Floor of the Mouth and Palate GN 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)? 4 Floor of the mouth (FOM) 5  Beneath moveable part of tongue-floor of mouth Above muscular diaphragm produced by myshyoid muscle. l the thinnest in Oral cavity ↳ highly susceptible 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 mucous membrane Compressible - on keratinized stratified squamous. 7  - extremely thin redness lamina Histology overlies very vascular - propria Vascular can be seen through very - this epithelium - attacked rete pegs loosely. to underlying musch is allows for connective some movement in - look tongue during speech. adipe alt mandible , grand -. moisture saliva 8 Muscle Support The FOM is supported by 3 muscles: Mylohyoid Hyoglossus Geniohyoid - MoM. 9  flat, trianguleur supe Mylohyoid Paired muscle - mouth The mylohyoid muscles support the forms floor of 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. Speaking - swallowing dresponsible for positioning of eating 10 hyoid bore  mastication AcEon Accessory muscle of Forms Door of the oral cavity, elevates the FOM and the hyoid bone. It also assists in depressing the mandible. Nerve Supply opening of mandible I Trigeminal nerve (mylohyoid branch) Draws hyoid Blood Supply bone forward + up 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 (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 AcEon Depresses and retracts the tongue, and pulls the lateral edges down onto the FOM Nerve Supply Hyoglossal nerve - Blood Supply Lingual Artery & - 13  accessory muscles MoM. responsible frgoid Geniohyoid of positioning Origin bone - 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 AcEon Elevates the hyoid bone, shortens the FOM and widens the pharynx Swallowing. Nerve Supply us Hypoglassal Nerve - - same as hyogloss but sublingual Blood Supply same as hyoglossus - branch. 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  fold of tissue found in midline near base of tongue inferior surface - of tongue Lingual Frenum (or frenulum) Ankyloglossia-tonguetied limited movement. 17  centrally positioned protrubrence Base of tongue Sublingual Papilla Submandibular + Sublingual Saliva ducts open here. O-sublingual folds ↳ openings af rivinus ducts 18  Bony swellings Sublingual to premolar region - Mandibular Tori (sing. Torus) Usually above myohyloid live Bilateral can appear on radiographs. 19  Inferior covered in thin lining non Karatinized Tongue: Ventral surface - epithelium. [also covered in tongue lecture] - Irregular fringe fold of mucous membrane. Clateral to lingual frenum) 20  /Salivary stones Changes of the FOM - piercings. Self-inQicted Natural abnormaliEes 2 lingual frenums present different healthy just appearance - 21 Still The Palate 22  Separates oral Cavity from nasal cavity The Palate - Anterior Hard Palate SoR Palate - Posterior 23  - Aids in feeding + speech. Hard Palate sord 24 Clinical Appearance AcEvity: Have a look in the mirror at the hard palate; how would you describe what you see? Ortho Keratinized Stratified The hard palate is: squamous. Pink in appearance Immobile and \rm More cushioned feeling towards the lateral por>ons Firmer feeling towards the medial por>on 25 Histology S retepeg) 26  no submucosa attaches lamina propria - Midline submencora to bone- directly I firmer contains Adipose tissue ↑ Anterior L contains minor salivary hard palate. gands submucosa Posterior present N & Lateral (further from the midline) more cushioned Medial (closer to the midline) 27  border posterior is concave where Features of the hard palate it meets soft palate High vaulted palate different vaultedness - Hig n dome Shape in individuals. 28  and in between upper central incisors.. just behind emerged through incisive foramen. # covers nasopulative verves - · Incisive Papilla O PalaEne Rugae - folds · some more pronouned tissue that form irregular ridges of incisive radiates transversally from papilla + anterior part of raphe. Median PalaEne Raphe where bones fise. · covers medium palatine suture - palative ~ 29  Palatal Torus Bony overgrowth ↳ palate or floor of mouth. I mandibular 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. How may this impact on the func>ons of the hard palate? l drinking eating, speech ,. How may this inDuence your barrier. delivery of treatment? cavity adjustments communicationetalinasal - Do you know what this appliance is called? ' Palate obturator 32  White in colour on Anterior 2/5 of hard palate = lacks moisture Smokers Keratosis dry - How would you describe the appearance of the hard palate? What could be the possible cause? + Is there cause for concern? anterior lateral , a regions on - redness /inflammation posterior a palate Denture StomaEEs denture not being How would you describe the removed at appearance of the hard palate? night 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? not Thermal Trauma dinwittin color food are aware off this How would you describe the appearance of the hard palate? What could be the possible cause? Is there cause for concern? 34  /posterior's of palate SoR Palate - continuous anterior border with hard Palate · free posterior barber · movable · no bony Skeleton 35  'all' depress tongue Say to to get a good view of soft palate Clinical Appearance AcEvity: Have a look in the mirror at the soQ palate; how would you describe what you see? non Keratinized stratified squamous The soR palate is: ↳ lining mucosa. Deeper pink in appearance (might also be slightly yellowish) Moist Compressible and elas>c 36  Yellowish appearance > - Adipose tissue contained Elastic Histology minor salivary glands giving it layer to aid moisture e. mobility - Multiple Connective tissue papillar thin very attaches to muscle to aid in - swallowing , speech, mastication 37 Features of the soR palate -muscular posterior margin of soft palate extending Uvula downwards+ backwards. Prominent bulge extending from each side free border of soft palate of Pillars of the fauces Anterior pillar = palatoglossal arch - Posterior pillar = palatopharyngeal - arch Tonsillar fossa houses palatine tonsil Hover your mouse over the image 38  Separates cheek from throat-border extends downto - junction of Mandible hard + soft palate distal surface of last tooth - section of Pterygomandibular most posterior. fold dental nerve block Landmark forinferior For what dental procedure is this feature used as a Hover your mouse over the image for answer landmark? 39 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  white patches on soft palate /fungi Candida Albicans Immunosupped patients -. How would you describe the appearance of the soQ palate? What could be the possible cause? Is there cause for concern? more investigation Size , Shape Aphthous Ulcer does patient know - How would you describe the appearance of the soQ palate? What could be the possible cause? Is there cause for concern? 41  Just below Pterygomandibular fold border on soft palate is irregular whiteish. referral. Squamous 3 cl carcinoma - urgent & (Sx)  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  double uvula # Self-inQicted changes Natural abnormaliEes 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 Supply Supply Inner surface opening of Mylonyoid Inferior alveolar Mylonyoid Body of hyoid mandible branch sublingual+ mental of mandible. bone. arteries. Depressestretracte superior border of Hyoglossus lateral Hyoglossal greater Cornu borders of tongue tongue , pulls down Nerve lingual artery of hyoid bone lateral edges Inferior genial Body of Hyoid elevates hyoid bone Lingual artery Genionyoid tubercle (mental spine) lingual surface bone. widens pharynx Hyoglossal nerve. sublingual branch Shortens floor of of Mandible at. mouth midline. 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 FOM Pink + red nonkeratinzed thin-shows through Vascular Yes · · -Blue of veins stratified Squamous Vascular lamina propria. Hard Pink Keratinized dense · Immobile firm Keratinized to NO Palate · · firmer towards medial stratified Squamous protect from trauma attaches to bone Soft Deeper pink or yellowish nonkeratized thin protective look Yes moist Palate stratified Squamous - Compressible + 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: 47 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