L1 anatomy

GASTRO-INTESTINAL TRACT

•GIT CONSISTS OF a hollow muscular tube starting from the oral cavity, where food enters the
mouth , continuing through the pharynx, oesophagus , stomach & intestine to the rectum and
anus , where food is expelled
There are VARIOUS ACCESSORY ORGANS that
assist the tract by secreting enzymes to help
break down food into its component nutrients.
Thus the SALIVARY GLANDS ,LIVER , PANCREAS &
GALL BLADDER have important functions in the
digestive system.
Food is propelled along the length of the GIT by
peristaltic movements of the muscular walls
The primary purpose of GIT is to break
food down into nutrients , which can
be absorbed into the body to provide energy.
 FIRST food must be ingested into the
mouth to be mechanically
processed and moistened.

 SECONDLY, Digestion occurs mainly

in the stomach & small intestine
where proteins , fats & carbohydrates are
chemically broken down into their basic
building blocks.
Smaller molecules are then absorbed across the epithelium of the small intestine &
subsequently enter the circulation.
The large intestine plays a key role in reabsorbing excess water

 FINALLY , Undigested material & secreted waste products are excreted from the body
via defecation ( passing of faeces)
In the case of GIT diseases or disorders , These functions of the GIT are not achieved
successfully Patients may develop symptoms of nausea , diarrhea , malabsorption , constipation
or obstruction.

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 ORAL CAVITY
•BOUNDARIES
-THE ROOF is formed of hard and soft palate.

-THE FLOOR formed mainly by 2 MYLOHYOID

MUSCLES, and the structures above mylohyoid which
includes:
•GENIOHYOID, SUBLINGUAL SALIVARY
GLAND, DEEP PART OF SUBMANDIBULAR
SALIVARY GLAND.
•TONGUE with most of its muscles, vessels and nerves.

-The Lateral Wall

-Is formed by cheek which continuous anteriorly with lips.
-It is limited anterior by nasolabial groove. Each cheek is
formed mainly by
BUCCINATORS MUSCLE with lining mucous membrane &
structures superficial to buccinators
(BAD OF FAT & BUCCOPHARYNGEAL FASCIA)
and covering skin.
Skin & mucosa supplied by BUCCAL BRANCH OF
MANDIBULAR NERVE.
Buccinator muscle supplied by BUCCAL BRANCH of facial
nerve.

•OPENINGS OF ORAL CAVITY

-Anterior opening of oral cavity(mouth )or oral
fissure that opens on to the face and
bounded by lips.
-POSTERIOR OPENING: or OROPHARYNGEAL ISTHMUS
which opens into the oropharynx.
•PARTS OF ORAL CAVITY
1- Vestibule the part of the cavity outside teeth and
gums. i.e. between teeth and gums internally and
inner aspect of cheeks and lips externally.
- It receives the opening of parotid duct opposite the
upper second molar tooth.

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2- ORAL CAVITY PROPER (rest of oral cavity) i.e. the part internal to teeth and gums.
- The oral cavity proper is roofed by palate and floored by mylohyoid as mentioned above.
•LIP
The lip formed of Orbicaris oris covered by skin & lined
by mucous membrane. The median groove in upper lip
called PHILTRUM.
-Nerve supply
1-Motor Buccal branch(upper lip),marginal mandibular
(lower lip) of facial nerve.
2- SENSORY Upper lip by Infraorbital branch of maxillary
& lower lip by mental branch of inf. alveolar of
mandibular nerve.

•Teeth
-TYPE OF TEETH
1-MILK OR DECIDUOUS TEETH
-20 in number each 1⁄2 jaw contains 5 teeth 2 incisor
1 canine and 2 molars.
-The deciduous teeth start eruption at 6 month after
birth and eruption is
completed at 2 years.
2-PERMANENT TEETH
-32 in number, each 1⁄2 jaw contains 8 teeth: 2
incisors 1 canine 2 premolars and 3 molars.
-It starts eruption at 6 years and continuous to 12
years but the 3rd molar is erupted usually at 18y.
-N. SUPPLY
> Teeth of upper jaw by maxillary nerve.
>Teeth of lower jaw by mandibular nerve.

