Floor of the Mouth and Palate PDF

Floor of the mouth & Palate [Oral and dental sciences] Miss H Rogers GDC ILOS  1.1.5 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and explain their applica>on to pa>ent management  1.1.6 Describe relevant and appropriate physiology and explain...

Floor of the mouth & Palate [Oral and dental sciences] Miss H Rogers GDC ILOS  1.1.5 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and explain their applica>on to pa>ent management  1.1.6 Describe relevant and appropriate physiology and explain its applica>on to pa>ent management Related topics:  Epithelium  Muscles  Regional anatomy 2 Aim: To gain an overview of the oral cavity structures: Floor of the mouth Palate (hard and soQ) Learning Outcomes: By the end of this lecture you should be able to: 1.Describe the clinical appearance and histopathology of the Door of the mouth and palate 2.Outline the muscles associated with the Door of the mouth including their origin, inser>on and ac>on 3.Iden>fy and outline the key features of the Door of the mouth and palate 4.Name the nerve innerva>on and blood supply to both the Door of the mouth and the palate 3 Grab a mirror and see if you can iden>fy the structures of the Door of the mouth and palate as they are covered in this lecture. Why do you think it’s important to be able to locate these structures and their appearance in health (and disease)? Oral concer screening · 4 Floor of the mouth (FOM) 5  shaped region · Horseshoe tounge under the diaphram the muscular · Above muscle mylohad. produced by · Thin +issue · sensitive to trauma. Clinical Appearance AcEvity: Have a look in the mirror at the Door of your mouth; how would you describe what you see? The FOM is: Reddish-pink in appearance Vascular blue in areas of veins Shiny and moist Compressible soft/bouncy 7  FOM Histology of Thir - Vascular , Loose connective - -glands. tissue & allows tounge. movement compressable Strecky a 8 Muscle Support hyoid bae Attached to The FOM is supported by 3 muscles: Mylohyoid Hyoglossus Geniohyoid 9 Mylohyoid The mylohyoid muscles support the FOM by forming a sling from the mylohyoid line on one side of the medial surface of the mandible, to the same line on the other side. Origin The whole length of the mylohyoid lies on the inner surface of the mandible InserEon The posterior edge is free. The \bres run medially and downwards to insert into the anterior surface of the body of the hyoid bone. 10  my lohyoid muscle. AcEon Forms Door of the oral cavity, elevates the FOM and the hyoid bone. It also assists in depressing the mandible. opening Nerve Supply Trigeminal nerve (mylohyoid branch) Blood Supply Inferior alveolar, sublingual & submental arteries The main structures found in the FOM above the mylohyoid muscle are the: Lingual glossopharyngeal & hyoglossal nerves Sublingual and submandibular salivary glands Lingual artery For more informa>on- Mylohyoid video 11 Hyoglossus muscle (also covered in tongue lecture) Origin A thin, quadrilateral sheet of muscle arising from the superior border of the greater cornu of the hyoid bone. InserEon Fibres pass upwards to be inserted into the lateral borders of the tongue 12  nyoglussus muscle. AcEon Depresses and retracts the tongue, and pulls the lateral edges down onto the FOM Nerve Supply Hyoglossal nerve Blood Supply Lingual Artery 13 Geniohyoid Origin A narrow band of muscle that arises from the inferior genial tubercle (also known as mental spine) on the lingual surface of the mandible at the midline InserEon Runs downwards and backwards inser>ng into the body of the hyoid bone 14  muscle. Genichyoid AcEon Elevates the hyoid bone, shortens the FOM and widens the pharynx Nerve Supply Hypoglassal Nerve Blood Supply Lingual artery (sublingual branch) For more informa>on- Geniohyoid video 15 Features of the FOM  Lingual frenum  Sublingual papillae (and sublingual folds)  Mandibular Tori  [Ventral surface of the tongue]  Whartons duct (submandibular salivary glands)  Bartholins duct and Rivinus ducts (sublingual salivary glands)  Floor of the mouth minor salivary glands 16  sa ne Lingual Frenum (or frenulum) O of o K ↑ Tissue found in the fold of , tounse Extends midline , near base of , to interior surface of Tongue. 17  positioned · centrally 1 submandibula · Sublingual open at Selliva glads Sublingual Papilla Point of this Papiva. Either Side · are Sub- Lingual folds openings of Revenous ducts. O 18  Mandibular Tori (sing. Torus) Lower · Near Bony swellings · Canines · Bilateral Line · Above Myichiod can be seen on - X-rays sometimes19  · covere by thin non Keratnized epithelium Tongue: Ventral surface to [also covered in tongue lecture] Tightly · bound muscles underlying - 20 Changes of the FOM Self-inQicted Natural abnormaliEes · Pircings · two lingual frenums. 21 The Palate 22  from the Separates oral cavity The Palate - Cavity nasal. · Divided into affected Can be two parts. featal Hard Palate during & development * Soft Palate Clef es. Palate. Hard Palate SoR Palate 23  · Aids in feeding and Speach. Hard Palate and of Bones two Palatine process · Formed , Palatine bone. 24 Clinical Appearance AcEvity: Have a look in the mirror at the hard palate; how would you describe what you see? The hard palate is: Pink in appearance Immobile and \rm More cushioned feeling towards the lateral por>ons Firmer feeling towards the medial por>on 25 Histology 26  Midline Anterior S offerorder i Posterior contains Lateral Saliva gland has submucosa of (further from the midline) hard pallet contains adipose tissue Medial No Submucosa (closer to the midline) attached directly to bae 27 Features of the hard palate High vaulted palate High dome can hosts. · shape - rainy in concave where meets soft Pallet. 