Oral Cavity

subdivided into:
1. Lips- formed largely by orbicularis oris muscle
2. buccal mucosa
3. upper and lower alveolar ridges- hold the teeth
4. retromolar trigone
5. oral tongue- anterior mobile tongue
6. palate- HARD: maxilla and palatine bones, SOFT: uvula
7. floor of mouth

ROOF OF MOUTH
Formed by hard palate in front and soft palate behind

FLOOR OF MOUTH
Formed by anterior 2/3 of tongue and by the reflection of the mucous membrane from the sides of the tongue
to the gum of mandible

Muscles of Tongue (Extrinsic Muscles)

Muscle Origin Insertion Innervation Action
Genioglossus Superior part of Dorsum of tongue Hypoglossal nerve Depresses tongue;
mental spine of and body of hyoid (CN XII) its posterior part
mandible protrudes tongue
Hyoglossus Body and greater Sides and inferior Hypoglossal nerve Depresses and
horn of hyoid aspect of tongue (CN XII) retracts tongue
Styloglossus Styloid process and Sides and inferior Hypoglossal nerve Retracts tongue
stylohyoid ligament aspect of tongue (CN XII) and draws it up to
create a trough for
swallowing
Palatoglossus Palatine Side of tongue Cranial root of CN Elevates posterior
aponeurosis of soft XI via pharyngeal part of tongue
palate branch of CN X and
pharyngeal plexus
Intrinsic muscles of tongue
 Superior longitudinal- on the dorsum of the tongue; shortens tongue and raises tip and sides
 Inferior longitudinal- on underside of tongue; shortens tongue and depresses tip
 Transversus- narrows and increases height of tongue
 Verticalis- makes tongue flat and braodens it

Nerve Supply of Tongue

Sensory

 Facial
 Trigeminal
 Glossopharyngeal

Motor

1
  Hypoglossal (CN XII)

BLOOD Supply of Tongue

Arteries: derive from the lingual artery; which arises from the external carotid artery

Main branches:

 Dorsal lingual arteries- supply the posterior part of the tongue and send a tonsillar branch to the
palatine tonsil
 Deep lingual artery- supplies the anterior part of the tongue; dorsal and deep arteries communicate
with each other near the apex of the tongue
 Sublingual artery- supplies the sublingual gland and the floor of the mouth

VEINS of the Tongue

Dorsal lingual veins- accompany the lingual artery
Deep lingual veins- begin at the apex of the tongue and run posteriorly beside the lingual frenulum to join the
sublingual vein

All lingual veins terminate directly and indirectly in the internal jugular vein

LYMPHATICS OF TONGUE

 Lymph from the posterior third drains to the superior deep cervical nodes on both sides
 Lymph from medial part of anterior 2/3 drains to the inferior deep cervical nodes
 Lymph from lateral parts of anterior 2/3 drains into submandibular lymph nodes
 Lymph from the apex of the tongue drains to the submental lymph nodes
 Lymph from the posterior third and the area near the midline groove drain bilaterally

Boundaries
ORAL CAVITY: Vermilion border to junction of hard and soft palate superiorly and circumvallate papillae (linea
terminalis) inferiorly.
OROPHARYNX: Kunction of hard and soft palate to the plane of the hyoid bone.
HYPOPHARYNX: Pharyngoepiglottic folds and the inferior margin of the cricoid cartillage.
NASOPHARYNX: From orophaynx to the skull base.

External anatomy
 SAGITTAL DIVISIONS:
- 2 LATERAL HEMISPHERES
- 1 MEDIAL VERMIS
 TRANSVERSE DIVISIONS:
- ANTERIOR LOBE
- POSTERIOR LOBE
- FLOCCULONODULAR LOBE

Surface landmarks
 PRIMARY FISSURE
- between ANTERIOR & POSTERIOR L.
 HORIZONTAL FISSURE
2
- divides POSTERIOR L. Into 2

 POSTEROLATERAL FISSURE
- between POSTERIOR &FLOCCULONODULAR LOBE

Phylogeny
 ARCHICEREBELLUM (flocculonodular)
- connected with dentate and vestibular nuclei
- balance and equilibrium
 PALEOCEREBELLUM (anterior lobe)
- conn. With spinocerebellar tract, globose and emboliform nuclei
- invol. Muscle tone, posture, locomotion
 NEOCEREBELLUM (posterior lobe)
- non-stereotyped, learned behavior (learning manual skills), thalamus and motor cortex

