Nasal and oral cavities, tongue, taste, olfaction, salivary glands

Describe the central pathways of olfaction (CN I) and taste (VII, IX, X) Describe the anatomy of the tongue, including motor and sensory (general and taste) innervation, blood supply, and lymphatic drainage Identify the salivary glands and components of the palate, nasal and oral cavities, and paranasal air sinuses, and summarise their innervation and blood supply Summarise functions of CN I, V, VII, IX, X, XII related to the above regions

Dissection Lab availability during study week and exams

Open
5 June 9 June, 9am-5pm 12-13 June, 9am-5pm

Written 14 June, 9-11am Prac 16 June, 1pm 5pm (4 groups, 1 hour each)

Suprahyoid muscles
Digastric, anterior (V3) & posterior bellies (VII) Stylohyoid (VII) Mylohyoid - floor of mouth (V3) Geniohyoid (C1) Actions: raise hyoid bone and floor of mouth during swallowing, stabilise hyoid, lower mandible (open mouth)

Netter 47

Oral cavity
Boundaries: cheeks, lips, palate, floor of mouth and tongue Subdivisions: vestibule (between cheek/lips & teeth/gums), oral cavity proper (deep to teeth) Continues into oropharynx posteriorly

Netter 45

 Joints: gomphoses (fibrous peg in socket joint) between teeth and superior/inferior alveolar processes of maxilla/mandible 4 x (2 incisors, 1 canine/cuspid, 2 premolars/bicuspids, 3 molars) = 32 permanent Crown, root Root canal with nerves, vessels Mandibular teeth inferior alveolar n (V3) Maxillary teeth superior alveolar nn (V2) Vessels for both from maxillary artery R

Teeth

L Upper

Lower
Netter 50, http://www.ada.org/public/topics/permanent_number.asp

Parotid salivary gland

Key n/a/v relations: facial n, retromandibular v, external carotid a, superficial temporal aa/vv, auriculotemporal n Parotid duct pierces buccinator, opens opposite 2nd upper molar

Netter 19, 45, 54

Submandibular and sublingual salivary glands

Submandibular duct opens at sublingual papilla (caruncle) Sublingual ducts along sublingual fold Key relations of submandibular gland: facial a&v, hypoglossal n, lingual a&v, lingual n Key relations of sublingual gland: submandibular duct, branches of lingual a,v,n

Netter 45, 55, Drake 8.252b

Parasympathetic innervation of salivary glands

Parotid: inferior salivatory nucleus, glossopharyngeal n (IX), otic ganglion (synapse), postganglionics via auriculotemporal n (of V3) Submandibular and sublingual: superior salivatory nucleus, facial n (VII), chorda tympani to lingual nerve (of V3), submandibular ganglion (synapse)

Netter 127, 128

 Intrinsic: longitudinal, transverse, vertical (change shape of tongue) Extrinsic: genioglossus (protrudes), hyoglossus (lowers and retracts), styloglossus and palatoglossus (elevate and retract)

Tongue muscles
Netter 54, 53

Innervation of tongue muscles: hypoglossal nerve (CN XII)

All muscles of tongue by XII except palatoglossus (X) Lower motor neurons in hypoglossal nucleus in medulla Exit brainstem at preolivary sulcus, cranial cavity at hypoglossal canal

Netter 108 Fix 23

UMN control over hypoglossal nucleus LMNs: Corticobulbar tract

Cell bodies in primary motor cortex and nearby areas Fibres travel through internal capsule, cerebral peduncle of midbrain, basal pons UMNs supply LMNs bilaterally
Unilateral UMN lesion - usually no observable effect on tongue Unilateral LMN lesion - ipsilateral tongue paralysed, atrophies with time Stick tongue out deviates towards side of lesion (paralysis of genioglossus)

Netter 53, Nolte 447

Gustatory sensation
Taste includes smell, gustatory sense, general sensation (touch, temperature) Dorsum of tongue contains papilla, most without taste buds (filiform), some with (fungiform, foliate, vallate) Taste buds detect salty, sweet, sour, bitter, umami (glutamate)

Netter 53, Wheater 316

Taste pathways
Anterior 2/3 tongue: VII, geniculate ganglion (1o) Posterior 1/3 tongue: IX, petrosal ganglion (1o) Epiglottis, pharynx: X, nodose ganglion (1o) Nucleus of solitary tract (2o) Pontine taste area (3o) Thalamus (VPM) (4o) Insula, postcentral gyrus (5o) Limbic system, hypothalamus, orbital cortex of frontal lobe
Netter 129 Fix 23

General sensation from tongue

Anterior 2/3 of tongue: V3 Posterior 1/3 of tongue: IX Trigeminal, petrosal ganglia (1o) Same pathway as general sensation from face: Descending (pain,temp), main (touch) nuclei of V (2o) (cross) trigeminothalamic tract VPM thalamus (3o) Postcentral gyrus of cortex (4o)

