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anatomy

anatomy

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Published by Danielle

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Published by: Danielle on Feb 20, 2011
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06/04/2013

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THE MOUTH
the
vestibule
is formed from the lips and cheeks, bounded within by the teeth & gumsthe opening to the
 parotid duct
is adjacent the 2
nd
upper molarthe potential space is minimised by facial muscle tone (VII)the
 mouth cavity
is bounded by,i.the alveolar ridge & teeth in frontii.the hard & soft palate aboveiii.the anterior 2/3 of the tongue & its mucosal fold onto the mandible belowiv.the oropharyngeal isthmus behindthe mucosa of the floor has a midline
 frenulum linguae
, either side of which are openings to thesubmandibular salivary glandsthe majority of these glands open as a series of small orifices along the
sublingual fold 
, othersdrain into the
duct of the submandibular gland 
(Wharton's duct)
The Palate
the
 hard palate
is comprised of the palatine processes of the maxilla and the horizontal plates of the palatine bonesthe mucous membrane is stratified squamous, closely adherent to the periosteum, forming asingle sheet, the
mucoperiosteum
the
 soft palate
is suspended from the free border of the hard palatecentrally, its free edge bears the
uvula
and laterally it blends with the pharyngeal wallthe mucous membrane covering is,i.anterior- stratified squamousii.posterior- ciliated columnarthe 'skeleton' of the soft palate is a thick fibrous membrane, the
 palatine aponeurosis
this is continuous in front with the hard palate and laterally with the tendon of the
 tensor palati
there are 5
 muscles
of the
 soft palate
,1.
 tensor palati
arises from the scaphoid fossa at the root of the medial pterygoid plate, from thelateral side of the eustachian cartilage and the medial side of the spine of thesphenoiddescends passing
lateral
to the superior constrictor and medial pterygoid plateends in a tendon which pierces the pharynx, loops medially around the hook of thehamulus to insert into the palatine aponeurosisacts to tighten and flatten the soft palate
Anatomy & Regional Anaesthesia
 
2.
levator palati
arises from the under surface of the petrous temporal bone and the medial side of the Eustachian tubeinserts into the upper surface of the soft palate, meeting in the midlineelevates the soft palate3.
 palatoglossus
arises in the soft palate, descending in the
 palatoglossal fold 
, blending with the sideof the tongueacts to approximate the palatoglossal folds4.
 palatopharyngeus
arises in the soft palate, descending in the
 palatopharyngeal fold 
, blending with theside of the pharynxsome fibres insert into the side of the thyroid cartilageacts to approximate the palatopharyngeal folds5.
 musculus uvulae
arises from the palatine aponeurosis, at the posterior nasal spine of the palatinebone and inserts into the uvulaesupplied by the cranial root of the accessory nerve, injury to which results inelevation of the uvula to the opposite side
 NB:
1.
 tensor palati
is supplied by the
 mandibular branch of V 
, via the otic ganglion
2.
the remaining muscles are supplied by the
 pharyngeal plexus
,which transmits cranial fibres from the
 accessory nerve
these muscles act to close the nasophayrnx during phonation and deglutitionaided by contraction of the
 superior constrictor
, which produces a transverse ridge on theposterior and lateral walls of the pharynx, at the level of C
2
, the
 ridge of PassavantCleft Palate
the palate develops from the
 premaxilla
(usually contains all 4 incisor teeth, occasionally only 2),and a pair of 
lateral maxillary processes
all degrees of failure of fusion are seen, and may involve the posterior palate, or pass to one orboth sides of the premaxilla
Anatomy & Regional Anaesthesia
2
 
THE NOSE
the
external nose
is formed by,a.an upper framework of bone- the nasal bones- the nasal part of the frontal bones- the frontal part of the maxillab.a lower series of cartilagesc.a small zone of fibro-fatty tissue laterally, the
ala
the
 cavity of the nose
is subdivided by the nasal septum into two halvesa.opening to the exterior through the
 nares
b.opening into the nasopharynx through the posterior nasal apertures, or
 choanae
immediately within the nares is a small dilatation, the
vestibule
each side of the nose has a roof, lateral & medial walls, and a floor,a.
the roof 
slopes up and backwards forming the bridge of the nose (nasal & frontal bones)then passes horizontally (cribriform plate of the ethmoid bone)finally curves downward (body of the sphenoid)b.
the floor
slightly concave from side to side, and antero-posteriorlyformed from the palatine process of the maxilla and the horizontal plate of thepalatine bonec.
medial wall
or nasal septum
formed from the septal cartilage, the perpendicular plate of the ethmoid superiorlyand the vomer infero-posteriorlydeviation of the anterior septum is seen in ~ 75% of adults, males > femalesd.
lateral wall
nasal aspect of the ethmoidal labyrinth above, the nasal surface of the maxillainfero-anteriorly, and the perpendicular plate of the palatine bone posteriorlyprojects 3
 chonchae
, or turbinate bones, each arching over a
 meatus
the upper & middle chonchae arise from the ethmoidal labyrinththe inferior choncha is a separate bonehouses the orifices of the paranasal sinuses & the nasolacrimal duct,i.sphenoid sinus- opens into the
 spheno-ethmoidal recess
- between the short superior choncha & the sphenoid bodyii.posterior ethmoidal cells- into the superior meatusiii.middle ethmoidal cells- bulge into & open on the middle meatus= the
 bulla ethmoidalis
iv.maxillary sinus- ostium opens below the
 hiatus semilunaris
- this is situated below the bulla ethmoidalis
Anatomy & Regional Anaesthesia
3

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