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Head and neck > Lecture 18- The oral cavity and the pharynx > Flashcards

Lecture 18- The oral cavity and the pharynx Flashcards

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1
Q

what separates the nasal cavity from the oral cavity

A

the hard and soft palate

  • Tip of soft palate= uvula
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2
Q

tip of the soft palate is the

A

uvula

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3
Q

how many teeth do we have

A

32

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4
Q

area between the lips and teeth

A

vestibule

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5
Q

where do the tonsils sit

A
  • Palatoglossal and palatopharyngeal arches (Mc Donalds signs)
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6
Q

the tongue has

A

intrinsic and extrinsc muscles

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7
Q

intrinsic muscles of the tongue

A
  • not attached to other muscles except other intrinsic muscles
    • 4 pair muscles
      • Longitudinal (superior and inferior)
      • Transverse
      • Vertical
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8
Q
A
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9
Q

motor innervation of the itnrinsic muscles

A

hypoglossal enrve (CN XII)

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10
Q

extrinsic muscles

A
  • arise from other structures and insert into tongue
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11
Q

extrinsic muscles

A
  • Genioglossus
  • Hyoglossus
  • Styloglossus
  • Palatoglossus
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12
Q

Styloglossus

A
  • Motor innervation: hypoglossal nerve
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13
Q

palatoglossus

A
  • Motor innervation (vagus nerve)
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14
Q

anatomy of the extrinsic muscles

A
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15
Q

sensory supply of the tongue (anterior 2/3)

A
  • Sensation- trigeminal (V3)
  • Taste- facial
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16
Q

posterior 1/3 of the tongue

A
  • Sensation and tase- glossopharyngeal
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17
Q

how many pairs of salivary glands

A

3

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18
Q

salivary glands

A
  • parotid
  • submandibular
  • sublingual
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19
Q
A
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20
Q

where does the parotid lie

A
  • Lies anterior to the SCM and ear
  • Behind the masseter and zygomatic arch
  • Duct opens up in the upper region of the oral cavity- Stenson’s duct (near upper 2nd molar)
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21
Q

submandibular gland

A
  • Most of saliva (60%)
  • Sits under the mandibular in the submandibular triangle
  • Saliva exits the Wharton’s ducts
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22
Q
  • Sublingual
A
  • Under the tongue
  • Produce 3-5% of saliva
  • Smallest and most diffuse of the majority salivary glands
  • 8-20 excretory ducts per gland
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23
Q

