DIGESTIVE SYSTEM: Introduction

Oral cavity
GIT
Functions: it supplies the organism
by energetic and trace nutrients
Digestive
Two processes:
system
•mechanic and chemic decomposition of food
•absorption of chemical components
into intrinsic environment of organism

Petr Hajek
Dpt. of Anatomy Hradec Kralove
 Directions:
Organs which compose the digestive system may be divided:  oral
A) by location:
- in head & neck (oral cavity, salivary glands, pharynx,
 aboral
(= distal)
cervical part of esophagus)
- in thorax – in mediastinum (thoracic part of esophagus)
- in abdominal cavity & lesser pelvis
a) in peritoneal cavity (abdominal part of esophagus, stomach,
small & large intestines except duodenum and part of rectum,
liver)
b) in retroperitoneal space (duodenum and pancreas)
c) subperitoneal organs (distal part of rectum)  mesenteric
B) by the structure - tube → antimesenteric
- gland
Arrangement of wall of digestive tube
•Mucosa
- epithelium (stratified squamous,
or monolayer cylindric)
- folds, villi, lymphoid follicles
•Submucosa
- vascular and nervous plexuses
•Muscle layer
- striated or smooth muscle tissue
- circular and longitudinal layers
- local strengthening: sfincters, teniae)
•Serosa (visceral peritoneum, it passes into
parietal peritoneum by reduplications)
or adventitia – connective tissue
Rathke’s pouch Development
- adenohypophysis
branchial arches (mesenchyme)
branchial pouches (end.) x branchial clefts (ekt.)

stomodeum foregut

tongue (end.)
thyroglossal duct

source for lower

respiratory tract
source for liver and pancreas
midgut
yolk duct
proctodeum
hindgut
 thyroid gland
Branchial arches Branchial pouches
1. Bones - mandibula, 1
malleus, incus 1. auditory tube
Muscles - masticatory mm
2. B- hyoid bone, 2
styloid process, stapes 2. palatine tonsil
M- mimetic muscles
3. B- great horns of hyoid b. 3
M- muscles of pharynx 3. thymus,
inf. parathyroid glands
4-6. B- cartilages of larynx 4
M- muscles of pharynx 4. sup. parathyroid glands
and larynx
5
mesenchyme 5. parafolicular cells of thyroid gl.

ektoderm 6

endoderm Branchiogenic organs

 Oral cavity = cavum oris
The walls:
ventrally – lips (labia oris); oral slit (rima oris)
dorsally – fauces
laterally – cheeks (buccae)
cranially – palate
caudally – floor of the mouth (= mylohyoid m.)

proper cavity

vestibule
Vestibule
sup. & inf. vestibular fornix
frenulum of lip
parotid papilla

Communications with proper

cavity:
- gaps between neighbor teeth
(interdental spaces)
- behind dental arches
(retromolar trigone)
Proper oral cavity
contains:
teeth (dentes)
tongue (lingua)
palate (palatum)
palatine tonsil (tonsilla
palatina)
salivary glands
isthmus of fauces
Lips
Tissues: skin with hair & sebaceous glands
orbicularis oris muscle
mucose with non-keratinized epithelium &
small salivary glands

Demarcation
labium sup. - nasolabial groove
labium inf. - mentolabial groove

x red area of the lip = transitional zone

- skin with reduced pigmentation

Clinical tip: cleft lip – usually at the level

between the 2nd a 3rd tooth
Blood and nerve supply of lips & cheeks
A. facialis → a. labialis sup.& inf.
A. temporalis superficialis → a. transversa faciei
A. maxillaris → a. buccalis

V. facialis
V. transversa faciei → v. retromandibularis
V. faciei profunda → pl. pterygoideus

Nodi submentales, submandibulares

Innervation
sensory: n.V/2 → n.infraorbitalis, zygomaticus
V/3 → n.mentalis, buccalis
motor: n.VII
 Tongue - lingua (Latin), glossa (Greek)
epiglottic valleculae
glossoepiglotic folds
(both belong to pharynx)
root (radix)
terminal sulcus for. cecum

body (corpus)
dorsum margin

apex
Lower surface of tongue

fimbriate fold
deep lingual vein
frenulum
 Muscles of tongue
Connective tissue: skeleton of tongue, shape of „T“
lingual aponeurosis, lingual septum
Muscles: Extraglossal muscles: genioglossus m.
hyoglossus m.
styloglossus m.
palatoglossus m.
Intraglossal muscles – 3D network of fascicles in mass of tongue,
by direction:
sup., inf. longitudinal m. of tongue
transverse m. of tongue innervation – CN. XII
vertical m. of tongue except the palatoglossus (IX)
 Vessels of tongue
Deep cervical nodes

