1 Anatomy of Oral Cavity Pharynx Oesophagus
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Transcript of 1 Anatomy of Oral Cavity Pharynx Oesophagus
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Anatomy of Oral
Cavity, Pharynx &
OesophagusDr. Vishal Sharma
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Oral Cavity
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Parts of Oral Cavity
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Floor of mouth
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Lymphatic drainage
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Intrinsic tongue muscles
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Extrinsic tongue muscles
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Coronal section of tongue
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Actions of tongue musclesInferior Longitudinal: moves tip up & down
Superior Longitudinal: moves tip up & down
Transverse: narrows & lengthens tongue
Vertical: flattens & depresses tongue
Genioglossus: Prevents tongue from falling back
Styloglossus: Pulls tongue up & back
Palatoglossus: Pulls tongue back
Hyoglossus: Depresses tongue
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Nerve Supply of Tongue
*** except palatoglossus which is supplied by
pharyngeal plexus
Anterior 2/3 Posterior 1/3
Sensory Lingual Glossopharyngeal
Motor Hypoglossal ***
Taste Chorda tympani Glossopharyngeal
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Nerve
Supply
of
Tongue
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Papillae in tongue
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Papillae in tongue
Lingual taste buds sit on lateral borders of
raised papillae. They are classified as:
Fungiform: at tip & sides of tongue
Circumvallate: just in front of terminal sulcus
Foliate: at posterior lateral margins of tongue
Filiform: centre of tongue, have no taste buds
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Papillae in tongue
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Tongue Map ?
Sweet = Sucrose
Salty = NaCl
Sour = HCl
Bitter = Quinine
Umami = Glutamate
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Taste Bud
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Taste Pathway
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Pharynx
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Divisions
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Divisions
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Lower Limit of
Nasopharynx Lower border of soft palate or
Junction b/w hard & soft palate
Oropharynx Tip of epiglottis or
Body of hyoid bone or
Base of vallecula
Hypopharynx Lower border of cricoid or
Lower border of C6 vertebra
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Anterior Relations
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Nasopharynx
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Nasopharyngeal isthmus
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Nasopharyngeal Isthmus
Separates nasopharynx from oropharynx
Bounded anteriorly by soft palate & posteriorly
by mucosal ridge on nasopharyngeal wall called
Passavant’s ridge (due to palatopharyngeus)
Closure of this isthmus prevents nasal
regurgitation & nasal intonation
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Parts of Oropharynx
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Parts of Oropharynx
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Oropharyngeal Isthmus
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Oropharyngeal Isthmus
Separates oral cavity from oropharynx
Boundaries are:
Superior: Junction between hard & soft palate
Inferior: Circumvallate papillae
Lateral: Anterior tonsillar pillars (palatoglossus)
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Waldeyer’s Tonsillar Ring
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Waldeyer's tonsillar ring Vertically oriented, sub-epithelial lymphoid
tissue ring located in pharynx, thought to
function as a barrier to infection in first few
years of life. Named after nineteenth century
German anatomist Heinrich Wilhelm Gottfried
von Waldeyer-Hartz.
