~ ~ ~ ORAL CAVITY ~ ~ ~

Dr. Singh

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

Oral cavity is divided into:

vestibule = the space b/t teeth and mucosa of lips / cheeks
oral cavity proper = space b/t Mx and Md dental arches that includes:
tongue
hard palate, soft palate
palatoglossal (anterior) pillar
- vestibule & oral cavity proper are separated from e/o by the teeth
- anything posterior to Anterior Pillar is part of the oropharynx

Boundaries:
- roof = hard palate separates from the nasal cavity
- floor = mylohyoid muscle
- posterior = oropharyngeal isthmus separates from the pharynx
- anterior & lateral = buccal / labial mucosa

Things briefly noted:

philtrum = the divit b/t the upper lip and nose
nd

parotid glands Stensons Duct = opens adjacent to the Mx 2 molar

Facial Nerve (VII) pierces the parotid gland but does not innervate it
palatal arches (anterior & posterior pillars)
palatine tonsil in b/t the pillars (begins to atrophy during puberty)
hard palate
soft palate w/ uvula
2 labial frenula (mx & md) + 1 lingual frenulum (md only)
- excessively short frenula = ankyloglossia / tongue-tied can be corrected w/ surgery
- excessively large frenula = can cause central diastemmas and / or gingival recession
floor of the mouth:
note the PROFUNDA (deep) Lingual arteries & veins underneath tongue can be a method of quick medication absorption
sublingual caruncles on the floor of the mouth have an opening = submandibular glands Whartons Duct
sublingual / fimbriae folds have many openings = sublingual glands MANY ducts
when both sublingual + submandibular ducts are combined = Bartholins Duct
- sublingual salivary glands do not have just one single duct!

Gag reflex is due to the Glossopharyngeal Nerve (IX) = which innervates the walls of the pharynx

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FLOOR OF THE MOUTH

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

INFERIOR VIEW
Mylohyoid muscle = joined together in the middle by Midline Raphe
this muscle forms the floor of the mouth
innervated by Mylohyoid nerve (V3 posterior division)
Anterior Digastric = innervated by Mylohyoid nerve (V3 posterior division)
Posterior Digastric = innervated by Facial Nerve (VII)
Stylohyoid muscle = innervated by Facial Nerve (VII)
Geniohyoid = innervated by APR of C1

Mylohyoid Line (on the body) = divides 2 fossa on the lingual inner surface of the mandible bone
below = submandibular gland
above = sublingual gland
note the green line = submandibular glands Whartons Duct that exits at the sublingual caruncles
Mylohyoid Groove (on the ramus) = has the mylohoyd BV-Ns running thru it
Lingual Nerve
descends downward and forward on the mandibular ramus
turns at the angle of the mandible behind the last molar
turns medially and crosses underneath the Submandibular Duct, above the Mylohyoid muscle,
runs on top of the Sublingual Gland
proceeds throughout the tongue for innervation

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CROSS SECTION VIEW

- masseter muscle
- medial pterygoid muscle
- buccinator muscle
- orbicularis oris muscle

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

- parotid gland is located on both lateral and mesial surface of the mandible (but mostly lateral)
we inject on the medial surface sometimes if you go too far, you will inject into the parotid gland! Oops!
then youll also be anesthetizing the Facial Nerve (VII) that pierces that parotid gland
drooping of the lower facial muscles of expression
- vertebral artery on either side of the Axis vertebra
- Internal Jugular Vein & External Carotid Artery
- palatoglossal + palatopharungeal arches w/ palatine tonsils in b/t

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- hyoglossus muscle
- styloglossus muscle
- sublingual gland
- submandibular gland
- lingual nerve (V3)
- hypoglossal nerve (XII)

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

- Submandibular Duct = runs across on top of the Sublingual Gland & Lingual Nerve, then opens up at the Caruncles
- Lingual Nerve (V3) runs medially underneath the Submandibular Duct, and then proceeds towards the tongue
- Hypoglossal Nerve (XII) emerges from the neck, runs b/t mylohyoid & hyoglossal muscles, and then proceeds towards the tongue

- mylohyoid muscle
- mylohyoid nerve
- inferior alveolar nerve
- lingual nerve
- sphenomandibular ligament
this is the medial ligament of the TMJ
origin = spine of sphenoid
insertion = lingula of mandible

Space of Donders b/t palate & tongue = clinically important to maintain when making dentures to allow proper speech & swallowing
Bells Palsy: injury to Facial Nerve (VII) before it exits the Stylomastoid Foramen paralysis of buccinator muscle
Forceps delivery will sometimes crush the immature mastoid process and crush the Facial nerve Compiled for you by:
Drooping of facial muscles, drooling, eyelid can open but cannot close (O. Oculi muscle injured), dry corneas

