Nasal And Oral Cavities, Exam 5

Front 1

1. How is the nasal cavity seperated from the anterior cranial fossa?
2. What is lateral to the upper half of the lateral wall of nasal cavity?
3. What is lateral to the lower half of the lateral nasal wall?
4. What's below the floor of the nasal cavity?
5. Posteriorly, what is the nasal cavity continuous with?

Back 1

1. By the perforated cribiform plate of ethmoid bone..
2. Lateral to the upper half of the lateral wall of the nasal cavity is the ethmoidal air sinus, and lateral to the ethmoid sinus is the medial wall of the orbit.
3. Maxillary air sinus
4. Below the floor of the nasal cavity is the oral cavity. The hard palate forms a common partition separating the oral cavity below from the nasal cavity above.
5. nasopharynx

Front 2

Name the bones that make up the roof of the nasal cavity

Back 2

– nasalcartilages(seen
best in anterior view)
– nasalbones – nasal spine of the
frontal bone
– cribriformplateofthe ethmoid bone
– anteriorandinferior aspects of the body of the sphenoid bone.

Front 3

What bones make up the floor of the nasal cavity?

Back 3

– palatineprocessesof
maxilla
– horizontalplatesof palatine bone

Front 4

What makes up the medial wall of the nasal cavity?

Back 4

– Formed by the nasal septum.
– Components of the nasal septum are:
• septalcartilage
• perpendicular (vertical) plate of ethmoid bone
• vomer

Front 5

What are the bones that make up the lateral wall of the nasal cavity?

Back 5

– maxilla * – ethmoid bone *
• which provides the superior and middle conchae
– inferior concha *

Front 6

Name the 4 passages of the nasal cavity that are divided by the superior, middle, and inferior nasal conchae.

Back 6

• • • •
Sphenoethmoidal recess
Superior meatus
Middle meatus
Inferior meatus

Front 7

1. How are tears from the lacrimal glands removed? What drains them into the nasal cavity?
2. What drains the anterior ethmoidal sinus, frontal and maxillary sinuses?
3. What drains the middle ethmoidal sinuses?
4. What drains into the superior and sphenoethmoidal recess?

Back 7

1. Tears produced by the lacrimal glands are removed from the orbit by the nasolacrimal apparatus. The nasolacrimal duct drains to the inferior meatus of the nasal cavity
2. The hiatus semilunaris that's a depression found in the middle meatus.
3. Bulla ethmoidalis - swelling on superior border of hiatus semilunaris.
4. Posterior ethmoidal sinuses drains into superior meatus and sphenoid drains into sphenoethmoidal recess

Front 8

Where is the nasogastric tube inserted and what complications may this lead to?

Back 8

“Insert the nasogastric tube along the floor of the nose and advance it parallel to the nasal floor (ie, directly perpendicular to the patient's head, not angled up into the nose) until it reaches the back of the nasopharynx, where resistance will be met (10-20 cm).
At this time, ask the patient to sip on the water through the straw and start to swallow. Continue to advance the nasogastric tube until the distance of the previously estimated length is reached.”

Complications:
• Perforation of the esophagus • Misplacement in the airway (tracheobronchial placement)
• 35 cases of intracranial pacement

Front 9

What are paranasal sinuses extensions of?

Back 9

The paranasal sinuses are air-filled extensions of the respiratory part of the nasal cavity into the following cranial bones:
– Frontal – Ethmoid – Sphenoid – Maxilla

Front 10

Where do the paransal air sinuses drain into the nasal cavity?

Back 10

All via openings in lateral nasal wall.
Ex. hiatus semilunaris, bulla ethmoidalis, nasolacrimal duct through inferior meatus of nose

Front 11

Where are the front sinuses, and where do they drain?

Back 11

The frontal sinuses are between the outer and the inner tables of the frontal bone, posterior to the superciliary arches and the root of the nose.
• Each sinus drains through a frontonasal duct, which opens into the semilunar hiatus of the middle nasal meatus.

