NASAL AND ORAL CAVITIES,

PARANASAL SINUSES, PHARYNX

EXTERNAL NOSE
Root
Bridge / Dorsum
Free Tip / Apex
Anterior Nares / Nostrils
Supported By:

Bones:
frontal
nasal
maxillary

Cartilages:
Piriform Aperture
INTERNAL NOSE

Nasal Cavity
- extends between
Anterior Nares /
nostrils to
Posterior Nares /
Choanae
INTERNAL NOSE

Choanae
Bounded by:
Vomer - medially
Horizontal plate of palatine
bone - inferiorly
Medial Pterygoid plate -
medially
Body of Sphenoid –
superiorly
INTERNAL NOSE
2 chambers:
1. Nasal Vestibule
- dilatation inside
the nostril
- limited by a ridge,
the limen nasi
- walls have stout
hairs – vibrissae in
filter like arrangement
INTERNAL NOSE
2 chambers:
2. Nasal Cavity Proper
- divided by nasal
septum into right and
left cavity
- each cavity – 2 x 2-3
inches in height and
length
- width is ½ inch in floor
and 1-2 mm in roof
- with conchae projecting
from lateral wall
INTERNAL NOSE
2 chambers:
2. Nasal Cavity Proper
- divided into a lower
respiratory area and
upper olfactory area
INTERNAL NOSE
Nasal Cavity:
WALLS:
1. ROOF
- formed by:
nasal cartilages
nasal bone
cribriform plate of ethmoid
body of sphenoid
INTERNAL NOSE
Nasal Cavity:
WALLS:
2. FLOOR
- formed by:
palatine process of
maxilla
horizontal plate of
palatine bone
INTERNAL NOSE
Nasal Cavity:
WALLS:
3. MEDIAL WALL
- the Nasal septum
a. vomer
b. perpendicular plate
of ethmoid
c. septal cartilage

- Usually deviated (to the right)

INTERNAL NOSE
Nasal Cavity:
WALLS:
3. MEDIAL WALL
Septal Mucosa
- covered by yellowish
mucous membrane
- softer more delicate with
very small glands over
olfactory area
- very thick, spongy, vascular
with large glands over
respiratory area
INTERNAL NOSE
Nasal Cavity:
WALLS:
4. LATERAL WALL
- Nasal Conchae
1. Superior Concha
- short, upper and posterior part
2. Middle Concha
- bigger,
- fr. posterior part to the Atrium
3. Inferior Concha
- longer than middle
- independent facial bone
INTERNAL NOSE
Nasal Cavity:
WALLS:
4. LATERAL WALL
Nasal Meatuses
- spaces between conchae
1. Superior Meatus
- short, upper and posterior part
- receives opening of posterior
ethmoidal sinus in upper
anterior part
INTERNAL NOSE
Nasal Cavity:
WALLS:
4. LATERAL WALL
Nasal Meatuses
2. Middle Meatus
- roomier
- between superior
and middle conchae
- from atrium going back
INTERNAL NOSE
Nasal Cavity:
WALLS:
4. LATERAL WALL
Nasal Meatuses
2. Middle Meatus
- Atrium – above and
behind nasal vestibule
- with elevation near the
upper part called Agger
Nasi (additional concha)
INTERNAL NOSE
Nasal Cavity:
WALLS:
4. LATERAL WALL
Nasal Meatuses
2. Middle Meatus
- Infundibulum
- funnel shaped passage
communicating with
frontal sinus
- Hiatus Semilunaris
- deep curved groove
- openings of maxillary sinus
and anterior ethmoidal air
cells
INTERNAL NOSE
Nasal Cavity:
WALLS:
4. LATERAL WALL
Nasal Meatuses
2. Middle Meatus
- Bullae Ethmoidalis
- prominent bulge at upper
part of hiatus
- openings of middle
ethmoidal air cells
INTERNAL NOSE
Nasal Cavity:
WALLS:
4. LATERAL WALL
Nasal Meatuses
3. Inferior Meatus
- below inferior concha
- opening of nasolacrimal
duct

