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Oral cavity palate - pharynx

The document describes the anatomy of the head and neck region, specifically focusing on the oral cavity and pharynx. It is divided into several sections that describe: 1) the oral cavity including the oral vestibule and oral cavity proper, 2) the floor of the mouth including structures like the frenulum and papillae, 3) the tongue including its muscles and blood supply, 4) the palate including the hard and soft palate, and 5) the pharynx including its walls, muscles like the constrictors, and structures like the tonsils. Each section provides details on the boundaries, structures, and relations of the different anatomical regions within the head and neck.

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Head and Neck Oral cavity Professor Dr. Mohamed El Fiky Professor of anatomy and embryology
A. ORALVESTIBULE Boundaries: 1. Anteriorly by lips 2. Laterally by cheeks 3. Posteriorly and medially by teeth and gums B. ORAL CAVITY PROPER Boundaries: 1. Anteriorly laterally by teeth and gums 2. Superiorly by the palate 3. Inferiorly by the tongue and the floor of the mouth 4. Posteriorly by opening into the pharynx 1- Vestibule 2- mouth cavity proper . The Mouth Oral Vestibule Oral Cavity Proper The mouth cavity extends from the lips to the oropharyngeal isthmus. It is composed of 2 main parts Mohamed el fiky
III. FLOOR OF THE MOUTH Lingual frenulum (connects the tongue to the floor of the mouth) Papillae ( openings of submandibular duct) Sublingual fold (passes lateraly and backwards from the papilla and overlies the sublingual gland) Sublingual region Shows the following structures: Ø Frenulum of the tongue Ø Sublingual papilla : lies on each side of the frenulum and the submandibular duct opens on it Ø Sublingual fold : produced by the underlying sublingual salivarygland and the ducts of the gland open on its summit. Mohamed el fiky
TONGUE Ø It is composed of a striated muscular mass, covered by mucous membrane. Ø It is anterior 2/3 (oral part) lies in the floor of the mouth Ø It is posterior 1/3 (pharyngeal part) lies in the oropharynx Muscles of the tongue: Intrinsic muscles: Ø They consist of longitudinal, transverse & vertical fibers. Ø Nerve supply : Hypoglossal nerve. Ø Action: They alter the shape of the tongue. Extrinsic muscles: Hyoglossus , genioglossus , styloglossus and palatoglossus. Nerve supply of the tongue: = Motor: Ø All the intrinsic & extrinsic muscles of the tongue are supplied by the hypoglossal nerve EXCEPT the palatoglossus which is supplied by the cranial root of accessory nerve through the pharyngeal plexus ( vago- accessory complex ). = Sensory: Ø Anterior 2/3: - Lingual nerve (general sensation) - Chorda tympani (taste sensation) Ø Posterior 1/3 : Glossopharyngeal nerve : (general & taste) Ø Root: Vagus nerve, through the internal laryngeal nerve. Blood supply of the tongue: Ø Lingual artery Ø Tonsillar branch of facial artery Ø Ascending pharyngeal artery Mohamed el fiky
PALATE Mohamed el fiky Hard palate Soft palate
PALATE Ø It forms the roof of the mouth and floor of the nasal cavity. Ø It is divided into : hard (anterior 2/3) & soft (posterior 1/3) Hard palate Ø It is the bony portion which is formed by the palatine process of the maxillae and the horizontal plates of the palatine bone. Soft palate Ø A mobile fold attached to posterior border of hard palate Ø It is formed of the palatine aponeurosis and muscles. Muscles of the soft palate: = Tensor palati: Ø Origin : scaphoid fossa , spine of sphenoid and lateral surface of the cartilaginous part of auditory tube. Ø Insertion : palatine aponeurosis and palatine crest. Ø Nerve supply : nerve to medial pterygoid Ø Action : the 2 muscles tighten the soft palate. Levator veli palatini: Ø origin : lower part of the auditory tube and lower surface of the petrous bone. Ø Insertion : into the palatine aponeurosis. Ø Nerve supply : pharyngeal plexus. Action : elevates the soft palate. Mohamed el fiky
Palatoglossus: Origin: platine aponeurosis. Insertion : into the side of the tongue. Nerve supply : pharyngeal plexus . Action : pulls the root of the tongue upwards. = Palatopharyngeus: Origin : palatine aponeurosis. Insertion : posterior border of thyroid cartilage . Nerve suppy : pharyngeal plexus. Action : elevates the wall of the pharynx. = Musculus uvulae : Origin : posterior border of hard palate . Insertion: mucous membrane of uvula. Nerve supply : pharyngeal plexus. Action : elevates the uvula. Blood supply of the palate Ø Greater palatine , lesser palatine and sphenopalatine arteries (from maxillary artery). Ø Ascending palatine artery (from facial artery) Ø Ascending pharyngeal artery . Nerve supply of the palate: = Sensory Ø Glossopharyngeal nerve. Ø Greater & lesser palatine nerves. Ø Middle palatine nerve. Ø Sphenopalatine nerve. = Motor: · All the muscles of the soft palate are supplied by the cranial part of the accessory nerve through the pharyngeal plexus EXCEPT the tensor palati which is supplied by the mandibular nerve. Mohamed el fiky