INTERNAL STRUCTURE
 FOLIA CEREBELLAR CORTEX folds
 Layers of Cortex
- MOLECULAR: BASKET & STELLATE cells
- PURKINJE: GOLGI type I cells
- GRANULAR: GRANULAR & GOLGI II cells
 INTRINSIC NUCLEI: 4 pairs
- DENTATE
- GLOBOSE
- EMBOLIFORM
- FASTIGIUS
B. H & E microscopic sections

Outer Molecular layer Stellate cells, basket cells

Middle Purkinje cell layer Purkinje cells
Inner Granular layer Granule cells, golgi cells
CEREBELLAR CONNECTIONS
 Intracerebellar
- Intrinsic nuclear projections
 Extracerebellar
(3 cerebellar peduncles)
- Superior (brachium conjunctivum)
- Middle (brachium pontis)
- Inferior (restiform body)
Afferent inputs

 Climbing fiber to each purkinje cell

-From contralateral inf olive
 Mossy fibers

3
 - From pontine nuclei
- Multiple rosettes (?) W/c synapse w/ several granular cell dendrites (---purkinje cells)
Cerebellar peduncles

 Superior cerebellar peduncle

- Efferent: dentatothalamic/dentatorubral
- Afferent: from spinocerebellar tract
 Middle cerebellar peduncle (largest)
- Afferent pontocerebellar
 Inferior cerebellar peduncle
- Afferent
- Efferent: fastigiobulbar (vestibular)/ juxtarestiform
Functions

 Maintain equilibrium
- Maintain posture & balance
 Coordination of vol. Motor act
- Execute sequential movements
- Rapid alternating repetitive
- Smooth pursuit
- Trajectory, velocity, acceleration
Clinical correlation

 Ipsilateral manifestation
 Incoordination
- Ataxia/ dysmetria (limbs)
- Dysarthria (speech)
- Nystagmus (eye muscles)
 Hypotonia: dec. Muscle tone
 Balance & equilibrium

Palate

 Hard Palate-formed by palatine process of maxilla and horizontal plates palatine bone.
 Soft palate-mobile fold attached to the posterior border of the hard palate
Composed of:
 Mucous membrane
 Palatine aponeurosis
 Muscles
Uvula- midline conical projection at free end of soft palate

4
 Muscles of the Soft Palate

MUSCLE ORIGIN INSERTION NERVE SUPPLY ACTION

Tensor veli Spine of With muscles of Nerve to medial Tenses soft palate
palatine sphenoid other side, pterygoid from
Auditory tube Forms palatine mandibular
aponeurosis nerve

Levator veli Petrous part of Palatine Pharyngeal Raises soft palate

palatini temporal bone, aponeurosis plexus
Auditory tube
Palataglossus Palatine Side of tongue Pharyngeal Pulls root of tongue upward
aponeurosis plexus and backward, narrows
oropharyngeal isthmus
Palatopharyngeus Palatine Posterior border Pharyngeal Elevates wall of pharynx,
aponeurosis of thyroid plexus pulls palatopharygeal folds
cartilage medially
Musculus uvulae Posterior border Mucous Pharyngeal Elevates uvula
of hard palate membrane of plexus
uvula
Nerve Supply of the Palate

 Greater and lesser palatine nerves-from the maxillary division of the trigeminal nerve.
 Nasopalatine nerve- from maxillary nerve.
 Glossopharyngeal nerve

Blood Supply of Palate

 Greater palatine branch of the maxillary artery

 Ascending palatine branch of facial artery
 Ascending pharyngeal arch
Lymph Drainage

 Via deep cervical nodes

5
Heinrich Wilhelm Gottfried von Waldeyer-Hartz 

 (6 October 1836, Hehlen an der Weser, Braunschweig, Germany – 23 January 1921, Berlin)

 German anatomist
 Famous for consolidating the neuron theory of organization of the nervous system and for naming
the chromosome.
 He is also remembered in two macro anatomical structures of the human body which were named
after him:
 Waldeyer's tonsillar ring (the lymphoid tissue ring of the naso- and oropharynx)
 Waldeyer's glands (of the eyelids)