Front 12

What are the ethmoidal cells (sinuses)?
Describe where the anterior, middle, and posterior ethmoidal cells drain

Back 12

The ethmoidal cells (sinuses) are small invaginations of the middle and superior nasal meatus into the ethmoid bone between the nasal cavity and the orbit
– Theanteriorethmoidalcells drain into the middle nasal meatus via the frontonasal duct
– The middle ethmoidal cells drain into the middle meatus where they form the ethmoidal bulla a swelling on the superior border of the semilunar hiatus

Theposteriorethmoidalcells open directly into the superior meatus

Front 13

Where are the sphenoidal sinuses, and where do they drain?

Back 13

The sphenoidal sinuses are located in the body of the sphenoid and may extend into the wings of this bone. They are unevenly divided and separated by a bony septum.

The sphenoidal sinuses drain into the sphenoethmoidal recess.

Front 14

What structures are the sphenoidal sinuses separated from, by thin plates of bone?

Back 14

– – – –
the optic nerves and optic chiasm the pituitary gland the internal carotid arteries
the cavernous sinuses

Front 15

1. Where are the maxillary sinuses?
2. What do the medial, roof, and floor of the maxillary sinus form?
3. How is the maxillary sinus drained?

Back 15

The maxillary sinuses are the largest of the paranasal sinuses. They occupy the bodies of the maxillae and communicate with the middle nasal meatus
– The medial wall of the maxillary sinus forms the inferior part of the lateral wall of the nasal cavity.
– The roof of the maxillary sinus is formed by the floor of the orbit.
– The floor of the maxillary sinus is formed by the alveolar part of the maxilla of the oral cavity.
• Each maxillary sinus drains by one or more openings, the maxillary ostium, into the middle nasal meatus of the nasal cavity by way of the semilunar hiatus.

Front 16

Where do the roots of the maxillary teeth elevate into?

Back 16

The floor of the maxillary sinus is formed by the alveolar part of the maxilla of the oral cavity.
The roots of the maxillary teeth, particularly the first two molars, often produce conical elevations in the floor of the sinus.

Front 17

Name the 2 regions of the oral cavity

Back 17

• vestibule - space between teeth and mucosal lining of the lips and cheeks (labial & buccal mucosa)
• oral cavity proper - space between upper and lower dental arches

Front 18

Oral vestibule
1. What are the lips controlled by?
2. Cheeks?

Back 18

1. Msucles of facial expression which are all innervated by CN7
2. Buccinator muscle
Attachments: alveolar prcess of maxillae and mandbile to pterygomandibular raphe. inserts into area near orbicularis oris.
Actions: keeps cheek taut, assists in smiling
Innervation: buccal branch of facial nerve

Front 19

What can underdevelopment of the 6th and 7th cranial nerve lead to?

Back 19

Mobius Syndrome.
-asymmtery of facial expression
-severe tooth decay

Front 20

What is the 1 salivary gland associated with the oral vestibule?

Back 20

Parotid Gland
-ducts opens in oral vestibule opposte to crown of 2nd molar

Front 21

• A 13-year-old boy who had recently begun playing the tuba presented with a 2-day history of facial swelling on the left side and pain without fever or ear or nasal discharge.
• On physical examination, he had swelling of the left cheek with tenderness on palpation.

What anatomical structures are affected?

Back 21

-Air in left parotid gland and in parotid duct
-air lateral to carotid sheath

Front 22

1. What structure forms the roof of the oral cavity proper and floor of nasal cavity?
2. What are the 2 parts?

Back 22

1. palate
2. hard palate:
• Forms rigid surface for food during
chewing
• Formed from 2 bones of skull:
1) Horizontal plate of palatine bone
2) Palatine process of maxilla
• 3 pairs of foramina present
Greater palatine foramen
– Lateral posterior aspect of palate
– Greater palatine nerves and arteries
Lesser palatine foramen
– Posterior to GPF
– Lesser palatine nerves and arteries

Incisive canal (fossa)
– Behind central incisors
– Nasopalatine nerves and greater palatine artery


