The Oral Cavity I

THE MOUTH
The mouth is enclosed between the lips and the cheeks. It extends from the lips to the oropharyngeal ishthmus. (the junction of mouth with the pharynx).

Functions
The function of the mouth and its associated structures is to form a receptacle for food, to begin mechanical digestion through chewing (mastication), and to form words in speech. It can also assist the respiratory system in the passage of air.

The mouth is divided into two parts:

1-VESTIBULE. 2-MOUTH CAVITY PROPER.
Vestibule lies between the lips and cheeks externally and the gums and teeth internally. Mouth cavity proper is the space inside the teeth and gums.

THE VESTIBULE

The vestibule is a slit like space that communicates with the exterior through the oral fissure. It leads, by the space behind the teeth ,into the cavity of the mouth. Superiorly and inferiorly the vestibule is limited by the mucous membrane. The cheek forms the lateral wall of the vestibule. It is made up of buccinator muscle. On the mucous membrane of the cheek ,the parotid duct opens on a low papilla opposite the second molar teeth.

THE MOUTH CAVITY PROPER

ROOF: Formed by the hard and soft palate. FLOOR: Largely occupied by tongue. The frenulum of the tongue connects the undersurface of the tongue with the floor of the mouth.

Parts of the oral cavity

Hard & Soft palate Tongue Alveolar margins of maxillae & mandible Teeth Gums Cheek

The palate

It forms the arched roof of the oral cavity & the floor of the nasal cavities On the nasal side it is lined by respiratory mucosa & on the oral side by oral mucosa, densely packed with glands It consists of the hard palate anteriorly & the soft palate posteriorly

The hard palate

Concave towards the oral side Filled with tongue when at rest The ant 2/3 has a bony skeleton formed by

Palatine process of maxilla Horizontal plates of palatine bones

Features of the hard palate

Incisive fossa behind the central incisors. Structures passing from nasal to oral side Nasopalatine nerves They enter the incisive canals

Features of the hard palate

The greater palatine foramen medial to 3rd molar for the passage of Greater palatine vessels and nerves which emerge & run forwards to supply the molars, premolars, canines & the palatine mucosa

The hard palate

The lesser palatine foramen through which the following structures pass

Lesser palatine vessels and nerves to supply the soft palate

The hard palate

Mucosa. Firmly adherent to the bone. Lingual gingiva is continuous with the mucosa An injection of local anaesthetic into gingiva also anaesthetises the palate Deep to mucosa are mucous secreting palatine glands, hence the pitted appearance

The hard palate

Posterior to maxillary incisor teeth is incisive papilla, an elevation of mucosa anterior to underlying incisive foramen Several transverse folds radiate from the papilla, the transverse palatine folds or rugae Central white ridge, the palatine raphe,marks the site of embryonic fusion of bones.

The hard palate

incisive papilla transverse palatine folds or rugae palatine raphe Soft palate uvula

Cleft palates
Partial cleft Complete cleft

The soft palate

It is the movable posterior third of palate It hangs from the post border of hard palate The expanded tendon of tensor veli palatini muscle forms a strong aponeurosis, the palatine aponeurosis which is attached to the post border of hard palate.

The soft palate

The soft palate extends posteriorly as a free margin The central part hangs as a conical process called uvula The strength of the soft palate comes from palatine aponeurosis which is thick anteriorly & thin posteriorly

The soft palate

During swallowing the soft palate is tensed to push the bolus into oropharynx, then it is elevated to prevent the food from entering into nasal cavity Laterally it is continuous with the tongue & pharynx by palato glossal & palatopharyngeal folds

Oral cavity showing the palate

The soft palate

Soft palate Uvula Palatine tonsil Palatoglossal fold Palatopharyngeal fold Dorsum of the tongue

The fauces

The space b/w oropharynx & oral cavity Faucial pillars The isthmus of the fauces Tonsillar sinus or fossa

Muscles of the soft palate

Tensor & levator arise from the cranial base & are inserted into the palate They can elevate, tense or depress the soft palate

Muscles of the soft palate

Tensor veli palatini Levator veli palatini Palatoglossus Palatopharyngeus Musculus uvulae The last three arise from the palate

Muscles of the soft palate

Tensor veli palatini Origin

Scaphoid fossa Spine of sphenoid Cartilage of the auditory tube Takes a 90 degree bend around hamulus

Insertion Palatine aponeurosis

Muscles of the soft palate

Actions Tenses the soft palate Opens the mouth of auditory tube during swallowing & yawning Nerve supply Medial pterygoid nerve via otic ganglion

Muscles of the soft palate

Levator veli palatini Origin Cartilage of the auditory tube Petrous part of temporal bone Insertion Palatine aponeurosis

Muscles of the soft palate

Actions Elevates soft palate during swallowing & yawning Nerve supply Pharyngeal branch of vagus via pharyngeal plexus

Muscles of the soft palate

Palatoglossus Origin Palatine aponeurosis Insertion Side of the tongue

Muscles of the soft palate

Actions Brings posterior part of the tongue & soft palate together Nerve supply Pharyngeal branch of vagus via pharyngeal plexus

Muscles of the soft palate

Palatopharyngeus Origin Hard palate Palatine aponeurosis Insertion Lateral wall of pharynx