Salivary gland stones (sialolithiasis) most commonly found in the

A

submandibular - whartons ducts

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24
Q

causes of salivary stones

A
  • Dehydration, reduced salivary flow
  • Most stoned less than 1cm
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25
* Symptoms (eating) of sialothiasis
* Pain in gland * Swelling * Infection
26
diagnosis of sialolithiasis
* **Diagnosis** * History * X-ray * Sialogram- contrast dye injected into gland
27
what is tonsilitis
inflammation of the palatine tonsils
28
**Symptoms of tonislitis**
* Fever * Sore throat * Pain/difficulty swallowing * Cervical lymph nodes * Bad breath
29
tonsilitis causes
* Viral causes (most common) * Bacterial causes (up to 40% of cases) * Strep pyogenes * White spots * Can be bacterial secondary to viral tonisilittis
30
**Peritonsillar abscess**
Diff to tonsilitis * Affects tissue around the tonsil * If its unilateral (quinsy)à will deviate the uvula towards the swelling
31
**Symptoms of peritonsilar abscess**
* Severe throat pain * Fever * Bad breath * Drooling * Difficulty opening mouth
32
when can peritonsillar abscesses occur
Severe throat pain Fever Bad breath Drooling Difficulty opening mouth
33
the pharynx can be split in 3
(all exist behind various structures) * **Nasopharynx** * Behind nasal cavity * **Oropharynx** * Behind oral cavity * **Laryngopharynx** * Behind larynx
34
the nasopharynx is the
upper pharynx- pink part
35
where is the nasopharynx found
* Behind the nasal cavity
36
borders of the nasopharynx
* Base of skull- upper border * C1,C2- posterior border * Nasal cavity- anterior border
37
the nasopharynx contains the
* Pharyngeal tonsil e.g. adenoids
38
**Pharyngeal tonsil (adenoid)- clinical correlates** *
* Enlarged pharyngeal tonsils * Block eustachian tube (recurrent/persistent middle ear infection * Snoring/sleep apnoea * Sleeping with mouth open * Chronic sinusitis * Sore throat * Nasal tone to voice
39
the oropharynx- middle pharynx
* Yellow part on photo * Starts where the nasopharynx end
40
borders of the orpharynx
* Soft palate to epiglottis * Anterior- oral cavity * Posterior (C2,C3)
41
oropharynx contains the
palatine tonsils
42
43
coronal view of the pharynx
44
the laryngopharynx
lower pharynx
45
46
borders of the laryngopharynx
* Oropharynx to oesophagus * Epiglottis to cricoid cartilage * Anterior- larynx * Posterior (C4, C5, C6)
47
laryngopharynx contains
* Piriform fossa
48
piriform fossa
* Epiglottis (flap on right photo) acts as a director of flow of fluid and water into the piriform fossa into the oesophagus instead of the trachea
49
**General overview of muscle arrangements of the pharynx**
**3- longitudinal muscles** Stylopharyngeus Palatopharyngeus Salpingopharyngeaus They act to shorten and widen the pharynx, and elevate the larynx during swallowing.
50
3 longitudinal muscles
elevate pharynx and larynx during swallowing * Stylopharyngeus * Palatopharyngeus * Salpingopharygeus
51
**Stylopharyngeus**
* Originates from the styloid process and goes down to the posterior border of the thyroid cartilage * **Innervation-** glossopharyngeal nerve (CN IX)
52
**Palatopharyngeus**
* Originates from the hard palate and extends down to the attach to the posterior border of the thyroid gland * Pharyngeal branch of vagus (CN X)
53
**Salpingopharyngeaus**
* Originates from the cartilaginous part of ET- merges with the palatopharyngeus * Pharyngeal branch of vagus (CN X)
54
pharngeal constrictors
**X3 circular (more semi-circular) muscles all insert on the pharyngeal raphe)** * **Constrict walls of pharynx when swallowing**
55
what are the 3 circular muscles
* **Superior pharyngeal constrictor** * Origin – pterygomandibular raphe * **Middle pharyngeal constrictor** * Origin- hyoid bone * **Inferior** * 2 parts * Thyropharyngeal (origin- thyroid cartilage) * Cricopharyngeal (origin- cricoid cartilage * All supplies by the vagus nerve
56
what do pharngeal constrictures and the pharngeal raphe loop like
57
**Pterygomandibular raphe**
58
3 forms of innervation of the pharynx
- pharyngeal plexus - motor - sensory
59
* **Pharyngeal plexus**
* Located mainly on surface of middle constrictor muscle * Vagus, glossopharyngeal and cervical sympathetic nerve
60
* **Motor**
* CNX -Vagus innervates all muscles * Except stylopharyngeus (glossopharyngeal nerve (CN IX)
61
* **Sensory**
* Nasopharynx (maxillary nerve CN V2) * Oropharynx ( glossopharyngeal nerve CN IX) * Laryngopharynx (vagus nerve CNX)
62
**Clinical correlates with pharyngeal**
* Caused by a posteromedial (false diverticulum)à arises in weakness between the 2 parts of the inferior constrictor (Killians dehiscence)
63
false diverticulum in killians dehiscence is probably caused by
* Failure of UOS to relax * Abnormal timing of swallowing * Essentially there is a higher pressure in laryngopharynx * Weakness in inferior constrictor muscle produces outpouching
64
stage sof swallowing
oral pharngeal oesophageal
65
outline the oral stage of swallowing (stage 1)
* voluntary * prepatory phase- making the bolus * transit phase- bolus compressed agaisnt palate nad pushed into oropharynx by tongue and soft palate
66
which nerve is associated with the oral stage
hypoglossal CNXII- muscles of the tongue
67
outline the pharyngeal phase of swallowing
* involuntary * tongue positioned against the hard palate (food cannot re-enter mouth (CN XII) * soft palate elevated sealing off nasopharnx * opens ET tubule * suprahyoud and longituidnal muscles shorten * pharynx widwns and shortens to receive bolus * larymx elevated and sealed off by vocal folds * epiglottis closes over larynx (result of elevated hyoid) * bolus moves throguh pharynx by sequential contraction of constrictors * relaxation of the UOS
68
69
pharangeal phase is
dangerous- shared airway sapce * Need to protect airway * By shortening longitudinal muscles- elevate larynx and pharynxà widening it * Closure of epiglottis (sealing the airway)
70
Oesophageal phase
* involuntary * uppder strated muscle of oesophagus (CNX) * lower smooth muscle * LOS covered in GI unit
71
dysphagia
problems swallowing Neurological conditions makes swallowing liquids harder (solid= more due to obstruction)
72
**Signs and symptoms of dysphagia**
* Coughing and chocking * Sialorrhea (drooling) * Recurrent pneumonia * Change in voice/speech (wet voice) * Nasal regurgitation
73
causess of dysphagia
* **Stroke** * Progressive neurological disease * Parkinson’s/MS * COPD * Dementia * 30% of post stroke death are due to pneumonia * E.g. aspiration pneumonia
74
dysphagia interventions
Fluids are thickened
75
1) cranial nerve problems with dysphagia realted to which CN
**Intervention** * Fluids are thickened * Absent gag * Uvula deviated away from lesion (Lower Motor Neurone lesion) * More subtle * Dysphagia * Taste impairment (posterior tongue IX) * Loss of sensation oropharynx
76
**Injury to IX/V caused by**
Medullary infarct, jugular foramen issues (fracture)
77
**2) Cranial nerve problems in this area** *
**XII- hypoglossal** * Wasted tongue * Stick tongue out- tongue may deviated * Damage to nerve itself (LMN)- points to side of the lesion (tongue never lies) * Muscle wasting * Fasciculations

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