Oral Cavity, Plate, and Pharynx Anatomy (PDF)

Anatomy of the palate Dr. Mohamed Elfiky PROFESSOR OF Anatomy and embryology  ORAL CAVITY The mouth cavity extends from the lips to the oropharyngeal isthmus. It is composed of 2 main parts 1- Vestibule 2- mouth cavity proper....

Anatomy of the palate Dr. Mohamed Elfiky PROFESSOR OF Anatomy and embryology  ORAL CAVITY The mouth cavity extends from the lips to the oropharyngeal isthmus. It is composed of 2 main parts 1- Vestibule 2- mouth cavity proper. Oral Cavity Proper a. ORALVESTIBULE Oral Vestibule 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 Mohamed el fiky  III. FLOOR OF THE MOUTH Sublingual region Shows the following structures: Frenulum of the tongue Sublingual papilla : lies on each side of the frenulum and the submandibular duct opens on it Sublingual fold : produced by the underlying sublingual salivarygland and the ducts of the gland open on its summit. Lingual frenulum (connects the tongue to the floor of the mouth) Sublingual fold (passes lateraly and backwards from the papilla and overlies the sublingual gland) Papillae ( openings of submandibular duct) Mohamed el fiky  Tongue It is composed of a striated muscular mass, covered by mucous membrane. It is anterior 2/3 (oral part) lies in the floor of the mouth It is posterior 1/3 (pharyngeal part) lies in the oropharynx Muscles of the tongue Intrinsic muscles They consist of longitudinal, transverse & vertical fibers. Nerve supply : Hypoglossal nerve. Action: They alter the shape of the tongue. Extrinsic muscles Hyoglossus , genioglossus , styloglossus and palatoglossus. Mohamed el fiky  Tongue Nerve supply of the tongue ROOT Anterior 2/3: Snsory & taste Vagus N. General : lingual nerve branch from mandibular of trigeminal sensation Taste : chorda tympani branch from facial Posterior 1/3 : general and taste from glossopharyngeal Root of tongue : general and taste from vagus Blood supply of the tongue: Lingual artery Tonsillar branch of facial artery Ascending pharyngeal artery Mohamed el fiky  Palate Introduction ▪ Palate is the roof of the mouth. It separates the oral cavity from the nasal cavity ❑ Lies in the roof of the oral cavity ❑ Has two parts: Hard (bony) palate anteriorly Soft (muscular) palate posteriorly Mohamed el fiky  Hard Palate ❑ The hard palate separates the oral cavity from the nasal cavities. It consists of a bony plate covered above and below by mucosa: ❑ Above, it is covered by respiratory mucosa and forms the floor of the nasal cavities (superior surface) ❑ Below , it is covered by a tightly bound layer of oral mucosa and forms much of the roof of the oral cavity (inferior surface) ❑ The posterior margins gives attachment to soft palate. ❑ The anterolateral margins are continuous with alveolar arches and gums. ❑ The palatine processes of the maxillae form the anterior three-quarters of the hard palate. ❑ The horizontal plates of the palatine bones form the posterior one-quarter. In the oral cavity, the upper alveolar arch borders the hard palate anteriorly and laterally. Posteriorly, the hard palate is continuous with the soft palate. Mohamed el fiky  Hard Palate 1.Incisive papilla: ends anteriorlyi n a small oval elevation over incisive fossa 2.Palatine Rugae: The mucosa of the hard palate possesses numerous transverse palatine folds. 3.Mid-Palatine raphe: a median longitudinal ridge Mohamed el fiky  Soft Palate Muscles of Soft Palate ❑It helps close off the nasopharynx during deglutition. ❑The soft palate is composed of 5 muscles: ▪ Musculus uvulae ▪ Tensor velipalatini ▪ Levator velipalatini ▪ Palatopharyngeus ▪ Palatoglossus Mohamed el fiky  Soft Palate Muscles of Soft Palate Mohamed el fiky  Tensor velipalatini Origin ▪ Sphenoid bone (scaphoid fossa of pterygoid process and medial aspect of the spine);. It is also connected cartilaginous part of pharyngo- tympanic(auditory) tube Insertion ▪ Palatine aponeurosis and palatine bone (horizontal plate) via a tendon Levator veli palatini that is redirected medially by the pterygoid hamulus Nerve Supply : N. to medial pterygoid (CN V3) Lateral lamina of cartilagenous Action part of pharyngotympanic tube ▪ Bilaterally: Tensesanterior portion of the soft palate and flattens its arch, separating the nasopharynxfrom the oropharynx. ▪ Opens