Session 8: Oral Cavity, Tongue & Pharynx

Question 1

Lateral walls of the oral cavity.

Answer 1

Buccinator

Question 2

Roof of the oral cavity.

Answer 2

Hard and soft palate

Question 3

Floor of the oral cavity.

Answer 3

Muscles like two mylohyoid, the tongue and other soft tissues.

Question 4

Where does the oral cavity begin?

Answer 4

At the oral fissure

Question 5

Where does the oral cavity end?

Answer 5

At the oropharyngeal isthmus

Question 6

Explain what the oropharyngeal isthmus is.

Answer 6

An arch formed by the soft palate above and the upper surface of the tongue below.

The sides of the oropharyngeal isthmus are formed by the anterior and posterior pillars of the fauces.

Question 7

What are the anterior and posterior pillars of the fauces formed by?

Answer 7

The palatoglossus (anterior) and the palatopharyngeal (posterior) muscles.

Question 8

Action of the palatoglossus and the palatopharyngeal.

Answer 8

Pulls the soft palate down towards the back of the tongue during chewing. This is important for closing the oropharyngeal isthmus in order for food to remain in the oral cavity while chewing.

Question 9

What lies between the pillars?

Answer 9

The tonsillar fossa

Question 10

What can be found in the tonsillar fossa?

Answer 10

The palatine tonsils.

Question 11

What are the classifications of muscles in the tongue?

Answer 11

Intrinsic muscles

Extrinsic muscles

Question 12

Explain the action of the intrinsic muscles.

Answer 12

Found within the tongue and run longitudinally, vertically and transversely.

They alter the shape of the tongue.

Question 13

What are the extrinsic muscles of the tongue?

Answer 13

Genioglossus

Hypoglossus

Styloglossus

Palatoglossus

Question 14

Innervation of the extrinsic muscles of the tongue.

Answer 14

Genioglossus - Hypoglossal nerve

Hyoglossus - Hypoglossal nerve

Styloglossus - Hypoglossus nerve

Palatoglossus - Vagus nerve

Question 15

Action of the extrinsic muscles of the tongue.

Answer 15

Protraction, retraction and side to side movement of the tongue.

Question 16

Which muscle is the most important in the tongue, and why?

Answer 16

The genioglossus as its contraction causes protraction of the tongue and its action is therefore used to determine the hypoglossal nerve function. Patient should stick out their tongue.

Question 17

Special sensory (taste) of the tongue.

Answer 17

Anterior 2/3rds by the facial nerve (Chordae tympani)

Posterior 1/3rd by the glossopharyngeal nerve

Question 18

General sensation of the tongue.

Answer 18

Anterior 2/3rd by the trigeminal nerve Vc lingual branch

Posterior 1/3rd by the glossopharyngeal nerve

Question 19

How can you test the vagus nerve by the tongue?

Answer 19

The patient is asked to open their mouth and say ‘ahhh’.

Upon this the uvula to see if there is any deviation to one side of the uvula.

Deviation of the uvula to one side will indicate weakness of the contralateral soft palate (opposite).

You can also test the gag reflex (afferent CN IX, efferent CN X)

Question 20

Through what does the parotid gland’s saliva enter the oral cavity?

Answer 20

The stensen duct.

Question 21

Through what does the submandibular gland’s saliva enter the oral cavity?

Answer 21

Wharton duct

Question 22

What is sialolithiasis?

Answer 22

Salivary gland stones

Question 23

Where can most sialolithiases be found?

Answer 23

In the submandibular glands

Question 24

Signs and symptoms of sialolithiasis.

Answer 24

Dehydration and reduced salivary flow.

Pain in gland

Swelling

Infection

Increased pain on salivating and eating.

Most stones are less than 1cm in diamater.

Question 25

Diagnosis of sialolithiasis.

Answer 25

History X-ray Sialogram

Question 26

What is tonsillitis?

Answer 26

Inflammation of the palatine tonsils

Question 27

Signs and symptoms of tonsillitis.

Answer 27

Fever Sore throat Pain and difficulty swallowing Cervical lymph nodes Bad breath Uvula remains central and no deviation

Question 28

Pathogens causing tonsillitis.

Answer 28

Viral causes (most common) Less common is bacterial and due to Streptococcus pyogenes

Question 29

Signs and symptoms of peritonsillar abscess.

Answer 29

Severe throat pain Fever Bad breath Drooling Difficulty opening mouth due to pain 'Hot potato voice' **Deviated** uvula Quinsy

Question 30

Causes of peritonsillar abscess.

Answer 30

Can follow on from an untreated or partially treated tonsillitis. Can arise on its own by aerobic or anaerobic bacteria.

Question 31

Upon examination of tonsillitis and peritonsillar abscess what do you need to watch out for?

Answer 31

Epiglottitis. It also causes sore throat and fever. However if you poke around in the mouth and it turns out the patient has epiglottitis they epiglottis might shut. This will shut the airways and the patient can go into respiratory arrest.

Question 32

Boundaries of the nasopharynx.

Answer 32

Superiorly the base of the skull to the superior border of the soft palate. Posteriorly **C1** and **C2** Anteriorly the nasal cavity

Question 33

What does the nasopharynx contain?

Answer 33

The pharyngeal tonsil

Question 34

What are the pharyngeal tonsil also called?

Answer 34

The adenoid

Question 35

Complications of pharyngeal tonsils.