Salivary Glands

Major Salivary Glands:

 Parotid- inferior and anterior to ears; between the skin and masseter muscle
 Submandibular- found beneath the base of the tongue in the posterior part of the floor of the mouth
 Sublingual-at the floor of the mouth superior to the submandibular glands
Sublingual Gland

 Mucous Gland
 Between mylohyoid and genioglossus
 15 ducts- 1/2 into submandibular tract
 ½ into sublingual fold
 Nerve Supply-secretomotor via submandibular ganglion
General secretion via submandibular ganglion
6
  Blood supply- lingual artery and branches of submental artery
 Drainage from a groove in floor of mouth that becomes a tunnel
 All salivary glands develop from epithelial lining of mouth
Ducts in the Oral Cavity

 Parotid (Stensen’s) duct- opens opposite the 2nd maxillary molar on either side.
 Submandibular (Wharton’s) duct- opens on either side of the floor of the mouth arteriorly.
 Sublingual (Rivinus’ duct)-opens into mucosa of floor of the mouth via multiple ducts.
Oropharynx

Contents:

1. Soft palate and uvula

2. Base of the tongue- includes the pharyngoepiglottic and glossoepiglottic folds.
3. Palatine arch
4. Tonsillar region- tonsillar fossa and pillars
5. Vallecula
6. Oropharyngeal walls-lateral amd posterior
Hypopharynx

Includes:

1. Pyriform sinus (laryngopharyngeal sulcus) bounded by the larynx (medially). Soft tissue (anteriorly).
Thyroid cartilage (laterally) and is open posteriorly. The pyriform sinus tapers to an apex posteriorly.
2. Pharyngeal wall: the lateral and posterior mucosa from the level of the epiglottis superiorly to the
esophagus inferiorly.
3. Postcricoid region: the mucosal cavity of the posterior region of the cricoid cartilage

Nasopharynx
 Boundaries:
 Rostrally: the choanae
 Posteriorly: the pharyngeal wall against the occipital bone, the anterior arch of vertebrae C1 and body
of C2;
 Caudally: opens into the pharynx at border of soft palate.

 Contents:
 Adenoid
 Eustachian orifice
Teeth

 Child- has 20 deciduous teeth

 Adult-has 32 permanent teeth

7
Approximate time schedule for tooth eruption

DECIDUOUS Age (months) PERMANENT Age (years)

Medial incisors 7 First Molar 6
Lateral incisors 9 Medial incisor 6-7
First molar 15 Lateral Incisor 8-9
Canine 18 First Premolar 10-11
Second Molar 20-24 Canine 10.5-11.5
Second Premolar 11-12
Second molar 12-13
Third Molar 17-25

Temporomandibular joint

 Type: combined hinge or ginglymus and diarthrodial (synovial)

 Movements: Opening and closing jaws, protrusion, retraction, lateral displacement
 Bones: Condyle of mandible, the mandibular fossa (posteriorly) and articular tubercle of temporal
bone (anteriorly)
 Ligaments:
A. Capsule: from rim of mandibular fossa and articular tubercle to neck of condyloid process of mandible
B. Lateral (temporomandibuar): from zygomatic arch to neck of mandible
C. Sphenomandibular: from angular spine of sphenoid to lingua of mandible
D. Stylomandibular: apex of styloid to angle and posterior of mandible

Muscles of Mastication
Muscle Origin Insertion Nerve Action
Supply
Masseter Zygomatic arch Lateral surface Mandibular Elevates mandible to
ramus of division of occlude teeth
mandible trigeminal
nerve
Temporalis Floor of Coronoid Mandibular Anterior and superior
temporal fossa process of division of fibers elevate mandible;
mandible trigeminal posterior
nerve fibers retract mandible

Lateral Greater wing of Neck of Mandibular Pulls neck of mandible

pterygoid (two sphenoid mandible and division of forward
heads) and lateral articular disc trigeminal
pterygoid nerve
plate
Medial Tuberosity of Medial surface Mandibular Elevates mandible
pterygoid (two maxilla and of angle division of
heads) lateral pterygoid of mandible trigeminal
plate nerve

8
 Muscles acting on TMJ
Open Close Protrude Retract Lateral
displacement
Lateral Masseter Lateral Post. Fibers of Lat. Pterygoids
pterygoid pterygoid(together temporalis (individually)
)
Digastric Medial
pterygoid
Mylohyoid Temporalis
geniohyoid

