What % of care home residents have dysphagia?
50%
In the mouth, what is the vestibule?
Area between the teeth, lips and cheeks
What are the three types of mucosa found in the oral cavity?
Masticatory- Keratinised stratified squamous epithelium
Lining- Non keratinised stratified squamous epithelium
Specialised- (In lingual papillae region, has free nerve endings for sensation)
Where is the masticatory type of oral mucosa found in the mouth?
Masticatory is keratinised stratified squamous
Dorsum (top) of tongue/ hard palate and gingiva (gums)
Where is the lining type of oral mucosa found in the mouth?
Lining in non-keratinised stratified squamous
Buccal (cheeks), labia (inside of lips)
Where is the special type of oral mucosa found in the mouth?
On lingual papillae
has free nerve endings for sensation
What are the boundaries of the oral cavity proper?
Side/ ant- Alveolar processes (ridge of bone containing dental alveoli- (teeth sockets)
Post- Isthmus of the fauces
What is the isthmus of the fauces?
Fauces are two pillars formed by palatoglossus (ant arch) and palatopharyngeus (post arch)
The isthmus is the opening from the mouth to the oropharynx that they create
Where is the palatine tonsil found?
Between the palatoglossal (ant) and palatopharyngeus (post) arches
What does the hard palate consist of?
Palatine process of mouth and horizontal palate of palatine bone
What are the (5) muscles of the soft palate and their function?
Tensor veli palatini- Tenses palate for swallowing
Palatoglossus- Elevates post tongue/ initiates swallow
Palatopharyngeus- Pulls pharynx up (breath/swallow)
Levator veli palatini- Elevates palate (swallow)
Muscularis uvulae
What is deciduous dention?
Children’s teeth (milk teeth)
- Children have 20 (missing back 3 molars)
In children premolars are known as molars
Teeth usually start transition to permanent at age 6, often finished by age 12
What teeth make up each quadrant?
Central incisor/ lateral incisor
Canine
1st and 2nd premolars
1/2/3 molars (with the 3rd being your ‘wisdom tooth’
How many teeth do adults have?
32
What passes through the incisive foramen?
Nasopalatine nerves
What are palatine rugae?
Ridges which help food move backwards
What is your lingual frenulum?
Small mucus membrane fold from the floor of the mouth to the underside of the midline of the tongue
Where does the submandibular duct open?
Into the sublingual papillae on the underside of the tongue
What are the sublingual folds?
Where the sublingual duct opens, next to the sublingual papillae
What the name of the ring of MALT tissue found in the naso and oropharynx?
Waldeyers tonsillar ring
What tonsils do you have?
1(or2) pharyngeal tonsils (adenoids)- Nasopharynx
2 tubal tonsils- By eustachian tube into nasopharynx
2 palatine tonsils (‘the tonsils’) - Oropharynx
1/ many lingual tonsils - On posterior tongue
Which nerve does taste sensation on the ant 2/3 of the tongue?
Corda tympani (CN VII)
Which nerve does sensation on the ant 2/3 of the tongue?
Lingual nerve (CN V)
Which nerve does taste and sensation for the post 1/3 of the tongue?
Glossopharyngeal
What structure divides the two sides of the tongue?
Lingual septum
What structure splits ant/ post 1/3’s of the tongue?
Lingual sulcus
What is the function of the vallecula?
Two depressions at the base of the tongue which hold saliva and prevent the swallow reflex
(Important intubation landmark)
Where are the sublingual coruncles and what are they?
Under tongue, small papillae either side of frenulum
Sublingual and submandibular duct empty into them
Where does the parotid gland open into? What nerve controls it?
Controlled by CN IX (PNS)
Goes through buccinator and emerges from:
STENSON duct by 2nd molar
Which mouth gland contributes most to total salvia volume?
Submandibular 70%
Where do most stones which cause blockages in the ducts which open in the mouth from?
80% in submandibular gland
Which nerve controls the intrinsic tongue muscles?
Hypoglossal (CN XII)
Which nerve does sensation from the teeth/ cheeks/ palate/ fauces and floor of mouth?
Trigeminal
The trigeminal nerve does sensation of which area’s?
Entire face/ oral cavity/ eye etc
What is the OIA of the masseter muscle?
O: Zygomatic arch
I: Lat mandible ramus
A: Elevates mandible
Which nerve supplies the muscles of mastication?
Trigeminal
What is the OIA of the temporalis muscle?
O: Temporal fossa
I: Coronoid process/ ramus of mandible
A: Elevates and retracts mandible
What is the OIA of the lateral pterygoid muscle?
O: Roof infratemporal fosssa (UH) + lateral pterygoid process (LH)
I: Capsule of TMJ
A- Protrusion and side to side movement
What is the OIA of the medial pterygoid muscle?
O- Pterygoid process (DeepH) + Tuberosity maxilla (SuperficialH)
I- Medial mandible (near angle)
A- Elevate and side to side movement
Which muscles depress the mandible?
Diagastric/ geniohyoid/ myelohyoid
What type of joint is the TMJ?
Synovial (covered by fibrocartlidge articular disc)
What is translation?
The down/ out protrusion of mandible
Superior compartment rotates to allow maximal opening
What is the major ligament which covers the TMJ?
Temporomandibular lig
Zygomatic process - lateral neck of mandible
Stops excessive retraction
Describe the pharynx
A fibromuscular tube which goes from the base of the skull to the oesophagus
What type of epithelium lines the nasopharynx?
Pseudostratified columnar epithelium
What type of epithelium oropharynx?
Non-keratining stratified squamous epithelium
What type of epithelium laryngopharynx?
Non-keratining stratified squamous epithelium
What is the border between the nasopharynx and the oropharynx?
Upper soft palate/ uvula
What is the border between the oropharynx and the laryngopharynx?
Hyoid bone/ epiglottis
At what vertebral level does the oesophagus start?
C6
Where does the oesophagus enter the diaphragm?
Oesophageal hiatus (T10)
Which nerves supply sensation to the naso/oro and laryngopharynx?
Naso- CN V (Maxillary branch- V2)
Oro- CN IX
Laryngo- CN X
Innervation the pharynx comes from what nerve structure?
Pharyngeal plexus
All of the pharynx motor component is supplied by the X nerve except for the Y muscle?
X= Vagus Y= Stylopharyngeus (CN IX)
What is the arterial/ venous supply to the pharynx?
Art- Branches of ECA (Ascending pharyngeal/ lingual/ maxillary0
Vein- Pharyngeal venous plexus (into IJV)
What is the art/venous supply to the thoracic portion of the oesophagus?
Art- Branches of aorta
Vein- Branches of azygous veins
What is the art/venous supply to the abdominal portion of the oesophagus?
Art- L gastric artery
Vein- To portal circulation via L gastric vein
Which cranial nerve innervates the oesophagus?
CN X
What type muscle makes up each 1/3 of the oesophagus?
Cervical (upper 1/3)- Striated
Middle 1/3- Striated and smooth
Lower 1/3- Smooth
Which plexus supplies innervation to the oesophagus?
Myenteric