Oral Cavity

Tongue, Salivary
gland & Palate

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 What is in the Oral Cavity?
 The oral cavity (or mouth)
consists of the teeth,
tongue, salivary glands,
cheeks, lips, palate (soft
and hard), and the floor of
the mouth.
 The mucosa of the hard
palate, cheeks, tongue,
and lips contain numerous
minor salivary glands that
secrete directly into the
oral cavity.
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 Oral Cavity (Mouth)
 Extends from the lips to the
oropharyngeal isthmus
 The oropharyngeal
isthmus:
 Is the junction of
mouth and pharynx.
 Is bounded:
 Above by the soft palate
and the palatoglossal
folds
 Below by the dorsum of
the tongue
 Subdivided into Vestibule &
Oral cavity proper

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 Vestibule
 Slit-like space between the
cheeks and the gums
 Communicates with the
exterior through the oral
fissure
 When the jaws are closed,
communicates with the oral
cavity proper behind the 3rd
molar tooth on each side
 Superiorly and inferiorly
limited by the reflection of
mucous membrane from lips
and cheek onto the gums

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 Vestibule cont’d
 The lateral wall of the
vestibule is formed by the
cheek
 The cheek is
composed of
Buccinator muscle,
covered laterally by the
skin & medially by the
mucous membrane
 A small papilla on the
mucosa opposite the
upper 2nd molar tooth
marks the opening of the
duct of the parotid gland

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 Oral Cavity
Proper
 It is the cavity within the
alveolar margins of the
maxillae and the mandible
 Its Roof is formed by the
hard palate anteriorly and
the soft palate posteriorly hard

 Its Floor is formed by the

mylohyoid muscle. The soft palate

anterior 2/3rd of the tongue

lies on the floor.

mylohyoid
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 Floor of the Mouth
 Covered with mucous
membrane
 In the midline, a mucosal
fold, the frenulum, connects
the tongue to the floor of the
mouth
 On each side of frenulum a
small papilla has the
opening of the duct of the
submandibular gland
 A rounded ridge extending
backward & laterally from
the papilla is produced by
the sublingual gland

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Nerve Supply
o Sensory
 Roof: by greater palatine and nasopalatine nerves
(branches of maxillary nerve)
 Floor: by lingual nerve (branch of mandibular nerve)
 Cheek: by buccal nerve (branch of mandibular nerve)

o Motor
 Muscle in the cheek (buccinator) and the lip (orbicularis
oris) are supplied by the branches of the facial nerve

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 Tongue
 Mass of striated muscles
covered with the mucous
membrane
 Divided into right and left
halves by a median septum
 Three parts:
 Oral (anterior ⅔)
 Pharyngeal (posterior ⅓)
 Root (base)
 Two surfaces:
 Dorsal
 Ventral

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Dorsal Surface
 Divided into anterior two
third and posterior one third
by a V-shaped sulcus
terminalis.
 The apex of the sulcus faces
backward and is marked by
a pit called the foramen
cecum
 Foramen cecum, an
embryological remnant,
marks the site of the upper
end of the thyroglossal duct

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 Dorsal Surface
 Anterior two third: mucosa is rough, shows three types of
papillae:
 Filiform: numerous slender projections that lack taste buds;
give the tongue its rough feel

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 Dorsal Surface
 Fungiform: larger mushroom-shaped papillae scattered on
the dorsum of the tongue’s surface; possess taste buds.
 Vallate; larger papillae that lie in a row just anterior to the
sulcus terminalis; possess taste buds

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Dorsal Surface
 Foliate: lie along the sides of
the tongue and are
rudimentary in humans;
possess taste buds
 Posterior one third: No
papillae but shows nodular
surface because of
underlying lymphatic
nodules, the lingual tonsils

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Ventral Surface
 Smooth (no papillae)
 In the midline anteriorly, a
mucosal fold, frenulum
connects the tongue with
the floor of the mouth
 Lateral to frenulum, deep
lingual vein can be seen
through the mucosa
 Lateral to lingual vein, a
fold of mucosa forms the
plica fimbriata

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Muscles
 The tongue is composed of two types of muscles:
 Intrinsic and Extrinsic

