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SA head and neck > S9) Functional Anatomy of the Oral Cavity, Tongue & Pharynx > Flashcards

S9) Functional Anatomy of the Oral Cavity, Tongue & Pharynx Flashcards

1
Q

Identify and describe the borders of the oral cavity

A
  • Roof: hard and soft palates
  • Floor: muscular diaphragm & tongue
  • Lateral walls: buccinators
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2
Q

Describe the anterior and posterior extensions of the oral cavity

A
  • The oral cavity begins anteriorly at the oral fissure (bounded by lips)
  • The oral cavity extends posteriorly to the oropharyngeal isthmus
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3
Q

The oropharyngeal isthmus is an arch in the oral cavity (continues into oropharynx).

Identify and describe its borders

A
  • Superior: soft palate

- Below: upper surface of the tongue

  • Sides: anterior and posterior pillars of the fauces
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4
Q

Which muscles form the anterior and posterior faucial pillars?

A
  • Palatoglossus (anterior)
  • Palatopharyngeus (posterior)
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5
Q

What do the palatopharyngeus and palatoglossus muscles do?

A

They contract during chewing to pull the soft palate down towards the back of the tongue, closing the oropharyngeal isthmus so food remains in the oral cavity while chewing

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6
Q

What is the tonsillar fossa and why is it significant?

A

The tonsillar fossa is the space between the two faucial pillars which contains the palatine tonsils (visible when inflamed)

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7
Q

The intrinsic muscles of the tongue only attach to other structures in the tongue.

What are the four paired intrinsic muscles of the tongue?

A
  • Superior longitudinal muscle
  • Inferior longitudinal muscle
  • Transverse muscle
  • Vertical muscle
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8
Q

Describe the function and innervation of the intrinsic muscles of the tongue

A
  • Function: affect the shape and size of the tongue and have a role in facilitating speech, eating and swallowing
  • Motor innervation: hypoglossal nerve (CNXII)
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9
Q

Identify the 4 extrinsic muscles of the tongue

A
  • Genioglossus muscle
  • Hyoglossus muscle
  • Styloglossus muscle
  • Palatoglossus muscle
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10
Q

What are the general functions of the extrinsic muscles of the tongue?

A

Extrinsic muscles allow protrusion, retraction and side-to-side movement of the tongue

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11
Q

What is the clinical significance of the genioglossus muscle?

A

The genioglossus muscle contracts to protrude the tongue and by its action, one can test the function of the hypoglossal nerve (CN XII)

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12
Q

Describe the motor innervation of the extrinsic muscles of the tongue

A
  • Hypoglossal nerve (CN XII) – genioglossus, hyoglossus, styloglossus muscles
  • Vagus nerve (CN X) – palatoglossus muscle
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13
Q

Describe the sensory innervation of the anterior 2/3 of the tongue

A
  • Sensation – trigeminal nerve (CN V3)
  • Taste – facial nerve (CN VII)
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14
Q

Describe the sensory innervation of the posterior 1/3 of the tongue

A

Sensation and taste – glossopharyngeal (CN IX)

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15
Q

What is the Wharton duct?

A

The submandibular duct (Wharton duct) is one of the salivary excretory ducts which drains saliva from each bilateral submandibular gland and sublingual gland to the base of the tongue

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16
Q

What is the Stensen duct?

A

The parotid duct (Stensen duct) is a duct and the route that saliva takes from the major salivary gland, the parotid gland into the mouth

found on the side of the cheek

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17
Q

What is Sialolithiasis?

A

Sialolithiasis (salivary gland stones) is a condition where a calcified mass / sialolith forms within a salivary gland, usually in the duct of the submandibular gland (Wharton) as concentration of Ca produced in submandibular is 2x parotid

mainly pain when salivating as saliva can’t get through

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18
Q

Salivary gland stones reduce salivary flow.

Other than dehydration, what symptoms are experienced?

A
  • Pain in gland
  • Swelling
  • Infection
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19
Q

How is Sialolithiasis diagnosed?

A
  • History
  • X-ray
  • Sialogram
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20
Q

What is tonsillitis?

A

Tonsilitis is the recurrent inflammation of the tonsils (especially palatine tonsils) due to a virus or bacteria, often requiring a tonsillectomy (less common)

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21
Q

Identify 5 symptoms of tonsillitis

A
  • Fever
  • Sore throat
  • Pain/difficulty swallowing
  • Cervical lymph node enlargement (jugulo-digastric)
  • Bad breath
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22
Q

What is a peritonsillar abscess?

A
  • A peritonsillar abscess is a bacterial infection that usually begins as a complication of untreated strep throat or tonsillitis
  • It generally involves a pus-filled pocket that forms near one of your tonsils
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23
Q

Identify 5 symptoms of peritonsillar abscesses

A
  • Severe throat pain
  • Fever
  • Bad breath
  • Drooling
  • Difficulty opening mouth
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24
Q

What is the pharynx and where is it found?

