Week 14 Oral Cavity, Pharynx and Oesophagus Gross Anatomy.pdf

CAM202 online module Gross anatomy: Oral cavity, pharynx, and oesophagus Derek Choi-Lundberg • Learning objectives: • Describe the gross anatomy of the oral cavity, salivary glands, tongue, pharynx, and oesophagus, including their muscles and innervation as relevant. Suggested readings • Revise...

CAM202 online module Gross anatomy: Oral cavity, pharynx, and oesophagus Derek Choi-Lundberg • Learning objectives: • Describe the gross anatomy of the oral cavity, salivary glands, tongue, pharynx, and oesophagus, including their muscles and innervation as relevant. Suggested readings • Revise CAM101 lecture on digestive system • Marieb & Hoehn: sections on mouth and associated structures, pharynx, oesophagus • Drake or Moore anatomy textbook – various pages in head & neck, thorax, abdomen chapters (use index) • Smith & Morton. The Digestive System: Basic Science and Clinical Conditions (Systems of the Body Series), relevant sections (use table of contents or index) • Note: white background slides: labels/images may have moved. Refer to blue background slides CAM202 online module Gross anatomy: Oral cavity, pharynx, and oesophagus Derek Choi-Lundberg • Part 1: Oral cavity and teeth • Learning objective: Describe the gross anatomy of the oral cavity and teeth, including the sensory innervation of the teeth. and • Ingestion Bringbolusoffood liquid • Taste (taste buds) ontongue • Mixing of food and saliva smashing • Digestion initiated – mechanical (teeth, tongue, hard pressfood against palate) & chemical ciguallipase hardpalate Salivaryamylase • First steps of swallowing • Immune protection (lingual tonsils) component in saliva • Involved in speech, non-verbal communication, breathing, etc. • Secretions from oral cavity and salivary glands (mucus, water, ions, small molecules, enzymes, etc.) contribute to many of above functions Mariana Ruiz Villarreal (LadyofHats). Public Domain. Image cropped by DCL Oral cavity (mouth) - functions Oral cavity (mouth) Demarcation Border • Continues into oropharynx posteriorly at palatoglossal arch • Palate (hard and soft) separates oral cavity from nasal cavity iegThegoa cheeks ny.ME atPalatoglossal Hard palat e Lining arch separate Palatopharyngeal arch Posterior6 pelotoglosselarch Inoropharynx MADARA-2016. CC-BY-SA-4.0 intl Tongue largelyfills oralcarry proper oralcavity 6teeth Deep Bruce Blaus. Blausen.com staff (2014). CC-BY-3.0 oralcavity fromneses Canty Soft palat e Teeth – permanent • For tearing and grinding food • Permanent dentition: 4 quadrants (R/L 32 maxilla/mandible) x 8 teeth/quadrant total • 2 incisors • 1 canine/cuspid • 2 premolars/bicuspids Plate 40 • 3 molars Plate 100 Plate 331 Sobotta's Atlas and Text-book of Human Anatomy. 1909. Public domain. Teeth - primary • Primary (deciduous): winfaraway 20 • 4 quadrants x 5 teeth/quadrant total • 2 incisors • 1 canine • 2 molars Plate 40 Walker J. 1900. Anatomy, Physiology and Hygiene. Teeth – joints Superior alveolar processof • Fibrous gomphosis joints maxilla • Maxillary teeth articulate with superior alveolar process of maxilla • Mandibular teeth articulate with inferior alveolar process of mandible c Maxillary teeth mandibular teeth Interioralveolar mandible processof Plate 40 Sobotta's Atlas and Text-book of Human Anatomy. 1909. Public domain. Innervation of teeth Living structure rd • Pulp cavity and root canal with nerves and bloodyears vessels • Maxillary teeth – superior alveolar nn (branches of division maxillary division of trigeminal n, CN V2) 2nd • Mandibular teeth – inferior alveolar n (branches of mandibular division of trigeminal n, CN V3) Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". CC-BY-3.0 Gray 779 amenities Henry Gray (1918) Anatomy of the Human Body 20th edn Illustrator: Henry Vandyke Carter (1831-1897). Public Domain Gray 779 CAM202 online module Gross anatomy: Oral cavity, pharynx, and oesophagus Derek Choi-Lundberg • Part 2: Muscles of mouth, mastication and tongue & TMJ • Learning objectives: • Identify the muscles around the mouth, the muscles of mastication, and muscles of the tongue and describe their actions and innervation • Demonstrate and describe the movements at the temporomandibular joint (TMJ) and of the tongue Muscles around mouth openup Elevators Pressors ipg orbit circle oris • Sphincter of lips: orbicularis Don'texpect knowall thenames • Numerous dilators of lips (levators/depressors of upper/lower lip and angle of mouth) – you do not need to learn their names • Buccinator • Assists in positioning bolus of food between molar teeth The Fitathisestion Aamuscies • Also involved