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 Intrinsic Muscles
 Confined to tongue
No bony attachment
Consist of:
 Longitudinal fibers
 Transverse fibers
 Vertical fibers
 Function: Alter the
shape of the tongue

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 Extrinsic Muscles
 Connect the tongue to
the surrounding
structures: the soft
palate and the bones
(mandible, hyoid bone,
styloid process)
 Include:
 Palatoglossus
 Genioglossus
 Hyoglossus
 Styloglossus
 Function: Help in
movements of the
tongue 17
 Extrinsic Muscles
 Origin
 The palatoglossus: from the palatine aponeurosis
and is inserted into the side of the tongue.
 Hyoglossus: from the greater horn of the hyoid
bone.
 Genioglossus: from the genial tubercle on the
back of the mandible.
 Styloglossus: from the styloid process.

 They blend in with the intrinsic muscles.

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 Movements
 Protrusion:
 Genioglossus on both sides acting together
 Retraction:
 Styloglossus and hyoglossus on both sides acting
together
 Depression:
 Hyoglossus and genioglossus on both sides acting
together
 Elevation:
 Styloglossus and palatoglossus on both sides acting
together

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20
Innervation

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 Sensory Nerve Supply
 Anterior ⅔:
 General sensations:
Lingual nerve
 Special sensations :
chorda tympani
 Posterior ⅓:
 General & special
sensations:
glossopharyngeal nerve
 Base:
 General & special
sensations: internal
laryngeal nerve
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 Motor Nerve Supply
 Intrinsic muscles:
 Hypoglossal nerve

 Extrinsic muscles:
 All supplied by the
hypoglossal nerve,
except the
palatoglossus

 The palatoglossus
supplied by the
pharyngeal plexus
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 Blood Supply
 Arteries: Lingual Dorsal lingual
artery & vein
 Lingual artery artery & vein

 Tonsillar branch of
facial artery
 Ascending
pharyngeal artery
 Veins:
Deep lingual
 Lingual vein, Hypoglossal vein
nerve
ultimately drains
into the internal
jugular vein
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 Lymphatic Drainage
 Tip:
Submental nodes
bilaterally & then deep
cervical nodes

 Anterior two third:

Submandibular
unilaterally & then
deep cervical nodes

 Posterior third:
 Deep cervical nodes
(jugulodigastric mainly)

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 Functions
 The tongue is the most important
articulator for speech production.
During speech, the tongue can
make amazing range of
movements
 The primary function of the
tongue is to provide a mechanism
for taste. Taste buds are located
on different areas of the tongue,
but are generally found around the
edges. They are sensitive to
four main tastes: Bitter, Sour,
Salty & Sweet

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 The tongue is needed for
sucking, chewing, swallowing,
eating, drinking, kissing,
sweeping the mouth for food
debris and other particles and
for making funny faces (poking
the tongue out, waggling it)
 Trumpeters and horn & flute
players have very well
developed tongue muscles, and
are able to perform rapid,
controlled movements or
articulations

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 Clinical Notes
 Lacerations of the
tongue
 Tongue-Tie
(ankyloglossia) (due to
large frenulum)
 Lesion of the
hypoglossal nerve
 The protruded tongue
deviates toward the
side of the lesion
 Tongue is atrophied &
wrinkled

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 Ankyloglossia (Tongue-Tie)
 This is a condition that
restricts the movement.
 lingual frenulum (piece of
skin under tongue) restricts
the movement of the tongue
which can cause difficulty
sticking their tongue out
 Sometimes it can loosen on
its own, but other times, it
has to be surgically cut to
remove issues of the patient
 This affects the ability to
function restricts the tongue’s
ability to help swallow, eat,
and breathe
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Ankyloglossia (Tongue-Tie):
Treatment
 The only treatment for this condition
cutting it to ensure that the tongue is now
free from any restriction
 Some doctors suggest the patients just
wait and see what will happens.

