1. Dr Pedro Amarante Andrade, Ph.D.
Head & Neck 2 Oral & Pharyngeal Structures
Dr Pedro Amarante Andrade, Ph.D.
LCSC06 BIOSCIENCES FOR SPEECH AND LANGUAGE THERAPY

2. Oral & pharyngeal structures
THIS SESSION
Oral & pharyngeal structures
Dentition
Tongue
Taste & Sensation
Tonsillar Tissue

3. ORAL & PHARYNGEAL ANATOMY
Cavities of the oropharynx:
Oral
Nasal
Pharynx
Laryngopharynx
Oropharynx
Cavities of the oropharynx:
Oral
Nasal
Pharynx
Laryngopharynx
Oropharynx
Cavities of the oropharynx:
Oral
Nasal
Pharynx
Laryngopharynx
Oropharynx
Cavities of the oropharynx:
Oral
Nasal
Pharynx
Laryngopharynx
Oropharynx
Cavities of the oropharynx:
Oral
Nasal
Pharynx
Laryngopharynx
Oropharynx
Cavities of the oropharynx:
Oral
Nasal
Pharynx
Laryngopharynx
Oropharynx

4. THE ORAL CAVITY Extends from oral opening (lips) to
“pillars of the fauces”
at back
Teeth and alveolar ridge or maxillae make up lateral margins
Wikicommons. Public Domain

5. Housed in alveolar of maxillae and mandible
DENTITION
Housed in alveolar of maxillae and mandible
Function: Mastication
Articulatory surface for speech sounds
Upper and lower dental arches: equal numbers of teeth
Incisors
Cuspids
Bicuspids
Molars
Each has root in gingival or gum line
Crown is visible 1/3: surface of dental enamel
Heart of tooth is pulp: contains nerve supply
Enemal – hard mineralized surface of the teeth
Blausen gallery.
Bruce Blaus.

6. Public domain by author.
DENTITION
DENTITION ZSIGMOND SYSTEM
Public domain by author.
Wikicommons.
These bones of mine.

7. DENTITION ZSIGMOND SYSTEM
Upper right quadrant EDCBA Lower right quadrant
Upper left quadrant ABCDE Lower left quadrant
(primary dentition,
deciduous, milk teeth)
Teeth model front by Xauxa. Modified by Partynia.
Wikicommons.

8. DENTITION Types of occlusion: A+B : Class I Normal occlusion
(upper teeth slightly in front of lower teeth)
C+D: Class II Malocclusion
(upper teeth too far in front of lower teeth)
E+F: Class III Malocclusion
(upper teeth behind lower teeth)
From pocket dentistry

9. DECIDUOUS/ PERMANENT DENTITION
For development of decidious & permanent dentition, see Atkinson & McHanwell (2002) Basic Medical Science for SLT students. London:Whurr (p308)

10. THE HARD PALATE Palatine Rugae Median raphe (groove, ridge)
Easy Notecards.
Palatine Rugae
Median raphe (groove, ridge)
Soft palate
Anatomy of the Human Body. Gray’s Anatomy
Author: Henry Vandyke Carter

11. MUSCLES

12. Wikicommons. Public Domain
SOFT PALATE
Soft Palate (Velum)
Uvula
Pillars of the fauces
Anterior
Posterior
SofT PALATE aka VELUM: movable muscle mass separating oral and nasal cavities (orophx and nasophx)
Attaches in front to patetine bone-is a muscular extension of the hard palate
PILLARS of FAUCES/FAUCIAL ARCHES:
Anterior: aka glossopalatine arch
Posterior: aka pharyngopalatine arch
With palatine tonsil inbetween
Wikicommons. Public Domain

13. (also movement of Eustachian tube)
MUSCLES OF THE VELUM
MUSCLE
FUNCTION
Levator veli palatine
Musculus uvulae
Tensor veli palatine
Palatoglossus
Palatopharyngeus
Elevator
(also movement of Eustachian tube)
Elevator/bunching
Tenses and shortens
Depressor
levator veli palatini – Swallowing contracts -

14. MUSCLES OF THE VELUM
Levator veli palatine
Wikicommons.
Public Domain

15. MUSCLES OF THE VELUM Levator veli palatine Musculus uvulae
Tensor veli palatine
Palatoglossus
Palatopharyngeus
Levator veli palatine
Wikicommons.
Public Domain

