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Chonticha Srivanitchapoom, M.D.

Otolaryngology Department, Faculty of Medicine

Nov 14th ,2012

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Anatomy of oral cavity, pharynx, nose, paranasal sinus ,salivary gland & neck

Basic examination of oral cavity and associated structure

Common & emergency diseases of oral cavity and associated structure

Referral the patient to otolaryngologist

Cumming, Otolaryngology Head & Neck surgery 4th ed, 2005

Bailey, Head & Neck Surgery Otolaryngology 4th ed, 2006

Update in practical ear nose and throat IV 2003

Bull, Color Atlas of ENT Diagnosis 2003

Netter, Head and neck anatomy for dentistry 2nd ed, 2012

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Examination of ENT tonsil & air sinus

◦ Antomy

◦ Basic examination & investigation

ENT tonsil & air sinus diseases related to dental

◦ Sinonasal diseases

◦ Tonsillar diseases

◦ Deep neck infection

◦ Salivary gland diseases

◦ Oral cavity carcinoma

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nasopharynx

oropharynx

hypopharynx

epiglottis

False vocal cord

pyriform Arytenoid, corniculate, cuneiform cartilage

True vocal cord

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Nose Maxillary sinus

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Oral cavity Neck

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Anatomy : nose

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Bony structure of septum

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Anatomy : nose

Nasal turbinate

Opening of ◦ Sinus ◦ Nasolacrimal duct ◦ Eustachain tube(nasopharynx)

Anatomy : nose & PNS opening

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Bony structure of lateral wall

1. Nasal bone

2. Lacrimal bone

3. Inferior concha

4. Palatine bone

5. Sphenoid bone

6. Frontal bone

7. Maxillary bone

8. Vomer

9. Perpendicular plate of ethmoid

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Anatomy : nose

Anatomy : nose

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1.External carotid a.system 1.1 maxillary a.

-sphenopalatine a. -descending palatine a. -infraorbital a.

1.2 facial a. -sup. labial a. 2. Internal carotid a.system 2.1 opthalmic a.

-post ethmoidal artery -ant ethmoidal artery -dorsal nasal artery

Anatomy : nose

Nerve supply Anatomy : nose

Sensory innervation => Olfactory nerve (olfaction), Ophthalmic & maxillary division of CN V (general

sensation) Autonomic innervation=> through the sensory br of

maxillary division of CN V

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Anatomy : paranasal sinus

Anatomy : PNS

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Anatomy : PNS (lateral view)

Anatomy : PNS

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Anatomy : PNS (axial view)

Anatomy : PNS

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Anatomy : PNS & lateral wall of nose

Maxillary sinus opening

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Rigid endoscopy

Imaging

◦ Plain film (Caldwell’s view, Waters’ view, submentovertex view & lateral view)

◦ CT scan

◦ MRI

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1. Lip 2. Alveolar ridge 3. Hard palate 4. Retromolar

trigone 5. Buccal mucosa 6. Oral tongue 7. Floor of mouth

Branches of external carotid arteries

Vascular supply

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Branch of

• Glossopharyngeal nerve ( CN IX)

• Trigeminal nerve (CN V)

• Facial nerve (CN VII)

Nerve supply

Muscle of mastication

Muscle of tongue : extrinsic & intrinsic muscle of tongue

Muscle of soft palate group

Muscular part

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Taste zone and taste bud

Parotid gland Stensen’s duct

opening at upper 2nd molar

Main of serous secretion

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Submandibular gland

Wharton’s duct opening

Mixed of serous & mucous secretion

Largest duct (duct of

Batholin) & small duct (duct

of Rivinus) ,some drain into submandibular gland, some opening in elevated crest of mucous membrane (plica sublingualis)

Main of mucous secretion

Sublingual gland

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• Salivary gland and opening

Submucosal of upper aerodogestive tract

Oral cavity : hard palate, buccal, lip, pharyngeal wall

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Plain film

◦ Bony lesion

◦ Calcification : sialolithiasis

Sialography

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Tonsil / Base of tongue / Soft palate/ Oropharyngeal wall

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◦ A pair of tubal tonsils

◦ A pair of palatine tonsils

◦ A single lingual tonsil

◦ A single pharyngeal tonsil

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Superficial cervical fascia Deep cervical fascia ◦ Superficial Lower : sternum, clavicle, scapular, cervical

spine Upper : lower border of mandible, zygomatic

arch, mastoid, superior nuchal line ◦ Middle Middle cervical fascia “ muscular part” Cervical visceral fascia “visceral part” Carotid sheath “3 layers of deep cervical fascia”

◦ Deep Prevertebral fascial Alar fascia

Deep space of neck

(potential space)

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Fibrous connective tissue connecting from ◦ Lower : shoulder,

chest wall, axillar ◦ Upper : lower border

of mandible Content in this layer :

platysma muscle, subcutaneous fat, external jugular vein, superficial cervical lymph node

Lower : sternum, clavicle, scapular, cervical spine

Upper : lower border of mandible, zygomatic arch, mastoid, superior nuchal line

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Muscular part Visceral part Carotid sheath

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