17 - Oral Cavity, Palate, and Tonsils.docx

BMS 133: Oral Cavity, Palate, and Tonsils Hypertrophy Increase in cell size Hyperplasia Increase in number of cells Tonsils Detects pathogens Waldeyer’s ring Pharyngeal tonsils Palatine tonsil Between the palatoglossus and palatopharyngeus Forms arches around the tonsil Carotid artery lies behind Li...

BMS 133: Oral Cavity, Palate, and Tonsils Hypertrophy Increase in cell size Hyperplasia Increase in number of cells Tonsils Detects pathogens Waldeyer’s ring Pharyngeal tonsils Palatine tonsil Between the palatoglossus and palatopharyngeus Forms arches around the tonsil Carotid artery lies behind Lingual tonsil Posterior 1/3 of tongue No taste fibers Hard pallet Anterior 2/3 of the pallet Soft pallet Fibromuscular Pterygomandibular raphe Buccinator and superior constrictor attachment site Oral cavity Stratified squamous epithelium Keratinized Parakeratinized Orthokeratinized Non-keratinized Nasopharynx Intersection of nasal cavity and the pharynx Sensory innervation by V2 Involved in the gag reflex Separated from the oropharynx by the palate Important for talking Oropharynx Intersection of oral cavity and the pharynx Sensory innervation by CN IX Laryngopharynx Intersection of larynx and the pharynx Sensory innervation by CN X Oral cavity bones Maxilla + Palatine Anterior 2/3 of the palate Posterior nasal spine Part of the palatine bone Pterygoid plates Part of the sphenoid bone Lateral pterygoid plate Attachment of medial pterygoid + lateral pterygoid Medial pterygoid plate Hamulus Attachment of soft palate muscle Spine of sphenoid Attachment of the sphenomandibular ligament Injection sites Incisive foramen Behind #8-#9 Greater palatine foramen Medial aspect of upper 2nd and 3rd molar Lesser palatine foramen Medial aspect of the maxillary tuberosity Taste fibers On the anterior 2/3 of tongue Also found on the soft pallet Minor salivary glands All over the soft and hard pallet Soft palate borders Anterior: hard palate Posterior: nasopharynx Laterally: tongue and pharyngeal wall Hard palate borders Anterior: palatine process of the maxilla + Horizontal palatine plates Lateral: alveolar processes Posterior: soft palate Hard palate features Incisive papilla Palatine/Median raphe Transverse Folds Minor salivary gland opening Hard palate conditions Biopsy abnormalities that don’t resolve in 2 weeks Inflammatory papillary hyperplasia From dirty dentures, candida albicans, … Adenocarcinoma Tumor of minor salivary glands Torus palatinus Removed by OMFS Nasopalatine duct cyst Cystic lining goes from pseudostratified columnar to stratified squamous epithelium Soft palate borders Anterior: hard palate Posterior: nasopharynx Lateral: tongue + pharyngeal wall Soft palate parts Palatoglossus arch Palatine tonsil Palatopharyngeus arch Uvula Posterior wall of pharynx Visible lymphoid nodules Tonsils In-foldings and crypts of the oral mucosa Stratified squamous epithelium lining Lymphoid follicles within HPV oral cancer Related to the posterior aspect of the tongue + lingual tonsils Difficult to see + gag reflex Soft palate muscles Palatoglossus muscle Aponeurosis of soft palate to tongue Innervated by the pharyngeal plexus of CN X / CN XI via X Seals oral cavity from the oropharynx Palatopharyngeus muscle Aponeurosis of soft palate to lateral pharynx + posterior thyroid cartilage Innervated by the pharyngeal plexus of CN X / CN XI via X Uvula muscle Nasal spine (palatine) to itself Innervated by the pharyngeal plexus of CN X / CN XI via X Seals nasopharynx from the oropharynx (with tensor palatini) Levator palatini muscle Aponeurosis of soft palate to auditory tube + petrous temporal Innervated by the pharyngeal plexus of CN X / CN XI via X Elevates palate Tensor palatini muscle Aponeurosis of soft palate to auditory tube Tendon hooks under hamulus Motor innervation from V3 Seals nasopharynx from the oropharynx (with uvula) Palatine aponeurosis Expanded tendon of the tensor villi palatini muscle Strength and supports soft pallet muscles Site of soft palate muscle attachment Palate blood supply Nasopalatine Exits the nasopalatine canal Anastomoses with the greater palatine artery Descending palatine artery Greater palatine Blood to hard palate and nasal septum Exits the greater palatine foramen Lesser palatine Blood to soft palate and tonsils Exits the lesser palatine foramen Facial artery Ascending palatine Passes between the styloglossus and the stylopharyngeus Blood to soft palate and palatine glands Greater and lesser palatine nerve From the pterygopalatine ganglion Also called hay fever ganglion Palate sensory nerves Nasopalatine nerve Sensory to #6-#11 Posterior to incisive papilla Greater palatine nerve Sensory to bicuspids and molars Medial aspect of 2nd and 3rd molar Lesser palatine nerve Sensory to soft palate Parasympathetic From the greater petrosal nerve Synapses in the sphenopalatine ganglion Salivary glands Sympathetic Intermediolateral horn (T1-T3) → Superior cervical ganglion → Deep petrosal → Greater petrosal → Oral/Nasal cavity Doesn’t synapse in the sphenopalatine ganglion Ex: smooth muscle contraction and mucosal secretions Lesser petrosal from CN IX Goes to the parotid gland