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 Clinical Notes
 Gag reflex : It is possible to touch the anterior part of the
tongue with out feeling discomfort. When the posterior part
is touched, the individual gags. CN IX, CN X, are
responsible for the muscular contractions of each side of
the pharynx.
 Paralysis of genioglossus: When this muscle is
paralyzed the tongue has a tendency to fall posteriorly ,
obstructing the airway and there is risk of suffocation. Total
relaxation of the genioglossus muscles occurring during
general anesthesia therefore an airway is inserted in an
anesthetized person to prevent the tongue from relapsing
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 Clinical Notes
 Ulcers of the tongue: Various types of ulcers are follows
 (i) Aphthous ulcers: is a small painful ulcer seen on
tip, under surface of the tongue in its anterior part.
(ii) Dental ulcer : is caused by mechanical irritation
either by a jagged tooth or denture.
 (iii) Syphilitic ulcer: mainly snail track ulcers ulcers in
second stage of syphilis.
 (iii) carcinomatous ulcers : It usually occurs in elderly
individuals above the age of 50 years . Common site is
at the margins particularly in anterior two third of the
tongue.
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‘If there is goodness in your heart,
it will come to your tongue’.
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 Teeth
 Teeth do most of the physical
breakdown in the digestive
system by crushing and
tearing food to be broken into
smaller pieces
 This process helps with the
saturating of materials with
salivary secretions and
enzymes and it breaks
connective tissue of meat and
the plant fibres of vegetation
 There are four types of teeth:
incisors, canines,
premolars, and molars

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Teeth
 The non-exposed part of the tooth
is the root and the exposed is the
crown (which is covered by
enamel- the hardest substance of
the body)
 Most of the tooth is made from a
mineralized matrix almost like
bone called dentin
 Another type of bony substance is
the cementum which covers the
root
 The chamber on the inside of the
tooth (pulp cavity) holds nerves
and blood vessels that come
through the root canal.
 Root canal is a small tunnel at the
bottom of the tooth
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Teeth
 Each root sits in a bony socket
to hold it in place called the
alveolus
 Some issues with the teeth are:
Gingivitis and Periodontal
disease
 Gingivitis-a disease that the
cells in the gingivae (gums)
break down and can lead to
infections from bacteria
 Periodontal disease-when the
gums recede from the teeth to
create erosion by bacteria
going into the gums. This
causes tooth loss

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Teeth
 There are 20 teeth in a child and 32 in an adult
 In adults, there are 16 teeth in the maxilla and
16 in the mandible.
 Branches of CN V-2 and the maxillary artery and
veins supply the maxillary teeth and gingivae.
 Branches of CN V-3, and the inferior alveolar
artery and veins supply the mandibular teeth
and gingivae.

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Clinical Notes
 Cavities (dental carries) are holes in the
teeth. Cavities form through the deposit of
food products on teeth, known as plaque.
 Bacteria inhabit the plaque and metabolize
carbohydrates into acids. Over time, the
acids dissolve the outer protection of the
tooth, the enamel, resulting in cavities.

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Clinical Notes
 Extraction of teeth
Impacted third molars become painful,
they have to be removed . when doing
this, caution is taken to avoid injury to
lingual nerve as this is closely related to
the medial aspect of teeth.

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 Palate
 Lies in the roof of
the oral cavity hard

 Has two parts:

 Hard (bony) soft palate

palate anteriorly
 Soft (muscular)
palate posteriorly

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 Hard Palate
 Lies in the roof of the
oral cavity
 Forms the floor of the
nasal cavity
 Formed by:
 Palatine processes of
maxillae in front
 Horizontal plates of
palatine bones
behind
 Bounded by alveolar
arches
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 Hard Palate
 Posteriorly,
continuous with soft
palate
 Its undersurface
covered by
mucoperiosteum
 Shows transverse
ridges in the anterior
parts

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Soft Palate
 The soft palate forms the soft, posterior segment
of the palate. It has a structure called the uvula,
which is suspended from the midline.
 The soft palate is continuous with the
palatoglossal and palatopharyngeal folds.
 Functionally, the soft palate ensures that food
moves inferiorly down into the esophagus when
swallowing, rather than up into the nose.

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Soft Palate

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 Soft Palate
 Attached to the posterior
border of the hard palate
 Covered on its upper and
lower surfaces by mucous
membrane
 Composed of:
 Muscle fibers
 An aponeurosis
 Lymphoid tissue
 Glands
 Blood vessels
 Nerves

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Muscles of Soft Palate
 There are five pairs of palatine muscles,
1. Tensor palati,
2. Levator palati,
3. Palatoglossus,
4. Palatopharyngeus and
5. Musculus uvulae.

