GIT: TONGUE AND

ORAL CAVITY
Mary Aljaelen Dotillos-Quinsat, MD
ORAL CAVITY
Oral cavity
• Oral cavity is inferior to the nasal cavities
• It has a roof and floor and lateral walls

• Opens onto the face through the oral fissure, and is

continuous with the cavity of the pharynx at the
Oropharyngeal isthmus

• The roof of the oral cavity consists of the hard and soft
palates

• The floor is formed mainly of soft tissues, which include a

muscular diaphragm and the tongue
Oral Cavity
• ORAL FISSURE
• Anterior opening of the oral cavity
• Location where cheeks merge anteriorly with the lips
• The oral cavity is separated into two regions by the upper
and lower dental arches consisting of the teeth and
alveolar bone:
• ORAL VESTIBULE
• Outer, horseshoe shaped area
• Located between dental arches and deep surfaces of of the cheeks and
lips
• Location where oral fissures opens
• Close by muscles of facial expression and movements of lower jaw
Oral Cavity
• ORAL CAVITY PROPER
• Located on inner portion of oral cavity
• enclosed by the dental arches
• The oral cavity has multiple functions:
• Inlet for the digestive system involved with the initial processing of
food, which is aided by secretions from salivary glands
• It manipulates sounds produced by the larynx and one outcome of
this is speech
Innervation
• General sensory innervation is carried predominantly by
branches of the trigeminal nerve:
• Upper parts of the cavity (palate and the upper teeth) Branches
of the maxillary nerve

• Lower parts (teeth and oral part of the tongue)  Branches of the
mandibular nerve

• Taste (special afferent [SA]) from the oral part or anterior two-thirds
of the tongue  Branches of the facial nerve
Innervation
• Parasympathetic fibers to the glands within the
oral cavity Facial nerve distributed with Branches of
Trigeminal nerve

• Sympathetic fibers in the oral cavity Spinal cord level

T1, synapse in the Superior cervical sympathetic ganglion
distributed by Trigeminal nerve

• Allmuscles of the tongue are innervated by the

hypoglossal nerve except the Palatoglossus Vagus
nerve
Innervation
• All muscles of the soft palate Vagus nerve except for
the Tensor veli palatini Mandibular nerve

• The muscle (Mylohyoid) that forms the floor of the oral

cavity is also innervated by the Mandibular nerve
Walls: Cheeks
• The walls of the oral cavity are formed by the cheeks

• Cheek consists of fascia and a layer of skeletal muscle

sandwiched between skin externally and oral mucosa
internally

• The thin layer of skeletal muscle within the cheeks is

principally the Buccinator muscle
Buccinator
• The buccinator muscle holds the cheeks against the
alveolar arches and keeps food between the teeth when
chewing

• The buccinator is innervated Buccal branch of the

Facial nerve

• General sensation from the skin and oral mucosa of the

cheeks Buccal branch of the Mandibular nerve
Floor
• The floor of the oral cavity proper is formed mainly by
three structures:
• Muscular diaphragm fills the U-shaped gap between the left and
right sides of the body of the mandible; composed of the paired
mylohyoid muscles
• Two cord-like Geniohyoid muscles above the diaphragmrun from
the mandible in front to the Hyoid bone posteriorly
• Tongue Superior to the geniohyoid muscles. Also present in the
floor of the oral cavity proper are salivary glands and their ducts
PALATE
Roof- Hard Palate
• The roof of the oral cavity consists of the palate, which
has two parts—an anterior hard palate and a posterior
soft palate

• HARD PALATE
• separates the oral cavity from the nasal cavities
• It consists of a bony plate covered above and below by
mucosa:
• Superiorly, it is covered by respiratory mucosa and forms the floor
of the nasal cavities.
• Inferiorly, it is covered by a tightly bound layer of oral mucosa and
forms much of the roof of the oral cavity
Roof
• TRANSVERSE PALATINE FOLDS
• Palatine rugae
• Mucosal rugae of the hard palate in the oral cavity

• PALATINE RAPHE
• Median longitudinal raphe

• INCISIVE PAPILLA
small oval elevation anteriorly
• Overlies the incisive fossa formed between horizontal
plates of the maxillae behind the incisor teeth
Soft Palate
• Continues posteriorly from the hard palate and acts as a
valve that can be:
• depressed to help close the oropharyngeal isthmus
• elevated to separate the nasopharynx from the oropharynx

• formed and moved by four muscles and is covered by

mucosa that is continuous with the mucosa lining the
pharynx and oral and nasal cavities

• UVULA
• small tear-shaped muscular projection that hangs from the
posterior free margin of the soft palate
Muscles of soft Palate
• Five muscles on each side contribute to the formation and
movement of the soft palate
• The tensor veli palatini and levator veli palatini, descend
into the palate from the base of the skull.
• The Palatoglossus and Palatopharyngeus, ascend into
the palate from the tongue and pharynx, respectively.
• Musculus uvulae is associated with the uvula

• All muscles of the palate are innervated by the vagus

nerve except for the tensor veli palatini, which is
innervated by the mandibular nerve
Arteries
• ASCENDING PALATINE ARTERY
• Branch of the Facial Artery
• Ascends along the external surface of the Pharynx
• Loops medially around the Superior constrictor muscle of
the Pharynx with the Levator veli palatini going to the soft
palate