Muscles of the pharynx

Muscle Origin Insertion Action
Superior constrictor Medial pterygoid Pharyngeal Aids soft palate in
plate, pterygoid tubercle of closing
hamulus, occipital bone, off nasal pharynx,
pterygomandibular raphe propels bolus downward
ligament, mylohyoid in midline
line of mandible posteriorly

Middle constrictor Lower part of Pharyngeal raphe Propels bolus downward

stylohyoid ligament,
lesser and greater
cornu of hyoid
bone
Inferior constrictor Lamina of thyroid Pharyngeal raphe Propels bolus downward
cartilage, cricoid
cartilage
Cricopharyngeus Lowest fibers of Sphincter at lower end
inferior constrictor of
muscle pharynx
Stylopharyngeus Styloid process of Posterior border of Elevates larynx during
temporal bone thyroid cartilage swallowing

Salpingopharyngeus Auditory tube Blends with Elevates pharynx

palatopharyngeus

Palatopharyngeus Palatine Posterior border of Elevates wall of pharynx,

aponeurosis thyroid cartilage pulls palatopharyngeal
arch medially

Function:
A. Mastication; biting, chewing, and preparation of food bolus
B. Deglutition: swallowing
C. Phonation
9
 Saliva

1. 1500ml/day (90% from parotid and submandibular glands; remainder from minor and sublingual
glands)
2. pH 6.2 to 7.4
3. 99.5 % water, 0.5% organic/ inorganic solids
4. Organic component: glycoprotein
5. Electrolytes:
a. Sodium: 10 mEq/L
b. Potassium: 26mEq/L
c. Chlorine: 10mEq/L
d. Bicarbonate: 30mEq/L

Oral phase:
a. Voluntary
b. Solids are masticated
c. Saliva mixes with food bolus
d. Bolus is moulded by tongue and teeth
e. Bolus is collected on tongue dorsum
f. Anterior tongue elevated/ base of tongue is elevated
g. Mylohyoid muscle elevates floor of mouth
h. Hyoid is pulled up and forward
i. Bolus is propelled into the pharynx
j. For liquids, the mouth and contents form an anatomic funnel

Pharyngeal phase:
A. Reflex response due to wall receptors. Most sensitive area is anterior tonsillar pillar
B. Nasopharynx closed off (levator/ veli palatine)
C. Contraction of lingual muscles keeps tounge against palate.
D. Larynx is closed off
1. Elevated and moves forward
2. Glottis closure
3. Epiglottis
E. Three sphincters (true vocal chords, false vocal cords, aryepiglottic folds)
F. Vertical height of the pharynx is reduced by palatopharyngeus, stylopharyngeus, and elevation of the
hyoid.
G. Circular and horizontal fibers in synchrony, move food inferiorly
H. Cricopharyngeus opens
I. Peristaltic waves pick up in esophagus, not in pharynx

Esophageal phase:
A. Fluid movement is passive
B. Peristalsis affects solids and semisolids
C. Gravity plays only a small role in food passage in esophagus
D. Changes in position play minimal or no role
E. Reverse peristalsis is not normal
F. There are bare nerve endings that cause spasm if the esophagus is overly distended
10
 Neck

Between the lower margin of mandible and superior nuchal line of the occipital bone above the suprasternal
notch and the upper border of the clavicle below.

Surface Anatomy

Major Surface:

 Thyroid Cartilage (adam's apple)

 Hyoid Bone
 Cricoid catilage
 thyroid cartilage
 Sternocleidomasto=oid muscle
 Common carotid artery
 Internal jugular vein
 subclaivian artery
 external Carotid Artery
 External jugular vein

SKIN AND CUTANEOUS NERVES

 Greater occipital nerve

 Lesser occipital nerve
-Skin over later part of occipital region and the medial surface of the auricle

 Greater auricular nerve

-Skin over the ngle of the mandible, the parotid gland, and on both surfaces of the auricle
 Transverse cutaneous nerve
-Skin on the anterior and lateral surfaces of the neck, from the body of the mandible to the
sternum
 Supraclavicular nerve
A. Medial supraclavicular nerve- clavicle to medial plane
B. Intermediate supra clavicular nerve - skin of chest wall
C. Skin over the shoulder and upper half of deltoid muscle; supplies posterior aspect of
shoulder as far down as the spine of the scapula

