The Teeth,Oral Cavity Tongue, Salivary Glands, Pharynx. Their Vessels and Innervation Gitivo Klepáček Digestive System

General Anatomy of Gastro-IntesTinal System

The Teeth,Oral Cavity Tongue, Salivary Glands, Pharynx. Their Vessels and Innervation GITIvo Klepáček Digestive System:

Oral cavity (ectodermal origin)

The gut and ist derivatives (entodermal origin) is divided in four sections:

1. Pharyngeal gut or pharynx 2. Foregut - esophagus, stomach, ¼ of duodenum, liver and gallblader, pancreas 3. Midgut – ¾ of duodenum, jejunum, ileum, colon caecum, colon ascendens and 2/3 of colon transversum 4. Hindgut – 1/3 of colon transversum, colon descendens, GITcolon sigmoideum, colon rectum, canalis analis Function Structure Accessory glands

Cavum oris Glandulae Digestio salivariae Pancreas hepar

Absorptio GITEliminatio Primordium of the alimentary canal (GastroInTestinal Canal)

● GIT develops together with respiratory system – systema gastropulmonale –

● it develops from the embryonal intestine (entoderm) ; lower respiratory structurses are splitted from intestine as a tracheobronchial pouch

● Ventral (head) intestine part is added to ectodermal pouch called stomodeum, caudal part of the intestine is added to ectodermal pouch called tracheobronchial proctodeum pouch

● Division of the alimentary tract:

● 1) oral ectodermal segment 2) main entodermal segment 3) caudal ectodermal segment

● děivision of the main segment:

● ventral gut (foregut – to biliary duct opening) middle gut (midgut – to 2/3 colon) GITdorsal gut (hindgut – to upper part of the anal canal Alimentary tube (canal) - general structure – tunica mucosa (mucous membrane) 1 • epithelium • lamina propria mucosae (lymph tissue) • lamina muscularis mucosae – tunica submucosa (submucous layer) – vessels, nerves (plexus submucosus Meissneri) – tunica muscularis (outer + inner muscular layer) – longitudinal, circular even plexiform; vessels, salivary glands (glandulae salivariae) nerves (plexus myentericus Auerbachi) pancreas – tunica serosa (serous layer) or liver (hepar) tunica adventitia (fibrous layer) 14 gall bladder and bile ducts (vesica fellea, GITductus choledochus) Maxilla and Mandible formation

Philtrum, Frontonasal Nasolacrimal maxillary groove, et Lacrimal sac, Cheeks, mandibular Maxillae, processes 28 day 35 day Nose

GIT48 day 14 week Development of the facial skeleton, formation of the nasal and oral cavities ● Primitive lips: – week 6 - ectoderm ingrowth to mesenchyme in developing jaw – formation of the labiogingival lamina ● lamina splits into two layers separated by groove ● central part of upper lip (known as a philtrum develops from the intermaxillary segment)

Primitive oral cavity - Week 5-6 – 10-14 stomodeum depression lined by ectoderm and oropharyngeal membrane margines: lower processes (mandibular) from the 1. pharyngeal arch - laterally of them upper processes (maxillary) of the 1. pharyngeal arch superiorly frontonasal process where nasal placodes appear (→pits, sacs and later are opened to primitive nasal cavity), medial and GITlateral nasal processes. Šikmý rozštěp tváře Oblique facial cleft

Sulcus nasolacrimalis

Nude ductus nasolacrimalis

Příčný rozštěp tváře GITTransverse facial cleft Cavitas oris Oral cavity rima oris – isthmus faucium

Dental arches divide cavity:

vestibulum oris and cavitas oris propria

borders: Ventrally: lips - labia oris laterally: faces – buccae roof: palatum bottom: mylohyoid m. + geniohyoid m., tongue (lingua, glossa)

Masticatory mucosa - Hard palate + gum (keratinized) Specialised mucosa - Tongue + papillary epithelium GITLining mucosa - Bucca, soft palate (non-keratinized) Periodontium Innervation: free endings pain Ruffini bodies traction Vater-Paccini bodies pressure, vibration

Mucosa - masticatory specialised lining Innervation: free, Paccini, Ruffini, Meissner pain, temperature, vibration, traction, pressure free, Paccini, Ruffini, taste buds pain, temperature, vibration, traction, taste free, Paccini, Meissner, Merkel GITtemperature, vibration, pressure, pressure The border between the lips and the surrounding skin is referred to as the vermilion.

