Anatomy of Swallowing• Strucures• Muscles• Nerves• Vascular supply

PALATE

HARD AND SOFT

• Forms the arched part of the mouth and floor of nasal cavities.

• Separates the oral cavity from the nasal cavities and the nasopharynx, part of the pharynx superior to the soft palate.

• Superior (nasal) surface of the palate is covered with respiratory mucosa and the inferior (oral) surface is covered with oral mucosa densely packed with glands.

• The palate consists of two regions: the hard and soft palate posteriorly.

Hard Palate• Palatine processes of the maxillae form the

anterior 2/3s of the hard palate. Could be 3/4s• The horizontal plates of the palatine bones

form the posterior 1/3. Could be 1/4s• In the oral cavity, the upper alveolar arch

borders the hard palate anteriorly and laterally. • Posteriorly the hard palate is continuous with

the soft palate.

• A single nasal spine is formed at the midline where the 2 horizontal plates join and projects backwards from the margin of the hard palate. The posterior margin of the horizontal plates and the posterior nasal spine are associated with the attachment of the soft palate.

• The mucosa of the hard palate in the oral cavity possesses numerous transverse palatine folds ( palatine rugae) and a median longitudinal ridge (palatine raphe) which ends anteriorly in a small oval elevation (incisive papillae) The incisive papillae overlies the incisive fossa formed between the horizontal plates of the maxillae immediately behind the incisor teeth.

GREATER PALATINE FORAMEN

• Formed mainly by the horizontal plate of the palatine bone and completed laterally by the adjacent part of the maxilla, opens onto the posterolateral aspect of the horizontal plate.

• This foramen is the inferior opening of the palatine canal, which continues superiorly into the pterygopalatine fossa and transmits the greater palatine nerves and vessels to the palate.

• Greater palatine foramen medial to the 3rd molar the greater palatine foramen pierces the lateral border of the bony plate

• The greater palatine vessels and nerve emerge from this foramen and run anteriorly on the plate

• The lesser palatine foramina posterior to the greater palatine foramen pierce the pyramidal process of the palatine bone

• These foramina transmit the lesser palatine nerves and vessels to the soft palate and adjacent structures.

Incisive Fossa

• Incisive Fossa is a depression in the midline of the bony palate posterior to the central incisive teeth into which the incisive canals open. The nasopalatine nerves pass from the nose though a variable number of incisive canals and foramina that open into the incisive fossa.

Greater palatine foramen

Lesser palatine foramen

incisive fossa

Innervation Palate

• The sensory nerves of the palate are branches of the maxillary nerve ,(CNV2), which branch from the pterygopalatine ganglion.

• The greater palatine nerve supplies the gingivae, mucous membrane and glands of most of the hard palate.

• The nasopalatine nerve supplies the mucous membrane of the anterior part of the hard palate.

• The lesser palatine nerve supply the soft palate.

Swallowing

• When a person swallows the soft palate initially is tensed to allow the tongue to press against it, squeezing the bolus of food to the back of the mouth. The soft palate is then elevated posteriorly and superiorly against the wall of the pharynx, thereby preventing the passage of food into the nasal cavity.

SOFT PALATE

The soft palate • The structure composed of mucous membranes, muscular fibers,

and mucous glands, suspended from the posterior border of the hard palate forming the roof of the mouth.

• When the soft palate rises, as in swallowing, it separates the nasal cavity and nasopharynx from the posterior part of the oral cavity and oral portion of the pharynx.

• In sucking the soft palate and posterior superior surface of the tongue occlude the oral cavity from the oropharynx, creating a posterior seal. Thus the soft palate prevents the escape of fluid and food up through the nose and with the tongue allows fluid and food to collect in the mouth until swallowed.

SOFT PALATEHARD PALATE

UVULA

• While swallowing, the soft palate is pushed backwards. This prevents food and drink from entering the nasal cavity; if the soft palate cannot touch the back of the throat while swallowing, food and drink can enter the nasal cavity.

• Moveable posterior third of the palate and is suspended from the posterior border of the hard palate.

• The soft palate has no bony skeleton however its anterior aponeurotic part is strengthened by the palatine aponeurosis which attaches to the posterior edge of the hard palate.

• The aponeurosis is thick anteriorly and thin posteriorly where it blends with a posterior muscular part.

• Posterioinferiorly the soft palate has a curved free margin from which hangs the uvula.

• Laterally the soft palate is continuous with the wall of the pharynx and joined to the tongue by the palatoglossal and palapharyngeal arches respectively.

