1
Q
lymphatic system function
A
- drainage of surplus tissue fluid and leaked plasma proteins to the bloodstream
- removal of debris from cellular decomposition
- production of immune cells
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2
Q
lymph nodes are important for indicating…
and can also spread
A
- infection
- swollen if they are active
- can also spread infection or facilitate spread of malignancy
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3
Q
where is most lypmh returned to body and what is the exception
A
- through thoracic duct on left venous angle
- exception of right upper limb, right side of head and neck and thorax
- exceptions drain into right lypmphatic duct
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4
Q
5 groups of superficial nodes of the head
and approx how many of each group
A
- posterior auricular LN (1-3)
- anterior auricular LN (1-3)
- occipital LN (1-3)
- facial LN (up to 12)
- superficial parotid LN (10)
- nodes are paired
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5
Q
describe healthy lymph nodes
A
- small
- soft
- mobile
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6
Q
describe lymph nodes indicating pathology
A
- hardened
- enlarged
- can be palpated
- can be tender to touch
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7
Q
what does the posterior auricular, anterior auricular and superficial parotid lymph nodes drain
where do these nodes empty
A
- external ear
- lacrimal gland
- adjacent regions of the scalp and face
- drain into superior deep cervical nodes
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8
Q
what does occipital lymph node drain
where does it empty
A
- drains scalp of that region
- drains into inferior deep cervical nodes
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9
Q
what do facial lymph nodes drain/location of LN/names of sub-groups
A
- located along the facial vein
- 4 subgroups- infraorbital, nasolabial, buccal, mandibular
- drains skin and mucous membrane where nodes located
- all drain into superior deep cervical LN
- infections of teeth may spread to facial nodes
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10
Q
deep lymph nodes of the head
A
- cannot be palpated
- deep parotid nodes drain middle ear, auditory tube and parotid gland
- retropharyngeal nodes drain pharynx and paranasal sinuses and nasal cavity
- drain into deep cervical nodes
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11
Q
4 main groups of superficial cervical lymph nodes/paired on unpaired/approx how many of each group
A
- submental (2-3) and unpaired (bilateral drainage)
- submandibular (3-6) and paired
- external jugular
- anterior jugular
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12
Q
submental lymph nodes drain/then drain to
what can swelling of these nodes indicate
A
- drain lower lip, both sides of chin, FOM, apex of tongue and mandibular incisors/their periodontium/gingivae
- drain either directly into deep cervical nodes or via submandibular nodes
- swelling can indicate epstein-barr virus (member of herpes virus family and can cause glandular fever)
- swelling can also indicate toxoplasmosis or dental infection
- spread of cancer from these areas may occur via nodes
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13
Q
submandibular lymph nodes drain/then drain to
what can swelling of these nodes indicate
A
- unilaterally drain cheeks, upper lip, body of tongue, anterior hard palate and most of teeth/periodontium/gingivae (except mand incisors and max 3rd molars)
- most common cause of enlargement is infection from head and neck, sinuses, ears, eyes, scalp, pharynx
- may be involved in spread of cancers from oral cavity, anterior nasal cavity, soft tissue of midface and submanduibular salivary gland
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14
Q
deep cervical lymph nodes number/location
A
- spprox 15-30
- drain all nodes from head
- located along length of IJV, deep to SCM
- divides into superior and inferior deep cervical nodes based on position of omohyoid which crosses IJV
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15
Q
superior deep cervical nodes drain/clinical application
A
- drain post nasal cavity, post hard palate, soft palate, base of tongue, maxillary 3rd molars/periodontium/gingivae, TMJ, esophagus, trachea and thyroid gland
- tongue lymph drainage is bilateral so pathology may appear on lymph nodes of either side of neck
- jugular digastric node drains palatie tonsils so can be enlarged if tonsils and associated nodes are active in immune response
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16
Q
inferior deep cervical nodes drain/clinical application
A
- prominent palpable node is jugulo-omohyoid LN
- this node drains lymph from tongue and submental triangle
- enlargement may be a sign of pathology of the tongue such as carcinoma
- inferior deep cervical nodes communicate with axilary LN that drain breast region so they are at greater risk for involving the spread of breast cancer or adenocarcinoma
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17
Q
main deep cervial lymph nodes
A
- jugulodigastric
