Oral Cavity [Mouth Cavity]

Dr. Aymen Ahmed Warille

Dr Moahip Mohamed
Mouth

:Oral or buccal cavity

Is bounded by lips, cheeks, palate, and
tongue
Has the oral orifice as its anterior opening
Is continuous with the oropharynx posteriorly

: To withstand abrasions
The mouth is lined with stratified squamous
epithelium
The gums, hard palate, and dorsum of the
tongue are slightly keratinized
Oral fissure and lips
Oral fissure is the slit-like opening between the lips and
altered in shape by the movements of the muscles facial
expression associated with the lips and by movements of
the lower jaw

Lips are lined internally by oral mucosa and covered externally by skin.

Upper lip has a shallow vertical groove on its external surface (Philtrum)

Median labial (Frenulum) connects the lip to the adjacent gum.

Upper lip - V2, Lower lip V3
Philtrum Vermilion

2 2 1 2
2 1

1 - Oral fissure 2 - Angle of the mouth

Lips and Cheeks

Have a core of skeletal muscles

Lips: orbicularis oris
Cheeks: buccinators
Vestibule bounded by the lips and
cheeks externally and teeth and gums
internally
Oral cavity proper area that lies within
the teeth and gums
Labial frenulum median fold that
joins the internal aspect of each lip to
the gum Figure 24.7b
The oral cavity
:is divided into
Vestibule
. Mouth cavity proper

Vestibule

Lies between the lips and the cheeks externally and the gums and the
teeth
.internally
Duct of the parotid salivary gland opens on a small papilla into the vestibule
. opposite the upper second molar tooth
Roof of oral cavity
formed by the hard palate in front and the soft palate
behind

Floor of oral cavity

formed by the anterior two thirds of the tongue and by the reflection of the
.mucous membrane from the sides of the tongue to the gum of the mandible
 Subdivisions

Vestibule Oral Cavity Proper

V
Oral cavity [mouth cavity] divided into vestibule
& oral cavity proper
 The
frenulum
 uvula
Soft
palate

Anterior &
lateral teeth palatoglossal
& gums fold
palatine tonsil
Posterior
oropharyngeal
isthmus

Floor tongue,
Roof hard
mucous membrane,
& soft palate
mylohyoid &
geniohyoid muscles
Oral cavity proper Boundaries
Lips and Cheeks

Figure 24.7b
 Sagittal Section

Soft
Hard palate palate

Palatoglossal
fold
Palatopharyngeal
fold

Floor occupied
by the tongue

Palatine tonsil
Tongue

Occupies the floor of the mouth and

fills the oral cavity when mouth is
closed
:Functions include
Gripping and repositioning food during
chewing
Mixing food with saliva and forming the bolus
Initiation of swallowing, and speech
Intrinsic muscles change the shape of
the tongue
Extrinsic muscles alter the tongues
position
Lingual frenulum secures the tongue to
 Tongue
Inspection of the
tongue

Mainly composed of
striated muscles,
covered by mucous
membrane Base

Organ of taste, Body

deglutition, mastication
& speech
Apex
Oral & pharyngeal in
position

Apex / tip, body & base;

Palatoglossal fold
dorsal & ventral
 Tongue External features
Dorsal surface 2 parts
Foramen by the terminal sulcus
cecum
embryonic site of attachment of the
thyroglossal duct [lingual thyroid may
Pharyngeal be present]
part
Dorsal surface

Terminal
sulcus Oral part
anterior two thirds
Shows lingual papillae

Inferior / ventral surface

Tongue

Superior surface bears three types of

papillae
Filiform give the tongue roughness and
provide friction
Fungiform scattered widely over the tongue
and give it a reddish hue
Circumvallate V-shaped row in back of
tongue
Sulcus terminalis groove that
:separates the tongue into two areas
Anterior 2/3 residing in the oral cavity
Posterior third residing in the oropharynx
Papillae
Filiform papillae are small cone-shaped
projections of the mucosa that end in one or more
points

