بسم الله الرحمن الرحيم ” و فى أنفسكم أفلا تبصرون“

Anatomy of Ingestion Anatomy of Ingestion By Dr.Wael Elsaed By Dr.Wael Elsaed

Mouth cavity

Oral mucosa:  Masticatory Formed of keratinized st. sq. epithelium. Found in dorsum of tongue, hard palate and gingiva.  Lining Formed of nonkeratinized st. sq. epithelium. Found buccal, labial and alveolar.  Specialized On the dorsum of the tongue. It has taste buds and lingual papillae. Mouth cavity

Vestibule:  It is the space which lies between lips and cheeks externally and teeth and gums internally.  It receives the ducts of the parotid glands (opposite the upper 2 nd molar teeth). Mouth cavity

Mouth cavity proper:  It is the space which is surrounded by the alveolar arches, teeth and gums. roof  Its roof is formed of the hard palate (anteriorly) and the soft palate (posteriorly).

Mouth cavity proper:  It is the space which is surrounded by the alveolar arches, teeth and gums. roof  Its roof is formed of the hard palate (anteriorly) and the soft palate (posteriorly). Mouth cavity

Roof

Muscles of the palate  Tensor palati.  Levator palati.  Palatoglossus.  Palatopharyngeus.  Musculus uvulae. Levator palati Palatopharyngeus Tensor palati Musculus uvulae Palatoglossus Roof

 The incisive papilla is a projection on the palate near the incisors.palateincisors  The palatal rugae are irregular ridges in the mucous membrane that help facilitate the movement of food backwards towards the pharynx Roof

Nerve supply of the palate  Motor: All the muscles of the palate are supplied pharyngeal branch of vagus except the tensor palati which is supplied by the nerve of medial pterygoid of the mandibular division of the trigeminal nerve.  Sensory: Palate

Nerve supply of the palate  Motor:  Sensory: A. Hard palate: Greater palatine and long Sphenopalatine nerves B. Soft palate : Lesser palatine nerve. Palate

Blood supply of the palate  Arteries:  Veins: Palate

 Its formed of muscles covered with mucous membrane:  The muscles forming the floor of the mouth are Rt. and Lt. myelohyoid muscles.  Its shows : Frenulum of the tongue: Sublingual papillae: In which opens the duct of the submandibular salivary gland. Sublingual folds: Under which lies the sublingual salivary gland. Floor

We have two sets of teeth The 20 deciduous teeth are replaced by the permanent teeth between ages 6 and 12 years. The 32 permanent teeth appear between 6 years and adulthood. Four types of teeth Incisors (8): used to cut food Cuspids (canines) (4): used to tear food Premolars (8): for crushing and grinding food Molars (12): used for crushing and grinding food Dental arches

The dental arches are the two arches of teeth, one on each jawarchesteethjaw The superior (maxillary or upper) dental arch is slightly larger than the inferior (mandibular or lower) arch.superiormaxillaryinferiormandibular In the normal condition the teeth in the maxilla slightly overlap those of the mandible both in front and at the sides. maxillamandible Dental arches

Mouth cavity Palatoglossal fold: Connects palate to the tongue. Formed of palatoglossal muscle. Palatopharyngeal fold: Connects palate to the pharynx. Formed of palatopharyngeus muscle. Tonsillar fossa: Lies between palatoglossal and palatopharyngeal fold. Contains the tonsil. Uvula: Lies at the end of the soft palate. Contains the musculus uvulae.

mucous membrane The tongue is a mass of striated muscles covered with mucous membrane. Tongue

Mucous membrane of the tongue (dorsum) Upper surface (dorsum) of the tongue: Sulcus terminalis: Foramen caecum: Tongue

Mucous membrane of the tongue (dorsum) Upper surface (dorsum) of the tongue: Sulcus terminalis: Foramen caecum: Tongue

Mucous membrane of the tongue (dorsum) Upper surface (dorsum) of the tongue: The anterior 2/3: Lingual papillae: taste buds. The posterior 1/3: the lingual tonsil. Tongue

Mucous membrane of the tongue Lower (ventral) surface of the tongue:  Frenulum of the tongue.  Deep lingual vein  Deep lingual vein.  Plica fimbriata. Tongue

Muscles of the tongue  Extrinsic: 1. Genioglossus. 2. Hyoglossus. 3. Styloglossus. 4. Palatoglossus.  Intrinsic: 1. longitudinal. 2.Transverse. 3.Vertical. Tongue

Blood supply of the tongue  Lingual artery.  Lingual veins: 1.Deep lingual vein. 2.Dorsal lingual vein. 3.Lingual vein. Tongue

Nerve supply of the tongue  Motor: All extrinsic and intrinsic muscles of the tongue are supplied by the hypoglossal nerve XII except the Palatoglossus, which is supplied the pharyngeal plexus.  Sensory: 1.Anterior 2/3: General sensations: lingual nerve. Taste sensation: chorda tympani nerve VII. 2. Posterior 1/3: Glossopharyngeal nerve. 3. Most posterior part: Vagus nerve. Tongue

Lymph drainage of the tongue: 1.Tip: submental of both sides. 2.Margins of the anterior 2/3: Submandibular of same side. 3.Central part of the anterior 2/3: Submandibular of both sides. : 4.Posterior 1/3 : Deep cervical of both sides Tongue

Tongue

Salivary Glands Parotid: opposite the upper 2 nd molar tooth. Submandibular: summit of the sublingual papilla on both sides of the frenulum of the tongue. Sublingual: has duct which opens separately in the floor of the mouth. Sialolithiasis : is a condition where a calcified mass or sialolith forms within a salivary gland, usually in the duct of the submandibular gland. Less commonly the parotid gland or rarely the sublingual gland.submandibular glandparotid glandsublingual gland

Salivary Glands Sialolithiasis: is a condition where a calcified mass or sialolith forms within a salivary gland, usually in the duct of the submandibular gland. Less commonly the parotid gland or rarely the sublingual gland.submandibular glandparotid glandsublingual gland Why 1.The submandibular duct is long. 2.The duct possesses two bends. 3.The flow of saliva is against gravity. 4.The orifice is small.