Soft palate:
Rises as a reflex to close off
nasopharynx during swallowing
• Sides are attached to
pharyngeal walls
Composed of muscles:
1) Levator veli palatini 2)Tensor veli palatini 3) Palatoglossus 4) Palatopharyngeus 5) Musculus uvulae

Front 23

Name the attachments and action of the levator veli palatini

Back 23

– originatesfromthetemporal bone and inserts into the palatine aponeurosis (interlacing tendons of the soft palate)
– functions to elevates the soft palate

Front 24

Name the attachments and action of the tensor veli palatini

Back 24

– originatesonthesphenoid bone, and the auditory tube and inserts into the palatine aponeurosis
– acts to flatten and tense the soft palate.

Front 25

Where is the palatine aponeurosis attached? what is its function?

Back 25

• Attached to the posterior border of the hard palate is a thin, firm fibrous lamella called the Palatine Aponeurosis (XXX), which supports the muscles and gives strength to the soft palate.
• Formed by the expanded interlacing tendons of the tensor veli palatini muscles in the anterior two thirds of the soft palate

Front 26

Attachments and action of palatoglossus

Back 26

– Originates in the soft palate and inserts onto the lateral surface of the intrinsic muscles of the tongue.
– Elevates posterior 1/3 of the tongue and, with its counterpart on the other side

Front 27

Attachments and action of palatopharyngeus

Back 27

– Arises from the soft palate and inserts into the thyroid cartilage and the pharynx
– Functions to elevate the pharynx and larynx

Front 28

Attachments and action of musculus uvulae

Back 28

– Originates on the palatine bone and from the palatine aponeurosis
– Acts to retract and elevate the uvula.

Front 29

What are tonsils? What are the 3 types and where are they located?

Back 29

• Aggregates of lymphoid tissue
• Palatine- bilateral, located at boundary of oral cavity and pharynx
• Pharyngeal-single, roof of nasal pharynx
• Lingual-dorsal surface of posterior tongue

Front 30

What are the 5 functions of the tongue?

Back 30

1) mastication
2) taste 3) deglutition (swallowing) 4) articulation (speech) 5) oral cleansing

Front 31

Name and describe 4 structures on the dorsal surface of the tongue

Back 31

Sulcus terminalis
– V-shaped groove that divides anterior 2/3 from the posterior 1/3 of the tongue
Circumvallate papillae
– 8-10 rows of structures containing taste buds
Filiform and fungiform papillae
– Projections on the surface of the tongue
– Fungiform papillae contains taste buds
– Filiform papilla direct food ( not pictured)

Front 32

What are 2 structures you can find underneath the tongue?

Back 32

• Lingual Frenulum
a midline fold of mucous membrane running from the lingual gingiva behind the mandibular central incisors posteriorly to the undersurface of the tongue.
• Sublingual papilla
located on either side of the frenulum and is the opening of the duct of the submandibular gland

Front 33

Extrinsic tongue muscles action and innervation
1. genioglossus
2. hyoglossus
3. styloglossus
4. palatoglossus

Back 33

1. action: depresses and protrudes tongue; hypoglossal n.
2. action: depresses and retracts tongue; hypoglossal n.
3. action: retracts tongue; hypoglossal n.
4. elevates posterior part of tongue; pharyngeal plexus via CNX

Front 34

What are the 4 intrinsic muscles of the tongue?

Back 34

1) superior longitudinal 2) inferior longitudinal 3) transverse 4) vertical

Front 35

Blood supply to tongue and floor of mouth
1. What's the main artery to the tongue, and what is it a branch of?
2. What provides blood supply to the root of the tongue?
3. Deep lingual artery?
4. Sublingual branch?

Back 35

•The main artery to the tongue is the lingual artery, a branch of the external carotid artery.
•The dorsal lingual artery provides the blood supply to the root of the tongue •(The dorsal lingual artery also sends a branch to the palatine tonsil)
•The deep lingual artery supplies the body of the tongue
•The sublingual branch of the lingual artery provides the blood supply to the floor of the mouth, including the sublingual gland.

