Oral Cavity.txt

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Oral Cavity.txt
2011-11-29 12:48:25
Oral HN

Oral HN
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  1. Nasopharynx Innervation
    • superior 1/2 of the nasopharynx is supplied by SA fibers from V2 which are travelling in the pharyngeal br. of the pterygopalatine ganglion.
    • inferior 1/2 of the nasopharynx is innervated by VA fibers from CN IX via the pharyngeal plexus.
  2. Oropharynx Innervation
    • supplied by VA fibers from CN IX.
    • VA fibers from CN X also innervate the lower aspect of the oropharynx.
    • The VA fibers of these nerves are from the pharyngeal plexus.
  3. Laryngopharynx innervation
    • supplied by VA fibers from CN X.
    • VA fibers from CN IX also innervate the superior aspect of the laryngopharynx.
    • The VA fibers of these nerves are from the pharyngeal plexus.
  4. Nasopharynx Autonomics
    The pharyngeal br of the pterygopalatine ganglion brings VE-para/post fibers to the mucosal glands of the superior 1/2 aspect of the nasopharynx.
  5. Autonomics of Inferior ½ Nasopharynx, Oropharynx, & Laryngopharynx
    • The pharyngeal plexus carries fibers of CN X which bring in the VE-para/pre fibers to the submucosa of the inferior ½ nasopharynx, oropharynx, and laryngopharynx.
    • These fibers synapse on VE-para/post cell bodies in the submucosa which then send axons to directly innervate the mucus glands.
  6. Oral Cavity
    • consists of two parts: the vestibule and the oral cavity proper.
    • The vestibule communicates with the exterior through the mouth.
    • The size of the oral fissure opening (rima oris) is controlled by muscles such as the orbicularis oris.
    • The oral cavity proper is the space posterior and medial to the upper and lower dental arches.
    • It is limited laterally and anteriorly by the maxillary and mandibular alveolar arches housing the teeth.
    • The roof of the oral cavity is formed by the palate.
    • Posteriorly, the oral cavity communicates with the oropharynx.
    • When the mouth is closed and at rest, the oral cavity is fully occupied by the tongue.
  7. Vestibule
    narrow interval between the lips/cheeks and teeth/gingivae.
  8. Posterior Nasal Spine
    posterior projection of horizontal plates of the palatine bones
  9. Lips
    • The lips are covered by skin externally & a mucous membrane internally.
    • The principle muscle of the lips is the orbicularis oris.
    • Between the muscle and mucous membrane there are labial salivary glands (don’t worry about their innervation).
    • The blood supply to the lips are by way of the superior & inferior labial arteries (branches of the facial a.).
    • The innervation (SA) is by way of the infraoribital (upper lip) and mental nerves (lower lip).
    • The muscle of the lips is the orbicularis oris which is innervated by CN VII motor branches.
  10. Cheeks
    • have the same structure as the lips.
    • The principle muscle is the buccinator (innervated by CN VII motor branches).
    • The cheeks have buccal salivary glands (don’t worry about their innervation).
    • The parotid duct opens on the parotid papilla, opposite the 2nd maxillary molar.
    • Sensory innervation (SA) to the cheek is by the long buccal nerve (br of V3).
  11. Gingivae (gums)
    • composed of fibrous tissue that is covered with mucous membrane.
    • Sensory innervation is by the superior alveolar nerves, greater palatine nerve, nasopalatine nerve, long buccal nerve, inferior alveolar nerve, lingual nerve, and mental nerve.
  12. Teeth
    • divided between incisors, canines, premolars, and molars.
    • Sensory innervation for the maxillary teeth is by the posterior, middle, and anterior superior
    • alveolar nerves.
    • Branches from the inferior alveolar teeth supply the mandibular teeth.
  13. Oral Cavity Proper
    limited laterally and in front by alveolar arches and the teeth and is continuous posteriorly with the oropharynx
  14. palate
    roof of the mouth. It separates the oral cavity from the nasal cavities and the nasopharynx and consists of a bony part called the hard palate and a muscular part called the soft palate.
  15. Hard Palate:
    1. The hard palate is formed by the palatine processes of the maxillae and the horizontal plates of the palatine bones.
  16. Hard Palate Foramina:
    • a. The incisive foramen located posterior to the maxillary central incisors is the common opening fo the right and left incisive canals.
    • It transmits the nasopalatine nerves and septal br. of the sphenopalatine artery (which anastomosis with the greater palatine a.)
    • b. The greater palatine foramen transmits the greater palatine nerve and vessels to the hard palate.
    • c. The lesser palatine foramen (they may be multiple on each side) transmits the lesser palatine nerve and vessels to the soft palate.
