General Anatomy of Gastro-IntesTinal

System

The Teeth,Oral CavityTongue, Salivary Glands,

Pharynx. Their Vessels and Innervation

Ivo Klepáček

GIT

Digestive System:

Oral cavity (ectodermal origin)

The gut and ist derivatives (entodermal origin) is divided in four sections:

1. Pharyngeal gut or pharynx2. Foregut - esophagus, stomach, ¼ of duodenum, liver

and gallblader, pancreas3. Midgut – ¾ of duodenum, jejunum, ileum, colon

caecum, colon ascendens and 2/3 of colon transversum4. Hindgut – 1/3 of colon transversum, colon descendens,

colon sigmoideum, colon rectum, canalis analisGIT

Function Structure Accessory glands

Digestio

Absorptio

Eliminatio

Glandulae salivariae

Pancreashepar

Cavum oris

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Primordium of the alimentarycanal (GastroInTestinal Canal)

● GIT develops together with respiratory system –systema gastropulmonale –

● it develops from the embryonal intestine (entoderm); lower respiratory structurses are splitted from intestine as a tracheobronchial pouch

● Ventral (head) intestine part is added to ectodermal pouch called stomodeum, caudal part of the intestine is added to ectodermal pouch called proctodeum

● Division of the alimentary tract: ● 1) oral ectodermal segment

2) main entodermal segment3) caudal ectodermal segment

● děivision of the main segment:● ventral gut (foregut – to biliary duct opening)

middle gut (midgut – to 2/3 colon) dorsal gut (hindgut – to upper part of the anal canal

tracheobronchial pouchGIT

Alimentary tube (canal) -

general structure– tunica mucosa (mucous membrane)

1• epithelium• lamina propria mucosae (lymph tissue)• lamina muscularis mucosae

– tunica submucosa (submucouslayer) – vessels, nerves (plexus submucosus Meissneri)

– tunica muscularis (outer + inner muscular layer) – longitudinal, circular even plexiform; vessels, nerves (plexus myentericus Auerbachi)

– tunica serosa (serous layer) ortunica adventitia (fibrous layer) 14

salivary glands (glandulae salivariae)pancreasliver (hepar)gall bladder and bile ducts (vesica fellea, ductus choledochus)

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Maxilla and Mandible formation

48 day

35 day

14 week

28 day

Philtrum, Nasolacrimal

groove, Lacrimal sac,

Cheeks, Maxillae,

Nose

Frontonasal maxillary

et mandibular

processesGIT

Development of the facialskeleton, formation of the nasal

and oral cavities● Primitive lips:

– week 6 - ectoderm ingrowth to mesenchyme in developing jaw – formation of the labiogingival lamina

● lamina splits into two layers separated by groove● central part of upper lip (known as a philtrum

develops from the intermaxillary segment)

Primitive oral cavity -stomodeum

depression lined by ectoderm and oropharyngeal membranemargines:

lower processes (mandibular) from the 1. pharyngeal arch -laterally of them upper processes (maxillary)of the 1. pharyngeal arch superiorly frontonasal process where nasal placodes appear (→pits, sacs and later are opened to primitive nasal cavity), medial and lateral nasal processes.

Week 5-6 – 10-14GIT

Příčný rozštěp tvářeTransverse facial cleft

Šikmý rozštěp tvářeOblique facial cleft

Sulcus nasolacrimalis

Nude ductus nasolacrimalisGIT

Cavitas oris Oral cavityrima oris – isthmus faucium

Dental arches divide cavity:

vestibulum orisandcavitas oris propria

borders:Ventrally: lips - labia oris laterally: faces – buccae roof: palatum bottom: mylohyoid m. + geniohyoid m., tongue (lingua, glossa)

Masticatory mucosa - Hard palate + gum (keratinized)Specialised mucosa - Tongue + papillary epitheliumLining mucosa - Bucca, soft palate (non-keratinized)

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Periodontium Innervation: free endings pain

Ruffini bodies tractionVater-Paccini bodies pressure, vibration

Mucosa - masticatoryspecialisedlining

Innervation: free, Paccini, Ruffini, Meissner pain, temperature, vibration, traction, pressurefree, Paccini, Ruffini, taste buds pain, temperature, vibration, traction, tastefree, Paccini, Meissner, Merkel temperature, vibration, pressure, pressure

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Labium + mentum

Lip Chin

The border between the lips and the surrounding skin is referred to as the vermilion.