Fungiform papillae are rounder in shape and

larger than the filiform papillae, to be
. concentrated along the margins of the tongue

Vallate papillae, about 8 to 12 vallate papillae

anterior to the terminal sulcus

Foliate papillae on the sides of the tongue

Tongue

Figure 24.8a
Posterior one third [Pharyngeal part] - Posterior to the sulcus
terminalis

Lateral Median glossoepiglottic folds palatoglossal folds - side of

the tongue between oral &
pharyngeal parts
Vallecula
Lingual Connected to the epiglottis
by a median and two lateral
tonsil glossoepiglottic folds

devoid of papillae but

shows low elevations of
lymphoid nodules -
collectively form lingual
tonsil
Circumvallate papillae anterior
Palatine
to the terminal sulcus
tonsil
Ventral surface

fimbriated fold

Deep lingual vessels

Frenulum

Base of the frenulum submandibular

duct opens at the summit of the
sublingual papilla

Sublingual fold - mucous fold

raised by the sublingual gland
Ankyloglossia congenital situation
where the lingual frenulum is
extremely short
Commonly referred to as being
tongue-tied Corrected surgically by
cutting the frenulum
 Ankyloglossia (tongue tie)

Frenulum

fenulum too short or extends far

anteriorly interferes with tongue
movements [breast feeding & speech
are affected]
 Muscles of the Tongue
, Intrinsic superior longitudinal, inferior longitudinal
transverse & vertical

Intrinsic muscles are within the tongue [no bony

attachments] and alter the shape of the tongue

Extrinsic genioglossus, hyoglossus, styloglossus

and palatoglossus

Extrinsic muscles are attached to mandible [genial

tubercles] / hyoid / styloid process / palate
Extrinsic muscles move the tongue

All are paired, separated by a median fibrous septum

All extrinsic & intrinsic muscles of the tongue

are innervated by the hypoglossal nerve (CN
Extrinsic muscles
Palatoglossus [elevates the
tongue & approximates the
palatoglossal folds]
Genioglossus protrusion &
depression; prevents the tongue
from sinking back / obstructing
respiratory passage

Styloglosssus [draws the

tongue up & backwards]

Hyoglossus
[depression]

Genioglossus Geniohyoid
 Movements of the Tongue

Protrusion: The genioglossus muscles on both sides acting together

Retraction: Styloglossus and hyoglossus muscles on both sides acting

together
Depression: Hyoglossus muscles on both sides acting together
 Tongue arterial supply lingual arteries

Branches dorsal
lingual, sublingual &
deep lingual

Injury to the tongue accidental, during recovery from anesthesia, epileptic

attack etc. bleeding is arrested by grasping the tongue posterior to the wound
Nerve Supply general
sensory, taste and muscles Epiglottis

Posterior third
including the
vallate papillae
[General & special
sensory]
glossopharyngeal

Anterior two thirds

excluding vallate papillae Vallate
General sensory lingual papilla
Taste chorda tympani

Motor
Motor hypoglossal except palatoglossus [vagus through pharyngeal plexus]
Muscles are derived from the occipital myotomes
The glossopharyngeal nerve supplies the tongue,
throat, & one of the salivary glands (the parotid
gland).

Problems with the

glossopharyngeal nerve
result in trouble taste &
swallowing
Lingual nerve is at risk during removal of the lower third molar
or during operations of the submandibular gland / duct

Paralysis

Normal
Damage to the hypoglossal nerve tongue
deviates to the paralyzed side; longstanding
paralysis wasting of the muscles

Normal genioglossus pulls the same side forwards leaving the

paralyzed side stationary
Lymphatics
All lymphatic vessels from the tongue ultimately
drain into the deep cervical nodes along the
internal jugular vein.
The pharyngeal part of the tongue drains into
the jugulodigastric node
The oral part of the tongue drains both directly into
the deep cervical nodes, and indirectly into
these nodes by passing first through the mylohyoid
muscle and into submental and submandibular
. nodes
The tip of the tongue drains into the submental
nodes .
 Lymphatic drainage Medial area of anterior part
jugulo-omohyoid