Sphenoethmoidal Recess
-Space between sphenoid and
superior concha
-Opening of sphenoidal sinus
INTERNAL NOSE
Nasal Cavity:
NERVES of Nasal Septum
a. Special Sense -
Olfactory Nerve
b. Ordinary Sensation
1. Long Sphenopalatine N.
2. Short Sphenopalatine N.
3. Medial Nasal Br. Of
Anterior Ethmoidal N.
INTERNAL NOSE
Nasal Cavity:
NERVES of Nasal Septum
1. Long Sphenopalatine N.
- long, slender
- arises from Sphenopalatine
(Pterygopalatine) Ganglion
- enters nasal cavity via
sphenopalatine foramen
2. Short Sphenopapatine N.
- from Sphenopalatine Ganglion
- send filaments to postero-
superior part of nasal septum
INTERNAL NOSE
Nasal Cavity:
Sphenopalatine (Pterygopalatine)
Ganglion
- small, triangular, flattened body
- in pterygopalatine fossa
- parasympathetic ganglion of CN VII
- Largest peripheral Parasympathetic G.
- Root suspended from Maxillary N.
by ganglionic branches
- sympathetic and parasympathetic root
provided by Nerve to Pterygoid canal
INTERNAL NOSE
Nasal Cavity:
Sphenopalatine
(Pterygopalatine) Ganglion
-Most of branches of the ganglion
are Maxillary division sensory
fibers supplying
palate, nasal mucosa,
pharynx and orbit
INTERNAL NOSE
Nasal Cavity:
NERVES of Nasal Septum
3. Medial Nasal Branch of
Anterior Ethmoidal N.
- descends over anterior part of
nasal septum
- go as far as nasal vestibule
INTERNAL NOSE
Nasal Cavity:
ARTERIES of Nasal Septum
1. Sphenopalatine A.
- from Maxillary Artery
- passes sphenopalatine
foramen with Long
Sphenopalatine N.
2. Anterior and Posterior
Ethmoidal A.
- from Ophthalmic Artery
3. Superior labial Artery
- from Facial a. supplying
anterior septum
Paranasal Sinuses
ORAL CAVITY
- First subdivision of
digestive system
2 PARTS:
1. Oral Vestibule
- smaller, external
2. Oral Cavity Proper
- larger, internal
ORAL CAVITY
2 PARTS:
1. Oral Vestibule
- communicates posteriorly
with cavity proper through
retromolar space (between
last molar and ramus of mandible
-Receives opening of Stensen’s duct
opposite 2nd upper molar
ORAL CAVITY
2 PARTS:
1. Oral Vestibule
- cleft like space
- bounded by lips and cheeks
anteriorly and by teeth and
gums posteriorly
- opens anteriorly via oral
fissure
ORAL CAVITY
A. LIPS
4 layers:
1. cutaneous 2. mucous
- skin and mucous membrane
- Vermillion border –
mucosal-epidermal junction
- mucous membrane reflected
and raised in the gums via
Frenulum
ORAL CAVITY
A. LIPS
4 layers:
3. Muscular Layer
- orbicularis oris
4. Submucosal Layer
- areolar tissues
- mucous labial glands
- arterial arch and lymph vessels
ORAL CAVITY
B. CHEEKS
Layers:
1. Skin
2. Fatty Layer
- buccal fat fad of Bichat
3. Buccopharyngeal fascia
4. Buccinator
5. Submucous areolar tissue
- with molar glands
6. Mucous membrane
- with sebaceous glands
(fordyce spots)
ORAL CAVITY
2 PARTS:
2. Oral Cavity Proper
Boundaries:
A. gums and teeth - anterolateral
B. tongue and mucous membrane –
inferior
C. hard and soft palate - superior
D.posteriorly communicates with
pharynx via isthmus of fauces
ORAL CAVITY
2. Oral Cavity Proper
A. gums and teeth
Gums
- composed of dense fibrous tissue
- covered with smooth and vascular
mucous membrane
- attached to alveolar margin of jaw
ORAL CAVITY
2. Oral Cavity Proper
Teeth
- highly specialized structure
- for mastication and speech
- Parts:
1. Crown - part above the gum
2. Root – embedded in alveolar sockets
3. Neck – connects crown with root
4. Enamel – very hard, rigid, covers crown
5. Dentine – hard, elastic, yellowish, avascular
- forms greater part of tooth, highly calcified
- with lots of organic matter and water,
phosphates and carbonates of lime
6. Cementum –modified bone encasing roots
Permanent teeth(6-12 yrs)
=32(3 2 1 2 : 2 1 2 3 )
(3 2 1 2 : 2 1 2 3 )
central incisor
lateral incisor
canine
first premolar(bicuspid)
second premolar(bicuspid)
first molar
second molar
third molar (wisdom tooth)
Teeth
• Deciduous teeth(6 mos-2yrs)
• =20 (2 1 2 : 2 1 2)
• (2 1 2 : 2 1 2)
• central incisor
• lateral incisor
• canine(cuspid)
• first molar
• second molar
ORAL CAVITY
B. TONGUE
-Mobile organ at floor of mouth
-Mass of muscle covered with mucous
membrane
-Dorsum is divided into 2 parts by a V
shaped groove called Sulcus terminalis
1. Palatine or Oral part – anterior
2/3; presulcal
2. Pharyngeal Part –
posterior 1/3; postsulcal
-Tip of sulcus terminalis points
backwards marked by a pit called
Foramen cecum
ORAL CAVITY
B. TONGUE
Lingual papillae:
1.Filiform - most numerous, with pointed ends;
presulcal
2. Fungiform – larger, rounded,
mushroom shaped with some
taste buds; on lingual margin
and apex
3. Foliate – red, leaf like at sides near sulcus
4. Vallate – 10-12, cylindrical forming V shaped
row anterior to sulcus terminalis
- contains the greatest amount
of taste buds
ORAL CAVITY
B. TONGUE
Lingual papillae – all have taste buds
except filiform papillae

