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)? 4 Floor of the mouth (FOM) 5  horseshoe shape in oral thinnest cavity Posterior part not to traume movable sensitive Crea of tongue) 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 - thin epithelium Vascular blue in areas of veins - thin layer Shiny and moist - salivary glands moisture - -bouncey Compressible to - attached loosely underlying muscle allowing tongue movement. 7  this epithelium vascular Histology overlaying a lamina propia zp vascenter = pink appearem stretchy compressable 8 Muscle Support The FOM is supported by 3 muscles: Mylohyoid Hyoglossus Geniohyoid 9  muscle Sling shape 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 AcEon Forms Door 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 For more informa>on- Mylohyoid video 11 origin bare : hyoid insertion : tongue # tongue. Hyoglossus depresses (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 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 Protudes tonge the body of the hyoid bone 14 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  foldof Hisarange Lingual Frenum (or frenulum) too close to tip- Gongue tied) 17  circle -glesly Sublingual Papilla were does open sublingual salivary &Sublingual folds & Rivinus docts 18 Mandibular Tori (sing. Torus) Boney swellings-bilateral line canine area , above Mylohyoid can appear rads un radio opaque 19  covered in lining of this non peratinised epithelium Tongue: Ventral surface /interior surface [also covered in tongue lecture] O plicacriata 20 Changes of the FOM Self-inQicted Natural abnormaliEes oral piercing 2 lingual fremums how will eeen the ? (healthy) 21 The Palate 22  Roof of Mouth The Palate separates oraf) nasal cavity 213 Hard Palate - SoR Palate Y3 23  Hard Palate bones a nulate ward I median Palatine Raphe 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 thick - layer 26  Midline waeos Anterior adipose tissue moreened & Posterior - molar region Lateral - salivary gland, (further from the midline) Firmer Medial & submucosa Property underlying bane no to (closer to the midline) 27 lamina  dome shape Features of the hard palate - high - height can vary posterior -narrow palateenee arch High vaulted palate 28  covers naso palative neives as they emerge incisive foramen through Incisive Papilla (do not damage) E PalaEne Rugae tissue p folds , firm irregular Median PalaEne Raphe covers median palatine Suture 29  Tori = plural Boney Growths in palate Palatal Torus Singula 30 Changes of the hard palate What changes in appearance may you see in the hard palate? Consider changes in: blue Colour - Red white grey , , , 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  tissue didn't fuse during CleR Palate development in womb. 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? eating + drinking difficulties cleaning speech , How may this inDuence your  delivery of treatment? -give breaks - avoid water -clear communicating Do you know what this appliance is called? obturator + palate dature) help speech eating. 32  white/Red appearance I thick white Patch Smokers Keratosis How would you describe the appearance of the hard palate? What could be the possible cause? heat from smoking inflames mocoos glands. Is there cause for concern? heals within weeks not smoking Risk of oral canter Denture StomaEEs How would you describe the appearance of the hard palate? What could be the possible cause? not removing dentre Is there cause for concern? Red , inflammed , some 33 can lead to fungal infection.  realbrown patches Kaposi Sarcoma How would you describe the appearance of the hard palate? What could be the possible cause? Is there cause for concern? yes cancer white patch Thermal Trauma reddish boarde How would you describe the appearance of the hard palate? What could be the possible cause? not Is there cause for concern? food/drink bunt math should heal on its own 34  1/3 of palate SoR Palate continuous e hard Palate - Movable -no bong suckton 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) adipose tissue ~ Moist Salivay stands - Compressible and elas>c 36  Histology thin epithelin elastic Hick to layer a living lamina aid propria mobility (Swallowing speech i swallowing FOM as same 37 Features of the soR palate soft palate of margin muscular posterior Uvula prominat folds Pillars of the fauces Bilatral - Anterior pillar = palatoglossal arch Posterior pillar = palatopharyngeal arch Tonsillar fossa Tonsils. Hover your mouse over the image tonsil Palative 38 inferior neve separates cheek + throat dental. block juction or soft palate to Pterygomandibular Posterior toch fold For what dental procedure is this feature used as a Hover your mouse over neive the image for answer landmark? ID block. 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 yellow/ Candida Albicans oral throsh How would you describe the appearance of the soQ palate? What could be the possible cause? Is there cause for concern? Immunosuppressed pts Aphthous Ulcer size shape of it. , How would you describe the appearance of the soQ palate? What could be the possible cause? Is there cause for concern? traume " Yes immune system do , it dosent dear. 41  board White irregular = raised  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? yes referral urgent - all squamous carcinoma. cancer 42 Self-inQicted changes Natural abnormaliEes uvula double 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 posterin edge free floor cual of Trigeminal Nene Inferior aveolar, Mylohyoid of medially down d Cavity Mylohyoid Sublingual Submental + mandible lyoid lyoidthe bare brance elevates For from arteries band o narrow anterior surraces elevates hyadbare Geniohyoid mosches lingual surface madbl of Lyndbars Shorten FOM widen pharynx Hypoglossal neive Lingual subling a branch) thin muscle Depresses + contracts lateral hyoglossal Hyoglossus from hyaid tongue pulls , nerve Lingual bare boards tongue lateral edges du atery 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 Shing moist, blue FOM veins , red/pink living mocosa non keratinized thick Yes , compressible stratified squares Hard Pink, firm immobile masticatory Keratinized thick stratified squares No Palate firm medial softer laterally mucosa moist yellow Soft lining Thick Yes non keratinized elastic stratified Palate Reddish pink mucosa squares How does the clinical appearance relate to the histological structure? 46  What anatomical features can you iden>fy in each of these clinical photos: incisive papilla palatine rugal uvula - S pillars of - tonsillar fossa the faces Anterior + posterior median palative palatophaned Raphe Palatoglossal arch ach ventral Hinge of lingualaen sublingual papilla 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