- jugulo-omohyoid
- acessory
- supraclavicular
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18
Q
accessory and supraclavicular LN drain/clinical importance
A
- drain lateral triangles of the neck
- very close to thoracic duct so at risk for involving the spread of cancers, especially those arising from lungs, esophagus and stomach
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19
Q
clinical importance of lymphatic system
difference between infection and cancer
A
- enlarged LN may indicate current or past pathology or immune activity
- can point to systemic (eg lymphoma) or local disease
- inflammation/infection = swollen, tender nodes
- malignancy = hard, painless LN
- area of lymph drainage indicates potential location of disease or malignancy
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20
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A
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21
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22
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23
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24
Q
Oral cavity boundaries
A
- roof = hard and soft palates
- floor = soft tissues, tongue, mylohyoid
- lateral walls = cheeks
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25
Q
Dental arches separate
A
Oral cavity into oral vestibule and oral cavity proper
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26
Q
Anteriorly to the Oral cavity
A
Oral fissure created by the lips
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27
Q
Posterior to the oral cavity
A
Oropharynx
Accessed through the oropharyngeal isthmus
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28
Q
Lips composed of/vestigial feature/cut causes
A
Composed of soft tissue and lined externally by skin and internally by oral mucosa
Orbicularis oris main muscle component- acts as sphincter for oral fissure
Buccinator and other lip muscles also involved in altering shape and size
Vestigial feature = the Philtrum above upper lip
Cut causes bleed from both sides as arteries anastomose across midline
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29
Q
Sensory innervation/blood supply/lymphoma drainage of the lip
A
Sensory innervation via CNV2 (superior labial branches of infraorbital nerve ) and CNV3 (inferior labial branch of mental nerve)
Blood supply from superior and inferior labial arteries- branches of CNVII
Lymph drainage primarily via submandibular lymph nodes apart from medial part of lower lip draining to submental LN
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30
Q
Cheeks composed of/innervation/blood supply
A
Composed of muscle and fascia lined superficially with skin and deep with oral mucosa
Main muscle component is buccinator
Sensory innervation from buccaneers branches of CNV3
Buccinator innervation by CNVII
blood supply via buccal branches of maxillary artery
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31
Q
Key features of the oral vestibule
A
Upper labial frenulum
Lower labial frenulum
Upper and lower buccal frenulum
All are mucosal folds
Also papilla of parotid duct
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32
Q
Floor of mouth formed by
A
Muscular diaphragm created by the paired mylohyoid muscles
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33
Q
Mylohyoid attachments
A
Mylohyoid line of mandible
Body of hyoid
Two mylohyoid muscles attach in the mid,one to the mylohyoid Raphe
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34
Q
geniohyoid attachments
A
Inferior mental spine of mandible
Body of the hyoid
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35
Q
What forms the anterior wall of the oropharynx
A
Posterior 1/3 of the tongue
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36
Q
What separates anterior and posterior parts of the tongue
A
Terminal sulcus
V shapes groove on dorsum of tongue
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37
Q
Root vs body vs apex of tongue
A
Root is the post portion attached to other structures such as mandible, hyoid
Body is anterior 2/3 between root and apex
Apex is tip of the tongue
Body and apex extremely mobile to allow articulation and movement of food into oropharynx
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38
Q
Types of papillae on tongue
A
Fungiform
Foliate
Vallate
Filiform
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39
Q
Fungiform papillae
A
Mushroom shaped papillae on tongue
Most numerous at apex and margins of tongue
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40
Q
Foliate papillae
A
Folds on mucosa lining of tongue both posteriorly and laterally on superior surface of tongue
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41
Q
Vallate papillae
A
Largest papillae of tongue
Arranged in v shape anterior to terminal sulcus
Surrounded by trenches which have taste buds in walls and ducts for serious glands
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42
Q
Filiform papillae
A
Only papillae of tongue that do not have any tastebuds
Contain nerve endings sensitive to touch
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43
Q
Lymphoid nodules on tongue
A
