Gross anatomy | GIT & Nutrition-I module

Gross Anatomy
(GIT & Nutrition-I module)

Medicnetic – MBBS Modular series

Gross anatomy | GIT & Nutrition-I module

GIT-A-001: Oral cavity and oropharynx

Oral cavity:
The oral cavity extends from the lips to the pharynx. The paired palatoglossal
folds form the oropharyngeal isthmus, which is the entrance into the pharynx. The oral
cavity has two components: the vestibule and the oral cavity proper.
Vestibule:
The vestibule is a slitlike space that lies between the lips and the cheeks externally and the
gums and the teeth internally. It communicates with the exterior through the oral fissure

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Gross anatomy | GIT & Nutrition-I module

between the lips. The duct of the parotid salivary gland opens on a small papilla into the
vestibule opposite the upper second molar tooth. Its boundaries are:
• limited above and below by the reflection of the mucous membrane from the lips
and cheeks onto the gums.
• lateral wall of the vestibule is formed by the cheek, which is made up by the
buccinator muscle
Oral cavity proper:
The oral cavity proper has a roof and a floor.
• Roof: The palate forms the roof; it consists of the hard palate the soft palate.
• Floor: The anterior two thirds of the tongue and the reflection of the mucous
membrane from the sides of the tongue to the gum
of the mandible form the floor.
A midline fold of mucous membrane, the frenulum of the
tongue, connects the undersurface of the tongue to the
floor of the mouth. The submandibular duct of the
submandibular gland opens onto the floor of the mouth on
the summit of a small papilla on either side of the frenulum
of the tongue.
Sensory Innervation:
• Roof: The greater palatine and nasopalatine nerves
from the maxillary division of the trigeminal nerve
• Floor: The lingual nerve (general sensation), a
branch of the mandibular division of the trigeminal
nerve. The taste fibers travel in the chorda tympani
nerve, a branch of the facial nerve.
• Cheek: The buccal nerve, a branch of mandibular
division of the trigeminal nerve.
Tonsils:
Collections of lymphoid tissue (tonsils) of considerable clinical importance are located at the
junction of the mouth with the oral part of the pharynx (palatine and lingual tonsils) and
the nose with the nasal part of the pharynx (pharyngeal tonsil). The palatine tonsils and the
pharyngeal tonsils are the most important.
Features Nasopharyngeal Tonsil Palatine Tonsil Lingual Tonsil
Location Roof of nasopharynx, Oropharynx, lateral Base of the tongue
posterior to nasal walls
cavity
Anatomical Contains lymphoid Paired, located in Located at the base of
Features tissue, covered by the lateral walls of the tongue, posterior to
mucosa the oropharynx the circumvallate
papillae
Relations Adjacent to the Bound laterally by Bordered by the
pharyngeal opening of the palatoglossal & glossopalatine arches,
the Eustachian tube, palatopharyngeal extending into the
pharyngeal tonsil arches, medial to posterior third of the
the palatine tongue
tonsillar fossa

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Gross anatomy | GIT & Nutrition-I module

Vascular Ascending pharyngeal Tonsillar branches Branches of the lingual

Supply artery, branches of the of the facial artery artery, tonsillar branch
maxillary artery of the ascending
pharyngeal artery
Nerve Supply Glossopharyngeal Glossopharyngeal Lingual nerve (branch of
nerve (CN IX) nerve (CN IX) mandibular nerve - CN
V3)
Hard palate:
It is the anterior part of palate and is mostly filled
by tongue when it is at rest.
Skeletal framework:
• The anterior two thirds of the palate have a
bony skeleton formed by the palatine
processes of the maxillae and the
horizontal plates of the palatine bones
• The incisive fossa is a depression in the
midline of the bony palate posterior to the
central incisor teeth into which the incisive canals open
• Medial to the 3rd molar tooth, the greater palatine foramen pierces the lateral
border of the bony palate
• The lesser palatine foramina posterior to the greater palatine foramen pierce the
pyramidal process of the palatine bone.
Neurovascular supply:
• Greater palatine artery: It is a branch of descending palatine artery and passes
through greater palatine foramen. It is the main (chief) arterial supply of palate.
• Lesser palatine artery: It is a smaller branch of the descending palatine artery,
enters the palate through the lesser palatine foramen and anastomoses with the
ascending palatine artery, a branch of the facial artery
• Veins of the palate are tributaries of the pterygoid venous plexus.
• Sensory nerves of the palate are branches of the maxillary nerve (CNV2), which
branch from the pterygopalatine ganglion
• Greater palatine nerve: It supplies most of the hard palate.
• Nasopalatine nerve: It supplies anterior part of hard palate.
Lymphatic drainage:
• Lymph drains to the deep cervical lymph nodes.
Soft palate:
It is a mobile fold attached to the posterior border of the hard palate.
Gross anatomical features:
• Its free posterior border presents a conical projection in the midline called the uvula.
• The soft palate is continuous at the sides with the lateral wall of the pharynx.
• Two arches extend off each side of the soft palate:
o The palatoglossal arch is a fold of mucous membrane containing the
palatoglossus muscle, which extends from the soft palate to the side of the
tongue. The palatoglossal arch marks where the oral cavity becomes pharynx.
o The palatopharyngeal arch is a fold of mucous membrane behind the
palatoglossal arch that runs downward and laterally to join the pharyngeal