Lingual a.+v. nodus jugulodigastricus

(Küttner’s node)
nodus juguloomohyoideus

Submandibular nodes

Submental nodes
Inervation X
autonomic:

sensory IX

special sensory parasympathetic

(taste) submandibular ggl.

motor:
n. XII V/3
VII sympathetic
lingual plexus
(except the
palatoglossus)
 Palate
Hard palate
Soft palate (velum palati)
palatine aponeurosis – tendinous skeleton of the soft palate, with
insertions of muscles
Vessels & nerves:
Descending palatine a. ( maxillary a.),
ascending palatine a. ( facial a.)
Venous pterygoid plexus, pharyngeal plexus
Submandibular nodes, deep cervical nodes
Innervation - sensory: V/2 lesser & greater palatine nn., nasopalatine n.
- motor: IX, V/3 (the tensor)
 levator veli palatini m.

palatoglossus m.
palatopharyngeus m.
tensor veli palatini
V/3
innervation:
dilation of the Eustachian tube
pharyngeal plexus IX (+X)
musculus uvulae
Isthmus of fauces (oropharyngeal isthmus):
uvula
palatoglossal and palatopharyngeal arches (ant. & post. pillars)
tonsillar sinus (fossa, bed) - palatine tonsil
 Dentition
forms the upper & lower arches (arcus dentalis sup.& inf.)

occlusal surface
upper arch – half of ellipse lower - parabola
mesial direction
distal
mesial
labial

oral
distal
Parts of the tooth: Tissues:

crown enamel

pulp
neck
dentin

root
cement
root apex

pulp cavity, root canal

Periodontium
system of connective tissue fibers holding the tooth in alveolus

Parodontium – all tissues around neck and root of tooth:

gingiva, periodontium, cement, bone of alveolus
Gingiva – gum = –mucose
Parodontium all tissues around covering
membrane neck and alveolar
root of tooth:
processes,
gingiva, isperiodontium, cement, with
firmly grown together boneperiosteum
of alveolus
 kind of tooth - number of tubercles - number of roots
I cutting edge 1
C Types of the
2 oblique teeth:
edges → 1 1
P 2 1 (2)
ParticularM
teeth differ by shape,
- upper numbers
4 ; grooves of occlusal
to shape „H“ tubercles
3 and roots
- lower 4 (5) ; grooves to cross 2
Permanent dentition = 32 teeth in 4 quadrants
1 quadrant contains: 2 incisiors, 1 canine tooth, 2 premolars, 3 molars

How to express :
ATTENTION!!
Number of a quadrant 1 2 1) Numbers of quadrants
make a circle.
4 3 2) Pacient‘s left side
is at your R hand.
+ order of a tooth in the dental arch

Use numbers to express: left upper first premolar. 24

Milk (deciduous) dentition = 20 teeth in 4 quadrants
1 quadrant contains: 2 incisiors, 1 canine tooth, 2 molars.
No premolars

How to express:

Number of a quadrant 5 6

8 7

+ order of a tooth in the dental arch

Use numbers to express: right lower first molar of milk dentition.

84
Eruption of the teeth
i1 6th-8th M M1 6-8Y
i2 7th-12th M (the upper is sooner) I1 6-7Y
m1 12th-16th M I2 7-9Y
c 15th-20th M
m2 20th-30th M P1 9 - 11 Y
C 9 - 14 Y
P2 11 - 14 Y
M2 10 - 15 Y

M3 17 - 30 Y
Features of milk teeth
*all sizes are smaller, low & rounder crowns
*whiter color of crowns
*shorter lifetime period – sooner abrasion, decline of roots
*wide distance of molar roots
Differences of left and right side
*angle of the crown is sharper on the mesial side
*root is turned to the distal side
Sex differences – smaller female canine teeth (in general, teeth are not
apposite for determination of sex)
Variations – of shape of separate teeth (numbers of tubercles,…)
- of numbers of teeth (e.g. accessory upper incisor in the midline)
- of position of separate teeth (e.g. horizontal position of distal molar)
- of placement (= dystopia, e.g. distal molar in branch of mandible)
- of occlusion (prognathism,…)
Changes of teeth during a life
*abrasion of both occlusal and neighbor facets → mesial shift
*decline of gum → reduction of alveolar processes
Occlusion = relation, reciprocal position of teeth