  17. Hard Palate Structure
    • covered by a mucous membrane that is intimately connected to the periosteum (covering the bone).
    • Deep to the mucosa, there are mucus-secreting palatine glands.
    • These glands are innervated by VE-para/post fibers from the pterygopalatine ganglion carried by the greater palatine nerve.
  18. Hard Palate Mucosal Innervation
    • The sensory (SA) innervation of the hard Palate (gingivae & mucous membrane) is by the greater palatine & nasopalatine nerves (SA fibers are from V2).
    • They also carry VE-para/post fibers (for the innervation of palatine glands) and symp/post fibers (to arteries for vasoconstriction).
  19. Soft Palate
    • extends the hard palate postero-inferiorly and ends in a curved free margin containing a conical process called the uvula.
    • The principle action of the soft palate is to close off the nasopharynx in swallowing, in suckling and during oral speech.
  20. Soft Palate structure
    • The soft palate is composed of a fold of mucous membrane enclosing an aponeurosis, muscles, vessels, nerves, and mucus glands.
    • The mucus glands are palatine glands.
    • These glands are innervated by VE-para/post fibers from the pterygopalatine ganglion carried by the lesser palatine nerve.
  21. Pillars
    • At its lateral borders, the soft palate blends with the pharyngeal wall and gives rise to two arches (pillars) formed by folds of mucosa overlying muscles.
    • The anterior pillar is the palatoglossal arch or fold – from the soft palate to the lateral margin of the tongue.
    • The posterior pillar is the palatopharyngeal arch or fold – from the soft palate to the side of the pharynx.
    • The palatine tonsil is located between the two arches or pillars.
  22. Fauces
    • The aperature by which the mouth communicates with the oropharynx is called the fauces.
    • The isthmus of the fauces is bounded superiorly by the soft palate, inferiorly by the dorsum of the tongue, and on either side by the palatoglossal arch (anterior pillar).
  23. Soft Palate Muscles
    • There are 5 muscles of the soft palate:
    • musclesinnervationaction
    • a. tensor veli palatinibr of V3tenses soft palate
    • b. levator veli palatiniXI via Xelevates soft palate
    • c. palatoglossusXI via Xelevates tongue, depresses soft palate
    • d. palatopharyngeusXI via Xelevates pharynx
    • e. musculus uvulae XI via Xcontracts uvula, pulls it upward
  24. Soft Palate Mucosal Innervation
    • The sensory (SA) innervation of the soft palate is by the lesser palatine nerve (SA fibers are from V2).
    • It also carries VE-para/post fibers (for the innervation of palatine glands) and symp/post fibers (to arteries for vasoconstriction).
  25. The Tongue
    • highly moveable organ important in mastication, taste, swallowing (deglutition), and speech.
    • The tongue has 2 parts: the oral part (anterior 2/3rd of the tongue) and pharyngeal part (posterior 1/3rd of the tongue). This division of the dorsum of the tongue is reflected in different sensory innervation sources.
    • The extrinsic & intrinsic muscles of the tongue are innervated by CN XII.
    • The lingual artery is the principle artery of the tongue.
  26. Tounges 2 Parts
    • The two parts of the tongue, the pharyngeal and oral parts.
    • The boundary between the parts is indicated by the anterior pillars (palatoglossal arches) and a V-shaped groove called the sulcus terminalis – whose apex projects posteriorly and ends in a median pit called the foramen cecum.
  27. Tongue Parts Boundary
    • indicated by the anterior pillars (palato-glossal arches)
    • sulcus terminalis- V-shaped groove whose apex projects posteriorly and ends in a median pit called the foramen cecum
  28. Papillae
    • The entire tongue is covered by a mucous membrane.
    • The mucous membrane of the oral part is attached to the underlying muscles and possesses numerous papillae: filiform, fungiform, valate and folliate.
    • The vallate (a.k.a. “circumvallate”), foliate, and fungiform papillae contain taste buds.
    • The filiform papillae contain
    • sensory nerve endings that are sensitive to touch.
  29. Lingual Tonsils
    • The mucous membrane of the pharyngeal part of the tongue is thick and contains large a collection of lymphatic nodules forming the lingual tonsils.
    • It also contains taste receptors.
  30. Inferior Surface of the Tongue
    • reflects onto the lingual gingivae and onto the floor of the mouth.
    • In the midline, the mucosa is elevated into a fold called the frenulum of the tongue (a.k.a. lingual frenulum).
  31. Extrinsic and Intrinsic Tongue Muscles
    • provide the mobility of the tongue.
    • All of the muscles of the tongue are innervated by CN XII.
    • Extrinsic muscles suspend the tongue from the mandible, the styloid process of the temporal bone, and the hyoid bone.