SUPERFICIAL CERVICAL FASCIA

 Forms a thin layer that encloses the platysma muscle superficial nerves, superficial veins and superficial
lymph nodes

11
PLATYSMA

Origin: From the deep fascia that covers the upper part of the pectoralis major and deltoid muscles

Insertion: Lower margin of the body of mandible; some of the posterior fibers enter the face and blend
with muscles at angle of the mouth

Nerve Supply :Cervical branch of facial nerve

Action: Depresses the mandible and also draws down the lower lip and the angle of the mouth

DEEP CERVICAL FASCIA

 Areolar tissue that supports the muscle vessels and viscera of the neck
 3 LAYERS:
 Investing Layer- Conpletely encircles the neck, splitting to enclose the sternocleidomastoid and
trapezius muscle; it is attached posteriorly to the ligametum nuchae
 Pretracheal Layer- attached above the thyroid and cricoid cartilages . Below, it blends with the crotud
sheath and with the investing layer of deep cervical fascia beneath the sternocleidomastoid muscle
 Prevertebral Layer- covers the prevertebral muscle, namely the longus capitis and longus cervicis

NECK TRIANGLES

 Anterior Triangle- formed by:

Sternocleidomastoid

Mandible

Midline of the neck

 Posterior Triangle- formed by:

Sternocleidomastoid

Clavicle

Trapezius

12
CERVICAL NERVES

 Brachial Plexus- anterior roots of C1-4

 Ansa cervicalis- to strap muscles (some travel with XII)
 Branches to phrenic nerves
 Sensory
 Phrenic nerve- C3-5
 Brachial Plexus- C5-T1
 Posterior rami- to posterior muscles and skin
 Cervical sympathetic chain- travels in carotid sheath

CERVICAL PLEXUS

B. MOTOR BRANCHES

 Ansa cervicalis
-nerve loop formed by the union of the superior root (C1 or C1 &C2; descends hypoglossei) and
the inferior root (C2 & C3; descends cervicalis)
-Lies superficial to or within the carotid sheath in the anterior cervical triangle
-Innervates the infrahyoid (or strap) muscles, such as the omohyoid, sternohyoid, and
sternothyroid muscles, except the thyroid muscle ( innervated by C1 via
hypoglossal nerve.)

 Phrenic Nerve
-arises from 3rd, 4th, 5th cervical nerves but chiefly from 4th
-contains motor, sensory and sympathetic nerve fibers
-provides motor supply to the diaphragm and sensation to its central part

C. TWIGS FROM THE PLEXUS

 Supply the longus capitis and cervicis or colli, sternocleidomastoid, trapezius, levator scapulae and
scalene muscle

D. ACCESSORY PHRENIC NERVE (C5)

 Occasionally arises as a contribution of C5 to the phrenic nerve or a branch of the nerve to the
subclavius (C5), descends lateral to the phrenic nerve, enters the thorax by passing posterior to the
subclaivian vein, and joins the phrenic nerve below the 1st rib to supply the diaphragm

13
THE BRACHIAL PLEXUS
 Origin- Chiefly, anterior primary division of cervical nerves 5 to 8 plus 1st thoracic nerve
 Components- roots, trunks, cords
 MANNER OF FORMATION

 ROOTS- (Anterior primary divisons)

C5 and C6 join to form upper trunk
C7 continues by itself as middle trunkk
C8 AND T1 JOIN TO FORM LOWER TRUNK

 TRUNKS - short and split into anterior &posterior divisons

Anterior divisions of upper and middle trunks from the lateral cord
Anterior part of the lower trunk becomes the medial cord
Posterior divisions of all trunks from the posterior cord

 CORDS- give rise to terminal branches

14
MUSCLES OF
NECK        
Muscles Origin Insertion Action Nerve
Deltoid &
pectoral Mandible Depresses angle of
PLATYSMA fascia & skin mouth, opens jaw Facial Nerve
Bends head to same
side, rotates head,
raises chin to opposite
side, together bend
STERNOCLEIDO Sternum, Mastoid head forward & elevate Accessory (XI)
MASTOID Clavicle process chin C2 &C3

MUSCLES OF NECK (SUPRAHYOID)