pharyngotympanic(auditory) tube. ▪ Unilaterally: Deviates soft palate laterally Medial lamina of cartilagenous part of pharyngotympanic tube Cartilagenous part of Tensor veli palatini pharyngotympanic tube  Levator velipalatini Origin ▪ Vaginal process and petrous partof temporal bone (via a tendon, anterior to the carotid canal); ▪ it is also connected to the inferior portion of the cartilaginous pharyngo- tympanic tube Insertion : Palatine aponeurosis(the two levatorscombine to form a muscular sling) Nerve Supply : Vagus n. (CN X) via pharyngeal plexus Action ▪ Bilaterally: Pulls the posterior portion of the soft palate superoposteriorly, separating the nasopharynxfrom the oropharynx. Mohamed el fiky  Musculus uvulae Origin ▪ Palatine bone (posterior nasal spine) and palatine aponeurosis (superior surface) Insertion: Mucosa of the uvula Nerve Supply: Vagus n. (CN X) via pharyngeal plexus Action ▪ Pulls the uvula posterosuperiorly, separating the nasopharynx from the oropharynx. Mohamed el fiky  Palatoglossus Forms palatoglossal arch Origin: Palatine aponeurosis (oral surface) Insertion: Lateral tongue to dorsum or intrinsic transverse muscle Nerve Supply: Vagus n. (CN X) via pharyngeal plexus Action: Pulls the root of the tongue superiorly and approximates the palatoglossal arch, separating the oral cavity from the oropharynx. Mohamed el fiky  Palatopharyngeus Forms palatopharyngeal arch Origin: Palatine aponeurosis (superior surface) and posterior border of palatine bone Insertion: Thyroid cartilage (posterior border) or lateral pharynx Nerve Supply: Vagus n. (CN X) via pharyngeal plexus Action : Elevates the pharynx anteromedially bilaterally Mohamed el fiky  Vessels of Palate Arteries ▪ greater palatine branch of the maxillary artery ▪ the ascending palatine branch of the facial artery ▪ the palatine branch of the ascending pharyngeal artery Veins ▪ generally follow the arteries ▪ Ultimately drain into the pterygoidplexus of veins in the infratemporal fossa ▪ Or a network of veins associated with the palatine tonsil -drain into the pharyngeal plexus of veins or directly into the facial vein ▪ pterygoidplexus of veins pharyngeal plexus of veins facial vein Lymphatic: drain into deep cervical nodes Mohamed el fiky Vessels of Palate Mohamed el fiky  Nerve Supply of the palate ▪ Sensory: Supplied by the greater and lesser palatine nerves and the nasopalatine nerve which are branches from pterygoplatine ganglion. ▪ Motor : All muscles of the palate takes nerve supply from cranial accessory via pharyngeal plexus (vago-accesory complex) except tensor palati from mandibular nerve (branch from trigeminal nerve ). Mohamed el fiky  ANATOMY OF PHARYNX ▪ Pharynx is a conical fibromuscular tube forming the upper part of air and food passages ▪ 12-14cm long. Width :3.5cm at base; 1.5cm at pharyngo-oesophageal junction STRUCTURE OF PHARYNGEAL WALL From outwards: Mucus membrane: Pseudostratified ciliated columnar(in the nasopharynx) Stratified squamous epithelium Pharyngeal aponeurosis: Pharyngobasilar fascia, Fibrous layer lining muscular coat Muscular coat: Longitudinal muscles(internal layer) and Constrictors Buccopharyngeal fascia: Covers pharynx externally Pharyngeal plexus of nerves Mohamed el fiky  Pharyngeal Muscles LONGITUDINAL MUSCLES Stylopharyngeus Palatopharyngeus Salpingopharyngeus Origin :medial aspect Origin: upper Origin : cartilage of styloid process surface of of the auditory Nerve supply: palatine tube near the glossopharyngeal aponeurosis pharyngeal Nerve supply: opening of it. pharyngael plexus Nerve supply : pharyngael plexus All the 3 are inserted as a conjoint sheet at the post border of the thyroid cartilage and lat. aspect of epiglottis Mohamed el fiky  Pharyngotympanic tube Tensor veli palatini Mandibular nerve Levator veli palatini Buccinator Middle meningeal artery Digastric (posterior belly) cut Pterygomandibular Superior constrictor raphe Glossopharyngeal nerve Stylopharyngeus Stylohyoid ligament Stylohyoid Middle constrictor Thyropharyngeu sCricopharyngeus Recurrent laryngeal nerve Trachea Oesophagus Mohamed el fiky  CONSTRICTOR MUSCLES Attachment of pharyngeal raphe to pharyngeal tubercle (occipital bone ) Pharyngobasilar fascia Levator veli palatini Tensor veli palatini Styloid process Fibres of middle