ANATOMY
THE DIGESTIVE SYSTEM IN THE HEAD AND NECK
DR. VION GUZMAN, M.D.
THE LIPS
 The lips are two fleshy folds that surround the oral orifice. They are
covered on the outside by skin and are lined on the inside by
mucous membrane. The substance of the lips is made up by the
orbicularis oris muscle and the muscles that radiate from the lips
into the face.
 Also included are the labial blood vessels and nerves, connective
tissue, and many small salivary glands
 The philtrum is the shallow vertical groove seen in the midline on
the outer surface of the upper lip. Median folds of mucous
membrane—the labial frenulae—connect the inner surface of the
lips to the gums.
THE MOUTH CAVITY
 The mouth extends from the lips to the pharynx. The entrance into
the pharynx, the oropharyngeal isthmus, is formed on each side by
the palatoglossal fold (Fig. 11.72).
 The mouth is divided into the vestibule and the mouth cavity proper.
TRANSCRIBERS EDITOR
December 2018
Vestibule
 The vestibule lies between the lips and the cheeks externally and the
gums and the teeth internally.
 The vestibule is limited above and below by the reflection of the
mucous membrane from the lips and cheeks to the gums.
 This slitlike space communicates with the exterior through the oral
fissure between the lips. When the jaws are closed, it communicates
with the mouth proper behind the third molar tooth on each side.
 The lateral wall of the vestibule is formed by the cheek, which is
made up by the buccinator muscle and is lined with mucous
membrane. The tone of the buccinator muscle and that of the
muscles of the lips keeps the walls of the vestibule in contact with
one another. The duct of the parotid salivary gland opens on a small
papilla into the vestibule opposite the upper second molar tooth
MOUTH PROPER
Roof of mouth
 The roof of the mouth is formed by the hard palate in front and the
soft palate behind
Floor of mouth
 The floor is formed largely by the anterior two thirds of the tongue
and by the reflection of the mucous membrane from the sides of the
tongue to the gum of the mandible.
 A fold of mucous membrane called the frenulum of the tongue
connects the undersurface of the tongue in the midline to the floor
of the mouth. Lateral tothe frenulum, the mucous membrane forms
a fringed fold,the plica fimbriata
 The submandibular duct of the submandibular gland opens onto the
floor of the mouth on the summit of a small papilla on either side of
the frenulum of the tongue
 The sublingual gland projects up into the mouth, producing a low
fold of mucous membrane, the sublingual fold.
 Numerous ducts of the gland open on the summit of the fold.
Mucous membrane of mouth
 In the vestibule, the mucous membrane is tethered to the
buccinator muscle by elastic fibers in the submucosa
 The mucous membrane of the gingiva, or gum, is strongly attached
to the alveolar periosteum.
 In the vestibule, the mucous membrane is tethered to the
buccinator muscle by elastic fibers in the submucosa that prevent
redundant folds of mucous membrane from being bitten between
the teeth when the jaws are closed.
Shaira 1 of 6
 THE DIGESTIVE SYSTEM IN THE HEAD AND NECK
0000

SENSORY INNERVATION OF MOUTH

Roof
 The greater palatine and nasopalatine nerves from the
maxillary division of the trigeminal nerve

 Thus, the epithelium of the hard palate, sides of the mouth, lips, and
enamel of the teeth are ectodermal structures.
 The secretory epithelium and cells lining the ducts of the parotid
salivary gland also are derived from ectoderm.
 On the other hand, the epithelium of the tongue, the floor of the
mouth, the palatoglossal and palatopharyngeal folds, and most of the
soft palate are entodermal in origin.
Floor
 The secretory and duct epithelia of the sublingual and submandibular
 The lingual nerve (common sensation), a branch of the mandibular
salivary glands also are believed to be of entodermal origin.
division of the trigeminal nerve.
 The taste fibers travel in the chorda tympani nerve, a branch of the
THE TEETH
facial nerve.
Decidous teeth
 There are 20 deciduous teeth: four incisors, two canines, and four
Cheek
molars in each jaw.
 The buccal nerve, a branch of the mandibular division of the
 They begin to erupt about 6 months after birth and have all erupted
trigeminal nerve (the buccinator muscle is innervated by the buccal
by the end of 2 years.
branch of the facial nerve)
 The teeth of the lower jaw usually appear before those of the upper
jaw.