On posterior part of tongue no lingual papillae but instead lymphoid nodules
Gives the tongue cobblestone appearance
Known collectively as lingual tonsils
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44
Q
Tongue inferior surface key features
A
Does not have any papillae
Frenulum marking midline
Lingual vein
Sublingual folds
Sublingual caruncle- opening of submandibular duct
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45
Q
Muscles of the tongue
A
Extrinsic muscles: palatoglossus, styloglossus, hyoglossus, genioglossus
Intrinsic muscles: super longitudinal, inferior longitudinal, vertical, transverse
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46
Q
General Function of tongue muscles
A
Intrinsic muscles change the size and shape of the tongue
Extrinsic muscles responsible for protruding, retracting, elevating and depressing the tongue
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47
Q
Genioglossus originates/attaches/function and clinical problem
A
Originates from superior mental spine of mandible
Attach to hyoid bone and also blend with intrinsic muscle fibres
Function is to protrude the tongue
When not working falls posteriorly and obstructs airway which happens during GA so airway inserted
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48
Q
Hyoglossus originates/attaches/function
A
Originates from greater horn of hyoid
Blends with intrinsic muscles on lateral aspect of tongue
Depresses side of tongue
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49
Q
Where do lingual artery, lingual nerve and hypoglossal nerve run in relation to tongue muscles
A
Lingual artery enters between hyoglossus and genioglossus
Hypoglossal and lingual nerves enter the tongue on the external surface of the hyoglossus
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50
Q
Styloglossus originates/attaches/function
A
Originates from styloid process of temporal bone
Fibres blend with intrinsic muscles of tongue and superior fibres of hyoglossus
Elevates and retracts tongue
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51
Q
Palatoglossus originates/attaches/function
A
Originates from palatine aponeurosus - on posterior border of hard palate
Fibres blend with intrinsic muscles on the lateral surface of the tongue
Elevate post portion of tongue
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52
Q
Tongue innervation motor/general sensation/special sensation (taste)
A
Motor- all supplied by hypoglossal nerve CNVXII except palatoglossus which supplied by vagus nerve
General sensation- anterior 2/3 by CNV3, posterior 1/3 by CNIX
Special sensation - anterior 2/3 by chorda tympani CNVII, posterior 1/3 by CNIX
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53
Q
Tongue blood supply
A
Lingual artery from external carotid is major arterial supply
Deep lingual and dorsal lingual veins drain the tongue - drain to IJV
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54
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55
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56
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57
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58
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59
Q
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60
Q
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61
Q
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62
Q
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63
Q
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64
Q
submandibular gland location/secretion/duct
Study These Flashcards
A
- located in submandibular fossa on mandible
- partly superficial and partly deep to mylohyoid (wraps around mylohyoid)
- deep part lies in floor of the oral cavity next to root of tongue
- mixed serous and mucus secretions
- duct approx 5cm between mylohyoid and hyoglossus
65
Q
submandibular gland nerve association, blood supply and lymph drainage
Study These Flashcards
A
- lingual nerve from CNV3 loops under duct before opening into oral cavity
- submental artery (branch facial artery) supplies gland
- submental vein drains
- lymphatic vessels in gland end in deep cervical lymh nodes (particularly jugulo-omohyoid node)
66
Q
what covers submandibular gland
Study These Flashcards
A
- fascial capsule
- continuous with the deep investing cervical fascia
67
Q
submandibular duct
where it opens
Study These Flashcards
A
- opens into 3 orifices in the ora cavity
- besides base of frenulum (besides sublingual caruncles)
- openings are visible and saliva can be sen coming from them while yawning
68
Q
sublingual gland location/secretion/duct
Study These Flashcards
A
- almond shaped and lies in floor of mouth between mandible and hyoglossus
- sits in sublingual fossa of mandible
- lateral to submandibular duct and lingual nerve
- mostly mucous secretions, some serous
- duct open into floor of mouth along sublingual folds
69
Q
sublingual gland blood supply
Study These Flashcards
A
- sublingual artery - branch of lingual artery
- submental artery - branch of facial artery
- venous drainage via submental veins to lingual and facial veins
70
Q
sublingual duct location
Study These Flashcards