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 Tensor Palati or Tensor Veli
Palatini
 Origin from the scaphoid fossa
at the base of medial pterygoid
plate, lateral (membranous)
wall of auditory tube and the
spine of sphenoid.
 It ends in a tendon, which
winds round the pterygoid
hamulus to turn medially
towards the pharynx. It
spreads out in the soft palate
to become the palatine
aponeurosis.
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Tensor Palati or Tensor Veli
Palatini
 Actions
1. The tensor palati is the tensor of the soft
palate.
2. It opens the auditory tube during deglutition
and yawning to equalize the air pressure
between the middle ear and the
nasopharynx.

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 Levator Palati or Levator Veli
Palatini
 Origin from the medial
(cartilaginous) wall of the
auditory tube and the part of
petrous temporal bone in
front of the lower opening of
carotid canal.
 It is inserted in the upper
surface of palatine
aponeurosis between the
two strands of
palatopharyngeus muscle.

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 Levator Palati or Levator Veli
Palatini
 Actions
 The contraction of muscles both sides raises
the soft palate towards the posterior wall of the
oropharynx.
 This action helps in closure of nasopharyngeal
isthmus during swallowing.

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Palatoglossus
 Origin from the oral
surface of the palatine
aponeurosis.
 Inserts into the side of
the tongue
 It is covered with
mucosa of oropharynx
and thus, forms the
palatoglossal arch
(anterior pillar of
tonsillar fossa). 52
Palatoglossus
 Actions
 The contraction of the muscles of both sides
elevates the base of the tongue and brings
the two palatoglossal arches in approximation
in order to close the oropharyngeal isthmus.

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Palatopharyngeus
 Origin from the palate by two slips,
anterior slip from the hard palate and the
posterior slip from the palatine
aponeurosis.
 The muscle attach to the posterior border
of the lamina of thyroid cartilage.

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Palatopharyngeus

 Actions
1. The muscle depresses the soft palate on the dorsum
of the pharyngeal part of tongue
2. The fibers that arise from the hard palate pass
horizontally backwards with the superior constrictor
and meet each other to form a circular muscular ridge
called Passavant’s ridge.
3. This muscular ridge is responsible for closure of
the nasopharyngeal isthmus

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 Musculus Uvulae
 These are the paired intrinsic
muscles.
 Each takes origin from the
posterior nasal spine of the
hard palate
 It is inserted in the mucosa of
the uvula. The palatine
aponeurosis splits to enclose
the musculus uvulae near the
midline.
 The action of these muscles is
to shorten and tense the uvula.
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 Palatine Aponeurosis

 Fibrous sheath
 Attached to posterior
border of hard palate
 Is expanded tendon of
tensor veli palatini
 Splits to enclose
musculus uvulae
 Gives origin & insertion
to palatine muscles

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 Sensory Nerve Supply
 Mostly by the maxillary
nerve through its
branches:
Greater palatine nerve
Lesser palatine nerve
Nasopalatine nerve
 Glossopharyngeal
nerve supplies the
region of the soft palate

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Motor Nerve Supply

 All the muscles, except tensor veli palatini,

are supplied by the:
Pharyngeal plexus (CN X)

 Tensor veli palatini supplied by the:

 Mandibular nerve through its branch to medial
pterygoid via otic ganglion.

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Motor Nerve Supply
 Paralysis of muscles of the soft palate may
occur in injury to the vagus nerve or due to
lesion of nucleus ambiguus in the medulla
oblongata (lateral medullary syndrome).
 This results in nasal regurgitation of food and
nasal voice.

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Secretomotor Nerve Supply
 The secretomotor supply to the palatine
glands is by the postganglionic fibers of
the sphenopalatine ganglion via the
palatine nerves.
 The preganglionic fibers arise in the
superior salivatory nucleus, travel in
nervus intermedius,

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 Blood Supply
 Branches of the maxillary
artery
Greater palatine
Lesser palatine
Sphenopalatine

 Ascending palatine, branch

of the facial artery

 Ascending pharyngeal,
branch of the external
carotid artery

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 Clinical Notes
o Cleft palate:
o Unilateral
o Bilateral
o Median
o Paralysis of the soft
Pharyngeal
palate isthmus

o The pharyngeal
isthmus can not be
closed during
swallowing and
speech
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Clinical Notes
o Inflammation of the palatine tonsils (tonsillitis)
is associated with difficulty swallowing and sore
throat.
o Because the palatine tonsils are visible when
inspecting the oral cavity, the tonsils of a patient
who has tonsillitis will appear enlarged and red.
o In cases of chronic tonsillitis, the tonsils may be
surgically removed (tonsillectomy) to ensure that
the patient can swallow and breathe properly.