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Gross anatomy | GIT & Nutrition-I module

wall. This arch contains the palatopharyngeus muscle. The palatine tonsils,
which are masses of lymphoid tissue, are located in the tonsillar fossa
between the palatoglossal and palatopharyngeal arches
Neurovascular supply:
• Vascular supply is same as hard palate.
• Lesser palatine nerve mainly supplies the soft palate.
• Glossopharyngeal nerve also supplies the soft palate.
Muscles of soft palate:

• Vagus nerve (CN X), via the pharyngeal

plexus, supplies all the muscles of the
soft palate except one, the tensor veli
palatini (supplied by the mandibular
division of the trigeminal nerve)
• Tensor veli palatini turns medially (90
degree) around the pterygoid hamulus.
The tendon, together with the tendon of
the opposite side, expands to form the
palatine aponeurosis
• Tensor and levator palatini muscles also
act on the mucous membrane of the
auditory tube and so affect function in
the middle ear
• Raising the soft palate closes the
pharyngeal isthmus (the communicating
channel between the nasal and oral parts of the pharynx)
• Bilateral contraction of the levator veli palatini muscles raises the soft palate
Tongue:
The tongue is a mass of striated muscle covered with mucous membrane. Muscles attach
the tongue to the styloid process and the soft palate above and to the mandible and the
hyoid bone below. A median fibrous septum divides the tongue into right and left halves.
Lingual Mucous Membrane:
A V-shaped sulcus, the sulcus terminalis, divides the mucous membrane of the upper
surface of the tongue into anterior and posterior parts. The apex of the sulcus projects
backward and is marked by a small pit, the foramen cecum. The sulcus divides the tongue
into the anterior two thirds (oral part; body) and the posterior third (pharyngeal part; root).

Medicnetic – MBBS Modular series

Gross anatomy | GIT & Nutrition-I module

The foramen cecum is an embryologic remnant and marks the site of the upper end of the
thyroglossal duct. Three types of papillae are present on the upper surface of the anterior
two thirds of the tongue:
• filiform papillae
• fungiform papillae
• vallate papillae
The mucous membrane covering the posterior third of the tongue is devoid of papillae but
has an irregular surface, caused by presence of underlying lymph nodules, the lingual tonsil.
Tongue muscle:
The tongue possesses two groups of skeletal muscles:
• Intrinsic muscles are confined to the tongue and are not attached to bone.
• Extrinsic muscles originate outside the tongue; they attach to bones and the soft
palate.
Hypoglossal nerve (CN XII) supplies all the tongue muscles, except one, the palatoglossus
(supplied by vagus fibers in the pharyngeal plexus)

Blood supply:
The lingual artery, the tonsillar branch of the facial artery, and the ascending pharyngeal
artery supply the tongue. The veins drain into the internal jugular vein.
Sensory Innervation: (Diagram given below)
• Anterior two thirds: Lingual nerve branch of the mandibular division oftrigeminal
nerve (general sensation) and chorda tympani branch of the facial nerve (taste)
• Posterior third: Glossopharyngeal nerve (general sensation and taste)
• Internal laryngeal nerve, a branch of the vagus nerve (CN X), supply mostly general
but some special sensation to a small area of the tongue just anterior to epiglottis