Front 36

Venous drainage of tongue
1. Lingual veins
2. Deep lingual vein?
3. Sublingual vein?
4. dorsal lingual vein?

Back 36

The tongue is drained by two lingual veins that accompany the lingual arteries and receive the dorsal lingual veins.
The deep lingual vein runs posteriorly under the mucous membrane of the underside of the tongue at the side of the lingual frenulum (where it can be observed through the mucosa).
It unites with the sublingual vein from the floor of the mouth and the sublingual salivary gland and then receives the dorsal lingual vein.
All these veins drain directly or indirectly into the internal jugular vein (IJV).

Front 37

Lymphatics of tongue
1. Tip of tongue
2. Side of tongue
3. Central part
4. Jugulodigastric and retropharyngeal

Back 37

1. submental group
2. submandibular group
3. juguloomohyoid group
4. jugulo-omohyoid group

Front 38

GSA vs. SA fibers of tongue
Name the cranial nerves that contribute to these fibers based on the following locations on the tongue
1. Posterir most area
2. Posterior 1/3
3. Anterior 2/3

Back 38

1. SA: CNX via internal laryngeal
GSA: same
2. SA and GSA: CNIX
3. SA: CN7 via chorda tympani
GSA: CNV via lingual nerve

Front 39

What is the floor of the oral cavity formed by?

Back 39

– A muscular diaphragm, which fills the U-shaped gap between the sides and body of the mandible- this is composed of paired mylohyoid muscles
(Attachments: mylohyoid line of mandible to median raphe and hyoid bone; Innervation: nerve to mylohyoid from IAN)
– Twocord-likegeniohyoid muscles above the diaphragm, which run from the mandible to the hyoid
(Attachments: inferior mental spines of mandible to body of hyoid bone; Innervation: C1)

Front 40

Name all the structures in the floor of the mouth

Back 40

Glands and Ducts
Submandibular duct and sublingual gland and ducts
Lingual Nerve
Sensory form anterior 2/3 tongue
Hypoglossal Nerve
Motor to Intrinsic and Extrinsic Ms. of tongue
Lingual Artery
Major arterial blood supply to the tongue Branches include dorsal lingual, deep lingual, and sublingual arteries
1. Dorsal lingual artery – supplies the posterior part 2. Deep lingual artery – supplies the anterior part 3. Sublingual artery – supplies the sublingual gland and the floor of the mouth
Lingual Veins (not reviewed) Dorsal, deep and sublingual veins to the internal jugular veins

Front 41

Describe the submandibular gland and sublingual gland

Back 41

Submandibular Gland
• Duct passes between
mylohyoid, hyoglossus, and genioglossus
• Opens lateral to lingual frenulum
Sublingual Gland
• Ducts open into oral cavity or connects with submandibular duct

Front 42

Describe the course of the lingual nerve in the floor of the oral cavity

Back 42

1. This arises as a branch off of V3 in the infratemporal fossa
2. It curves downward, lateral, and forward to the medial and lateral pterygoid muscles
3. Here, it joins the chorda tympani
4. Lingual nerve continues anteriorly and downward, enters into floor of mouth, medial to root of mand M3.
5. Curves downward and loops upward on top of hypoglossus muscle.
5. Ends by supplying branches to anterior 2/3 tongue.

Front 43

What's the relationship between the lingual nerve and submandibular duct?

Back 43

Above the mylohyoid muscle, you see the lingual nerve wrapping around the submandibular duct.

Specifically, it passes first underneath the duct, and then cross over it.

Front 44

Describe the course of the hypoglossal nerve as it leaves the skull and finally to reach its destination

Back 44

• The hypoglossal nerve leaves the skull through the hypoglossal canal and descends almost vertically in the neck to a level just below the angle of the mandible.
• Here it angles sharply forward and crosses the external carotid artery
• It continues forward and crosses the lingual artery to reach the hyoglossus muscle
• The hypoglossal travels on the external surface of the hyoglossus muscles and deep to the mylohyoid muscle to reach the tongue.