A
  • The pharynx is a muscular tube arising from the base of the skull down to the level of C6
  • It forms the upper part of the alimentary canal and lies posterior to the nasal and oral cavities
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25
Q

Describe the fascial covering of the pharynx

A

The posterior wall of the pharynx is covered with buccopharyngeal fascia and lies against the prevertebral layer of the deep fascia

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26
Q

What are the boundaries of the nasopharynx?

A
  • Superior: base of skull
  • Inferior: upper border of soft palate
  • Posterior: C1-C2 vertebrae
  • Anterior: nasal cavity
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27
Q

What is found in the nasopharynx?

A
  • Pharyngeal tonsils (adenoids)
  • Orifice of the Eustachian tube
  • can have recurrent ear infections
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28
Q

What are the boundaries of the oropharynx?

A
  • Superior: soft palate
  • Inferior: epiglottis
  • Anterior: oral cavity
  • Posterior: C2-C3 vertebrae

behind the oral cavity closed to to the exit

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29
Q

What is found in the oropharynx?

A

Palatine tonsils (in tonsillar fossa)

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30
Q

What are the boundaries of the laryngopharynx?

A
  • Superior: oropharynx / epiglottis
  • Inferior: oesophagus / cricoid cartilage
  • Anterior: laryngeal inlet
  • Posterior: C4-C6 vertebrae
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31
Q

What is found in the laryngopharynx?

A

The piriform fossae (small depressions) are found on each side of the laryngeal inlet

32
Q

What is the clinical significance of the piriform fossa?

A
  • Potential site for the lodging of foreign bodies e.g. fish bone, chicken bone
  • Potential site for pharyngeal cancers
33
Q

What is the narrowest part of the pharynx?

A

The inferior end of the laryngopharynx

34
Q

Identify the 3 longitudinal muscles which elevate pharynx and larynx during swallowing

A
35
Q

State the origin and attachment of the stylopharyngeus muscle

A
  • Origin: styloid process
  • Attachment: posterior border of thyroid cartilage

forms the hard palate

36
Q

What innervates the stylopharyngeus muscle?

A

Glossopharyngeal nerve (CN IX)

37
Q

State the origin and attachment of the palatopharyngeus muscle

A
  • Origin: hard palate
  • Attachment: posterior border of thyroid cartilage
38
Q

What innervates the palatopharyngeus muscle?

A

Pharyngeal branch of vagus (CN X)

39
Q

State the origin and attachment of the salpingopharyngeus muscle

A
  • Origin: cartilaginous part of ET
  • Attachment: merges with palatopharyngeus
40
Q

What innervates the salpingopharyngeus muscle?

A

Pharyngeal branch of vagus (CN X)

41
Q

Identify the 3 circular muscles which constrict the walls of the pharynx when swallowing

A
42
Q

Which nerve innervates the pharyngeal constrictor muscles?

A

Vagus nerve (CN X)

43
Q

What are the two muscles forming the inferior pharyngeal constrictor?

A
  • Thyropharyngeal muscle
  • Cricopharyngeal muscle
44
Q

What is found between the two muscles of the inferior pharyngeal constrictor?

A

Killian’s dehiscence – point of potential weakness between thyropharyngeus and cricopharyngeus

45
Q

What is a pharyngeal pouch?

A
  • A pharyngeal pouch represents a posteromedial (false) diverticulum through Killian’s dehiscence
  • The herniation occurs between the thyropharyngeus and cricopharyngeus muscles
46
Q

How does a pharyngeal pouch occur?

A
  • Failure of the UOS to relax (higher pressure in laryngopharynx)
  • Abnormal timing of swallowing
  • Weakness in inferior constrictor muscle produces outpouching
47
Q

How does a patient with a pharyngeal pouch present?

A

Symptoms related to food material collecting in pouch or disruption of swallowing:

  • Bad breath
  • Food regurgitation
  • Choking on fluids
  • Dysphagia
48
Q

What is the pharyngeal plexus and where is it located?

A
  • Pharyngeal plexus is a network of vagus, glossopharyngeal and cervical sympathetic nerves
  • Located mainly on surface of middle constrictor muscle
49
Q

Describe the motor innervation of the pharynx

A
  • Stylopharyngeus – glossopharyngeal nerve CN IX
  • All other muscles – vagus nerve CN X
50
Q

Describe the sensory innervation of the pharynx

A
  • Nasopharynx – maxillary nerve CN V2
  • Oropharynx – glossopharyngeal nerve CN IX
  • Laryngopharynx – vagus nerve CN X
51
Q

Stage 1 (oral) of swallowing is voluntary.

Outline what happens in this stage

A
  • Preparatory phase – making bolus
  • Transit phase – bolus compressed against palate and pushed into oropharynx by tongue and soft palate
52
Q

Which nerve controls stage 1 of swallowing?

A

Hypoglossal nerve (CN XII)

53
Q

Stage 2 (pharyngeal) of swallowing is involuntary.