in facial expression, a w speech • Innervated by CN VII – facial n By Patrick J. Lynch, medical illustrator - CC BY 2.5 between Articulation boneandmandiblecondylar Temporomandibular joint (TMJ) temporal process • Movement of mandible (including mandibular teeth) relative to rest mandibular teethto of skull (including maxillary teeth) occurs at the TMJ More maxillaryteeth Allowchewing • Modified synovial hinge joint: hinge and gliding movements moneforword Morebackward Elevate Depression • Elevation/depression (close/open jaw), protrusion/retraction, ab/adduction of mandible (side to side grinding) temporary bone Condylar Condylar Sobotta 191 Sobotta's Atlas and Text-book of Human Anatomy. 1909. Public domain. process Gray 188 Henry Gray (1918) Anatomy of the Human Body 20th edn Illustrator: Henry Vandyke Carter (1831-1897). Public Domain Muscles of mastication (chewing) • Temporalis cetera tohead Temporalis Temporalis 6 Superficial of • Masseter Action chewing ramusofmandible Attachment 6bony process ofsphenoidboneofskull • Lateral pterygoid • Medial pterygoid Heda.tw Farfa mFEE.name • Act across temporomandibular joint (TMJ) • Innervated by CN V3 (mandibular division of trigeminal) Henry Gray (1918) Anatomy of the Human Body 20th edn Gray 382 Illustrator: Henry Vandyke Carter (1831-1897). Public Domain Gray 383 Lateral Lateral pterygoid pterygoid D Immiscible by Tdvorak, CC-BY-SA-3.0 Medial media pterygoid pterygoid Mrs Masseter Masseter Berichard. CC-BY-SA-3.0 Muscles of mastication: Actions at TMJ • Analyse force vectors Determinebylookingat the musclefibredirections • Elevation / depression. Ab / adduction. Protrusion / retraction. • Temporalis: Elevate and retract • Masseter: Elevate and protrude 0 Plate 264. Sobotta's Atlas and Text-book of Human Anatomy. 1909. Public domain. Plate 262. Muscles of mastication: Actions at TMJ • Analyse force vectors • Elevation / depression. Ab / adduction. Protrusion / retraction. • Lateral pterygoid: Protrude and abduct to opposite side ofelevation Little and protrude • Medial pterygoid: Elevate, protrude and abduct to opposite side right es Lettpterygoid moreto Rightpterygoidmoveto left Gray 383 Abductingto oppositeside Bock CE. 1841. Handbuch der Anatomie des Menschen. Public domain T Henry Gray (1918) Anatomy of the Human Body 20th edn Illustrator: Henry Vandyke Carter (1831-1897). Public Domain Tongue muscles • Intrinsic – within tongue: longitudinal, transverse, vertical (change shape of tongue)qunffaction • Extrinsic – bone to tongue. Actions (analyse force vectors): chinattached6Engine • Genioglossus: protrude, depress Hyoid1tongue : depress, retract • Hyoglossus Fd : retract, elevate • Styloglossus the'EmPpFeT Digital Slidebox. UTAS collection. Slide 17 uterebitabore PT m palatoglossus palateetongue • soft Palatoglossus : elevate, retract T I I Henry Gray (1918) Anatomy of the Human Body 20th edn Illustrator: Henry Vandyke Carter (1831-1897). Public Domain Gray 1019 Motor innervation of tongue Enterstonguebelow • Motor: CN XII (hypoglossal n) • Except palatoglossus by CN X (vagus n) OpenStax Anatomy and Physiology CC-BY-4.0 Sensory innervation of tongue • Taste (gustatory) sensation • Anterior 2/3 of tongue: CN VII (facial n) • Posterior 1/3 of tongue: CN IX (glossopharyngeal n) • General sensation (pain, temperature, touch) • Anterior 2/3 of tongue: CN V3 (mandibular division of trigeminal n) • Posterior 1/3 of tongue: CN IX (glossopharyngeal n) Ant 2/3 Post 1/3 Ant 2/3 OpenStax Anatomy and Physiology. CC-BY-4.0 CAM202 online module Gross anatomy: Oral cavity, pharynx, and oesophagus Derek Choi-Lundberg • Part 3: Salivary glands • Learning objective: Identify the salivary glands and describe their parasympathetic innervation Salivary glands Adjacent to ears undermandibles Undertongue • Parotid, submandibular, sublingual, and many small intrinsic withinoralcountylinings salivary glands oral mucosae • Produce saliva (1-1.5 litres/day) – see other lectures for composition and functions Gray 1024 Sublingual Submandibular Parotid Toldt, Carl; Dalla Rosa, Alois. 