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Oral cavity, pharynx radio-anatomy

Oral cavity, pharynx radio-anatomy

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Oral cavity, pharynx radio-anatomy

  1. 1. Anatomy of Oral cavity and Pharynx Dr Mohit Goel JR1 22 aug. 2012
  2. 2. Oral Cavity 2 parts: 1] Oral vestibule 2]Oral cavity proper Oral vestibule = slit space between teeth- buccal gingiva and lips-cheek . >Vestibule communicates with exterior through mouth. >Size of opening is controlled circumoral muscles such as orbicularis oris, buccinator,depressors and elevators of lips.
  3. 3. ORAL CAVITY PROPER  It is the cavity within the alveolar margins of the maxillae and the mandible  Its Roof is formed by the hard palate anteriorly and the soft palate posteriorly  Its Floor is formed by the mylohyoid muscle. The anterior 2/3rd of the tongue lies on the floor. hard soft palate mylohyoid
  4. 4. FLOOR OF THE MOUTH Covered with mucous membrane In the midline, a mucosal fold, the frenulum, connects the tongue to the floor of the mouth On each side of frenulum a small papilla has the opening of the duct of the submandibular gland A rounded ridge extending backward & laterally from the papilla is produced by the sublingual gland
  5. 5. NERVE SUPPLY oSensory  Roof: by greater palatine and nasopalatine nerves (branches of maxillary nerve)  Floor: by lingual nerve (branch of mandibular nerve)  Cheek: by buccal nerve (branch of mandibular nerve) oMotor  Muscle in the cheek (buccinator) and the lip (orbicularis oris) are supplied by the branches of the facial nerve
  6. 6. MUSCLES  The tongue is composed of two types of muscles: • Intrinsic • Extrinsic
  7. 7. Mylohyoid The main muscle forming the floor of the mouth is mylohyoid.
  8. 8. GENIOHYOID Geniohyoid is a narrow muscle which lies above the medial part of . It arises from the inferior mental spine (genial tubercle) on the back of the symphysis menti, and runs backwards and slightly downwards to attach to the anterior surface of the body of the hyoid bone. Genioglossus It arises from a short tendon attached to the superior genial tubercle behind the mandibular symphysis, above the origin of geniohyoid. From this point it fans out backwards and upwards.
  9. 9. Hyoglossus Hyoglossus is thin and quadrilateral, and arises from the whole length of the greater cornu and the front of the body of the hyoid bone. It passes vertically up to enter the side of the tongue between styloglossus laterally and the inferior longitudinal muscle medially. Styloglossus It arises from the anterolateral aspect of the styloid process near its apex Passing downwards and forwards, it divides at the side of the tongue into a longitudinal part, which enters the tongue dorsolaterally to blend with the inferior longitudinal muscle in front of hyoglossus, and an oblique part, overlapping hyoglossus and decussating with it.
  10. 10. Tip: Submental nodes bilaterally & then deep cervical nodes Anterior two third: Submandibular unilaterally & then deep cervical nodes Posterior third: Deep cervical nodes (jugulodigastric mainly) Lymphatic Drainage
  11. 11. Classification of Neck Nodes According to Levels Level I Level II Level III Level IV Level V Level VI Level VII Submental (IA) Submandibular (IB) Upper jugular middle jugular Lower jugular Posterior triangle group (Spinal accessory and transverse cervical chains) Prelaryngeal Pretracheal Paratrachal Nodes of upper mediastinum
  12. 12. PHARYNX Extends from the base of the skull to the lower border of the cricoid cartilage (at which point it border of the cricoid cartilage (at which point it becomes the oesophagus). Portions of the pharynx lie posterior : • nasal cavity (nasopharynx) • oral cavity (oropharynx) • larynx (laryngopharynx)
  13. 13. Nasopharynx Roof : body of sphenoid, basilar part of occipital, bone pharyngeal tonsil Floor: soft palate, pharyngeal isthmus Anterior wall : post. nasal apertures Posterior wall: ant. arch of atlas Lateral wall : auditory tube , tubal elevation , salpingo pharyngeal fold and tubal tonsil
  14. 14. Oropharynx Roof : soft palate, pharyngeal isthmus Floor : post. 1/3 tongue, epiglottis, lingual tonsil, median glossoepiglottic fold, 2 lateral glosso epiglottic Fold and vallecula. Anterior wall : mouth, tongue Posterior wall : C2,C3 Lateral wall : palatoglossal , palatopharyngeal arches/folds and palatine tonsils