 
Muscles Origin Insertion Innervation Action
Intermediate tendon Mylohyoid Depresses the
DIGASTRIC: body of w/c attaches to branch of mandible;
anterior belly mandible hyoid bone trigeminal nerve elevate hyoid
Mastoid process
of temporal Digastric branch
posterior belly bone Intermediate tendon of facial nerve As above
Styloid process Stylohyoid Elevates,
of temporal branch of facial retracts hyoid
STYLOHYOID bone Body of hyoid bone nerve bone
Posterior fibers- to
body of hyoid bone Elevates floor of
ant. &middle fibers mouth and
Mylohyoid line median raphe Mylohyoid hyoid;
of body of between muscles of branch of depresses
MYLOHYOID mandible both sides trigeminal nerve mandible
Elevates hyoid
Inferior mental bone; retracts &
spine of depresses
GENIOHYOID mandible Body of hyoid bone __ cervical nerve mandible

15
 MUSCLES OF NECK (INFRAHYOID)
Innervati
Muscles Origin Insertion on Action
Manubrium of Ansa
sternum and cervicalis
STERNOHYOI medial end of (C1,C2,C3 Depresses
D clavicle Body of hyoid bone ) hyoid bone
Ansa
Posterior surface Oblique line on cervicalis Depresses
STERNOTHYR of manubrium lamina of thyroid (C1,C2,C3 hyoid bone
OID sterni cartilage ) and larynx
Depresses
Oblique line on Lower border of the 1st hyoid bone
the lamina of the graeter horn of the cervical and elevate
THYROHYOID thyroid cartilage hyoid bone nerve larynx
Ansa
inferior belly- Intermediate tendon cervicalis
upper margin of held to clavicle and (C1,C2,C3 Depresses
OMOHYOID scapula 1st rib by fascial ___ ) hyoid bone
Superior belly-
lower border of
body of hyoid
  bone      

MUSCLES OF NECK (INFRAHYOID)

Innerva
Muscles Origin Insertion tion Action
RECTUS CAPITIS        
Root of transverse
anterior process of atlas Basilar part of occipital bone C1-C2 Flexes head
Anterior tubercle,
transverse process of Lower jugular process of
Lateral C3 to C_ occipital bone   Bends head to side
Anterior tubercle,
transverse process of
LONGUS CAPITIS C3 to C__ Basilar part of occipital bone C1C3 Flexes head
LONGUS COLLI        
Anterior tubercle, Flexes neck, slight
transverse process of Tubercle on anterior arch of rotation of cervical
Superior oblique C3 to C__ atlas C2-C7 part
Inferior oblique Bodies of T1-T3 Anterior tubercle, transverse C2-C7 Slight rotation of
16
 vertebrae process __ vertebrae cervical part
Bodies of C5-C7, T1-
Vertical T3 Bodies of C2-C4 C2-C7 Flexes neck

VISCERA OF NECK

 Thyroid Gland
 Parathyroid Glands
 Larynx
 Trachea
 Esophagus

THYROID GLAND

 Developmentally derived from pharyngeal floor

 Located anterior and lateral to the trachea
 Closely related to recurrent laryngeal nerve and parathyroid glands
 Blood Supply
 ATERIAL
 Superior thyroid artery (branch of external carotid)
 Inferior thyroid artery (branch of thyrocervical trunk)
 Thyroid "ima" artery (variable)- in 10% of people
 VENOUS
 Superior thyroid vein
 Middle thyroid vein
 Inferior thyroid vein

 LYMPHATIC VESSELS
 Superior & isthmus = superior deep cervical nodes
 Inferior= inferior deep cervical nodes

Some drain into brachiocephalic nodes or thoracic duct

PARATHYROID GLANDS

 Four Glands: 2 on each side (2 supeior, 2 inferior)

 Drived from branchial pouches III and IV:
 Superior parathyroid glands from pouch IV
 Inferior parathyroid glands from pouch III
 Glands usually related to posterior surface of thyroid gland, but may be found as inferior as
mediastinum

LARYNX
-the voice box
- a short passageway that connects the pharynx with trachea

17
TRACHEA
-Windpipe
-tubular air passageway extending from the larynx to the 5th thoracic vertebra

ESOPHAGUS
-A hollow muscular tube connecting the pharynx and the stomach

18