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Labia

The skin of the lip, with three to five cellular layers, is very thin compared to face skin, which has up to 16 layers. Lip skin contains fewer melanocytes (pigment cells). Because of this, the blood vessels appear through the skin of the lips, which leads to their notable red coloring. The lip skin is not hairy, and does not have sweat glands or sebaceous glands. Therefore it does not have the usual protection layer of sweat and body oils which keep the skin smooth, inhibit pathogens, and regulate warmth. For these reasons, the lips dry out faster and become chapped more easily.

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http://en.wikipedia.org/wiki/Melanocytes�http://en.wikipedia.org/wiki/Blood_vessel�http://en.wikipedia.org/wiki/Sweat_gland�http://en.wikipedia.org/wiki/Sebaceous_gland�

Outer keratinized epithelium is followed by internal multilayered cuboid and slowly keratinized (para-keratinization) epithelium lamina propria mucosae submucous layer with small salivary and mucous glands (in soft palate)

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GIT

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vascular and nervous suply of the face and lipsA. facialis a. labialis sup.& inf.A. temporalis superficialis a. transversa facieiA. maxillaris a. buccalis

V. facialisV. transversa faciei v. retromandibularis

v. faciei profunda pl. pterygoideus

Ln. submentales, submandibulares

Inervationsensitive: n.V/2 n.infraorbitalis, zygomaticus

V/3 n.mentalis, buccalismotor: n.VII

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OROFACIAL SYSTEM(Maxilomandibular, maxilofacial, chewing, stomatognathic)

Jaws, hyoid bone, face bones, temporomandibular joints, teeth, periodontium, face soft tissues lips,, oral cavity organs, mucous membrane of the oral cavity, salivary glands, pharynx, tonsills,

vessels, nerves, receptors

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Palatum durum, Palatum molle

Hard palateSoft palate

PremaxillaMaxillaOs palatinum

Papilla, rugae (folds), pits (foveolae)Lines (crests)

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Palate – surface features

Incisive papilla

Rugae palatinae

Median rapheGIT

Palatum palateNeonatusnewborn

Senilisold

pink – extent of the total tooth prosthesisdash lines – areae where prosthesis pressure on the palate has to be controlled

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Palatal relief with rugae, foveolae and incisal papila

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Stěna jícnu a –a.+v. +n. palatinus majorgreater palatine artery, vein, nerve

b –sulcus palatinus majorgreater palatine groove

c –glandulae palatinaepalatal glands

d –a.+v.+n. palatinus minorlesser palatine artery, vein, nerve

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Stěna jícnu Tunica mucosa – plicae transversae – multilayered poorly keratinized epithelium

Tunica submucosaCan be found only inside palatal grooves

Tunica muscularis– found in the soft palate as intrinsic and extrinsic muscular structuresTunica adventitiaIn the hard palate there is periosteum; inside soft palatum there is a aponeurosis in the midline

GIT

OROFACIAL SYSTEM(Maxilomandibular, maxilofacial, chewing, stomatognathic)

GIT

OROFACIAL SYSTEM(Maxilomandibular, maxilofacial, chewing, stomatognathic)