Labium + mentum Lip GITChin Labia

The skin of the lip, with three to five cellular layers, is very thin compared to face skin, which has up to 16 layers. Lip skin contains fewer melanocytes (pigment cells). Because of this, the blood vessels appear through the skin of the lips, which leads to their notable red coloring. The lip skin is not hairy, and does not have sweat glands or sebaceous glands. Therefore it does not have the usual protection layer of sweat and body oils which keep the skin smooth, inhibit pathogens, and regulate warmth. For these reasons, the lips dry out faster and become chapped GITmore easily. Outer keratinized epithelium is followed by internal multilayered cuboid and slowly keratinized (para- keratinization) epithelium lamina propria mucosae submucous layer with small salivary and mucous glands GIT(in soft palate) GIT GIT vascular and nervous suply of the face and lips A. facialis a. labialis sup.& inf. A. temporalis superficialis a. transversa faciei A. maxillaris a. buccalis

V. facialis V. transversa faciei v. retromandibularis v. faciei profunda pl. pterygoideus

Ln. submentales, submandibulares

Inervation sensitive: n.V/2 n.infraorbitalis, zygomaticus V/3 n.mentalis, buccalis GITmotor: n.VII OROFACIAL SYSTEM (Maxilomandibular, maxilofacial, chewing, stomatognathic)

Premaxilla Papilla, rugae Maxilla (folds), pits Os (foveolae) GITpalatinum Lines (crests) Palate – surface features

Incisive papilla

Rugae palatinae GITMedian raphe Palatum palate Neonatus newborn

pink – extent of the total tooth prosthesis Senilis dash lines – areae where prosthesis pressure on the old GITpalate has to be controlled Palatal relief with rugae, foveolae and incisal papila GIT Stěna jícnu a – a.+v. +n. palatinus major greater palatine artery, vein, nerve

b – sulcus palatinus major greater palatine groove

c – glandulae palatinae palatal glands

d – a.+v.+n. palatinus minor lesser palatine artery, vein, GITnerve Stěna jícnu Tunica mucosa – plicae transversae – multilayered poorly keratinized epithelium

Tunica submucosa Can be found only inside palatal grooves

Tunica muscularis – found in the soft palate as intrinsic and extrinsic muscular structures Tunica adventitia In the hard palate there is periosteum; inside soft palatum there is a aponeurosis GITin the midline OROFACIAL SYSTEM (Maxilomandibular, maxilofacial, chewing, stomatognathic) GIT OROFACIAL SYSTEM (Maxilomandibular, maxilofacial, chewing, stomatognathic)

Jaws, hyoid bone, face bones, temporomandibular joints, teeth, periodontium, face soft tissues lips,, oral cavity organs, mucous membrane of the oral cavity, salivary glands, pharynx, tonsills, GITvessels, nerves, receptors Soft mm. levatores veli palatini palate tensores veli palatini palatoglossi – ventral view palatopharyngei uvulares Dots – line between ventral and dorsal (more moveable) parts of the soft palate GIT– dorsal view GIT Chrápání Snoring GIT Separation of the nasal and oral cavities – Ectoderm plate, mesoderm – Primary palate : intermaxillary segment Secondary palate (6.-8. week) – Horizontalization and fusion of the palatine shelves – Mesenchymal nasal septum develops from the frontal process GITPrimary palate Secondary palate Secondary palate formation GIT Ventral Dorsal

Unilateral GITBilateral Week 6 Tongue Lingua Glossa

Mobile musculoepithelial organ; Located in the oral cavity and pharynx apex corpus (body) dorsum facies inferior radix (root) margo (margin) sulcus (groove) terminalis medianus (midline) foramen caecum GITtonsilla lingualis Palatoglossal arch Palatopharyngeal arch

