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Anatomy

Innervation of the Pharynx

  • The motor and most of the sensory supply of the pharynx is derived from the pharyngeal plexus of nerves on the surface of the pharynx.
  • The plexus is formed by pharyngeal branches of the vagus (CN X) and glossopharyngeal (CN IX) nerves, and by sympathetic branches for the superior cervical ganglion.
  • The motor fibres in the pharyngeal plexus are derived from the cranial root of accessory nerve (CN XI), and are carried by the vagus nerve to all muscles of the pharynx and soft palate.
  • The exceptions are stylopharyngeus (supplied by CN IX) and the tensor veli palatini (supplied by CN V3).

Stylohyoid Muscle

  • Origin: Posterior border of the styloid process of the temporal bone.
  • Insertion: Body of the hyoid bone at the junction with the greater horn.
  • Nerve Supply: Facial nerve (CN VII).
  • Arterial Supply: Muscular branches of the facial artery and muscular branches of the occipital artery.
  • Action: Elevates the hyoid bone and base of the tongue.

  • The palate has a rich blood supply from branches of the maxillary artery.

The Tongue

  • The tongue (L. lingua; G. glossa) is a highly mobile muscular organ that can vary greatly in shape.
  • It consists of three parts, a root, body, and tip.
  • The tongue is concerned with mastication, taste, deglutition (swallowing), articulation (speech), and oral cleansing.
  • Its main functions are squeezing food into the pharynx when swallowing, and forming words during speech.

 

Gross Features of the Tongue

  • The dorsum of the tongue is divided by a V-shaped sulcus terminalis into anterior oral (presulcal) and posterior pharyngeal (postsulcal) parts.
  • The apex of the V is posterior and the two limbs diverge anteriorly.
  • The oral part forms about 2/3 of the tongue and the pharyngeal part forms about 1/3.

 

Oral Part of the Tongue

  • This part is freely movable, but it is loosely attached to the floor of the mouth by the lingual frenulum.
  • On each side of the frenulum is a deep lingual vein, visible as a blue line.
  • It begins at the tip of the tongue and runs posteriorly.
  • All the veins on one side of the tongue unite at the posterior border of the hyoglossus muscle to form the lingual vein, which joins the facial vein or the internal jugular vein.
  • On the dorsum of the oral part of the tongue is a median groove.
  • This groove represents the site of fusion of the distal tongue buds during embryonic development.

 

The Lingual Papillae and Taste Buds

  • The filiform papillae (L. filum, thread) are numerous, rough, and thread-like.
  • They are arranged in rows parallel to the sulcus terminalis.
  • The fungiform papillae are small and mushroom-shaped.
  • They usually appear are pink or red spots.
  • The vallate (circumvallate) papillae are surrounded by a deep, circular trench (trough), the walls of which are studded with taste buds.
  • The foliate papillae are small lateral folds of lingual mucosa that are poorly formed in humans.
  • The vallate, foliate and most of the fungiform papillae contain taste receptors, which are located in the taste buds.

 

The Pharyngeal Part of the Tongue

  • This part lies posterior to the sulcus terminalis and palatoglossal arches.
  • Its mucous membrane has no papillae.
  • The underlying nodules of lymphoid tissue give this part of the tongue a cobblestone appearance.
  • The lymphoid nodules (lingual follicles) are collectively known as the lingual tonsil.

  • This is the posterior curtain-like part, and has no bony support. It does, however, contain a membranous aponeurosis.
  • The soft palate, or velum palatinum (L. velum, veil), is a movable, fibromuscular fold that is attached to the posterior edge of the hard palate.
  • It extends posteroinferiorly to a curved free margin from which hangs a conical process, the uvula (L. uva, grape).
  • The soft palate separates the nasopharynx superiorly and the oropharynx inferiorly.
  • During swallowing the soft palate moves posteriorly against the wall of the pharynx, preventing the regurgitation of food into the nasal cavity.
  • Laterally, the soft palate is continuous with the wall of the pharynx and is joined to the tongue and pharynx by the palatoglossal and palatopharyngeal folds.
  • The soft palate is strengthened by the palatine aponeurosis, formed by the expanded tendon of the tensor veli palatini muscle.
  • This aponeurosis attaches to the posterior margin of the hard palate.

