Digestive System
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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: -
Physiology H Digestive
2/28/18 Introduction • Provides processes to break down molecules into a state easily used by cells - A disassembly line: Starts at the mouth and ends Digestive System at the anus • Digestive functions are initiated by the parasympathetic division Chapter 29 - Digestion occurs during periods of low activity - Produces more energy than it uses Copyright © 2016 by Elsevier Inc. All rights reserved. 1 Copyright © 2016 by Elsevier Inc. All rights reserved. 2 Anatomy The Digestive System • Oral cavity • Pharynx • Esophagus • Stomach • Small intestine and large intestine • Accessory organs: Pancreas, liver, and gallbladder From Herlihy B: The human body in health and illness, ed 4, St. Louis, 2011, Saunders. Copyright © 2016 by Elsevier Inc. All rights reserved. 3 Copyright © 2016 by Elsevier Inc. All rights reserved. 4 Physiology Gastrointestinal Tract • Ingestion: Taking materials into mouth by • Muscular tube throughout digestive system eating/drinking • Accessory organs and glands secrete • Digestion: Breaking down food into molecules substance to aid in digestion that can be used by the body • GI tract wall has four layers: - Includes mechanical and enzymatic action - Mucosa • Absorption: Simple molecules from the - Submucosa gastrointestinal (GI) tract move into the - Muscle layer: Responsible for peristalsis bloodstream or lymph vessels and then into - Serosa body cells • Defecation: Eliminating indigestible or unabsorbed material from the body Copyright © 2016 by Elsevier Inc. All rights reserved. 5 Copyright © 2016 by Elsevier Inc. All rights reserved. 6 1 2/28/18 Peristalsis Oral Cavity • First portion of GI tract • Contains: - Teeth - Tongue - Openings for salivary glands From Thibodeau GA, Patton KT: Anatomy & physiology, ed 6, St. -
Abbreviations - Diagnosis
Abbreviations - Diagnosis AB abrasion AT attrition CA caries CFL cleft lip CFP cleft palate CLL cervical line lesion - See TR CMO craniomandibular osteopathy DT deciduous (primary) tooth DTC dentigerous cyst E enamel E/D enamel defect E/H enamel hypocalcification or hypoplasia FB foreign body FORL feline odontoclastic resorptive lesion - See TR FX fracture (tooth or jaw) G granuloma G/B buccal granuloma (cheek chewing lesion) G/L sublingual granuloma (tongue chewing lesion) G/E/L eosinophilic granuloma - lip G/E/P eosinophilic granuloma - palate G/E/T eosinophilic granuloma - tongue GH gingival hyperplasia GR gingival recession LAC laceration LAC/B laceration buccal (cheek) LAC/L laceration lip LAC/T laceration tongue MAL malocclusion MAL/1 class 1 malocclusion (neutroclusion - normal jaw relationship, specific teeth are incorrectly positioned) MAL/2 class 2 malocclusion (mandibular distoclusion - mandible shorter than maxilla) MAL/3 class 3 malocclusion (mandibular mesioclusion - maxilla shorter than mandible) BV buccoversion (crown directed towards cheek) CXB caudal crossbite DV distoversion (crown directed away from midline of dental arch) LABV labioversion (crown directed towards lip) LV linguoversion (crown directed towards tongue) MV mesioversion (crown directed towards midline of dental arch) OB open bite RXB rostral crossbite MN mandible or mandibular MN/FX mandibular fracture MX maxilla or maxillary MX/FX maxillary fracture OM oral mass OM/AD adenocarcinoma OM/EPA acanthomatous ameloblastoma (epulis) OM/EPF fibromatous epulis -
Angina Bullosa Haemorrhagica (Oral Blood Blister) (PDF)
Patient Information Maxillo-facial Angina Bullosa Haemorrhagica (Oral Blood Blister) What is Angina Bullosa Haemorrhagica? Angina Bullosa Hemorrhagica (ABH) is a condition where an often painful, but benign blood-filled blister suddenly develops in the mouth. The blisters are generally not due to a blood clotting disorder or any other medical disorder. It is a fairly common, sudden onset and benign blood blistering oral (mouth) disorder. It mainly affects people over 45 years and both males and females are equally affected. Usually there is no family history of the condition. It may be associated with Type 2 Diabetes, a family history of diabetes or Hyperglycaemia. What are the signs