The Mouth and Pharynx Flashcards by Rachel Agnew

What are the borders of the oral cavity?

Upper and lower teeth
Floor of mouth/tongue
Oropharynx
Hard palate and soft palate

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What is the oral vestibule?

The space between the lips and teeth

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What structures are found in the floor of the mouth?

Deep lingual vein
Frenulum
Sublingual caruncle
Sublingual fold

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What are the muscles of the floor of the mouth and what is their innervation?

Geniohyoid - C1 via hypoglossal nerve

Mylohyoid - CN V3

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Which muscle of the floor of the mouth has a free border and why is this clinically significant?

Mylohyoid

Potential space for transfer of infection

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What are the major salivary glands?

Bilateral pairs:
Parotid
Submandibular
Sublingual

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What are the minor salivary glands and what is their function?

1000’s in oral mucosa

Basal secretion to keep mouth moist

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What stimulates salivation?

Thought, site, smell of food or presence of food in the mouth
Painful oral conditions (teething or fracture)

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What is the surface anatomy of the parotid duct?

Parotid duct crosses face and secretes into mouth by upper 2nd molar

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What is the surface anatomy of the submandibular duct?

Submandibular duct enters floor of mouth and secretes via lingual caruncle

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What is the surface anatomy of the sublingual gland?

Sits n floor of mouth and secretes via several ducts superiorly

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What is the potential consequence of duct clogging/blockage?

Swelling due to a back up of secretions

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What is the innervation of the submandibular and sublingual salivary glands?

Parasympathetic from CN VII

Chorda tympani connects to lingual nerve branch of CN V3

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What is the innervation of the parotid gland?

Parasympathetic from CNIX

Hitches a ride on branches of CN V3 (auriculotemporal branch)

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What is the basic histology of the tongue?

Made from skeletal muscle

Covered in mucosa

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Where is the posterior 1/3 of the tongue and what is it’s innervation?

Vertical part - not in oral cavity

Taste and general sensory by CN IX

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Where is the anterior 2/3 of the tongue and what is it’s innervation?

Horizontal part - in oral cavity
General sensory by CN V3
Taste by CN VII

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What papillae are found in the tongue and what are their functions?

Foliate, vallate and fungiform = Taste buds

Filliform = Touch, temperature

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What structure divides the tongue into its anterior and posterior portions?

Sulcus terminalis

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What is found at the apex of the sulcus terminalis?

Foramen caecum

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Where does the thyroid originate and how does it get to its final destination?

Originates in pharynx and descends through foramen caecum of tongue

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What are the 4 pairs of extrinsic muscles of the tongue?

Palatoglossus
Styloglossus
Genioglossus
Hyoglossus

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What is the function of the extrinsic muscles of the tongue?

Change the position of the tongue during mastication, swallowing and speech

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How many intrinsic muscles of the tongue are there and where are they found?

4 pairs

Mainly dorsally/posteriorly

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What is the function of the intrinsic muscles of the tongue?

Modify the shape of the tongue during function

What is the innervation of the tongue muscles?

All = hypoglossal nerve | Except palatoglossus = Vagus

What is the CNS connection of hypoglossal nerve?

Medulla oblongata

Through which foramina does the hypoglossal nerve exit the base of the skull?

Hypoglossal canal | found in anterior all of foramen magnum

What is the extra cranial course of the hypoglossal nerve?

Descends in neck lateral to carotid sheath | At level of hyoid passes anteriorly to lateral aspect of tongue

What is the clinical test for the hypoglossal nerve?

Ask the patient to stick their tongue straight out NORMAL = Tip in midline UNILATERAL CNXII DAMAGE = Tip of tongue points towards the side of the injured nerve

What is the blood supply to the tongue?

Lingual artery

Where are arteries and nerves found in relation to the tongue?

Arteries pass medial to hypoglossus | Nerves pass lateral to hypoglossus

What is the gingivae?

Mucosa covering the alveolar bone

What passes through the greater and lesser palatine foramina?