    • The extrinsic muscles are the hyoglossus, styloglossus, and genioglossus.
    • The palatoglossus(considered previously) is better thought of as a muscle of the soft palate and not a tongue muscle.
  32. Intrinsic Tongue Muscles
    • have their attachment entirely within the tongue.
    • These are small muscles that criss-cross within the substance of the tongue.
    • Their main function is to change the shape of the tongue.
    • They include: (1) superior & inferior longitudinal muscles, (2) transverse muscles, (3) vertical muscles.
  33. Lingual Artery
    • is the principle artery to the tongue.
    • It arises from the external carotid artery (opposite the tip of the hyoid bone).
    • It ascends and turns forward deep to hyoglossus where it gives off its terminal branch – the deep lingual artery.
    • This terminal branch runs to the tip of the tongue.
    • Its principle branches of the lingual artery are: the dorsal lingual, sublingual, and deep lingual arteries.
  34. veins of the tongue
    • dorsal lingual veins
    • deep lingual veins (which begin at the apex of the tongue and run posteriorly beside the lingual frenulum to join the sublingual vein)
    • sublingual veins
    • All these veins bring blood directly or indirectly into the IJV (internal jugular vein).
    • Clinical Note: The mucosa under the tongue is thin and allows for the quick transmucosal absorption of medications (such as nitroglycerin) which enter the deep lingual veins in less than a minute.
  35. Innervation of the Tongue
    • involves 5 cranial nerves.
    • The anterior 2/3rd of the tongue receives SA fibers from CN V3 (lingual n.) and SS/taste fibers from CN VII (via chorda typani fibers).
    • The posterior 1/3rd of the tongue receives VA & SS/taste fibers from CN IX.
    • CN X also supplies VA & SS/taste fibers to some areas at the base of the tongue, vallecula, and anterior epiglottis.
    • CN XII provides SE (motor) innervation to all 3 tongue muscles.
  36. Glossoepiglottic Folds
    • The posterior 1/3rd of the tongue (also called the base or root) is connected to the epiglottis via 3 folds: the median glossoepiglottic fold, and 2 lateral glossoepiglottic folds.
    • Between the lateral and median glossoepiglottic folds is the vallecula.
  37. Lymph Drainage (Tongue)
    • from the posterior 1/3rd and medial part of the anterior 2/3rd of the tongue drains into deep cervical lymph nodes.
    • Lymph from the lateral parts of the anterior 2/3rd of the tongue drains to submandibular nodes.
    • Lymph from the apex of the tongue drains into the submental lymph nodes.
  38. Floor of the Mouth
    • under the tongue and covered with mucous membrane that becomes continuous with the gingivae of the mandible.
    • The mylohyoid forms the inferior limit of the floor.
    • Within the floor is the geniohyoid, deep process of the submandibular gland, submandibular duct, lingual nerve, sublingual gland & its ducts.
  39. Sublingual Caruncle
    • On the floor of the mouth, the median fold forms the frenulum of the tongue, on either side of which lies the sublingual caruncle (the opening of the
    • duct of the submandibular gland).
  40. Mylohyoid relation to oral cavity
    • forms the floor of the mouth.
    • When viewed from the anterior triangle, it helps form the floors of the submental and submandibular triangles.
    • On the superior surface of the myloyoid are the geniohyoid muscles.
  41. lingual nerve relation
    • salso traverses the floor of the mouth.
    • The submandibular ganglion hangs from it.
    • VE-para/post fibers (secretomotor) from the ganglion innervate the submandibular & sublingual glands.
  42. deep process of the submandibular gland
    • superior to the mylohyoid and gives rise to the submandibular duct.
    • Note: Tthe lingual nerve passes from lateral to medial, under the submandibular duct.
  43. sublingual gland
    • superior to the mylohyoid and occupies the anterior aspect of the floor of the mouth.
    • It is deep to the mucosa and has 8-20 ducts which open separately into the mouth on the elevated crest of mucous membrane called the plica sublingualis (sublingual fold).
  44. three salivary glands
    • (the parotid, submandibular, and sublingual glands)produce saliva and open into the mouth through their ducts.
    • Saliva is a clear, tasteless, odorless viscid fluid secreted by these glands and the mucous glands of the oral cavity.
    • It keeps the mucous membrane of the mouth moist, lubricates the food during mastication, and begins the digestion of starches.
  45. maxillary teeth innervation
    • SA fibers of the superior alveolar nerves (posterior, middle, and anterior) which are direct or indirect branches of CN V2.
    • The mandibular teeth are innervated by SA fibers of the inferior alveolar nerves (V3 br).