•TONGUE
-DEFINITION mass of skeletal (striated) muscles
covered by mucous membrane.
-PARTS
• ORAL PART, anterior 2/3 lies in the floor of oral cavity.
• PHARYNGEAL PART, posterior 1/3 lies in anterior wall of oropharynx.
*Sulcus terminalis (terminal sulcus)

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-It is v- shaped sulcus that marks the junction

between anterior 2/3 and post. 1/3 of tongue.
-It lies on superior surface and its apex directed backwards.
•FORAMEN CAECUM depression at the apex of the sulcus, it is
the site of origin of thyroglossal duct (development of thyroid
gland)

1-ORAL PART OF TONGUE

- Triangular in shape with the apex (tip of tongue) lies just behind the incisors.
IT HAS 2 SURFACES:
•SUPERIOR SURFACE shows 3 types of papillae
1. FILIFORM: arranged in rows parallel to vallate papillae.
2. FUNGIFORM: arranged in the sides & tip of tongue.
3. VALLATE PAPILLAE row of papilla in front of sulcus
terminals, it is large enough
to be easily seen by naked eye.
- The papillae increase the surface area of mucous
membrane of tongue and contains
taste buds except FILIFORM PAPILLAE has no buds.
•INFERIOR SURFACE Has no papilla, but it shows.
- LINGUAL FRENULUM midline fold connects this surface
with the floor of mouth.
- DEEP LINGUAL VEIN appears as a dark line lateral to
frenulum.
, Lingual artery-lingual nerve.
- FIMBRIATED FOLD lateral to the vein.

2-PHARYNGEAL PART OF THE TONGUE

- The post. 1/3 that lies behind the
terminal sulcus.
- Has no papilla, no taste buds.
- It is irregular due to presence of
nodules of lymphoid tissue in the submucosa (LINGUAL TONSILS).

-MUSCLES OF TONGUE
INTRINSIC AND EXTRINSIC.

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1-INTRINSIC MUSCLES
- Arise and end within the substance of
tongue &no bony attachment.
- These include: superior longitudinal ms,inferior
longitudinal ms, transverse ms,
and vertical muscle.
- They alter the shape of tongue.

2-EXTRINSIC MUSCLES arise outside the tongue and

inserted into the tongue, these are.

N.B: the tongue is divided into right and left halves by a connective tissue median septum so all
muscles of tongue are paired muscles
-BLOOD SUPPLY OF TONGUE
Mainly by lingual artery of
external carotid artery, additional supply from tonsillar &
ascending pharyngeal artery.
•Veins it is drained by 2 veins.
1- DEEP LINGUAL VEIN: end in internal jugular vein.
2- DORSAL LINGUAL VEIN: accompanying lingual artery, end
in internal jugular vein.

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•Lymphatics it drains to.

Submental lymph nodes (tip)
Submandibular lymph nodes(margins & centrum)
Upper Deep cervical lymph nodes
(posterior third of tongue) Deep cervical lymph nodes

-
NERVE SUPPLY OF TONGUE
•MOTOR all muscles (extrinsic and intrinsic) are supplied by
HYPOGLOSSAL NERVE
except PALATOGLOSSUS which is supplied by pharyngeal branch
of vagus
along the pharyngeal plexus.
•SENSORY
Anterior 2/3
• GENERAL SENSATION by lingual nerve,
• TASTE SENSATION by chorda tympani nerve.
• CHORDA TYMPANI also supplies ant 2/3 by parasympathetic fibers to lingual glands,
these fibers relay in SUBMANDIBULAR GANGLION.
Posterior 1/3
• GENERAL SENSATION TASTE SENSATION AND
PARASYMPATHETIC SECRETORY SUPPLY, all by
GLOSSOPHARYNGEAL NERVE,
• parasympathetic fibers relay in ganglia within
the mucous membrane of tongue.
MOST LOWER PART OF PHARYNGEAL SURFACE
OF TONGUE (ANT. WALL OF VALLECULA) is
innervated by internal laryngeal nerve
(of superior laryngeal of vagus nerve).
APPLIED: Paralysis of hypoglossal nerve
.

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PROTRUDED TONGUE FALLS ON PARALYZED SIDE

•SOFT PALATE
-DEF. it is a fold of mucous membrane filled with muscle
extending posteriorly from hard palate.
-SURFACES AND BORDERS
1- ATTACHED ANTERIOR BORDER attached to hard
palate.
2- FREE POSTERIOR (POSTERIO-INFERIOR) BORDER
Shows the uvula at midline , the uvula is a conical
projection hangs from the posterior border
Upper surface continuous with floor of nasal cavity
Inferior surface Palatoglossal arch and
palatopharyngeal arch start at this surface.

