HNSS ANATOMY

Oral Region
Dr. Sammy C. Wong
Learning Objectives:

1. To enable the students to identify the boundaries, subdivisions and

contents of the oral cavity.
2. To enable the students to describe the innervation of the cheeks, teeth
and gingivae.
3. To enable the students to name the intrinsic and extrinsic muscles of the
tongue and their origin, insertion, innervation and specific action
4. To enable the students to describe the regions of the tongue and their
innervation
5. To enable the students to describe the various papillae of the tongue
6. To enable the students to name the different salivary glands, their
innervation and secretion
 ORAL REGION
➢ Oral Cavity

➢ Teeth

➢ Gingivae

➢ Tongue

➢ Palate
➢ Region of Palatine
Tonsils
 ORAL CAVITY

➢ Where food and drinks are tasted

➢ Mastication and lingual
manipulation
➢ Extends from the Lips to the
entrance of the pharynx called
Oropharyngeal Isthmus
➢ Divided into Oral Vestibule and
Oral Cavity Proper
 ORAL VESTIBULE
➢ Slit-like horseshoe-shaped space between the teeth and gingiva,
and lips and cheeks
➢ Boundaries:
• Externally: Lips and cheeks
• Internally: gums and teeth
• Superior and Inferior: reflection of mucus membrane (tethered
buccinator muscle by elastic fibers in the mucosa)
• Lateral: Cheeks (Buccinator muscle and mucus membrane)
 ORAL CAVITY PROPER
Space between upper and lower
dental arches
When mouth is closed and in rest,
tongue occupies oral cavity
Boundaries
• Anterior and Laterally: Teeth and
gums
• Superior: Hard palate and soft
palate behind
• Inferior: Tongue and floor of mouth
 COMMUNICATIONS

➢ Oral vestibule communicates with exterior through oral fissure

controlled by circumoral muscles
➢ Oral cavity communicates with oropharynx at oropharyngeal
isthmus
➢ When closed jaw: oral vestibule and oral cavity communicate
behind third molar of each side
Salivary Glands That Terminate in the Oral Cavity

1. Parotid duct/Duct of Stensen

• Enters the vestibules of the mouth upon a small papilla
opposite the upper 2nd molar tooth

2. Submandibular duct/Wharton’s duct

• Opens into the mouth on a small papilla situated at the side
of the frenulum of the tongue

3. Sublingual Duct - Terminates along the sublingual fold

 RETROMOLAR SPACE

➢ The retromolar triangle/ retromolar fossa or retromolar gap

➢ Space posterior to the third molar, between the distal edge of the
tooth and the anterior margin of the ascending ramus when the
mandible is held in lateral view
➢ The vestibule communicates with the mouth proper via the
space behind the third molar tooth
➢ Foramen called retromolar foramen present in retromolar area,
which transmits a neurovascular bundle consisting of an artery,
vein and a nerve.
 PALATE

The palate forms the arched

roof of the oral cavity proper
and the floor of the nasal
cavities. The palate consists
of hard and soft parts: the
hard palate anteriorly and the
soft palate posteriorly.
 HARD PALATE
The hard palate separates the anterior part of the oral cavity from the
nasal cavities. The hard palate (covered by a mucous membrane) is
formed by the palatine processes of the maxillae and the horizontal
plates of the palatine bones.
 HARD PALATE
Three foramina open on the oral aspect of the hard palate: the
incisive fossa and the greater and lesser palatine foramina. The
incisive fossa is a slight depression posterior to the central incisor
teeth. The nasopalatine nerves pass from the nose through a variable
number of incisive canals and foramina that open into the incisive
fossa. Medial to the third molar tooth, the greater palatine foramen
pierces the lateral border of the bony palate. The greater palatine
vessels and nerve emerge from this foramen and run anteriorly on the
palate. The lesser palatine foramina transmit the lesser palatine
nerves and vessels to the soft palate and adjacent structures.
 SOFT PALATE
The soft palate separates the posterior part of the oral cavity from the
nasopharynx. The soft palate is the movable third of the palate,
which is suspended from the posterior border of the hard palate. The
soft palate extends posteroinferiorly as a curved free margin from
which hangs a conical process, the uvula.
The soft palate is strengthened by the palatine aponeurosis, formed
by the expanded tendon of the tensor veli palatini.
When a person swallows, the soft palate is then elevated posteriorly
and superiorly against the wall of the pharynx, thereby preventing
passage of food into the nasal cavity.
SENSORY INNERVATION OF THE PALATE
The sensory nerves of the palate pass through the pterygopalatine
ganglion and are considered branches of the maxillary nerve. The
greater palatine nerve supplies the gingivae, mucous membrane,
and glands of most of the hard palate. The nasopalatine nerve
supplies the mucous membrane of the anterior part of the hard
palate. The lesser palatine nerves supply the soft palate. The
palatine nerves accompany the arteries through the greater and
lesser palatine foramina, respectively. Except for the tensor veli
palatini supplied by CN V3, all muscles of the soft palate are supplied
through the pharyngeal plexus of nerves, derived from pharyngeal
branches of the vagus nerve (CN X).
 TONGUE