  46. Maxillary Gingivae innervation
    • The maxillary buccal and labial gingivae are innervated by the superior alveolar nerves (anterior, middle, and posterior).
    • The palatine gingivae are innervated by the greater palatine nerve (premolar & molar gingivae) and nasopalatine nerve (incisor gingivae).
  47. Mandibular Gingivae innervation
    • The mandibular buccal gingivae is innervated by the long buccal nerve (V3).
    • The lingual gingivae of all mandibular teeth is innervated by the lingual nerve (V3).
    • The labial gingivae of the mandibular incisors are innervated by the incisive br. of the inferior alveolar nerve.
  48. PSA Nerve Block
    • The posterior superior alveolar (PSA) nerve block, otherwise known as the tuberosity block or the zygomatic block, is used to achieve anesthesia of the
    • maxillary molar teeth up to the 1st molar with the exception of its mesiobuccal root in some cases.
    • One of the potential complications of this technique is the risk of hematoma formation from injection of anesthetic into the pterygoid plexus of veins or accidental puncture of the maxillary artery.
  49. MSA Nerve Block
    • The middle superior alveolar (MSA) nerve block is useful for procedures where the maxillary premolar teeth or the mesiobuccal root of the 1st molar
    • require anesthesia.
    • Although the MSA is not always present, it is useful if the posterior or anterior superior alveolar nerve blocks or supraperiosteal infiltration fails to achieve adequate anesthesia.
    • Individuals in whom the MSA nerve is absent, the PSA and ASA nerves provide innervation to the maxillary premolar teeth and the mesiobuccal root of the 1st molar.
  50. ASA Nerve Block
    • The anterior superior alveolar (ASA) nerve block or infraorbital nerve block is a useful technique for achieving anesthesia of the maxillary central and lateral incisors and canine as well as the surrounding soft tissue on the buccal aspect.
    • In patients that do not have an MSA nerve, the ASA nerve may also innervate the premolar teeth and mesiobuccal root of the 1st molar.
  51. greater palatine nerve block
    • useful when treatment is necessary on the palatal aspect of the maxillary premolar and molar dentition.
    • This technique targets the area just anterior to the greater palatine canal.
    • The greater palatine nerve exits the canal and travels forward between the bone and soft tissue of the palate.
  52. nasopalatine nerve block
    • otherwise known as the incisive nerve block and sphenopalatine nerve block, anesthetizes the nasopalatine nerves bilaterally.
    • In this technique anesthetic solution is deposited in the area of the incisive foramen.
    • This technique is indicated when treatment requires anesthesia of the lingual aspect of multiple anterior teeth.
  53. tensor veli palatini
    • origin: scaphoid fossa of sphenoid, spine of sphenoid, auditory tube cartilage
    • insert:palatine aponeurosis
    • nerve: V3 (br from medial pterygoid n. that goes through otic ganglion).
    • action:tenses soft palate, opens auditory tube during swallowing & yawning
  54. musculus uvulae
    • origin: posterior nasal spine, palatine aponeurosis
    • insert: mucosa of uvula
    • nerve: CN XI via X.(via pharyngeal plexus)
    • action: shortens (contracts) uvula and pulls it superiorly
  55. palatopharyngeus
    • origin: palatine aponeurosis (of the soft palate)
    • insert: lateral wall of pharynx
    • nerve: CN XI via X.(via pharyngeal plexus)
    • action: pulls walls of pharynx superiorly, anteriorly, & medially during swallowing
  56. palatoglossus
    • origin: palatine aponeurosis
    • insert: lateral margin of tongue
    • nerve: CN XI via X.(via pharyngeal plexus)
    • action: elevates posterior part of tongue and depresses soft palate
  57. levator veli palatini
    • origin: auditory tube cartilage, petrous part of temporal b.
    • insert: palatine aponeurosis
    • nerve: CN XI via X.(via pharyngeal plexus)
    • action: elevates soft palate during swallowing & yawning
  58. genioglossus
    • origin: superior genial tubercle (mental spine) of mandible
    • insert: entire dorsum of tongue; some fibers attach to hyoid
    • nerve: CN XII
    • action: protrudes & depresses tongue
  59. hyoglossus
    • origin: greater horn & body of hyoid
    • insert: inferior aspects of lateral part of tongue
    • nerve: CN XII
    • action: depresses tongue
  60. styloglossus
    • origin: styloid process of temporal bone
    • insert: side of tongue, interdigitating with hyoglossus
    • nerve: CN XII
    • action: retracts tongue, curls up sides of tongue
  61. geniohyoid
    • origin: inferior genial tubercles (mental spines)
    • insert:hyoid
    • nerve: C1 via CN XII
    • action:assists in depressing mandible; raises hyoid & larynx when swallowing