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SISTEM PENCERNAAN MAKANAN Bagian 1

drg. Happy Harmono, M.Kes

ORAL STRUCTURES - Sagittal view

HARD PALATE TOOTH LIP

SOFT PALATE

TONGUE
LIP GUM SALIVARY GLANDS

+ CHEEK

ALVEOLAR BONE

WABeresford

1. LABIA
Bibir berdsr strukturnya 3 bagian : 1. Bag. luar ditutupi kulit tipis disbt pars cutanea - punya epitel berlapis pipih bertanduk - dgn kel. sebacea, ` - kel. sudorifera - folikel rambut. 2. Pd bagian merah bibir atau pars intermedia, - mengandung pblh darah & syaraf. - disbt Red area / transitional zone / lip margin. - epitel berlapis pipih tanpa tanduk serta pd lamina proprianya punya papillae.

3. Bag. Mukosa / pars mukosa, punya epitel berlapis pipih tak bertanduk serta lamina propria dgn papillae yg tinggi-tinggi & banyak dijumpai glandulae labialis yg bersifat sero-mukos.

RED MARGIN
VERMILION BORDER

LIP

LABIAL MUCOSA thick strat squam ep

HAIRY SKIN

LABIALGLAND mucous

MUSCLE

RED MARGIN keratin thins away no follicles or glands

Gambar 14.1 A, Keratinized stratified squamous epithelium (pars cutanea); B, Red margin; C, Nonkeratinized stratified squamous epithelium (pars mucosa); D, Minor mucoserous salivary glands

Gambar 14.2: Pars cutanea labia A, Sweat gland; B, Sebaceous gland; C, Hair follicle

Gambar 14.3: Pars intermedia labia A, Red margin; B, Nonkeratinized oral mucosa; C, Orbicularis oris muscle

Gambar 14.4: Sub mukosa A, Mixed seromucous glands; B, Dense connective tissue; C, Blood vessels

2. LINGUA Struktur sebagian besar otot-otot bergrs yg tdr gabungan sabut-sabut otot yg berjln saling tegak lurus satu dgn lainnya pd 3 arah.
Lidah dibagi 2 daerah : - didepan (ventral) seluas 2/3 bagian, pd permuk. banyak ditemukan papilla lingualis. - 1/3 bag. dorsal banyak terdpt limphonodi & kel. spt kel. Ebner serus murni & bermuara didsr sulcus papilla sirkumvalata & kel. Weber mukos murni, Juga terdpt kelenjar Blandin Nuhn yg bersifat seromukos.

Papa PAPILLA & Dental Family


Interdental/interproximal papilla of gingiva GINGIVA TONGUE
Developing DENTAL ORGAN

VALLATE, FILIFORM, & FUNGIFORM

Dermis DERMAL PAPILLA

LINGUAL PAPILLAE
HAIRs

dermal papilla
DENTAL PAPILLA
& palates incisive papilla

TONSILS

TONGUE - dorsum

CIRCUMVALLATE PAPILLA
Trench

FUNGIFORM PAPILLA

FILIFORM PAPILLAE Taste bud


FOLIATE PAPILLAE on the lateral tongue are vestigial in man, prominent in rabbit

Gambar 14.5: Potongan lidah

Mukosa bag. dorsal penuh tonjolan papilla lingualis dgn epitel berlapis pipih & penandukan tdk sempurna. Papilla lingualis dibtk oleh propria papil dan permuk. diliputi epitel. Propria papil bercabang lagi shg ada papil primer dan sekunder. Dibwhnya terdpt otot bergaris.
Pd lidah manusia didptkan 3 jenis papilla lingualis : papilla filiformis, fungiformis & sirkumvalata.

Papilla filiformis berbtk konis relatif panjang & sempit, dgn epitel berlapis pipih bertanduk, & epitelnya mengikuti kontur papil sekunder. Jml papilla filiformis banyak menutupi hampir seluruh permukaan dorsal lidah. Papilla fungiformis btknya spt jamur menonjol pd permuk. lidah dgn bag. dekat basal lebih kecil dr bag. atasnya. Epitelnya berlapis pipih tanpa tanduk shg warnanya nampak lebih merah. Papilla ini mempunyai papilla primer & sekunder, ttp epitel tdk mengikuti kontur papilla sekunder. Kadang dipermuk. terdpt Taste bud yg berfungsi alat pengecap.