Posterior part jugulo-

digastric

Apex submental
nodes

Margins of anterior part

submandibular nodes
jugulo-omohyoid
[inferior deep
cervical]
Carcinoma can spread to
bilateral nodes
Palate

Hard palate underlain by palatine

bones and palatine processes of the
maxillae
(Assists the tongue in chewing
Soft palate mobile fold formed mostly
of skeletal muscle
Closes off the nasopharynx during swallowing
Uvula projects downward from its free edge
Palatoglossal and palatopharyngeal
arches form the borders of the fauces
Incisive fossa HARD PALATE
Forms floor of the nasal cavity;
roof of the oral cavity

palatine processes of maxillae

horizontal plates of palatine bones

Greater palatine
canal Oral
cavity
HARD PALATE

Greater palatine
nerve & vessels

Mucous
glands Palatine
aponeurosis

Uvular
muscle
 Soft palate mobile flap sloping
down & back from the hard palate

Anterior / oral surface [taste

buds are present]

Posterior surface

Median conical
process - Uvula

Soft palate is elevated during deglutition &

comes in contact with the pharynx

Structure fold of mucosa enclosing

aponeurosis, muscles, vessels & nerves
tensor veli palatini - pulls the palate Muscles of the soft palate
to one side [tenses by stretching]

levator veli palatini -

elevates the palate

Palatine aponeuorosis

musculus uvulae -
retracts the uvula [pulls
uvula to the same side]

Unilateral paralysis uvula

deviates to the normal side
 POSTERIOR VIEW Levator veli palatini

Tensor veli
palatini Medial
pterygoid plate
Medial
pterygoid
muscle Palatopharygeus

Musculus uvulae

Muscle paralysis nasal regurgitation during

swallowing
 Palate Blood supply

Arterial branches of maxillary [greater palatine],

facial [ascending palatine) & ascending pharyngeal
[palatine branch]

Venous drainage to pterygoid venous plexus

 Palate Nerve supply
Motor All muscles by vagus [cranial accessory] through pharyngeal plexus,
except tensor veli palatini (CN V3, nerve to medial pterygoid)
Sensory greater, lesser & nasopalatine branches of the maxillary
Taste pass through the pterygopalatine ganglion to the greater petrosal
nerve

Pterygopalatine
ganglion

Greater
petrosal

Greater
palatine
Lesser
palatine Nasopalatine
Teeth and gingivae
The teeth are attached to sockets (alveoli) in two
elevated arches of bone on the mandible below
and the maxillae above (alveolar arches).

The gingivae (gums) are specialized regions of

the oral mucosa that surround the teeth and cover
adjacent regions of the alveolar bone.

In adults, there are 32 teeth, 16 in the upper jaw

and 16 in the lower jaw. On each side in both
maxillary and mandibular arches are two incisor,
one canine, two premolar, and three molar teeth
Teeth
Incisor teeth are the 'front teeth' and have one
root and a chisel-shaped crown, which 'cuts';
Canine teeth are posterior to the incisors, are
the longest teeth, have a crown with a single
pointed cusp,

Premolar teeth (bicuspids) have a crown with

two pointed cusps, one on the buccal (cheek) side
of the tooth and the other on the lingual
(tongue) ,have one root
Molar teeth are behind the premolar teeth, have
three roots and crowns with three to five cusps
20 deciduous teeth ('baby' teeth) consist of two
incisor, one canine, and two molar teeth on each
General Characteristics
Each tooth consists of three portions ;
Crown projecting above the gum
Root imbedded in the alveolus
Neck the constricted portion between the crown and root.
.

Pulp cavity
Cavity found in the interior of the crown and the center of root
and contains the dental pulp, a loose connective tissue richly
supplied with vessels and nerves, which enter the cavity through
the small aperture at the point of each root.

