ORALCAVITY

WORLD OF MOUTH
PARTS
• Mouth floor
• Lips
• Buccal / cheek mucosa
• Gums (gingiva)
• Retromolar trigone
• Hard palate
• Oral tongue
• Floor of mouth
• Prepared by: Ayat Alosta
• REVISED BY: Dr. M GABEROUN
ORAL CAVITY PARTS

Oral cavity:
Consists of two parts: the (oral vestibule) and the ( oral cavity proper)

• The oral cavity proper is the space between the upper

and the lower dental arches When the mouth is closed at
the rest position, the oral cavity is fully occupied by the
tongue
ORAL CAVITY BORDERS:
From the lips and cheeks externally to anterior pillars of the fauces internally, where
it continues into the oropharynx.

ORAL CAVITY:

1. vestibule external to the teeth

2. oral cavity proper internal to the teeth
 Where the mucosa that covers the alveolus of the jaw reflected on to the lips and
cheeks, sulcus formed which called the fornix.
Note: Teeth has lingual and buccal (labial) surfaces

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
The mylohyoid muscle forms its Floor. The anterior 2/3rd of the tongue
lies on the floor Covered with mucous membrane
NOTE :The palate forms the roof of the mouth and separates the oral
and nasal cavities.
The floor of the mouth formed by:
1. Mylohyoid muscles
2. Tongue
The main muscle forming the floor of the mouth is mylohyoid, with geniohyoid lying
immediately above it.

Mylohyoid muscle
Lies superior to the anterior belly of digastric muscle
Mylohyoid blood supply:

 sublingual branch of the lingual artery,

 maxillary artery, via the mylohyoid branch of the inferior alveolar artery,

 Submental branch of the facial artery.

The lateral walls of the mouth BORDERS are:
1. cheeks
2. retromolar regions

Salivary glands, which open into the mouth, are:

1. (parotid, submandibular and sublingual)
2. Numerous minor salivary glands (labial, buccal, palatal, lingual)

Cheeks
Internally, the mucosa of the cheek is tightly adherent to buccinator, stretched
when the mouth opened and wrinkled when closed.
Ectopic sebaceous glands may be evident as yellow patches (Fordyce spots).
(The linea Alba): A hyperkeratinized line may seen related to the occlusal plane of the teeth

Cheek blood supply: buccal branch of the maxillary artery,

Cheek nerve supply:
1. Zygomaticofacial?!
 2. infraorbital nerves,
3. Buccal branch of the mandibular division of the trigeminal nerve.

Lips
Oral fissure= mouth (Rima oris = the oral opening)
• orbicularis oris (the sphincter of the oral fissure), the buccinator, risorius, and
depressors and elevators of the lips (dilators of the fissure).

Lips blood supply: superior and inferior labial branches of the facial artery
Lips Nerve supply:
 upper lip is innervated by superior labial branches of the infraorbital nerve,
 Lower lip is innervated by the mental branch of the mandibular division of V.
LIPS MOVMENT EXPRESION RELATED TO MANY MUSCLES AROUND MOUTH WHICH CONTRLLED BY FACIAL NEVE

Gingivae
The gingivae (gums) Are composed of fibrous tissue covered with mucous membrane.
– The gingiva proper (attached gingiva)
• is firmly attached to the alveolar processes of the jaws and the necks of
the teeth
• The gingiva proper is normally pink, stippled, and keratinizing.
– The alveolar mucosa (unattached gingiva)
• is normally shiny red and non-keratinizing

•
.
Types of Oral Mucosa
Oral mucosa : lips,cheeks, vestibule floor of mouth soft palate are non-
keratinized (not involved in mastication )
 Masticatory Mucosa
 Lining Mucosa
 Specialized Mucosa
Masticatory Mucosa
Free, attached gingiva and hard palate comes in primary contact with food
during mastication and it is keratinized.
Specialized Mucosa
On the dorsal surface (dorsum) of the tongue. It is covered with cornified
epithelial papillae.
Gingivae nerve supply:
Upper jaw : maxillary nerve via its greater palatine, nasopalatine, and anterior,
middle and posterior superior alveolar branches
The submandibular salivary ducts open into the mouth at the sublingual papilla
(caruncle), which is a large, centrally positioned protuberance at the base of the
tongue.
GINGIVA N SUPPLY
UPPER GUMS
 The labial part is supplied by posterior, middle, and anterior-superior
alveolar nerves.
 The lingual part is supplied by greater palatine and nasopalatine nerves.
LOWER GUMS
 The labial part is supplied by buccal branch of mandibular nerve, and incisive
branch of mental nerve.
 The lingual part is supplied by lingual nerves.
 Retromolar region:

Triangular area of mucosa covering anterior surface of the ascending ramus of mandible.