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Gross anatomy | GIT & Nutrition-I module

Lymph Drainage:
• Tip: Submental lymph nodes
• Sides of the anterior two thirds:
Submandibular & deep cervical lymph nodes
• Posterior third: Deep cervical lymph nodes
Injury to Hypoglossal Nerve:
Trauma, such as a fractured mandible, may injure
the hypoglossal nerve (CN XII), resulting in paralysis
and eventual atrophy of one side of the tongue. The
tongue deviates to the paralyzed side during
protrusion because of the action of the unaffected
genioglossus muscle on the other side.
Parotid gland:
The parotid gland is the largest salivary gland and is composed mostly of serous acini.
• It lies in a deep hollow below the external auditory meatus, behind the ramus of the
mandible, and in front of the sternocleidomastoid muscle.
• The facial nerve divides the gland into superficial and deep lobes.
• It in enclosed within a tough, unyielding, fascial compartment, the parotid sheath.
• The apex of the parotid gland is posterior to the angle of the mandible, and its base
is related to the zygomatic arch. The subcutaneous lateral surface of the parotid
gland is almost flat.
• The parotid duct emerges from the anterior border of the gland and passes forward
over the lateral surface of the masseter. It pierces the buccinator muscle and enters
the vestibule of the mouth upon a small papilla opposite the upper 2nd molar tooth
Nerve Supply:
The glossopharyngeal nerve carries preganglionic parasympathetic secretomotor fibers.
These pass into the tympanic nerve and synapse in the otic ganglion. Postganglionic fibers
attach to the auriculotemporal nerve and follow that to the gland.
Contents:
• Parotid plexus of facial nerve and its branches
• Retromandibular vein
• External carotid artery
• Parotid lymph nodes

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Gross anatomy | GIT & Nutrition-I module

Clinical correlates of parotid gland:

• Parotiditis & mumps: The parotid gland may become acutely inflamed as a result of
retrograde bacterial infection from the mouth via the parotid duct. The gland may
also become infected via the bloodstream, as in mumps. In both cases, the gland is
swollen; it is painful because the fascial capsule derived from the investing layer of
deep cervical fascia is strong and limits the swelling of the gland. The swollen glenoid
process, which extends medially behind the temporomandibular joint, is responsible
for the pain experienced in acute parotitis when eating. Parotid gland disease often
causes pain in the auricle and external acoustic meatus of the external ear, the
temporal region, and TMJ because the auriculotemporal and great auricular nerves,
from which the parotid gland and sheath receive sensory fibers, also supply sensory
fibers to the skin over the temporal fossa and auricle.
• Frey’s Syndrome: Frey’s syndrome is an interesting complication that sometimes
develops after penetrating wounds of the parotid gland. When the patient eats,
beads of perspiration appear on the skin covering the parotid. This condition is
caused by damage to the auriculotemporal and great auricular nerves. During the
process of healing, the parasympathetic secretomotor fibers in the auriculotemporal
nerve grow out and join the distal end of the great auricular nerve. Eventually, these
fibers reach the sweat glands in the facial skin. By this means, a stimulus intended
for saliva production produces sweat secretion instead.
• Parotid Duct Injury: The parotid duct, which is a comparatively superficial structure
on the face, may be damaged in injuries to the face or may be inadvertently cut
during surgical operations on the face. The duct is about 2 in. (5 cm) long and passes
forward across the masseter about a fingerbreadth below the zygomatic arch.
• Parotid tumor surgery with its complications: Most (80% of) salivary gland cancers
begin in the parotid glands. Surgical excision of the parotid gland (parotidectomy) is
often performed as part of the treatment. Because the parotid plexus of CN VII is
embedded in the parotid gland, the plexus and its branches are in jeopardy during
surgery. An important step in parotidectomy is the identification, dissection,
isolation, and preservation of facial nerve, Injury of this can cause facial paralysis.
Waldeyer’s Ring of Lymphoid Tissue:
The lymphoid tissue that surrounds the opening into the respiratory and digestive systems
forms a ring.
• Two palatine tonsils and two tubal tonsils (lymphoid tissue around the opening of
the auditory tube) form the lateral part of the ring.
• The pharyngeal tonsil in the roof of the nasopharynx forms the upper part
• The lingual tonsil on the posterior third of the tongue forms the lower part
Submandibular Gland:
The submandibular gland consists of a mixture of serous and mucous acini. It lies beneath
the lower border of the body of the mandible and is divided into superficial and deep parts
by the mylohyoid muscle. The submandibular duct emerges from the anterior end of the
deep part of the gland and runs forward beneath the mucous membrane of the mouth. It
opens into the mouth on a small papilla, which is situated at the side of frenulum of tongue.
Passing from lateral to medial, the lingual nerve loops under the duct that runs anteriorly,
opening by one to three orifices on a small sublingual papilla beside the base of the
frenulum of the tongue
Neurovascular Supply:

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• Arterial supply is from the submental arteries. The veins accompany the arteries.
• The facial nerve provides the parasympathetic secretomotor supply via its chorda
tympani branch and the submandibular ganglion.
Sublingual Gland:
The sublingual gland lies beneath the mucous membrane (sublingual fold) of the floor of
the mouth, close to the frenulum of the tongue. It has both serous and mucous acini, with
the latter predominating. The sublingual ducts (8 to 20 in number) open into the mouth on
the summit of the sublingual fold.
Neurovascular Supply:
• Arterial supply is from the sublingual and submental arteries, branches of the lingual
and facial arteries, respectively
• Nerve supply is same as that for the submandibular gland.
.

Pharynx:
The pharynx is situated behind the nasal cavities, the mouth, and the larynx and aptly
consists of three parts: nasopharynx, oropharynx, and laryngopharynx.
Features Nasopharynx Oropharynx Laryngopharynx
Extent From the base of the skull Extends from the soft Extends from the
to the upper surface of palate to the upper upper border of the
the soft palate border of the epiglottis to the lower
epiglottis border of the cricoid
cartilage
Anatomical Contains the adenoids Contains the palatine Contains the piriform
features (pharyngeal tonsil), tonsils, lingual tonsils, recesses and the
openings of the and openings of the opening of the larynx
Eustachian tubes, and oral cavity and
pharyngeal recess nasopharynx
Structure pharyngeal recess is a The median Thyroid cartilage and
depression in the glossoepiglottic fold is the thyrohyoid
pharyngeal wall behind in the midline and the membrane form the

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Gross anatomy | GIT & Nutrition-I module

the tubal elevation. The lateral lateral wall, piriform

salpingopharyngeal fold is glossoepiglottic fold is fossa is a depression in
a vertical fold of mucous to the side. The the mucous membrane
membrane covering the depression on each on each side of the
salpingopharyngeus side of the median laryngeal inlet
muscle. glossoepiglottic fold is
the vallecula.
Nerve Maxillary nerve Glossopharyngeal Internal laryngeal
supply nerve branch of vagus nerve
Blood Ascending pharyngeal, tonsillar branches of facial arteries, and branches of
supply the maxillary and lingual arteries
Lymphatic Lymph drains directly into the deep cervical lymph nodes or indirectly via
drainage the retropharyngeal or paratracheal nodes into the deep cervical nodes.
Pharyngeal constrictor muscles:

The overlapping of the pharyngeal constrictor muscles leaves four gaps in the musculature
for structures to enter or leave the pharynx:
Gap Structures passing through gap
B/W the superior pharyngeal levator veli palatini, pharyngotympanic tube, and
constrictor and the cranium ascending palatine artery
B/W the superior and middle stylopharyngeus, glossopharyngeal nerve, and
pharyngeal constrictors stylohyoid ligament
B/W the middle and inferior internal laryngeal nerve and superior laryngeal artery and
pharyngeal constrictors vein
Inferior to the inferior recurrent laryngeal nerve as inferior laryngeal artery
pharyngeal constrictor
Piriform Fossa and Foreign Bodies:
The piriform fossa is a recess of mucous membrane situated on either side of the entrance
of the larynx. Clinically, it is important because it is a common site for the lodging of sharp
ingested bodies such as fish bones. The presence of such a foreign body immediately causes
the patient to gag violently.

