Dr. Mohamed elfiky

1. Head and Neck
Oral cavity
Professor Dr. Mohamed El Fiky
Professor of anatomy and embryology

2. A. ORALVESTIBULE
Boundaries:
1. Anteriorly by lips
2. Laterally by cheeks
3. Posteriorly and medially by teeth
and gums
B. ORAL CAVITY PROPER
Boundaries:
1. Anteriorly laterally by teeth
and gums
2. Superiorly by the palate
3. Inferiorly by the tongue and
the floor of the mouth
4. Posteriorly by opening into
the pharynx
1- Vestibule
2- mouth cavity proper .
The Mouth
Oral Vestibule
Oral Cavity Proper
The mouth cavity extends from the lips to the oropharyngeal
isthmus. It is composed of 2 main parts
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3. III. FLOOR OF THE MOUTH
Lingual frenulum
(connects the tongue to the
floor of the mouth)
Papillae ( openings of
submandibular duct)
Sublingual fold
(passes lateraly and
backwards from the papilla
and overlies the sublingual
gland)
Sublingual region
Shows the following structures:
Ø Frenulum of the tongue
Ø Sublingual papilla : lies on each side of the frenulum and the submandibular duct opens on it
Ø Sublingual fold : produced by the underlying sublingual salivarygland and the ducts of the gland open on
its summit.
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4. TONGUE
Ø It is composed of a striated muscular mass, covered by mucous membrane.
Ø It is anterior 2/3 (oral part) lies in the floor of the mouth Ø It is posterior 1/3 (pharyngeal part) lies in the
oropharynx
Muscles of the tongue:
Intrinsic muscles:
Ø They consist of longitudinal, transverse & vertical fibers.
Ø Nerve supply : Hypoglossal nerve.
Ø Action: They alter the shape of the tongue.
Extrinsic muscles:
Hyoglossus , genioglossus , styloglossus and palatoglossus.
Nerve supply of the tongue: = Motor:
Ø All the intrinsic & extrinsic muscles of the tongue are
supplied by the hypoglossal nerve EXCEPT the
palatoglossus which is supplied by the cranial root of
accessory nerve through the pharyngeal plexus ( vago-
accessory complex ).
= Sensory:
Ø Anterior 2/3:
- Lingual nerve (general sensation)
- Chorda tympani (taste sensation)
Ø Posterior 1/3 : Glossopharyngeal nerve : (general & taste)
Ø Root: Vagus nerve, through the internal laryngeal nerve.
Blood supply of the tongue:
Ø Lingual artery
Ø Tonsillar branch of facial artery
Ø Ascending pharyngeal artery Mohamed el fiky