  15. 15. Laryngo pharynx • Walls: Ant. – inlet of pharynx Post. – C3 – C6 Lat. – thyroid cartilage
  16. 16. The pharyngeal muscles are a group of muscles that act upon the pharynx. They include: Inferior constrictor muscle Middle constrictor muscle Superior constrictor muscle Stylopharyngeus muscle Salpingopharyngeus muscle Palatopharyngeus muscle
  17. 17. MRI BUCCINATOR MASSETER INTRINSIC MUSCLE OF TONGUE GENIOGLOSSUS MYLOHOID LINGUAL SEPTUM GENIOHYOID DIGASTRIC PLATYSMA
  18. 18. HARD PALATE TONGUE HYOGLOSSUS M. LINGUAL TONSIL SUBMANDIBULAR GLAND GLOSSOEPIGLOTIC FOLD DIGASTRIC M. PLATYSMA
  19. 19. NASOPHARYNX PAROTID GLAND UVULA PALATINE TONSIL DIGASTRIC MUSCLE SUBMANDIBULAR GLAND PLATYSMA LATERALPTERYGOID MEDIAL PTERYGOID
  20. 20. HARD PALATE NASOPHARYNX SUPERIOR CONSTRIC. M SOFT PALATE INTRINSIC MUSCLE OF TONGUE MIDDLE CONSTRIC. M. GENIOGLOSSUS MYLOHOID OROPHARYNX EPIGLOTIS HYPOPHARYNX INFERIOR CONSTRICTOR M.
  21. 21. Buccinator m. Hard palate Masseter muscle Lateral & medial pterygoid m. Nasopharynx Longus capitis muscle
  22. 22. Buccinator m. Tongue(genioglossus m.) Masseter muscle Medial pterygoid m. Palatine tonsil Oropharynx Longus capitis muscle
  23. 23. Orbicularis oris Hyoglossus Genioglossus Mylohoid Oropharynx Submandibular gland Palatopharyngeus m. Superior constrictor m.
  24. 24. Orbicularis oris Hyoglossus Genioglossus Mylohoid Epiglotis Hypopharynx Submandibular gland Palatopharyngeus m. Middle constrictor m.
  25. 25. Mandible Digastric m. Mylohyoid Geniohyoid Hyoid bone Submandibular gland Epiglotis Hypopharynx Piriform recess Inferior constrictor m.
  26. 26. SUBLINGUAL SPACE Paired non-fascial lined spaces of oral cavity in deep oral tongue above floor of mouth superomedial to mylohyoid muscle Communication between sublingual spaces occurs in midline anteriorly as a narrow isthmus beneath frenulum o SLS communicates with SMS(submandibular space) and inferior para pharyngeal space (PPS) at posterior margin of mylohyoid muscle • There is no fascia dividing posterior SLS from adjacent SMS.Therefore there is direct communication with SMS and PPS in this location. Posterior aspect of SLS is divided into medial and lateral compartments by hyoglossal muscle. Clinical Importance • Since neurovascular bundle to tongue travels in SLS,oral cavity SCCa involving posterior SLS is challenging to treat. • If SCCa crosses lingual septum to contralateral SLS, lesion becomes unresectable for cure.
  27. 27. SUBMANDIBULAR SPACE Fascial-lined space inferolateral to mylohyoid muscle containing submandibular gland, nodes and anterior belly of digastric muscles. SMS is defined as a superficial space above hyoid bone deep to platysma and superficial to mylohyoid sling . Continues inferiorly into infrahyoid neck as anterior cervical space. Inferolateral to mylohyoid muscle of floor of mouth • Deep to platysma muscle • Cephalad to hyoid bone • "Vertical horseshoe-shaped" space between hyoid bone below and mylohyoid sling above. • SMS communicates posteriorly with sublingual space and inferior para pharyngeal space at posterior margin of mylohyoid muscle. • Continues inferiorly into infrahyoid neck as anterior cervical space.
  28. 28. RETROMOLAR TRIGONE Triangle-shaped area of mucosa posterior to last mandibular molar that covers anterior surface of lower ascending ramus of mandible. Pterygomandibular raphe (PMR)- Thick fascial band that extends between posterior border of mandibular mylohyoid ridge and hamulus of medial pterygoid plate. It represents thickening of middle layer of deep cervical fascia condensed between posterior margin of buccinator muscle and anterior margin of superior constrictor muscle.
  29. 29. Clinical Importance • SCCa (squamous cell ca.) of RMT may spread along PMR (Pterygomandibular raphe ). o Cephalad spread along PMR takes tumor up to inferolateral pterygoid plate- Anteromedial masticator space. • Tumor is seen at level of inferior pterygoid Plate involving posterior buccinator muscle and anterior superior constrictor muscle. • Enlarging tumor involves maxillary sinus, Buccal and masticator spaces. o Caudal spread along PMR takes tumor inferiorly to posterior margin of mylohyoid m. • Enlarging tumor in this location involves floor of mouth of oral cavity.
  30. 30. THANK U

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