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Surface Anatomy (Part 2) By the end of the session, students should be able to: 1) Locate and identify the regions of the head and neck: – – REGIONS OF HEAD • Frontal Region • Parietal and Occipital Regions • Temporal and Auricular Regions • Orbital Region • Nasal Region • Infraorbital, Zygomatic, and Buccal Regions • Oral Region • Mental Region REGIONS OF NECK 2) Locate and identify anatomical landmarks on a diagram and on a patient. 3) Discuss normal anatomical variation and how it applies to different structures of the head and neck. Oral Exam Video: http://www.dentistry.umn.edu/dentalce/oral-cancervideo/index.htm 1 Surface anatomy is the study of the structural relationships of the external features of the body to the internal organs and parts. 2 Health and Disease http://oralcancerfoundation.org/dental/slide_show. htm http://www.healthsym.com/causes-and-treatmentfor-jaundice.html http://www.nidcr.nih.gov/imagegallery/oralhealth/OralCancerE xam.htm http://commons.wikimedia.org/wiki/File:Goiter.JPG 3 Surface Anatomy Overview The regions of the head include the frontal, parietal, occipital, temporal, auricular, orbital, nasal, infraorbital, zygomatic, buccal, oral, and mental regions. 4 1Frontal Region 2 Parietal Region Orbital Region 6 Infraorbital Region 7 Nasal Region 8 3 Temporal Region 4 Zygomatic Region Oral Region 9 Buccal Region 10 5 Occipital Region Mental Region 11 Regions of the Head 5 Frontal Eminence 3 Supraorbital Ridge 4 Glabella 5 1 External Acoustic Meatus, Tragus 2 Angle of the Mandible Anatomical Landmarks 6 Practice 7 Forehead (Frontal) 8 Frontal Region Review Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007 9 Parietal and Occipital Regions Both the parietal region and occipital region of the head are covered by the scalp. 10 Temporal Region External ear most prominent, includes: • Auricle • External acoustic meatus • Helix • Lobule • Tragus • Antitragus • Intertragic notch 11 Ear Structure Otitis Externa: inflammation or infection of the external ear or “swimmer's ear.” Usually bacterial in origin, with the pathogens that include Pseudomonas aeruginosa and Staphylococcus aureus. Patient may present with itchiness, a sensation of having the ear blocked, and pain. Drake RL, et al. Gray’s Anatomy for Students, ed 2, Churchill Livingson, 2010 Otitis Media: pulling or rubbing the ears because of ear pain, fever, fussiness, or irritability, fluid leaking from the ear, changes in appetite or sleeping patterns, and trouble hearing. Usually bacterial infection 12 Auricular Region Review Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007 13 Orbital Region • • • • • • • • • Orbit Sclera Conjunctiva Iris Lateral canthus Pupil Medial Canthus Eyelids Lacrimal gland 14 5 Lacrimal Gland 1 Upper eyelid 6 Pupil 2 Medial Canthus 7 Lateral Canthus 8 Sclera 3 Lower eyelid 4 Outline of Orbit 9 Iris 15 Eye 16 Eyelids • When an eye becomes dry, "blinking" – closing the eyelid and opening it again rapidly – can help to spread moisture across the surface of the eye and ease the discomfort. • Blinking helps remove irritants in the eye. • Eye blink reflexes reveal nervous system function. Eyelids close the eyes when a threat comes too near to protect the eye. 17 • Pupils Pupillary reflexes reveal information about the nervous system. – – – • • • In normal room light, a healthy pupil has a diameter of about 3 to 4 mm. In bright light = 1.5 mm. In dim light, enlarged to about 8 mm. Pupil constricts to view something close. Some drugs cause pupil constriction (miosis), such as alcohol. Some drugs cause pupil dilation (mydriasis) e.g. psychedelics (LSD). http://library.med.utah.edu/kw/hyperb rain/movies/ch7/orbit_autonomic.htm http://www.ebmedicine.net/topics.php?paction=showTopicSeg&topic_i d=69&seg_id=1320 http://library.med.utah.edu/kw/animations/hyperbr ain/parasymp_reflex/reflex.html 18 Disease: Conjunctivitis and Cataracts A cataract disrupts the organization of the connective tissue that forms the lens, changing the optical properties the opacity of the lens. Conjunctivitis is an inflammation of the epithelial lining of the eye (the conjunctiva). 19 National Eye Institute, NIH Orbital Region Review Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007 20 Orbital Region Review Fehrenbach MJ, editor, Dental Anatomy Coloring Book, WB Saunders, Philadelphia, 2007 21 Nasal Region • • • • • • • The root of the nose is located between the eyes. Inferior to the glabella is a midpoint landmark of the nasal region that corresponds with the junction between the underlying bones, the nasion. Inferior to the nasion is the bony structure that forms the bridge of the nose. At the other end is the tip or apex of the nose. Inferior to the apex on each side of the nose is a nostril or naris (plural, nares). The nares are separated by the midline nasal septum. The nares are bounded laterally on each side by a winglike cartilaginous structure, the ala (plural, alae) of the nose. 22 Nasal Region Review Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007 23 Infraorbital, Zygomatic, and Buccal Regions 24 Health and Disease: Enlarged Masseter Muscle The masseter muscle can become enlarged with constant use such as with teeth grinding (bruxism) or clenching. If you use it, it will adapt. In this case, grinding your teeth builds a bigger stronger muscle. 