1903. An atlas of human anatomy for students and physicians. No known copyright restrictions. Henry Gray (1918) Anatomy of the Human Body, 20th ed Illustrator: Henry Vandyke Carter. Public domain. • Thought, sight, smell of food, and food in mouth, stimulates parasympathetic nervous system (craniosacral division of autonomic nervous system) to stimulate saliva production and secretion • Gland Preganglionic nucleus CN ganglion toofar • Parotid in medulla IX otic Not fromear • Submandibular 1under • and sublingualin pons VII submandibular Deep mandible • Note: nucleus = a collection of neuron cell bodies in the central nervous system • Ganglion = a collection of neuron cell bodies outside the CNS Gray 843 Gray 842 Henry Gray (1918) Anatomy of the Human Body, 20th ed Illustrator: Henry Vandyke Carter. Public domain. Stimulation of salivary gland secretions CAM202 online module Gross anatomy: Oral cavity, pharynx, and oesophagus Derek Choi-Lundberg • Part 4: Soft palate, pharynx and oesophagus • Learning objectives: • Identify the muscles of the soft palate and pharynx and describe their actions and innervation Palate, pharynx and oesophagus – functions Hard • Palate – separate nasal andpalate oral cavities, ofpalate lead soft palate separate oral cavity from oropharynx, separate nasopharynx from oropharynx • Pharynx and oesophagus: swallowing: propulsion of food / liquid to stomach • Pharynx – also a part of upper respiratory tract for breathing • Secretions (mucus) protect mucosa • Upper and lower oesophageal sphincters – limit air entering oesophagus and reflux of stomach contents, respectively Mariana Ruiz Villarreal (LadyofHats). Public Domain. Image cropped by DCL TensorVeli palatini Levator elipaletiri Soft palate – muscles ElevatorofSottpelatelthEFal M ne Tensorsofsotepakeelmediel • Levator veli palatini (LVP), tensor veli palatini (TVP) – elevate and tense soft palate during swallowing to prevent food moving into nasopharynx to softpalace pharynx wallof • Palatoglossus (PG), palatopharyngeus (PP) – depress palate and narrow opening to oropharynx – chew & breathe at same time • All muscles by vagus n (CN X), except tensor veli palatini by CN V3 Posterior views, with posterior pharyngeal wall opened opening to nasal cavity Softpalate opening6 ordcarty PP 9 palatal pharyngeal arch PG c Paletin tonsil A arch Palatine tonsils opening to larynx Cunningham DJ. 1914. Cunningham’s Text-book Toldt C, Dalla Rosa A. 1903. An Atlas of Human Anatomy for Students and Remove membrane of Anatomy. No known copyright restrictions. mucous Physicians. No known copyright restrictions. Gray 994 Pharynx • 3 parts of the pharynx: • Nasopharynx Posterior6 • Oropharynx posterior6 nasopharynx oropharynx 6 • Laryngopharynx posterior larynx • Base of skull to C6/C7 vertebra level • Sensory innervation mostly by CN IX (glossopharyngeal n), I and CN X (vagus n) • Part of nasopharynx by CN V2 Henry Gray (1918) Anatomy of the Human Body, 20th ed Illustrator: Henry Vandyke Carter. Public domain. Narrow pharynx • Superior pharyngeal Ake.chto constrictor parygomandibular Muscles of pharynx raphaelligament IEnompterygotomandible Gray 1030 • Middle pharyngeal constrictor Attachhyoidbone • Inferior pharyngeal thyroid constrictor Attach andcrycoid cartilages Arranged like stacking oneach other • includes Cricopharyngeuss (upper oesophageal sphincter, UOS or UES) lowestpartofinteriorconstrictor cricoid 6 pharynx From • Constrictors innervated by CN X (vagus n) • Stylopharyngeus – innervated by CN IX (glossopharyngeal n) Posterior view Toldt C, Dalla Rosa A. 1903. An Atlas of Human Anatomy for Students and Physicians. No known copyright restrictions. lateral view Henry Gray (1918) Anatomy of the Human Body, 20th ed. Illustrator: Henry Vandyke Carter. Public domain. Oesophagus (esophagus) • Innervated by CN X (vagus n) Mixof Skeeter smooth and muscles Gray 1032 • Constrictions of oesophagus at origin (UOS), arch of tower aorta, diaphragm, LOS – oesophageal pathology more likely at sphincter these areas • UOS, UES / LOS, LES – upper/lower oesophageal sphincters Someticinnerrations superiorly Parasympathetic innervation linteriorly Henry Gray (1918) Anatomy of the Human Body, 20th ed. Illustrator: Henry Vandyke Carter. Public domain. Posterior view Anatomical relationships of oesophagus • Posterior to trachea LA • Posterior to heart (which chamber?) • Anterior to…?vertebral Descending Azygos aorta neens bodies A Descending aorta Azygos vein Image courtesy of Dr J Beadle Nevit Dilmen. CC-BY-SA-3.0 Image courtesy of Dr J Beadle Anatomical relationships of oesophagus • Application: transoesophageal echocardiography valves Seemovementof heartwalls contractionof measurespeedofbloodflow Doppler's swallowing Goesdown probe tooesophagus posterior6heart LA National Heart Lung and Blood Institute (NIH). Public domain. Image courtesy of Dr J Beadle • • Gross anatomical structure of • Oral cavity, tongue, muscles of mastication, salivary glands • Pharynx, soft palate, oesophagus More details in CAM304 (head & neck anatomy, blood supply & lymphatic drainage) Mariana Ruiz Villarreal (LadyofHats). Public Domain. Image cropped by DCL Summary Thank you for watching • End of online asynchronous module 1