16. THE TONGUE Occupies floor of mouth Functions include: Articulation
Mastication
Deglutition
Etc…
Wikicommons. Public Domain

17. Diagram Resources. http://diagramreview.com/human-tongue-diagram/
THE TONGUE
StudyBlue.
Median fibrous septum
TIP or APEX
Base of tongue
Dorsum
Terminal sulcus
Lingual papillae
Lingual tonsils
Inferior surface
Sublingual frenulum
Sublingual fold
Observe/palpate and identify in partners mouth:
MEDIAN FIBROUS SEPTUM: divides longitudinally: separates L & R: origin of transverse muscles over this MEDIAN SULCUS
TIP or APEX: anterior most portion
BASE of TONGUE: resides in oropharynx
DORSUM/DORSAL SURFACE: superior surface, mucous membrane covers superior surface. The dorsum (upper surface) of the tongue can be divided into two parts:
1. oral part (anterior two-thirds of the tongue) that lies mostly in the mouth
2. pharyngeal part (posterior third of the tongue), which faces backward to the oropharynx
The two parts are separated by a V-shaped groove, which marks the sulcus terminalis (or terminal sulcus).
TERMINAL SULCUS: marks posterior surface of tongue (SURROUNDED BY PAPPILLAE)
LINGUAL PAPILLAE: aka taste buds: small irregular prominences on surface
LINGUAL TONSILS: beneath membranous lining of pharyngeal surface of tongue: groups of lymphoid tissue
INFERIOR SURFACE of TONGUE: rich blood supply under tongue-meds easily absorbed
Palpate gently: LINGUAL FRENULUM
SUBLINGUAL FRENULUM: band of tissue from inferior tongue to mandible
SUBLINGUAL FOLD: transverse band of tissue on either side of tongue: at this point are DUCTS of SUB LINGUAL SALIVARY GLandS
Lateral to lingual frenulum: DUCTS for SUBMandIBULAR SALIVARY GLandS: hidden under mucosa on inner surface of mandible
Diagram Resources.

18. THE TONGUE TASTE AND SENSATION
Bitter
Sour
Salt
Sweet
INNERVATION of TASTE and SENSATION
Sensory innervation of the tongue is different for taste sensation and general sensation.
ANTERIOR 2/3 of TONGUE: general sensations and taste sensations are carried via different nerves.
Somatic (TOUCH, PRESSURE, TEMP) sensations travel from the tongue via the TRIGEMINAL NERVE (V)
Taste sensation is carried to the FACIAL NERVE (VII)
POSTERIOR 1/3 of TONGUE: more simple innervation, as both taste and general sensations are carried by the GLOSSOPHARYNGEAL NERVE (IX)
CENTRAL AREA: SOMATIC SENSATION: CN V
Wikicommons. Messer Woland

19. THE TONGUE TASTE AND SENSATION
INNERVATION of TASTE and SENSATION
Sensory innervation of the tongue is different for taste sensation and general sensation.
ANTERIOR 2/3 of TONGUE: general sensations and taste sensations are carried via different nerves.
Somatic (TOUCH, PRESSURE, TEMP) sensations travel from the tongue via the TRIGEMINAL NERVE (V)
Taste sensation is carried to the FACIAL NERVE (VII)
POSTERIOR 1/3 of TONGUE: more simple innervation, as both taste and general sensations are carried by the GLOSSOPHARYNGEAL NERVE (IX)
CENTRAL AREA: SOMATIC SENSATION: CN V
Anatomy & Physiology. OpenStax College

20. THE TONGUE - MUSCLES and MOVEMENT Intrinsic muscles of the tongue
LOCATION
ACTION CN
Superior longitudinal
Near epiglottis-sides of tongue
Widens, thickens and shortens tongue tip and edges
Xii
Inferior longitudinal
Hyoid bone/base of tongue-apex of tongue
Widens, shortens, creates convex dorsum, depresses tip
Transverse
Tongue septum-mucosa at sides of tongue
Elongates, narrows, thickens, lifts sides
Vertical
Superior surface-inferior surface
Widens and flattens tongue tip
FINE GRADED MOVEMENTS: CONTROL REQUIRED FOR ARTICULATION