25 Infraorbital, Zygomatic, and Buccal Regions Review 26 Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007 Oral Region 27 Nasolabial sulcus Oral Fissure Labiomental groove 28 Health and Disease A. Angular cheilitis (also called cheilosis or angular stomatitis) is an inflammatory lesion at the labial commissure and often occurs bilaterally. B. Loss of vermillion border as a result of sunburn. 29 Fehrenbach MJ, contributor: Inflammation and repair, immunity. In Ibsen AC, Phelan JA, editors. Oral pathology for the dental hygienist, ed 5, St. Louis, 2009, Saunders. Lip Anatomy Review 30 Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007 Oral Cavity Structures: – – – – – – – – – – – – Maxilla Mandible Mucosa Labial mucosa Buccal mucosa Buccal fat pad Parotid papilla Maxillary tuberosity Vestibules Alveolar mucosa Mucobuccal fold Labial frenum 31 Oral Cavity – facial surface = facial – lips = labial – inner cheek = buccal – tongue = lingual, and palate = palatal. Figure 2-11 32 Oral Vestibule Fordyce Granules 33 Oral Mucosa The oral cavity is lined by a mucous membrane called the oral mucosa. It consists of a stratified squamous epithelium, which may or may not be keratinized, and an underlying connective tissue layer, the lamina propria. The surface is kept moist with mucus produced by the major and numerous minor salivary glands. The oral mucosa is well supplied with nerve endings and, on the dorsal surface of the tongue, special sensory endings for taste. The submucosa underlying the lamina propria of the oral cavity is variable. At times the lamina propria and submucosa are substantively so similar that they merge imperceptibly. Can you draw a picture of a keratinized epithelium? Where else in the body do you find such an organ? http://141.214.65.171/Histology/Digestive%20System/Pharynx% 20Esophagus%20and%20Stomach/152_HISTO_20X.svs/view.a pml? And http://141.214.65.171/Histology/Digestive%20System/Pharynx% 20Esophagus%20and%20Stomach/152AF_HISTO_40X.svs/view .apml? And lip:http://141.214.65.171/Histology/Digestive%20System/Oral%2 0Region/114triC_HISTO_40X.svs/view.apml? 34 Gingiva and gingival mucosa Canine Fossa Canine Eminence Incisive Fossa Gingival margin Interdental papilla 35 Gingiva 36 Variations of the oral cavity Linea alba is a white ridge of raised callused tissue that extends horizontally at the level where the maxillary and mandibular teeth come together and occlude. Fordyce spots (or granules) are often on the surface of the labial and buccal mucosa is a normal variation. They are small, yellowish elevations due to deeper deposits of sebum from trapped or misplaced sebaceous gland tissue, usually associated with hair follicles. Cheek biting leads to mucosal irritation. 37 Teeth and Jaws Bath-Balogh M and Fehrenbach MJ. Illustrated Dental Embryology, Histology, Anatomy, ed 3. Saunders, Philadelphia, 2011. 38 Teeth are held in place by ligaments that allow very little little movement. 39 Oral Cavity Review 40 Palate 41 Palate Review Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007 42 Oral Cavity 43 Palate and Jaws Review Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007 44 Tongue 45 Tongue • The apex is the highly mobile, pointed anterior part of the tongue. • Posterior to the apex lies the body of the tongue, which has dorsal (superior) and ventral (inferior) surfaces. • The base is the most posterior part of the tongue and is not very mobile; a terminal V- shaped sulcus, or groove separates the body from the base of the tongue. http://www.siumed.edu/~dking2/erg/GI049b 46 .htm Tongue: Dorsal Surface 47 Tongue Papillae • • • The dorsal surface of the tongue also has many lingual papillae. The slender, threadlike lingual papillae are the filiform lingual papillae. The red mushroom-shaped dots are the fungiform lingual papillae (contain taste buds). http://www.siumed.edu/~dking2/erg/GI064b.htm 48 Taste Buds http://www.siumed.edu/~dking2/erg/GI064b.htm 49 Tongue: Ventral Surface 50 Tongue Review Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007 51 Tongue Review 52 Floor of the Mouth Review Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007 53 Pharynx • The oral cavity also provides the entrance into the throat or pharynx. • The pharynx consists of three parts: nasopharynx, oropharynx, and laryngopharynx. 54 Oropharynx 55 Pharynx Review 56 Mental Region • The mental protuberance is the prominence of the chin. 57 Regions of Head Review Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007 58 Regions of the Neck Triangles: • Posterior • Carotid • Submandibular • Submental • Muscular 59 Regions of Neck • Thyroid cartilage • Trachea • Hyoid 60 Regions of Neck Review Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007 61 Regions of Neck Review Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007 62 Extra and Intra Oral Exam Oral Exam Video: http://www.dentistry.umn.edu/dentalce/oral-cancer-video/index.htm 63