➢ A mass of striated muscle covered with mucous membrane

➢ Articulation (word formation during speaking)
➢ Squeezing food into oropharynx, in deglutition (swallowing)
➢ Mastication
➢ Taste
➢ Oral cleansing
 TONGUE

ATTACHMENTS:

• Superior: Styloid process and Soft palate

• Inferior: Mandible and Hyoid bone

SURFACES:

• Superior & posterior surface – dorsum, “top”

• Inferior surface – ventral, “underside”

 TONGUE

Divided by:
• Median fibrous septum –
right and left halves
• Superior surface: median
sulcus/midline groove
• Inferior surface: frenulum
• Sulcus terminalis – anterior
and posterior parts
TONGUE
 INFERIOR SURFACE OF TONGUE
Frenulum of the tongue
• Mucous membrane connected to the floor of the mouth
• Deep lingual vein is seen in each side of the frenulum through the
thin mucous membrane
Sublingual caruncle
• On each side of the base of the lingual frenulum
• Includes the opening of the submandibular duct
Plica fimbriata
• Mucous membrane that forms a fringe fold lateral to the lingual vein
TONGUE
SUPERIOR SURFACE OF TONGUE

Sulcus terminalis

• V-shaped groove

• Foramen cecum

• Apex of the sulcus that projects backwards

• Frequently absent and is a nonfunctional remnant of

thyroglossal duct which the thyroid gland developed
 SUPERIOR SURFACE OF TONGUE
Lingual papillae
• Filiform - long & numerous; sensitive
to touch; no taste buds
• Fungiform – mushroom-shaped;
numerous at apex and margins of
the tongue
• Circumvallate – large and flat
topped; directly anterior to sulcus
terminalis
• Foliate – lateral folds poorly
developed in humans
 PARTS OF TONGUE
ORAL PART (Apex)
• Presulcal (Anterior 2/3)
• Located in oral cavity proper
• Has thin mucosa closely attached to the underlying muscle
• Numerous small lingual papillae Anterior to palatoglossal arch
(and oropharyngeal isthmus)
PHARYNGEAL PART (Root)
• Postsulcal (posterior 1/3)
• Located in oropharynx
• Has thick mucosa that is freely moveable
• Lacks lingual papillae
• Lymphoid nodules (Lingual Tonsil)
• Anterior wall of oropharynx
PARTS OF TONGUE
 MUSCLES OF TONGUE

INTRINSIC MUSCLES
• Not attached to the bone
• Confined within the tongue
• SUPERIOR LONGITUDINAL
• TRANSVERSE
• VERTICAL
• INFERIOR LONGITUDINAL
 INTRINSIC MUSCLES
ORIGIN:
• Median Septum and Submucosa
INSERTION:
• Mucous Membrane
NERVE SUPPLY:
• Hypoglossal Nerve
ACTION:
• Alters Shape of Tongue
INTRINSIC MUSCLES
 MUSCLES OF TONGUE
EXTRINSIC MUSCLES
• Attached to bones and soft palate
• Originate outside tongue
• GENIOGLOSSUS
• STYLOGLOSSUS
• HYOGLOSSUS
• PALATOGLOSSUS
 GENIOGLOSSUS

ORIGIN:
• Superior genial spine of mandible

INSERTION:
• Blends with other tongue muscles

NERVE SUPPLY:
• Hypoglossal nerve

ACTION:
• Protrudes apex of tongue through
mouth
 HYOGLOSSUS
ORIGIN:
• Body and greater cornu of
hyoid bone

INSERTION:
• Blends with other tongue
muscles

NERVE SUPPLY:
• Hypoglossal nerve

ACTION:
• Depresses tongue
 STYLOGLOSSUS
ORIGIN:
• Styloid process of temporal bone

INSERTION:
• Blends with other tongue muscles

NERVE SUPPLY:
• Hypoglossal nerve

ACTION:
• Draws tongue upward and
backward
 PALATOGLOSSUS
ORIGIN:
• Palatine aponeurosis

INSERTION:
• Side of tongue

NERVE SUPPLY:
• Pharyngeal plexus

ACTION:
• Pulls root of tongue upward and
backward, narrows oropharyngeal isthmus
 TONGUE MUSCLES

➢ Protrusion – genioglossus (both sides)