Papilla sirkumvalata Jmlhnya sedikit hanya sekitar 7 12 buah. Btk spt fungiformis ttp jauh lebih besar & dikelilingi parit. Letaknya di sepanjang sulcus terminalis. Dilapisi epitel berlapis pipih tdk bertanduk ttp tdk mengikuti kontur papilla sekunder. Punya Taste bud yg banyak trtm di bag. lateral. Papilla foliata btk spt daun ttp pd manusia rudimenter. Letaknya diposterior lateral lidah dekat sulcus terminalis. Epitel nya tdk bertanduk, punya 3 propria papilla sekunder & yg tengah terdpt pemblh darah sedang yg tepi terdpt sabut saraf.

Gambar 14.6: Papilla fungiform

Gambar 14.7: Papilla sirkumvalata, A. Taste bud

Taste bud : mrpk alat pengecap rasa. Taste bud terdpt diantara epitel permuk. papilla yg tampak pucat dgn bentuk spt tong. Basalnya berhub. dgn tunica propria, taste bud ini punya lubang kecil yg sebelah luar disbt outer taste pore (pori gustatori) & kearah dalam terdpt bentukan sel reseptor (neuroepitel cell) yg memanjang kearah basal berhub. dgn serat saraf serta dikelilingi sel selubung (sel penyangga/sustentaculer cells) serta ada sel basal.

3. MUKOSA GINGIVA
Epitel berlapis pipih bertanduk dgn berbagai tingkat. Penandukkan paling tebal pd bagian yg banyak terkena gesekan pd proses mengunyah.

Epitel disebelah dlm punya tonjolan diantara propria papil yg dinamakan retepeg. Disisi luar epitel retepeg terdpt cekungan yg disbt stipling. Mukosa ggv punya Propria papil tinggi-tinggi & banyak mengandung pblh darah.
Propria tdr anyaman sabut-sabut jar. ikat kasar yg melekat pd tulang alveol atau pd permuk. akar di sekitar servikal gigi. Tdk mempunyai sub mukosa yg jelas.

Muco-gingival junction
TOOTH Muco-gingival junction

FREE GINGIVA

Periodontal ligament

ATTACHED GINGIVA

Crest of Alveolar bone

Alveolar mucosa
lies outside alveolar bone

Gambar 14.9: A, Rete peg; B, Connective tissue papilla; C, Oral cavity adjacent to attached gingiva; D, Parakeratinized stratified squamous epithelium

Gambar 14.11: Mukosa pipi

Gambar 14.10: A, Stippling gingiva; B, Keratin layer

A A

Gambar 14.12: A. Mukosa gingiva, B. Mukosa pipi

5. MUKOSA PALATUM Palatum Durum, epitelnya berlapis pipih bertanduk, propria papil panjang-panjang & byk pblh darah shg berwarna merah muda. punya sub mukosa ttp didekat ggv & di Midline tdk ada. Punya sabut-sabut jar. ikat kasar yg berarah vertikal yg mengikat lamina propria dgn kuat thd periosteum palatum durum. 1/3 anterior submucosanya disbt fatty zone krn banyak lemak, ttp 2/3 bagian posterior glandulla zone byk ngandung kel. mukous. Didekat raphe sering dijumpai epithelial peare yg mrpk kumpulan sel epitel pipih berbtk bulat sbg sisa fusi process. palatinus.

HARD PALATE: Cross-section


PALATE BONE why it is hard! Periosteum

RAPHE midline ridge (a join) ADIPOSE CT - anterior MUCOUS GLANDS - STRATIFIED SQUAMOUS EPITHELIUM para-keratinized posterior act as thin padding Rugae - ridges - not shown
& palates incisive papilla

Gambar 14.13: Regio posterolateral dari palatum keras. A, Submucosa mengandung glandula seromucous; B, Mucoperiosteum

Palatum Molle, epitelnya berlapis pipih tanpa tanduk. Lapisan ini terus ke permuk. uvula & nasopharynx yg kemudian dilanjutkan dgn epitel berderet silindrik bersilia dgn sel goblet. Submukosa banyak ngandung kel. mukous sedang yg kearah pharyngeal kel. campur. Otot bergaris yg kecil-kecil terdpt dlm palatum molle & uvula.