Outline the 8 steps occuring in this stage

A

⇒ Tongue positioned against hard palate

⇒ Soft palate elevated to seal off nasopharynx

⇒ Suprahyoid and longitudinal muscles shorten

⇒ Pharynx widens and shortens to receive bolus

⇒ Larynx elevated and sealed off by vocal folds

⇒ Epiglottis closes over larynx (result of elevated hyoid)

⇒ Constrictors contract and bolus moves through pharynx

⇒ Relaxation of UOS

54
Q

Stage 3 (oesophageal) of swallowing is involuntary.

Identify the structures involved in this stage

A
  • Upper striated muscle of oesophagus (CN X)
  • Lower smooth muscle
55
Q

Identify 4 clinical conditions which cause dysphagia

A
  • Stroke
  • Progressive neurological disease (Parkinson’s/ MS)
  • COPD
  • Dementia
56
Q

Identify 5 signs and symptoms of dysphagia (swallowing issues)

A
  • Coughing & choking
  • Sialorrhoea (drooling)
  • Recurrent pneumonia
  • Change in voice/speech (wet voice)
  • Nasal regurgitation
57
Q

Which clinical signs indicate cranial nerve problems (CN IX, X) in the oral cavity?

A
  • Absent gag reflex (CN X & IX)
  • Uvula deviation – contralateral side to lesion (CN X)
58
Q

What are the subtle presentations of cranial nerve problems (CN IX, X) in the oral cavity?

A
  • Dysphagia
  • Taste impairment (posterior tongue)
  • Loss of sensation oropharynx
59
Q

Identify two causes of cranial nerve problems (CN IX, X) in the oral cavity

A
  • Medullary infarct
  • Jugular foramen issue (fracture)
60
Q

How do cranial nerve problems (XII) in the oral cavity present?

A
  • Wasted tongue (LMN)
  • Muscle wasting
  • Fasiculations
61
Q

How can one test for cranial nerve problems (XII) in the oral cavity?

A

Stick tongue out (tongue may deviate, points to side of lesion)

62
Q

What is adenoiditis?

A

Adenoiditis is the chronic inflammation of the pharyngeal tonsils which may obstruct the passage of air from the nasal cavities into the nasopharynx, adding a nasal tone to speech

  • snoring
  • sleep with mouth open
  • chronic sinusitis (sore throat)
  • nasal tone to voice
63
Q

What is the temporomandibular joint?

A

The temporomandibular joint is a joint formed by the articulation of the mandible and the temporal bone of the cranium

64
Q

Where is the TMJ found?

A

The TMJ is located anteriorly to the tragus of the ear, on the lateral aspect of the face

65
Q

Describe the articulating surfaces of the TMJ

A

The TMJ consists of articulations between the mandibular fossa and articular tubercle (from the squamous part of the temporal bone), and the head of mandible

66
Q

The articular surfaces of the bones are separated by an articular disk.

What is its role?

A

The articular disk splits the joint into two synovial joint cavities, each lined by a synovial membrane

67
Q

Which type of cartilage lines the articular surfaces of the TMJ?

A

The articular surface of the bones are covered by fibrocartilage, not hyaline cartilage

68
Q

There are three extracapsular ligaments which stablise the temporomandibular joint.

Identify them and describe their course/properties

A
  • Lateral ligament – runs from articular tubule to the mandibular neck, prevents posterior dislocation
  • Sphenomandibular ligament – runs from sphenoid spine to the mandible
  • Stylomandibular ligament – a thickening of the fascia of the parotid gland, supports the weight of the jaw
69
Q

Which two groups of muscles produce movement at the TMJ

A
  • Muscles of mastication
  • Suprahyoid muscles
70
Q

Identify two sets of movements possible at the TMJ

A
  • Protrusion & retraction
  • Elevation and depression
71
Q

Identify the muscles responsible for the protrusion and retraction of the jaw

A

The upper part of the joint allows protrusion and retraction:

  • Protrusion: lateral pterygoid (assisted by medial pterygoid)
  • Retraction: geniohyoid, digastric
72
Q

Identify the muscles responsible for the depression and elevation of the jaw

A

The lower part of the joint permits elevation and depression:

  • Depression: gravity (digastric, geniohyoid, mylohoid if resistance)
  • Elevation: temporalis, masseter, medial pterygoid
73
Q

Describe the neurovascular supply of the TMJ

A
  • Arterial supply via branches of external carotid artery (superficial temporal & maxillary)
  • Innervation via auriculotemporal and masseteric branches of the mandibular nerve (CN V3)
74
Q

What is a TMJ dislocation?

A
  • TMJ dislocation is a dislocation where the head of the mandible slips out the mandibular fossa, is pulled anteriorly, and the patient is unable to close their mouth
  • It can occur due to a blow to the side of the face, yawning, or taking a large bite
75
Q

Can a posterior TMJ dislocation occur?

A

Posterior dislocations of the TMJ are possible, but very rare as it requires a large amount of force to overcome the postglenoid tubercle and strong intrinsic lateral ligament

76
Q

which 3 longitudinal muscles help to elevate the pharynx and larynx during swallowing

A
  • stylopharyngeus
  • palatopharyngeus
  • salpingopharngeus

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