A
- numerous and drain into oral cavity via openings into crest of sublingual fold
- sublingual folds overlay the sublingual glands and extend to frenulum of tongue
- can sometimes empty with submandibular duct and sublingual caruncle
71
Q
submandibular and sublingual glands sympathetic innervation
Study These Flashcards
A
- derived from superior cervical ganglia and nerve plexus on external carotid artery
- results mainly in vasoconstriction and reduction in volume of saliva
- leads to dry mouth
72
Q
submandibular and sublingual glands parasympathetic innervation
Study These Flashcards
A
- secretomotor innervation to produce saliva
- chorda tympani nerve CNVII - preganglionic parasympathetic fibres travel to submandibular ganglion via the lingual nerve
- postganglionic parasympathetic fibres travel to glands either via lingual nerve OR travel directly to glands not in a nerve
73
Q
minor salivary glands and what are they susceptible to
Study These Flashcards
A
- found embedded in submucosa of oral cavity
- buccal
- palatine
- lingual (tongue)
- labial
- glands are susceptible to mucoceles
74
Q
mucocele
Study These Flashcards
A
- salivary gland cyst
- contains mucous content
- usually arises from minor salivary glands
- occur due to trauma to SG or SG duct blockage
75
Q
minor salivary gland parasympathetic innervation
palatine gland
Study These Flashcards
A
- preganglionic parasymp fibres travel to pterygopalatine ganglion via greater petrosal nerve (CNVII)
- postganglionic fibres travel to palate via palatine nerves
76
Q
minor salivary gland parasympathetic innervation
buccal, lingual and labial glands
Study These Flashcards
A
- same as submandibular and sublingual SG innervation
- preganglionic parasympathetic fibres travel to submandibular ganglion from chorda tympani and via the lingual nerve
- postganglionic fibres travel to gland either via lingual nerve or travel directly to the glands not in a nerve
77
Q
possible pathologies of SG/ducts
Study These Flashcards
A
- mumps
- salivary stone/calculi (sialolithiasis)
- mucoceles
- excessive salivation (ptyalism)
78
Q
mumps
Study These Flashcards
A
- viral infection
- presents in children as painful swelling over SG
- most commonly over parotid gland
- MMR vaccine
- supportive treatment to relieve pain
- can spread to other parts of the body (viral meningitis)
79
Q
salivary stones/calculi presentation and tx
Study These Flashcards
A
- pain, swelling and lack of salivation
- tend to be common in submandibular duct due to its upward course into the oral cavity
- best treated with surgical resection - care to avoid lingual nerve and other surrounding nerves
- also called sialolithiasis
80
Q
ptyalism
Study These Flashcards
A
- excessive salivation
- commonly occurs prior to vomiting
- can also be associated with several disease processes/pathologies
81
Q
mylohyoid origin/insertion/action//innervation
Study These Flashcards
A
- originates at mylohyoid line on mandible
- inserts into body of hyoid and fibres of opposite mylohyoid
- elevates hyoid and floor of mouth, reinforces floor of oral cavity
- innervated by nerve to mylohyoid (branch of CNV3)
82
Q
digastric origin/insertion/action//innervation
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A
- anterior belly originates at digastric fossa of lower medial aspect of mandible
- posterior belly originates from mastoid notch on medial side of mastoid
- both insert at intermediate tendone which attaches to hyoid via fascial sling
- anterior belly raises hyoid and opens mouth by lowering mandible
- posterior belly elevates and retracts hyoid
- anterior belly innervated by nerve to mylohyoid CNV3
- posterior belly innervated by digastric branch of CNVII
83
Q
stylohyoid origin/insertion/action//innervation
Study These Flashcards
A
- originates at styloid process
- inserts into body of hyoid
- pulls hyoid bone upward
- innervation via CNVII
84
Q
geniohyoid origin/insertion/action//innervation
Study These Flashcards
A
- originates from inferior mental spine of mandible
- inserts at body of hyoid
- when mandible fixed it elevates and pulls hyoid forward
- when hyoid fixed it pulls mandible downward and inward
- innervation via anterior ramus of C1 (travels with CNXII)
85
Q
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86
Q
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87
Q
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88
Q
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89
Q
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90
Q
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91
Q
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92
Q
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93
Q
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94
Q
what is the pharynx
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A
- tube of fibrous and muscular tissue
- lies posterior to nasal cavity, oral cavity and larynx
95
Q
what are oral cavity fauces
Study These Flashcards
A
- regarded usually part of oropharynx
- extend between palatoglossal and palatopharyngeal arches
- to base of tongue inferiorly and soft palate superiorly
96
Q