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Parts of Hypopharynx
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Coronal section of Pharynx
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Layers of Pharyngeal Wall Mucosa: ciliated columnar in nasopharynx &
stratified squamous elsewhere
Pharyngo-basilar fascia
Longitudinal muscles: stylo-pharyngeus +
salpingo-pharyngeus + palato-pharyngeus
Constrictor muscles: superior + middle + inferior
Bucco-pharyngeal fascia
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Muscles
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Structures PassingBetween Skull Base & Superior Constrictor (Sinus of Morgagni)
Eustachian tube + Levator palatini + Tensor palatini + Ascending palatine artery
Between Superior & Middle Constrictors
Glossopharyngeal nerve & Stylopharyngeus muscle
Between Middle & Inferior Constrictors
Internal Laryngeal nerve & Superior Laryngeal artery
Below Inferior Constrictor
Recurrent Laryngeal nerve & Inferior Laryngeal artery
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Nerve Supply Nasopharynx: pterygo-palatine ganglion (V2)
Oropharynx: glossopharyngeal & vagus nv
Hypopharynx: Superior & recurrent laryngeal nv
All muscles by pharyngeal nerve plexus (vagus
nv carrying cranial part of accessory nv) except
stylopharyngeus (glossopharyngeal nv) &
cricopharyngeus (also by recurrent laryngeal)
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Arterial Supply Facial artery
Lingual artery
Ascending pharyngeal artery
Ascending palatine artery
Greater palatine artery
Artery of pterygoid canal
Superior laryngeal artery
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Venous DrainageUpper pharynx:
Pharyngeal venous plexus situated on middle
constrictor pterygoid venous plexus &
internal jugular vein
Lower pharynx:
Inferior thyroid veins
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Lymphatic Drainage Nasopharynx: upper deep cervical + retro-
pharyngeal + parapharyngeal +
posterior triangle
Oropharynx: upper deep cervical + retro-
pharyngeal + parapharyngeal
Hypopharynx: deep cervical + parapharyngeal +
paratracheal + supraclavicular
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Killian’s Dehiscence
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Killian’s Dehiscence Triangular weak area between thyropharyngeus
& cricopharyngeus part of inferior constrictor
Mucosa herniates through it to form hypo-
pharyngeal pouch (Zenker’s diverticulum)
Perforation occurs here during forceful
oesophagoscopy (gateway of tears)
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Oesophagus
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Introduction
Also called gullet
23 to 25 cm long
Extends from crico-pharyngeal sphincter (C6
vertebra) to cardiac orifice of stomach (T11
vertebra)
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Anterior Curvature
Follows antero-
posterior curve of
vertebral column
through neck, thorax
(postr mediastinum)
& upper abdomen
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Lateral curvatures
Starts in midline →
deviates to left at C7
→ returns to midline
at T5 → deviates to
left again at T7 to
reach gastric cardia
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Natural Constrictions
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Natural ConstrictionsSite Vertebral Level Distance from
central incisor
Cricopharynx C 6 15 cm
Aortic arch T 4 25 cm
Lt main bronchus
T 5 28 cm
Oesophageal hiatus
T 10 40 cm
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Importance of constrictions
Common sites for lodgement of oesophageal
foreign bodies
Common sites for caustic stricture of
oesophagus
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Blood SupplyPart Arterial Venous
Cervical Inferior thyroid Inferior thyroid
Thoracic Descending thoracic aorta,
Bronchial
Azygos,Hemi-azygos
Abdominal Left gastric, Inferior
phrenic
Left gastric,Abdominal azygos
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Oesophageal varices
Left gastric vein is a
site of portal-systemic
anastomosis. Portal
obstruction leads to
varicose veins in
lower oesophagus
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Nerve SupplyCervical: recurrent laryngeal nerve & cervical
sympathetic trunk
Thoracic: vagal trunks, oesophageal plexus & thoracic
sympathetic trunk
Abdominal: vagal trunks & thoracic sympathetic trunk
Esophageal pain mimics cardiac angina due to
common nerve supply
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Lymphatic Drainage
deep cervical + posterior mediastinal + left
gastric lymph nodes
drain into coeliac lymph nodes
thoracic duct
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Histology
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Histology
Four coats from outside inwards:
1. Fibrous coat (adventitia)
2. Muscular coat (muscularis propria)
3. Submucous coat
4. Mucous coat
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Detailed Histology
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Mucous coat
1. Epithelium: non-keratinizing stratified sqamous
2. Lamina propria: loose areolar tissue with
lymphoid aggregates
3. Muscularis mucosae: produces local
movement of mucosa & helps in
drainage of gland secretions
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Mucous coatPink, smooth, protective
oesophageal mucosa
leads to red, mamillated,
secretory gastric mucosa
across Z (zigzag) line at
38-40 cm from incisors.
Higher Z line seen in
Barret’s esophagus.
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Z line in endoscopy
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Barret’s esophagus
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Submucous coat
Loose supporting areolar tissue contains:
Seromucous glands
Blood vessels
Lymphatic channels
Parasympathetic ganglia forming Meissner's
nerve plexus
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Muscularis propria External longitudinal muscle
Internal circular muscle
Parasympathetic ganglia forming Auerbach's
nerve plexus lies b/w them
Upper 1/3: striated muscle
Middle 1/3: striated & smooth
Lower 1/3: smooth muscle
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Fibrous coat (adventitia)
Layer of loose, supportive fibrous tissue
Conducts major vessels & nerves longitudinally
A serosa formed by visceral peritoneum
replaces adventitia of intra-abdominal segment
of oesophagus
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Thank You