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Oral cavity and pharynx

Oral cavity and pharynx. Face = Facies. labia oris (sup.+inf.) frenulum angulus oris philtrum sulcus mentolabialis nasolabialis bucca = cheek m. buccinator corpus adiposum buccae Bichati = buccal pat pad extensions. General structure of digestive tube.

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Oral cavity and pharynx

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  1. Oral cavity andpharynx

  2. Face = Facies • labia oris (sup.+inf.) • frenulum • angulus oris • philtrum • sulcus • mentolabialis • nasolabialis • bucca = cheek • m. buccinator • corpus adiposum buccae Bichati = buccal pat pad • extensions

  3. General structure of digestive tube • tunica mucosa (mucosa; mucous membrane) • epithelium • lamina propria mucosae • lamina muscularis mucosae • tela submucosa (submucosa) • tunica muscularis (muscular layer) • tunica serosa (serosa) x tunica adventitia (adventitia)

  4. tunica serosa / tunica adventitia tunica muscularis tela submucosa tunica mucosa General structure of digestive tube

  5. epithelium lamina propria mucosae lamina muscularis mucosae mucosa Tunica mucosa connective tissue blood vessels, lymphatics, macrophages and lymphocytes, sometimes glands smooth muscles movements of mucosa – better contact with food

  6. submucosa Tela submucosa connective tissue blood and lymph vessels, glands, lymphoid tissue submucous plexus (of Meissner) of autonomic nerves function: secretion submucous plexus

  7. muscularis Cajal cells - pacemaker Tunica muscularis smooth muscle cells 2 sublayers longitudinal 1) internal - circular circular 2) external - longitudinal myenteric plexus – (of Auerbach) contraction of muscular layer Enteric nervous system– part of autonomic nervous system • plexus submucosus et myentericus • aggregates of nerve cells that form parasympathetic ganglia (contains autonomic neurons) • origin from neural crest

  8. Enteric nervous system • Hirschsprung disease (megacolon congetinum, aganglionosis intestinalis) • cells from neural crest do not migrate properly • Chagas disease (American trypanosomiasis) • parasite (Trypanosoma cruzi) • trasmitted by "kissing bugs“ • injures nervous plexuses • dilations (mega-oesophagus, megacolon)

  9. serosa / adventitia Tunica serosa / Tunica adventitia • tunica serosa • simple squamous • mesothel • + tela subserosa • connective tissue • rich in vessels and adipose tissue • continuous with mesenterium and peritoneum • only on organs which are inside the abdominal cavity (= intraperitoneal organs) • tunica adventitia • connective tissue • on organs outside the abdominal cavity and on retroperitoneal organs

  10. Oral cavity (Cavitas oris) • oral vestibule (vestibulum oris) • oral cavity proper (cavitas oris propria) • hard palate (palatum durum) • soft palate (palatum molle) • gum (gingiva) • tongue (lingua) • teeth (dentes) • salivary glands (glandulae salivariae)

  11. Oral cavity (Cavitas oris) • lips – transition to keratinizing epithelium • pars cutanea • pars intermedia (vermilion part) – glandulae sebaceae • pars mucosa – glandulae labiales • m. orbicularis oris (n. VII • stratified sqamous non-keratinizing epithelium(epithelium stratificatum squamosum non cornificatum / paracornificatum) • lamina propria mucosae underlied with submucosa containing small salivary or mucinous gland (soft palate)

  12. Stratified sqamous epithelium • keratinizing – skin, hard palate, gum • non-keratinizing – rest of oral cavity, pharynx, oesophagus

  13. Cheek (bucca) https://web.duke.edu/anatomy/Lab17/Lab17.html • m. buccinator (n. VII) covered by fascia buccopharyngea • corpus adiposum buccae (buccal fat pad of Bichat) –reaches under ramus mandibulae into the fossa infratemporalis • glandulae buccales • ductus parotideus • papilla parotidea in vestibulum oris • at the level of the 2nd upper molar