Dentin forms the bulk of the tooth.

It is a modification of osseous tissue .
Enamel covers the exposed part of the crown .
Blood supply of the teeth
Inferior alveolar artery
All lower teeth are supplied by the inferior alveolar artery, which
originates from the maxillary artery in, enters the mandibular canal of the
mandible, supplying the more posterior teeth, and divides opposite the
first premolar into incisor and mental branches. The mental branch
leaves the mental foramen to supply the chin, while the incisor branch
continues in bone to supply the anterior teeth .
The posterior superior alveolar artery
originates from the maxillary artery just after the maxillary artery enters
the pterygopalatine fossa . It descends on the posterolateral surface of the
maxilla, branches, and enters small canals in the bone to supply the molar
and premolar teeth.
The anterior superior alveolar artery
originates from the infra-orbital artery, which arises from the maxillary
artery in the pterygopalatine fossa. supply the incisor and canine teeth.
Maxillary artery
Gingival supply
buccal gingiva of the lower teeth
is supplied by branches from the inferior
alveolar artery whereas the lingual side is
supplied by branches from the lingual artery of
; the tongue
buccal gingiva of the upper teeth
is supplied by branches of the anterior
and posterior superior alveolar arteries
palatal gingiva
is supplied by branches from the
nasopalatine (incisor and canine teeth) greater
palatine (premolar and molar teeth) arteries
.
Innervation of teeth
Inferior alveolar nerve

The lower teeth are all innervated by branches from the inferior alveolar
nerve, which originates in the infratemporal fossa from the mandibular

,
nerve [V3], enter the mandibular foramen through the bone in the
mandibular canal. Adjacent to the first premolar tooth, divides into
incisive and mental branches
the incisive branch

innervates the first premolar, the canine, and the incisor teeth
the mental nerve

exits the mandible through the mental foramen and innervates the chin and
. lower lip
Innervation of teeth
The posterior superior alveolar nerve
Originates from the maxillary nerve [V2] in the pterygopalatine fossa,
innervates the molar teeth .

the middle superior alveolar nerve

arises from the infra-orbital nerve in the infra-orbital groove, passes

through the bone in the lateral wall of the maxillary sinus, and innervates
.the premolar teeth

the anterior superior alveolar nerve

originates from the infra-orbital nerve in the infra-orbital canal, passes

through the maxilla in the anterior wall of the maxillary sinus, supplies the
. canine and incisor teeth
Innervation of gingivae
Gingiva associated with the upper teeth is innervated by branches
derived from the
maxillary nerve [V2]
Gingiva associated with the lower teeth is innervated by branches
of the mandibular nerve [V3].

The gingiva on the buccal side of the upper teeth is innervated by

the anterior, middle, and superior alveolar nerves, which also
innervate the adjacent teeth. Gingiva on the palatal (lingual) side
of the same teeth is innervated by the nasopalatine and the
. greater palatine nerves
the nasopalatine nerve innervates gingiva associated with the
, incisor and canine teeth
the greater palatine nerve supplies gingiva associated with the
. remaining teeth
Salivary Glands

: Produce and secrete saliva that

Cleanses the mouth
Moistens and dissolves food chemicals
Aids in bolus formation
Contains enzymes that breakdown starch
Three pairs of extrinsic glands
parotid, submandibular, and sublingual
Intrinsic salivary glands (buccal
glands) scattered throughout the oral
mucosa
Salivary Glands

Parotid lies anterior to the ear

between the masseter muscle and skin
Parotid duct opens into the vestibule next to
the second upper molar
Submandibular lies along the
medial aspect of the mandibular body
Its ducts open at the base of the lingual
frenulum
Sublingual lies anterior to the
submandibular gland under the tongue
It opens via 10-12 ducts into the floor of the
mouth
Salivary Glands II

Figure 24.9a
THANKs