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Surgical anatomy of oral cavity.pptx

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Surgical anatomy of oral cavity.pptx

  1. 1. Surgical and functional anatomy of the oral cavity
  2. 2. Outline Orofacial spaces and spread of infection Ludwig's angina Lymphatic drainage of the oral cavity • Tumors-squamous cell carcinoma Gross anatomy oral cavity Floor: • Tongue • Muscles of the tongue • Embryology of the tongue • Taste buds • Taste pathways Roof: Palate • Anatomy of the palate • Embryology of the palate • Cleft palate/lip
  3. 3. Oral cavity • Function Special sense of taste Physical and chemical digestion Articulation Alternative route for air flow into the lungs • Oral vestibule: Space between teeth and lips/cheeks. • Contents: Lips, gingivae, upper and lower labial frenula • Oral cavity proper: Space enclosed by the dental arches Roof: Hard and soft palates Floor: Geniohyoid muscles and muscular diaphragm (mylohyoid muscles); tongue Lateral walls: Dental arches Posterior limit: Isthmus of fauces (contains palatine tonsils between palatoglossal and palatopharyngeal arches, marks the transition to oropharynx)
  4. 4. Dorsum of tongue
  5. 5. Tongue Parts Body, apex, root Surfaces Dorsal (superior) and ventral (inferior) Papillae Filiform, fungiform, foliate, vallate Innervation • Hypoglossal nerve (CN XII): provides motor innervation to all muscles of the tongue, except palatoglossus muscle (vagus nerve (CN X)) • Lingual nerve: conveys general somatic afferent impulses from anterior two- thirds of tongue • Glossopharyngeal nerve (CN IX): carries general afferent impulses from vallate papillae along posterior third of tongue, as well as taste sensation from postsulcal tongue, vallate papillae, palatoglossal arche and oropharynx • Facial nerve (CN VII): taste sensation of anterior two-thirds of tongue and inferior part of soft palate • Vagus nerve (CN X): provides taste buds in extreme areas of pharyngeal tongue Mucosa Stratified squamous keratinized (dorsal surface) and non-keratinized (ventral surface) epithelium
  6. 6. Taste buds
  7. 7. Taste bud • Taste buds are chemoreceptors located in the papillae of the human tongue • Taste buds are composed of basal cells and 3 types of taste cells( dark, light and intermediate) • Taste cells extend from the base of the taste bud to the taste pore where microvilli contact testants dissolved in saliva and mucus. • Each taste bud contains 50-100 taste receptor cells, numerous basal cells and support cells. • Basal cells differentiate into new taste cells (taste cells survive about 10 days only)
  8. 8. Taste buds • The form of transduction used for bitter and sweet tastes is G-protein coupled receptors • acidic and salty foods lead to direct activation of ion channels that cause nerve signal propagation. • Umami taste sensation appears to involve both G-protein coupled receptors as well as ion channels. • Taste may be affected in many clinical conditions due to inflammation and damage of specific neural pathways involved in taste sensation; this may be due to infection, drugs, radiation, etc.
  9. 9. Taste pathways
  10. 10. Bells Palsy • Disordered movement of the muscles that control facial expressions, such as smiling, squinting, blinking, or closing the eyelid. • Loss of feeling in the face. • Headache. • Tearing. • Drooling. • Loss of the sense of taste on the front two-thirds of the tongue.
  11. 11. Facial nerve pathway
  12. 12. Glossopharyngeal nerve damage • difficulty swallowing; • impairment of taste over the posterior one-third of the tongue • impaired sensation over the posterior one-third of the tongue, palate and pharynx • an absent gag reflex • dysfunction of the parotid gland.
  13. 13. Glossopharyngeal nerve injury • Iatrogenic glossopharyngeal nerve injuries are commonly associated with procedures such as a tonsillectomy, carotid endarterectomy, and endotracheal intubation.