and symptoms of ABH? The first indication is a stinging pain or burning sensation just before the appearance of a blood blister The blisters last only a few minutes and then spontaneously rupture (burst), leaving a shallow ulcer that heals without scarring, discomfort or pain They can reach an average size of one to three centimetres in diameter The Soft Palate (back of the mouth) is the most affected site If they occur on the palate and are relatively big, they may need to be de-roofed (cut and drained) to ease the sensation of choking Patient Information Occasionally blisters can occur in the buccal mucosa (cheek) and tongue Approximately one third of the patients have blood blisters in more than one location. What are the causes of ABH? More than 50% of cases are related to minor trauma caused by: hot foods, restorative dentistry (fillings, crowns etc) or Periodontal Therapy (treatment of gum disease). -
Lecture 2 – Bone
Oral Histology Summary Notes Enoch Ng Lecture 2 – Bone - Protection of brain, lungs, other internal organs - Structural support for heart, lungs, and marrow - Attachment sites for muscles - Mineral reservoir for calcium (99% of body’s) and phosphorous (85% of body’s) - Trap for dangerous minerals (ex:// lead) - Transduction of sound - Endocrine organ (osteocalcin regulates insulin signaling, glucose metabolism, and fat mass) Structure - Compact/Cortical o Diaphysis of long bone, “envelope” of cuboid bones (vertebrae) o 10% porosity, 70-80% calcified (4x mass of trabecular bone) o Protective, subject to bending/torsion/compressive forces o Has Haversian system structure - Trabecular/Cancellous o Metaphysis and epiphysis of long bone, cuboid bone o 3D branching lattice formed along areas of mechanical stress o 50-90% porosity, 15-25% calcified (1/4 mass of compact bone) o High surface area high cellular activity (has marrow) o Metabolic turnover 8x greater than cortical bone o Subject to compressive forces o Trabeculae lined with endosteum (contains osteoprogenitors, osteoblasts, osteoclasts) - Woven Bone o Immature/primitive, rapidly growing . Normally – embryos, newborns, fracture calluses, metaphyseal region of bone . Abnormally – tumors, osteogenesis imperfecta, Pagetic bone o Disorganized, no uniform orientation of collagen fibers, coarse fibers, cells randomly arranged, varying mineral content, isotropic mechanical behavior (behavior the same no matter direction of applied force) - Lamellar Bone o Mature bone, remodeling of woven -
The Digestive System
Connective tissue The Digestive System Part 1 Structure of digestive system Functions Basic Structure of the Alimentary Canal Wall Tube is made up of four layers: 1. Mucosa 2. Submucosa 3. Muscularis externa 4. Serosa (Peritoneum) or Adventitia Mucosa The innermost wall of the alimentary tube. Consists of: • Epithelium - usually simple columnar epithelium with goblet cells; may be stratified squamous if protection is needed (e.g. esophagus) • Lamina propria – loose connective tissue • Muscularis mucosae – takes part in the formation of folds Submucosa Made up of loose connective tissue. Contains submucosal (Meissner’s) nervous plexus and blood vessels, sometimes glands. Muscularis externa Usually two layers of smooth muscle: • inner circular layer • outer longitudinal layer. • Myenteric (Auerbach’s) nervous plexus in between • Responsible for peristalsis (controlled by the nerve plexus) Outer membrane • A serous membrane/peritoneum consisting of the mesothelium (simple squamous epithelium), and a small amount of underlying loose connective tissue. • Or adventitia consisting only of connective tissue is found where the wall of the tube is directly attached or fixed to adjoining structures (i.e., body wall and certain organs). Enteric nervous system The Alimentary Canal Pharynx Common respiratory and digestive pathway (both air and swallowed food and drinks pass through). • Stratified squamous non-keratinized epithelium • Lamina propria contains many elastic fibers • No muscularis mucosae • No submucosa • Striated muscle in the muscularis externa Esophagus Fixed muscular tube that delivers food and liquid from the pharynx to the stomach. Esophagus Epithelium - stratified squamous Mucosal and submucosal glands of the esophagus secrete mucus to lubricate and protect the luminal wall. Esophageal glands proper lie in the submucosa. -