21. INTRINSIC TONGUE MUSCLES
Voice & Speech source.
StudyBlue.

22. INTRINSIC TONGUE MUSCLES
Voice & Speech source.

23. THE TONGUE - MUSCLES and MOVEMENT Extrinsic muscles of the tongue
Location
Action CN
Genioglossus
Anterior
Posterior
Mandible-dorsum + hyoid
Ant. Contraction = retraction.
Post. Contraction = protrusion
Xii hypoglossal
Hyoglossus
Tongue-hyoid
Depresses and retracts tongue
Xii
Palatoglossus
Soft palate-tongue
Contraction = elevation of back of tongue
Xi accessory
Styloglossus
Temporal bone-sides of tongue
Contraction = upwards and backwards movement
FINE GRADED MOVEMENTS: CONTROL REQUIRED FOR ARTICULATION

24. Anatomy & Physiology. OpenStax College
THE TONGUE
Anatomy & Physiology. OpenStax College

25. EXTRINSIC TONGUE MUSCLES
Intelligent Dental.

26. EXTRINSIC TONGUE MUSCLES
Voice & Speech source.

27. CLINICAL ORAL ASSESSMENT Remember to wash your hands

28. PALPATION OF ORAL CAVITY
In pairs
Open wide
Torch in non dominant hand:
identify faucial pillars and soft palate
Say ‘aaah’ observe soft palate movement: symmetrical?
Look for palatine tonsils between faucial pillars
Wikicommons. Public Domain

29. DENTAL ASSESSMENT Identify: Incisors Cuspids Bicuspids Molars
Bite lightly on molars and
hold lips (not teeth) open for an /i/ vowel
Use gloved finger to palpate lateral margins of the teeth and gums
Use tongue depressor to move cheek away from teeth and examine for occlusion

30. THE HARD PALATE Observe and palpate:
Run fingers gently back along hard palate
RUGAE: prominent lateral ridges
MEDIAN RAPHAE: divides hard palate into equal halves
Palpate margin between hard and soft palate

31. THERAPY

32. Ora-Light. http://www.chewytubes.com/oralight/oralighttools.php
THERAPY
Lip stimulator
Ora-Light.

33. Ora-Light. http://www.chewytubes.com/oralight/oralighttools.php
THERAPY
Tongue tip stimulator
Ora-Light.

34. Ora-Light. http://www.chewytubes.com/oralight/oralighttools.php
THERAPY
Strengthen
tongue tip
Ora-Light.

35. THERAPY Strengthen the back of Tongue
Ora-Light.

36. SALIVATION Salivary glands Parotid Submandibular Sublingual
Saliva: two types of saliva
SEROUS : thin and watery
MUCOIDAL: more viscous/sticky
Function of saliva:
DIGESTIVE
DISINFECTANT
Types of saliva
Mucoidal: SYMPATHETIC NERVOUS SYSTEM: THICK/STICKY: fight or flight response-staying power
Serous: PARASYMPATHETIC NERVOUS SYSTEM: THIN/WATERY: rest and digest
Why have two types of saliva?
Salivary glands
(25%) The parotid is the largest salivary gland and is situated below the ear. The saliva is released through an opening called the parotid duct which enters the mouth on the inside of the cheek next to the upper molar teeth. There is one on each side.
Serous saliva-thin and watery.
Innervation is through CNIX (glossopharyngeal nerve)
(60%) The submandibular salivary gland is situated under the mandible (lower jaw bone) and releases saliva just underneath the front of the tongue, behind the front teeth. There is one on each side.
Produce both serous and mucoidal saliva.
Secreted through Wharton’s Duct on either side of the frenulum of the tongue.
Innervated through branches of CN VII
(15%) The sublingual salivary glands are situated under the tongue and release saliva from many small openings (ducts) under the tongue. This pair of salivary glands sit next to each other under the tongue.
Produces serous and mucoidal saliva.
Innervated by CV VII-facial nerve
Approximately one to one and a half litres of saliva is produced every day. If volume falls outside a person’s norm by 50% or more they experience symptoms of dry mouth. Normal healthy adults swallow their saliva approx once or twice per minute If one salivary gland is damaged it is thought some form of homeostatic mechanism will increase the flow of saliva from other glands to compensate: thus keeping production as near normal as possible
Function of saliva:
Lubrication Moistening food, and helping to create a food bolus, so it can be swallowed easily.
Digestion : Contains the enzyme amylase that breaks some starches down into maltose and dextrin.
Secretes enzyme: salivary lipaseto start digestion of fats
Thus, digestion of food occurs within the mouth, even before food reaches the stomach.
Disinfection: A common belief is that saliva contained in the mouth has natural disinfectants, researchers find human saliva contains such antibacterial agents as secretory IgA, lactoferrin, and lactoperoxidase.

