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 application to patient management  1.1.6 Describe relevant and appropriate physiology...

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 application to patient management  1.1.6 Describe relevant and appropriate physiology and explain its application to patient management Related topics:  Epithelium  Muscles  Regional anatomy 2 1 Aim: To gain an overview of the oral cavity structures:  Floor of the mouth  Palate (hard and soft) Learning Outcomes: By the end of this lecture you should be able to: 1. Describe the clinical appearance and histopathology of the floor of the mouth and palate 2. Outline the muscles associated with the floor of the mouth including their origin, insertion and action 3. Identify and outline the key features of the floor of the mouth and palate 4. Name the nerve innervation and blood supply to both the floor of the mouth and the palate 3 Grab a mirror and see if you can identify the structures of the floor 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)? 4 2 Floor of the mouth (FOM) 5 3  Clinical Appearance Activity: Have a look in the mirror at the floor 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 7 Histology 8 4  Muscle Support 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 Insertion The posterior edge is free. The fibres run medially and downwards to insert into the anterior surface of the body of the hyoid bone. 10 5  Action Forms floor of the oral cavity, elevates the FOM and the hyoid bone. It also assists in depressing the mandible. 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 11 For more information- Mylohyoid video Hyoglossus (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. Insertion Fibres pass upwards to be inserted into the lateral borders of the tongue 12 6  Action 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 Insertion Runs downwards and backwards inserting into the anterior surface of the body of the hyoid bone 14 7 Action Elevates the hyoid bone, shortens the FOM and widens the pharynx Nerve Supply Hypoglassal Nerve Blood Supply Lingual artery (sublingual branch) For more information- 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 8  Lingual Frenum (or frenulum) 17 Sublingual Papilla 18 9  Mandibular Tori (sing. Torus) 19 Tongue: Ventral surface [also covered in tongue lecture] 20 10 Changes of the FOM Self-inflicted Natural abnormalities 21 The Palate 22 11 The Palate Hard Palate Soft Palate 23 Hard Palate 24 12  Clinical Appearance Activity: 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 firm  More cushioned feeling towards the lateral portions  Firmer feeling towards the medial portion 25 Histology 26 13  Midline Anterior Posterior Lateral (further from the midline) Medial 27 (closer to the midline) Features of the hard palate High vaulted palate 28 14 Incisive Papilla Palatine Rugae Median Palatine Raphe 29 Palatal Torus 30 15  Changes of the hard palate What changes in appearance may you see in the hard palate? Consider changes in:  Colour  Texture  Impact on function The following are examples of changes to the hard palate- these will be explored in more detail in future lectures (e.g. Effects of smoking, Oral Medicine etc) 31 Cleft Palate  How does this occur? You may need to refer to lectures on foetal development.  How may this impact on the functions of the hard palate?  How may this influence your delivery of treatment?  Do you know what this appliance is called? 32 16  Smokers Keratosis  How would you describe the appearance of the hard palate?  What could be the possible cause?  Is there cause for concern? Denture Stomatitis  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 17 Soft Palate 35 Clinical Appearance Activity: Have a look in the mirror at the soft palate; how would you describe what you see? The soft palate is:  Deeper pink in appearance (might also be slightly yellowish)  Moist  Compressible and elastic 36 18  Histology 37 Features of the soft palate Uvula Pillars of the fauces Anterior pillar = palatoglossal arch Posterior pillar = palatopharyngeal arch Tonsillar fossa Hover your mouse over the image 38 19 Pterygomandibular fold For what dental procedure is this Hover your mouse feature used as a over the image for answer landmark? 39 Changes of the soft palate What changes in appearance may you see in the soft palate? Consider changes in:  Colour  Texture  Impact on function The following are examples of changes to the soft palate- these will be explored in more detail in future lectures (e.g. Effects of smoking, Oral Medicine etc) 40 20 Candida Albicans  How would you describe the appearance of the soft palate?  What could be the possible cause?  Is there cause for concern? Aphthous Ulcer  How would you describe the appearance of the soft 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 location?  What do you think the cause may be?  Is there cause for concern? 42 21  Self-inflicted changes Natural abnormalities 43 Nerve innervation and blood supply [of the palate] Nerve innervation Sensory innervation is supplied by branches of the maxillary nerve (a branch of the trigeminal nerve V):  Hard palate is innervated by the greater palatine and nasopalatine nerves  Soft palate is innervated by the lesser palatine nerve Blood Supply  Hard palate: greater palatine artery  Soft palate: lesser palatine arteries This will be covered in more detail in regional anatomy 44 22  Summary Complete the summary table below for the muscles of the FoM Name Origin Insertion Action Nerve Blood Supply Supply 45 Complete the summary table below for the clinical appearance and histology of the FoM and hard/soft palate: Clinical Type of Epithelium Lamina Submucosa Appearance mucosa Propria FOM Hard Palate Soft Palate How does the clinical appearance relate to the histological structure? 46 23 What anatomical features can you identify in each of these clinical photos: 47 Additional Resources YouTube  Sam Webster- Palate (anatomy of the) https://youtu.be/TO97fCz59bo 48 24 References  Bath-Balogh, M. & Fehrenbach, M.J., 2006. Dental Embryology, Histology, and Anatomy. 2nd ed. Elsevier.  Teachmeanatomy.info. 2020. The Palate - Hard Palate - Soft Palate - Uvula - Teachmeanatomy. [online] Available at: [Accessed 30 November 2020]. 49 25