Tongue and palate

Presented by:-Dr Jayesh

1° year MDS

TONGUE AND PALATE

1. Introduction2. Embryology3. Anatomy of the tongue4. Musculature5. Arterial supply6. Venous drainage7. Lymphatics8. Nerve supply9. Anomalies10. Applied aspects

TONGUECONTENTS

1. Introduction2. Development3. Hard palate 4. Structures on hard palate5. Soft palate introduction6. Soft palate musculature7. Structure of soft palate8. Arterial supply9. Venous drainage10. Nerve supply11. Bibliography

PALATE

TONGUE OR LINGUAINTRODUCTION

TONGUE IS A MUSCULAR ORGAN

SENSE OF TASTE

SPEECH

MASTICATION DEGLUTITIO

N

INTRODUCTIONCONTD......

SITUATION

IN THE CURVE OF THE

MANDIBLE

FLOOR OF THE MOUTH

IS MADE UP OF

APEX

BODYROO

T

CURVED DORSU

M

INFERIOR

SURFACE

EMBRYOLOGY

First , a midline swelling ( Tuberculum Impar) arises in

the midline of mandibular process and is flanked by two other swellings, the Lateral

Lingual Swellings

Local proliferation of the mesenchyme give rise to a

number of swellings in floor of the mouth

Begins to develop at about 4 weeks of gestation

Mucous membrane of the Anterior Two Thirds Of The

Tongue

Enlarge & form a large mass

Very quickly these Lateral Swellings enlarge & merge with

each other and Tuberculum Impar

MUSCLES- OCCIPITAL

MYOTOMES.- NERVE FROM

HYOGLOSSAL NERVE

CONNECTIVE TISSUE

- FROM LOCAL MESENCHYM

LINGUAL PAPILLAE DEVELOPMENT

Appears towards end of eighth week.

Vallate and Foliate Papillae appear first, close to terminal branches of glosspharyngeal nerve.

Fungiform papillae appear near terminations of chorda tympani branch of facial nerve

Filiform papillae develop during early fetal period(10-11wks).

TASTE BUDS DEVELOPMENT

Develop during 11th -13th week

By inductive interaction between epithelial cells of tongue and invading gustatory nerve cells from chorda tympani, glossopharyngeal and vagus nerve.

ANATOMY OF THE TONGUE

ROOT OF THE TONGUE

POSTERIOR PART OF

THE TONGUE

ENTRY OF THE NERVE

AND VESSELS

CONNECTIONS OF THE ROOT OF THE TONGUE

HYOID BONE :- HYOGLOSSUS AND GENIOGLOSSUS MUSCLE

EPIGLOTTIS:- 3 GLOSSOEPIGLOTTIC FOLDS

CONTDD....

SOFT PALATE:- GLOSSOPALATINE ARCHES

PHARYNX:- SUPERIOR CONSTRICTOR

This forms the anterior free end which, at rest lies behind the upper incisor teeth.

APEX OF THE TONGUE

BODY

A curved upper surface or dorsum An inferior surface.

Anterior 2/3rd

Posterior1/3rd

DORSUM OF THE TONGUE

DORSUM OF THE TONGUE

Is convex

Divided into 2 equal halves by median sulcus

Foramen caecum

Sulcus terminalis. A v shaped groove

Anterior 2/3rd

Posterior 1/3rd

INFERIOR SURFACECovered with a smooth

mucus membrane, which shows a median fold called Frenulum

Linguae.

On either side of frenulum, there is a

Lingual Vein

lingual papillaefiliform papillaefungiform papillaefoliate papillaevallate papillae

PAPILLAE OF TONGUE

They are spherical or avoid groups of cells occupying pockets which extend through the tongue epithelium and open on the free surface.

They are compared of modified epithelial cells arranged as spherical masses within the epithelium covering the tongue. They are numerous on the sides of vallate papillae. Each taste bud in made up of slender, spindle shaped pale cells, some of which are gustatory and others are supporting cells. Each bud opens on the surface of epithelium by an operative known as gustatory pore through which gustatory hair made up of microvilli project. The base of the bud is penetrated by the afferent gustatory nerve fibers.  