Branches of CN V2 | Branches of maxillary a.

What is the pterygoid haulus?

Projection of the medial pterygoid plate of sphenoid bone

What are the muscles of the soft palate?

``` Tensor veli palatini Levator veli palatini Palatopharyngeus Palatoglossus Musculus uvulae ```

What is the function of tensor veli palatini?

Tenses palatine apopneurosis

What is the function of elevator veli palatini?

Lifts palatine apopneurosis

What is the function of palatopharyngeus?

Lifts pharynx and thyroid cartilage

What is the function of palatoglossus?

Brings tongue and soft palate together

What is the function of muscles uvulae?

Shortens uvula

What is the innervation of the skeletal muscles of the soft palate?

``` CN X (vagus) Exception: Tensor veli palatini - CN V3 ```

What is the function of the soft palate?

Stops food entering nose while swallowing Directs air into nose or mouth during speech, sneezing, coughing, vomiting Helps close off entrance into oropharynx during gag reflex

What is the clinical test for the vagus nerve?

Ask patient to say "aaah" NORMAL = Uvula lifts straight in midline UNILATERAL NERVE PATHOLOGY = Uvula pulled away from the non functioning side

What is the function of the outer circular muscles of the pharynx?

During sequential contraction, push food bolus inferiorly towards oesophagus

What is the function of the inner longitudinal muscles of the pharynx?

During contraction, pulls larynx superiorly shortening pharynx during swallowing

What are the circular muscles of the pharynx?

Superior constrictor Middle constrictor Inferior constrictor

What is the innervation of the muscles of the pharynx?

All = CNX | Exception: Stylopharyngeus = CN IX

What is the "Gateway to mouth" ?

Formed by gaps between the circular muscles of the pharynx | CN IX, Lingual artery and stylopharyngeus muscle pass here

What is the common insertion of the circular constrictors of the pharynx?

Midline raphe

What are the longitudinal muscles of the pharynx?

Stylopharyngeus Palatopharyngeus Salpingopharyngeus

What is the common insertion of the longitudinal muscles of the pharynx?

Posterior border of thyroid cartilage

What is the origin of the superior constrictor of the pharynx?

Pterygoid hamulus Pterygomandibular raphe Mylohyoid line

What is the origin of the middle constrictor of the pharynx?

Greater horn of hyoid

What is the origin of the inferior constrictor of the pharynx?

``` Thyroid cartilage (oblique line) Cricoid cartilage ```

What is the origin of Stylopharyngeus?

Styloid process

What is the origin of Palatopharyngeus?

Palate

What is the origin of Salpingopharyngeus?

Cartilage of pharyngotympanic tube

What are the components of Waldeyer's Tonsillar Ring?

Pharyngeal tonsil (Adenoid) Tubal tonsil Palatine tonsil (The Tonsil) Lingual tonsil

What is the function of Waldeyer's Tonsillar Ring?

Defence against invading pathogens

Where is Waldeyer's Tonsillar Ring located?

Within the mucosa of the nasopharynx and oropharynx

What are the regional lymph nodes associated with the mouth/salivary glands/pharynx?

``` Retropharyngeal nodes Jugulo-digastric node Deep cervical nodes Submental nodes Submandibular nodes ```

Which lymph nodes drain the tip of the tongue?

Submental

Which lymph nodes drain the parotid gland?

Jugulo-digastric node

What are some of the features of an infected lymph node?

``` Swollen Painful Soft Smooth Not fixed to adjacent structures Improve rapidly with antibiotics etc. ```

What are some of the features of a lymph node due to cancer?

``` Swollen Not painful Hard Irregular Fixed to adjacent structures Do not improve ```

Why must examination of the head and neck lymph nodes be bilateral?

Midline structures often drain bilaterally

What are the bilateral regional lymph nodes to be examined?

``` Submental Submandibular Parotid (pre auricular) Mastoid (post auricular) Occipital Deep cervical (along IJV) Superficial cervical (along EJV) ```