Oral cavity, palate and

pharynx
Oral cavity
• The oral cavity (mouth) is the gateway of
entrance to the digestive system. It is
bounded anteriorly by the lips and
posteriorly by the oropharyngeal isthmus,
a circular aperture that guards the
entrance to the pharynx.
• The oral cavity is lined with mucous
membrane composed of stratified
squamous epithelium and an underlying
dense connective tissue that contains
minor salivary glands.
• The oral cavity is subdivided into two
major regions:
1. The outer vestibule.
2. The inner oral cavity proper.
 Vestibule
• The vestibule is the space between the lips and
cheeks externally and the teeth and gum
(gingiva) internally when the teeth are in
occlusion.
• The vestibule communicates with the outside
through the oral fissure and with the oral cavity
proper via the interdental spaces and the
interval behind the last molar teeth.
• Laterally, the vestibule is called the buccal
vestibule, whereas anteriorly, in the region of
the lips, it is called the labial vestibule.
• The parotid gland empties its salivary
secretions into the buccal vestibule at a small
orifice opposite the second maxillary molar.
• Labial frenula appear as folds of tissue in the
midline attaching the superior and inferior lips
to the gingiva where the superior labial
frenulum is the most prominent
 Oral cavity proper
• The oral cavity proper lies internal to the dental
arches and their contained teeth and gingiva.
• It is bounded superiorly by the palate and inferiorly
by the tongue and the mucous membrane of the
floor of mouth.
• Anterolaterally, it is bounded by the lingual surfaces
of the teeth, gingiva, and alveolar mucosa.
• The posterior boundary of the oral cavity proper is
formed by the soft palate superiorly and by the
palatoglossal arch. This arch, which includes the
palatoglossus muscle and overlying oral mucosa,
extends from the soft palate to the sides of the base
of the tongue.
• The oral cavity communicates with the oral pharynx
via the oropharyngeal isthmus, the fauces. This
aperture is bounded by the soft palate superiorly, by
the surface of the posterior one third of the tongue
inferiorly, and by the palatoglossal arch laterally.
• Anything posterior to these named structures lies in
the pharynx.
 lips
• The lips are two fleshy, mobile structures
guarding the entrance to the mouth. They are
covered externally with skin that overlies
muscle, glands, and connective tissue.
Internally they are lined with a mucous
membrane.
• The superior lip is bounded laterally by the
nasolabial groove extending from the ala of
the nose to a short distance lateral to the
corner of the mouth.
• A slight shallow, vertical depression in the
midline of the upper lip order is the philtrum
• The two lips are connected laterally by the
labial commissures, which are thin folds of
tissue that are seen when the mouth is slightly
opened.
• The oral fissure lies between the superior and
inferior lips, which may be opened or closed
when the two lips are in contact with each
other.
 Teeth
• The teeth are arranged in a row on both the maxillary
and the mandibular dental arches. They form a
boundary between the vestibule and the oral cavity
proper.
• Permanent teeth, are two incisors, one canine, two
premolars, and three molars; thus, eight teeth are in
each quadrant of the jaw, for a total of 32 teeth in
mature adult. The third molar, wisdom tooth, is slow
to erupt and may not present itself in the oral cavity.
• Deciduous teeth, are those that are shed or replaced.
Thus they represent teeth present in childhood. Each
quadrant contains the following deciduous teeth: two
incisors, one canine, and two molars; thus, there are
five deciduous teeth in each quadrant for a total of 20
teeth.
• The crown of the tooth is that part exposed in the oral
cavity, whereas the root lies in the bony alveolus, out
of view. The central core of the tooth is composed of
the soft-tissue pulp containing blood vessels, nerves,
and lymphatics that reach the area through the apical
foramen at the tip of the root.
Gum (gingiva)
• It is highly vascular connective
tissue covered with mucous membrane.
• It is composed of 2 parte :
1. Free part surrounding the neck of the
teeth.
2. Attached part attached to the alveolar
arches of the upper and lower jaw.
• Healthy gums are pink, stippled, and
tough.
• The upper gum is supplied by branches of
maxillary nerve. The lower gum is
supplied by branches of mandibular nerve
 Tongue
• The tongue, a muscular organ, is divided into the
body, which lies relatively free in the oral cavity, and
the base, which is fixed to the hyoid bone.
• The dorsum of the body has the median sulcus,
dividing the tongue longitudinally in the midline
into right and left halves. The sulcus terminalis is a
shallow groove separating the anterior two thirds
(or body) from the posterior one third (base) of the
tongue.
• Lying anterior to the terminal sulcus is a row of 8 to
10 mushroom-shaped circumvallate papillae (vallate
papillae). These structures possess taste buds.
• The remaining mucosal surface of the dorsum of
the anterior two thirds of the tongue has
specialized projections, known as lingual papillae.