TASTE BUDS

The tongue is divided into two symmetrical halves by a median fibrous septum. Each half contains striated muscles which are arranged in two

groups. Extrinsic muscles Intrinsic muscles.

MUSCULATURE

The extrinsic muscles originate from outside the tongue and are insured within the tongue. They alter the position of the tongue and also alter the shape. They have a bony attachment the following are the extrinsic muscles: Genioglossus Hyoglossus Styloglossus Palatoglossus

EXTRINSIC MUSCLES

It is a fan shaped muscle and forms the bulk of the tongue. Origin: it originates from the superior genial tubercles of the symphysis menti of mandible.Insertion:Lowest fibers are attached to the body of hyoid bone. Intermediate fibers pass deep to the hyoglossus and are inserted to the dorsum of the tongue. Upper fibers turn forward the upward and are inserted into the tip. Action:It protrudes the tongue and makes the dorsal surface concave from side to side.

GENIOGLOSSUS

It is a quadrilateral muscle. Origin: It arises from the upper surface of the greater cornu and partly from the body of the hyoid bone. Insertion: The muscle passes upward and slightly forward under cover of the mylohyoid and is inserted into the side of the tongue between the styloglossus laterally and the inferior longitudinal muscles medially. Actions: It depresses the side of the tongue and makes the dorsal surface convex.

HYOGLOSSUS

HYOGLOSSUS CONTDD…..

Relations: Superficial/lateral relations:Covered by mylohyoid Between mylohyoid and hyoglossus the following structures are situated from above downwards. Stylogossus Lingual nerve Submandibular ganglion, which is suspended from the lingual nerve by two roots. Deep part of submandibular gland and its duct; the duct is hooked at its lower margin from lateral to medial side by the lingual nerve. Hypoglossal nerve Suprahyoid branch of first part of lingual artery. Deep/medial relations:Inferior longitudinal muscle, close to the insertion. Middle constrictor of pharynx, record part of the lingual artery – close to the origin. Stylopharyngeus, glossopharyngeal nerve, stylohyoid ligament and the junction of first and second parts of lingual artery.

Origin: The muscle arises from the tip of the styloid process and stylomandibular ligament. Insertion: It passes downward oral forward, and is inserted to the side of tongue; the oblique fibers interdigitates with the hyoglossus and the longitudinal fibers are continuous with the inferior longitudinal muscle of the tongue. Action: It retracts the tongue backward and upward; and is antagonistic to the action of the genioglossus.

STYLOGLOSSUS

Origin: It takes origin from the undersurface of palatine aponeorosisInsertion: It passes downward and formed in front of the tonsillar fossa under cover of the palatoglossal arch, and is inserted into the side of the tongue in from of the sulcus terminalis, forming with its fellow of opposite cover of the palatoglossal arch, and is inserted into the side of the tongue in from of the sulcus terminalis, forming with its fellow of opposite side, the palatoglossal arch.

PALATOGLOSSUS

MUSCLE ORIGIN INSERTION INNERVATION FUNCTION

GENIOGLOSSUS

Superior mental spines

Body of hyoidEntire length of tongue

Hypoglossal nerve(XII)

Protudes tongueDepress centre of tongue

HYOGLOSSUSGreater horn & adjacent part of body of hyoid bone

Lateral surface of tongue

Hypoglossal nerve(XII)

Depress tongue

STYLOGLOSSUSStyloid process (anterolateral surface)

Lateral surface of tongue

Hypoglossal nerve(XII)

Elevates and retracts tongue

PALATOGLOSSUS

Inferior surface of palatine aponeurosis

Lateral margin of tongue

Vagus nerve (X) Depress palateMovespalatoglossal fold toward midlineElevates back of the tongue

The intrinsic muscles one wholely within the tongue and has no bony attachment. These muscles alter the shape of the tongue these consists of four pair of muscles: Superior longitudinal muscle Inferior longitudinal muscleTransverses lingual Verticals lingual

INTRINSIC MUSCLES

It lies beneath the muscles membrane of the dorsal surface of the tongue. Origin: Posterior part of the median fibrous septum Insertion: It diverges forwards and laterally and are inserted into the sides of the tongue. Action:Reduce length of the tongueIt curls the tip upwards and rolls it posteriorly