Soft Palate Muscles of Soft Palate Mohamed el fiky
PHARYNX Ø It is a funnel shaped fibro-muscular tube of about 13 cm . length Ø It extends form the base of the skull to the level of the 6th cervical vertebrae. Ø Its anterior wall is deficient and lies behind the cavities of the nose, mouth and larynx Ø Accordingly it is divided into 3 parts: Nasopharynx , oropharynx & laryngeopharynx . a)Base of skull (basioociput and basi sphenoid) àsoft palate b)Plane of hard palate àhyoid bone c) Hyoid boneà lower border of cricoid cartilage Nasopharynx Oropharynxx Larygeopharynx Mohamed el fiky
WALLS OF THE PHARYNX Consists of the following from within outwards: 1. Mucous coat lined by stratified squamous epithelium. 2. Inner fibrous coat (pharyngo-basilar fascia). 3. Muscular coat. 4. Outer fibrous coat (buccopharyngeal fascia). Muscles of the pharynx Ø Outer circular layer: 3 constrictors of the pharynx. Ø Inner longitudinal layer: 3 longitudinal muscles. Sup.constrictor mid.constrictor inf.constrictor Constrictors of the pharynx. 1- Sup.constrictor 2- mid.constrictor 3- inf.constrictor longitudinal muscles. 1- Stylo-pharyngeus 2- Salpingo – pharyngeus N.B. All muscles of pharynx take nerve supply from pharyngeal plexus except stylopharyngeus from glossopharyngeal nerve 3-Palato-pharyngeus: Mohamed el fiky
Pharyngeal Muscles Stylopharyngeus • O:medial aspect of styloid process • Gap between middle and superior constrictor • NS: glossopharyngea l Palatopharyngeus • O: upper surface of palatine aponeurosis as 2 fasiculi • Moves along inner aspect of the constrictor • NS: pharyngael plexus Salpingopharyngeus • O: cartilage of the auditory tube near the pharyngeal opening of it. LONGITUDINAL MUSCLES All the 3 are inserted as a conjoint sheet at the post border of thyroid cartilage and lat aspect of epiglottis Mohamed el fiky
Pharyngeal Muscles Mohamed el fiky
Trachea Oesophagus Digastric (posterior belly) cut Middle constrictor Stylohyoid ligament Stylohyoid Recurrent laryngeal nerve Stylopharyngeus Glossopharyngeal nerve Thyropharyngeus Cricopharyngeus Pterygomandibular raphe Buccinator Pharyngotympanic tube Superior constrictor Tensor veli palatini Mandibular nerve Levator veli palatini Middle meningeal artery Mohamed el fiky
Pharyngeal Muscles Pharyngobasilar fascia Styloid process Attachment of pharyngeal raphe to pharyngeal tubercle (occipital bone) Tensor veli palatini Levator veli palatini Stylohyoid (cut) Stylopharyngeus Styloglossus Fibres of middle constrictor from stylohyoid ligament Stylohyoid (cut) Pharyngeal raphe Greater cornu of hyoid bone Inferior constrictor (cricopharyngeus) Inferior constrictor (thyropharyngeus) Middle constrictor Superior constrictor Mohamed el fiky
Lies in wall of nasopharynx and oropharynx Wide origin • Post border of med pterygoid plate &pterygoid hamulus • Pterygomandibular raphae • Post end of mylohyoid line • Mucus membrane on side of tongue Lower part covered by middle constrictor. Superior Constrictor Mohamed el fiky
Middle Constrictor • Hypopharynx • O: lower part of stylohyoid ligament lesser and greater cornu of hyoid • Inferiorly overlapped by inferior constrictor. Mohamed el fiky
Inferior Constrictor Thickest of the 3 Thyropharyngeus O:oblique line of thyroid cartilage inferior cornu of thyroid Cricopharyngeus O: ant part of cricoid cartilage between attachment of cricothyroid and articulation of inferior cornu . ************************************* qInsertion :All of the fibres get inserted into the median fibrous raphae Extending from Pharyngeal tubercle up to the oesophagus qActions 0f the constrictor muscles : Muscles of 2 sides act as a sphincter Function– prevent the entry of air in to the oesophagus in the interval between swallowing So sphincter relaxes during swallowing Contracts between the acts of swallowing.Mohamed el fiky
Killian’s Dehiscence • Potential gap b/w weak area of pharyngeal wall • Gateway of Tear à perforation can occur at this site during oesophagostomy. Killian’s triangle Laimer’s triangle Inferior constrictor (cricopharyngeal part) Inferior constrictor (thyropharyngeal part) Fundiform part (cricopharyngeal sphincter, Killian’s sling) Mohamed el fiky
