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Anatomy

The Cheeks

  • The cheeks (L. buccae) form the lateral wall of the vestibule of the oral cavity.
  • They have essentially the same structure as the lips with which they are continuous.
  • The principal muscular component of the cheeks is the buccinator muscle.
  • Superficial to the fascia covering this muscle is the buccal fatpad that gives cheeks their rounded contour, especially in infants.
  • The lips and cheeks act as a functional unit (e.g. during sucking, blowing, eating, etc.).
  • They act as an oral sphincter in pushing food from the vestibule to the oral cavity proper.
  • The tongue and buccinator muscle keep the food between the molar teeth during chewing.

Sensory Nerves of the Cheeks

  • These are branches of the maxillary and mandibular nerves.
  • They supply the skin of the cheeks and the mucous membrane lining the cheeks.

Muscles Moving the Auditory Ossicles

The Tensor Tympani Muscle

  • This muscle is about 2 cm long.
  • Origin: superior surface of the cartilaginous part of the auditory tube, the greater wing of the sphenoid bone, and the petrous part of the temporal bone.
  • Insertion: handle of the malleus.
  • Innervation: mandibular nerve (CN V3) through the nerve to medial pterygoid.
  • The tensor tympani muscle pulls the handle of the malleus medially, tensing the tympanic membrane, and reducing the amplitude of its oscillations.
  • This tends to prevent damage to the internal ear when one is exposed to load sounds.

 

The Stapedius Muscle

  • This tiny muscle is in the pyramidal eminence or the pyramid.
  • Origin: pyramidal eminence on the posterior wall of the tympanic cavity. Its tendon enters the tympanic cavity by traversing a pinpoint foramen in the apex of the pyramid.
  • Insertion: neck of the stapes.
  • Innervation: nerve to the stapedius muscle, which arises from the facial nerve (CN VII).
  • The stapedius muscle pulls the stapes posteriorly and tilts its base in the fenestra vestibuli or oval window, thereby tightening the anular ligament and reducing the oscillatory range.
  • It also prevents excessive movement of the stapes.

 
Anterior 2/3 of tongue Posterior 1/3 of tongue
Motor Innervation All muscles by hypoglossal nerve (CN XII) except palatoglossus muscle (by the pharyngeal plexus)
General Sensory Innervation
Lingual nerve (branch of mandibular nerve CN V3) Glossopharyngeal nerve (CN IX)
Special Sensory Innervation
Chorda tympani nerve (branch of facial nerve) Glossopharyngeal nerve (CN IX)

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.

The Skeleton of the Nose

  • The immovable bridge of the nose, the superior bony part of the nose, consists of the nasal bones, the frontal processes of the maxillae, and the nasal part of the frontal bones.
  • The movable cartilaginous part consists of five main cartilages and a few smaller ones.
  • The U-shaped alar nasal cartilages are free and movable.
  • They dilate and constrict the external nares when the muscles acting on the external nose contract.

 

The Nasal Cavities

  • The nasal cavities are entered through the anterior nares or nostrils.
  • They open into the nasopharynx through the choanae.

 

The Roof and Floor of the Nasal Cavity

  • The roof is curved and narrow, except at the posterior end.
  • The floor is wider than the roof.
  • It is formed from the palatine process of the maxilla and the horizontal plate of the palatine bone.

 

The Walls of the Nasal Cavity

  • The medial wall is formed by the nasal septum; it is usually smooth.
  • The lateral wall is uneven owing to the three longitudinal, scroll-shaped elevations, called the conchae (L. shells) or turbinates (L. shaped like a top).
  • These elevations are called the superior, middle and inferior conchae according to their position.
  • The superior and middle conchae are parts of the ethmoid bone, whereas the inferior conchae are separate bones.
  • The inferior and middle conchae project medially and inferiorly, producing air passageways called the inferior and middle meatus (L. passage). Note: the plural of "meatus" is the same as the singular.
  • The short superior conchae conceal the superior meatus.
  • The space posterosuperior to the superior concha is called the sphenoethmoidal recess.

