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Oral Cavity and Pharynx

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1 Oral Cavity and Pharynx
Hannah Lea M. David

2 Anatomy of the Lips and Oral Cavity

3 Oral Vestibule bounded externally by the lips and cheeks and internally by the alveolar processes and teeth


5 Lips Longer upper lip, shorter lower lip
Connected by the Labial commisures (corners) Separated from the cheek by the nasolabial fold Orbicularis oris- muscular foundation of the lips Blood supply: Superior and inferior labial arteries (from the Facial artery) Drained by the facial vein, which communicates with the orbital vein via the angular vein

6 Lips Lymphatic drainage- submandibular and submental lymph nodes
Innervation: upper lip-infraorbital nerve; lower lip- mental nerve

7 Cheeks Lateral boundaries of the oral vestibule
Buccinator- muscular framework, innervated by the facial nerve Buccal fat pad- between the buccinator muscle and masseter Excretory duct of the parotid gland- runs through the buccinator muscle and opens into the mucosa of the cheek opposite the upper second molar

8 Masticator muscles Masseter Temporalis muscle
Medial and Lateral pterygoid muscles Supplied by the mandibular nerve (3rd div of the trigeminal nerve)


10 Teeth Deciduous teeth, permanent teeth
8 per maxilla/ mandible:2 incisors,1 canine, 2 premolars, 3 molars


12 Oral Cavity Anterior and lateral: alveolar ridge and teeth
Superiorly: Hard and soft palate Posteriorly: faucial isthmus

13 Palate Hard palate- palatine process of the maxilla anteriorly, incisive bone, horizontal plates of the palatine bone posteriorly.\ Soft palate- posterior; palatal muscles (tensor veli palatini, levator veli palatini, palatoglossus muscle) Mucosa: contains numerous salivary glands (palatine glands) Sensory innervation (mucosa): Greater and lesser palatine nerves Blood supply: ascending palatine branch of the facial artery

14 Tongue Mylohyoid muscle- muscular foundation
Sublingual folds and sublingual papillae- undersurface of the tongue on both sides of the frenulum Apex, body, base Terminal sulcus-: V-shaped groove which separates the body from the base


16 Tongue Mucosa- numerous papillae (filiform, fungiform, vallate, foliate) Blood supply (tongue and oral floor): Lingual and sublingual artery Drainage: facial vein to the IJV Lymphatic drainage: ipsilat and contralat submandibular and submental LN Motor innervation: Hypoglossal nerve Sensory innervation (terminal sulcus): lingual nerve, (base) glossopharyngeal and superior laryngeal nerve

17 Diseases of the Lips and Oral Cavity

18 Cleft Lip and Palate Epidemiology: 1 in 500, one of the most common malformation Classification: Cleft lip and alveolar ridge Cleft lip, alveolar ridge, and palate and isolated cleft palate Symptoms: hypernasal speech (due to incomplete closure of the nasopharynx), recurrent middle ear effusions and inflammatioons, septal deviations


20 Pathogenesis: developmental anomaly of the embryonic head (genetic, viral infections, placental oxygen deficiency, intrauterine bleeding, exposure to ionizing radiation) Diagnosis should include palaption of the hard palate Tx: surgery

21 Dermoid cyst of the oral floor
Presents with submental swelling, tense bulging of the entire anterior and lateral oral floor DDx: Dysgenetic salivary gland cyst May also involve the tongue and mandible

22 Transverse facial cleft
Failure of the fusion of the maxillary and mandibular processes or failure of the buccal membrane to regress due to fusion of the myoblasts Bilateral extension of the oral fissure Aassociated with facial dysplasia and auricular dystropia

23 Inflammations of the Lips and Oral Cavity
Herpes simplex Virus Usually HSV type 1 MOT: Contact or droplet infection Symptoms: Primary infection- childhood, herpetic gingivostomatitis ( bullae/vesicles on the oral mucosa preceded by fever and lethargy accompanied by regional lymphadenitis) Reactivation- in response to physical exertion, fever, Uv radiation, stress, pregnancy, herpes labialism