• PALATINE BRANCH
• Branch of the Ascending Pharyngeal Artery
• Follows the same course of the Ascending palatine artery
from the Facial artery
Arteries
• GREATER PALATINE ARTERY
• Originates from the Maxillary Artery in the Pterygopalatine
fossa
• Descends into the Palatine canal to give Branch to the
LESSER PALATINE BRANCH onto the inferior surface of
the hard palate
• Terminates into the medial wall of the Nasal cavity
Veins
• Veins from the palate generally follow the arteries and
ultimately drain into the Pterygoid plexus of veins in the
infratemporal fossa or network of veins associated with
the palatine tonsil, which drain into the Pharyngeal
plexus of veins or directly into the Facial vein
Lymphatics
• Lymphatics from the palate drain into DEEP CERVICAL
NODES
Innervation
• GREATER AND LESSER PALATINE NERVES
• The greater and lesser palatine nerves descend through
the pterygopalatine fossa and palatine canal to reach the
palate:
• Greater Palatine nerve travels the greater palatine foramen going
anteriorly to supply the hard palate and first premolar
• Lesser Palatine nerve passes posteromedially to supply soft
palate
• NASOPALATINE NERVE
• Originates in the Pterygopalatine fossa but passes medially in to
Nasal cavity
• Continues to the roof of nasal cavity to anterior floor descending to
reach the hard palate
• Supplies the gingiva and mucosa of incisors and canine
Lips and oral fissure
• ORAL FISSURE
• Slit-like opening between lips that connects the oral vestibule to the
outside

• LIPS
• Entirely composed of soft tissues
• lined internally by oral mucosa and covered externally by skin

• PHILTRUM
• shallow vertical groove on its external surface sandwiched between
two elevated ridges of skin
• The philtrum and ridges are formed embryologically by fusion of the
medial nasal processes
Lips and Oral fissure
• MEDIAL LABIAL FRENULUM
• A fold of mucosa on inner surface of both lips
• Connects the lip to the adjacent gum

• OROPHARYNGEAL ISTHMUS
• The oropharyngeal isthmus is the opening between the oral cavity
and the oropharynx
• It is formed:
• laterally by the palatoglossal arches
• superiorly by the soft palate
• inferiorly by the sulcus terminalis of the tongue that divides the oral surface
of the tongue (anterior two-thirds) from the pharyngeal surface (posterior
one-third)
SALIVARY GLANDS
Salivary glands
• Salivary glands are glands that open or secrete into the
oral cavity
• Most are small glands in the submucosa or mucosa of the
oral epithelium lining the tongue, palate, cheeks, and lips

• Open into the oral cavity directly or via small ducts.

Parotid gland
• Located in a shallow, triangular-shaped trench formed by:
• Sternocleidomastoid muscle posteriorly
• Ramus of the mandible anteriorly
• Superiorly- Base of the trench is formed by the external acoustic
meatus and the posterior aspect of the zygomatic arch
• The gland normally extends anteriorly masseter
muscle
• Inferiorlyposterior belly of the digastric muscle
Submandibular glands
• Elongated, hook-shaped
• Smaller than Parotid glands but larger than Sublingual
glands
• Larger arm directed towards below Mylohyoid muscle
• Larger superficial part of the gland is directly against a shallow
impression on the medial side of the mandible (submandibular
fossa) inferior to the mylohyoid line
• smaller arm of the hook (or deep part) of the gland loops
around the posterior margin of the mylohyoid muscle
lateral to the Hyoglossus muscle
• Submandibular duct medial side of the deep part of the
gland in the oral cavity, opens beside the base of the
Frenulum of the tongue
Sublingual glands
• smallest of the three major paired salivary glands
• almond shaped
• Immediately lateral to the submandibular duct and
associated lingual nerve in the floor of the oral cavity
• SUBLINGUAL FOSSA
• Shallow groove superior to the anterior 1/3 of the mylohyoid line
where each sublingual gland lies directly against the medial surface
of mandible

• SUBLINGUAL FOLD
• Elongate fold of mucosa at the superior margin of sublingual gland
• Extends from posterolateral aspect of floor of oral cavity to
sublingual papilla beside frenulum of tongue
Sublingual glands
• It drains into the oral cavity via numerous small ducts
(Minor sublingual ducts)
• Anterior part of the gland drained by Major Sublingual
duct
Arteries
• Parotid gland supplied by vessels originating from
External Carotid Artery

• Submandibular and Sublingual glands supplied by

Branches of Facial and Lingual Arteries
Veins
• Veins form Parotid gland EXTERNAL JUGULAR VEIN

• Veins from Submandibular and Sublingual glands

LINGUAL and FACIAL VEINS
Lymphatics
• Lymphatic vessels from the parotid gland drain into nodes
that are on or in the gland

• Parotid nodes drain into Superficial and Deep cervical

nodes

• Lymphatics from the submandibular and sublingual glands

submandibular nodes Deep cervical node
(Jugulomohyoid node)
Innervation
• PARASYMPATHETIC
• Parasympathetic innervation to all salivary glands in the
oral cavity Branches of the Facial nerve join branches
of the Maxillary and Mandibular nerve

• Parotid gland outside the oral cavity receives its

parasympathetic innervation from fibers that initially
traveled in the Glossopharyngeal nerve join Branch of
the Mandibular nerve
Greater Petrosal Nerve
• All salivary glands above the level of the oral fissure, as
well as all mucus glands in the nose and the lacrimal
gland in the orbit Parasympathetic fibers of Greater
Petrosal Branch of Facial Nerve
Chorda tympani
• All glands below the level of the oral fissure (small glands
in the floor of the oral cavity, in the lower lip, and in the
tongue, and the larger submandibular and sublingual
glands) innervated by Parasympathetic fibers carried in
the Chorda tympani branch of the Facial nerve