Permanent teeth
 There are 32 permanent teeth: 4 incisors, 2 canines, 4 premolars,
and 6 molars in each jaw
 They begin to erupt at 6 years of age.
 The last tooth to erupt is the third molar, which may happen
between the ages of 17 and 30.
 The teeth of the lower jaw appear before those of the upper jaw.

THE TOUNGE
 The tongue is a mass of striated muscle covered with mucous
membrane.
 The muscles attach the tongue to the styloid process and the soft
palate above and to the mandible and the hyoid bone below.
 The tongue is divided into right and left halves by a median fibrous
septum.

 The cavity of the mouth is formed from two sources: a depression

from the exterior, called the stomodeum, which is lined with
ectoderm, and a part immediately posterior to this, derived from
the cephalic end of the foregut and lined with entoderm. These two
parts at first are separated by the buccopharyngeal membrane, but
this breaks down and disappears during the third week of
development
 This means that the structures that are situated in the mouth
anterior to this plane are derived from ectoderm.
 If this membrane were to persist into adult life, it would occupy an
imaginary plane extending obliquely from the region of the body of
the sphenoid, through the soft palate, and down to the inner surface
of the mandible inferior to the incisor teeth.
Shaira
TRANSCRIBERSx 2 of 6
 THE DIGESTIVE SYSTEM IN THE HEAD AND NECK
0000

Mucous membrane of the tounge  Nerve supply: Hypoglossal nerve

 The mucous membrane of the upper surface of the tongue can be  Action: Alter the shape of the tongue
divided into anterior and posterior parts by a V-shaped sulcus, the  Extrinsic Muscles
sulcus terminalis  These muscles are attached to bones and the soft palate.
 The apex of the sulcus projects backward and is marked by a small  They are the genioglossus, the hyoglossus, the styloglossus,and
pit, the foramen cecum. the palatoglossus.
 The sulcus serve to divide the tongue into the anterior two thirds, or  Nerve supply: Hypoglossal nerve
oral part, and the posterior third, or pharyngeal part.
 The foramen cecum is an embryologic remnant and marks the site of
the upper end of the thyroglossal duct
 Three types of papillae are present on the upper surface of the
anterior two thirds of the tongue: the filiform papillae, the
fungiform papillae, and the vallate papillae.
 Filiform: numerous slender projections that lack taste buds;
give the tongue its rough feel
 Fungiform: larger mushroom-shaped papillae (may appear as
red caps) scattered on the dorsum of the tongue’s surface;
possess taste buds
 Circumvallate: larger papillae that lie in a row just anterior to
the sulcus terminalis; possess taste buds
 Foliate: lie along the sides of the tongue and are rudimentary
in humans; possess taste buds
 The mucous membrane covering the posterior third of the tongue is  Protrusion: The genioglossus muscles on both sides acting together
devoid of papillae but has an irregular surface, caused by the  Retraction: Styloglossus and hyoglossus muscles on both sides acting
presence of underlying lymph nodules, the lingual tonsil. together
 Depression: Hyoglossus muscles on both sides acting together
 Retraction and elevation of the posterior third: Styloglossus and
palatoglossus muscles on both sides acting together
 Shape changes: Intrinsic muscles

Blood supply of the tounge

 The lingual artery, the tonsillar branch of the facial artery, and the
ascending pharyngeal artery supply the tongue.
 The veins drain into the internal jugular vein.