Haines 230; Drake 8.248

Glossopharyngeal n (IX), hypoglossal nerve (XII), and lingual n (V3 branch)

Lingual n: deep to mandible Hypoglossal n: superficial to external and internal carotid aa and hyoglossus, superior to mylohyoid motor to tongue Glossopharyngeal n: close to stylopharyngeus (supplies it), between external and internal carotid arteries
Sensory (general and taste) to posterior 1/3 of tongue Sensory to much of pharynx Supplies carotid sinus and body Parasympathetic to parotid

Netter 65

Blood supply of tongue

Lingual artery from external carotid artery
branches include dorsal lingual, sublingual, deep lingual aa

Lingual veins (with lingual a and XII) drain to internal jugular vein (usually join facial vein first)

Netter 53

Lymphatic drainage of tongue

Important in spread of cancer Anterior tongue: to submental, submandibular nodes and then to deep cervical nodes (including juguloomohyoid node) Posterior tongue: to deep cervical nodes (including jugulodigastric node) Central part of tongue bilateral drainage

Netter 66

External nose
Bony margins: nasal bones, maxillae Major cartilages: lateral nasal cartilage greater alar cartilage - lateral crus and medial crus

Netter 31

Nasal cavity
Anterior entrance: nares (nostrils), vestibule Posteriorly continuous with nasopharynx at choanae Respiratory region: thick mucous membrane for warming and humidifying inspired air, mucus captures dust etc, cilia move mucus posteriorly into nasopharynx Olfactory region: superior-most part of nasal cavity

Netter 32, Drake 8.219

Nasal septum
Separates nasal cavity on midline Bony: vomer, perpendicular plate of ethmoid Cartilaginous: septal cartilage, medial crura of greater alar cartilages

Netter 34, Weir 9e

Lateral nasal wall

Nasal, maxilla, lacrimal, ethmoid (middle and superior concha), inferior nasal concha, palatine, medial pterygoid plate of sphenoid Conchae (turbinates) with associated air passages, the meatuses Concha increase surface area of respiratory region and cause turbulent flow in inspired air, aiding warming and humidification

Netter 33, Weir 9e

 Diverticula of nasal cavity, expand into Paranasal air sinuses diploe of bone with increasing age Sphenoid sinus: within body of sphenoid (inferior and anterior to pituitary fossa)
Opens into sphenoethmoidal recess posterior to superior concha

Frontal sinus
Opens via nasofrontal duct into semilunar hiatus into middle meatus

Netter 32, Weir 7e,h

Paranasal air sinuses

Maxillary sinus
Opens into semilunar hiatus of middle meatus

Ethmoid air cells

open into middle and superior meatuses

(Note: nasolacrimal duct opens into inferior meatus)

Netter 32, Weir 8d, Drake 8.218

Palate
Separates nasal and oral cavities, and can separate naso- and oro-pharynx Hard palate: maxilla and palatine bones Soft palate: posterior to hard palate

Netter 5 , Weir 18b

Muscles of soft palate

Levator veli palatini, tensor veli palatini, palatoglossus, palatopharyngeus, musculus uvulae Elevated during swallowing, depressed during chewing Innervated by vagus n (X), with LMNs in nucleus ambiguus (Exception: tensor veli palatini by V3) Unilateral LMN or CN X lesion: uvula deviates away from side of lesion, soft palate droops on affected side
Netter 46, 58, Drake 8.257, 8.258

Nerves: Mostly branches of maxillary division of trigeminal n (V2)

General sensory innervation and blood supply of nasal cavity and palate

Anteriorly, branches of ophthalmic division of trigeminal n (V1) Arteries: Mostly from maxillary artery (from external carotid a) Anteriorly and superiorly from ophthalmic artery (from internal carotid a) Near vestibule from facial artery (from external carotid a)

Netter 36, 37

Parasympathetic innervation of nasal cavity and palate

Supplies mucus glands Superior salivatory nucleus Facial nerve (CN VII) Pterygopalatine ganglion (synapse), postganglionic fibres via branches of maxillary nerve (V2) (also to lacrimal gland)

Netter 127

 Olfactory epithelium in superior nasal cavity-lateral wall&septum Receptor cells are bipolar neurons - dendrite has cilia with Gprotein coupled odorant receptors (about 1000 different odorant receptors, each neuron expresses only one type of receptor) Olfactory axons pass through cribriform plate of ethmoid bone to synapse in olfactory bulb Head trauma may cause anosmia - loss of smell, and reduced taste Olfactory neurons replaced throughout life, and axons must grow to correct targets in olfactory bulb (CNS) Netter 36, 113

Olfaction (smell)

Olfaction (smell)
Olfactory bulb projects ipsilaterally via olfactory tract to primary olfactory cortex (piriform cortex, anterior perforated substance) Only sensory modality to reach cerebral cortex without first synapsing in thalamus From primary olfactory cortex, to hypothalamus, amygdala, limbic system, DM thalamus, other cerebral cortex including insula

Netter 113, Nolte 13.15