Things to from BD

Things to from BD;  CH# 14 page 226, 227  Lymphatic drainage of cheeks, oraplacgaevi2ty35proper and gingivae  CH#7 Page 138  Lymphatics of Palate from CH; C1H4#7 Page 139 Relations of submandibular gland ImpR.eSlaEtioQnssof sublingual gland First priority    Mention the relation of of the submandibular gland.  Give location of palatine tonsil  What is nerve supply of tongue? Write the lymphatic drainage of tongue. nd 2 pWrriioterditoyw;n innervation of salivary glands.    What is fauces? what are its boundaries? Write the vasculature, innervation and lymphatics of palate? Write origin, insertion, nerve supply and action of muscles of pawlawtwe.tihnetmaebduiclaatlgelodbfeo.cromm. / www.mgElearning.net Page 1 of 10    Briefly describe lingual papillae. What is the vasculature of tongue? What are the extrinsic and intrinsic muscles of tongue? Write  their origin, insertion, nerve supply and actions in tabulated  form. What are the relations of sublingual gland? NOTEW; DhyogfiernsitopglroisosruitsyisSEcaQllsefdirssatfeatnydmtuhsecnlesoefctoonndguper?iority SEQs. Do not skip any

Imp clinicals    Gag reflex  Paralysis of genioglossus Injury to hypoglossal nerve ImpLoinrgtuaalncatrcpinooimnats for MCQs and VIVA 

 Lips contain the orbicularis oris and superior and inferior labial muscles, vessels, and nerves  The upper lip is supplied by superior labial branches of the facial and infra-orbital arteries.  The lower lip is supplied by inferior labial branches of the facial and mental arteries. The upper lip is supplied by the superior labial branches of the infra-orbital nerves (of CN V2)

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 the lower lip is supplied by the inferior labial branches of the mental nerves (of CN V3).  Lymph from the upper lip and lateral parts of the lower lip passes primarily to the submandibular lymph nodes  lymph from the medial part of the lower lip passes initially to the submental lymph nodes.  Numerous small buccal glands lie between the mucous  membrane and the buccinators Buccal fat pads are present superﬁcial to the buccinators.  The cheeks are supplied by buccal branches of the maxillary artery  The cheeks are innervated by buccal branches of the mandibular nerve. The lymphatics of cheeks drain chiefly into submandibular and  preauricular lymph nodes and partly to buccal and mandibular lymph nodes  Lymphatics from anterior part of floor of mouth pass to submental lymph nodes  Lymphatics from hard palate and soft palate pass to retropharyngeal and upper deep cervical lymph nodes  The gums and rest of floor of mouth drain into submandibular lymph nodes  Lymphatics from upper gums drain into submandibular lymph nodes.  The anterior part of lower gums passes to submental lymph nodes The posterior part of lower gums drains to submandibular lymph nodes www.themedicalglobe.com / www.mgElearning.net Page 3 of 10 

The superior and inferior alveolar arteries, branches of the  maxillary artery, supply the maxillary and mandibular teeth, respectively.  The alveolar veins have the same names and distribution accompany the arteries.  Lymphatic vessels from the teeth and gingivae pass mainly to the submandibular lymph nodes The named branches of the superior (CN V2) and inferior (CN  V3) alveolar nerves give rise to dental plexuses that supply the maxillary and mandibular teeth. The anterior two thirds of the palate have a bony skeleton  formed by the palatine processes of the maxillae and the horizontal plates of the palatine bones  Medial to the 3rd molar tooth, the greater palatine foramen present in horizontal plate of palatine bones  The lesser palatine foramina posterior to the greater palatine foramen pierce the pyramidal process of the palatine bone  soft palate is joined to the tongue and pharynx by the palatoglossal and palatopharyngeal arches, respectively  The isthmus is bounded anteriorly by the palatoglossal folds and posteriorly by the palatopharyngeal folds  Each tonsil is in a tonsillar sinus (fossa), bounded by the palatoglossal and palatopharyngeal arches and the tongue. The palate has a rich blood supply, chieﬂy from the greater  palatine artery on each side, a branch of the descending palatine artery. The veins of the palate are tributaries of the pterygoid venous plexus. www.themedicalglobe.com / www.mgElearning.net Page 4 of 10 