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

TONGUE

SURFACE ANATOMY
- note the anterior & posterior pillars w/ the palatine tonsils in b/t them
- midline exists b/c the tongue develops bilaterally
blood supply doesnt mix b/t R&L sides (except right at the anterior tip)
you can potentially slice the tongue exactly in the middle and not draw blood!
sulcus terminalis divides anterior 2/3 and posterior 1/3
(lingual & palatine tonsils located behind it)
(circumvallate papillae located in front of it)
foramen cecum = foramen that goes nowhere = its a blind pouch
Thyroid gland descends thru the foramen cecum in embryo development
Thyroglossal Duct = a remnant of the thyroids descending tract
Thyroglossal Cyst = when the duct becomes cystic
circumvallate papilla = 7-12 arranged in a V-shape anterior to sulcus terminalis
filiform, fungiform, foliate papillae too
- Epiglottis
- 1 Median + 2 Lateral Glossoepiglottic Folds
- Valeculla = a depression located b/t the Median & Lateral Glossoepiglottic Folds
- aspirated things will most likely lodge in these places:
- vallecula
- piriform recess
nd
- 2 primary bronchus

INNERVATION
Motor Nerve Supply
All tongue muscles = HYPOGLOSSAL NERVE (XII)
Palatoglossal Muscle = PHARYNGEAL PLEXUS
(which also supplies pharyngeal & palatine muscles)
(EXCEPT: Stylopharyngeus (IX) and Tensor Veli Palatini (V3)
General touch sensation
Anterior 2/3 = LINGUAL NERVE (V3)
Posterior 1/3 = GLOSSOPHARYNGEAL (IX)
- Internal Laryngeal supplies posterior part of the tongue in the area near the valeculla & epiglottis (above vocal cords)
Special taste sensation
Anterior 2/3 = CHORDA TYMPANI (from VII, follows w/ Lingual)
Poster 1/3 = GLOSSOPHARYNGEAL (IX)

Chorda Tympani fibers (VII):

special sensory (taste) to anterior 2/3 tongue
pre-ganglionic parasympathetic to SM & SL salivary glands
(synapses in Submandibular Ganglion)

- Palatal taste buds = Greater Petrosal (originates from Facial Nerve VII, but carried by Maxillary V2)
- Oropharynx taste buds = Vagus Nerve (X)
- Epiglottis taste buds = Vagus Nerve (X)
- Anterior Pillar taste buds = Glossopharyngeal Nerve (IX)
- Circumvallate papillae = Glossopharyngeal Nerve (IX)
There are 3 ganglia from where taste fibers originate:
Geniculate Ganglion of VII (chorda tympani)
Inferior Ganglion of IX (glossopharyngeal)
Inferior ganglion of X (vagus)

Greater Petrosal fibers (VII):

special sensory (taste) to palate
pre-ganglionic parasympathetic to lacrimal gland, pharynx,
palate, nasal anything the gets innervated by V2
(synapses in Pterygopalatine Ganglion)

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Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

TONGUE MUSCLES
Muscle
Genioglossus

Hyoglossus

Origin
Superior Genial Tubercle

Insertion
superior fibers = tip of tongue
middle fibers = dorsum of tongue
inferior fibers = hyoid body

Action
depression & protrusion

Hyoid Bone

depression & retrusion

dorsum, lateral, inferior
parts of the tongue

Styloglossus

Styloid Process

Palatoglossus

Palate

Innervation

Hypoglossus
(XII)

elevation & retrusion

posterior tongue

elevation to close palatal space

Pharyngeal
Plexus

INTRINSIC MUSCLES = allow the tongue to change shape

Longitudinal
- superior fibers run just below the dorsum
- inferior fibers run b/t genioglossus & hyoglossus muscles
- all fibers runs parallel to the long axis of the tongue
- shortens the length of the tongue
- curls the tip up and back
Transverse
- fibers run horizontally at right angles to the longitudinal fibers
- narrows the tongue to form a longitudinal trough (like a burrito)
Vertical
- fibers run vertically at right angles and in b/t the superior & inferior longitudinal fibers
- flatten and broaden the tongue
EXTRINSIC MUSCLES = allow the tongue to move & position
Genioglossus = attaches the tongue to mandible bone
Pulls down and forward (sticking out your tongue)
Hyoglossus = attaches the tongue to hyoid bone
Pulls down and backward
Styloglossus = attaches the tongue to styloid process
Pulls up and backward
Palatoglossus = attaches the tongue to palate
Lifts the tongue up and pulls the palate down to close the palatal space
Chondroglossus = when the anterior fibers of the Hyoglossus muscle become cartilaginous

