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.

1

Oral Exam Video: http://www.dentistry.umn.edu/dentalce/oral-cancer-

video/index.htm

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

3

http://www.nidcr.nih.gov/imagegallery/oralhealth/OralCancerE

xam.htm http://commons.wikimedia.org/wiki/File:Goiter.JPG

http://www.healthsym.com/causes-and-treatment-

for-jaundice.html

http://oralcancerfoundation.org/dental/slide_show.

htm

Surface Anatomy Overview

4

The regions of the

head include the

frontal, parietal,

occipital, temporal,

auricular, orbital, nasal,

infraorbital, zygomatic,

buccal, oral, and

mental regions.

5

Frontal Region

Parietal Region

Temporal Region

Zygomatic Region

Occipital Region

Orbital Region

Infraorbital Region Nasal Region

Oral Region

Buccal Region

Mental Region

1

2

3

4

5

6

7 8

9

10

11

Regions of the Head

6

External Acoustic Meatus, Tragus

Angle of the Mandible

Glabella

Frontal Eminence

Supraorbital Ridge

1

2

3

4

5

Anatomical Landmarks

Practice

7

Forehead (Frontal)

8

Frontal Region Review

9 Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007

Parietal and Occipital Regions

10

Both the parietal region and occipital region of the head

are covered by the scalp.

11

Temporal Region

External ear most prominent,

includes:

• Auricle

• External acoustic meatus

• Helix

• Lobule

• Tragus

• Antitragus

• Intertragic notch

Ear Structure

12 Drake RL, et al. Gray’s Anatomy for Students, ed 2,

Churchill Livingson, 2010

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. 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

Auricular Region Review

13 Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007

14

Orbital Region

• Orbit

• Sclera

• Conjunctiva

• Iris

• Lateral canthus

• Pupil

• Medial Canthus

• Eyelids

• Lacrimal gland

15

Upper eyelid

Medial Canthus

Lower eyelid

Outline of Orbit

Lacrimal Gland

Pupil

Lateral Canthus

Sclera

Iris

1

2

3

4

5

6

7

8

9

Eye

16

Eyelids

17

• 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.

Pupils

18

• 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/animations/hyperbr

ain/parasymp_reflex/reflex.html

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

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

20 Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007

Orbital Region Review

21 Fehrenbach MJ, editor, Dental Anatomy Coloring Book, WB Saunders, Philadelphia, 2007

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

23 Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007

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

28

Labiomental

groove

Oral Fissure

Nasolabial sulcus

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

31

Oral Cavity

Structures:

– Maxilla

– Mandible

– Mucosa

– Labial mucosa

– Buccal mucosa

– Buccal fat pad

– Parotid papilla

– Maxillary tuberosity

– Vestibules

– Alveolar mucosa

– Mucobuccal fold

– Labial frenum

Oral Cavity

32

Figure 2-11

– facial surface =

facial

– lips = labial

– inner cheek =

buccal

– tongue = lingual,

and palate =

palatal.

Oral Vestibule

33

Fordyce

Granules

Oral Mucosa

34

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?

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?

Gingiva

35

Incisive

Fossa

Canine Eminence

Canine Fossa

and gingival

mucosa

Gingival margin Interdental papilla

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

38

Bath-Balogh M and Fehrenbach MJ.

Illustrated Dental Embryology, Histology,

Anatomy, ed 3. Saunders, Philadelphia,

2011.

Teeth are held in place by ligaments that allow very little

little movement.

39

Oral Cavity Review

40

Palate

41

Palate Review

42 Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007

Oral Cavity

43

Palate and Jaws Review

44

Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007

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.

46

http://www.siumed.edu/~dking2/erg/GI049b

.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).

48 http://www.siumed.edu/~dking2/erg/GI064b.htm

Taste Buds

49

http://www.siumed.edu/~dking2/erg/GI064b.htm

Tongue: Ventral Surface

50

Tongue Review

51 Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007

Tongue Review

52

Floor of the Mouth Review

53

Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007

Pharynx

54

• The oral cavity also provides the entrance into the throat or pharynx.

• The pharynx consists of three parts: nasopharynx, oropharynx, and laryngopharynx.

Oropharynx

55

Pharynx Review

56

Mental Region

57

• The mental

protuberance is

the prominence

of the chin.

Regions of Head Review

58 Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007

Regions of the Neck

59

Triangles:

• Posterior

• Carotid

• Submandibular

• Submental

• Muscular

Regions of Neck

60

• Thyroid cartilage

• Trachea

• Hyoid

Regions of Neck Review

61 Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007

Regions of Neck Review

62 Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007

Extra and Intra Oral Exam

63 Oral Exam Video: http://www.dentistry.umn.edu/dentalce/oral-cancer-video/index.htm