Stylohyoid (cut) constrictor from stylohyoid ligament Stylopharyngeus Styloglossus Superior Stylohyoid (cut) constrictor Greater cornu Middle of hyoid bone constrictor Pharyngeal raphe Inferior constrictor (thyropharyngeus) Inferior constrictor (cricopharyngeus) MOHAMED EL FIKY Mohamed el fiky  CONSTRICTOR MUSCLES Relations :  Medial surface Covered lateral surface  Capsule : the mucous membrane Mohamed el fiky November 12, 2023  Superior Constrictor Superior Constrictor Lies in the wall of the nasopharynx and oropharynx Wide origin ▪ Post border of med pterygoid plate &pterygoid hamulus ▪ Pterygomandibular raphae ▪ Post end of the mylohyoid line ▪ Mucus membrane on the side of the tongue ▪ Lower part covered by middle constrictor. Mohamed el fiky  Middle Constrictor Middle Constrictor ▪ Origin : 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 musles it is formed of 2 parts: 1- Thyropharyngeus : origin : oblique line of thyroid cartilage Relations : inferior cornu of thyroid 2- Cricopharyngeus:  Medial surface origin : ant part of cricoid cartilage Covered lateral surface Thyropharyngeus ❑Insertion :All of the fibres get  Capsule : inserted into the median fibrous raphae Cricopharyngeus: Inferior Constrictor the mucous membrane Extending from Pharyngeal tubercle up to the oesophagus ❑Actions 0f the constrictor muscles : Muscles of 2 sides act as a sphincter function to prevent the entry of air in to the esophagus in the interval between swallowing So, the sphincter relaxes during swallowing Contracts between the acts of swallowing. Mohamed el fiky  Killian’s Triangle ▪ Potential gap weak area of pharyngeal wall ▪ Gateway of Tear → perforation can occur at this site during oesophagostomy. Inferior constrictor (thyropharyngeal part) Killian’s triangle Inferior constrictor (cricopharyngeal part) Laimer’s triangle Fundiform part (cricopharyngeal sphincter, Killian’s sling) Mohamed el fiky Division of Pharynx Nasopharynx The nasopharynx is behind the posterior apertures (choanae) of the nasal cavities and above the level of the soft palate Oropharynx The oropharynx is posterior to the oral cavity, inferior to the level of the soft palate, and superior to the upper margin of the epiglottis Laryngopharynx The laryngopharynx extends from the superior margin of the epiglottis to the top of the esophagus at the level of vertebra CVI 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 the stylopharyngeus, which is supplied by the glossopharyngeal nerve Mohamed el fiky  Gaps in the pharyngeal wall ▪ Gaps between muscles of the pharyngeal wall provide important routes for muscles and neurovascular tissues. ▪ First gape ( Sinus of Morgagni ) : Above the margin of superior constrictor, the pharyngeal wall is deficient in muscle and completed by pharyngeal fascia. Pierced by: ▪ Eustachian tube ▪ Levator veli palatini ▪ Tensor veli palatini ▪ Ascending palatine artery Mohamed el fiky  Gaps in the pharyngeal wall 2nd gape : One of the largest and most important apertures in the pharyngeal wall is between the superior and middle constrictor muscles of the pharynx and the posterior border of the mylohyoid muscle, which forms the floor of the mouth. It contain the follwing structures : 1- stylopharyngeal muscle. 2- glossopharyngeal nerve. 3rd gape : between the lower border of the middle constrictor and and upper border of the inferior constrictor. it contain the following structures : 1- internal laryngeal nerve 2- superior laryngeal artery 4th gape : below the lower border of inferior constrictor. It contain the following structures : 1- recurrent laryngeal nerve 2- inferior laryngeal artery. Mohamed el fiky  Blood supply of Pharynx ▪ Arterial supply : From external carotid artery: ❖ Ascending pharyngeal artery - Tonsillar branch of facial artery. From maxillary artery ❖ Greater palatine artery ❖ Artery of the pterygoid canal From lingual artery: Dorsal lingual branch. ▪ Venous drainage: Pharyngeal plexus which drains into the internal jugular vein. ▪ Lymphatic drainage of pharynx The lymphatic vessels of the pharynx drain into : Deep cervical lymph nodes. Rtropharyngeal lymph nodes. Mohamed el fiky Nerve supply of pharynx  Motor All the muscles of the pharynx are supplied by cranial part of the accessory nerve through the pharyngeal