Fauces• The Fauces (the throat) is the space between the cavity of the mouth

and the pharynx.• The fauces is bounded superiorly by the soft palate and inferiorly by

the root of the tongue and laterally by the pillars of the fauces, the palatoglossal and palatopharyngeal arches.

• The isthmus of the fauces is the short constricted space that establishes the connection between the oral cavity proper and the oropharynx. The isthmus is bounded anteriorly by the palatoglossal folds and posteriorly by the palatopharyngeal arches.

• The palatine tonsils often referred to as the “the tonsils” are masses of lymphoid tissue, one on each side of the oropharynx.

• Each tonsil is in a tonsillar fossa (sinus) bounded by the palatoglossal and palatopharyngeal arches and the tongue.

1vestibule2hard palate3soft palate4uvula5palatoglossal arch6palatine tonsil7palatopharyngeal arch8posterior wall of oropharynx9pterygoid hamulus

Muscles soft palate

Tensor veli Palatini

Levator veli Palatini

Palatoglossus Paltopharyngeus

Musculus Uvulae

TENSOR VELI PALATINI• Composed of two parts• Vertical muscle muscular part• Horizontal fibrous part which forms the

palatine aponeurosis

• Vertical part of the tensor veli palatini is thin and triangular in shape with its base attached to the skull and its apex pointed inferiorly.

• The base is attached along an oblique line that begins medially at the scaphoid fossa near the root of the pterygoid process of the sphenoid bone and continues laterally along the membranous part of the pharynotympanic tube to the spine of the sphenoid bone.

Tensor Veli Palatini • The tensor veli palatini descends vertically along the

lateral surface of the medial plate of the pterygoid process and pharyngeal wall to the pterygoid hamulus where the fibers converge to form a small tendon.

• The tendon loops 90 degrees medially around the pterygoid hamulus, penetrating the origin of the buccinator muscle as it does and expands like a fan to form the fibrous horizontal part of the muscle. This fibrous part is continuous across the midline with the partner on the other side to form the palatine aponeurosis

Palatine Aponeurosis

• Attached anteriorly to the margin of the hard palate but is unattached posteriorly where it ends in a free margin. This expansive aponeurosis is the major structural element of the soft palate to which the other muscles of palate attach.

Tensor Veli Palatini

• Actions:• Tenses (makes firm) the soft palate • Opens the mouth of the pharyngotympanic

tube (auditory tube) during yawning and swallowing.

The tensor veli palatini it is found lateral to the levator veli palatini muscle.It arises by a flat lamella from the scaphoid fossa at the base of the medial pterygoid plate, from the spina angularis of the sphenoid and from the lateral wall of the cartilage of the auditory tubeDescending vertically between the medial pterygoid plate and the medial pterygoid muscle, it ends in a tendon which winds around the pterygoid hamulus, being retained in this situation by some of the fibers of origin of the medial pterygoid muscleBetween the tendon and the hamulus is a small bursa.The tendon then passes medialward and is inserted into the palatine aponeurosis and into the surface behind the transverse ridge on the horizontal part of the palatine bone.

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• O9 The tensor veli palatini it is found lateral to the levator veli palatini muscle.It arises by a flat lamella from the scaphoid fossa at the base of the medial pterygoid plate, from the spina angularis of the sphenoid and from the lateral wall of the cartilage of the auditory tubeDescending vertically between the medial pterygoid plate and the medial pterygoid muscle, it ends in a tendon which winds around the pterygoid hamulus, being retained in this situation by some of the fibers of origin of the medial pterygoid muscleBetween the tendon and the hamulus is a small bursaThe tendon then passes medial ward and is inserted into the palatine aponeurosis and into the surface behind the transverse ridge on the horizontal part of the palatine bone.

Levator veli palatini

• Origin base of skull and descends to the upper surface of the palatine aponeurosis.

• On the skull it originates from a roughened area on the petrous part of the temporal bone immediately anterior to the opening of the Carotid canal.

• Levator veli palatini passes anterioinferiorly through fascia of the pharynotympanic tube and inserts onto the palatine aponeurosis. Its fibers interlaces at the midline with those of the levator veli palatini on the other side.

• The levator veli palatinin does not pass around the pterygoid hamulus but courses directly from the base of the skull to the upper surface of the palatine aponeurosis.

• Therefore they elevate the palate above the neutral position and close the pharyngeal isthmus between the nasopharynx and oropharynx.

Palatopharyngeus

• Originates from the superior surface of the palatine aponeurosis and passes posterolaterally over its margin to descend and become one of the longitudinal muscles of the pharyngeal wall.