Normal occlusion: orthognathism

(upper and lower incisors are like
halves of the scissors)
Malocclusions: prognathism, …
 Blood & nerve supply of teeth
V/2 N. - sup. post. alveolar br.
sup. ant. alveolar br.
V/3 N. - inf. alveolar n.

dental plexus (sup., inf.)

dental, gingival br.

sup. post. alveolar aa.

sup. ant. alveolar aa.
inf. alveolar a.

vv. – along arteries into

the pterygoid plexus

submandibular nodes and

submental nodes (incisors) (x M3 - deep cervical)
 Salivary glands
- small – in mucosa of oral cavity
(labial, buccal, lingual, palatine glands)
- large
Parotid gland
Position: behind the masseter m.
Parotid duct (Stenon’s) meets vestibulum of oral cavity at the
level of upper M2
Vessels : superficial temporal a., post. auricular a., maxillary a.
parotid veins → retromandibular v.
parotid nodes → superficial and deep cervical ln.
Nerves - parasympathetic innervation: n. IX (→ tympanic n. →
lesser petrosal n. → otic ggl.)
Parotid gland - topography: parotideomasseteric region
parapharyngeal space

parotideomasseteric fascia
parotid f.- deep sheat

N.VII
Submandibular gland
Position: submandibular triangle
Submandibular duct – ascends and turns around posterior border of the
mylohyoid m. → it forms content of the sublingual space → opens on
sublingual caruncle under the apex of tongue
Vessels: facial & lingual a.+ v.; submandibular nodes
Sublingual gland
Position: sublingual space (between the tongue and mylohyoid m.)
Ducts: major sublingual duct - opens on sublingual caruncle
minor sublingual ducts – short ducts straight up into oral cavity
Vessels: sublingual & submental a.+ v.; deep cervical nodes

Both these glands are innervated by parasympathetic fibers coming from

n.VII and relayed in submandibular ggl.
sublingual fold
sublingual
.
.
. . caruncle
 Sublingual space
sublingual gl.
submandibular d.
sublingual a.
lingual n.
hypoglossus n.
comitans v.
Clinical tips:
- spreading inflamation from dental roots into submandibular trig.
- sialolithiasy (small stones from saliva inside submandibular duct)
Pharynx

fm

nasal part – choanae

C2 oral part –
C3
isthmus of fauces
C4 laryngeal part –
laryngeal inlet
(aditus laryngis)
 Muscles of pharynx
- sphincters - circular course
m. constrictor pharyngis sup.
m. constrictor pharyngis med.
splanchnocranium
m. constrictor pharyngis inf.

- levators
m. stylopharyngeus
hyoid m. palatopharyngeus
m. salpingopharyngeus
laryngeal cartilages
pharyngeal raphe
lymphatic tissue in the pharynx
Lymphatic circle of Waldeyer
3 protective barriers

retropharyngeal nodes

pharyngeal tonsil
tubal t.
palatine t.
Wood’s node
lingual t.
nodus jugulodigastricus
(Küttner’s node)

deep cervical nodes

- lower group
I. Tonsils:
Pharyngeal t.
Tubal t. II.
Retropharyngeal nodes
Palatine t. Wood’s node -
=„advanced“ deep cerv.nod.
Lingual t.
Nodus jugulodigastricus
m. digastricus (Küttner’s node)
m. omohyoideus Nodus juguloomohyoideus
v. jugularis int. = upper deep cerv. nodes

III.
Lower group of deep cervical nodes
 Blood and nerve supply of the pharynx

Arteries - a. pharyngea asc., a. palatina asc., a. palatina desc.

Veins - plexus pharyngeus
Nerves - motor: pl. pharyngeus IX, X
- sensory: IX, X ; V/2 (nasopharynx)
- vegetative: parasympathetic - IX
sympathetic - ggl. cervicale sup.
 Spaces around the pharynx

Styloid
1) Parapharyngeal septum
space
Cervical
1a) prestyloid fascia:
superficial
1b) retrostyloid * layer
prevertebral
(deep) layer
2) Retropharyngeal
space Alar fascia
“danger space“ (intercarotid)

* int. jugular v., n. IX-XII, int. carotid a., ascending pharyngeal a.