for pressure equalization
The pharyngeal recess is ___ and ___ to the torus tubarius around the entrance of pharyngotympanci tube
Posterior & superior
The oropharynx is below the soft palate, above the upper edge of the epiglottis, and behind the pharyngeal part of the tongue
Palatoglossal folds/arches on each side of the oropharynx mark the boundary between the oral pharynx and the _____
Oral cavity
Palatopharyngeal folds/arches cover the
palatopharyngeus muscles
Lingual tonsils vs Palatine tonsils- locations in the oropharynx
Lingual tonsil is on the pharyngeal part of tongue
Palatine tonsil are between the palatoglossal and palato pharyngeal folds
Piriform fossa - where is it and what is its clinical significance?
Between the central part of larynx and inner aspect of the lateral lamina of the thyroid cartilage
- Common site for lodging of foreign bodies
- Branches of internal laryngeal and recurrent laryngeal n are deep the mucous membrane of the fossa; can be injured when removing foreign body
Gag reflex afferent & efferent limb
Afferent: Glossopharyngeal (CN9)
Efferent: Vagus (CN10) mostly (a lil from CN12 & V3)
Main blood supply to pharynx
Main venous drainage of pharynx
Lymphatics of pharynx
Ascending pharyngeal, giving off the pharyngeal branch supplying the roof of the nasal cavity
Venous: pterygoid plexus drains nose and palate
Lymph: tonsils drina into jugular digastric node
Innervation of the hard palate vs soft palate
Hard palate - greater palatine n
Soft palate & palatine tonsil - lesser palatine n
Locations of the tonsils