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. -
Head and Neck
DEFINITION OF ANATOMIC SITES WITHIN THE HEAD AND NECK adapted from the Summary Staging Guide 1977 published by the SEER Program, and the AJCC Cancer Staging Manual Fifth Edition published by the American Joint Committee on Cancer Staging. Note: Not all sites in the lip, oral cavity, pharynx and salivary glands are listed below. All sites to which a Summary Stage scheme applies are listed at the begining of the scheme. ORAL CAVITY AND ORAL PHARYNX (in ICD-O-3 sequence) The oral cavity extends from the skin-vermilion junction of the lips to the junction of the hard and soft palate above and to the line of circumvallate papillae below. The oral pharynx (oropharynx) is that portion of the continuity of the pharynx extending from the plane of the inferior surface of the soft palate to the plane of the superior surface of the hyoid bone (or floor of the vallecula) and includes the base of tongue, inferior surface of the soft palate and the uvula, the anterior and posterior tonsillar pillars, the glossotonsillar sulci, the pharyngeal tonsils, and the lateral and posterior walls. The oral cavity and oral pharynx are divided into the following specific areas: LIPS (C00._; vermilion surface, mucosal lip, labial mucosa) upper and lower, form the upper and lower anterior wall of the oral cavity. They consist of an exposed surface of modified epider- mis beginning at the junction of the vermilion border with the skin and including only the vermilion surface or that portion of the lip that comes into contact with the opposing lip. -
The Small and Large Intestines∗
OpenStax-CNX module: m46512 1 The Small and Large Intestines∗ OpenStax College This work is produced by OpenStax-CNX and licensed under the Creative Commons Attribution License 3.0y Abstract By the end of this section, you will be able to: • Compare and contrast the location and gross anatomy of the small and large intestines • Identify three main adaptations of the small intestine wall that increase its absorptive capacity • Describe the mechanical and chemical digestion of chyme upon its release into the small intestine • List three features unique to the wall of the large intestine and identify their contributions to its function • Identify the benecial roles of the bacterial ora in digestive system functioning • Trace the pathway of food waste from its point of entry into the large intestine through its exit from the body as feces The word intestine is derived from a Latin root meaning internal, and indeed, the two organs together nearly ll the interior of the abdominal cavity. In addition, called the small and large bowel, or colloquially the guts, they constitute the greatest mass and length of the alimentary canal and, with the exception of ingestion, perform all digestive system functions. 1 The Small Intestine Chyme released from the stomach enters the small intestine, which is the primary digestive organ in the body. Not only is this where most digestion occurs, it is also where practically all absorption occurs. The longest part of the alimentary canal, the small intestine is about 3.05 meters (10 feet) long in a living person (but about twice as long in a cadaver due to the loss of muscle tone). -
Basic Histology (23 Questions): Oral Histology (16 Questions
Board Question Breakdown (Anatomic Sciences section) The Anatomic Sciences portion of part I of the Dental Board exams consists of 100 test items. They are broken up into the following distribution: Gross Anatomy (50 questions): Head - 28 questions broken down in this fashion: - Oral cavity - 6 questions - Extraoral structures - 12 questions - Osteology - 6 questions - TMJ and muscles of mastication - 4 questions Neck - 5 questions Upper Limb - 3 questions Thoracic cavity - 5 questions Abdominopelvic cavity - 2 questions Neuroanatomy (CNS, ANS +) - 7 questions Basic Histology (23 questions): Ultrastructure (cell organelles) - 4 questions Basic tissues - 4 questions Bone, cartilage & joints - 3 questions Lymphatic & circulatory systems - 3 questions Endocrine system - 2 questions