- MUSCLES OF SOFT PALATE

5 pairs of muscles.
1- TENSOR PALATI (TENSOR VELI PALATINAE)
ORIGIN scaphoid fossa. Cartilaginous part of auditory tube
(lat. Side).
INSERTION by a palatine aponeurosis into posterior
border of hard palate.
Palatine aponeurosis
Muscle fibers of tensor palate form a slender
tendon at lateral side of root of pterygoid

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hamulus, the tendon expands to form aponeurosis.

The aponeurosis is called palatine aponeurosis, it forms the basic structure of soft palate to
which are inserted or from which arise other muscles of soft palate.
ACTION Tensor for soft palate - Assists in opening of auditory tube

2- LEVATOR lPALATI MUSCLE (LEVATOR VELI PALATINAE).

ORIGIN
- Petrous bone in front of carotid canal.
- Medial side ofauditory tube.
INSERTION
upper surface of palatine aponeurosis.
ACTION
- Elevates the palate.
- Open auditory tube.
- Actions of tensor palate and lavatory palate lead to
elevation of soft palate to posterior wall of pharynx closing
the pharyngeal isthmus, this occurs during
swallowing to prevent regurge of food to nasal
cavity.

3- PALATOGLOSSUS MUSCLE see tongue.

N.B: palatoglossus raise the mucous membrane
forming palatoglossus arch which
bounds the oropharyngeal isthmus.

4- PALATOPHARYNGEUS MUSCLE see pharynx.

5- MUSCULUS UVULAE
ORIGIN posterior nasal spine.
INSERTION mucous membrane of uvula.
ACTION pull uvula to its own side.
NERVE SUPPLY OF PALATE

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MOTOR all muscles of palate are

supplied by PHARYNGEAL BR. OF VAGUS through PHARYNGEAL PLEXUS except TENSOR
PALATE which is supplied NERVE TO MEDIAL PTERYGOID which is a branch of
MANDIBULAR NERVE TRUNK Of TRIGEMINAL NERVE
SENSORY
- LESSER, GREATER &
SPHENOPALATINE PALATINE BRANCHES of
PTERYGOPALATINE GANGLION to hard palate.
- TONSILLAR BRANCHES of
- GLOSSOPHARYNGEAL NERVE to soft palate.
BLOOD SUPPLY OF PALATE
- Arteries:- greater palatine art.of 3rd part of maxillary to hard palate.
- Lesser palatine art.of 3rd part of maxillary to soft palate.
Veins of palate: end in: pharyngeal venous plexus to IJV.

•SALIVARY GLANDS
- salivation refers to the mixing of the oral cavity
contents with salivary gland
secretions.
- Salivation occurs in response to the taste, smell or
even appearance of food. This
occurs due to nerve signals that tell the salivary glands
to secrete saliva to prepare
and moisten the mouth.
1- PAROTID GLANDS They secrete 25% of saliva.
2- SUBMANDIBULAR GLANDS
- The submandibular glands secrete 70% of the saliva.
- These glands produce a more viscid (thick)
secretion, rich in mucin with a smaller amount of protein.Mucin acts as a lubricant.
3- SUBLINGUAL GLANDS
- They produce approximately 5% of the saliva and their secretions are
sticky due to the large concentration of mucin
The main functions are to provide buffers and
lubrication.

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1-PAROTID GLAND
DEFINITION one of the major salivary glands, it is the largest.
SITE bounded by:
• EXTERNAL AUDITORY MEATUS: above.
• RAMUS OF MANDIBLE (& RELATED MS) anteriorly.
• MASTOID PROCESS (& RELATED MS) posteriorly.
• STYLOID PROCESS (& RELATED MS) medially.
PARTS
- MAIN PART.
- ACCESSORY PART small detached part just in front of the
main part.
▪ superficial to masseter,
▪ Above parotid duct and below zygomatic arch.
THE MAIN PART
Shape inverted 3 sided pyramid : It has
- APEX (LOWER END) directed downwards.
- BASE (UPPER END): directed upwards.
3 surfaces
• SUPERFICIAL SURFACE (LATERAL).
• ANTEROMEDIAL (ANTERIOR) SURFACE.
• POSTEROMEDIAL (DEEP) SURFACE.
- 3 borders
• ANTERIOR BORDER, POSTERIOR BORDER AND MEDIAL BORDER.