The most numerous are the filiform papillae and,
interspersed among them are the fungiform
papillae.
• The rest of the dorsal surface of the posterior one
third of the tongue exhibits irregular bulges in its
mucosa representing the lingual tonsils.
• The mucosa of the ventral surface of the
tongue is smooth and without surface
papillae. Lingual frenulum attaches the
anterior two thirds of the tongue to the floor
of the mouth.
• The bilateral deep lingual veins can be
observed through the transparent mucosa on
either side of the frenulum along the
tongue’s inferior surface from the tip to the
deep regions in the floor of the mouth.
• Just above the floor of the mouth on either
side of the lingual frenulum is an elevation of
the mucous membrane (plica sublingualis)
overlying the bulging sublingual glands.
• Several small openings along the surface of
the plica sublingualis representing the small
sublingual ducts (ducts of Rivinus) can be
observed.
• The submandibular duct (Wharton duct)
opens at the sublingual papilla adjacent to
the lingual frenulum.
 Palate
• The palate forms the roof of the mouth and the floor of the nasal cavities. It
consists of two regions, one containing a bony shelf, the immovable hard palate,
and the other, a more posteriorly located, muscular, movable soft palate.
The hard palate
• is a bony plate composed of the palatine processes of the maxillae and the
horizontal processes of the palatine bones fused in the midline with their
counterparts of the opposite side.
• Anteriorly and laterally, it is bounded by the alveolar arches, and posteriorly its
boundary is demarcated by the beginning of the soft palate.
• The bone is covered by a specialized mucoperiosteum on both its oral and nasal
surfaces. The posterior border of the hard palate possesses the palatine
aponeurosis for attachment of the muscles of the soft palate..
The soft palate
• is a muscular structure, covered with a mucous membrane, suspended between
the oral pharynx and the nasal pharynx. Its sides are attached to the lateral
pharyngeal walls.
• The anterior portion of the soft palate, near its junction with the hard palate, is
almost immobile, whereas its posterior-most extent, the uvula, is freely movable.
• Lateral to the uvula is the palatoglossal arch (palatoglossal fold), containing the
palatoglossal muscle, forming the anterior pillar of the oropharyngeal isthmus
(fauces), extending into the side of the tongue.
• Arising posteriorly is the palatopharyngeal arch, containing the palatopharyngeus
muscle, forming the posterior pillar of the oropharyngeal isthmus extending into
the lateral pharyngeal wall. The palatine tonsils are located between the two
fauces in the tonsillar sinus .
 Muscles of the soft palate
• The muscles of the soft palate are the levator
palati, tensor palati, musculus uvulae,
palatoglossus, and palatopharyngeus.
levator palate is intimately associated with the
lateral aspect of the choana.
• Origin from the inferior aspect of the petrous
portion of the temporal bone, and from the the
cartilaginous portion of the auditory tube.
• Insertion it inserts into the palatine
aponeurosis.
• Action: It elevates the soft palate.
Tensor Palati
Origin: It originates in the scaphoid fossa, on the
spine of the sphenoid bone.
• Insertion The fibers collect into a tendinous
cord that wraps medially around the hamulus of
the medial pterygoid plate to insert into the
palatine aponeurosis.
• Action: This muscle acts to flatten and tense the
soft palate.
Musculus Uvulae muscle
Origin: from the posterior nasal spine and from the palatine
aponeurosis.
• Insertion: insert in common with its opposite side, forming
the substance of the uvula.
• Action: It retracts and elevate the uvula.
Palatoglossus muscle, is covered by a mucous membrane
forming the palatoglossal arch.
• Origin; from the fascia and musculature of the lateral
aspect of the soft palate.
• Insertion: It inserts by interdigitating with the intrinsic
muscles of the tongue in its lateral margin.
• Action: It elevates the posterior one third of the tongue and
with the other side, constricts the fauces.
Palatopharyngeus muscle and its mucosal covering form the
palatopharyngeal arch.
• Origin: arising by two fleshy slips from the side of the soft
palate, with the levator palati and the musculus uvulae
being interposed between the two origins.
• Insertion: It inserts, along with fibers of the stylopharyngeus
muscle, into the posterior aspect of the thyroid cartilage.
• Action: It elevates the pharynx and larynx.
 Vascular and nerve supply of the palate
• Arterial supply of the palate is derived chiefly from:
1. Greater and lesser palatine branches of the maxillary artery.
2. Ascending palatine branch of the facial artery.
3. Ascending pharyngeal artery from the external carotid artery.
• Venous drainage is by the accompanied veins to the above arteries that are
tributaries of the pterygoid and tonsillar plexus.