Respiratory system - 1 question Gastrointestinal system - 3 questions Genitouirinary systems - (reproductive & urinary) 2 questions Integument - 1 question Oral Histology (16 questions): Tooth & supporting structures - 9 questions Soft oral tissues (including dentin) - 5 questions Temporomandibular joint - 2 questions Developmental Biology (11 questions): Osteogenesis (bone formation) - 2 questions Tooth development, eruption & movement - 4 questions General embryology - 2 questions 2 National Board Part 1: Review questions for histology/oral histology (Answers follow at the end) 1. Normally most of the circulating white blood cells are a. basophilic leukocytes b. monocytes c. lymphocytes d. eosinophilic leukocytes e. neutrophilic leukocytes 2. Blood platelets are products of a. osteoclasts b. basophils c. red blood cells d. plasma cells e. megakaryocytes 3. Bacteria are frequently ingested by a. neutrophilic leukocytes b. basophilic leukocytes c. mast cells d. small lymphocytes e. fibrocytes 4. It is believed that worn out red cells are normally destroyed in the spleen by a. neutrophils b. -
E Pleura and Lungs
Bailey & Love · Essential Clinical Anatomy · Bailey & Love · Essential Clinical Anatomy Essential Clinical Anatomy · Bailey & Love · Essential Clinical Anatomy · Bailey & Love Bailey & Love · Essential Clinical Anatomy · Bailey & Love · EssentialChapter Clinical4 Anatomy e pleura and lungs • The pleura ............................................................................63 • MCQs .....................................................................................75 • The lungs .............................................................................64 • USMLE MCQs ....................................................................77 • Lymphatic drainage of the thorax ..............................70 • EMQs ......................................................................................77 • Autonomic nervous system ...........................................71 • Applied questions .............................................................78 THE PLEURA reections pass laterally behind the costal margin to reach the 8th rib in the midclavicular line and the 10th rib in the The pleura is a broelastic serous membrane lined by squa- midaxillary line, and along the 12th rib and the paravertebral mous epithelium forming a sac on each side of the chest. Each line (lying over the tips of the transverse processes, about 3 pleural sac is a closed cavity invaginated by a lung. Parietal cm from the midline). pleura lines the chest wall, and visceral (pulmonary) pleura Visceral pleura has no pain bres, but the parietal pleura covers -
Cleft Palate/Lip
CLEFT PALATE/LIP WHAT IS A CLEFT? A cleft is a separation in the skin, tissue lining of the mouth, muscle, and bone that is normally fused together; however, no structures are missing. Clefts can be either unilateral (one side) or bilateral (both sides) and may include the lip, soft palate and/or hard palate or any of the structures in isolation. TYPES OF CLEFTS Cleft Lip – separation in the lip and may include the bottom of the nose Cleft Palate – separation in the hard palate and/or soft palate Submucous Cleft – separation in the muscle of the soft palate with the tissue lining of the mouth intact. Often, it is not easily viewed. WHEN DID CLEFTING HAPPEN? During the 4th week of fetal development, the primary palate (line from nostril to upper lip and mucosa behind upper teeth) fuse together. By the 8th week, the tongue drops in the mouth and the secondary palate (hard palate and soft palate) fuse together with the nasal septum. By the 12th week, if the process is not complete, a cleft (separation) will develop. WHAT CAUSED MY CHILD’S CLEFT? The exact cause is not known but theories include: Low intake of Folic Acid (Vitamin B) Large intake of Vitamin A Genetic disposition Syndromes or Sequences (Pierre Robin, Treacher Collins) Drugs, alcohol, medication, and smoking CLEFT PALATE MANAGEMENT You and your child will be in contact with many different healthcare professionals who need to work together. Every case is individualized, therefore your child will need a thorough assessment to the appropriate treatment plan.