PHARYNGEAL SPACES • 2 potential spaces in relation to pharynx: • Retropharyngeal space: – Situated behind pharynx – Extends from base of skull to the bifurcation of trachea • Parapharyngeal space: – Situated on the side of pharynx – Contains carotid vessels, jugular veins, last four cranial nerves & cervical sympathetic chain Mohamed el fiky
Pharyngeal Plexus of Nerves • Almost all of the nerve supply to the pharynx, whether motor or sensory, is derived from the pharyngeal plexus • Formed by the pharyngeal branches of the glossopharyngeal (sensory )and vagus nerves (motor) with contributions from the superior cervical sympathetic ganglion. all the muscles of the pharynx take nerve supply from The pharyngeal branch of the vagus except stylopharyngeus , which is supplied by the glossopharyngeal nerve Mohamed el fiky
Passavant’s Ridge • A mucosal ridge raised by fibres of palatopharyngeus. • Forms a ring around post and lat walls of nasopharyngeal isthmus. • When soft palate is elevated the muscle band appear as a ridge àPassavant’s ridge • During act of swallowing palate and the ridge approximated. Mohamed el fiky
Gaps in the pharyngeal wall Mohamed el fiky
RELATIONS (GAPS IN LATERAL WALL OF PHARYNX) I-first gap : ( Above superior constrictor Between Base of the skull and Upper border of the superior constrictor ) . It occupied by : - Auditory tube. - Levator palati muscle. II-second gap : Between : Lower border of the superior constrictor &Upper border of the middle constrictor. . It occupied by : - Stylopharyngeus muscle. -Glossopharyngeal nerve. III-third gap : Lower border of the middle constrictor& Upper border of the inferior constrictor It occupied by : - Internal laryngeal nerve . - Superior laryngeal artery. IV-fourth gap :Below lower border of the inferior constrictorIt occupied by : - Recurrent laryngeal nerve. - Inferior laryngeal artery. Mohamed el fiky
Nasopharynxx it shows the following features: Ø Opening of auditory tube . Ø Tubal elevation : it is the elevation formed by the upper and posterior margins of the opening of the auditory tube. Ø Pharyngeal recess: is a depression in the pharyngeal wall behind the tubal elevation Ø Salpingopharyngeal fold: § It is a vertical fold of mucous membrane which runs downwards from the tubal elevation to the side wall of pharynx. § It contains the salpingopharyneus muscle. Tubal tonsils: collections of lymph tissue near the tubal opening. Mohamed el fiky
Oropharynxx It lies behind the oral cavity : extends from the soft palate above to the upper border of epiglottis below. Palatine tonsil Ø A large ovoid mass of lymphoid tissue Ø It looks like a large almond. Ø It has : § 2 poles : upper & lower § 2 borders : anterior & posterior § 2 surfaces : medial & lateral Ø It has 12-15 tonsillar crypts which open on its medial surface q Position : Located in the tonsillar fossa on the lateral wall of oropharynx Ø The tonsillar fossa is bounded by : § Anteriorly : the palatoglossal arch § Posteriorly : the palatopharyngeal arch Relations : Medial surface Ø Covered by the mucous membrane Ø Tonsillar pits are small orifices on the medial surface which lead into the tonsillar crypts. Latcral surface ¡ Capsule : Ø Separates the tonsil from the superior constrictor of pharynx. Superior constrictor:Ø Separates the tonsil from: 1- The facial artery and its branches: 2- Para-tonsillar vein: 3- Glossopharyngeal nerve: Mohamed el fiky
Blood supply of the tonsil: Arteries : Ø Tonsillar branches of descending palatine artery Ø Tonsillar branch of the facial artery. Ø Tonsillar branches of ascending palatine artery. Ø Tonsillar branches of dorsal lingual artery. . = Veins : Ø Pharyngeal plexus of veins receives most of the veins. Ø Some veins drain into the lingual vein Sensory nerve supply : lesser palatine (maxillary) and glossopharyngeal nerve. r Lymphatic srainage of the tonsil: Ø The deep cervical lymph nodes. Waldeyer’s ring : is a tonsilar ring at the oropharyngeal isthmus , formed of linguinal , palatine , tubal and pharyngeal tonsils . Mohamed el fiky
Waldeyer’s Ring q The palatine tonsils, nasopharyngeal tonsil (adenoid) and lingual tonsil constitute the major part of Waldeyer's ring or nasal-associated lymphoid tissue (NALT), with the tubal tonsils and lateral pharyngeal bands as less prominent component q A ring composed of NALT at beginning of food and air passage. q Produce B and T lymphocytes q Local defense q Also produce lymphocytes to send to other lymph nodes. Mohamed el fiky