Frenulum linguae – median fold of

mucous membrane connecting it to floor
- at sides of frenulum are sublingual
papillae containing openings of:
submandibular duct (Wharton’s)
Sublingual Duct (Bartholin’s)
-Sublingual Fold – lateral to sublingual
papilla where sublingual ducts of Rivinus
opens
ORAL CAVITY
B. TONGUE
2 Groups of Muscles
1.Intrinsic
– transverse, longitudinal, vertical
- alters shape of tongue
2. Extrinsic
a. genioglossus
b. hyoglossus
c. styloglossus
d. palatoglossus
ORAL CAVITY
B. TONGUE
2. Extrinsic Muscles
a. genioglossus
O: superior genial spine mandible
I: blends with other muscles
A: protrudes tongue
b. hyoglossus
O: body of greater cornu hyoid bone
I: blends with other muscles
A: depresses tongue
c. styloglossus
O: styloid process
I: blends with other muscles
A: draws tongue upwards and backwards
d. palatoglossus
O: palatine aponeurosis
I: side of tongue
A: pulls root upwards and backwards
narrows oropharyngeal isthmus
ORAL CAVITY
B. TONGUE
Nerve Supply of tongue
1.General Sensory
- lingual nerve (CN V3) - anterior 2/3
- glossopharyngeal nerve – post 1/3

2. Special Sensory
anterior 2/3 – facial
posterior 1/3 – glossopharyngeal

3. Motor
- hypoglossal
- except palatoglossus – pharyngeal
plexus
ORAL CAVITY
C. PALATE
-Forms roof of mouth
-Divided into:
1.Hard palate
a. palatine process of maxilla
b. horizontal plate of palatine bone
2. Soft palate
uvula – free posterior margin
ORAL CAVITY
C. PALATE
MUSCLES:
1.Tensor veli palatini
O: spine of sphenoid, lateral side of
auditory tube, scaphoid fossa
I: form palatine aponeurosis attached
to posterior border of hard palate
A: the 2 muscles tighten soft palate

2. Levator Veli Palatini

O: petrous part of temporal bone
medial surface auditory tube
I: upper border palatine aponeurosis
A: raises soft palate
ORAL CAVITY
C. PALATE
MUSCLES:
3. palatoglossus
O: palatine aponeurosis
I: side of tongue
A: pulls root upwards and palate

4. Palatopharyngeus
O: posterior border hard palate;
palatine aponeurosis
I: posterior border lamina thyroid cartilage
A: pulls wall of pharynx upward
pull palatopharyngeal arches to midline
ORAL CAVITY
C. PALATE
MUSCLES:
5. Musculus uvulae
O: posterior border hard palate
palatine aponeurosis
I: mucous membrane uvula
A: pulls up the uvula

All muscles of soft palate are supplied by

Pharyngeal plexus except for Tensor veli palatini
– nerve to medial pterygoid from CN V3
ORAL CAVITY
C. PALATE
PHARYNGEAL PLEXUS:
1. Motor component
- cranial part of Accessory nerve
- through vagal branches, it supplies
all pharyngeal and palatal muscles
except for stylopharyngeus (CN IX)
and tensor veli palatini (CN V3)