• Base – Posterior to the last molar while

• Apex – Adjacent to the tuberosity of maxilla

 Pterygomandibular raphe: a fold of mucosa extends from the upper to the lower
alveolus.

Complete names of unlabeled lines?

 the lingual and inferior alveolar nerves entrance to the pterygomandibular space
(lateral to pterygomandibular raphe and medial to the ridge of anterior border of the
ramus of the mandible
  Note: this is the site for injection for an inferior alveolar nerve block,
commonly used to anaesthetize teeth
 When teeth occluded, vestibule is a closed space except where it communicates with
the oral cavity proper in the retromolar regions behind the last molar tooth on each
side

MOUTH MUCOSA
The lining mucosa is red in colour, covers the soft palate, ventral surface of the tongue,
floor of the mouth, alveolar processes excluding
 gingivae,
 internal surfaces of the lips
 cheeks

The m u c o g I n g I v a l
junction..
 Masticatory mucosa are keratinized or parakeratinized

THE PALATE

 Palatine processes of the maxillae form the anterior 3/4 of the hard palate
  Horizontal plates of the palatine bones form the posterior 1/4

Palate Forms the roof of the mouth:

 hard palate in front
 soft palate behind.
It is covered by a thick mucosa bound tightly to the underlying periosteum.

Hard Palate
Lies in the roof of the oral cavity, Forms the floor of the nasal cavity
SUTURES:
• INTERMAXILLARY SUTURE
• INTERPALATINE SUTURE
• PALATOMAXILLARY SUTURE

Palatine raphe :A narrow ridge, , devoid of submucosa, runs anteroposteriorly in the

Midline. Ends anteriorly by incisive papilla which covers the incisive fossa
Transverse rugae: ridges or in the anterior half of the hard palate; their pattern is
unique to the individual.

The palate blood supply:

Blood supply of gingivae, palatine glands and mucous membrane by anastomosis from:
 Greater palatine branch of the maxillary artery
 Ascending palatine branch of the facial artery
 Palatine branch of the Ascending pharyngeal artery
 septal branches of the nasopalatine artery

NERVE SUPPLY
• Supplied by the greater and lesser palatine nerves and the nasopalatine nerve
• General sensory fibers carried in all these nerves originate in the pterygopalatine fossa
from the maxillary nerve
• Special sensory and secretomotor nerves are contained in Soft Palate
Revision: few Taste impulses from the palate probably pass via the palatine nerves to the
pterygopalatine ganglion, and travel through it without synapsing to join the nerve of the
pterygoid canal and the greater petrosal nerve to the facial ganglion, where their cell
bodies are situated. The central processes of these neurones traverse the sensory root of
the facial nerve (nervus intermedius) to pass to the gustatory nucleus in the nucleus of the
tractus solitarius.

Hard palate Composed of:

• Muscle fibers
• An aponeurosis
• Lymphoid tissue
• Glands
• Blood vessels
• Nerves
MUSCLES OF SOFT PALATE
• Tensor veli palatini • Levator veli palatini
• Musculus uvulae • Palatopharyngeus
• Palatoglossus
Palatine Aponeurosis Is expanded tendon of tensor velli palatine
Tensor veli palatini
Origin: spine of sphenoid; auditory tube
Insertion: forms palatine aponeurosis
Action: Tenses soft palate

Levator veli palatini

Origin: petrous temporal bone, auditory tube, palatine aponeurosis
Insertion: palatine aponeurosis
Action: Raises soft palate

Musculus uvulae
Origin: posterior border of hard palate
Insertion: mucosa of uvula
 Action: Elevates uvula

Palatoglossus
Origin: palatine aponeurosis
Insertion: side of tongue
Action: pulls root of tongue upward, narrowing oropharyngeal isthmus

Palatopharyngeus
Origin: palatine aponeurosis
Insertion: posterior border of thyroid cartilage
Action: Elevates wall of the pharynx

Sensory Nerve Supply:

Mostly by the maxillary nerve through its branches:
Greater palatine nerve
Lesser palatine nerve
Nasopalatine nerve
Glossopharyngeal nerve supplies the region of the soft palate

Motor nerve supply:

All the muscles, except tensor veli palatini, are supplied by the:

Pharyngeal plexus
Blood Supply
Branches of the maxillary artery, Greater palatine, lesser palatine, Sphenopalatine
Ascending palatine branch of the facial artery, ascending pharyngeal branch of the
external carotid artery
 Tongue
tongue = lingua = glossa

Attached by its muscles to ":

1.Hyoid bone 2.mandible 3.Styloid processes
4.soft palate 5.Pharyngeal wall

Pharyngeal wall

The tongue has a root, a body, an apex, a curved dorsum, and an inferior surface.

1. Root of the tongue is attached to the hyoid bone and mandible

 2. Oral part (anterior ⅔)
3. Pharyngeal part (posterior ⅓)

Two surfaces:
• Dorsal
• Ventra
Also Oral Tongue is divided into

. Tip

. lateral borders

. Dorsum

. Undersurface.
The dorsum surface (posterosuperior) covered by filiform, fungiform And
circumvallate papillae, Convex divided by a V-shaped sulcus terminalis into:
 Anterior, oral part that faces upwards,
 Posterior, pharyngeal part that faces posteriorly.

Note:
 the foramen caecum, which marks the site of the upper end of the
embryonic thyroid
Diverticulum (thyroglossal duct).
 The oral and pharyngeal parts of the tongue differ in their mucosa,
innervation and developmental origins
 On each side, in front of the palatoglossal arch, there are four or five
vertical folds, the foliate papillae,
 Foliate papillae: Small lateral folds of the lingual mucosa They are poorly
developed in humans. The vallate, foliate, and most of the fungiform
papillae contain taste
receptors in the taste buds

Inferior (ventral) surface

  the lingual frenulum": connected to the oral floor
 Deep lingual vein, which is visible, lies lateral to the frenulum on either side.
 (Fimbriated fold), a fringed mucosal ridge directed anteromedially towards the
apex of the tongue, lies lateral to the vein.
 Anterior third tongue develops from the lingual swellings of the mandibular arch
and from the tuberculum impar
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
 Tongue-Tie (ankyloglossia) (due to large frenulum)
The upper labial frenulum normally attached well below the alveolar crest.
A large frenulum with an attachment near or on the crest may be associated with a midline gap
(diastema) between the maxillary first incisors.

Sublingual fold
 A rounded ridge extending backward & laterally from the papilla is produced by the
sublingual gland

PHARYNGEAL PART
 Forms the anterior wall of the oropharynx

 connects to the epiglottis by a median and two lateral glossoepiglottic folds,

 which surround two depressions or valleculae
The pharyngeal part of the tongue is devoid of papillae
Underlying ventral surface contains lymphoid nodules ( lingual tonsil)
The pharyngeal part of tongue develops from the hypobranchial eminence

MUSCLES OF THE TONGUE

Intrinsic muscle :
-longitudinal, -transverse,
-vertical -horizontal fasciculi
The tongue divided by a median fibrous septum, attached to the body of the hyoid bone.
• extrinsic muscles alter the position of the tongue while
• intrinsic muscles alter its shape.
• four intrinsic and four extrinsic muscles
• The superior and inferior longitudinal muscles act together to make the tongue
short and thick and to retract the protruded tongue
• The transverse and vertical muscles act simultaneously to make the tongue long and
narrow, which may push the tongue against the incisor teeth or protrude the tongue
from the open mouth (especially when acting with the posterior inferior part of the
genioglossus).
The extrinsic musculature consists of Four pairs of muscles, namely: genioglossus,
hyoglossus, styloglossusand palatoglossus. Hyoglossus

Hyoglossus

Is thin and quadrilateral, and arises from hyoid bone

Hyoglossus Superficial surface relations:
- the digastric tendon - stylohyoid
- Styloglossus - mylohyoid
 - Lingual nerve
- Deep part of the submandibular ganglion, gland and its duct, the sublingual gland,
- Hypoglossal nerve , deep lingual vein.(vena comitans)

Deep surface relations:

- Stylohyoid ligament, - genioglossus,
- Middle constrictor - inferior longitudinal muscle of the tongue
- The glossopharyngeal nerve. - Lingual artery
Posteroinferiorly it separated from the middle constrictor by the lingual artery.
This part of the muscle is in the lateral wall of the pharynx, below the palatine tonsil.
Passing deep to the posterior border of hyoglossus are, in descending order:
1. the glossopharyngeal nerve,
2. stylohyoid ligament
3. Lingual artery.