Muscles of the soft palate

Actions Tenses the soft palate Brings pharyngeal walls forwards, medially & superiorly Nerve supply Pharyngeal branch of vagus via pharyngeal plexus

Muscles of the soft palate

Musculus uvulae Origin Post nasal spine & palatine aponeurosis Insertion Own mucosa

Muscles of the soft palate

Actions Shortens uvula & pulls it up Nerve supply Pharyngeal branch of vagus via pharyngeal plexus

Muscles of the soft palate

Palatine tonsils inflamed

Blood supply of the palate

Greater palatine artery a branch of descending palatine artery. It also gives off Lesser palatine artery Ascending palatine artery from facial artery

Sensory nerves of the palate

These are branches of maxillary nerve through pterygopalatine ganglion Nasopalatine nerve. Greater palatine nerve. Lesser palatine nerve.

THE TONGUE

The Tongue

Muscular organ, mobile & can adapt many positions & shapes About 2/3 is in the oral cavity & the rest in oropharynx Its functions are Taste Mastication Swallowing Cleansing Speech or articulation

Parts of the tongue

Apex, is the tip & is highly mobile Body, ant 2/3,highly mobile Root, post. 1/3 Curved dorsum Inferior surface

The Tongue

Dorsal surface of the tongue

Curved & partly in the oral cavity & partly in pharynx V shaped sulcus terminalis marks the boundry Points towards foramen caecum Remnant of embryonic thyroglossal duct

Dorsal surface of the tongue

The margins are in relation to lingual gingivae Mucous membrane on ant. 2/3 is rough due to the presence of lingual papillae. Most of these contain taste buds Vallate papillae: Large & flat, make a V shaped row in front of sulcus terminalis Each is surrounded by a trench into which the ducts of the serous glands open

Dorsal surface of the tongue

Foliate papillae: Small leaf like folds, poorly developed Filiform papillae: Vshaped rows of conical projections, pinkish in colour & sensitve to touch

Dorsal surface of the tongue

Fungiform papillae: Numerous at the apex & margins. Shaped like mushroom, pink to red in colour

Dorsal surface of the tongue

M. memb over the dorsum is thin & adherent to the muscle anteriorly Shallow midline groove indicates site of fusion of distal buds Posteriorly the m. memb. is thick & movable. No papillae, but irregular appearance due to underlying lymphoid follicles Collectively they are known as lingual tonsils.

Inferior surface of tongue

Thin transparent m. memb Veins visible Midline fold called frenulum On each side a deep lingual vein & a sublingual papilla is visible Opening of the sublingual salivary gland on the summit of the papilla

Muscles of the tongue

Two groups Extrinsic: Alter the position of the tongue Intrinsic: Alter the shape of the tongue

Muscles of the tongue

EXTRINSIC M: Genioglossus: Fan shaped Origin Mental spine or genial tubercle on mandible Insertion Under surface of the entire dorsum Body of the hyoid

Muscles of the tongue

Hyoglossus: Thin quadrilateral Origin Body & greater horn of hyoid bone Insertion Inferior aspect of the lateral part

Muscles of the tongue

Styloglossus: Short & triangular Origin Ant. Border of styloid process Stylohyoid lig. Insertion Post. Part of the side of the tongue, interdigitates with hyoglossus

Muscles of the tongue

Palatoglossus: Narrow sickle shaped Origin Palatine aponeurosis Insertion Enters post part of lateral margins transversely & becomes continuous with intrinsic transverse mm.

Muscles of the tongue

There is a vertical fibrous septum that runs anteroposteriorly from the base to the tip. INTRINSIC muscles are: Sup longitudinal m. Oblique fibres lying beneath the dorsal mucosa. Extends from submucous fibrous tissue & the median septum to the margins of the tongue.

Muscles of the tongue Inf. Longitudinal m

Narrow band close to inf. mucosa from the root to the apex. Transverse muscle From median fibrous septum to the lingual margins. Vertical muscle From dorsal to ventral mucosa in the ant. & lat. Parts of tongue.

Muscles of the tongue

Nerve supply All are supplied by the hypoglossal n. Actions They alter the shape of the tongue Longitudenal m. shorten the tongue. They can turn the apex upwards or downwards Transverse m narrow & elongate the tongue Vertical muscles widen & flatten the tongue

Muscles of the tongue

Nerves in relation to the lingual muscles

Blood supply of the tongue

Arteries

Lingual artery Ascending palatine branch of facial Ascending pharyngeal a. Dorsal lingual vein IJV Deep lingual vein + sublingual vein vena comitans nervi hypoglossi joins either facial or lingual v IJV

Venous drainage

Vessels of the tongue

Lymphatic drainage of the tongue

Lymphatic plexus in the lingual mucosa Muscular lymphatic plexus Both plexuses are connected & drain into marginal lymph vessels from apex to frenula enter submental, juguloomohyoid, submandibular & jugulodigastric nodes deep cervical nodes

Lymphatic drainage of the tongue

Central lymph vessels Jugulodigastric, jugulo-omohyoid & submandibular nodes deep cervical nodes Dorsal vessels drain the region behind the vallate papillae they join the marginal vessels deep cervical nodes