The Mouth and Pharynx

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The Mouth and Pharynx The Mouth Learning Points The mouth provides another entrance to the airway. The upper portion of the oral cavity comprises of the hard palate and soft palate, whilst the lower portion is dominated by the tongue. The tongue is a muscular structure used for digestion and phonation. Negotiating the airway can be challenging when the tongue is enlarged. The tongue may be enlarged in congenital conditions such as Down’s syndrome, or swell during an allergic reaction. The Pharynx The pharynx is the cavity which connects the nose and the mouth to the larynx and the esophagus. It is divided into 3 sections, the nasopharynx, oropharynx and laryngopharynx. The nasopharynx runs from the back of the nasal cavity down the posterior aspect of the soft palate. The oropharynx runs from the uvula (a finger like projection at the posterior aspect of the soft palate) to the epiglottis. The oropharynx contains anteriorly the palatoglossal arch, and postertiorly the palatopharyngeal arch. Between the two arches lie the tonsils. Just above the epiglottis is a fold called the vallecula. This where the blade of the laryngoscope is placed during laryngoscopy. The laryngopharynx runs from the epiglottis to the cricoid cartilage, and contains the vocal cords. Nerve supply of the pharynx Broadly speaking the nose and nasopharynx are supplied by the trigeminal nerve, the oropharynx is supplied by the glossopharyngeal nerve and the laryngopharynx is supplied by the vagus nerve. The Teeth Teeth arise from the top and bottom jaw and provide structural support to facial architecture. Their main role is in mastication and digestion but they also influence facial aesthetics and facilitate speech. During direct laryngoscopy, rigid bronchoscopy, biting during emergence or even vigorous oropharyngeal suctioning there is a high risk of damaging teeth. Dental damage is the leading cause of complaint and medicolegal claims against anaesthetists. Each tooth consists of a crown covered in calcified enamel and dentine, and a root which is anchored into the jawbone. Within the root is the pulp containing vessels and nerves. .

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Selecting Different Approaches for Palate and Pharynx Surgery
SPECIAL ISSUE 4: INVITED ARTICLE Selecting Different Approaches for Palate and Pharynx Surgery: Palatopharyngeal Arch Staging System Rodolfo Lugo-Saldaña1 , Karina Saldívar-Ponce2 , Irina González-Sáez3 , Daniela Hernández-Sirit4 , Patricia Mireles-García5 ABSTRACT The examination of the anatomical structures involved in the upper airway collapse in patients with the obstructive sleep apnea-hypopnea syndrome (OSAHS) is a key for integrated evaluation of patients. Our proposal is for a noninvasive classification system that guides us about the presence of anatomical differences between the palatopharyngeal muscle (PFM). The functions of the PFM are narrowing the isthmus, descending the palate, and raising the larynx during swallowing; these characteristics give the PFM a special role in the collapse of the lateral pharyngeal wall. Complete knowledge of the anatomy and classification of different variants can guide us to choose the appropriate surgical procedures for the lateral wall collapse. Until now there is not a consensus about description of the trajectory or anatomical variants of the PFM into oropharynx, the distance between both muscles, and the muscle tone. Here we also present the relationship between the lateral wall surgeries currently available (lateral pharyngoplasty by Cahali, expansion sphincteroplasty by Pang, relocation pharyngoplasty by Li, Roman blinds pharyngoplasty by Mantovani, and barbed sutures pharyngoplasty by Vicini) with the proposed classification of the palatopharyngeal arch staging system (PASS). Keywords:
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Septoplasty, Rhinoplasty, Septorhinoplasty, Turbinoplasty Or
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Vestibule Lingual Frenulum Tongue Hyoid Bone Trachea (A) Soft Palate
Mouth (oral cavity) Parotid gland Tongue Sublingual gland Salivary Submandibular glands gland Esophagus Pharynx Stomach Pancreas (Spleen) Liver Gallbladder Transverse colon Duodenum Descending colon Small Jejunum Ascending colon intestine Ileum Large Cecum intestine Sigmoid colon Rectum Appendix Anus Anal canal © 2018 Pearson Education, Inc. 1 Nasopharynx Hard palate Soft palate Oral cavity Uvula Lips (labia) Palatine tonsil Vestibule Lingual tonsil Oropharynx Lingual frenulum Epiglottis Tongue Laryngopharynx Hyoid bone Esophagus Trachea (a) © 2018 Pearson Education, Inc. 2 Upper lip Gingivae Hard palate (gums) Soft palate Uvula Palatine tonsil Oropharynx Tongue (b) © 2018 Pearson Education, Inc. 3 Nasopharynx Hard palate Soft palate Oral cavity Uvula Lips (labia) Palatine tonsil Vestibule Lingual tonsil Oropharynx Lingual frenulum Epiglottis Tongue Laryngopharynx Hyoid bone Esophagus Trachea (a) © 2018 Pearson Education, Inc. 4 Visceral peritoneum Intrinsic nerve plexuses • Myenteric nerve plexus • Submucosal nerve plexus Submucosal glands Mucosa • Surface epithelium • Lamina propria • Muscle layer Submucosa Muscularis externa • Longitudinal muscle layer • Circular muscle layer Serosa (visceral peritoneum) Nerve Gland in Lumen Artery mucosa Mesentery Vein Duct oF gland Lymphoid tissue outside alimentary canal © 2018 Pearson Education, Inc. 5 Diaphragm Falciform ligament Lesser Liver omentum Spleen Pancreas Gallbladder Stomach Duodenum Visceral peritoneum Transverse colon Greater omentum Mesenteries Parietal peritoneum Small intestine Peritoneal cavity Uterus Large intestine Cecum Rectum Anus Urinary bladder (a) (b) © 2018 Pearson Education, Inc. 6 Cardia Fundus Esophagus Muscularis Serosa externa • Longitudinal layer • Circular layer • Oblique layer Body Lesser Rugae curvature of Pylorus mucosa Greater curvature Duodenum Pyloric Pyloric sphincter antrum (a) (valve) © 2018 Pearson Education, Inc. 7 Fundus Body Rugae of mucosa Pyloric Pyloric (b) sphincter antrum © 2018 Pearson Education, Inc.
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