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Salivary Glands
o The salivary glands
mainly make the mouth
moist and also start the
digestion of complex
carbohydrates before
swallowing
o They also moist and
lubricate food that is in
the mouth and they also
provide info about the
material in the mouth.
They can also dissolve
chemicals that can
stimulate the taste buds
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Salivary Glands  There are 3 types of salivary
glands:
 Parotid salivary gland,
 Sublingual salivary glands,
 Submandibular salivary gland.
 Each gland has a different
and irregular shape
 These glands are surrounded
by connective tissue and are
internally separated by lobes
 A condition that affects the
salivary glands is the mumps
virus. It is a swollen parotid
gland

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 Parotid Salivary Gland
 This gland secretes
the amylase that
breaks down carbs
 These secretions are
drained through the
parotid duct and
empties into a
vestibule at the upper
second molar
 25% of saliva comes
from this gland
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Sublingual Salivary Gland
 It is on the floor of the
oral cavity and it is
covered in mucous
membrane that lies on
the gland
 This gland creates a
watery secretion that
acts as a buffer and
lubricant
 The sublingual ducts
open underneath
lingual frenulum
 5% of saliva is
produced in this gland
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 The sublingual gland
 This is an almond-shaped
salivary gland lying
immediately in front of the
deep part of the
submandibular gland.
 Laterally, it rests against the
sublingual groove of the
mandible while
 Medially it is separated from
the base of the tongue by the
submandibular duct and its
close companion, the lingual
nerve. 69
 The sublingual gland
 The gland opens by a series of ducts into the floor of the
mouth and also in the submandibular duct.
 The sublingual gland produces a mucous secretion, the
parotid a serous secretion and the submandibular gland a
mixture of the two.

70
 The submandibular gland
 The submandibular gland is made up of a large superficial
and a small deep lobe which connect with each other around
the posterior border of the mylohyoid.
 The superficial lobe of the gland lies at the angle of the jaw,
wedged between the mandible and the mylohyoid and
overlapping the digastric muscle .

71
The submandibular gland
 Posteriorly it comes into contact with the parotid
gland, separated only by a condensation of its
fascial sheath (the stylomandibular ligament).
 Superficially, the gland is covered by platysma
and by its capsule of deep fascia, but it is
crossed by the cervical branch of the facial
nerve (VII) and by the facial vein.
 Its deep aspect lies against the mylohyoid for the
most part

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Submandibular Salivary Gland
 It creates a mixture of
buffers, amylase, and
glycoproteins called
mucins
 Submandibular ducts
are opened right after
the teeth, on either side
of the lingual frenulum
 This gland releases
70% of the saliva
created in the body
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 DUCTUAL OPENINGS INTO
THE ORAL CAVITY
 Parotid. The duct opens opposite the second maxillary molar.
 Submandibular. The duct courses medial to the lingual nerve
and opens into the area adjacent to the lingual frenulum
 Sublingual. The duct opens at the base of the tongue.

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INNERVATION OF THE
SALIVARY GLANDS
 The parasympathetic nervous system is
responsible for providing visceral motor
innervation to the salivary glands via the cranial
nerves
 Parotid gland. CN IX, via the otic ganglion.
 Submandibular gland. CN VII, via the
submandibular ganglion.
 Sublingual gland. CN VII, via the submandibular
ganglion.
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76
Applied anatomy
 The formation of calculus is more common in
the submandibular gland than in the parotid.
 A stone in the submandibular duct(wharton’s
duct) can be palpated bimanually in the floor
of the mouth and can even be seen if
sufficiently large.
 Of all tumors, mixed tumor is most common

77
Applied anatomy
 Sublingual:
 Mucous cyst (retention cyst) : Ranula,
sailoliths
 Inflammatory salivary gland diseases
 Tumors are uncommon

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