2. Sensory component
- CN IX, CN X
ORAL CAVITY
D. ISTHMUS OF FAUCES
-Communication between oral
cavity and oropharynx
- Bounded by:
palatoglossal arch - on each side
soft palate – above
Sulcus terminalis - below
-
PHARYNX
ATTACHMENTS:
- superiorly attached to base of skull
- On each side from top to down:
1.Medial pterygoid lamina
2.Pterygomandibular raphe
3.side of the tongue
4.medial side of mandible
5. Hyoid bone
1.Thyroid cartilage
2.Cricoid cartilage
Pterygomandibular raphe
- strong narrow ligamentous
band
- Acts as a tendinous band of union
between buccinator and
superior pharyngeal
constrictor
PHARYNX
WALL:
- Outside going in
1.Bucopharyngeal fascia
2.Pharyngeal muscles
3.Pharyngobasilar fascia
4.Submucous coat
5.Mucous membrane
PHARYNX
WALL:
1.Bucopharyngeal fascia
- coating of fibrous tissue covering
both buccinator and pharyngeal
muscles
PHARYNX
WALL:
2. Pharyngobasilar fascia
-Lines the deep surface of pharyngeal
muscles
-between muscles and submucous coat
-strong in upper part
-Maintains integrity of pharyngeal wall in
portions where superior constrictor is
absent
-Principal attachment of pharynx to the
skull
-Attached to auditory tube andbont
margins of choanae
PHARYNX
WALL:
3. Submucous coat
-Contains mucous pharyngeal glands,
lymphatic tissues forming
nasopharyngeal tonsils

4. Mucous membrane
-Lines the interior
-Continous with mucous membrane of
other cavites connected to pharynx
PHARYNX
WALL:
PHARYNGEAL MUSCLES
-composed of:
3 constrictors – superior,
middle,
inferior
Longitudinal muscles
stylopharyngeus
salpingopharyngeus
palatopharyngeus
PHARYNX
WALL:
PHARYNGEAL MUSCLES
A.Constrictors
- 3 pairs
-sides and posterior wall
-Inserted to the median raphe
-Nerve Supply: pharyngeal plexus with
Inferior constrictor also from external
and recurrent laryngeal n.
-Action: contract during swallowing
sequentially from superior to inferior
to propel food downwards
PHARYNX
WALL:
PHARYNGEAL MUSCLES
A.Constrictors
1.Inferior Constrictor
O: side of cricoid
oblique line of thyroid
I: median raphe
lower fibers horizontal with
increasing obliquity as it goes up
PHARYNX
WALL:
PHARYNGEAL MUSCLES
A.Constrictors
1.Inferior Constrictor
O: side of cricoid
oblique line of thyroid
I: median raphe
lower fibers horizontal with
increasing obliquity as it goes
up
PHARYNX
WALL:
PHARYNGEAL MUSCLES
A.Constrictors
2.Middle Constrictor
O: lesser and greater cornua of
hyoid bone
stylohyoid ligament
I: median raphe
PHARYNX
WALL:
PHARYNGEAL MUSCLES
A.Constrictors
2.Middle Constrictor
O: lesser and greater cornua of
hyoid bone
stylohyoid ligament
I: median raphe
PHARYNX
WALL:
PHARYNGEAL MUSCLES
A.Constrictors
3.Superior Constrictor
O: medial pterygoid plate
pterygoid humulus
Pterygomandibular raphe
myelohyoid line
I: median raphe
upper fibers to pharyngeal tubercle
of occipital bobe
PHARYNX
WALL:
PHARYNGEAL MUSCLES
A.Constrictors
3.Superior Constrictor
O: medial pterygoid plate
pterygoid humulus
Pterygomandibular raphe
myelohyoid line
I: median raphe
upper fibers to pharyngeal tubercle
of occipital bobe
PHARYNX
WALL:
PHARYNGEAL MUSCLES
B. Stylopharyngeus
O: styloid process
I: posterior border thyroid
cartilage
A: elevates larynx and pharynx
during swallowing
NS: CN IX
PHARYNX
WALL:
PHARYNGEAL MUSCLES
C. Salphingopharyngeus
O: lower part cartilage auditory
tube
I: blends with palatopharyngeus
A: assists in elevating pharynx
NS: pharyngeal plexus
PHARYNX
WALL:
PHARYNGEAL MUSCLES
D. Palatopharyngeus
O: posterior border hard palate
palatine aponeurosis
I: posterior border lamina of
thyroid cartilage
A: pulls pharynx upwards
acting on both sides pull
palatopharyngeal arches towards the
midline
NS: pharyngeal plexus
PHARYNX
DIVISIONS:
A.NASOPHARYNX or Epipharynx