24 SOP: Perioral region Dx: History, clinical exam, Tzanck smear Complications: secondary bacterial superinfection by Staphylococcus aureus (Herpes impetiginatus), Exudative Erythema multiforme, Pospischill- Feyrter aphthoid, herpetic meningoenecephalitis Tx: acyclovir

25 Varicella Zoster Virus
Chickenpox(primary), Zoster (reinfection) Symptoms: Chickenpox- papulovesicular lesions esp on the head and trunk. Zoster- segmental distribution associated with neuropathic pain Tx: acyclovir/ famciclovir

26 Herpangina Causes: Group a coxsackie virus, Group B CV, Retrovirus, Echovirus Symptoms: Fever, malaise, headache, muscle pain, bullous eruptions surrounded by red halo on the oral mucosa particularly on the anterior faucial pillars, uvula and palatine tonsils DDx: Gingivostomatitis Tx: Symptomatic

27 Recurrent aphthous stomatitis
Inflammatory shallow ulcers with slightly raised erythematous borders Tx: Symptomatic

28 Oral hairy leukoplakia
Pathognomonic of HIV infection Believed to be caused by EBV Patchy, whitish, slightly raised lesions predominantly on the border of the tongue Painless Tx: topical Vit A and/or podophyllin

29 Oral floor Abscess Usu. originates from the lower molars, mucosal injuries in the oral floor Edematous expansion with a firm erythematous swelling in the submental to submandibular areas Difficulty swallowing and speaking High fever May progress to ARDS or mediastinitis Dx: US, CT to define the extent Tx: Incision and drainage, antibiotic treatment

30 Candidiasis Impaired immune sytem
Whitish, firmly adherent plaques that can be scraped from the mucosa, leaving an erythematous bleeding surface Tx: Nystatin solution or amphotericin B lozenges

31 Lesions of the tongue Hunter’s glossitis- atrophic inflammatory condition of the tongue base, acconpanying feature of PA, s/s: burning of the tongue, dry mouth, altered sense of taste, smooth shiny appearance of the tongue with partial atrophy of the filiform papillae Fissured tongue- numerous furrows on the dorsal surface, maybe a sign of Melkersson-Rosenthal Synd Angioedema- swelling of the face, lips, tongue and laryynx due to a pronounced vascular reaction usu in anaphylactic or anaphylactoid reactions

32 Geographic tongue- areas of desquamation of the filiform papillae on the dorsal surface with occ burning sensation Black hairy tongue- hyperkeratosis of the filiform papillae due to failuure of desquamation of the cornified layers


34 Benign Tumors Epithelial or mesenchymal
Papilloma, pleomorphic adenoma, fibroma, lipoma, rhabdomyomas, leiomyomas, chondromas Tx: surgical

35 Precancerous Lesions Leukoplakia- asymptomatic, associated with denture pressure or alcohol/nicotine abuse, always investigated by biopsy, tx: complete surgical removal Bowen’s disease- chronic inflam disease caused by intraepidermal carcinomam

36 Malignant tumors (Lips)
Squamous cell carcinoma – usually affects the lower lip, associated with pipe smoking and sun exposure Intractable ulcerations in the vermillion border of the lips or large exophytic lesions, tx: surgical removal Basal cell Ca- involves the vermillion border of the lip only by secondary spread

37 Malignant Tumors (Oral cavity)
Squamous cell Ca- smoking and alcohol abuse, presents with painful swallowing, blood tinged saliva, fetid breath odor, or asymptomatic

38 Pharynx

39 Pharynx Tubular, fibromuscular space extending from the skull base to the inlet of the esophagus Consists of: nasopharynx, oropharynx, hypopharynx

40 Nasopharynx Highest part of the pharynx
From the bony skull bbase to an imaginary horizontal line at the level of the velum Communicates with the nasal cavity via the choanae and middle ear via the orifice of the eustachian tube (S) floor of the sphenoid sinus and pharyngeal roof , (P) first cervical vertebra

41 Oropharynx Communicates with oral cavity via the faucial isthmus
Extends inferiorly from the lowest border of the nasopharynx to the upper margin of the epiglottis (A) tongue base, (P) C2, C3, (L) faucial pillars

42 Hypopharynx Lowest segment
From the superior border of the epiglottis to the inf border of the cricoid catilage (P) C3-C6, (A) back of the larynx


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