• Sensory nerve supply of the palate is derived chiefly from:
1. Greater and lesser palatine nerves, (the lesser palatine carry general sensory
and taste fibers from the facial nerve via the greater petrosal nerve).
2. Additional sensory supply is derived from the nasopalatine nerve.
3. Tonsillar branches of the glossopharyngeal nerve
• Motor nerve supply
All the muscles of the palate are supplied by the vagus nerve via its contributions to
branches of the pharyngeal plexus except the tensor palate which is supplied by
nerve to medial pterygoid from the trunk of mandibular nerve.
 Pharynx
• The pharynx is a fibromuscular tube, 12 to 14 cm long,
extending from the base of the skull to become continuous
with the esophagus. It is a funnel shaped, broadest at its
cranial extent and narrowest at its esophageal junction.
• Superiorly, it is attached to the basilar part of the occipital
bone and the body of the sphenoid bone.
• Laterally, it is fixed to the medial pterygoid plate,
pterygomandibular raphe, alveolar process of the
mandible, lateral aspect of the tongue, hyoid bone, and
thyroid and cricoid cartilages.
• Posteriorly, the pharynx is related to the bodies of the
first six cervical vertebrae, being separated from them by
the prevertebral fascia.
• Anteriorly, the pharynx has no complete wall; instead, it
opens into the nasal, oral, and laryngeal cavities. So , the
pharynx is divided into 3 parts:
1. Nasopharynx.
2. Oropharynx.
3. Laryngeopharynx.
 Nasopharynx
• The nasopharynx is the upper most and broadest part
of the pharynx.
• Anteriorly, it communicates with the nasal cavity via
the paired choanae; inferiorly, it is limited by the soft
palate.
 During respiration, the soft palate is flaccid and the
nasopharynx communicates with the oral pharynx
through the pharyngeal isthmus which is a space
between the posterior wall of the pharynx and the free
border of the soft palate.
 During deglutition, the soft palate is elevated and
contacts the posterior wall of the pharynx, blocking the
communication between the nasal and oral cavities.
• The lateral wall of the nasopharynx presents the
opening of the auditory tube and forms an elevation
called tubal elevation. Behind the elevation is the
pharyngeal recess.
• The salpingopharyngeal fold covers the
salpingopharyngeus muscle, extending from the
posteroinferior aspect of the opening and passing
inferiorly to unite with the muscles of the pharynx.
• The posterior wall of the nasopharynx contains a mass
of lymphatic tissue, the pharyngeal tonsil.
Oropharynx
• It is the part of the pharynx that leads
to the laryngeal pharynx.
• It extends from the soft palate to the
upper end of the epiglottis, which is
positioned at the level of the hyoid
bone. Anteriorly, the oropharynx
communicates with the oral cavity
through the oropharyngeal isthmus.
• The lateral wall of the oropharynx
presents the palatine tonsil between
the palatoglossal and palatopharyngeal
arches
 Palatine tonsils
• It is an almond-shaped mass of lymphoid tissue covered, by mucous
membrane and located in the tonsillar sinus between the
palatoglossal and palatopharyngeal arches.
• The small triangular recess above the tonsil is the supratonsillar fossa.
• The medial surface of the tonsil is visible when the tongue is
depressed, and presents tonsillar crypts that may invade the entire
depth of the tonsil.
• The lateral surface is covered by a fibrous capsule, separating the
tonsil from the pharyngeal musculature.
Arterial supply is derived from:
1. Tonsillar branch the facial artery is the chief vascular supplier of the
tonsil,
2. Other minor vessels to the palatine tonsils are the palatine branch
of the ascending pharyngeal, the lesser palatine branch of the
maxillary artery.
Venous drainage is by the tonsillar plexus of veins on the deep aspect of
the tonsil, a tributary of the pharyngeal venous plexus.
Sensory innervation to the palatine tonsils is from:
• The glossopharyngeal nerve and the lesser palatine branches of the
maxillary nerve.
• Contributions from the greater petrosal branch of the facial nerve.
 Laryngeopharynx
• The most inferior part of the pharynx, extends
from the epiglottis, to the level of the inferior
border of the cricoid cartilage.
• Anteriorly, it communicates with the larynx,
via the laryngeal inlet (laryngeal opening).
• The epiglottis is connected to the midline and
side of the pharyngeal root(base) of the
tongue by the median and lateral
glossoepiglottic folds, respectively. The
resultant fossa on either side of the median
glossoepiglottic fold is known as the epiglottic
vallecula.
• Inferior to the laryngeal opening, the anterior
wall of the laryngeopharynx consists of the
mucosa lining the posterior aspect of the
arytenoid and cricoid cartilages.
• Lateral to the laryngeal opening ,there is the
piriform fossa.