Styloglossus M.
Origin : styloid process near its apex
 Insertion: it divides to
 longitudinal part, which enters the tongue dorsolaterally to blend with the inferior
longitudinal muscle in front of hyoglossus,
 Oblique part, overlapping hyoglossus and decussating with it.
i.e. longitudinal part into the inferior longitudinal muscles Oblique part into
Hyoglossus

. Nerve Supply of tongue:

Motor: all muscles of the tongue (intrinsic and extrinsic) are supplied by hypoglossal
nerve except palatoglossus which is supplied by pharyngeal plexus(CNX, vagus
nerve)
Sensory:
Anterior 2/3 of the tongue:
 general sensation: lingual nerve - branch of the mandibular nerve (with cell
bodies in the trigeminal ganglion)
  taste: chorda tympani (with cell bodies in the geniculate ganglion of facial
nerve)
 parasympathetic secretomotor fibres to the anterior
lingual gland run in the chorda tympani from the superior salivary nucleus, and relay
in the submandibular ganglion

Posterior 1/3 of the tongue:

 Glossopharyngeal nerve (both general sensation and taste), with cell bodies in
the glossopharyngeal ganglia in the jugular foramen
 Posterior most part of the tongue: innervated by the vagus nerve through the
internal laryngeal branch (with cell bodies in the inferior vagal ganglion)
Note:
– All intrinsic lingual muscles are innervated by the hypoglossal nerve.
– The deep lingual artery is the terminal part of the lingual artery

Note :
• For special sensation (taste), anterior 2/3rd part of the tongue, except for the vallate papillae, is
supplied through the chorda tympani nerve, a branch of CN VII.
• The mucous membrane of the posterior third of the tongue and the vallate papillae
are supplied by the lingual branch of the glossopharyngeal nerve (CN IX) for both
general and special sensation.
• Small branches of the internal laryngeal nerve (CN X), supply mostly general but
some special sensation to a small area of the tongue just anterior to the epiglottis

Lingual artery
•A branch of external carotid artery (after passing deep to the hyoglossus muscles)
•Divides into:
1. •Dorsal lingual arteries: supply posterior part
2. •Deep lingual artery: supplies the anterior part
3. •Sublingual artery: supplies the sublingual gland and floor of the mouth
• The dorsal lingual arteries supply the posterior part (root); the deep lingual
arteries supply the anterior part to apex.

Lingual veins
Dorsal lingual vein drains the dorsum and sides of the tongue
 • Deep lingual veins
(Ranine veins) – drains the tip of the tongue and join sublingual veins from sublingual
Salivary gland
• All these veins terminate directly or indirectly into internal jugular veins

lingual veins

from the union of:

 dorsal lingual , accompanying the dorsal lingual artery between hyoglossus and genioglossus
 deep lingual veins , begins near the tip
 vena comitans of the hypoglossal nerve
The lingual veins usually join the facial and retromandibular veins (anterior division) to form
the common facial vein, which drains into the internal jugular vein.

The lingual nerve

 sensory
 parasympathetic fibers from the submandibular ganglion

Passes below superior pharyngeal constrictor and pterygomandibular raphe, closely applied
to the periosteum of the medial surface. Opposite the distal (posterior) root of the third
molar tooth, where it is covered only by the gingival mucoperiosteum

Note: It passes below the submandibular duct, which crosses it, and curves
upwards, forwards and medially to enter the tongue by medial and lateral branches

Lymphatic Drainage:
 o Tip: Submental nodes bilaterally & then deep cervical nodes
o Anterior two third:Submandibular unilaterally & then deep cervical nodes
o Posterior third: Deep cervical nodes (jugulodigastric mainly)
The deep cervical nodes usually involved: jugulodigastric and jugulo-omohyoid
nodes

Hypoglossal nerve xii

It inclines upwards and forwards on hyoglossus, passing deep to stylohyoid, the tendon of
digastric and the posterior border of mylohyoid. Between mylohyoid and hyoglossus, the
hypoglossal nerve lies below the deep part of the submandibular gland, the submandibular
duct and the lingual nerve, with which it communicates.
Gag Reflex
When the doctor touching the pharynx by tongue depressor!!
• Glossopharyngeal branches provide the afferent (sensory )limb of the gag reflex.
• Glossopharyngeal (CN IX) and vagus (CN X) are responsible for the muscular
contraction of each side of the pharynx.