Note the Mylohyoid and Geniohyoid muscles

stacked on top of e/o on the floor

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PALATE

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

- maxilla bones (palatine shelf)

- palatine bones (horizontal plate)
- Greater & Lesser palatine foramina (w/ their respective BV-Ns)
- medial & lateral pterygoid plates
- pterygoid fossa
rd
- pterygoid hamulus can be palpated distal to the Mx 3 molar
Greater Palatine nerve (from V2) supplies sensory to hard palate mucosa
Lesser Palatine nerve (from V2) supplies sensory to soft palate mucosa
Greater Petrosal nerve (from VII) supplies taste to both palates mucosa

Pterygomandibular Raphe
- origin = pterygoid hamulus
- insertion = mylohyoid line on the mandible
- lateral attachment = buccinator muscle
- medial attachment = superior pharyngeal constrictor muscle
- this is a landmark for anesthetic block of Inferior Alveolar Nerve
Musculus Uvulae Muscle
- origin = posterior nasal spine
- insertion = uvula mucosa
- action = tenses the uvula upward to meet the pharyngeal wall
in order to close oropharynx from nasopharynx
Tensor Palatini Muscle
- origin = lateral auditory tube (bony part)
- pathway = hooks around the pterygoid hamulus as a pulley
- insertion = palatine aponeurosis
- action = contracts to stretch / tense the palate and
opens eustachian tube to let air from pharynx to middle ear
Levator Palatini Muscle
- origin = medial auditory tube (cartilaginous part)
- insertion palatine aponeurosis
- action = elevates the soft palate
in order to close oropharynx from nasopharynx
Pharyngeal Plexus
- motor fibers from XI
- sensory fibers from IX

supplies all Palatal Muscles

EXCEPT Tensor Palatini (V3 root)

His Drawing
- oral cavity
- nasal cavity
- Space of Donders
- Retropharyngeal Space (only a potential space)
- C6 = transition b/t larynx / pharynx trachea / esophagus
Torus Tubaris = cartilage wraps around in an inverted J-shape around the auditory tube
Salpingopharyngeus muscle originates here and blends into the pharyngeal wall
Eustachian Tube
- lateral bony part opens into the anterior wall of the middle ear
- medial cartilaginous part opens into the lateral wall of the nasopharynx
Inverted Skull Slide:
- Pterygoid canal
- Pharyngeal canal / Palatovaginal canal
- pharyngeal tubercle on the occipital bone
- groove for the cartilaginous portion of the Eustachian Tube

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Motor Innervation of Palatine Muscles

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

Pharyngeal Plexus = formed by CN #s IX, X, XI (all exit thru Jugular Foramen)

Cranial Accessory (XI) = supplies motor branches to the pharyngeal plexus
Glossopharyngeal (IX) = supplies sensory branches to the pharyngeal plexus
Cranial Accessory (XI)
- shares the same brainstem origin (medulla) with the Vagus Nerve (X)
- travels along with fibers of Vagus and sometimes separates from it, but otherwise, not very distinguishable from it
- gives rise to the motor efferent fibers of the pharyngeal plexus
Spinal Accessory (XI)
- comes from the spinal cord
- supplies motor innervation to the Sternocleidomastoid & Trapezius muscles
Glossopharyngeal (IX)
- provides only SENSORY branches to pharyngeal plexus
- provides MOTOR innervation ONLY to the Stylopharyngeus Muscle

All tongue muscles are supplied by Hypoglossal Nerve (XII) EXCEPT PALATOGLOSSAL (Pharyngeal Plexus)
All laryngeal muscles are supplied by Recurrent Laryngeal Nerve EXCEPT CRICOTHYROID (External Laryngeal Nerve)
All palatine muscles are supplied by Pharyngeal Plexus EXCEPT TENSOR PALATINI (V3)
All pharyngeal muscles are supplied by Pharyngeal Plexus EXCEPT STYLOPHARYNGEUS (IX)
EXCEPT CRICOPHARYNGEUS (Recurrent Laryngeal)

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Mandibular Nerve (V3)

