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NOSE AND TONGUEDr Laxman Khanal

MS- Human AnatomyDate: 19- June- 2012

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Pre-test

Which epithelium lines the nasal cavities ?

How many pair of pharyngeal arches persists in human embryo?

Median cleft lip is due to failure of fusion of which processes?

Which one is the largest nasal meatus ? Name the muscle attached to the nose. Name the largest vessel supplying nasal

cavity.

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Pre test

Which of the tongue papilla does not contain taste buds?

What is the safety muscle of tongue? Lymphatic of tip of the tongue drains to

which lymph node? Anterior 2/3rd of tongue is related with

which pharyngeal arch? What is ankyloglossia ?

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Your objectives

Nose – gross anatomy/ functions Nose – embryology Nose – vascular/nerve supply Tongue – gross anatomy/functions Tongue – embryoogy Tongue – vascular/ nerve supply Clinical coorelation

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Gross anatomy

Made up of external nose , nasal septum and a pair of nasal cavities.

Nasal cavities open through nares anteriorly and choanae posteriorly.

Nasal cavities separated from each other by nasal septum, from oral cavity by hard palate and from skull by skull bones(FSE).

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Lateral to nasal cavities lies the orbit Each nasal cavities has lateral wall,

medial wall, roof and floor. Nose is formed by Cartilage - septal, alar and lateral Bones Skin(up to vestibules) and inner mucosal

lining

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Openings in lateral walls

Sphenoethmoidal recess- sphenoid sinus Superior meatus Posterior ethmoidal sinus Middle meatus Anterior and middle ethmoidal sinus Maxillary and Frontal sinus Inferior meatus- NLD

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Paranasal sinuses

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Muscle attachment

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Embryology

The nose is formed from five facial prominences: the frontal prominence gives rise to the bridge; the merged medial nasal prominences provide the crest and tip; and the lateral nasal prominences form the sides (alae)

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Embryology

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Paranasal air sinuses develop as diverticula of the lateral nasal wall and extend into the maxilla, ethmoid, frontal, and sphenoid bones. They reach their maximum size during puberty and contribute to the definitive shape of the face.

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Vascular supply

Both external and internal carotid arteries Maxillary artery Sphenopalatine artery- major vessel Greater palatine artery Facial artery Superior labial Lateral nasal

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Ophthalmic artery anterior ethmoidal Posterior ethmoidal In the anterior region of the medial

wall there are anastomoses between branches of the greater palatine, sphenopalatine, superior labial, and anterior ethmoidal arteries, and where the vessels are relatively close to the surface . This is the major site of epistaxis (Little’s area or kisselbach’s area)

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Nerve supply

Olfactory nerve – smell Maxillary nerve – general sensation Ophthalmic nerve – general sensation Facial nerve – parasympathetic and

motor T1 – sympathetic supplyPterygopalatine ganglion- parasympathetic

ganglion

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Lymphatic drainage

Anterior part of nose Submandibular lymph nodes Posterior part of nose Upper deep cervical Retropharyngeal (sometime)

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Gateways of nasal cavities

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Histology of nasal concha

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Histology of olfactory epithelium

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For Taste ….. And For SpeechBitter and Sweet!

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Gross anatomy

Mobile muscular organ attached to the mandible, hyoid and skull by muscles.

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Gross Anatomy

Root- post 1/3rd Lingual tonsil Foramen caecum Sulcus terminalis Body-ant 2/3rd Apex Lingual papilla

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Muscles of tongue

Extrinsic muscles Genioglossus Hyoglossus Styloglossus Palatoglossus Attached to the

bone and Changes the movement of tongue

Intrinsic muscles Superior

longitudinal Inferior

longitudianal Transverse Vertical No bony

attachment and Changes the shape of the tongue

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Embryology

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Each pharyngeal arch is supplied by its own cranial nerve.

1- trigeminal nerve (mandibular nerve) 2- facial nerve. 3- glossopharyngeal nerve. 4- superior laryngeal branch of Vagus

nerve. 6- recurrent branch of Vagus nerve

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Embryology

Body – from tuberculum impar and two lingual swellings. Related with first pharyngeal arch.

Root – from hypobrachial eminence (copula). Related with 2nd and 3rd arch but 3rd arch overlies the 2nd.

Posterior most part derived from 4th arch. Muscles- from occipital myotomes.

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Development of tongue

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Vascular supply

Arterial supply Lingual artery –

branch of external carotid artery

Venous drainage Dorsal lingual vein Deep lingual veinBoth drain to the IJV

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Nerve supply

Anterior 2/3rd General sensation- lingual nerve Taste – chorda tympani Posterior 1/3rd General sensation- glossopharyngeal

nerve Taste – glossopharyngeal nerve

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Nerve supply…

Motor supply to all muscles by 12th nerve except………

Vallate papillae are innervated by 9th nerve

Taste sensation from posterior most part of tongue is carried out by 10th nerve

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Lymphatic drainage

Post 1/3rd – jugulo-omohyoid Ant 2/3rd - Submandibular lymph nodes. Tip of tongue- submental lymph nodes.

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Clinical correlation

Median cleft lip

A rare abnormality, is caused by incomplete merging of the two medial nasal prominences in the midline. This anomaly is usually accompanied by a deep groove between the right and left sides of the nose.

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Oblique facial clefts

produced by failure of the maxillary prominence to merge with its corresponding lateral nasal prominence. When this occurs, the nasolacrimal duct is usually exposed to the surface.

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epistaxis Anosmia DNS Allergic rhinitis

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Lingual thyroid- thyroid tissue is present on the base of tongue between circumvallate papillae and epiglottis.

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Ankyloglossia Limited tongue

movement secondary to the abnormal attachment to the floor of mouth. Also has familiar pattern.

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Hairy tongue elongation and

hyperkeratosis of filiform papillae resulting in hairy appearance. Common in anterior to circumvallate papillae.

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Fissured or Scrotal or Plicated tongue.

Associated with Melkersson- Rosenthal syndrome.

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Lingual varicosities dilated tortuous

vein on ventral surface of tongue.

Associate with cardiopulmonary disease and aging process.

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Syphilis chancre Associated with Non

tender lymphadenopathy.

Primary syphilis

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Syphilis Gumma Painless ulcer in

tertiary syphilis.

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Erythema migrans or Geographic tongue

the lesions persist for a short time in one area, then disappear completely and reappear in another area.

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THANK YOU