15 - Oral Cavity, Tongue and Pharynx Flashcards
What are the walls of the oral cavity?
Lateral: buccinators
Roof: hard and soft pallate
Floor: two mylohyoids, tongue and soft tissues
Goes from oral fissure to oropharyngeal isthmus
What is the oropharyngeal isthmus?
Arch formed by the soft pallate and the tongue
Sides are formed by anterior and posterior pillars of the fauces
Pillars formed by palatoglossus (anterior) and palatopharyngeal (posterior) muscles
What is the function of the palatoglossus and palatopharyngeal muscles?
They go from the soft palate (no bone) to the tongue and contract during chewing to close the oropharyngeal isthmus to keep food in mouth
(vestibule is space between teeth and lips)
What lies between the palatoglossus and palatopharyngeal arches?
Tonsillar fossa for the palatine tonsils
(Pompous Tarzan Pooped Lustily)
What is the structure of the tongue and the innervation of each muscle?
Entirely muscular, covered in mucous membrane (squamous)
Intrinsic: 2 longitudinal, 1 vertical, 2 transverse. They alter the shape of the tongue and blend with the extrinsic muscles not bone
Extrinsic: act to change the position of the tongue and anchor the tongue to the hyoid, mandible, styloid process and soft pallate
What is the most important extrinsic muscle of the tongue?
Genioglossus (one on each side of the tongue)
Contracts to protrude the tongue, can be used to test hypoglossal nerve
What is the motor, sensory and taste innervation to the tongue?
Label this diagram of the tongue.
Where do all of the salivary glands enter the oral cavity?
- Submandibular: Wharton’s duct
- Sublingual: lots ducts near frenulum
- Parotid: Stensen duct
What is the diagnosis and what symptoms would this gentleman be experiencing?
Sialothiasis (most common in submandibular gland and usually due to dehydration)
- Pain in gland when eating or thinking about eating
- Swelling and infection
- May want to xray or sialogram
What nerves are we testing when we do the gag reflex and ask the patient to say ‘ahh’?
Gag: IX afferent and X efferent
‘Ahh’: X, uvula will deviate to the non affected side as the soft pallate doesn’t rise
How can we test the hypoglossal nerve?
Stick tongue out, tongue will deviate to side of lesion as muscle pushes it to one side
What is the diagnosis?
- Don’t give antibiotics as mainly viral
- Uvula remains central
What are some of the symptoms of a peritonsillar abscess (Quinsy)?
- Deviates the uvula and hot potato voice
- Can close off airway if epiglottitis
What is the structure of the pharynx?
- From the base of the skull to the level of C6. Lays behind the nasal and oral cavities and is split into three
- Narrows and becomes continuous with the oesophagus
- Posterior wall of fascia is bucopharyngeal fascia
What are the three divisions of the pharynx?
Nasopharynx: from base of skull to upper border of soft palate. Contains pharyngeal tonsil. C1/C2 behind and nasal cavity in front
Oropharynx: soft palate to epiglottis. Contains palatine tonsils. C2/C3 posterior and oral cavity in front
Laryngopharynx: epiglottis to cricoid cartilage. Larynx in front and C4/C5/C6 behind. Contains piriform fossa
What is the piriform fossa?
Each side of laryngeal inlet there are small depressions called the piriform fossa that drain to the oesophagus so fluid can drain around epiglottis stopping aspiration
What are the muscles involved in elevating the larynx and pharynx during swallowing?
- All internal longitudinal muscles
- Stylopharyngeus (IX): styloid to thyroid cartilage
- Palatopharyngeus (X): hard palate to thyrouid
- Salpingopharyngeus (X) : ET cartilage to palato
What are the pharyngeal constrictors?
All external circular muscles innervated by X. They propel food into oesophagus. They all have a common insertion posteriorly on pharyngeal raphe
Vagus does peristalsis
What is a pharyngeal pouch?
- Weakness between thyro and cricopharyngeus called Killian’s dehiscence
- Incoordination of pharynx during swallowing can raise pressure in pharynx and cause herniations
What are some symptoms of a pharyngeal pouch?
- Food can become trapped and can be asymptomatic OR
- Dysphagia
- Regurgitation of food
- Lump in the neck
- Choking on fluids
- Bad breath
What is the motor and sensory supply of the pharynx?
- From the pharyngeal plexus of nerves (X, IX and sympathetics from superior cervical ganglion)
- Vagus innervates muscles of pharynx and soft palate apart from pharyngeus
- Oropharynx and ET are IX
What are the different nerves associated with the phases of swallowing?
- Oral: hypoglossal as tongue,
- Pharyngeal: hypoglossal to put tongue up, CN X to seal of nasopharynx, CNX and CNIX to shorten longitudinal muscules and suprahyoids and constrictors
- Oesophageal: CNX for striated muscle of oesophagus
What are some symptoms of dysphagia?
- Coughing and choking
- Sialorrhoea
- Recurreny pneumonia
- Change in voice to wet
- Nasal regurgitation
What would you see in CN IX, X and XII lesions?
If you have otalgia with a normal ear examination what could be some causes?
Referred pain from:
- Glossopharyngeal: Tonsils, oropharynx, middle ear
- Trigeminal: auricotemporal with TMJ
- Facial
- Vagus: larynx
- C2 and C3
How do we treat recurrent tonsilitis?
- Tonsillectomy (less common now)
- Profuse bleeding from tonsillar branch of facial artery
What are some issues that can arise with the piriform fossa?
- Potential site for foreign bodies (fish bone)
- Pharyngeal cancers that can grow quite large before symptoms
If there was a lesion at A of the facial nerve, which functions would be compromised?
Only the greater petrosal nerve would be spared so only lacrimal glands working
A is after the geniculate ganglion
Any middle ear pathology will affect all of facial apart from petrosal
Where are the sinuses on the following x-ray?