  14. 14. Glossopharyngeal nerve damage
  15. 15. Glossopharyngeal nerve taste pathway
  16. 16. Vagus nerve in taste pathway
  17. 17. Intrinsic muscles of the tongue Superior longitudinal muscle Origin: Submucosa of posterior tongue, lingual septum Insertion: Apex/anterolateral margins of tongue Action: Retracts and broadens tongue, elevates apex of tongue Inferior longitudinal muscle Origin: Root of tongue, body of hyoid bone Insertion: Apex of tongue Action: Retracts and broadens tongue, lowers apex of tongue Vertical muscle Origin: Root of tongue, genioglossus muscle Insertion: Lingual aponeurosis Action: Broadens and elongates tongue Transverse muscle Origin: Lingual septum Insertion: Lateral margin of tongue Action: Narrows and elongates tongue Neurovascular supply All supplied by lingual artery, hypoglossal nerve (CN XII)
  18. 18. Genioglossus muscle Origin: Superior mental spine of mandible Insertion: Entire length of dorsum of tongue, lingual aponeurosis, body of hyoid bone Function: Depresses and protrudes tongue (bilateral contraction); deviates tongue contralaterally (unilateral contraction) Neurovascular supply: Lingual and facial arteries, hypoglossal nerve (CN XII) Hyoglossus muscle Origin: Body and greater horn of hyoid bone Insertion: Inferior/ventral parts of lateral tongue Action: Depresses and retracts tongue Neurovascular supply: Lingual and facial arteries, hypoglossal nerve (CN XII) Styloglossus muscle Origin: Anterolateral aspect of styloid process (of temporal bone), stylomandibular ligament Insertion: Blends with inferior longitudinal muscle (longitudinal part); blends with hyoglossus muscle (oblique part) Action: Retracts and elevates lateral aspects of tongue Neurovascular supply: Lingual artery, hypoglossal nerve (CN XII) Palatoglossus muscle Origin: Palatine aponeurosis of soft palate Insertion: Lateral margins of tongue, blends with intrinsic muscles of tongue Action: Elevates root of tongue, constricts isthmus of throat Neurovascular supply: Ascending pharyngeal arteries and facial arteries, vagus nerve (CN X) (via branches of pharyngeal plexus)
  19. 19. Hypoglossal nerve injury
  20. 20. Tongue innervation summary
  21. 21. Tongue embryology 4th week
  22. 22. Thyroglossal duct cyst
  23. 23. Thyroglossal duct cyst • Signs and symptoms • A noticeable lump in the front of your throat that appears to be getting larger. • A noticeable lump in the front of your throat that feels hard. • Swollen lymph nodes. • Difficulty swallowing food or liquids. • Clinical examination Congenital cysts Benign (1% cancerous) Can become infected Younger than ten diagnosis Surgical excision they do not self resorb Low recurrence Lump moves up with swallowing
  24. 24. Ventral surface of the tongue
  25. 25. Whartons duct sialothiasis • Sialothiasis of salivary gland most common 80-90% in Wharton's duct Submandibular duct • It follows a convoluted course crossed by lingual nerve twice • Precipitation and accumulation of calcium phosphate and hydroxyapatite salts. • Fever chills ,unilateral pain, palpable along duct course in floor of the mouth. • antiumulation of calcium phosphate and hydroxyl-apatite (the main components of submandibular salivary stones) which leads to stone formation, salivary stasis and eventually duct obstruction. • precipitation and accumulation of calcium phosphate and hydroxyl-apatite (the main components of submandibular salivary stones) which leads to stone formation, salivary stasis and eventually duct obstruction. • precipitation and accumulation of calcium phosphate and hydroxyl-apatite (the main components of submandibular
  26. 26. Facial spaces and oral infections • Potential spaces along which maxillofacial and oral infections of from the oral cavity spread • Rapid spread along facial planes in hours leading to life threating complications eg pericarditis, respiratory obstruction, cavernous sinus thrombosis
  27. 27. Ludwig's angina
  28. 28. Ludwig's angina • Severe cellulitis involving floor of the mouth • Usually bacterial • 80-90% dental origin • Swelling raises floor of the mouth resulting in difficulty swallowing, speaking and breathing over a few hours. • Surgical emergency: tracheostomy, decompressing submental, submandibular and sublingual spaces by external incision and drainage; IV antibiotics
  29. 29. Palate
  30. 30. Soft palate • Sensory Innervation • Maxillary nerve through pterygopalatine ganglia via greater palatine, nasopalatine and lesser palatine nerve • Motor innervation • All muscles of the soft palate are supplied by the pharyngeal plexus except Tensor veli palatini supplied by medial pterygoid nerve branch of Mandibular nerve • Lesions of the vagus nerve deviate the uvula to the opposite side
  31. 31. Vagus nerve X • Motor fibers of the vagus nerve supply levator veli palatini, salpingopharyngeus, palatopharyngeus and uvula • tongue deviation when patient says “ah” to the unaffected side due to the unopposed action of the muscularis uvula • Soft palate dropped on affected side
  32. 32. Cleft lip and palate
  33. 33. Cleft lip and palate
  34. 34. Cleft lip and palate • Most common congenital craniofacial complex • Female >males (female palate closes 1 week later-hormonal) • Lowest risk Africans • Prevalence worldwide 1/700 live births • Pierre Robin sequence; Treacher Collins syndrome; trisomy 18 and other various syndromes • Genetics ; tobacco, drugs and alcohol use during pregnancy; folic acid deficiency; antineoplastic drugs • Complications: feeding difficulties infant unable to suckle; speech and language delays
  35. 35. •January 2020 •Journal of Cleft Lip Palate and Craniofacial Anomalies 7(1):8 DOI:10.4103/jclpca.jclpca_23_19
  36. 36. Lymphatic drainage • squamous cell carcinoma is the most common cancer o (90% of oral cavity cancers squamous origin) • HPV associated with 70% oropharyngeal cancers • Lateral border of tongue most frequent site • Lips, gingivae, cheeks, palate
  37. 37. Lymph drainage of palate and nasopharynx
  38. 38. Palate lymph drainage
  39. 39. References: • Clinically oriented anatomy; Keith Moore 6th edition • Human anatomy color atlas;Gosling, Harris et al 5th edition • https://www.kenhub.com/en/library/anatomy/tongue • January 2020 • Journal of Cleft Lip Palate and Craniofacial Anomalies 7(1):8 • DOI:10.4103/jclpca.jclpca_23_19