cleft lip and palate anatomy

orbicularis oris

opens, protrudes, inverts, twists lips. Upper fibers are separated with cleft

zygomaticus major

moves UL up and out

Zygomaticus minor

elevates upper lip

levator labii superioris

elevates and retracts lips

Levator Anguli oris

raises corners of lips

depressor anguli oris

depresses LL, draws angle of mouth down and in

Depressor Labii Inferioris

depresses LL

Mentalis

pushes up LL, raises chin

Risorius

draws angle of mouth outward, causes dimples

Buccinator

flattens cheek, holds food in contact with teeth

Oral part of tongue

tip, blade, front, center, back. Begins at tip ends at circumvallate papillae. Under cortical or voluntary control

Pharyngeal part of tongue

Tongue base. Begins at circumvallate papillae and extends to hyoid bone. Under involuntary control but can be placed under voluntary control

Dorsal

top part of tongue/ posterior

Ventral

under tongue/anterior

Incisive foramen

Lips develop from here forward and palate develops from here backward

vertical muscle

intrinsic, widens and flattens tongue tip

Transverse muscle

Intrinsic, elongates, narrows and thickens tongue

Inferior longitudinal muscle

intrinsic, creates convex shape, depresses tongue tip

styloglossus muscle

extrinsic, draws tongue back and up

genioglossus muscle

Extrinsic, protrudes tongue, depresses tongue/elevates hyoid

hyoglossus muscle

Extrinsic, depresses tongue

Palate is formed by…

maxilla/hard palate

velum/soft palate

uvula

levator veli palatini muscle

elevates velum (up and back)

tensor veli palatini muscle

stretches velum; open and closes Eustachian tubes

palatoglossus muscle

raises back of tongue, depresses velum

Palatopharyngeus muscle

closes nasopharyngeal port

narrows oropharynx, elevates pharynx

Uvular

shortens and raises uvula

2 types of faucial pillars

Anterior faucial and posterior faucial

Where are the palatine tonsils

between faucial pillars

Palatal Vault

dome on upper oral cavity

Alveolar ridge

provides bony support for teeth and place of articulation for speech sounds (t,d,l,n, ing)

rugae

ridges that run horizontally in the front part of the palate

Incisive papilla

projection of mucosa at area of incisive foramen

palatine (median) raphe

line from incisive foramen to uvula

Premaxilla

triangular-shaped bone bordered by 2 incisive sutures and incisive foramen

palatine processes of maxilla

Forms anterior 3/4th of maxilla

Two plates separated by median (intermaxillary) palatine suture

Nasal aspect of palatine suture forms groove for lower portion of vomer (nasal septum)

horizontal plates of the palatine bones

posterior part of the hard palate

bordered by the transverse palatine suture

ends with the posterior nasal spine (bony projection)

torus palatinus

prominent longitudinal ridge on oral surface of median palatine suture

Velum (soft palate)

consists of muscles and mucosa

attaches to hard palate

median palatine raphe continues to uvula

uvula attaches to posterior border

Vomer

perpendicular structure that fits in median palatine suture groove

Hard tissues of pharynx

cervical vertebrae

hyoid bone

laryngeal cartilages

The 4 laryngeal cartilages

cricoid, thyroid, arytenoids, epiglottis

Soft tissues of pharynx

Post pharyngeal wall, base of tongue, true VF, false VF

The three different tonsils

Adenoid (pharyngeal tonsils)

Tonsils (palatine tonsils)

Lingual tonsils

Nasopharynx

above velum

Oropharynx

below velum

Hypopharynx

below the base of the tongue

Eustachian tube

connects the middle ear with the pharynx, horizontal under age 6

Torus Tubarius

ridge located posterior to Eustachian tube

Salpingopharyngeal folds

originate from torus tubarius and course down to the lateral pharyngeal wall

Stylopharyngeus muscle

raises and dilates pharynx

Salingopharyngeus muscle

raises nasopharyx, draws LPW up

Cricopharyngeus

relaxes to allow passage of bolus into esophagus

Trigeminal Nerve (CN V)

Motor: mastication, hyolaryngeal excursion, tensing velum

Sensory: bolus manipulation(not taste)

Facial Nerve (CN VII)

Motor: lip closure, buccal tone, hyolaryngeal excursion

Sensory and Autonomic: taste, salivation

Glossopharyngeal Nerve (CN IX)

Motor: pharyngeal constriction, hyolaryngeal excursion

Sensory and autonomic: Taste and sensation, salivation

Plays role in resonance

Vagus Nerve (CN X)

Motor: velopharyngeal closure, tongue base retraction, pharyngeal squeeze, airway closure, UES closure and opening, esophageal motility

Sensory and autonomic: sensation

Accessory nerve (CN XI)

motor: pharyngeal shortening

Hypoglossal Nerve (CN XII)

tongue motility (all extrinsic and intrinsic muscles)

Structures of the velopharyngeal valve

velum

Lateral pharyngeal walls

Posterior pharyngeal wall

Function of LPW

move medially, close against velum

Function of PPW

tense the soft palate, pull pharyngeal walls superiorly, anteriorly, medially during swallowing

velopharyngeal function

regulates and directs sound energy and airflow

important for plosives, fricatives, affricates

Superior pharyngeal constrictor

move the LPW in, narrows nasopharynx

Musculus uvulae

elevates and retracts uvula, shortens velum

pharyngeal plexus

network of nerves along posterior wall of pharynx

consists of glossopharyngeal and vagus nerve

VP insufficiency

Structural: velum is too short or palate is cleft

VP incompetence

physiological: velum cannot be raised due to physiological reasons

VP mislearning

normal structure and physiology but shows VPD

nonpneumatic activities

swallowing, gagging, vomiting

pneumatic activities positive pressure

whistling, blowing, speech

pneumatic activities negative pressure

sucking, kissing

when is bite achieved

7 months

when is chewing achieved

10-12 months

when are cleft lips repaired

3 months

when are cleft palates repaired

around 12 months

overt cleft

visible from oral surface

occult cleft

normal on oral surface; abnormal on nasal surface

fistula

hole between nasal and oral cavity, resulting from repaired seams reopening