nasopharynx boundaries and lined with
Study These Flashcards
A
- extends from posterior border of nasal septum to soft palate
- lined with respiratory epithelium (ciliated columnar)
97
Q
what is opening of auditory tube called
clinical relevance
Study These Flashcards
A
- pharyngotympanic tube
- eustachian tube
- goes to the middle ear from nasopharynx
- connection between nasopharynx and middle ear so sometimes ear infections secondary to upper respiratory infections
98
Q
auditory/pharyngotympanic tube constituents
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A
- partly bone cartilagenous
- cartlagenous end is covered by mucosa and called the torus tubarius or torus of auditory tube
- also collection of lymphoid tissue in the area called the tubal tonsil
99
Q
auditory/pharyngotympanic tube constituents
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A
- partly bone cartilagenous
- cartlagenous end is covered by mucosa and called the torus tubarius or torus of auditory tube
- also collection of lymphoid tissue in the area called the tubal tonsil
100
Q
salpingopharyngeal fold
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A
- vertical fold of mucous membrane in nasopharynx
- covers the salpingopharyngeal muscle
101
Q
oropharynx boundaries and lining
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A
- soft palate superiorly
- base of tongue and superior border of epiglottis inferiorly
- palatoglossal and palatopharyngeal arches laterally
- lined with stratified squamous epithelium (same as oral cavity)
102
Q
pharyngeal isthmus formed by
Study These Flashcards
A
- posterior border of soft palate
- forms anterior margin of pharyngeal isthmus
- where nasopharynx and oropharynx communicate
103
Q
oropharynx main structures
Study These Flashcards
A
- posterior 1/3 tongue and lingual tonsils
- vallate papillae
- palatoglossal and palatopharyngeal arches
- tonsilar fossa where palatine tonsils sit
- epiglottis
104
Q
what is the epiglottis and vallecula
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A
- epiglottis is piece of elastic cartilage covered with mucosa and closes off the larynx during swallowing so food doesnt go in airway
- vallecula is valley between posterior end of tongue and epiglottis and one of the areas where food might get stuck (fishbones etc)
105
Q
laryngopharynx boundaries and lining
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A
- superior border or epiglottis superiorly
- inferior border of cricoid cartilage inferiorly
- continuous with oesophagus
- lined with stratified squamous epithelium (same as oral cavity) non keratinised
106
Q
layngopharynx posterior/lateral and internal walls formed by
Study These Flashcards
A
- posterior and lateral walls are formed by middle and inferior pharyngeal constrictor muscles
- internally wall formed by palatopharyngeus and stylopharyngeus muscles
107
Q
how does laryngopharynx communicate with larynx
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A
- through the laryngeal inlet
- on its anterior wall
108
Q
tonsils and types/location
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A
- lymphoid tissue forming waldeyers tonsillar ring
- pharyngeal tonsils in nasopharynx
- tubal tonsils around pharyngotympanic tube opening in nasopharynx
- palatine tonsils in isthmus of fauces of oropharynx
- lingual tonsils on posterior third of tongue
109
Q
tonsils function
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A
- immune function
- protect the airways from external bacteria
- lymphocytes and immune system recognises cells and microorganisms that gets trapped in the crypts of the lymphoid tissue to start immune response
110
Q
pharynx fascia and muscles overview
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A
- pharyngobasilar fascia is a stiff layer which holds nasopharynx open
- 3 pharyngeal constrictor muscles (superior, middle and inferior) which move food to oesophagus during swallowing
- 3 pharyngeal elevators lift the pharynx to recieve food bolus from the oral cavity
111
Q
pharyngeal constrictors name/function/nerve supply
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- superior, middle and posterior
- inferior pharyngeal constrictor forms a sphincter (cricopharyngeus) around the upper oesophagus which prevents air being drawn into stomach during inhalation
- when contracting sequentially they force the food bolus towards the oesophagus
- all supplied by vagus nerve via pharyngeal plexus
112
Q
pharyngeal elevators name/function/nerve supply
palatopharyngeus
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- descends from skulls to inner surface of pharynx
- elevates the pharynx and larynx
- draws the soft palate downwards
- supplied by vagus nerve
113
Q
pharyngeal elevators name/function/nerve supply
stylopharyngeus
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- originates from styloid process
- elevates pharynx and larynx
- only pharyngeal muscle supplied by glosopharyngeal nerve (CNIX)
114
Q
pharyngeal elevators name/function/nerve supply
salpingopharyngeus
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- originates from auditory tube
- elevates pharynx and the larynx