A.OROPHARYNX or Mesopharynx

A.LARYNGOPHARYNX or Hypopharynx
PHARYNX
DIVISIONS:
A.NASOPHARYNX or Epipharynx
-Behind nasal cavities
-Below body of sphenoid
-Widest
-Always patent; with immovable
walls
PHARYNX
DIVISIONS:
A.NASOPHARYNX or Epipharynx
WALLS:
1.Anterior Wall
-The Choanae
- Opens into nasal cavity
- Oblong orifices
- Slopes from base of skull to
posterior border of hard
palate
- 1 x 1 inch in height and width
- Separated by nasal septum
PHARYNX
DIVISIONS:
A.NASOPHARYNX or Epipharynx
WALLS:
1.Lateral Wall
Contains:
- Eustachian Tube
- Pharyngeal recess
- Torus tobarius – tubal
elevation; prominent, rounded
margin of ET orifice
- Salphingo-pharyngeal fold –
fold of mucous membrane
descending from posterior lip of
orifice; contains Salphingo-
pharyngeus muscle
PHARYNX
DIVISIONS:
A.NASOPHARYNX or Epipharynx
WALLS:
3. Roof and Posterior Wall
Contains:
- Nasopharyngeal tonsil
- collection of lymphoid tissue
in upper part of roof
- adenoids in children
- Pharyngeal bursa can
sometimes be found on its
lower end
PHARYNX
A. NASOPHARYNX or Epipharynx
WALLS:
4. Floor or Inferior Wall
- occupied by soft palate
- Pharyngeal isthmus –
- communication between naso
and oropharynx
- closed during swallowing by
elevation of soft palate
-Palatopharyngeal arch
- prominent fold of mucous
membrane beginning at posterior
edge of soft palate goes down and
back on side of pharynx
- encloses palatopharyngeus muscle
PHARYNX
B. OROPHARYNX or Mesopharynx
-Behind mouth and tongue
-Contains epiglottis
- Glossoepiglottic fold
– median ridge of mucous
membrane from front of epiglottis
to back of tongue
- Epiglottic Vallecula
– depression lateral to the
fold
PHARYNX
B. OROPHARYNX or Mesopharynx
-Behind mouth and tongue
-Contains epiglottis
- Glossoepiglottic fold
- Epiglottic Vallecula –
- Pharyngoepiglottic fold
– ridge of mucous membrane lateral
to vallecula
- Pharyngeal tonsils
– at the sidewalls between
palatoglossal and
palatopharyngeal arches
PHARYNX
B. OROPHARYNX or Mesopharynx
-Palatine Tonsils
- medial surface uneven with deep
narrow crypts called Tonsillar pits
the widest is called intertonsillar
cleft
-Blood supply: Tonsillar branch of
facial artery
-Nerve Supply: CN IX and lesser
palatine nerve
PHARYNX
DIVISIONS:
A.LARYNGOPHARYNX or
Hypopharynx
- behind larynx
- communicates with larynx through
laryngeal inlet
- continues inferiorly with
esophagus at level of C6
vertebra or lower border of
cricoid cartilage
PHARYNX
SENSORY INNERVATION:

A.NASOPHARYNX or Epipharynx
- Maxillary nerve
B.OROPHARYNX or Mesopharynx
- Glossopharyngeal nerve
C.LARYNGOPHARYNX or Hypopharynx
- Internal laryngeal branch of
Vagus nerve
PHARYNX
BLOOD SUPPLY:
from Branches of:
1. ascending pharyngeal
2. ascending palatine
3. facial artery
4. lingual artery
5. maxillary artery
PHARYNX

VENOUS DRAINAGE:
- Drains into Pharyngeal
Plexus to the Internal jugular
Vein
PHARYNX

LYMPHATIC DRAINAGE:
- Drains directly into Deep
Cervical Nodes
- indirectly to Retropharyngeal
and Paratracheal nodes
Thank you!

Henedina Eva Casis-Barilea

MD;DTM&H; FPSA