RELATIONS
LOWER END overlaps posterior belly of digastric
Gives passage to:
- Cervical branch of facial nerve.
- The 2 divisions of retromandibular vein.
UPPER END Concave, related to:
- Ext. auditory meatus.
- Temporomandibular joint.
* Gives passage to.
- Superficial temporal vessels.
- Auriculotemporal nerve.
ANTERIOR BORDER related to
- Masseter.
- Parotid duct.
- Transverse facial vessels
- Branches of facial nerve (Temporal,zygomatic, buccal, mandibular).
POSTERIOR BORDER
- Overlap sternomastoid.

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- Crossed by great auricular nerve.

MEDIAL BORDER: related to wall of pharynx.

SUPERFICIAL SURFACE (LATERAL) related to

- Skin
- Superficial fascia containing:
- Branches of great auricular nerve,superficial parotid lymph
nodes and platysma.

ANTEROMEDIAL SURFACE
- Masseter muscle
- ramus of mandible
- Medial pterygoid.Gives passage to
- branches of facial nerve and maxillary vessels.

POSTEROMEDIAL SURFACE
- Mastoid process with sternomastoid
- and posterior belly of digastric.
- Styloid process and structures attached to it (3 muscles + 2
lig).
- Styloid process separates this surface from carotid sheath
and its contents.
- It gives passage to: External carotid art. & Facial nerve.

STRUCTURES INSIDE THE PAROTID

3 main structures, from superficial to deep are:
1- FACIAL NERVE the most superficial.
- Enter the gland through posteromedial surface.
- Gives 5 terminal branches emerge from
anteromedial surface of gland
2- RETROMANDIBULAR VEIN lies between the
nerve and the artery.
- Formed within the gland by union of superficial
temporal and maxillary veins.
- At lower part of the gland it ends by dividing into
ant. & post divisions (both emerge through lower
end of the gland).
3- EXTERNAL CAROTID ARTERY: the deepest.
- Enter through posteromedial surface.
- Terminates within the gland by dividing into 2
terminal branches:
• MAXILLARY ARTERY emerge through
anteromedial surface.

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• SUPERFICIAL TEMPORAL ARTERY emerge

• through upper end.
Other structures inside parotid:
4-PAROTID LYMPH NODES

PAROTID DUCT
- 5 cm long.It emerges at the middle of anterior
border.
- Passes forwards superficial to masseter
between 2 buccal branches of facial nerve
- It lies below accessory part of the gland
and transverse facial artery.
- Crossing the anterior border of the
muscle it turns medially piercing:
• Buccal pad of fat.
• Buccopharyngeal fascia.
• Buccinators.
• Buccal mucous membrane.
open in the vestibule of mouth opposite the upper second molar tooth.

SURFACE ANATOMY OF PAROTID GLAND

MAIN PART OF THE GLAND represented by
4 points.
- POINT A at head of mandible in front of the tragus.
- POINT B center of masseter.
- POINT C below and behind angle of mandible by about
2cm (point of apex).
- POINT D middle of mastoid process.
- ANTERIOR BORDER represented by a line
- connecting points A,B,C
- POSTERIOR BORDER D&C
- UPPER END A&D
- LOWER END C
SURFACE ANATOMY OF THE DUCT
- Represented by middle 1/3 of a line:
- between point in tragus and point
- midway between ala of nose and angle of mouth.
APPLIED The parotid capsule is firmly adherent to
gland,so inflammation
of the gland stretches the capsule results in
severe pain transferred to auricle as both
fascia &auricle supplied by great auricular
nerve & auriculotemporal nerve.

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Parotid capsule
- Derived from INVESTING FASCIA OF THE NECK.
- The fascia divides at the gland into 2 LAMINAE
ENCLOSING THE GLAND.
a- SUPERFICIAL LAMINA: passes superficial to gland
and attached above to zygomatic arch.
b- DEEP LAMINA: passes deep to the gland to
be attached to styloid process and
post border of angle of mandible.
- The part of this lamina thickened
- to form the STYLOMANDIBULAR LIGAMENT.

BLOOD SUPPLY
Arteries: from ext. carotid and its branches arising inside the gland.
Veins: retromandibular vein.
NERVE SUPPLY
From OTIC GANGLION
- PARASYMPATHETIC ROOT: from inferior salivary nucleus (in medulla) to
glossopharyngeal nerve to its tympanic branch (in middle ear) to lesser petrosal nerve
to otic ganglion.
- SYMPATHETIC ROOT: from plexus around middle meningeal artery.
- SENSORY ROOT: from auricuotemporal nerve.
GLANDULAR BRANCHES of OTIC GANGLION carry through AURICULOTEMPORAL NERVE

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