Lymph drainage of the tounge

 Tip: Submental lymph nodes
 Sides of the anterior two thirds: Submandibular and deep cervical
lymph nodes
 Posterior third: Deep cervical lymph nodes

Sensory innervation of the tounge

 Anterior two thirds: Lingual nerve branch of mandibular division of
trigeminal nerve (general sensation) and chorda tympani branch of
the facial nerve (taste)
 Posterior third: Glossopharyngeal nerve (general sensation and
taste)

Development of the tounge

 At about the fourth week, a median swelling called the tuberculum
impar appears in the entodermal ventral wall or floor of the pharynx
(Fig. 11.79). A little later, another swelling, called the lateral lingual
swelling (derived from the anterior end of each first pharyngeal
arch), appears on each side of the tuberculum impar. The lateral
 the undersurface of the tongue is connected to the floor of the lingual swellings now enlarge, grow medially, and fuse with each
mouth by a fold of mucous membrane, the frenulum of the tongue. other and the tuberculum impar. The lingual swellings thus form the
On the lateral side of the frenulum, the deep lingual vein can be anterior two thirds of the body of the tongue, and since they are
seen through the mucous membrane. Lateral to the lingual vein, the derived from the first pharyngeal arches, the mucous membrane on
mucous membrane forms a fringed fold called the plica fimbriata each side will be innervated by the lingual nerve, a branch of the
Muscles of the tounge mandibular division of the 5th cranial nerve (common sensation).
 Intrinsic Muscles The chorda tympani from the seventh cranial nerve (taste) also
 These muscles are confined to the tongue and are not supplies this area.
attached to bone. They consist of longitudinal, transverse, and
vertical fibers.
Shaira
TRANSCRIBERSx 3 of 6
 THE DIGESTIVE SYSTEM IN THE HEAD AND NECK
0000

Hard palate
 The hard palate is formed by the palatine processes of the maxillae
and the horizontal plates of the palatine bones.
 It is continuous behind with the soft palate.

 Meanwhile, a second median swelling, called the copula, appears in

the floor of the pharynx behind the tuberculum impar. The copula
extends forward on each side of the tuberculum impar and becomes Soft palate
V shaped. At about this time, the anterior ends of the second, third,  The soft palate is a mobile fold attached to the posterior border of
and fourth pharyngeal arches are entering this region. The anterior the hard palate.
ends of the third arch on each side overgrow the other arches and  Its free posterior border presents in the midline a conical projection
extend into the copula, fusing in the midline. The copula now called the uvula.
disappears. Thus, the mucous membrane of the posterior third of  The soft palate is continuous at the sides with the lateral wall of the
the tongue is formed from the third pharyngeal arches and is pharynx.
innervated by the 9th cranial nerve (common sensation and taste).  The soft palate is composed of mucous membrane, palatine
 The anterior two thirds of the tongue is separated from the aponeurosis, and muscles.
posterior third by a groove, the sulcus terminalis, which represents
the interval between the lingual swellings of the first pharyngeal
arches and the anterior ends of the third pharyngeal arches. Around
the edge of the anterior two thirds of the tongue, the entodermal
cells proliferate and grow inferiorly into the underlying mesenchyme.
Later, these cells degenerate so that this part of the tongue
becomes free. Some of the entodermal cells remain in the midline
and help form the frenulum of the tongue. Remember that the
circumvallate papillae are situated on the mucous membrane just
anterior to the sulcus terminalis, and that their taste buds are
innervated by the ninth cranial nerve. It is presumed that during
development the mucous
 membrane of the posterior third of the tongue becomes pulled
anteriorly slightly, so that fibers of the ninth cranial nerve cross the
succus terminalis to supply these taste buds

Mucous membrane
 The mucous membrane covers the upper and lower surfaces of the
soft palate.

THE PALATE
 The palate forms the roof of the mouth and the floor of the nasal
cavity. It is divided into two parts: the hard palate in front and the
soft palate behind.
Palatine aponeurosis
 The palatine aponeurosis is a fibrous sheet attached to the posterior
border of the hard palate. It is the expanded tendon of the tensor
veli palatini muscle.
Muscles of the soft palate
 The muscles of the soft palate are the tensor veli palatini, the
levator veli palatini, the palatoglossus, the palatopharyngeus, and
the musculus uvulae