  14. Oral cavity (Cavitas oris) • rima oris (oral fissure)  isthmus faucium (isthmus of fauces) borders: • ventrally and externally: lips (labia oris) and cheeks (buccae) • roof: palate (palatum) • floor: m. mylohyoideus and m. geniohyoideus • vestibulum oris (oral vestibule) • fornix vestibuli sup. + inf. • frenulum labii sup. + inf. • papilla parotidea

  15. Tongue (Lingua, Gr. glossa) • apex • corpus (body) • dorsum • facies inferior • radix (root) • margo (margin) • sulcus (groove) • terminalis • medianus (midline) • foramen caecum • tonsilla lingualis

  16. Development of tongue - overview • 1st pharyngeal arch → tuberculum impar + tubercula lateralia • 2nd pharyngeal arch → overgrown by 1st • 3rd pharyngeal arch → cupola • 4th pharyngeal arch → eminetia hypopharyngea • occipital somites → muscles

  17. Tongue – structure • dorsum – papillae • radix – tonsilla lingualis • facies inferior linguae • frenulum • plica sublingualis • openings of ductus sublinguales minores • caruncula sublingualis (sublingual caruncle) • opening of ductus sublingualis major et dutcus submandibularis • plica fimbriata (remnant of mucous „sublingua“)

  18. Tongue - structure • lamina propria mucosae tvoří vysoké papily • papillae filiformes • papillae fungiformes • sparse gustatory buds • papillae foliatae - rudimentary • papillae vallatae - 12 shaped as letter „V“ • glandulae gustatoriae (= Ebner´s serous glands) • gustatory buds • tunica submucosa is missing at dorsum! • stratified muscle in 3 planes

  19. Papillae of tongue (Papillae linguales)

  20. papillae vallatae papillae foliatae papillae filiformes papillae fungiformes

  21. Taste buds (Gemmae gustatoriae) • in all papillae (except for papillae filiformes) • most of them within papillae vallatae • papilla vallata • vallum papillae • sulcus papillae • serous salivary glands (of von Ebner) glandulae gustatoriae • wash food particles away

  22. Tongue – muscles • aponeurosis, septum (incomplete) • intraglossal – n. hypoglossus • m. longitudinalis sup. et inf. • m. transversus • m. verticalis

  23. Extraglossal muscle of tongue innervation – n. hypoglossus • m. genioglossus • m. hyoglossus • m. styloglossus • m. palatoglossus ! exception ! – n. vagus

  24. Extraglossal muscle of tongue

  25. Tongue – vessels and nerves • arteries: a. carotis ext. →a. lingualis • veins: v. lingualis, v. comitans n. XII.→ v. jugularis int. • nerves: • motor n.XII, n.X (m. palatoglossus) • sensory n.V3. (n. lingualis), n.IX, n.X • gustatory VII. (chorda tympani), n.IX, n.X

  26. Tongue – lymph drainage nodi lymphoidei cervicales profundi • tip  n.l. submentales • margins  n.l. submandibulares • corpus, dorsum  n.l. cervicales profundi • n.l. jugulo-digastricus + jugulo-omohyoideus • ! contralateral connections !

  27. Salivary glands (Glandulae oris) • major salivary glands (glandulae salivariae majores) • gl. parotidea • gl. sublingualis • gl. submandibularis • minor salivary glands (glandulae salivariae minores) • gll. labiales, buccales, molares, palatinae • gll. linguales anteriores (Blandini-Nuhni) • gll. lingulaes posteriores • pars profunda = gl. gustatoria (von Ebneri) • pars superficialis = gl. radicis linguae (Weberi)

  28. Throat (Fauces) • hrad palate (palatum durum) • soft palate (palatum molle) • aponeurosis (formed by fuesd tendons of tensor veli palatini) • uvula (seals nasopharynx in swallowing) • arcus palatoglossus • arcus palatopharyngeus = isthmus faucium • palatine tonsil (tonsilla palatina)

  29. Isthmus faucium • arcus palatoglossus (palatoglossal arch; anterior pillar of fauces) • fossa (sinus) tonsillaris • tonsilla palatina • capsula • fossula • cryptae • fossa supratonsillaris • arcus palatopharyngeus palatopharyngeal arch (posteiror pillar of fauces)

