general anatomy i of gastro-intestinal systemanat.lf1.cuni.cz/souhrny/azubz_12.pdf · of...
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General Anatomy of Gastro-IntesTinal
System
The Teeth,Oral CavityTongue, Salivary Glands,
Pharynx. Their Vessels and Innervation
Ivo Klepek
GIT
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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, of duodenum, liver
and gallblader, pancreas3. Midgut 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
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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
division 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
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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
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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
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Pn roztp tveTransverse facial cleft
ikm roztp tveOblique facial cleft
Sulcus nasolacrimalis
Nude ductus nasolacrimalisGIT
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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/Melanocyteshttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Sweat_glandhttp://en.wikipedia.org/wiki/Sebaceous_gland
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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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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
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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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Stna jcnu 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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Stna jcnu 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
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OROFACIAL SYSTEM(Maxilomandibular, maxilofacial, chewing, stomatognathic)
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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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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
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Chrpn Snoring
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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
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Secondary palate formation
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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
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Palatoglossal archPalatopharyngeal arch
Triangular fold (plica) (there is r. tonsillaris)
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Papillae filiformesfungiformesvallataefoliatae
Foramen caecum
Filiformes
Fungiformes
Vallatae
Foliatae
Calliculus gustatorius
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salty
sour
sweet
bitterGIT
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Inervation motor:n. XII, (xm.palatoglossus)
sensitivesensory
vegetative:parasympathetic
ggl. submandibular
sympathetic
plexus lingualis
x
Ix
V3GIT
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Bottom of the oral cavityfrenulum linguae, sublingual fold, carunculae
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Spodina dutiny stnfrenulumlinguae, plicasublingualis, carunculae
Canalis paralingualis = mezi m. hyoglossus a m. genioglossus
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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
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Floor of the oral cavity
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Intrinsic lingual musclesalter lingual shape
Superior and inferior longitudinal, transverse, vertical musclesGIT
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StyloglossusPalatoglossus
HyoglossusGenioglossus
Palatoglossus
Extrinsic lingual musclesalter the position of the tongueGIT
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Relation between
tongue and styloid septum
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Arteriae
Arteries
Venae
VeinsGIT
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Lymph outflow from tongue
Finally to the deep nodes
jugulodigastric node
juguloomohyoid node
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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
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Salivary gland
scheme of the ductsGIT
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Mucous and serous lingual glands
Ebner gl.serous
Weber gl.mucinous
Anterior Lingual gl.GIT
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Glandula parotisSuperficial partDeep part (processus pharyngeusSerous tissueDuctus parotideus (of Stensen)GIT
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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
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Glandula submandibularis
Mucoserous tissueDuctus submandibularis (of Wharton)
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Glandula sublingualis
Seromucinous tissueDuctus sublingualis major et minores (of Santorinus)
GIT
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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
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Hltan Pharynx rozlenn
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
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Piriform recess
Pharyngeal recess
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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 /
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* 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
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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.
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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 st tuba Eustachi (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
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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.
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Jugulodigastricjuguloomohyoid
deep cervical lymph nodes
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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
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Esophageal (Zenker s) diverticleGIT
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Tonsillar lymph circle of Waldeyer
Heinrich Wilhelm Gottfried Waldeyer
1836-1921
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Anulus lymphoideus pharyngis /Waldeyeri/
Prvn ochrann barira organismu
Tonsilla pharyngea /1/ Tonsilla tubaria /Gerlachi/ /2/ Tonsilla palatina /2/ Tonsilla lingualis /1/
Heinrich Wilhelm Gottfried von Waldeyer-Hartz(1836 1921), German anatomist
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Waldeyer lymph circle
t.pharyngea
t.tubaria
t.palatina
t.lingualis
ln.retropharyngeal nodes
Wood node
ln.jugulodigastricus(Kttner node)
ln.cervicales profundi
- Lower group
3 protective barriers
ln.submentales &submandibulares
ln.juguloomohyoideus
tongueGIT
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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
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tonsillectomy
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Sources:Schumacher, G.H.: Anatomie fr 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 1992Schnke M: Topographie und Funktion des Bewegungssystems,
Thieme, Stuttgart 2000Ivo Klepek, J. Maznek a kol.: Klinick anatomie ve stomatologii, Grada 2002Vlastn 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
Snmek slo 1Snmek slo 2Snmek slo 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 cavitiesSnmek slo 9Cavitas oris Oral cavitySnmek slo 11Snmek slo 12Snmek slo 13Snmek slo 14Snmek slo 15Snmek slo 16Snmek slo 17Snmek slo 18Snmek slo 19Palate surface featuresPalatum palate Snmek slo 22Stna jcnu Stna jcnu Snmek slo 25Snmek slo 26Snmek slo 27Snmek slo 28Snmek slo 30Separation of the nasal and oral cavitiesSnmek slo 32Snmek slo 33Tongue Lingua GlossaPalatoglossal archPalatopharyngeal archSnmek slo 36Snmek slo 37Snmek slo 38Snmek slo 40Snmek slo 41Snmek slo 42Floor of the oral cavitySnmek slo 44Snmek slo 45Snmek slo 46Snmek slo 47Snmek slo 48Glandulae orisSalivary gland scheme of the ductsSnmek slo 51Snmek slo 52Snmek slo 53Snmek slo 54Snmek slo 55Snmek slo 56Snmek slo 57Snmek slo 58Snmek slo 59Development of pharynxPiriform recessPharynx - musclesSnmek slo 63Snmek slo 64Snmek slo 65Pharynx blood supplyJugulodigastricjuguloomohyoiddeep cervical lymph nodesSpaces surrounding pharynxSnmek slo 69Snmek slo 70Anulus lymphoideus pharyngis /Waldeyeri/Waldeyer lymph circleSnmek slo 73Snmek slo 74Snmek slo 75Snmek slo 76Pharynx Lymph and Nerves