Shaira
TRANSCRIBERSx 4 of 6
 THE DIGESTIVE SYSTEM IN THE HEAD AND NECK
0000
 The muscle fibers of the tensor veli palatini converge as they
descend from their origin to form a narrow tendon, which turns
medially around the pterygoid hamulus.
 The tendon, together with the tendon of the opposite side, expands
to form the palatine aponeurosis.
 When the muscles of the two sides contract, the soft
palate is tightened so that the soft palate may be moved
upward or downward as a tense sheet.
Nerve supply of palate
 The greater and lesser palatine nerves from the maxillary
division of the trigeminal nerve enter the palate through
the greater and lesser palatine foramina
Blood supply of palate
 The greater palatine branch of the maxillary artery, the ascending
palatine branch of the facial artery, and the ascending pharyngeal
artery
TRANSCRIBERSx
Lymph drainage of palate
 Palatoglossal Arch:
 The palatoglossal arch is a fold of mucous membrane
containing the palatoglossus muscle, which extends from the
soft palate to the side of the tongue.
 The palatoglossal arch marks where the mouth becomes the
pharynx.
 Palatopharyngeal Arch
 The palatopharyngeal arch is a fold of mucous membrane
behind the palatoglossal arch that runs downward and
laterally to join the pharyngeal wall. The muscle contained
within the fold is the palatopharyngeus muscle.
 The palatine tonsils, which are masses of lymphoid tissue, are
located between the palatoglossal and palatopharyngeal
arches.
Movements of the soft palate
 The soft palate is raised by the contraction of the levator veli palatini
on each side. At the same time, the upper fibers of the superior
constrictor muscle contract and pull the posterior pharyngeal wall
forward.
 The palatopharyngeus muscles on both sides also contract so that
the palatopharyngeal arches are pulled medially, like side curtains.
 By this means, the nasal part of the pharynx is closed off from the
oral part.
 The pharyngeal isthmus (the communicating channel between the
nasal and oral parts of the pharynx) is closed by raising the soft
palate. Closure occurs during the production of explosive consonants
in speech.
Shaira
5 of 6
 THE DIGESTIVE SYSTEM IN THE HEAD AND NECK
0000

the primary palate to fuse with the palatal processes of the maxilla
 In early fetal life, the nasal and mouth cavities are in communication, on each side are present. A baby born with a severe cleft palate
but later they become separated by the development of the palate presents a difficult feeding problem, since he or she is unable to
(Fig. 11.82). The primary palate, which carries the four incisor teeth, suck efficiently. Such a baby often receives in the mouth some milk,
is formed by the medial nasal process. Posterior to the primary which then is regurgitated through the nose or aspirated into the
palate, the maxillary process on each side sends medially a lungs, leading to respiratory infection. For this reason, careful
horizontal plate called the palatal process; these plates fuse to form artificial feeding is required until the baby is strong enough to
the secondary palate and also unite with the primary palate and the undergo surgery. Plastic surgery is recommended usually between 1
developing nasal septum. The fusion takes place from the anterior and 2 years of age, before improper speech habits have been
to the posterior region. The primary and secondary palates later will acquired.
form the hard palate. Two folds grow posteriorly from the posterior
edge of the palatal processes to create the soft palate, so that the
uvula is the last structure to be formed
 The union of the two folds of the soft palate occurs during the
eighth week. The two parts of the uvula fuse in the midline during
the 11th week. The interval between the primary palate and
secondary palate is represented in the midline by the incisive
foramen.

 Cleft palate is commonly associated with cleft upper lip. All degrees
of cleft palate occur and are caused by failure of the palatal
processes of the maxilla to fuse with each other in the midline; in
severe cases, these processes also fail to fuse with the primary
palate (premaxilla) (Figs. 11.83 and 11.84). The first degree of
severity is cleft uvula, and the second degree is ununited palatal
processes. The third degree is ununited palatal processes and a cleft
on one side of the primary palate. This type is usually associated
with unilateral cleft lip. The fourth degree of severity, which is rare,
consists of ununited palatal processes and a cleft on both sides of
the primary palate. This type is usually associated with bilateral cleft
lip. A rare form may occur in which a bilateral cleft lip and failure of
Shaira
TRANSCRIBERSx 6 of 6