  30. Muscles of soft palate innervation: plexus pharyngeus = n. vagus (n.X) • m. levator veli palatini • m. uvulae • m. palatoglossus • m. palatopharyngeus • m. tensor veli palatini – ! exception ! n.V3 (mandibularis)

  31. Hltan – pars nasalis = nasopharynx; epipharynx • fornix • fascia pharyngobasilaris • sinus Morgagni • recessus pharyngeus Luschkae (remnant after notochord) • pharyngeal tonsil (tonsilla pharyngealis Luschkae) • tuba auditiva Eustachii • torus tubarius • tonsilla tubaria Gerlachi • recessus pharyngeus Rosenmülleri • pseudostatified columnar epithelium with kinocilia

  32. Hltan (Pharynx)

  33. Hltan – other parts pars oralis (oropharynx; mezopharynx) • valleculae epiglotticae • plica glossoepiglottica mediana + laterales pars laryngea (laryngopharynx; hypopharynx) • recessus piriformis • aditus laryngis both lined with stratified nonkeratinizing squamous epithelium

  34. Pharynx – surrounding spaces • fascia cervicalis • spatium parapharyngeum (lateropharyngeum) • spatium prestyloideum • septum styloideum (aponeusoris stylopharyngea) • 5 muscles and ligament • m. stylopharyngeus + m. styloglossus + m. stylohyoideus + lig. stylohyoideum + venter posterior m. digastrici + m. sternocleidomastoideus spatium retrostyloideum • spatium retropharyngeum

  35. Muscles of pharynx • raphe pharyngis • fascia pharyngobasilaris • sinus Morgagni • 3 constrictors • 3 levators • innervation: plexus pharyngeus (n.X) • except m. stylopharyngeus (n.IX)

  36. Muscles of pharynx • constrictors (mm. constrictores) • m.c. superior – 4 parts – origin at skull (3) and tongue (1) • m.c. medius – 2 parts – origin at hyoid bone • m.c. inferior – 2 parts – origin at laryngeal cartilages • levators (mm. levatores) • m. palatopharygeus • part of soft palate muscles, base of palatopharyngeal arch • m. salpingopharyngeus • m. stylopharyngeus • ! exception ! – innervated by n.IX

  37. Pharynx – blood supply • arteries: a. carotis externa→ • a. pharyngea ascendens • a. facialis → a. palatina ascendens • a. lingualis → rr. dorsales linguae • a. maxillaris → a. palatina major, a. canalis pterygoidei, r. pharyngeus • veins: plexus (venosus) pharyngeus → v. facialis →v. jugularis interna

  38. Pharynx – lymph and nerves • lymph: n.l. retropharyngei, n.l. paratracheales →n.l. cervicales profundi • nerves: form plexus pharyngeus • motor n.X (plexus pharyngeus), n.IX (m. stylopharyngeus) • sensory n.X + n.IX (plexus pharyngeus), n.V2 (n. pharyngeus for nasopharynx) • autonomic (plexus pharyngeus) • n.X = parasympathetic • rr. laryngopharyngei = sympathetic

  39. Anulus lymphoideus pharyngis Waldeyeri • tonsilla lingualis • crypta, noduli • one smaller crypt • tonsilla palatina • fossulae, cryptae, capsula • thick capsule • tonsilla pharyngealis = adenoid vegetation • fossulae, cryptae, noduli • no crypts, thin capsule • tonsilla tubariaGerlachi • cryptae

  40. Sites with weakened wall • trigonum Killiani • cranially: m. thyropharyngeus (m. constrictor ph. inf.) • caudally: m. cricopharyngeus (m. constrictor ph. inf.) • diverticulum of Zenker (= pharyngo-oesophageal diverticle; dehiscence of Killian) • trigonum Laimeri • cranially: m. cricopharyngeus • caudally: upper oblique fibres of longitudinal muscle layer of oesophagues • (area Killian-Jamieson) • at lateral side of oesophagus • diverticulum of Killian-Jamieson

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