 The sensory nerves of the palate are branches of the maxillary nerve CNV2), which branch from the pterygopalatine ganglion.  The greater palatine nerve supplies the gingivae, mucous membrane, and glands of most of the hard palate.  The nasopalatine nerve supplies the mucous membrane of the  anterior part of the hard palate The lesser palatine nerves supply the soft palate. Except for the tensor veli palatini supplied by CN V3, all  muscles of the soft palate are supplied through the pharyngeal plexus of nerves.  Tensor veli Palatini is supplied by Medial pterygoid nerve (a branch of mandibular nerve, CN V3) via otic ganglion  The vallate, foliate, and most of the fungiform papillae contain taste receptors in the taste buds.  The lymphoid nodules are known collectively as the lingual tonsil are present in posterior part of tongue. A sublingual caruncle (papilla) is present on each side of the  base of the lingual frenulum that includes the opening of the submandibular duct from the sub mandibular salivary gland.  All muscles of the tongue, except the palatoglossus, receive motor innervation from CN XII, the hypoglossal nerve.  Palatoglossus is a palatine muscle supplied by the pharyngeal plexus. For general sensation (touch and temperature), the mucosa of the anterior two thirds of the tongue is supplied by the lingual nerve, a branch of CN V3.

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For special sensation (taste), anterior two-thirds of the tongue,  except for the vallate papillae, is supplied by the chorda tympani nerve, a branch of CN VII.  The chorda tympani join the lingual nerve in the infratemporal fossa and runs anteriorly in its sheath. The mucosa of the posterior third of the tongue and the vallate papillae are supplied by the lingual branch of the  glossopharyngeal nerve (CN IX) for both general and special sensation. Twigs of the internal laryngeal nerve, a branch of the vagus  nerve (CN X), supply mostly general but some special sensation to a small area of the tongue just anterior to the epiglottis.  The arterial supply of the tongue is derived from the lingual artery, which arises from the external carotid artery.  Lymph from the root of the tongue drains bilaterally into the superior deep cervical lymph nodes. Lymph from the medial part of the body of tongue drains  bilaterally and directly to the inferior deep cervical lymph nodes. Lymph from the right and left lateral parts of body of tongue  drains to the submandibular lymph nodes on the ipsilateral side.  The apex and frenulum of tongue drain to the submental lymph nodes, the medial portion draining bilaterally.  All lymph from the tongue ultimately drains to the deep cervical nodes. The parotid glands are located lateral and posterior to the rami of the mandible and masseter muscles, within ﬁbrous sheaths. www.themedicalglobe.com / www.mgElearning.net Page 6 of 10 

 The parotid glands drain anteriorly via single ducts that enter the oral vestibule opposite the second maxillary molar teeth. The submandibular glands lie along the body of the mandible, partly superior and partly inferior to the posterior half of the  mandible, and partly superficial and partly deep to the mylohyoid muscle  The arterial supply of the submandibular glands is from the submental arteries. The lymphatic vessels of the submandibular glands end in the  deep cervical lymph nodes, particularly the jugulo-omohyoid node The submandibular gland and sublingual gland are supplied by presynaptic parasympathetic secretomotor fibers conveyed from the facial nerve to the lingual nerve by the chorda tympani nerve, which synapse with postsynaptic neurons in the submandibular ganglion and by vasoconstrictive  postsynaptic sympathetic fibers from the superior cervical ganglion.  The almond shaped sublingual glands are the smallest and most deeply situated of the salivary glands.  Sublingual gland lies in the floor of the mouth between the mandible and the genioglossus muscle  Numerous small sublingual ducts open into the floor of the mouth along the sublingual folds. The arterial supply of the sublingual glands is from the sublingual and submental arteries, branches of the lingual and facial arteries, respectively.

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Relations of submandibular gland; Laterally mylohyoid,  medially hyoglossus, above lingual nerve with submandibular ganglion and below hypoglossal nerve  Relations of sublingual gland; below mylohyoid muscle, laterally sublingual fossa and medially genioglossus muscle. CN IX and CN X are responsible for the muscular contraction of  each side of the pharynx. Glossopharyngeal branches provide the afferent limb of the gag reﬂex. When the genioglossus muscle is paralyzed, the tongue has a  tendency to fall posteriorly, obstructing the airway and presenting the risk of suffocation. Trauma, such as a fractured mandible, may injure the hypoglossal nerve (CN XII), resulting in paralysis and eventual atrophy of one side of the tongue. The tongue deviates to the  paralyzed side during protrusion because of the action of the unaffected genioglossus muscle on the other side. A lingual carcinoma in the posterior part of the tongue metastasizes to the superior deep cervical lymph nodes on both sides, whereas a tumor in the anterior part usually does not metastasize to the inferior deep cervical lymph nodes until late in the disease. Because the nodes are closely related to the IJV, metastases from the tongue may be distributed through the submental and submandibular regions and along the IJVs in Imptohernteacnk.t tables for MCQs and SEQs   7.14 7.15 www.themedicalglobe.com / www.mgElearning.net Page 8 of 10 Important figures for MCQS, SEQs and VIVA (KLM)    7.77  7.79 C  7.91  7.92  7.93 7.94 A 7.95

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