- helps open the auditory tube during swallowing from pressure equalisation in the middle ear
- supplied by vagus nerve
115
Q
swallowing
oral phase description
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- food bolus formed in oral cavity by chewing and coordinated tongue movements to prevent tongue biting
- food bolus pushed into oropharynx by tongue and pressed against palate
- voluntary phase
116
Q
swallowing
pharyngeal phase description
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- involuntary phase
- superior constrictor contraction and soft palate elevation
- pharyngeal elevation to recieve food bolus (elevators)
- food bolush pushed towards oesophagus (pharyngeal constrictors)
- epiglottis closes laryngeal inlet protecting the airway
117
Q
swallowing
oesophageal phase description
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- as inferior oesophageal constrictor contracts the upper oesophageal sphincter relaxes allowing food bolus into oesophagus
- peristaltic movements move food bolus towards the stomach
118
Q
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120
Q
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121
Q
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122
Q
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123
Q
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124
Q
hard palate formed by
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- anterior 3/4 formed by palatine process of maxilla
- post 1/4 by horizontal process of palatine bones
- and overlying mucosa
125
Q
describe mucosa of the hard palate
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- has palatine rugae thought to help tongue with movement of food
- anterior to rugae is incisive papilla which overlies incisie fossa
126
Q
what is incisive fossa
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- opening of incisive canals
- nasopalatine nerve and greater palatine artery pass
127
Q
greater palatine nerve and vessels emerge from
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- greater palatine foramen
- greater palatine artery passes into incisive fossa
- lesser palatine structures through lesser palatine foramen
128
Q
why LA of hard palate is painful
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mucosa of hard palate is tightly bound to bone
129
Q
soft palate anterior part strengthened by
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- palatine aponeurosis
- which attaches to edge of hard palate
- between pterygoid hamuli on either side
130
Q
describe soft palate during swallowing
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- initially tensed to allow tongue to press against it and squeeze bolus
- then elevated posteriorly and superiorly against pharynx to prevent food entering nasal cavity
131
Q
muscles of the soft palate
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- levator veli palatini
- tensor veli palatini
- palatopharyngeus
- palatoglossus
132
Q
levator veli palatini origin/insertion/action/innervation
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A
- origin is pharyngotympanic tube and temporal bone
- inserts onto palatine aponeurosis
- lifts palate up for example during yawning or swallowing
- motor supplied by vagus nerve
133
Q
tensor veli palatini
origin/insertion/action/innervation
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A
- origin is spine of sphenoid and pharyngotympanic tube
- inserts onto palatine aponeurosis
- tenses soft palate and supports levator in its action
- also opens auditory tube during yawning or swallowin to facilitate pressure change between ear and outside
- only SP muscle to be supplied by mandibular nerve CNV3
134
Q
palatopharyngeus origin/insertion/action/innervation
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A
- origin is hard palate and palatine aponeurosis
- inserts onto lateral wall of pharynx
- tesnes soft palate and closes off nasopharynx from oropharynx
- innervated by vagus nerve
135
Q
blood supply of palate
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A
- greater and lesser palatine artery which are branches of maxillary artery from external carotid
- greater supplies hard palate whilst lesser supplies soft palate
136
Q
general sensation supply of palate
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A
- originates from maxillary nerve CNV2
- lesser palatine nerve supplies soft palate
- greater palatine nerve supplies hard palate and gingiva to the first premolar
- nasopalatine nerve supplies anterior gingiva and mucosa
137
Q
arches of the oral cavity and space between
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A
- palatoglossus and palatopharyngeus muscles or soft palate form arches
- palatoglossal arch is post boundary of oral cavity
- between two arches is isthmus of the fauces where tonsillar fossa found and palatine tonsils sit
138
Q
what is uvula
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- soft tissue projection
- posteriorly in oral cavity
- helps to create a seal when swallowing to prevent food and liquid entering nasopharynx
139
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