GITTriangular fold (plica) (there is r. tonsillaris) Papillae filiformes fungiformes Foramen vallatae caecum foliatae

Foliatae

Filiformes Vallatae

GITCalliculus gustatorius Fungiformes bitter sour salty GITsweet Inervation motor: vegetative: parasympathetic n. XII, (x m.palatoglossus) ggl. submandibular itive sens sympathetic sensory plexus lingualis x

Ix GITV3 Bottom of the oral cavity frenulum linguae, sublingual fold, carunculae GIT Spodina dutiny ústní frenulum linguae, plica sublingualis, carunculae

Canalis paralingualis = mezi m. hyoglossus a m. GITgenioglossus a. lingualis mm. geniohyoidei et m. Floor of the oral hyoglossus cavity

gl. submandibularis

ductus Whartoni Septum linguae – nervus lingualis sparse tissue

gl. sublingualis

GITcaruncula sublingualis Floor of the oral cavity GIT Intrinsic lingual muscles alter lingual shape Superior and inferior longitudinal, transverse, vertical GITmuscles Palatoglossus Extrinsic lingual muscles alter the position of the tongue

Styloglossus Palatoglossus Hyoglossus GITGenioglossus Relation between tongue and styloid GITseptum Arteriae Arteries Venae GITVeins Lymph outflow from tongue

Finally to the deep nodes

jugulodigastric node

juguloomohyoid GITnode Glandulae oris

 glandulae salivariae majores – gl. parotis – gl. sublingualis – gl. submandibularis  glandulae salivariae minores - labiales, buccales, molares, palatinae, linguales /Nuhni/

● Surrounded by capsules (dense connective tissue) → septae – Secretory part – serous and mucinous cells, myoepithelial (basket) cells GIT– Glandular ducts Salivary gland scheme GITof the ducts Mucous and serous lingual glands

Ebner gl. serous Anterior Lingual gl. Weber gl. GITmucinous Superficial part Glandula parotis Deep part (processus pharyngeus Serous tissue GITDuctus parotideus (of Stensen) Superficial and deep part of parotid gland can be separated from each other in level where facial plexus lies; there is also a thin layer of the sparse connective GITtissue GIT Glandula submandibularis

Mucoserous tissue Ductus submandibularis GIT(of Wharton) Glandula sublingualis

Seromucinous tissue Ductus sublingualis major et minores GIT(of Santorinus) Relation between Glandula serous and mucous parotidea parts Sublingualis Sublingualis anterior Submandibularis

Lingual nerve crosses submandibular duct 1:1S in the level of dorsal margine of mylohyoid muscle 3:2 GIT1:3 GIT Hltan Pharynx rozčlenění

Nasopharynx (epi-) Oropharynx (meso-) GITLaryngopharynx (hypo-) Development of pharynx

● Cranial part of the ventral gut ● 6 pharyngeal arches (gills, branchial arches) GIT● Pharyngeal pouches Pharyngeal recess

Piriform GITrecess Pharynx - muscles

● raphe pharyngis, fascia pharyngobasilaris, Luschka s space ● mm. constrictores /3/ – m.c. superior – 4 parts – origin at skull /3/ and tongue /1/ – m.c. medius – 3 parts – origin at hyoid bone – m.c. inferior – 2 parts – origin at laryngeal cartilages ● mm. levatores /3/ – m. palatopharygeus (part of soft palate muscles, mounting of the palatopharyngeal arch) – m. salpingopharyngeus – m. stylopharyngeus (!exception! – innervated by n.IX !) ● innervation: plexus pharyngeus z n. X GIT- except m. stylopharyngeus /n. IX / Piriform recess Recessus piriformis (piriform recess, pouch) is bordered by aryepiglottic fold and pharyngoepiglottic fold