SUPERIOR LONGITUDINAL MUSCLE

It lies beneath the mucous membrane of the under surface of the tongue, deep to the insertion, of hyoglossus. Origin: Posterior part of sides of the tongue. Insertion: Coverage forwards and gets inserted into the anterior part of the median fibrous septum. Actions:Widen the tongue Curl the tip of the tongue inferiorly

INFERIOR LONGITUDINAL MUSCLE

It lies inferior to the superior longitudinal muscles: Origin: Arises from the median fibrous septum Insertion: Pass laterally through the genioglossus are inserted to the side of the tongue. Action:Narrows the tongue Increases its height.

TRANSVERSES LINGUAE / TRANSVERSE MUSCLE

Origin: arises from the lamina propria of the dorsum of the tongue Insertion: Passes downward through the fibers of genioglossus and then curves laterally for insertion into the sides of the tongue. Action:Flatten the dorsum Increases the transverse diameter of the tongue.  

VERTICALS LINGUAE / VERTICAL MUSCLE

MUSCLE ORIGIN INSERTION INNERVATION FUNCTIONSUPERIOR LONGITUDINAL

Submucosal connective tissue at the back of tongue & median septum of tongue

Muscle fibers pass forward & obliquely to submucosal connective tissue & mucosa on margins

Hypoglossal nerve(XII)

Shortens tongueCurls apex and sides of tongue

INFERIOR LONGITUDINAL

Root of the tongue

Apex of tongue

Hypoglossal nerve(XII)

Shortens tongueUncurls apex and turns it downward

TRANSVERSE Median septum of tongue

Submucosal connective tissue on lateral marigns

Hypoglossal nerve(XII)

Narrows and elongates tongue

VERTICAL Submucosal connective tissue on dorsum

Connective tissue in more ventral regions of tongue

Hypoglossal nerve(XII)

Flattens and widens tongue

The chief blood supply of the tongue is derived from the lingual arteryOn each side, the lingual artery originates from the external carotid artery in the neck adjacent to the tip of the greater horn of the hyoid bone. It forms an upward bend and then loops downward and forward to pass deep to the hyoglossus muscle, and accompanies the muscle through the aperture formed by the margins of the mylohyoid, superior constrictor, and middle constrictor muscles, and enters the floor of the oral cavity.The lingual artery then travels forward in the plane between the hyoglossus and genioglossus muscles to the apex of the tongue.In addition to the tongue, the lingual artery supplies the sublingual gland, gingiva, and oral mucosa in the floor of the oral cavity.

ARTERIAL SUPPLY OF THE TONGUE

Its origin is just caudal to the posterior belly of digastric and the angle of mandible. As it passes anteriorly it gives off a tonsillar branch. The lingual artery than travels deep to the posterior part of the digastric tendon. It leaves the submandibular triangle and passes deep to the posterior border of the hyoglossus muscle where it gives off a small suprahyoid branch. Once caudal to the hyoglossus muscle, the lingual artery gives off the dorsal lingual artery, which supplies the dorsum of tongue, vallecula, epiglottis, and adjacent soft palate. The ravine branch unites both dorsal lingual arteries at the tip and provides a rich plexus.

LINGUAL ARTERY

Once the lingual artery reaches the anterior edge of the hyoglossus muscles, it divides in its terminal branch – the

sublingual and the deep lingual artery. The sublingual artery travels along the genioglossus and the sublingual gland and has

an extension anastomotic network with the contralateral sublingual artery. It supplies the sublingual gland, the

mylohyoid muscle and adjacent musculature. The deep lingual artery courses anteriorly, deep to ventral mucosa. It gives off

multiple branches that ascend toward the dorsum of the tongue. Communication between bilateral deep lingual arteries is seen posteriorly through the transverse lingual artery as well

as at the tip where the deep lingual arteries anastomose.