o    English: all speech sounds produced by making exhaled air audible

o    Two ways of producing sound
    at larynx
    further up in vocal tract (tongue, lips)
    
o    How to produce sound at larynx
    changes in breathing: regulate airstream from lungs to atmosphere by changing movements of vocal folds, pharynx, soft-palate, tongue, lips and jaws
    
•    inhalation: take in greater volume more quickly, abduct folds

•    expiration: variable force; use muscles of inhalation to control rate of expiration, adduct

    How to vibrate vocal cords
    
•    NOT rhythmic contraction of laryngeal muscles: would be impossible b/c frequenceies of virbration
•    Changes in air pressure cause vibrations


    o    Adduct folds increase in subglottal pressure force folds apart folds sucked back together (Bernouilli effect)
•    The vibration of vocal cords disturbs airareas of low pressure (rarefaction) alternating with areas of high pressure (compression)
•    Changes in pressure sound at ears
•    Sine waves

    o    Changes in amplitudes: loudness

    o    Changes in frequency: pitch

    o    Normal sounds have fundamental frequency, overtones or harmonics

    o    Mass of folds: critical in voice
    Low pitch of lion’s roar: due to massive fibrous pad that forms part of vocal cords
    Men: more massive vocal cords
    Larger foldsslow vibrationdeeper voice

    o    Producing vowels and constants
    Most vowels are “voiced”: vocal folds produce sounds
    Consonants: can be “voiced” (Z) or “non-voiced” (S)
•    Use higher regions of vocal tract to control by stopping, restricting airflow from vocal folds; use lips, teethaperiodic sound

o    Vocal folds and resonators emphasize and deemphasize certain frequencies
    Never hear sounds produced at vocal foldsevery sound changed by passage thru vocal tract: sinuses/resonating chambers
    Howling monkeys: large hyoid bonepowerful resonator

    o    Age-related changes in voice
    
    Infant larynx is smaller, different proportions
•    Arytenoids are proportionately larger
•    Smaller vocal apparatushigher pitch
•    Larynx sits higher easier to breathe thru nose
    Abrupt change in larynx at pubertycan’t control voice
    Older adult: normal degenerative changes in lamina propria, ossification of thyroid cartilagechanges in fundamental frequency
    Lose your voice vocal fold are irritated
•    Can’t adduct foldsair escapes

o    Singing v. speaking
    Singing: greater thoracic pressure and uneven breathing with changes in resonators

    o    Whispering
    Intercartilaginous portions of vocal folds: open to allow air to escapelesser subglottal pressureslittle vibration of foldslittle tonal quality, low volume

    o    Falsetto
    Allowing only part of vocal folds to vibrate
    Increase range by training which part of vocal folds to vibrate

    o    Colds
    Mucus secretions add mass to folds—decrease in pitch, can’t adduct folds as well

    o    Surgeryscars, fibrotic changes can interfere with voice

-> This is a wedge-shaped bone (G. sphen, wedge) is located anteriorly to the temporal bones.
-> It is a key bone in the cranium because it articulates with eight bones (frontal, parietal, temporal, occipital, vomer, zygomatic, palatine, and ethmoid).
-> It main parts are the body and the greater and lesser wings, which spread laterally from the body.
-> The superior surface of its body is shaped like a Turkish saddle (L. sella, a saddle); hence its name sella turcica.
-> It forms the hypophyseal fossa which contains the hypophysis cerebri or pituitary gland.
-> The sella turcica is bounded posteriorly by the dorsum sellae, a square plate of bone that projects superiorly and has a posterior clinoid process on each side.
-> Inside the body of the sphenoid bone, there are right and left sphenoid sinuses. The floor of the sella turcica forms the roof of these paranasal sinuses.
-> Studies of the sella turcica and hypophyseal fossa in radiographs or by other imaging techniques are important because they may reflect pathological changes such as a pituitary tumour or an aneurysm of the internal carotid artery. Decalcification of the dorsum sellae is one of the signs of a generalised increase in intracranial pressure.

 

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