The Middle Ear

 

  • This part of the ear is in a narrow cavity in the petrous part of the temporal bone.
  • It contains air, three auditory ossicles, a nerve and two small muscles.
  • The middle ear is separated from the external acoustic meatus by the tympanic membrane.
  • This cavity includes the tympanic cavity proper, the space directly internal to the tympanic membrane, and the epitympanic recess, the space superior to it.
  • The middle ear is connected anteriorly with the nasopharynx by the auditory tube.
  • Posterosuperiorly, the tympanic cavity connects with the mastoid cells through the aditus ad antrum (mastoid antrum).
  • The tympanic cavity is lined with mucous membrane that is continuous with the mucous membrane of the auditory tube, mastoid cells, and aditus ad antrum.

Contents of the Tympanic Cavity or Middle Ear

  • This cavity contains the auditory ossicles (malleus, incus and stapes); the stapedius and tensor tympani muscles; the chorda tympani nerve (a branch of the facial nerve, CN VII); and the tympanic plexus of nerves.

  •     Part of the axial skeleton; strong, flexible rod
        Supports the head
        Gives base to the ribs
        Encloses the spinal cord
        
    o    Vertebrae
        Consists of 34 bones composing the spinal column
    •    Cervical-7 bones
    •    Thoracic-12 bones
    •    Lumbar-5 bones
    •    Sacral- 5 bones.
    •    Coccygeal-4 to 5 bones

        In the adult the vertebrae of the sacral and coccygeal regions are united into two bones, the sacrum and me coccyx
        
    o    Curvatures-from a lateraI view there are four curves, alternately convex and concave ventrally
        Two convex curves are the cervical and lumbar
        Two concave curves are the thoracic and sacral

    o    Vertebra morphology

        Each vertebra differs in size and shape hut has similar components
        Body-central mass of bone
    •    Weight bearing
    •    Fonns anterior part of the vertebra
    •    Encloses the vertebral foramen
        Pedicles of the arch-two thick columns that extend backward from the body to meet with the laminae of the neural arch 

  •     Process (7)
    •    One spinous, two transverse, two superior articular, and two inferior articular
    o    Spinous process extends backward from the point of the union of thetwo laminae
    o    Transverse processes project laterally at either side from the junction of the lamina and the pedicle
    o    Articular processes arise near the junction of the pedicle and the lamina- superior processes project upward:inferior processes project downward
    •    Surfaces of the processes are smooth

    o    Inferior articular processes of the vertebra fit into the superior articular processes below
    o    Form true joints, but the contacts established serve to restrict movement

    Distinguishing features

    Cervical region- triangular shape

    •    All have foramina in the transverse process upper six transmit the vertebral artery
    •    Spinous processes are short
        o    C3 to C5 are bifurcated
        o    C7 is long-prominence felt at the back of the neck
    •    Have small bodies (except for C1 vertebra)
    •    C1 vertebra (atlas)
    o    No body
    o    Anterior and posterior arch and two lateral masses
    o    Superiorarticular processes articulate with the condyles of the occipital bone
    •    C2 vertebra (axis)-process on the upper surface of the body (dens) forms a pivot about which the axis rotates

    Thoracic region

    •    Presence of facets for articulation with the ribs (distinguishing feature)
    •    Processes are larger and heavier than those of the cervical region
    •    Spinous process is directed downward at a sharp angle
    •    Circular vertebral foramen

     Lumbar region
     
    •    Large and heavy bodies
    •    Four transverse lines separate the bodies of the vertebrae on the pelvic surface
    •    Triangular shape-fitted between the  halves of the pelvis
    •    Four pairs of dorsal sacral foramina communicate with four pairs of pelvic sacral foramina

    Sacral vertebrae 
    •    Five (sometimes six) vertebrae are fused in the adult to form the sacrum
    •    The sacrum articulates above with L5, laterally with the hip bones, and inferiorly with the coccyx.
    •    It has a roughly triangular appearance with a pelvic and dorsal surface, a lateral mass on each side, and a base and apex.
    •    An anesthetic for the spinal nerves may be injected extradurally through the sacral hiatus (caudal analgesia)
    •    The sacral canal (which contains the dura, cauda equina, and filum terminale) extends from the base to the sacral hiatus. 
    •    The apex of the sacrum may be fused with the coccyx.


    Coccygeal vertebrae

    •    Four to five modular pieces fused together
    •    Triangular shape with the base above and the apex below

    F Defects

    •    Lordosis-exaggerated lumbar concavity
    •    Scoliosis-lateral curvature of any region
    •    Kyphosis-exaggerated convexity in the thoracic region

 

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