37. SALIVATION Gland/ Location Saliva [%] Duct location CN Parotid
(Largest – below the ear) 25
Inside of the check next to the upper molar teeth IX
(glossopharyngeal nerve)
Submandibular 60
Underneath the front of the tongue, either ide of frenulum (Wharton’s duct)
VII
(facial nerve)
Sublingual 15
Under tongue
1.5 L/day if drop by 50 % = dry mouth
Swallowing 1-2x/minute Compensation if damaged

38. Blausen.com. Bruce Blaus
TONSILS
Pharyngeal tonsils (adenoids)
Palatine tonsils
Lingual tonsils
Blausen.com. Bruce Blaus

39. TONSILS NAME LOCATION Function: Part of limbic system/immune response
Believed to be involved in helping fight pharyngeal and Upper Respiratory Tract infection
NAME
LOCATION
Adenoids: pharyngeal tonsils
Roof of pharynx
Palatine tonsils
Sides of pharynx between
faucial arches
Lingual tonsils
Behind terminal sulcus (tongue)
tonsils are areas of lymphoid tissue
Most commonly, the term "tonsils" refers to the palatine tonsils that can be seen in the back of the throat
ADENOIDS (also termed "pharyngeal tonsils") located in roof of pharynx
PALATINE TONSILS: sides of pharynx between glossopalatine and pharyngopalatine arches (faucial arches)
LINGUAL TONSILS : behind terminal sulcus (tongue)
Together this set of lymphatic tissue is known as Waldeyer's tonsillar ring

40. NASAL CAVITIES Nasal septum Turbinates Nares Paranasal air sinuses
Note that the roof of the nasal cavity is made up of the cribriform plate (not labelled) but on each side of (1). Also note that the floor of the nasal cavity is made up of the palatine processes of the maxilla (6).
Nasal cavity: perpendicular aspect of ethmoid bone and vomer and septal cartilage
Divide nasal cavity laterally.
NASAL CONCHAE: (nasal turbinates or concha) scroll like bones on lateral surface of nasal cavity
Inferior
Middle
Superior
Covered with mucosal layer-rich blood supply
Function: warms and humidifies air before it reaches more delicate tissue of resp system
Their shape greatly increases surface area of nasal cavity-promoting rapid heat exchange
Dr. Shervin Aminpour.

41. SURFACE ANATOMY Paranasal sinuses
Air-filled spaces, communicating with nasal cavity within the bones of the skull and face
Function: debated
Decrease skull weight
Increased vocal resonance
Protection
Insulation
Anatomy & Physiology, Connexions Web site. OpenStax College

42. EUSTACHIAN TUBE
Location: Narrow passage leading from the pharynx to the cavity of the middle ear
Function: Equalization of pressure on each side of the eardrum
Connects middle ear with nasopharynx: approx 35mm long
Each tube exits m/ear as a narrow, boney canal in the petrous temporal bone
As they leave the bone the medial 2/3 of each tube is enclosed by cartilage beneath the bony roof
Tensor veli and levator veli palatine are attached to the cartilage and produce tubal elevation where tubes open into nasopharynx
Tubes: lined with respiratory epithelium containing mucous glands
Functions:
allows air into middle ear cavities so air pressure on each side of tympanic membrane can be equalised to prevent distortion or rupture of eardrum caused by excess pressure differentials
Also drains mucous from middle ear
Taken from WebMD.