28  Incisive Papilla · covers nasopalatine nerves as they emerge from incisive forman. PalaEne Rugae · firm Irregular tissue that radiate transversely from incisive papilla. Median PalaEne Raphe · This covers median Palatine suture (the bay fusion of Pallet) 29  Palatal Torus · Bony growth · Singular 30 Changes of the hard palate What changes in appearance may you see in the hard palate? Consider changes in: Colour Texture Impact on func>on The following are examples of changes to the hard palate- these will be explored in more detail in future lectures (e.g. Ecects of smoking, Oral Medicine etc) 31  CleR Palate How does this occur? You may need to refer to lectures on foetal development. foetal development How may this impact on the func>ons of the hard palate? Difficulty eating < speach How may this inDuence your delivery of treatment? Communication. Strong Suction/had scale Do you know what this appliance is called? obturator 32 Smokers Keratosis How would you describe the appearance of the hard palate? What could be the possible cause? Is there cause for concern? Denture StomaEEs How would you describe the appearance of the hard palate? What could be the possible cause? Is there cause for concern? 33 Kaposi Sarcoma How would you describe the appearance of the hard palate? What could be the possible cause? Is there cause for concern? Thermal Trauma How would you describe the appearance of the hard palate? What could be the possible cause? Is there cause for concern? 34  SoR Palate -makes up posterior of thePalate part is a free moveable. · Structure · not connecte to anything · no bary Sicleta. 35 Clinical Appearance AcEvity: Have a look in the mirror at the soQ palate; how would you describe what you see? The soR palate is: Deeper pink in appearance (might also be slightly yellowish) Moist Compressible and elas>c 36  Thin epithelium overlaying Laming propria Histology elastic Layer toreep with movement Spech · · masticatio · Swallowing Contains adipose Tissue 37 Features of the soR palate Uvula · muscular posterior O margu Pillars of the fauces Anterior pillar = palatoglossal arch Posterior pillar = palatopharyngeal arch Bilateral Tonsillar fossa · houses Palatine Hover your mouse over the image tonsil 38  Pterygomandibular fold · Separates cheek from the throate. of hard t · Extends from junction mandible Soft Palett to. For what dental procedure is this feature used as a Hover your mouse over the image for answer landmark? LA 39 In block. Changes of the soR palate What changes in appearance may you see in the soQ palate? Consider changes in: Colour Texture Impact on func>on The following are examples of changes to the soQ palate- these will be explored in more detail in future lectures (e.g. Ecects of smoking, Oral Medicine etc) 40 Candida Albicans - Oral Thrush How would you describe the appearance of the soQ palate? What could be the possible cause? Is there cause for concern? Aphthous Ulcer How would you describe the appearance of the soQ palate? What could be the possible cause? Is there cause for concern? 41  How would you describe the appearance of this lesion?  Can you describe its loca>on?  What do you think the cause may be?  Is there cause for concern? 42  Self-inQicted changes Natural abnormaliEes Oral Pircings Double uvla. 43 Nerve innervaEon and blood supply [of the palate] Nerve innervaEon Sensory innerva>on is supplied by branches of the maxillary nerve (a branch of the trigeminal nerve V): Hard palate is innervated by the greater pala>ne and nasopala>ne nerves SoQ palate is innervated by the lesser pala>ne nerve Blood Supply Hard palate: greater pala>ne artery SoQ palate: lesser pala>ne arteries This will be covered in more detail in regional anatomy 44 Summary Complete the summary table below for the muscles of the FoM Name Origin Insertion Action Nerve Blood Posterior edge Forms floor of Supply Supply Inferior Is free. Inserts Oral cavity. alveolar , Lies on the Into the anterior Elevates FOM and Mylohyoid Trigeminal sublingual , Inner surface Surface of the Hyoid bone. Assists in Nerve Submental Of mandible Hyoid bone Depressing mandible. arteries Thin quadrilateral Depresses and Sheet of muscle. Upwards into Retracts the Hyoglossal nerve Hyoglossus Arising from hyoid The lateral bordersTongue. Pulls edges Lingual artery bone Of the tongue Down onto the fom Narrow band of Runs downwards Elevates the Genihyoid Muscle, from the And into the body Hyoid bone. Hyoglossal nerve Lingual artery Of the hyoid bone Shortens the fom Geinal tubercle And widens the On the lingual surface Pharynx Of the mandible. 45  Complete the summary table below for the clinical appearance and histology of the FoM and hard/soQ palate: Clinical Type of Epithelium Lamina Submucosa Appearance mucosa Propria Reddish, vascular Blue in some areas, Masicatroy Non keratinized Shiny and moist Lining Stratified squamous Yes FOM Specialised Epithelium Yes Compressible Hard Pink , immobile, Keratinzed stratified Firm , cushions lateral Masticatroy Yes Palate Squamous epithelium No Firmer medial Soft Deeper pink Non keratinized Yes Moist Stratified squamous Yes Palate Compressible Epithelium Elastic How does the clinical appearance relate to the histological structure? 46  What anatomical features can you iden>fy in each of these clinical photos: la -vaLossa Incisio -Tonsile i Anterior piller - - posterior Palative mediate & pillar. rugae mundibular tori - lingual & frenum - e ventral - Sublingual of tounse 47 Papillae AddiEonal Resources YouTube Sam Webster- Palate (anatomy of the) hfps://youtu.be/TO97fCz59bo 48 References  Bath-Balogh, M. & Fehrenbach, M.J., 2006. Dental Embryology, Histology, and Anatomy. 2nd ed. Elsevier.  Teachmeanatomy.info. 2020. The Palate - Hard Palate - SoA Palate - Uvula - Teachmeanatomy. [online] Available at: [Accessed 30 November 2020]. 49