Venous tributaries accompanying the lingual artery and its dorsal branches forms the lingual vein. The venous return from the lip is by the deep lingual veins, visible on the each side of the midline on the undersurface. It runs back superficial to hyoglossus and is joined at the anterior of hyoglossus by the sublingual vein to form the vena comitans. It continuous backwards close to the nerve and has a variable ending, joining either the lingual, facial or internal jugular veins. The lingual vein usually joins the internal jugular vein near the greater horn of the hyoid bone.

VENOUS DRAINAGE

LYMPHATIC DRAINAGE

Tip of tongue- Submental NodesAnterior 2/3rd – Submandibular NodesPosterior 1/3rd – Juglo-omohyoid NodesPosterior most - Upper Deep Cervical Lymph Nodes

A significant feature of the tongues lymph drainage, which is through the floor of the mouth or pharyngeal wall, is that lymph from one side, especially of the posterior part, may reach nodes of both sides of the neck. The tip may drain to submental nodes or directly to deep cervical nodes. Marginal lymphatics from the rest of the anterior part tend to drain to ipsilateral submandibular nodes and ten or sometimes directly, to deep cervical nodes. Central lymphatics from the anterior part descend between the genioglossi and drain to deep cervical nodes of either side. The posterior part drains directly and frequently bilaterally to deep cervical nodes. The deep cervical nodes usually involved are the jugulodigastric and jugulo-omohyoid nodes. All lymph from the tongue is believed to eventually drain through the jugulo-omohyoid node before reaching the thoracic duct or right lymphatic duct.

Nerve supply

Sensory supply:From anterior two-thirds :

General sense, by the lingual nerve, special sense for taste except vallate papillae, by the chorda tympani nerve.  From posterior one-third, inducing Vallate papillae:

Supplied by glossopharyngeal nerve, which convey both general and special senses.  From the vallecula:

Supplied by the internal laryngeal branch of the superior laryngeal nerve from the vagus.

Taste (SA) and general sensation from the pharyngeal part of the tongue are carried by the glossopharyngeal nerve [IX].The glossopharyngeal nerve [IX] leaves the skull through the jugular foramen and descends along the posterior surface of the stylopharyngeus muscle. It passes around the lateral surface of the stylopharyngeus and then slips through the posterior aspect of the gap between the superior constrictor, middle constrictor, and mylohyoid muscles. The nerve then passes forward on the oropharyngeal wall just below the inferior pole of the palatine tonsil and enters the pharyngeal part of the tongue deep to the styloglossus and hyoglossus muscles. In addition to taste and general sensation on the posterior one-third of the tongue, branches creep anterior to the terminal sulcus of tongue to carry taste (SA) and general sensation from the vallate papillae.

GLOSSOPHARYNGEAL NERVE

General sensory innervation from the anterior two-thirds or oral part of the tongue is carried by the lingual nerve, which is a major branch of the mandibular nerve [V3]. It originates in the infratemporal fossa and passes anteriorly into the floor of the oral cavity by passing through the gap between the mylohyoid, superior constrictor, and middle constrictor muscles). As it travels through the gap, it passes immediately inferior to the attachment of superior constrictor to the mandible and continues forward on the medial surface of the mandible adjacent to the last molar tooth and deep to the gingiva. In this position, the nerve can be palpated against the bone by placing a finger into the oral cavity.The lingual nerve then continues anteromedially across the floor of the oral cavity, loops under the submandibular duct, and ascends into the tongue on the external and superior surface of the hyoglossus muscle.In addition to general sensation from the oral part of the tongue, the lingual nerve also carries general sensation from the mucosa on the floor of the oral cavity and gingiva associated with the lower teeth. The lingual nerve also carries parasympathetic and taste fibers from the oral part of the tongue that are part of the facial nerve [VII].

LINGUAL NERVE

The hypoglossal nerve [XII] leaves the skull through the hypoglossal canal and descends almost vertically in the neck to a level just below the angle of mandible (Here it angles sharply forward around the sternocleidomastoid branch of the occipital artery, crosses the external carotid artery, and continues forward, crossing the loop of the lingual artery, to reach the external surface of the lower one-third of the hyoglossus muscle.The hypoglossal nerve [XII] follows the hyoglossus muscle through the gap between the superior constrictor, middle constrictor, and mylohyoid muscles to reach the tongue.In the upper neck, a branch from the anterior ramus of C1 joins the hypoglossal nerve [XII]. Most of these C1 fibers leave the hypoglossal nerve [XII] as the superior root of the ansa cervicalis (Fig. 8.251). Near the posterior border of the hyoglossus muscle, the remaining fibers leave the hypoglossal nerve [XII] and form two nerves:the thyrohyoid branch, which remains in the neck to innervate the thyrohyoid muscle;the branch to the geniohyoid, which passes into the floor of the oral cavity to innervate the geniohyoid.