Answer 35

Can block the eustachian tube and cause recurrent and persisent middle ear infections. Snoring and sleep apnoea Nasal tone to voice Can cause chronic sinusitis Might sleep with mouth open

Question 36

Boundaries of the oropharynx.

Answer 36

Soft palate to epiglottis Anterior the oral cavity can be found Posteriorly **C2** and **C3**

Question 37

What does the oropharynx contain?

Answer 37

The palatine tonsils

Question 38

Boundaries of the laryngopharynx?

Answer 38

Oropharynx superiorly to the oesophagus inferiorly. Epiglottis to the cricoid cartilage. Anteriorly the larynx can be found. Posteriorly **C4, C5,** and **C6**

Question 39

What of clinical significance does the laryngopharynx contain?

Answer 39

The piriform fossa

Question 40

What muscles groups can be found in the pharynx?

Answer 40

The internal pharyngeal muscles and the external constrictors.

Question 41

What are the internal muscles of the pharynx?

Answer 41

Three longitudinal muscles Stylopharyngeus Palatopharyngeus Salpingopharyngeus

Question 42

Action of the internal muscles of the pharynx.

Answer 42

Shorten and widen the pharynx as well as elevate the pharynx and larynx during swallowing.

Question 43

Origination and insertion of stylopharyngeus

Answer 43

Styloid process to the posterior border of the thyroid cartilage

Question 44

Innervation of the stylopharyngeus.

Answer 44

Glossopharyngeus nerve

Question 45

Origination and insertion of palatopharyngeus.

Answer 45

Hard palate to the posterior border of the thyroid cartilage.

Question 46

Innervation palatopharyngeus.

Answer 46

Pharyngeal branch of the **vagus** nerve

Question 47

Origination and insertion of salpingopharyngeus.

Answer 47

Cartilaginous part of the eustachian tube. It inserts by merging with the palatopharyngeus.

Question 48

Innervation of the salpingopharyngeus.

Answer 48

Pharyngeal branch of the **vagus** nerve

Question 49

What are the pharyngeal constrictors (external)?

Answer 49

3 circular muscles. Superior pharyngeal constrictor Middle pharyngeal constrictor Inferior pharyngeal constrictor

Question 50

Action of the pharyngeal constrictors.

Answer 50

Constricts the wall of the pharynx when swallowing.

Question 51

Insertion of the pharyngeal constrictors.

Answer 51

The pharyngeal raphe

Question 52

Origin of the SPC

Answer 52

Pterygomandibular raphe

Question 53

Origin of the MPC

Answer 53

Hyoid bone

Question 54

Origin of the IPC

Answer 54

2 parts - Thyropharyngeal (thyroid cartilage) Cricopharyngeal (Cricoid cartilage)

Question 55

Innervation of the pharyngeal constrictors.

Answer 55

Vagus nerve

Question 56

What is important to note about the inferior pharyngeal constrictors (the two parts)?

Answer 56

That there is a weakness between the two parts of the the inferior constrictor.

Question 57

What is the weak area of the inferior constrictor called?

Answer 57

Killian's dehiscence.

Question 58

Explain why the Killian's dehiscence is important to be aware of.

Answer 58

Because during swallowing increased pressure within the pharynx can rise due to the pressure of the inferior constrictors. Pharyngeal mucosa can therefore **herniate** through Killian's dehiscence. This forms a pharyngeal pouch also called a **pharyngeal diverticulum.**

Question 59

Complications of pharyngeal diverticulum.

Answer 59

As food passes thorugh the pharynx, some of the food may become trapped in the diverticulum.

Question 60

What signs and symptoms might a foreign body stuck in a pharyngeal diverticulum cause?

Answer 60

Bad breath Regurgitation of food Occasional choking on fluids General difficulty swallowing

Question 61

Where can the pharyngeal plexus be found?

Answer 61

Located mainly on the surface of the middle constrictor muscle.

Question 62

Motor innervation of the pharyngeal muscles.

Answer 62

CN X innervates all except for stylopharyngeus which is innervated by the glossopharyngeal nerve.

Question 63

Sensory innervation of the pharynx.

Answer 63

Nasopharynx - maxillary nerve CN V2 Oropharynx - glossopharyngeal nerve Laryngopharynx - vagus nerve

Question 64

What elevates the larynx?

Answer 64

The suprahyoid muscles and the longitudinal pharyngeal muscles

Question 65

Give common causes of dysphagia.

Answer 65

Stroke Progressive neurological disease like Parkinson's and MS COPD Dementia

Question 66

Signs and symptoms of dysphagia.

Answer 66

Coughing Choking Recurrent pneumonia Change in voice and speech also called wet voice Nasal regurgitation

Question 67

Obvious signs upon examination of cranial nerve IX and X lesions.

Answer 67

Absent gag reflex Uvula **deviated** away from the lesion.

Question 68

Signs of cranial nerve lesions of the CN IX and CN X.

Answer 68

Dysphagia Taste impairment of the posterior tongue Loss of sensation of the oropharynx and the laryngopharynx. Absent gag reflex Uvula deviation

Question 69

Causes of cranial IX and X lesions.

Answer 69

Medullary infarct Jugular foramen problems

Question 70

Signs and symptoms of cranial nerve XII lesions.

Answer 70

Wasted tongue When tongue is sticking out the tongue may deviate. The deviation will be towards the lesion (pointing) Muscles wasting Twitching of the tongue called fasciculations.