➢ Retraction – styloglossus and hyoglossus
➢ Depression – hyoglossus
➢ Retractions & elevation of posterior third – styloglossus and
palatoglossus
➢ Shorten & thicken to retract – superior & inferior longitudinal
➢ Lengthen & narrow to protrude – transverse & vertical longitudinal
 TONGUE INNERVATIONS

Anterior 2/3:
• General sensation: Lingual
nerve (CN V3)
• Taste sensation: Chorda
tympani (CN VII)
Posterior 1/3:
• General and taste sensation:
CN IX
 BLOOD SUPPLY
Lingual Artery
• Main arterial supply from ECA
• Passes deep to the hyoglossus muscle
Dorsal lingual arteries
• Supply the root of the tongue
• Lingual septum prevents communication
Deep lingual arteries
• Supply the lingual body
• Communicate w/ each other near apex of
tongue
Tonsillar branch of Facial Artery
Ascending Pharyngeal Artery
 VENOUS DRAINAGE
Internal Jugular Vein
• Dorsal Lingual Vein
• Accompanies lingual artery
• Both run posteriorly to join
the sublingual vein
• Sublingual Vein
• Deep Lingual Vein
 LYMPHATIC DRAINAGE
Submental lymph nodes
• Drains tip
Submandibular lymph nodes
• Sides of anterior 2/3
Deep Cervical lymph nodes
• Posterior ⅓
• All lymph ultimately drains here
• Superior DC drains root
• Inferior DC drains medial part of body
LYMPHATIC DRAINAGE
Role of the Tongue in Mastication and Swallowing

Tongue turns the food and mixes it with saliva and aids in
separating and sorting out unsuitable particles.

During mastication, the tongue takes part in all stages, defined as

“preparation” when the tongue becomes trough-like, ‘throwing’ the
food between the teeth, ‘guarding’ the food from falling back from
the teeth, ‘sorting-out’ the particles and ‘bolus formation’, and in
swallowing.
 TEETH

➢ Hard, conical structures set in dental alveoli

➢ Incise (cut)

➢ Reduce and mix food with saliva (for mastication)

➢ Sustain themselves in the tooth sockets

➢ Articulation (distinct connected speech)

 TEETH PARTS
DIVISIONS
• Crown – projects from gingiva
• Neck – between crown and neck
• Root – fixed in tooth socket by periodontium
COMPOSITION
• Dentine
• Enamel (crown)
• Cement (root)
• Pulp cavity – has connective tissues, blood vessels, and nerves
• Pulp canal – transmits nerves and vessels to and from pulp cavity
through apical foramen
TEETH PARTS
 TEETH
Deciduous teeth
• Milk/primary teeth
• 20 deciduous teeth for each jaw
• 4 incisors, 2 canines, 4 molars
• Eruption/cutting
• Starts about 6 mos. after birth
• By the end of 2 years, all have
erupted
• Lower jaw teeth first usually
appear than those of upper jaw
 TEETH

Permanent teeth
• Replaces deciduous teeth
• Begin to erupt at 6 years of age
• 3rd molar last to erupt (~17-30
years old)
• 32 permanent teeth for each
jaw:
• 4 incisors, 2 canines, 4
premolars, 6 molars
TEETH
 TEETH TYPES
Incisors
• Front teeth
• Thin cutting edges
• 1 root and chisel-shaped crown
Canines
• Posterior to incisors
• Longest teeth having a crown with
single pointed cusps
• For grasping
 TEETH TYPES
Premolars/bicuspid
• crown with 2 cusps, 1 on buccal side,
and other on lingual
• For grinding
Molars
• Behind premolars
• 3 roots and crown with 3 to 5 cusps
• For grinding
 TEETH

INNERVATION
• Upper Jaw: Maxillary
branch of CN V
• Lower Jaw: Mandibular
branch of CN V
TEETH
SALIVARY GLANDS
 SUBMANDIBULAR REGION