Salivary Glands Secretomotor nerves: Parotid glossopharyngeal Tympanic Lesser S.P. Auriculotemporal nerve Otic g.

Salivary Glands Secretomotor nerves: Submandibular Sublingual

Structures inside the substance of the parotid gland 1.Facial nerve. 2.Posterior facial vein. 3.External carotid artery. Salivary Glands

TMJ Type : synovial, condylar (bicondylar) joint. Articular surfaces : Head of the mandible & mandibular fossa and articular tubercle. Capsule : Weak capsule Attached above to the margins of the mandibular fossa articular tubercle. Attached Below, to the neck of the mandible. There is an opening in the anterior part of the capsule for the tendon of lateral pterygoid.

TMJ Ligaments 1.Lateral temporomandibular ligament: attached to the posterior part of the zygomatic arch and to the lateral surface of the neck of the mandible. 2. Sphenomandibular ligament: attached to the spine of sphenoid above and the lingula of the mandible below. 3. Stylomandibular ligament: attached to the apex of the styloid process above and the angle of the mandible below

TMJ Intra-articular disc: It is a plate of fibrocartilage that divides the joint cavity into upper and lower cavities. The upper surface of the disc is concavoconvex while its lower surface is concave. Attached to the capsule of the joint and to lateral and medial ends of the head of the mandible by fibrous bands It is attached in front to the tendon of the lateral pterygoid.

Muscles of mastication 1. Temporalis. 2. Masseter. 3. Lat. Ptrygoid. 4. Med. Ptrygoid.

Muscles of mastication 1. All are supplied by Mandibular nerve. 2. All elevate the mandible EXCEPT lat. Ptrygoid. 3. All protrude the mandible EXCEPT temporalis. 4. Med. & Lat. Ptrygoids push the mandible to the opposite side.

Temporalis

Origin: Insertion: Nerve supply: Action:

Masseter

Origin: Insertion: Nerve supply: Action:

Lat. & med. ptrygoids

Muscles of mastication

Pharynx

Pharynx

Definition: is a tube of muscles and fascia. Extension: It extends from the base of the skull to the level of the 6th cervical vertebra. Site: It lies in front of the vertebral column and behind the nasal and oral cavities and the larynx. Division: It is divided into three parts: Nasopharynx, Oropharynx and Laryngopharynx. Pharynx

Division: 1.Nasopharynx. 2.Oropharynx. 3.Laryngopharynx. Pharynx

Division: 1.Nasopharynx. 2.Oropharynx. 3.Laryngopharynx. Pharynx

The Nasopharynx: 1.Opening of auditary tube 2.Tubal elevation. 3.Salpingopharyngeal fold 4.Pharyngeal recess. Pharynx

The Nasopharynx: 1.Opening of auditary tube 2.Tubal elevation. 3.Salpingopharyngeal fold 4.Pharyngeal recess. Pharynx

The Nasopharynx: Pharynx

Pharyngeal tonsil Adenoid Pharynx

The Oropharynx: Palatine tonsil Pharynx

The Laryngopharynx: Piriform fossa Lies between mucus membrane covering thyroid cartilage and thyrohyoid membrane laterally Mucus membrane covering aryepiglottic fold medially Pharynx

Pharyngeal muscles: 3 Constrictors: 1.Superior constrictor 2.Middle constrictor 3.Inferior constrictor 3 longitudinal: 1. Stylopharyngeus 2.Salpingopharyngeus 3.Palatopharyngeus Pharynx

Pharyngeal muscles: 3 Constrictors: 1.Superior constrictor 2.Middle constrictor 3.Inferior constrictor 3 longitudinal: 1. Stylopharyngeus 2.Salpingopharyngeus 3.Palatopharyngeus Pharynx

Pharyngeal muscles: 3 Constrictors: 1.Superior constrictor 2.Middle constrictor 3.Inferior constrictor 3 longitudinal: 1. Stylopharyngeus 2.Salpingopharyngeus 3.Palatopharyngeus Pharynx

Nerve supply : Motor: All muscles of the pharynx are supplied by pharyngeal plexus (pharyngeal branches of the vagus “cranial accessory”) Except stylopharyngeus by glossopharyngeal nerve. Sensory : 1.Nasopharynx → mainly by the maxillary nerve. 2.Oropharynx → mainly by the glossopharyngeal nerve. 3.Laryngeopharynx → by the internal laryngeal branch of the vagus nerve. Pharynx

Blood supply : Arteries: Ascending palatine, ascending pharyngeal, tonsillar, pharyngeal of maxillary, inferior thyroid. Veins: Internal jagular vein. Pharynx

Esophagus Structure and Function. It begins at the level of lower border of the cricoid cartilage (C6). It ends at the cardiac opening of the diaphragm. Anterior relations: Posterior relations: Lateral relations:

Swallowing Normal deglutition is a smooth coordinated process that involves a complex series of voluntary and involuntary neuromuscular contractions and typically is divided into three distinct phases: Oral Pharyngeal Esophageal

Swallowing Swallowing can be divided into: Voluntary stage of swallowing Bolus  voluntarily squeezed or rolled posteriorly against the palate Pharyngeal stage of swallowing Bolus reaches posterior mouth & pharynx  stimulates receptors  initiate series of automatic pharyngeal muscle contraction