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Oral Cavity, Tongue & Palate

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By Prof Nabil A Hasan Head of Anatomy Department Lies in the roof of the oral cavity Has two parts: hard • Hard (bony) palate soft palate anteriorly • Soft (muscular) palate posteriorly Lies in the roof of the oral cavity Forms the floor of the nasal cavity Formed by: • Palatine processes of maxillae in front • Horizontal plates of palatine bones behind Bounded by alveolar arches Posteriorly, continuous with soft palate Its undersurface covered by mucoperiosteum Shows transverse ridges in the anterior parts Attached to the posterior border of the hard palate Covered on its upper and lower surfaces by mucous membrane Composed of: • Muscle fibers • An aponeurosis • Lymphoid tissue • Glands • Blood vessels • Nerves Fibrous sheath Attached to posterior border of hard palate Is expanded tendon of tensor velli palatini Splits to enclose musculus uvulae Gives origin & insertion to palatine muscles Tensor veli palatini • Origin: Scaphoid fossa pterygoid bone & auditory tube • Insertion: superior surface of palatine aponeurosis • Action: Tenses soft palate Levator veli palatini • Origin:petrous part of the temporal bone & auditory tube • Insertion: superior surface of palatine aponeurosis • Action: Raises soft palate to close the posterior pharyngeal wall Musculus uvulae Origin: posterior border of hard palate Insertion: mucosa of uvula Action: Elevates uvula and contact the posterior pharyngeal wall Palatoglossus • Origin: inferior surface of palatine aponeurosis • Insertion: side of tongue • Action: pulls root of tongue upward, narrowing oropharyngeal isthmus Responsible for the rapid downward movement of the palate during speech Palatopharyngeus • Origin: inferior surface of palatine aponeurosis • Insertion: posterior border of thyroid cartilage Action: Sphincteric action to pull the lateral pharyngeal walls medially Mostly by the maxillary nerve through its branches: • Greater palatine nerve • Lesser palatine nerve • Nasopalatine nerve Glossopharyngeal nerve supplies the region of the soft palate All the muscles, except tensor veli palatini, are supplied by the: • Cranial root of accessory nerve via pharyngeal plexus Tensor veli palatini supplied by the: • Nerve to medial pterygoid, a branch of the mandibular nerve Branches of the maxillary artery • Greater palatine • Lesser palatine • Sphenopalatine Ascending palatine, branch of the facial artery Ascending pharyngeal, branch of the external carotid artery The pharynx has a musculomembranous tube, which is deficient anteriorly Here, it is replaced by the posterior openings into the nose (choana), the opening into the mouth, and the inlet of the larynx Its upper, wider end lying under the skull (basilar part of occipital bone) Its lower, narrow end becoming continuous with the esophagus opposite the sixth cervical vertebra Laterally, it is related to styloid apparatus , carotid sheath & lobes of thyroid gland By means of the auditory tube, the mucous membrane is also continuous with that of the tympanic cavity Its wall is composed of 5 layers 1- lining mucosa 2- sumucosa, aleolar CT 3- pharygobasilar fascia 4- musculosa, longitudinal (smooth ms) & circular (3 costrictors) 5- buccopharyngeal fascia Wall of the pharynx consist of 1 the superior , 2 middle 3 inferior constrictor muscles Fibers of these muscles run in a somewhat circular direction 4 Salpingopharyngeus 5 Palatoopharyngeus 6 Stylopharyngeus muscles Their fibers run in a somewhat longitudinal direction 1 4 2 5 3 6 The three constrictor muscles extend around the pharyngeal wall to be inserted into a fibrous band or raphe The raphe extends from the pharyngeal tubercle on the basilar part of the occipital bone of the skull down to the esophagus The three constrictor muscles overlap each other Superior Constrictor – Responsible for the medial displacement of the lateral pharyngeal walls – Narrows the VP port The lower part of the inferior constrictor, which arises from the cricoid cartilage, is called the cricopharyngeus muscle The fibers of Cricopharyngeus pass horizontally around the lowest and narrowest part of the pharynx and act as a sphincter First gap between base of the head & Sup. Constrictor for: Tensor & levator palati muscles and Eustachian tube Second gap between Sup. & middle Constrictors for:Stylopharyngeus muscle, stylohyoid ligament & glossopharyngeal nerve Third gap between middle & inferior Constrictors for: internal laryngeal nerve This lies above the soft palate and behind the nasal cavities In the submucosa of the roof is a collection of lymphoid tissue called the pharyngeal tonsil The pharyngeal isthmus is the opening in the floor between the soft palate and the posterior pharyngeal wall On the lateral wall is the opening of the auditory tube, the elevated ridge of which is called the tubal elevation The pharyngeal recess is a depression in the pharyngeal wall behind the tubal elevation The salpingopharyngeal fold is a vertical fold of mucous membrane covering the salpingopharyngeus muscle This lies behind the oral cavity The floor is formed by the posterior one third of the tongue and the interval between the tongue and epiglottis In the midline is the median glossoepiglottic fold on each side the lateral glossoepiglottic fold The depression on each side of the median glossoepiglottic fold is called the vallecula On the lateral wall on each side are the palatoglossal and the palatopharyngeal arches or folds and the palatine tonsils between them The palatoglossal arch is a fold of mucous membrane covering the palatoglossus muscle The interval between the two palatoglossal arches is called the oropharyngeal isthmus It marks the boundary between the mouth and pharynx The palatopharyngeal arch is a fold of mucous membrane covering the palatopharyngeus muscle The recess between the palatoglossal and palatopharyngeal arches is occupied by the palatine tonsil At the junction of the mouth with the oral part of the pharynx, and the nose with the nasal part of the pharynx, are collections of lymphoid tissue The palatine tonsils and the nasopharyngeal tonsils are the most important This lies behind the opening into the larynx The lateral wall is formed by the thyroid cartilage and the thyrohyoid membrane The piriform fossa is a depression in the mucous membrane on each side of the laryngeal inlet Nasopharynx: The maxillary nerve Oropharynx: The glossopharyngeal nerve Laryngeal pharynx: The internal laryngeal branch of the vagus nerve All Muscles of the pharynx are supplied by cranial root of accessory nerve via pharyngeal plexus which situated on the middle constrictor muscle of the pharynx EXCEPT stylopharyngeus that is supplied by glossophryngeal nerve Ascending pharyngeal, tonsillar branches of facial arteries, and branches of maxillary and lingual arteries Directly into the deep cervical lymph nodes or indirectly via the retropharyngeal or paratracheal nodes into the deep cervical nodes The lymphoid tissue that surrounds the opening into the respiratory and digestive systems forms a ring The lateral part of the ring is formed by the palatine tonsils and tubal tonsils The pharyngeal tonsil in the roof of the nasopharynx forms the upper part, and the lingual tonsil on the posterior third of the tongue forms the lower part • Velum is at rest and low while breathing • Velum is elevated and stretched during speech production of oral sounds • Velum is pulled down during production of nasal sounds • VP function differs for speech and non‐speech activities • Resonance: Refers to the acoustic phenomenon that –occurs when sound vibrates in the nasal or oral cavity – The velopharyngeal valve does not adequately close during speech – Velopharyngeal Incompetence = adequate structure, but inadequate function – Velopharyngeal Insufficiency = inadequate structure – Velopharyngeal Mislearning = inadequate closure due to faulty learning – Hypernasality: occurs when the oral and nasal cavities are abnormally coupled – Hyponasality: occurs typically due to a blockage in the nasal cavity THANK YOU .
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