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

Inferior Alveolar = all Md anterior & posterior teeth

Lingual = all Md anterior & posterior gingiva
Long Buccal = Md posterior facial gingiva
Mental = Md anterior facial gingiva
Maxillary nerve (V2)
Posterior Superior Alveolar = Mx molar teeth and facial gingiva EXCEPT MB of 1st molar
Middle Superior Alveolar = Mx premolar teeth and facial gingiva AND MB of 1st molar
Anterior Superior Alveolar = Mx anterior teeth and facial gingiva
Greater Palatine = Mx posterior lingual gingiva
Nasopalatine = Mx anterior lingual gingiva

Glossopharyngeal Nerve (IX)

- SVA supplies taste & touch to posterior 1/3 tongue
- SVA supplies taste to circumvallate papillae
- SVE supplies motor branches to Stylopharyngeus muscle
- GVA supplies sensory to soft palate

contributes sensory branches to the Pharyngeal Plexus

- GVA supplies sensory to palatine tonsil

located on the Middle Constrictor muscle of the pharynx

- GVA supplies sensory to posterior wall of the entire pharynx

- GVA supplies sensory to the pressure receptors in the carotid sinus & carotid body
- GVE supplies post-ganglionic parasympathetic fibers to the parotid gland
preganglionic parasympathetic fibers originate from IX in the Inferior Salivitory Nucleus
runs thru the Tympanic Canaliculus
forms the Tympanic Plexus in the middle ear
re-forms as the Lesser Petrosal Nerve
runs thru the Canaliculus Inominatus to enter the petrous temporal bone
runs thru the Hiatus for Lesser Petrosal Nerve to leave the petrous temporal bone
emerges within the middle cranial fossa
(sometimes) exits thru the Foramen Ovale
synapses at Otic Ganaglion
hitches a ride w/ Auriculotemporal Nerve (V3)
innervates parotid gland

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Facial Nerve (VII)

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

- Internal Auditory Meatus Stylomastoid Foramen pierces parotid T, Z, B, M, C, Posterior Auricular

Chorda Tympani
- emerges from Petrotympanic Fissure
- carries special sensory taste fibers to join the Lingual Nerve (V3) to supply anterior 2/3 of the tongue
- carries pre-ganglionic parasympathetic fibers originating from the Pons to synapse in the Submandibular Ganglion
- post-ganglionic parasympathetic fibers innervate:
submandibular salivary gland
Q: where does their sympathetic innervation come from?
sublingual salivary gland
A: postganglionic sympathetic fibers come from the
minor salivary glands on buccal mucosa
External Carotid Plexus. These fibers have already
synapsed in the Superior Cervical Ganglion
Greater Petrosal Nerve
- carries special sensory taste fibers to supply the palatine taste buds
- carries pre-ganglionic parasympathetic fibers originating from the Pons to synapse in the Pterygopalatine Ganglion
- post-ganglionic parasympathetic fibers innervate:
lacrimal gland
palatine glands
anything that gets innervated by
pharynx
Maxillary (V2) in the pterygopalatine fossa
nasal
Geniculate Ganglion
- motor branches to T,Z,B,M,C,PA run directly thru w/o synapsing (NO MOTOR CELL BODIES HERE)
- Greater Petrosal pregang. parasymp. fibers run straight thru w/o synapsing (NO GPN CELL BODIES HERE)
- CHORDA TYMPANI fibers SYNAPSES HERE (YES, THERE ARE TASTE CELL BODIES HERE)

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ARTERIAL SUPPLY TO ORAL CAVITY

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

Maxillary
Facial
Lingual

branches directly off the External Carotid

Ascending Pharyngeal

VENOUS DRAINAGE OF ORAL CAVITY

- Maxillary Artery part 1 has corresponding same-name veins
- Maxillary Artery parts 2 & 3 dont really have corresponding same-name veins
- Instead, there is the Pterygoid Plexus located within the Pterygopalatine Fossa

Pterygoid Plexus

Superior Thyroid
Pharyngeal
Lingual

Retromandibular Vein = Maxillary + Superficial Temporal

Anterior Retromandibular + Facial Vein = Common Facial Vein Internal Jugular Vein

Brachiocephalic Vein

Posterior Retromandibular + Posterior Auricular = External Jugular Vein Subclavian Vein

Superior Vena Cava

IMPORTANT VENOUS COMMUNICATIONS

Pharyngeal Plexus

Retropharyngeal Space

Mediastinum

[Pharyngeal Veins of the Pharyngeal & Pterygoid Canals]

PTERYGOID PLEXUS [Sphenoid Emissary Vein] Cavernous Sinus

[Deep Facial Vein] [Inferior Ophthalmic Vein]

Facial Vein

[Superior Ophthalmic Vein]

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