HYPOGLOSSAL NERVE

Taste from the oral part of the tongue is carried into the central nervous system by the facial nerve . Special sensory fibers of the facial nerve leave the tongue and oral cavity as part of the lingual nerve. The fibers then enter the chorda tympani nerve, which is a branch of the facial nerve that joins the lingual nerve in the infratemporal fossa

Motor supply:Somatomotor:The twelfth cranial nerve supplies the extrinsic and intrinsic musculature of the tongue except the palatoglossus, being essentially a palate muscle, is supplied by the pharyngeal plexus.  Secretomotor: To the anterior lingual glands Pre ganglionic fibers arise from the superior salivatory nucleus and pass through the facial, chorda tympani and lingual nerves, and are relayed into submandibular ganglion. Post ganglionic fibers reach the gland via the lingual nerve.

  Vasomotor: These are derived from the sympathetic nerves which surround the lingual artery and convey post ganglionic fibers from the superior cervical ganglion of the sympathetic trunk.  

NERVE SUPPLY

NERVE SUPPLY

Anterior 2/3rd Posterior 1/3rd Posterior most

Sensory nerve supply

Lingual ( post trematic branch of 1st arch)

Glossopharyneal

Internal laryngeal branch of vagus

Taste Chord

tymphanic (1st arch)

Glossopharyneal

Internal laryngeal branch of vagus

MOTOR SUPPLY- All muscles except Palatoglossus-

Hypoglossal Nerve Palatoglossus- Vagus Nerve

MacroglossiaMicroglossiaGlossoptosis

AnkyloglossiaBifid tongue / cleft tongue

Fissured tongue Median rhomboid glossitis Benign migratory glossitis

Hairy tongue Lingual thyroid

ANOMALIES OF TONGUE

TONGUE FLAPSThe tongue is an excellent donor site for soft tissue oral reconstruction mainly because of its abundant vascularity and the low morbidity associated with its use. The tongue flap tissue does become reinnervated from the adjacent host tissues, The tongue can provide 90-100cm2 of mucosal surface for rotation.

An excellent axial and collateral circulation provides for flap viability.

Half of the tongue can be rotated for tissue coverage without compromising speech, mastication or deglutition, as long as large piece of anterior tongue is preserved.

Because of its rich blood supply, the tongue can also be used in patients who have been irradiation.

APPLIED ASPECTS

Significance of vasculature in various designs of tongue flap:There are varieties of tongue flaps and all rely on the excellent

blood supply. Four arterial vessels supply most of the tongue: i) The super hyoid artery, which runs superior to the hyoid bone and supplies the muscles attached to it. ii) The dorsalis lingual artery, which supplies the posterior third of the tongue.iii) The sublingual artery, one of the two terminal branches which emerge deep to the hyoglossus muscle to supply the floor of the mouth and sublingual gland. iv) The deep lingual artery, which is larger of the terminal branches and passes to the tongue tip giving numerous branches. The lingual artery is the main vessel supplying the tongue. Anastomotic connections between the terminal lingual artery. The facial artery and tonsillar branch of the palatine artery are present.