Gambar 13.14 A, Hard palate; B, Soft palate; C, Nasal cavity (dorsal to the hard and soft palate)

6. DASAR RONGGA MULUT Epitel berlapis pipih tak bertanduk. Submukosanya kendor & berisi kel. sublingual

Gambar 14.13: Mukosa dasar mulut

Gambar 14.13: Mukosa dasar mulut

7. PHARYNX saluran berfungsi sbg jalan nafas atau jalan mkn. epitel berbeda-beda sesuai tempat & fungsinya. -Pd sal. mkn epitel berlps pipih tanpa tanduk, -pd sal. nafas epitel berderet silindrik -pd perbatasan epitel berlapis silindrik.

Pd lapisan bawah epitel terdpt jar. ikat padat fibroelastik, lebih kedlm terdpt sabut elastik berarah longitudinal.

Pd lapisan lebih dlm terdpt otot bergaris. Jar. ikat pd fibroelastik terdpt pd submukosa lapisan fibroelastik. Didlm nasopharynx terdpt banyak jar. limfoid yg tersusun difus maupun kel. limfonoduli, serta kel. campur. Pd oropharynx & laryngopharynx terdpt limfonoduli yg tersebar & sedikit kelenjar mukous.

terimakasih

study of oral mucosa:

1. Lip
This has three areas to study. i. External skin outer layer of epithelium - keratinised, stratified squamous relatively.thin epithelium with short flat epithelial ridges underlying dermis of connective tissue, contains: hair follicles, sebaceous glands, sweat glands and a diffuse network of collagen and elastic fibres over muscle bundles.

ii. Vermillion Border/transitional zone epithelium is keratinised (becoming parakeratinised). epithelium is thin with marked epithelial ridges and capillaries very close to the surface - hence red colouration. iii. Vestibular mucosa (Inner aspect of lip). epithelium - non-keratinised stratified squamous contains basal layer, prickle cell layer and no granular layer. desquamation takes place from a superficial layer. nuclei retained in the outer layers shallow, flat, irregular epithelial ridges. connective tissue base thin and delicate with deeper layers which contain collagen bundles and minor salivary glands

2. Floor of mouth
epithelial layer - thin non-keratinised stratified squamous. very shallow, infrequent epithelial ridges. lamina propria is thin and loose. the deeper layers of very loose areolar tissues contain salivary glands and fat cells. deeper still is a layer of muscle. The tissues on the previous two slides indicate some of the variations to be found in the oral lining. The inside of the lip and the floor of the mouth are protected from the wear and tear of mastication. They show no adaptation to stresses from this source.

3. Gingiva and muco-gingival junction the gingiva has a ortho or para- keratinised stratified squamous epithelium. very long and sharp epithelial ridges. the underlying lamina propria is a dense tissue which is continuous with the periosteum of the alveolar bone (which is missing from the slide this full thickness is known as a mucoperiosteum. compare the number and size of blood vessels with those found under the nonmasticatory mucosa (the alveolar mucosa) which is attached.

the alveolar mucosa is non-keratinised with short flat epithelial ridges and a sub-mucosa with prominent capillaries. note very sharp junction between the keratinised and non-keratinised epithelia the muco-gingival junction. 4. Hard Palate the hard palate in the mid line is a mucoperiosteum (similar to gingiva) with a keratinised epitheliumand long, sharp epithelial ridges. at the lateral borders there may be a submucosa with minor salivary glands and capillaries

5. Soft Palate the tissue has two 'outer' surfaces covered by an epithelium- an upper or dorsal surface and a lower or ventral surface. dorsal surface epithelium is a thin pseudo stratified ciliated columnar epithelium. the oral surface has a non-keratinised startified squamous epithelium with short, flat epthelial ridges. the lamina propria is thinner than the more anterior parts of the palate (the hard palate) with an increased number of capillaries. there is a large sub-mucosa with prominent minor salivary glands. deep to the sub-mucosa is the central core of striated muscles.

6. Cheek or Buccal Mucosa normally a non-keratinised epithelium with relatively short, flat epithelial ridges. a well vascularised lamina propria and a sub-mucosa attached to the underlying muscle secondary keratinisation may be present, particularly along the occlusal line.

7. Dorsum of tongue at the junction between the anterior 2/3 and posterior 1/3 of the tongue is the sulcus terminalis - this contains the circumvallate papillae. These possess many taste buds. the circumvallate papillae sit in depressions which are irrigated by the von Ebner glands which are minor serous salivary glands. the anterior 2/3 is covered by a highly specialised keratinised epithelium in the form of (primarily) filiform papillae. Less numerous (non-keratinised) fungiform papillae are also present.