Medicnetic – MBBS Modular series

Gross anatomy | GIT & Nutrition-I module

Past UHS Questions:

Glands:
1. Give the reason for radiation of pain from jaw to ear and forehead of same side in a
patient with swelling of parotid gland.
2. Where does parotid duct open within the buccal cavity?
3. What are the relations of various surfaces of the parotid gland?
4. Name the structures lying within the parotid gland.
5. Give nerve supply of parotid gland.
6. Mention the relation of lingual nerve to the submandibular gland.
Pharynx & palate:
7. Enlist the structures passing in gap between superior and middle pharyngeal
constrictors to the internal aspects of the pharyngeal wall.
8. Give the formation of pharyngeal plexus. What component of the tongue is supplied
by this plexus?
9. Give the formation of pharyngeal plexus. Enlist the structures supplied by This?
10. Name muscles of soft palate with their action and nerve supply.
11. Why Removal of foreign bodies lodged in piriformis fossa may lead to loss of
protective cough reflex? (Due to the injury of internal & recurrent laryngeal nerve)
Tonsils:
12. Name the components of Waldeyer’s (tonsillar) ring.
13. Give location of palatine tonsil and enumerate the structures forming tonsillar bed.
(It is formed by superior pharyngeal constrictor muscle, pharyngobasilar &
buccopharyngeal fascia and pharyngobasilar fascia)
14. Name the arterial supply of tonsils. Name the vessel most commonly responsible for
postoperative bleeding after tonsillectomy. (Tonsillar branch of facial artery)
Tongue:
15. What is nerve supply of tongue?
16. Write the lymphatic drainage of tongue.
17. What is tongue tie? (In this, frenulum of the tongue extending farther anteriorly
toward the apex and interferes with tongue movements and may affect speech)
18. Why Genioglossus is known as safety muscle of the tongue? (When it is paralyzed,
tongue has a tendency to fall backward and obstruct airway resulting in suffocation.)
19. Describe the sensory motor and taste innervation of tongue.
20. Draw and label a diagram showing sensory nerve supply of tongue
21. Briefly describe the lymphatic drainage of tongue
Past UHS MCQs:
Hard & soft palate
The superior surface of hard palate forms the Floor of the nose
Hard palate is supplied by the Greater palatine
The anterior two-thirds of the hard palate is formed by Process of the
jaws
The palatine aponeurosis is the flattened tendon of Tensor veli palatini
The hard palate separates which two cavities? Nasal cavity and
oral cavity
The hard palate contains rugae. What is the function of rugae? Increasing surface
area for food
Which nerve supplies sensory innervation to the hard palate? Trigeminal nerve

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Gross anatomy | GIT & Nutrition-I module

The incisive foramen, located in the midline of the hard palate, Nasopalatine
transmits which structure? nerve
The hard palate is continuous posteriorly with which structure? Soft palate
Which nerve supplies motor innervation to the muscles of the soft Vagus nerve
palate?
Which of the following structures is NOT attached to the soft palate? hyoid bone
Which nerve provides sensory innervation to soft palate Glossopharyngeal
nerve
The anterior fold form the base of the uvula is called Palatoglossal arch
Soft palate is supplied by the following arteries except Dorsal lingual
In the voluntary stage of swallowing, the bolus is compressed Palatopharyngeus
against the palate mainly by the action of muscle:
Which one of the following muscles of the palate is innervated by Tensor velli
the trigeminal nerve? palatini
Pharynx
The piriform sinuses are depressions. located in which region of the Laryngopharynx
pharynx?
The pharynx contains several constrictor muscles. What is their Propel food down
function? the esophagus
Which muscle forms the superior boundary of the laryngopharynx? Stylopharyngeus
muscle
The pharyngeal tonsils, also known as adenoids, are located in which Nasopharynx
region of the pharynx?
Which of the following is NOT a region of the pharynx? Thyropharynx
Which nerve provides sensory innervation to the pharynx? Glossopharyngeal
nerve
Which of the following structures is NOT found in the nasopharynx? Epiglottis
The laryngopharynx extends from which structures to the Epiglottis to the
esophagus? cricoid cartilage
Tubal elevation is located in which region of the pharynx? Nasopharynx
Beneath the mucosa of the piriform fossa, there lies the: Internal laryngeal
nerve
Superior constrictor muscle takes origin from the following except: Lesser cornia of
hyoid bone
Which structures pierce the thyrohyoid membrane? Internal laryngeal
nerve and superior
laryngeal vessels
Which of the following nerves plays a crucial role in coordinating the Vagus nerve
muscular movements involved in deglutition?
The pharyngeal phase of deglutition involves: Swallowing the
bolus and
transporting it
through the
esophagus
The initiation of deglutition is primarily controlled by the swallowing Brainstem
center located in the:

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Gross anatomy | GIT & Nutrition-I module

The pharyngotympanic tube connects which two structures? Nasopharynx and

middle ear
Which muscle is responsible for opening and closing the Levator palatini
pharyngotympanic tube? muscle
Which structure doesn't pass through the gap between superior and Internal laryngeal
middle constrictor muscles of pharynx? nerve
All the following muscles are supplied by cranial accessory nerve Stylopharyngeus
except:
Which of following reflexes test the integrity of nucleus ambiguous Gag reflex
The roof of the nasopharynx is built up by two bones; the basilar Sphenoidal
part of the occipital bone and the bone:
The pharyngeal muscle that originates from the pterygomandibular Superior
raphe is the: constrictor
The pharyngeal muscle that is innervated solely by the Stylopharyngeus
glossopharyngeal nerve is the muscle:
Tonsils
The palatine tonsil is normally found within Oro-pharynx
The palatine tonsils are covered by a mucosa that forms deep Crypts
invaginations called:
The palatine tonsils are located Between which two structures? Anterior &
posterior faucial
pillars
The tonsillar artery, a branch of which artery, supplies the palatine External carotid
tonsils? artery
Inflammation and enlargement of the palatine tonsils are commonly Tonsillitis
referred to as:
Removal of the palatine tonsils is called Tonsillectomy
The pharyngeal muscle forming the tonsillar bed is: Superior
pharyngeal
constrictor
Parotid gland
The largest of the salivary glands is: parotid gland
The capsule of the gland is formed by: Investing layer of
deep cervical
fascia
The deep lamina of parotid capsule is attached to: styloid process
The parotid gland resembles: pyramid
The parotid duct emerges from: anterior border of
parotid gland
All of the following are the Structures found within the parotid gland external jugular
except: vein
The parotid gland is supplied by: external carotid
artery
The veins from the parotid gland drains into external jugular
vein
While performing parotidectomy which nerve must be preserved? facial nerve

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The Hilton's method is draining the parotid abscess by: horizontal

incisions
The facial nerve leaves the skull by passing through: stylomastoid
foramen
Parasympathetic innervation to the parotid gland is provided Otic
through the ganglion:
A young boy suffering from inflammation of parotid gland Auricotemporal
complained of severe pain in the region of the gland, in the auricle and greater
and external acoustic meatus. The accompanied pain in the ear is auricular
due to common nerve supply by:
Sensory innervation of the parotid sheath is carried by nerve: Great auricular
The parotid duct opens into the opposite the tooth vestibule of mouth
2nd upper molar
Sensory innervation of the parotid gland is carried by Auriculotemporal
Submandibular gland
The submandibular duct opens at: side of frenulum
of the tongue
Blood supply to the submandibular gland is by: facial artery
The submandibular ganglion is: parasympathetic
peripheral
ganglion
Tongue
The tongue papillae which are numerous in number near the tip and Fungiform
the margins of the tongue are:
All of the following are intrinsic muscles of the tongue except: genioglossus
The tip of the tongue drains into: Submantle nodes
The bulk of the tongue is made up of: striated muscles
Paralysis of the tongue muscles is due to the Injury of: hypoglossal nerve
Palsy of right genioglossus causes Deviation of
tongue to right
During surgery under general anesthesia, tongue has the tendency Genioglossus
to fall back and obstruct the airway. This is because of relaxation of
which of the following muscles:
Protrusion of the tongue is produced by: Genioglossus
Which one of the following muscles of the tongue narrows it? Genioglossus
Special sensation from the tip of the tongue is carried by the nerve: Lingual
Lymph nodes draining lymph from lateral sides of anterior two thirds Submandibular
of tongue are:
It is the inverted V-shaped row at the back of the tongue. Circumvallate
Pick a suprahyoid muscle: geniohyoid
Posterior belly of digastric muscle arises from: mastoid notch of
temporal bone

Medicnetic – MBBS Modular series