5. PALATE
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Hard palate
Soft palate

6. PALATE
Ø It forms the roof of the mouth and floor of the nasal
cavity.
Ø It is divided into : hard (anterior 2/3) & soft (posterior 1/3)
Hard palate
Ø It is the bony portion which is formed by the palatine process of the maxillae and the horizontal
plates of the palatine bone.
Soft palate
Ø A mobile fold attached to posterior border of hard palate
Ø It is formed of the palatine aponeurosis and muscles.
Muscles of the soft palate:
= Tensor palati:
Ø Origin : scaphoid fossa , spine of sphenoid and
lateral surface of the cartilaginous part of auditory tube.
Ø Insertion : palatine aponeurosis and palatine crest.
Ø Nerve supply : nerve to medial pterygoid
Ø Action : the 2 muscles tighten the soft palate.
Levator veli palatini:
Ø origin : lower part of the auditory tube and lower
surface of the petrous bone.
Ø Insertion : into the palatine aponeurosis.
Ø Nerve supply : pharyngeal plexus.
Action : elevates the soft palate.
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7. Palatoglossus:
Origin: platine aponeurosis.
Insertion : into the side of the tongue.
Nerve supply : pharyngeal plexus .
Action : pulls the root of the tongue upwards.
= Palatopharyngeus:
Origin : palatine aponeurosis.
Insertion : posterior border of thyroid cartilage . Nerve suppy : pharyngeal plexus.
Action : elevates the wall of the pharynx.
= Musculus uvulae :
Origin : posterior border of hard palate .
Insertion: mucous membrane of uvula.
Nerve supply : pharyngeal plexus.
Action : elevates the uvula.
Blood supply of the palate
Ø Greater palatine , lesser palatine and sphenopalatine arteries (from maxillary artery).
Ø Ascending palatine artery (from facial artery)
Ø Ascending pharyngeal artery .
Nerve supply of the palate:
= Sensory
Ø Glossopharyngeal nerve.
Ø Greater & lesser palatine nerves.
Ø Middle palatine nerve.
Ø Sphenopalatine nerve.
= Motor:
· All the muscles of the soft palate are supplied by the cranial part of
the accessory nerve through the pharyngeal plexus EXCEPT the tensor palati which is supplied by the
mandibular nerve.
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8. Soft Palate
Muscles of Soft Palate
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9. PHARYNX
Ø It is a funnel shaped fibro-muscular tube of about 13 cm . length
Ø It extends form the base of the skull to the level of the 6th cervical vertebrae.
Ø Its anterior wall is deficient and lies behind the cavities of the nose, mouth and larynx
Ø Accordingly it is divided into 3 parts: Nasopharynx , oropharynx & laryngeopharynx .
a)Base of skull
(basioociput and basi
sphenoid) àsoft palate
b)Plane of hard palate
àhyoid bone
c) Hyoid boneà lower
border of cricoid
cartilage
Nasopharynx
Oropharynxx
Larygeopharynx
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10. WALLS OF THE PHARYNX
Consists of the following from within outwards:
1. Mucous coat lined by stratified squamous epithelium.
2. Inner fibrous coat (pharyngo-basilar fascia).
3. Muscular coat.
4. Outer fibrous coat (buccopharyngeal fascia).
Muscles of the pharynx
Ø Outer circular layer:
3 constrictors of the pharynx.
Ø Inner longitudinal layer:
3 longitudinal muscles.
Sup.constrictor
mid.constrictor
inf.constrictor
Constrictors of the pharynx.
1- Sup.constrictor
2- mid.constrictor
3- inf.constrictor
longitudinal muscles.
1- Stylo-pharyngeus
2- Salpingo – pharyngeus
N.B. All muscles of pharynx take nerve supply from pharyngeal plexus except stylopharyngeus
from glossopharyngeal nerve
3-Palato-pharyngeus:
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11. Pharyngeal Muscles
Stylopharyngeus
• O:medial aspect
of styloid
process
• Gap between
middle and
superior
constrictor
• NS:
glossopharyngea
l
Palatopharyngeus
• O: upper surface
of palatine
aponeurosis as 2
fasiculi
• Moves along
inner aspect of
the constrictor
• NS: pharyngael
plexus
Salpingopharyngeus
• O: cartilage of
the auditory tube
near the
pharyngeal
opening of it.
LONGITUDINAL MUSCLES
All the 3 are inserted as a conjoint sheet at the post
border of thyroid cartilage and lat aspect of epiglottis
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12. Pharyngeal Muscles
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13. Trachea Oesophagus
Digastric (posterior
belly) cut
Middle constrictor
Stylohyoid ligament
Stylohyoid
Recurrent laryngeal nerve
Stylopharyngeus
Glossopharyngeal nerve
Thyropharyngeus
Cricopharyngeus
Pterygomandibular
raphe
Buccinator
Pharyngotympanic tube
Superior constrictor
Tensor veli palatini
Mandibular nerve
Levator veli palatini
Middle meningeal
artery
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14. Pharyngeal Muscles
Pharyngobasilar fascia
Styloid process
Attachment of
pharyngeal raphe to
pharyngeal tubercle (occipital bone)
Tensor veli palatini
Levator veli palatini
Stylohyoid (cut)
Stylopharyngeus
Styloglossus
Fibres of middle
constrictor from
stylohyoid ligament
Stylohyoid (cut)
Pharyngeal raphe
Greater cornu
of hyoid bone
Inferior constrictor
(cricopharyngeus)
Inferior constrictor
(thyropharyngeus)
Middle
constrictor
Superior
constrictor
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15. Lies in wall of nasopharynx and oropharynx
Wide origin
• Post border of med pterygoid plate &pterygoid
hamulus
• Pterygomandibular raphae
• Post end of mylohyoid line
• Mucus membrane on side of tongue
Lower part covered by middle constrictor.
Superior Constrictor
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16. Middle Constrictor
• Hypopharynx
• O: lower part of stylohyoid ligament
lesser and greater cornu of hyoid
• Inferiorly overlapped by inferior constrictor.
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17. Inferior Constrictor
Thickest of the 3
Thyropharyngeus
O:oblique line of thyroid cartilage
inferior cornu of thyroid
Cricopharyngeus
O: ant part of cricoid cartilage between
attachment of cricothyroid and
articulation of inferior cornu .
*************************************
qInsertion :All of the fibres get inserted
into
the median fibrous raphae Extending
from
Pharyngeal tubercle up to the
oesophagus
qActions 0f the constrictor muscles :
Muscles of 2 sides act as a sphincter
Function– prevent the entry of air in
to the oesophagus in the interval
between swallowing So sphincter
relaxes during swallowing Contracts
between the acts of swallowing.Mohamed el fiky