43. THE PHARYNX Divided into areas: Oropharynx Nasopharynx Laryngopharynx
The pharynx: the part of the neck and throat situated immediately posterior to the mouth and nasal cavity, and cranial, or superior, to the esophagus, larynx, and trachea.
Functions
It is part of the digestive system and respiratory system of many organisms.
Because both food and air pass through the pharynx, a flap of connective tissue called the epiglottis closes over the trachea when food is swallowed to prevent choking or aspiration. In humans the pharynx is important in vocalization.
Parts
The human pharynx is conventionally divided into three sections:
Oropharynx
The oropharynx lies behind the oral cavity. The anterior wall consists of the base of the tongue and the vallecula; the lateral wall is made up of the tonsil, tonsillar fossa, and tonsillar (faucial) pillars; the superior wall consists of the inferior surface of the soft palate and the uvula.
Nasopharynx
The nasopharynx lies behind the nasal cavity.
Postero-superiorly this extends from the level of the junction of the hard and soft palates to the base of skull, laterally to include the fossa of Rosenmuller.
The inferior wall consists of the superior surface of the soft palate.
Laryngopharynx
The laryngopharynx, also known as the hypopharynx, roughly corresponds to the levels between C3 to C6, it includes the pharyngo-esophageal junction (postcricoid area), the piriform sinus, and the posterior pharyngeal wall.
Like the oropharynx above it the hypopharynx serves as a passageway for food and air and is lined with a stratified squamous epithelium.
It lies directly anterior to the upright epiglottis and extends to the larynx, where the respiratory and digestive pathways diverge.
At that point the laryngopharynx is continuous with the esophagus posteriorly. The esophagus conducts food and fluids to the stomach; air enters the larynx anteriorly. During swallowing, food has the "right of way", and air passage temporarily stops.

44. MARK THE STRUCTURES THAT DIVIDE THE VOCAL TRACT INTO *ynx

45. PHARYNGEAL MUSCLES Superior pharyngeal constrictor
Middle pharyngeal constrictor
Inferior pharyngeal constrictors
Superior pharyngeal
Middle pharyngeal
Inferior pharyngeal
thyropharyngeal-superior
cricopharyngeal-inferior
Salpingopharyngeal
Stylopharyngeal
The salpingopharyngeus muscle arises from the inferior part of the cartilage of the auditory tube in the nasal cavity; it passes downward and blends with the posterior fasciculus of the palatopharyngeus muscle.

46. PHARYNGEAL MUSCULATURE
MUSCLE
FUNCTION
INNERVATION
Superior pharyngeal constrictor
Velopharyngeal closure
Reduces diameter
CN XI & X
Middle pharyngeal constrictor
Inferior pharyngeal constrictor
Reduces diameter:
Two parts:
Cricopharyngeal muscle
*arises from cricoid
Muscular orifice of oesophagus
2. Thyropharyngeal muscle
*arises from thyroid
Salpingopharyngeus
Elevates lateral pharyngeal wall
Stylopharyngeus
Elevates pharynx
CN IX
Vertical tube
Muscles wrap horizontally from front to midline point at back.
Muscles also run horizontally from skull structures: salpingopharyngeus & stylopharyngeus

47. Salpingopharyngeus & Palatopharyngeus m.
PHARYNGEAL MUSCLES
Salpingopharyngeus & Palatopharyngeus m.
Superior pharyngeal
Middle pharyngeal
Inferior pharyngeal
thyropharyngeal-superior
cricopharyngeal-inferior
Salpingopharyngeal
Stylopharyngeal
The salpingopharyngeus muscle arises from the inferior part of the cartilage of the auditory tube in the nasal cavity; it passes downward and blends with the posterior fasciculus of the palatopharyngeus muscle.
Taken from studyblue.

48. THE EPIGLOTTIS Leaf-shaped cartilage Attached to root of tongue
Considered part of the larynx:
Leaf-shaped elastic cartilage attached below by a narrow stalk of connective tissue to internal surface of the thyroid angle just beneath the internal surface of the thyroid angle just beneath the thyroid notch.
Convex lingual surface of the epiglottis faces anteriorly and is separated from the tongue by the valleculae
More detail in Larynx lecture?
*****NEEDS SOMETHING ABOUT PYRIFORM SINUS’ UES and UPPER OESOPHAGUS

49. THE EPIGLOTTIS
Culture & Language Sciences – Information pack

50. THE EPIGLOTTIS Epiglottis in action
Culture & Language Sciences – Information pack