• Attached to the palatine aponeurosis by 2 flat lamellae separated by the levator veli palatini.

• The more anterior and lateral of these 2 lamellae is attached to the posterior margin of the hard palate as well as to the palatine aponeurosis.

• The 2 palatopharyngeus muscles one on each side underlie the palatopharyngeal arches on the oropharyngeal wall. The palatopharyngeal arches lie posterior and medial to the palatoglossal arches

•

• Action palatopharyngeus muscle• Depress the palate and move the

palatopharyngeal arches toward the midline like curtains both these actions help close the oropharyngeal isthmus.

• Elevate the pharynx during swallowing.

PALATOGLOSSUS

• This muscle is attached to the inferior (oral surface) of the palatine aponeurosis and passes inferiorly and anteriorly into the lateral surface of the tongue.

• The palatoglossus muscle underlies a fold of mucosa that arches from the soft palate to the tongue. These palatoglossal arches, one on each side are lateral and anterior to the palatopharyngeal arches and define the lateral margins of the oropharygeal isthmus.

• The palatine tonsil is between the palatoglossal and palatopharyngeal folds on the lateral oropharyngeal wall.

• The palatoglossus muscles depresses the palate, move the palatoglossal arches toward the midline like curtains and elevate the back of the tongue. These actions help close the oropharyngeal isthmus.

• Innervation vagus nerve.

Musculus Uvulae

• Originates from the posterior nasal spine on the posterior margin of the hard palate and passes directly over the dorsal aspect of the palatine aponeurosis to insert into connective tissue underlying the mucosa of the uvula.

• It passes between the 2 lamellae of the palatopharyngeus superior to the attachment of the levator veli palatini. Along the midline the muscle blends with its partner on the other side.

• ACTION: Elevates and retracts the uvula. This action thickens the central part of the soft palate and helps the levator veli palatini muscles close the pharyngeal isthmus between the nasopharynx and oropharynx.

• Innervated by the vagus (CNX) through the pharyngeal branch to the pharyngeal plexus.

• The uvula is a small, mucosa-covered set of muscles, musculus uvulae, hanging down from the soft palate, near the back of the throat. The word is derived from the diminutive of uva, the Latin word for "grape", due to the uvula's grape-like shape

VESSELS

• Arteries of the palate include the greater palatine branch from the maxillary artery, the ascending palatine branch of the facial artery and the palatine branch of the ascending pharyngeal artery. The maxillary, facial and ascending pharyngeal arteries are all branches that arise in the neck from the external carotid artery.

Ascending palatine artery and palatine branch

• The ascending palatine artery of the facial artery ascends along the external surface of the pharynx. The palatine branch loops medially over the top of the superior constrictor muscle of the pharynx to penetrate pharyngeal fascia with the levator veli palatini muscle and follow levator veli palatini to the soft palate.

• The palatine branch of the ascending pharyngeal artery follows the same course as the palatine branch of the ascending palatine artery from the facial artery and may replace the vessel.

GREATER PALATINE ARTERY

• Originates from the maxillary artery in the pterygopalatine fossa

• Descends into the palatine canal where it gives origin to a lesser palatine branch and then continues through the greater palatine foramen onto the inferior surface of the hard palate. The greater palatine artery passes forward on the hard palate and then leaves the palate superiorly through the incisive to enter the medial wall of the nasal cavity where it terminates.

• The greater palatine artery is the major artery of the hard palate

• The lesser palatine artery passes through the lesser palatine foramen just posterior to the greater palatine foramen contributes to the vascularization of the soft palate.

Innervation

• Palate receives its innervation from the nasopalatine, greater and lesser palatine nerves.

• Sensory fibers is carried in all of these nerves originate in the pterygopalatine fossa from the ( CN V2 maxillary nerve)

• Greater and lesser palatine nerves descend through the pterygopalatine fossa and palatine canal to reach the palate:

• Greater palatine nerve travels through the greater palatine foramen and turns anteriorly to supply the hard palate, gingiva as far as the first premolar.

• Lesser palatine nerve passes posteromedially to supply the soft palate

• Nasopalatine nerve also originates in the pterygoapalatine fossa but passes medially into the nasal cavity. It continues medially over the roof of the nasal cavity to reach the medial wall, then anteriorly and obliquely down the wall to reach the incisive canal in the anterior floor and descends through the incisive canal and fossa to reach the inferior surface of the hard palate. Supplies gingiva and mucosa adjacent to the incisors and canine.

Develops from 1st arch