- In the posterior region of the tongue, the dorsal lingual branch of the lingual artery has a submucosal connection with its contralateral dorsal lingual artery. - The lateral portion of the tongue receives blood from branches of sublingual artery, which arises at the anterior border of by hypoglossal muscle as a branch of the lingual artery. - The sublingual artery connects with the submental artery, a branch of facial artery, and supplies the lateral part of the tongue. - Submucosal connections exist between the right and left submental arteries. - The deep lingual artery gives off the ranine branch with it contralateral terminal connections supplying the mobile portions of the tongue. - The middle fibrous septum present an abundant interchange between the right and left side vessels, but a few branches do cross the fibrous septum to provide contralateral perfusion and rich anastomoses between these vessels. - There are vascular arcades which often perforate the midline of the tongueThese observations and the successful clinical results indicate that midline tongue flaps can be used successfully. • Dorsal based tongue flaps get most of their vascular supply from an intact lingual artery. The rich collateral circulation of the tongue prevents tongue flap death as long as the base of the flap and its design allow for distal collateral circulation fall-off at the distal aspect of the flap. • Lateral posterior based tongue flap is designed to pressure as much of the tongue tip as possible. It is important to pressure the tip for speech and other functions.

RANULAIntra cranial section of the ninth nerve for glossopharyngeal neuralgias produces both an anesthesia and a loss of taste on the posterior third of the tongue. In unilateral injury of the hypoglossal nerve, the tip of the tongue when protruded tilts to the paralyzed side. This is due to the unopposed action of the opposite genioglossus muscle. Muscles of the affected side undergo atrophy. During degultion the larynx is deviated to the sound wide due to ipsilateral paralysis of the depressors of the hyoid bone. When the muscles are paralysis, or in the unconscious patient, the tongue may fall backwards into the pharynx and obstruct respiration. In such cases head tilt-chin lift technique is performed. As the tongue is attached to the mandible. (by genioglossus muscle), lifting the chin will pull the tongue formed and off the posterior pharyngeal wall.

Cancer of the tongue frequently metastasizes bilaterally, primarily because of the rich lymphatics in the submucosal plexus, which freely communicates across the midline. In addition, collecting lymphatic trunks, from the apex, central and posterior groups have many collecting channels that cross over to terminate in contralateral lymph nodes. Malignancies of the tongue frequently grow to considerable size before producing symptoms

PALATE

The term palate refers to the roof of the mouth. (Latin. palate = roof of the mouth)

It separates the oral and nasal cavity.

PALATE

3. The medial edges of the palatal processes fuse with the free lower edge of the nasal septum, thus separating two nasal cavities, from each other and from the mouth.

4. At later stage mesoderm in the palate undergoes intramembranous ossification to form hard palate.

DEVELOPMENT OF PALATE

5. However, ossification does not extend to the most posterior portion hence it remains as the Soft palate.6. Part of the palate developed from frontonasal process is

Primary palate.7. Part of palate developed from Palatal processes is

Secondary palate.

Elevation of the palatine shelves occurs when tongue descends , which allows their meeting in the midline and fusion.

DEVELOPMENT OF PALATE

•Its anterior 2/3rd is formed by Palatine processes of Maxilla .

•Posterior 1/3rd is formed by Horizontal plates of Palatine bone.

HARD PALATE-

The hard palate is covered by a mucous membrane which is attached to the periosteum.

Deep to the membrane, there are mucus-secreting palatine glands.

The anterior mucous membrane has 3-4 transverse palatine folds called as Rugae.

Rugae

Boundaries of Hard palateAntero-lateral margins – Continuous with alveolar arches and gingiva .Posterior margins - Gives attachment to Soft Palate.Superior Surface - Forms the floor of nasal cavity.Inferior Surface – Forms the roof of the oral cavity.

ANATOMICAL STRUCTURES OF HARD PALATE

Median palatine suture

The incisive foramen - The opening of the incisive canal.

Neurovasculature - -The Nasopalatine nerve

-The terminal branch of the Sphenopalatine artery

Greater palatine foramen -One opening of the palatine canal.

Neurovasculature - -The Greater palatine nerve and vessels.

ANATOMICAL STRUCTURES OF HARD PALATE

Lesser palatine foramen -Another opening of the palatine canal.

Neurovasculature - -The Lesser palatine nerve and vessels.

Anatomical structures of Hard palate

Lymphatics – They drain mostly to Upper deep cervical lymph nodes and partly to

Retropharyngeal lymph nodes .