The region between the

mandible and the hyoid bone
contains the submandibular
and sublingual glands,
suprahyoid muscles,
submandibular ganglion, and
lingual artery.
 SUBMANDIBULAR GLANDS
➢ Lies beneath the lower border of the body of the mandible
➢ Divided into superficial and deep parts by the mylohyoid muscle
➢ Deep part: lies beneath the mucous membrane of the mouth on the
side of the tongue
➢ Submandibular duct/Wharton’s duct
• Emerges from the anterior end of the deep part of the gland
• Runs forward beneath the mucous membrane of the mouth
• Opens into the mouth on a small papilla situated at the side of the
frenulum of the tongue
➢ Type of Secretion: Mixture of serous (mainly) and mucous
 SUBMANDIBULAR GLAND
INNERVATION:
• CN VII via chorda tympani and the
submandibular ganglion
NERVE SUPPLY:
• Lingual Nerve
BLOOD SUPPLY:
• Submental arteries
VENOUS DRAINAGE:
• Submental veins
LYMPHATIC DRAINAGE:
• Deep cervical lymph nodes
 SUBMANDIBULAR GANGLION
The submandibular ganglion lies
on the lateral surface of the
hyoglossus muscle, medial to the
mylohyoid muscle, superior to the
submandibular duct and
hypoglossal nerve, and inferior to
the lingual nerve, from which it is
suspended by several branches.
 SUBMANDIBULAR GANGLION
Preganglionic parasympathetic fibers reach the ganglion from the
superior salivary nucleus of the seventh cranial nerve via the chorda
tympani and lingual nerves. The preganglionic fibers synapse within
the ganglion, and the postganglionic fibers pass to the submandibular
salivary gland, to which they are secretomotor. Other postganglionic
secretomotor fibers pass to the sublingual salivary gland and small
salivary glands in the mouth by returning to the lingual nerve and
traveling with the branches of the nerve to reach the glands.
Few postganglionic sympathetic fibers pass without interruption
through the ganglion and are vasomotor to the blood vessels of the
glands.
NERVES OF THE SUBMANIDIBULAR REGION

1. Lingual nerve

2. Glossopharyngeal nerve

3. Hypoglossal nerve
 LINGUAL NERVE
The lingual nerve is a branch of the posterior division of the mandibular
nerve. It enters the submandibular region by passing forward and
medially beneath the lower border of the superior constrictor of the
pharynx, related laterally to the lower third molar tooth.
Course in the submandibular region:
Lateral surface of hyoglossus >>> lateral surface of submandibular
duct >>> upward and forward on the medial side of submandibular duct
>>> under the sublingual gland on the lateral surface of genioglossus
>>> divides into terminal branches which supply the mucous
membrane of the anterior 2/3 of the tongue and floor of the mouth.
 Branches of the Lingual Nerve

1. Ganglionic branches – Submandibular ganglion and other

smaller ganglia
2. Sensory branches – Distributed to the mucous membrane of the
anterior 2/3 of the tongue and floor of the mouth and lingual
surface of the gums
3. Communicating branches – Connect the nerve to the hypoglossal
nerve on the side of the tongue
 Glossopharyngeal Nerve

The lingual branch of the glossopharyngeal nerve supplies

general sensory and special taste fibers to the mucous
membrane of the posterior third of the tongue and the
circumvallate papillae region of the anterior part of the tongue.
The lingual branch enters the tongue below the styloglossus
muscle.
 Hypoglossal Nerve

From the carotid sheath, this nerve reaches the lower border of
the posterior belly of the digastric >>> crosses the lingual artery
>>> lateral surface of the hyoglossus and medial part of the
mylohyoid . It lies below the deep part of the submandibular
gland, the submandibular duct and the lingual nerve. The nerve
ends by curving upward toward the tip of the tongue, supplying
branches to the muscles.
Branches of the Hypoglossal Nerve in the
Submandibular Region

1. Nerve to the thyrohyoid

2. Nerve to the geniohyoid
3. Muscular branches – All the muscles of the tongue except
the palatoglossus
4. Communicating branch – Hypoglossal nerve
communicates with the lingual nerve on the side of the
tongue
 SUBLINGUAL REGION

The sublingual space is

located on both sides of the
tongue, superomedial to the
mylohyoid muscle and lateral
to the midline geniohyoid-
genioglossus muscle complex
 SUBLINGUAL GLANDS

➢ Smallest and most deeply situated

➢ Lies beneath the mucous membrane (sublingual fold) of the floor of
the mouth, close to the frenulum of the tongue between the
mandible and genioglossus
➢ Glands from each side unite to form a horseshoe-shaped mass
around the lingual frenulum
➢ Terminates along the sublingual fold in a horizontally aligned
manner
➢ Type of Secretions: Mixture of serous and mucous (mostly)
 SUBLINGUAL GLAND
INNERVATION:
• CN VII via chorda tympani (motor)
• Lingual Nerve
BLOOD SUPPLY:
• Sublingual (from lingual artery)
• Submental arteries (from facial
artery
VENOUS DRAINAGE:
• Sublingual & submental veins
LYMPHATIC DRAINAGE:
• Deep cervical lymph nodes
 SUBLINGUAL GLANDS

Sublingual ducts:

• 8-20 in number

• Open into the mouth on the

summit of the sublingual fold

• Major: Duct of Bartholin

• Minor: Duct of Rivinus

Muscles of Submandibular Region
 References

Wineski, Lawrence: Snell’s Clinical Anatomy by Regions, 10th Edition, 2018.

Snell, Richard: Clinical Anatomy by Regions, 9th Edition, 2011.

Moore, K.L., Dalley, A.F., and Agur, A.R.:Clinically Oriented Anatomy, 8th Edition, 2017