Jaws, hyoid bone, face bones, temporomandibular joints, teeth, periodontium, face soft tissues lips,, oral cavity organs, mucous membrane of the oral cavity, salivary glands, pharynx, tonsills,

vessels, nerves, receptors

GIT

Soft palate

– dorsal view

– ventral view

mm. levatores veli palatinitensores veli palatinipalatoglossipalatopharyngeiuvularesDots – line between ventral

and dorsal (more moveable) parts of the soft palate GIT

GIT

Chrápání Snoring

GIT

Separation of the nasal and oral cavities– Ectoderm plate, mesoderm– Primary palate : intermaxillary

segmentSecondary palate (6.-8. week)

– Horizontalization and fusion of the palatine shelves

– Mesenchymal nasal septum develops from the frontal process

Primary palate Secondary palateGIT

Secondary palate formation

GIT

UnilateralBilateral

VentralDorsal

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Tongue Lingua Glossa

Mobile musculoepithelial organ;Located in the oral cavity and

pharynxapexcorpus (body)

dorsumfacies inferior

radix (root)margo (margin)sulcus (groove)

terminalismedianus (midline)

foramen caecumtonsilla lingualis

Week 6

GIT

Palatoglossal archPalatopharyngeal arch

Triangular fold (plica) (there is r. tonsillaris)

GIT

Papillae filiformesfungiformesvallataefoliatae

Foramen caecum

Filiformes

Fungiformes

Vallatae

Foliatae

Calliculus gustatorius

GIT

salty

sour

sweet

bitterGIT

Inervation motor:n. XII, (xm.palatoglossus)

sensitivesensory

vegetative:parasympathetic

ggl. submandibular

sympathetic

plexus lingualis

x

Ix

V3GIT

Bottom of the oral cavityfrenulum linguae, sublingual fold, carunculae

GIT

Spodina dutiny ústnífrenulumlinguae, plicasublingualis, carunculae

Canalis paralingualis = mezi m. hyoglossus a m. genioglossus

GIT

mm. geniohyoidei

gl. sublingualis

gl. submandibularis

caruncula sublingualis

ductus Whartoni

nervus lingualis

a. lingualis et m.

hyoglossus

Septum linguae –

sparse tissue

Floor of the oral cavity

GIT

Floor of the oral cavity

GIT

Intrinsic lingual musclesalter lingual shape

Superior and inferior longitudinal, transverse, vertical musclesGIT

StyloglossusPalatoglossus

HyoglossusGenioglossus

Palatoglossus

Extrinsic lingual musclesalter the position of the tongueGIT

Relation between

tongue and styloid septum

GIT

Arteriae

Arteries

Venae

VeinsGIT

Lymph outflow from tongue

Finally to the deep nodes

jugulodigastric node

juguloomohyoid node

GIT

Glandulae oris glandulae salivariae majores

– gl. parotis– gl. sublingualis– gl. submandibularis

glandulae salivariae minores - labiales, buccales, molares, palatinae, linguales /Nuhni/

● Surrounded by capsules (dense connective tissue) → septae– Secretory part – serous and mucinous cells, myoepithelial

(basket) cells– Glandular ducts

GIT

Salivary gland

scheme of the ductsGIT

Mucous and serous lingual glands

Ebner gl.serous

Weber gl.mucinous

Anterior Lingual gl.GIT

Glandula parotisSuperficial partDeep part (processus pharyngeusSerous tissueDuctus parotideus (of Stensen)GIT

Superficial and deep part of parotid gland can be separated from each other in level where facial plexus lies; there is also a thin layer of the sparse connective tissue

GIT

GIT

Glandula submandibularis

Mucoserous tissueDuctus submandibularis (of Wharton)

GIT

Glandula sublingualis

Seromucinous tissueDuctus sublingualis major et minores (of Santorinus)

GIT

1:1S

3:21:3

Relation betweenserous and mucous

parts

Lingual nerve crosses submandibular duct in the level of dorsal margine of mylohyoid muscle

Glandula parotideaSublingualisSublingualis anteriorSubmandibularisGIT

GIT

Hltan Pharynx rozčlenění

Nasopharynx (epi-)Oropharynx (meso-)Laryngopharynx (hypo-)