* m. stylopharyngeus

** Nervus et vasa laryngea superiora CN X

Nervus can be irritated through difficult GITswallowing or tumor growth Superior constrictor SC 1 Pars pterygopharyngea 2 Pars buccopharyngea 3 Pars mylopharyngea 4 Pars glossopharyngea 1 2 3 Medius constrictor MC 4 5 Pars chondropharyngea 5 6 Pars ceratopharyngea 6 7 Pars desmopharyngea 7 8 Inferior constrictor IC 8 Pars thyropharyngea 9 9 Pars cricopharyngea SC: raphe – mandible and hamulus MC: raphe – hyoid bone and stylohyoid lig. GITIC: raphe – cricoid and thyroid cartilages and cricothyroid lig. a – musculus constrictor pharyngis inferior, b – membrana thyreoidea, c – ligamentum thyreoideum medianum, d – os hyoideum, e – membrana hyoepiglottica, f – arcus palatopharyngeus, g – raphe buccopharyngea, h - arcus palatoglossus, i – musculus tensor veli palatini, j – musculus levator veli palatini, k – ústí tuba Eustachií (Eustachovy trubice), l – tonsilla tubaria, m – tonsilla nasopharyngea, n – membrana pharyngobasillaris; musculus constrictor pharyngis superior: o – pars pterygopharyngea, p – pars buccopharyngea, q – pars mylopharyngea, r – pars glossopharyngea; musculus constrictor pharyngis medius: s – pars desmopharyngea, t – pars chondropharyngea et ceratopharyngea, u – musculus stylopharyngeus, v – musculus stylohyoideus, w - vasa laryngea superiora et nervus laryngeus superior, x – musculus constrictor pharyngis inferior, y - musculus cricothyreoideus, z – conus elasticus (ligamentum thyreoideum medianum), * - GITspatium preepiglotticum Pharynx – blood supply

● Arteries: a. carotis ext. – 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. GITjugularis int. Jugulodigastric juguloomohyoid

deep cervical GITlymph nodes Spaces surrounding pharynx

● lamina prevertebralis fasciae cervicalis 8 +

● septum styloideum 11

● spatium retropharyngeum 4

● spatium paraviscerale

● spatium parapharyngeum 1. sp. prestyloideum 2 GIT2. sp. retrostyloideum 3 Esophageal (Zenker s) GITdiverticle Tonsillar lymph circle of Waldeyer

Heinrich Wilhelm Gottfried Waldeyer GIT1836-1921 Anulus lymphoideus pharyngis /Waldeyeri/

První ochranná bariéra organismu Tonsilla pharyngea /1/ ● Tonsilla tubaria /Gerlachi/ /2/ ● Tonsilla palatina /2/ ● Tonsilla lingualis /1/

Heinrich Wilhelm Gottfried von Waldeyer-Hartz GIT(1836 – 1921), German anatomist Waldeyer lymph circle

3 protective barriers

ln.retropharyngeal nodes

t.pharyngea t.tubaria t.palatina tongue Wood node t.lingualis ln.jugulodigastricus ln.submentales &submandibulares (Küttner node) ln.juguloomohyoideus ln.cervicales profundi GIT- Lower group GIT Incomplete capsule Only efferent lymph vessels Modified epithelium in crypts (lymphoepithel or FAE follicle-associated epithelium) Intraepithelial vascularization Free, T, B lymphocytes, active immunocompetitive cells, macrophages, Langerhans cells, fibrous GITstroma GITtonsillectomy Sources: Schumacher, G.H.: Anatomie für Stomatologen, Band 1, Johann Ambrosius Barth Leipzig 1984 Tillmann,B.: Atlas der Anatomie, Springer 2004 McKinnon,P and Morris J: Oxford Textbook of Functional Anatomy, Vol. 3. Oxford University Press 1990 Rogers AW: Textbook of Anatomy, Churchill Livingstone, Edinburgh 1992 Schünke M: Topographie und Funktion des Bewegungssystems, Thieme, Stuttgart 2000 Ivo Klepáček, J. Mazánek a kol.: Klinická anatomie ve stomatologii, Grada 2002 GITVlastní archiv 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 n.X (plexus pharyngeus) = GITparasympathetic, rr. laryngopharyngei = sympathetic