Assoc. Prof. Dr. Zul Izhar Mohd.
Ismail
Department of Anatomy,
School of Medical Sciences
November 2022
Copyright Reserved
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Outline We l e a d
Oral cavity
• Lips, cheeks & gingivae (gums)
• Teeth
• Palate
Tongue
• Muscles
• Innervation
Salivary glands
• Parotid
• Submandibular
• Sublingual
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ORAL CAVITY
We l e a d
• 2 parts:
– Oral vestibule – space between the
[teeth+buccal gingiva] – [lips+cheeks]
– Oral cavity proper – space between
the upper and lower dental arches
(maxillary and mandibular alveolar
arches)
• Mouth = oral fissure/opening
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LIPS We l e a d
• Covered externally by skin
• Transitional zone/vermilion border – Nasolabial sulcus
between the skin and mucous
membrane
• Contain – orbicularis oris, superior
and inferior labial muscles
• Nasolabial sulcus
• Mentolabial sulcus
• Philtrum
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Lips We l e a d
• Covered internally by
mucous membrane
• Labial frenulum –
midline fold of mucous
membrane
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Lips: Blood supply We l e a d
• Upper lip:
– by superior labial
branches of facial &
infraorbital arteries
• Lower lip:
– by inferior labial
branches of facial &
mental arteries
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Lips: Innervation We l e a d
• Upper lip: by superior labial
branches of infraorbital
nerves (of CN V2)
• Lower lip: by inferior labial
branches of mental nerves
(of CN V3)
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Lips: Lymphatic drainage We l e a d
• Upper lip + lateral parts of lower lip → submandibular lymph nodes
• Medial part of lower lip → submental lymph nodes
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CHEEKS We l e a d
• External aspect = buccal region;
bounded by:
– Oral & mental region (anteriorly)
– Zygomatic region (superiorly)
– Parotid region (posteriorly)
– Inferior border of mandible (inferiorly)
• Muscles – buccinator muscles
• Buccal fat-pads - superficial to
buccinator
• Blood supply – buccal branches of
the maxillary a.
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GINGIVAE
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• Fibrous tissue covered by mucous
membrane
• Gingiva proper
– Pink, stippled and keratinizing
– Divided into:
1) Attached gingiva
• Firmly attached to the alveolar processes and the
necks of the teeth
2) Unattached/free gingiva
• NOT attached to the alveolar processes and the
necks of the teeth
• Alveolar mucosa
– Shiny red and non-keratinising
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TEETH We l e a d
• Deciduous (primary) – 20 in children
• Permanent (secondary) – 32 in adults
• Before eruption, the developing teeth
reside in the alveolar arches as tooth buds 11
Teeth We l e a d
• Types:
– Incisors – thin cutting edges
– Canines – single prominent cones
– Premolars – 2 cusps
– Molars – 3 or more cusps
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TEETH: Parts We l e a d
• Parts
– Crown – projects from the gingiva Enamel
– Neck
– Root – fixed in the tooth socket by the Crown Dentin
periodontium
Dental pulp
• Composed of dentin, which is Neck
covered by enamel (over the crown)
and cement (over the root)
Cementum
• Pulp cavity – contains connective Root
tissue, blood vessels and nerves
Apical
• Root canal (pulp canal) transmits foramen
the nerves and vessels through the
apical foramen
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Teeth: Innervation & Blood supply We l e a d
Maxillary teeth: by superior alveolar vessels and nerves (Maxillary nerve, CN V2)
Mandibular teeth: by inferior alveolar vessels & nerves (Mandibular nerve, CN V3)
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PALATE We l e a d
Hard palate
(anterior 2/3)
Soft palate
(posterior 1/3)
• Forms the roof of the mouth & floor of the nasal cavity