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Development of pharynx● Cranial part of the ventral gut● 6 pharyngeal arches (gills, branchial arches)● Pharyngeal pouchesGIT

Piriform recess

Pharyngeal recess

GIT

Pharynx - muscles● raphe pharyngis, fascia pharyngobasilaris, Luschka s

space● mm. constrictores /3/

– m.c. superior – 4 parts – origin at skull /3/ and tongue /1/– m.c. medius – 3 parts – origin at hyoid bone– m.c. inferior – 2 parts – origin at laryngeal cartilages

● mm. levatores /3/– m. palatopharygeus (part of soft palate muscles, mounting

of the palatopharyngeal arch)– m. salpingopharyngeus– m. stylopharyngeus (!exception! – innervated by n.IX !)

● innervation: plexus pharyngeus z n. X- except m. stylopharyngeus /n. IX /

GIT

* m. stylopharyngeus

** Nervus et vasa laryngea superiora CN X

Piriform recessRecessus piriformis(piriform recess, pouch)is bordered by aryepiglottic fold and pharyngoepiglottic fold

Nervus can be irritated through difficult swallowing or tumor growth

GIT

Superior constrictor SC1 Pars pterygopharyngea2 Pars buccopharyngea3 Pars mylopharyngea4 Pars glossopharyngea

Medius constrictor MC5 Pars chondropharyngea6 Pars ceratopharyngea7 Pars desmopharyngea

Inferior constrictor IC8 Pars thyropharyngea9 Pars cricopharyngea

12

34

567

8

9

SC: raphe – mandible and hamulusMC: raphe – hyoid bone and stylohyoid lig.IC: raphe – cricoid and thyroid cartilages and cricothyroid lig.

GIT

a – musculus constrictor pharyngis inferior, b –membrana thyreoidea, c – ligamentum thyreoideum medianum, d – os hyoideum, e –membrana hyoepiglottica, f – arcus palatopharyngeus, g – raphe buccopharyngea, h - arcus palatoglossus, i – musculus tensor veli palatini, j – musculus levator veli palatini, k –ústí tuba Eustachií (Eustachovy trubice), l –tonsilla tubaria, m – tonsilla nasopharyngea, n –membrana pharyngobasillaris; musculus constrictor pharyngis superior: o – pars pterygopharyngea, p – pars buccopharyngea, q – pars mylopharyngea, r – pars glossopharyngea; musculus constrictor pharyngis medius: s – pars desmopharyngea, t –pars chondropharyngea et ceratopharyngea, u –musculus stylopharyngeus, v – musculus stylohyoideus, w - vasa laryngea superiora et nervus laryngeus superior, x – musculus constrictor pharyngis inferior, y - musculus cricothyreoideus, z – conus elasticus (ligamentum thyreoideum medianum), * -spatium preepiglotticum

GIT

Pharynx – blood supply

● Arteries: a. carotis ext.

– a. pharyngea ascendens

– a. facialis a. palatina ascendens

– a. lingualis rr. dorsales linguae

– a. maxillaris a. palatina major, a. canalis pterygoidei, r. pharyngeus

● Veins: plexus (venosus) pharyngeus v. facialis v. jugularis int.

GIT

Jugulodigastricjuguloomohyoid

deep cervical lymph nodes

GIT

Spaces surrounding pharynx

● lamina prevertebralis fasciae cervicalis 8 +

● septum styloideum 11

● spatium retropharyngeum 4

● spatium paraviscerale● spatium parapharyngeum

1. sp. prestyloideum 22. sp. retrostyloideum 3GIT

Esophageal (Zenker s) diverticleGIT

Tonsillar lymph circle of Waldeyer

Heinrich Wilhelm Gottfried Waldeyer

1836-1921

GIT

Anulus lymphoideus pharyngis /Waldeyeri/

První ochranná bariéra organismu

Tonsilla pharyngea /1/● Tonsilla tubaria /Gerlachi/ /2/● Tonsilla palatina /2/● Tonsilla lingualis /1/