Paralysis of hypoglossal nerve:The protruded tongue

deviates toward the side of the lesion

Tongue embryology :
ORAL VESTIBULE Boundaries:
*Anteriorly by lips. *Laterally by cheeks. *Posteriorly and medially by teeth and gums
Oral Cavity
Extends from the lips & cheeks
 to the anterior pillars of the fauces
 where it continues into the oropharynx isthmus.
The mouth can be subdivided into the vestibule externally to the teeth & the oral
cavity proper internal to teeth.
Isthmus of the fauces
 a part of the oropharynx directly behind the mouth cavity,
 bounded superiorly by the soft palate,
Laterally by the palatoglossal arches
Inferiorly by the tongue.
 The fauces are regarded as the two pillars, formed by the Palatoglossus and the
Palatopharyngeus muscle.
 anterior is known as the palatoglossal arch,
 posterior is known as the palatopharyngeal arch.
 Between these two arches is the palatine tonsil Blood is supplied to the oral
vestibule and oral cavity via branches of the external carotid artery (facial, maxillary,
and lingual).
Floor of mouth vascular supply:
The main muscle forming the floor of mouth is mylohyoid & above it is geniohyoid.
1. Mylohyoid – vascular supply arterial supply from the sublingual branch of lingual artery.
The maxillary artery, via the mylohyoid branch inferior alveolar artery & submental branch
of facial artery.
2. Geniohyoid – vascular supply derived from the lingual artery.

LIPS: 5 layers
1. Skin – contains hair follicles and sebaceous glands
2. Superficial Fascia- contains some fats
3. Orbicularis Oris muscle – serves as sphincter of the mouth
4. Submucous tissue – contains vessels, mucous labial glands and labial branches of facial
artery
5. Mucous membrane – innermost layer
Dimple
•‘Cute birth defect’= Short zygomaticus major muscle
•Dimples may disappear with age
•Can be created artificially by shortening or splitting of zygomaticus major
Palate blood supply :
Forms the roof of the mouth & divided into two regions
1) Hard palate – greater palatine artery and palatine veins
2) Soft palate – arterial supply ascending palatine branch of facial artery, also branch of
ascending pharyngeal artery
Venous supply drain into pterygoid venous plexusus.
Lingual artery
Arises anteromedially opposite the greater cornu of hyoid bone
It passes between the hyoglossus and the middle constrictor of pharynx to reach the floor
of mouth.
At anterior border of hyoglossus, it bends upwards, lies between genioglossus medially and
inferior longitudinal muscle laterally.
•A branch of external carotid artery (after passing deep to the hyoglossus muscles)
The branches of lingual artery are
1. Dorsal lingual artery
2. Sublingual artery
3. Deep lingual artery
The branches of the facial artery are:
Cervical
1. Ascending palatine artery
2. Tonsillar branch
3. Submental artery
 4. Glandular branches
Facial
1. Inferior labial artery
2. Superior labial artery
3. Lateral nasal branch to nasalis muscle
4. Angular artery - the terminal branch

Embryology of tongue :
From arch1 –oral part of the tongue(ant.2/3rd)
arch2 –initial contribution to surface is lost.
arch3 –pharyngeal part of the
Tongue (post.1/3rd)
arch4 –epiglottis & adjacent region.

ANTERIOR 2/3rd –from

 two lingual swellings
 one tuberculum impar,
Which arises from the first branchial arch ---- this tuberculum impar soon disappears

POSTERIOR 1/3rd
- cranial large part of the hypobranchial eminence i.e., from the 3rd arch.
POSTERIOR MOST PART
– from the 4th arch
Tuberculum Impar; first a swelling arises in the middle of the mandibular process.
And is flanked by two other swellings = Lingual swelling
These lateral swelling quickly enlarge and merge with each other and the tuberculum
impar to form a large mass from which mucous membrane of the anterior 2/3rd of
the tongue is formed.
Root of the tongue arises from large midline swelling develops from mesenchyme of 2nd,
3rd, and 4th arches. Consists of,
1. copula (associated with 2nd arch)
2. A large hypobranchial eminence (associated by 3, 4th arch)