• Oral surface is covered with oral mucosa, densely packed with glands
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Hard palate We l e a d
• Has bony skeleton formed by:
– Palatine processes of the
maxillae
– Horizontal plates of the palatine
bones
Foramina Structures passing through
Incisive foramina Nasopalatine nerves& vessel
Greater palatine foramen Greater palatine nerve & vessel
Lesser palatine foramen Lesser palatine nerve & vessel
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Soft palate We l e a d
• 2 parts:
– Aponeurotic part – palatine aponeurosis anteriorly
– Muscular part - posteriorly
• Uvula
• Palatine aponeurosis
– Is formed by the expanded tendon of the tensor
veli palatini muscle
– Laterally joined to the tongue by the palatoglossal
arch
– Laterally joined to the pharynx by the
palatopharyngeal arch
• Taste buds – present in the oral surface of the soft
palate, posterior wall of the oropharynx & epiglottis
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Waldeyer’s ring (Tonsillar ring) We l e a d
• Formed by the:
– Lingual tonsil
– Palatine tonsil (“tonsil”)
– Tubal tonsil
– Pharyngeal tonsil (“adenoid”)
Palatine tonsils (“tonsils”) - masses of lymphoid tissue in a tonsillar fossa (bounded by the palatoglossal &
palatopharyngeal arches and the tongue)
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Muscles of the soft palate We l e a d
Muscle Innervation Main action
Tenses soft palate
Medial pterygoid n. (a
Tensor veli palatini Opens mouth of pharyngotympanic tube during
branch of CN V3)
swallowing & yawning
Elevates soft palate during swallowing & yawning
Levator veli palatini
Elevates posterior part of tongue
Palatoglossus
Draws soft palate onto tongue
Pharyngeal branch of
CN X Tenses soft palate & pulls walls of pharynx
Palatopharyngeus superiorly, anteriorly, and medially during
swallowing
Musculus uvulae Shortens uvula & pulls it superiorly
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Palate: Blood supply & innervation We l e a d
Branches of maxillary nerve Branches of the 3rd part of maxillary a.
A branch of the facial a.
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TONGUE We l e a d
• Partly in the oral cavity & partly in the
oropharnynx
• Parts:
– Root (posterior 1/3)
– Body (anterior 2/3)
– Apex
• Surfaces:
– Dorsum
– Inferior/ventral
Terminal sulcus/groove (sulcus terminalis)
– divides the anterior and the posterior parts
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TONGUE: Dorsum surface We l e a d
• Foramen caecum - small pit, usually absent.
Non-functional remnant of the proximal part of
the embryonic thyroglossal duct from which the
thyroid gland developed
• Lingual papillae
– in the anterior 2/3
– Filiform, fungiform, circumvallate, foliate
papillae
• Posterior 1/3 – no lingual papillae, but
has lymphoid nodules (lingual tonsils)
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Tongue: Inferior/ventral surface We l e a d
• Inferior surface
– Frenulum of the tongue
– Sublingual caruncle (papilla) – opening of the submandibular salivary gland
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Muscles of the tongue We l e a d
• Extrinsic muscles – change the position
• Intrinsic muscles – change the shape
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Muscles of the tongue We l e a d
Muscle Innervation
Extrinsic muscles
Genioglossus
Hyoglossus CN XII
Styloglossus
Palatoglossus Pharyngeal plexus (CN X)
Intrinsic muscles
Superior longitudinal
Inferior longitudinal
CN XII
Transverse
Vertical 27
Tongue: Innervation We l e a d
General (mostly) and special sensory
General Special
sensory sensory
(Taste)
Anterior 2/3 Lingual n. Chorda
(Mandibular tympani
nerve, CN (CN VII)
V3)
Posterior 1/3 CN IX CN IX
Posteriormost CN X CN X
(touch & temperature)
(taste)
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Blood supply We l e a d
Lingual artery – dorsal lingual & deep lingual aa.