Heinrich Wilhelm Gottfried von Waldeyer-Hartz(1836 – 1921), German anatomist

GIT

Waldeyer lymph circle

t.pharyngea

t.tubaria

t.palatina

t.lingualis

ln.retropharyngeal nodes

Wood node

ln.jugulodigastricus(Küttner node)

ln.cervicales profundi

- Lower group

3 protective barriers

ln.submentales &submandibulares

ln.juguloomohyoideus

tongueGIT

GIT

Incomplete capsuleOnly efferent lymph vesselsModified epithelium in crypts (lymphoepithel or FAE follicle-associated epithelium)Intraepithelial vascularizationFree, T, B lymphocytes,active immunocompetitive cells, macrophages, Langerhans cells, fibrous stroma

GIT

tonsillectomy

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Sources:Schumacher, G.H.: Anatomie für Stomatologen, Band 1,

Johann Ambrosius Barth Leipzig 1984Tillmann,B.: Atlas der Anatomie,

Springer 2004McKinnon,P and Morris J: Oxford Textbook of Functional Anatomy, Vol. 3. Oxford University Press 1990Rogers AW: Textbook of Anatomy,

Churchill Livingstone, Edinburgh 1992Schünke M: Topographie und Funktion des Bewegungssystems,

Thieme, Stuttgart 2000Ivo Klepáček, J. Mazánek a kol.: Klinická anatomie ve stomatologii, Grada 2002Vlastní archiv

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Pharynx – Lymph and Nerves● Lymph: n.l. retropharyngei, n.l. paratracheales n.l. cervicales profundi

● Nerves: form plexus pharyngeus– motor n.X (plexus pharyngeus), n.IX (m.

stylopharyngeus)– sensory n.X + n.IX (plexus pharyngeus), n.V2 (n.

pharyngeus for nasopharynx)– autonomic n.X (plexus pharyngeus) =

parasympathetic, rr. laryngopharyngei = sympatheticGIT

Snímek číslo 1Snímek číslo 2Snímek číslo 3Primordium of the alimentary canal (GastroInTestinal Canal)Alimentary tube (canal) - general structure Maxilla and Mandible formationDevelopment of the facial skeleton, formation of the nasal and oral cavitiesSnímek číslo 9Cavitas oris Oral cavitySnímek číslo 11Snímek číslo 12Snímek číslo 13Snímek číslo 14Snímek číslo 15Snímek číslo 16Snímek číslo 17Snímek číslo 18Snímek číslo 19Palate – surface featuresPalatum palate Snímek číslo 22Stěna jícnu Stěna jícnu Snímek číslo 25Snímek číslo 26Snímek číslo 27Snímek číslo 28Snímek číslo 30Separation of the nasal and oral cavitiesSnímek číslo 32Snímek číslo 33Tongue Lingua GlossaPalatoglossal arch�Palatopharyngeal arch�Snímek číslo 36Snímek číslo 37Snímek číslo 38Snímek číslo 40Snímek číslo 41Snímek číslo 42Floor of the oral cavitySnímek číslo 44Snímek číslo 45Snímek číslo 46Snímek číslo 47Snímek číslo 48Glandulae orisSalivary gland scheme of the ductsSnímek číslo 51Snímek číslo 52Snímek číslo 53Snímek číslo 54Snímek číslo 55Snímek číslo 56Snímek číslo 57Snímek číslo 58Snímek číslo 59Development of pharynxPiriform recessPharynx - musclesSnímek číslo 63Snímek číslo 64Snímek číslo 65Pharynx – blood supplyJugulodigastric�juguloomohyoid��deep cervical lymph nodesSpaces surrounding pharynxSnímek číslo 69Snímek číslo 70Anulus lymphoideus pharyngis /Waldeyeri/Waldeyer lymph circleSnímek číslo 73Snímek číslo 74Snímek číslo 75Snímek číslo 76Pharynx – Lymph and Nerves