The soft palate is a fibro muscular contain which is suspended from the posterior body of the hard palate and project in backward and downward direction, with its superior and posterior surface towards the pharynx and its inferior and anterior surface towards the mouth

SOFT PALATE

It enables the mouth to the cut off from oral part of the pharynx as during breathing with mouth full, or separating the oral and nasal part of the pharynx. It is attached anteriorly to the hard palate but posteriorly it is free with a short, conical, midline process, the uvula, hanging down from its posterior border.

In the resting state i.e., relaxed and pendent its anterior part continues the curvature of the hard palate, while the posterior part turns downwards, following the curvature of the dorsum of the tongue. Laterally, it is continuous with the palatoglossal and palatopharyngeal arches, with which and with the dorsum of the tongue, it forms the isthmus of fauces (operative between the oral cavity and oro pharynx) superiorly, it forms the floor of the nasal part of the pharynx.

Soft palate is a thick fold of mucosa enclosing on aponeurosis, muscular tissue, vessels, nerves, lymphoid tissue and mucous glands, the glands lie deep to the oral mucosa of the anterior part, where they are continuous with those of the hard palate.

The epithelium on the upper surface is a pseudo stratified ciliated columnar epithelium i.e., the respiratory mucosa, whereas on the lower surface, it is lined by my nonkeratinized stratified squamous epithelium i.e. the oral mucosa.

The palatine aponeurosis is the flattened tendon of the tensor palate muscle and forms the fibrous basis of the palate. Near the median plane the aponeurosis splits to enclose the musculus uvulae. The levator palati and palatopharyngeus lie on the superior surface of the palatine aponeurosis and the palatoglossus lies on the inferior surface of the palatine aponeurosis.

The velum palatine is sometimes defined as the posterior portion of the soft palate, but in practice the term is used as a synonym for soft plate

The muscles of the soft palate are derived from the mesoderm of the fourth through the sixth bronchial arch

with the exception of tensor veli palatine, which is derived from the mesoderm of the first bronchial arch.

The soft palate is composed of fine muscles:Tensor veli palatini Levator veli palatiniPalatopharyngeus

Uvular / musculus uvulae.

MUSCLES OF THE SOFT PALATE

It is a fibrous sheet attached to

the posterior border of the hard

palate.

It is a extended tendon of Tensor veli palatini and forms the fibrous

basis of the palate.

PALATINE APONEUROSIS

Spine of Sphenoid bone

Soft palate

Uvula

Musculus Uvulae

Palatine aponeurosis

Pterygoid hamulus

Tensor veli palatini

Near median plane, the aponeurosis splits to enclose the musculus uvulae.

PALATINE APONEUROSIS

Origin: The muscles take origin from: The scaphoid fossa of the medial pterygoid plate. The lateral and fibrous lamina of the auditory tube. The sulcus tubae and the spine of the sphenoid bone.  Insertion: The muscle is triangular in shape and converges below to form a round tendon the tendon turns medially around the lateral side of pterygoid hamulus, from which it is separated by a bursa. Finally the tendon reaches soft palate for insertion as palatine aponeurosis after passing through the tendinous arch of the origin of the buccinator muscle.

TENSOR PALATI

Action:The main action of the tensor palati is to tense the palatine aponeurosis so that other muscles may elevate or depress it without altering its shape.

When the tensor palati contracts (e.g., in swallowing and yawning) it pull upon the cartilage of the auditory tube, opens the tube, and permits equalization of air pressure between the middle ear and nose. Applied anatomy this action is impaired in children with cleft palate, who hence have a higher incidence of middle can problems. (It is said to dilate the auditory tube – hence it is known as dilator tubae).

Origin: This muscle arises from the Quadrate area on the infection surface of the apex of petrous temporal bone anterior to the carotid canal.

Carotid sheath

Medial lamina of the cartilaginous part of auditory tube. Insertion: It forms a rounded belly that is inserted into the nasal surface of the palatine aponeurosis between the two heads of palatopharyngeus.

The two levator muscles in passing down to the palate are directed forwards and medially, together forming a V-shaped sling.   Action:Their contraction pulls the palate upwards and backwards to close the pharyngeal isthmus. Contraction of the levator also opens the cartilaginous tube and equalized air pressure between the middle ear and the nose

LEVATOR PALATI

Origin- From the undersurface of palatine aponeursis, where it is continuous with the muscle of opposite side.

