(Oral cavity & pharynx Dr. Kassim Raisan (19. 3.

2023

Anatomy
Oral cavity
Boundaries; vermilion border to junction of hard & soft palate, anterior tonsillar pillars
circumvallate papillae (linea terminalis).
Subunits include lip, buccal mucosa, upper & lower alveolar ridges (gingival mucosa),
retromolar trigons, oral tongue ( anterior to circumvallate papillae), hard palate, & floor of
mouth.

Pharynx (throat)
A tubular structure about 13 cm long that extends from the base of the skull to the
esophagus & is situated immediately in front of the cervical vertebrae. The pharynx serves
as a passageway for the respiratory & digestive tracts & changes shape to allow the
formation of various vowel sounds. The pharynx is composed of muscles, is lined with
mucous membrane, & is divided into the nasopharynx, oropharynx & laryngopharynx. It
contains the openings of auditory tubes, the openings of the two posterior nares, the
opening into the larynx & the opening into the esophagus.
Oropharynx
The oropharynx begins anteriorly at the circumvallate papillae, tonsillar pillars, & the
junction between the hard palate & the soft palate. The oropharynx extends vertically
from the inferior surface of the soft palate superiorly to the plane of the superior surface
of the hyoid bone. The oropharynx is divided into six subsites which include base of the
tongue, soft palate & uvula, palatine arch (including tonsillar fossae & pillars), valleculae
& lateral & posterior oropharyngeal walls.

Hypopharynx (laryngopharynx)
The vertical limits of the hypopharynx are the superior border of the hyoid bone & the
lower border of cricoid cartilage. It includes three subsites.
1. Pyriform sinus or fossa ( laryngopharyngeal sulcus), left & right.
2. Hypopharyngeal walls, lateral & posterior
3. Postcricoid region ( area of the pharyngoesophageal junction)
The postcricoid area extends from the arytenoid cartilages to the inferior aspect of the
cricoid. This watershed area connects the two pyriform sinuses, thus forming the anterior
wall of the hypopharynx.

Nasopharynx
The posterior choanae form the anterior limit of the nasopharynx. The nasopharynx is
divided into three subsites
1. Lateral walls ( including the fossa of Rosenmuller & torus tubarius)
2. Vault including the superior surface of the soft palate
3. Posterosuperior wall (extending laterally from the vault to the base of skull, including
the adenoid)

Major salivary glands and ducts

The major salivary glands include parotid, submandibular and sublingual glands,
each gland has a certain orifice position.
1.Parotid (Stenson’s duct); orifice is lateral to upper second molars.
2.Submandibular or submaxillary ( Wharton’s duct); orifice is in midline floor of mouth
adjacent to lingual frenulum.
3. Sublingual ( Rivinus’s ducts); multiple orifices draining into floor of mouth or into
submaxillary duct

Tongue
It is a muscular organ, the anterior two thirds is covered by Papillae including filiform (
no taste function), fungiform (diffuse), & foliate ( lateral tongue). The circumvallate
papillae are large & lie in a V shape at the junction of anterior & posterior portions of the
tongue.
The muscles of the tongue are extrinsic muscles which include genioglossus, hyoglossus,
styloglossus & palatoglossus while intrinsic muscles are superior & inferior longitudinal,
.vertical, & transverse

Sensory innervation
1. Anterior two-thirds (oral tongue): sensations of touch, pain, temperature transmitted via
lingual nerve (V3(. Taste sensation is transmitted via lingual nerve to chorda tympani
2. Posterior third (tongue base): touch & gag (visceral afferent) sensation is transmitted
via cranial nerve IX to nucleus solitarius.
Taste sensation from circumvallate papillae & mucosa of epiglottis & vallecullae to
nucleus solitarius of the pons via cranial nerve IX

Vascular supply
Lingual artery (second branch of external carotid artery) & lingual vein

Saliva of the mouth

1.Total of 1500 mL/day.
2. 99.5% of saliva is water with only 0.5% organic/inorganic solids

Waldeyer’s ring (internal Waldeyer’s ring)

Together, the lingual tonsils anteriorly, the palatine tonsils laterally, & the pharyngeal
tonsils (adenoids) posterosuperiorly form a ring of lymphoid or adenoid tissue around the
upper part of the pharynx known as Waldeyer’s tonsillar ring. All the structures of
Waldeyer’s ring have similar histology & presumably functions.
Palatine tonsils: composed of lymphoid tissue with germinal center containing 6 to 20
epithelium-lined crypts. There is a capsule over deep surface, separated from the superior
constrictor muscle by thin areolar tissue. The palatine tonsil is contiguous with the
lymphoid tissue of the tongue base (lingual tonsil).

Arterial blood supply to the tonsil

The main arterial is from tonsillar branch facial A.