18. Killian’s Dehiscence
• Potential gap b/w weak area of pharyngeal wall
• Gateway of Tear à perforation can occur at this
site during oesophagostomy.
Killian’s triangle
Laimer’s triangle
Inferior constrictor
(cricopharyngeal part)
Inferior constrictor
(thyropharyngeal part)
Fundiform part (cricopharyngeal sphincter,
Killian’s sling)
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19. PHARYNGEAL SPACES
• 2 potential spaces in relation to pharynx:
• Retropharyngeal space:
– Situated behind pharynx
– Extends from base of skull to the bifurcation of
trachea
• Parapharyngeal space:
– Situated on the side of pharynx
– Contains carotid vessels, jugular veins, last four
cranial nerves & cervical sympathetic chain
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20. Pharyngeal Plexus of Nerves
• Almost all of the nerve supply to the pharynx, whether motor
or sensory, is derived from the pharyngeal plexus
• Formed by the pharyngeal branches of the glossopharyngeal
(sensory )and vagus nerves (motor) with contributions
from the superior cervical sympathetic ganglion.
all the muscles of the pharynx take nerve supply from The
pharyngeal branch of the vagus except stylopharyngeus ,
which is supplied by the glossopharyngeal nerve
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21. Passavant’s Ridge
• A mucosal ridge raised by fibres of
palatopharyngeus.
• Forms a ring around post and lat walls of
nasopharyngeal isthmus.
• When soft palate is elevated the muscle band
appear as a ridge àPassavant’s ridge
• During act of swallowing palate and the ridge
approximated.
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22. Gaps in the pharyngeal wall
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23. RELATIONS (GAPS IN LATERAL WALL OF PHARYNX)
I-first gap : ( Above superior constrictor Between Base of the skull and Upper border
of the superior constrictor ) . It occupied by :
- Auditory tube.
- Levator palati muscle.
II-second gap : Between : Lower border of the superior constrictor &Upper border of the
middle constrictor. . It occupied by :
- Stylopharyngeus muscle.
-Glossopharyngeal nerve.
III-third gap : Lower border of the middle constrictor& Upper border of the inferior constrictor
It occupied by :
- Internal laryngeal nerve .
- Superior laryngeal artery.
IV-fourth gap :Below lower border of the inferior constrictorIt occupied by :
- Recurrent laryngeal nerve.
- Inferior laryngeal artery.
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24. Nasopharynxx
it shows the following features:
Ø Opening of auditory tube .
Ø Tubal elevation : it is the elevation formed by the upper and posterior
margins of the opening of the auditory tube.
Ø Pharyngeal recess: is a depression in the pharyngeal wall behind the
tubal elevation
Ø Salpingopharyngeal fold:
§ It is a vertical fold of mucous membrane which runs downwards from the tubal elevation to the side wall of pharynx.
§ It contains the salpingopharyneus muscle. Tubal tonsils: collections of lymph tissue near the tubal opening.
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25. Oropharynxx
It lies behind the oral cavity : extends from the soft palate above to the upper border of epiglottis below.
Palatine tonsil
Ø A large ovoid mass of lymphoid tissue
Ø It looks like a large almond.
Ø It has :
§ 2 poles : upper & lower
§ 2 borders : anterior & posterior
§ 2 surfaces : medial & lateral
Ø It has 12-15 tonsillar crypts which open on its medial surface
q Position :
Located in the tonsillar fossa on the lateral wall of oropharynx Ø The tonsillar fossa is bounded by :
§ Anteriorly : the palatoglossal arch
§ Posteriorly : the palatopharyngeal arch
Relations :
Medial surface
Ø Covered by the mucous membrane
Ø Tonsillar pits are small orifices on the medial surface which lead into the tonsillar crypts.
Latcral surface
¡ Capsule :
Ø Separates the tonsil from the superior constrictor of pharynx. Superior constrictor:Ø Separates the tonsil from:
1- The facial artery and its branches:
2- Para-tonsillar vein:
3- Glossopharyngeal nerve: Mohamed el fiky

26. Blood supply of the tonsil:
Arteries :
Ø Tonsillar branches of descending palatine artery
Ø Tonsillar branch of the facial artery.
Ø Tonsillar branches of ascending palatine artery. Ø Tonsillar branches of dorsal lingual artery.
.
= Veins :
Ø Pharyngeal plexus of veins receives most of the veins.
Ø Some veins drain into the lingual vein
Sensory nerve supply : lesser palatine (maxillary) and
glossopharyngeal nerve.
r Lymphatic srainage of the tonsil: Ø The deep cervical lymph nodes.
Waldeyer’s ring : is a tonsilar ring at the oropharyngeal isthmus , formed of linguinal , palatine ,
tubal and pharyngeal tonsils .
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27. Waldeyer’s Ring
q The palatine tonsils,
nasopharyngeal tonsil (adenoid)
and lingual tonsil constitute the
major part of Waldeyer's ring or
nasal-associated lymphoid tissue
(NALT), with the tubal tonsils and
lateral pharyngeal bands as less
prominent component
q A ring composed of NALT at
beginning of food and air passage.
q Produce B and T lymphocytes
q Local defense
q Also produce lymphocytes to send
to other lymph nodes.
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