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Lymphatic drainage
We l e a d
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SALIVARY GLANDS We l e a d
• 3 paired salivary glands:
– Parotid
– Submandibular
– Sublingual
• Small accessory salivary glands – scattered over the
palate, lips, cheeks, tonsils and tongue
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PAROTID SALIVARY GLANDS We l e a d
Parotid gland
We l e a d
• The largest of the three salivary
glands
• Pure serous gland
• Wedged between the ramus of
mandible and the mastoid process
• Anteriorly – overlaps the masseter
Parotid gland We l e a d
• Base – related to the zygomatic arch
• Apex – posterior to the angle of
mandible
Borders & Surfaces
We l e a d
• 3 borders:
– Anterior
– Posterior
– Medial
• 4 surfaces:
– Superior (base)
– Superficial
– Anteromedial
– Posteromedial
Relations We l e a d
Borders Related structures
Structures emerging from this border:
- Parotid duct
Anterior
- Terminal branches of CN VII
- Transverse facial vessels
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Structures within the gland We l e a d
Parotid Facial nerve Veins Arteries
lymph nodes
Superficial Deep
Structures within the gland We l e a d
Enters through the upper part of its posteromedial surface
Divides into terminal branches within the gland
Facial nerve
Leave through its anteromedial surface and appear at the anterior border
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Parotid gland We l e a d
Parotid duct (Stensen’s duct)
We l e a d
Emerges horizontally from the anterior border
crosses masseter (lies
between the upper &
lower buccal branches
of CN VII)
turns medially at the
anterior border of
the masseter
Parotid papilla
with opening of pierces the buccal fat pad,
parotid duct buccopharyngeal fascia and buccinator
enters the vestibule of the mouth through a small orifice
opposite the crown of the 2nd maxillary molar tooth
Blood supply &lymphatic drainage We l e a d
• External carotid artery and its branches within and near
the gland
• Venous drainage – external jugular vein
• Parotid l/n → upper deep cervical l/n
Innervation We l e a d
• Secretomotor: parasympathetic (GVE) component of CN IX: Inferior
salivatory nucleus → glossopharyngeal n. → tympanic branch (Jacobson) →
tympanic plexus → lesser petrosal nerve → otic ganglion → auriculotemporal
n. → parotid gland
Innervation We l e a d
• Vasomotor: sympathetic – derived from the cervical ganglia through
the external carotid nerve plexus on the ECA
• Sensory
– great auricular n. (C2,3) – parotid capsule
– auriculotemporal n. – overlying skin
We l e a d
Submandibular glands We l e a d
• Mylohyoid muscle – divides the
gland into:
– Superficial part (larger)
– deep part (smaller)
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Submandibular duct (Wharton’s duct) We l e a d
• 5 cm long
• Emerges at the anterior end of the deep part of the gland
• Lies between the mylohyoid and hyoglossus muscles
• Runs forward on the hyoglossus, between the lingual and hypoglossal nerves
• At the anterior border of hyoglossus, it is crossed inferiorly from lateral to medial by
the lingual nerve
• Opens by 1-3 orifices on the floor of mouth, at the summit of sublingual papilla,
beside the base of the frenulum
Submandibular glands We l e a d
• Arterial supply - submental a.(from facial a.)
• Veins – drain into common facial or lingual v.
• Lymphatic – ends in the jugulo-omohyoid node
Submandibular glands We l e a d
• Nerve supply
– Presynaptic parasympathetic secretomotor converted from CN VII to lingual
n. by the chorda tympani – synapse in the submandibular ganglion
– Vasomotor sympathetic from superior cervical ganglion
– Sensory – from lingual n.
SUBLINGUAL SALIVARY GLANDS We l e a d
Parotid duct
Sublingual folds
with opening of
sublingual ducts
Sublingual caruncle
with opening (papilla)
of submandibular
ducts
Sublingual gland
Mylohyoid
muscle
Sublingual salivary gland We l e a d
• The smallest
• Lies above the mylohyoid, below the mucosa of the floor of mouth
• Between the mandible and the genioglossus m.
• The glands from each side unite to form a horseshoe-shaped mass around the
connective tissue core of the lingual frenulum
• ~ 15 ducts. Most open into the floor of mouth on the summit of sublingual folds. A
few join the submandibular duct
Sublingual glands We l e a d
• Arterial supply
– sublingual & submental aa. (from lingual & facial
aa.respectively)
• Innervation
– secretomotor: parasympathetic (same as for
submandibular glands)
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