 Pharyngeal wall
• The pharyngeal wall is composed of 4 layers:
1. Inner-most mucous layer is continuous with
the mucosa of the chambers into which the
pharynx opens.
2. Inner fibrous layer (pharyngeobasilar fascia).
3. Muscular layer is positioned between the
pharyngobasilar fascia and the thin, outer-
most layer of the pharynx, the
buccopharyngeal fascia. The musculature of
the pharynx is composed of the superior,
middle, and inferior pharyngeal constrictors
as well as the stylopharyngeus,
salpingopharyngeus, and palatopharyngeus
muscles.
4. Outer fibrous layer (buccopharyngeal fascia)
Superiorly, in the region devoid of the
superior constrictor, this fascia fuses with the
pharyngobasilar fascia. Nerves and vessels
traveling along the pharynx course in the
buccopharyngeal fascia.
Pharyngobasilar fascia
• is Just deep to the mucosa, a layer of fibrous connective
tissue that is thick cranially but becomes thinner as it
progresses caudally.
• The cranial portion of the pharyngobasilar fascia has no
muscular covering.
• It is attached to the base of the skull at various points:
The basilar portion of the occipital bone, anterior to the
pharyngeal tubercle.
The petrous temporal bone.
The medial pterygoid plate.
Pterygomandibular raphe.
Stylohyoid ligament.
Hyoid bone.
Thyroid cartilage.
• Posteriorly this fascia is attached to the pharyngeal
raphe which is a strong, fibrous band of connective
tissue extending from the pharyngeal tubercle of the
occipital bone almost to the caudal border of the
pharynx. The constrictor muscles of the pharynx insert
into the pharyngeal raphe.
 Muscles of the pharynx
Superior Pharyngeal Constrictor
• Origin: from the pterygoid hamulus and an adjoining region of the
medial pterygoid plate, the pterygomandibular raphe, the posterior
quarter of the mylohyoid line, the alveolar process of the mandible, and
the lateral aspect of the root of the tongue.
• Insertion: the fibers curve posteriorly to insert into the pharyngeal
raphe and pharyngeal tubercle.
• Action: it constricts the pharynx.
Middle Pharyngeal Constrictor,
• Origin: originates from the lesser and greater cornu of the hyoid bone
and the stylohyoid ligament. The upper fibers pass superficial to the
superior constrictor muscle, thus covering part of it; the inferior fibers
pass deep to the inferior constrictor muscle.
• Insertion: into the pharyngeal raphe.
• Action: it constricts the pharynx.
Inferior Pharyngeal Constrictor
• Origin: It arises from the oblique line of the thyroid cartilage
thyropharyngeal part), and from the lateral aspect of the cricoid
cartilage (cricopharyngeal part).
• Insertion: insert into the pharyngeal raphe. The most inferior fibers are
continuous with the circular inner muscle fibers of the esophagus.
• Action: the thyropharyngeal part constricts the pharynx, and the
cricopharyngeal part acts as a pharyngoesophageal sphincter, preventing
reflux of esophageal contents into the pharynx.
Stylopharyngeus muscle
• Origin: arises from the styloid process and passes inferomedially between the middle and superior pharyngeal
constrictor muscles.
• Insertion: inserts in common with the palatopharyngeus muscle to posterior border of the thyroid cartilage.
• Action: it elevates the larynx and pharynx.
Salpingopharyngeus muscle
• Origin: Arises from the postero-inferior aspect of the cartilaginous auditory tube at its terminal end in the
nasopharynx.
• Insertion: it passes inferiorly, deep to the pharyngeal mucosa, to insert into the muscular wall of the pharynx
by joining the fibers of the palatopharyngeus muscle.
• Action: : It elevates the pharynx and may assist in opening the auditory tube during deglutition.
 Vascular and Nerve Supply Of The Pharynx
• Arterial supply of the cranial portion of the pharynx is derived chiefly from
1. The ascending pharyngeal branch of the external carotid artery,
2. The pharyngeal branches of the maxillary artery,
3. The ascending palatine and tonsillar branches of the facial artery.
4. The superior thyroid artery and, to a lesser extent, the inferior thyroid arteries supply the
caudal portion of the pharynx.
• Venous drainage is via a plexus of veins, the pharyngeal plexus, located between the
prevertebral fascia and the constrictor muscles. This plexus is drained by the pterygoid plexus of
veins and the internal jugular and facial veins.
• Sensory innervation
1. The nasopharynx and part of the oropharynx is supplied via branches of the maxillary nerve
and glossopharyngeal nerves.
2. The remainder of the pharynx is supplied by branches of the glossopharyngeal and vagus
nerves.
3. Motor innervation
• All the muscle of the pharynx are supplied by the vagus nerve via its contributions to the
pharyngeal plexus except the stylopharngeus muscle which is supplied by glossopharyngeal
nerve.