Insertion- It passes in front of tonsil and it is inserted into the side of the tongue.

PALATOGLOSSUS

Origin: The muscle arises from two heads, The anterior herd arises from the posterior border of the hard plate and the

anterior part of the upper surface of the palatine aponeurosis. The posterior head arises further back on the upper surface of the aponeurosis.

Insertions: The two heads arch downwards over the lateral edge of the aponeurosis, fair, and form or muscle that passes downwards beneath the

mucous membrane and submucosa of the lateral wall of the pharynx just behind the tonsil.

Actions:The upper part of the muscle raises the palatopharyngeal fold of mucous

membrane that constitutes the posterior pillar of the fauces.The lower part (blending with stylopharyngeus and salpingopharyngeus) is

inserted chiefly into the posterior border of the thyroid lamina and its horns. Some of the anterior fibers are inserted into the upper border of the thyroid

lamina first in front of the superior horn. Some of the posterior ones merge with the surrounding fibers of the inferior constrictor. The muscle is an element of larynx and pharynx.

It arches the palate, making it more concave on its oral surface.  

PALATOPHARYNGEUS

palatopharyngeous

Mucous membrane of the naso-pharyngeal surface. A layer of palatine glands Anterior fasciculus of palatopharyngeus, lenator veli palatine and posterior fasciculus of palatopharyngeus (from before backwards). Palatine aponeurosis which splits in the middle to enclose musculus uvular Palatoglossus A layer of palatine glands Mucous membrane of the buccal surface.

STRUCTURES OF SOFT PALATE

ARTERIAL SUPPLY:

Arteries of the palate include the greater palatine branch of 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 branchThe 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 the pharyngeal fascia with the levator veli palatini muscle and follow

the 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.

The greater palatine artery originates from the maxillary artery in the

pterygopalatine fossa. It descends into the palatine canal where it gives origin to a small 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 canal to enter the medial wall

of the nasal cavity where it terminates. The greater palatine artery is the major artery of the hard palate. It also supplies

palatal gingiva. The lesser palatine branch passes through the lesser palatine

foramen just posterior to the greater palatine foramen, and contributes to the

vascular supply of the soft palate.

Veins from the palate generally follow the arteries and ultimately drain into the pterygoid plexus of veins in the infratemporal fossa or into a network of veins associated with the palatine tonsil, which drain into the pharyngeal plexus of veins or directly into the facial vein

VENOUS DRAINAGE

Lymphatic from the soft palate empty into retropharyngeal and upper deep cervical lymph nodes.

LYMPHATIC DRAINAGE

Motor supply: all the muscles of the soft palate are supplied by the pharyngeal plexus except for the tensor

palate, which is supplied by a branch from the nerve to the medial pterygoid (from the mandibular branch of the

trigeminal nerve). The fibers to this plexus are from the nucleus ambiguous via the cranial part of the accessory

nerve and the pharyngeal branch of the vagus

NERVE SUPPLY

Secretomotor supply: the preganglionic fibers arise from the superior salivatory nucleus and pass successively

through the facial, greater petrosal, nerve to pterygoid canal and one relayed into the pterygo-palatine ganglion.

Post ganglionic fibers reach the palatine glands via greater and lesser palatine nerves.

General sensory nerves: are derived from Middle and posterior (lesser) palatine nerves, which are

branches of the maxillary nerves. (through the pterygopalatine ganglion) Glossopharyngeal nerve.

Special sensory (gustatory) nerves:Taste sensation from the oral surface of soft palate

are conveyed by the glossopharyngeal and lesser palatine nerves. The fibers travel through the greater petrosal nerve

to the geniculate ganglion of the facial nerve and from there to the nucleus of the solitary tract.

1. Gray’s anatomy 2° edition2. Atlas of human anatomy . frank H. Netter 6 th

edition3. Cunningham’s manual of practical anatomy,

vol.3, head, neck and brain1. Oral anatomy – sicher’s 4. Text book of anatomy hollinshead 5. Orban’s oral histology and embryology6. Tencate’s oral histology

BIBLIOGRAPHY