plexus EXCEPT the stylopharyngeus which is supplied by the glossopharyngeal nerve ▪ Sensory : Nasopharynx: by the maxillary nerve through the pharyngeal branch of sphenopalatine ganglion Oropharynx: by the glossopharyngeal nerve Laryngopharynx: by the vagus nerve through the recurrent and internal laryngeal nerves. Mohamed el fiky  Palatine tonsil Shape : ▪ A large ovoid mass of lymphoid tissue ▪ It looks like a large almond. ▪ It has : o 2 poles: upper & lower o 2 borders : anterior & posterior o 2 surfaces: medial & lateral ▪ It has 12-15 tonsillar crypts which open on its medial surface Position : Located in the tonsillar fossa on the lateral wall of the oropharynx The tonsillar fossa is bounded by : o Anteriorly: the palatoglossal arch o Posteriorly: the palatopharyngeal arch Mohamed el fiky Capsule : ▪ It covers its lateral surface. A number of septa extend from the capsule into the tonsil and serve to conduct blood vessels and nerves into it. Relations :  Medial surface : Covered by the mucous membrane ▪ Tonsillar pits are small orifices on the medial surface that lead into the Relations : tonsillar crypts.  surface Lateral Medial surface  Capsule: lateral surface CoveredSeparates the tonsil from the superior constrictor of the pharynx. The Superior constrictor: Separates the tonsil from  Capsule the following structures: : The facial artery and its branches: the mucous membrane Para-tonsillar vein: Lie between the tonsil and superior constrictor. Glossopharyngeal nerve: Lies lateral to the superior constrictor muscle. ▪ More laterally & and postero-laterally lie the following: Styloid process if it is long, Stylopharyngeus muscle, Styloglossus muscle Stylohyoid ligament, and Ascending pharyngeal artery.  Upper pole: Soft palate. Mohamed November 12, 2023 el fiky  Lower pole: Dorsum of the posterior 1/3 of the tongue Blood supply of the tonsil:  To the upper pole : Tonsillar branches of descending palatine artery.  To the lower pole Tonsillar:branch of the facial artery. Relations Tonsillar branches of ascending palatine artery.  Medial surface Tonsillar branches of the dorsal lingual artery. Covered lateral surface  Venous drainage :  Capsule : Pharyngeal plexus of veins receives most of the veins. the mucous Some membrane veins drain into the lingual vein Sensory nerve supply: lesser palatine (maxillary) and glossopharyngeal nerve. Lymphatic drainage of the tonsil: The deep cervical lymph nodes. Submandibular lymph nodes. Mohamed November 12, 2023 el fiky  The pharyngeal tonsil (termed “adenoid”) It is an aggregate of lymphoid tissue lying in the midline along the roof and posterior wall of the nasopharynx, at the level of the sphenoid and occipital bones. Blood supply Relations : of adenoid : Ascending  Medial pharyngeal surface artery, along with contributions from a branch of the ascending palatine artery, Covered lateral surface Tonsillar branch of the facial artery, the pharyngeal branch of the internal  Capsule : maxillary artery, the mucous Artery of themembrane pterygoid canal (a branch of the maxillary artery or in some cases the internal carotid artery). Venous drainage: passes from the external pharyngeal venous plexuses to the paratonsillar veins, and eventually to the facial or internal jugular veins. Lymphatic drainage is to the retropharyngeal and pharyngomaxillary lymph nodes Mohamed November 12, 2023 el fiky  Enlarged adenoids Enlarged adenoids are adenoids that are swollen. It is a common problem in children. Enlarged adenoids can make it hard to breathe through the nose. Your child might end up breathing only through the mouth. This may cause: A dry mouth, which can also lead to bad breath Cracked lips A runny nose Loud breathing Snoring Restless sleep Sleep apnea, a disorder that causes you to repeatedly stop breathing during sleep Ear infections Mohamed el fiky Waldeyer’s ring : Mohamed November 12, 2023 el fiky References 1- Gray's anatomy for students, 3rd edition. ISBN: 978-0-7020-5131-9 Copyright© 2015, 2010, 2005 by Churchill Livingstone, an imprint of Elsevier Inc. 2- Gray’s Anatomy 40th edition. ISBN: 978-0-443-06684-9 International Edition ISBN: 978-0-8089-2371-8 3. CLINICAL ANATOMY BY REGIONS Richard ร. Snell. ISBN 978-1-60913-446-4 Muscles of Shoulder By Dr. Hassan Rezk November 12, 2023 41