Venous blood supply

Lingual vein

Disorders of the oral cavity & pharynx

Disorders of the oral cavity
Inflammation of oral mucosa
Stomatitis is the general term for any inflammatory disorder of the oral mucosa. It can be
associated with the following diseases;

1. Gingivitis; a condition in which the free gingival margins close to the teeth are red,
swollen, usually painless, & bleeding.

2. Periodontitis; Inflammation of the periodontium, which includes the periodontal

ligament, the gingiva, & the alveolar bone.

3. Acute necrotizing ulcerative gingivitis (ANUG, Vincent’ angina, trench mouth)

which is due to synergistic mixed anaerobic infection including Borrelia vincenti
(fusiform bacillus). The condition has an acute onset with necrosis & ulceration of the
gums. Symptoms are pain, fetid odor to the breath, excessive salivation, & bleeding
gingiva. Treatment is oral hygiene, analgesics & antibiotics.

4. Herpetic gingivostomatitis & herpes labialis are usually due to human herpes
simplex virus (HHV-1) & rarely due to (HHV-2) which always causes herpes genitalis.
Herpes labialis is the most common viral infection of the mouth. The primary herpes
labialis develops approximately 5-7 days subsequent to contact with an infected person. A
prodrome lasting up to 48 hours can be characterized by focal mucosal tenderness &
erythema, quickly followed by evidence of group of small vesicles over the oral mucosa.
Such vesicles are thin-walled, delicate, & short-lived. An inflammatory periphery
surrounds each vesicle followed by the development of shallow, painful & discrete
superficial ulcerations. The duration of the entire process ranges from 7 to 14 days with a
generally self-limiting course. The treatment is generally to be symptomatic & supportive
in nature as the patient develops antibodies to the infectious agent.
5. Thrush (candidiasis of the tissues of the mouth), the condition is characterized by the
appearance of creamy white patches of exudate on an inflamed tongue or oral mucosa. It
is usually a benign condition in normal children, but may be a sign of AIDS in young
adults, in the elderly, or in patients who are using inhaled steroids, or patients who have
received radiation & have decreased salivary gland output. Topical or systemic therapy
may be used for treatment.

6. Pyogenic granuloma. A small nonmalignant mass of excessive granulation tissue,

usually found at the site of an injury, most often a dull red color & bleeds easily. When
forms on gingiva, termed epulis.

7. Mucositis commonly encountered as a result of chemotherapy or radiation therapy.

Noninfectious lesions
A. Recurrent aphthous stomatitis or recurrent aphthus ulcers (Sutton disease);
represents the most common nontraumatic form of oral ulceration with an incidence
range between 20% & 40% of population. This remains an incompletely understood
mucosal disease, chiefly affecting the oral & oropharyngeal mucosa & less
commonly, the genital mucosa. Of note are data indicating a greater prevalence
among those in professional groups, those of higher socioeconomic status, &
nonsmokers. The predisposing factors are stress, hormonal alterations, nutritional
deficiencies ( B12, folate, iron), food allergies (nuts, chocolate, gluten) &
immunologic abnormalities.
Treatment
Mild & infrequent episodes of minor aphthus ulcers generally require little more than
 symptomatic management. When treatment is necessary, the general mainstay is the use
of topical steroids. When lesions are severe or occur as a continuous series of outbreaks,
short-term systemic steroids are effective.

B. Behcet’s disease
Oral ulcerations, conjunctivitis, iritis & urethritis.

Other oral cavity lesions

1. Leukoplakia (white plaque). A white, hyperkeratotic lesion that may or may not be
associated with dysplastic change on histologic examination. It occurs most frequently on
the lip (vermilion), buccal mucosa, mandibular gingiva, tongue & floor of the mouth. Less
than 10% of cases will demonstrate carcinoma or severe dysplasia on biopsy.
2. Erythroplakia (red plaque). A granular erythematous area often encountered in
association with erthroplakia. About 50% will demonstrate severe dysplasia or carcinoma
in situ on biopsy.
3. Hairy tongue: due to hyperplasia of the filiform papillae. It may be black, blue, brown,
or white depending on microflora & nicotine staining, & is often associated with candida
overgrowth. It is asymptomatic, but for its appearance.
Treatment; by mechanical brushing or scraping of the dorsum of the tongue.

4. Ranula: a mucocele of the sublingual gland that presents in the floor of the mouth. If it
penetrates the mylohyoid muscle & presents as a soft submental neck mass, it is termed a
plunging ranula.
Treatment; is excision of entire sublingual gland in order to prevent recurrence.

5. Torus palatini: a benign excessive bone growth in midline of palate that continues to
enlarge beyond puberty. Occasionally it must be removed in order to prevent denture
irrigation.
6. Geographic tongue; irregularly shaped areas of depapillation occur over the dorsum of
the tongue. The patches vary in size & distribution over a period of days & it affects 1%
of the population. No treatment is needed.